Using Citalopram with Alcohol: What Are the Risks?

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Citalopram, a popular Food and Drug Administration (FDA)-approved prescription antidepressant drug that is also sold under the brand name Celexa, is used by millions of people across the United States for the treatment of major depressive disorder (MDD), anxiety disorders, post-traumatic stress disorder (PTSD), and other mental health conditions. 

Mixing antidepressants with alcohol is always potentially dangerous, but using citalopram with alcohol is particularly unsafe due to the high potential for life-threatening side effects, such as irregular heart rhythms, to occur.

What is citalopram?

Citalopram is a generic prescription antidepressant that is commonly sold under the brand name Celexa and belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs).

Other SSRIs include fluoxetine (Prozac), paroxetine (Paxil), escitalopram (Lexapro), and sertraline (Zoloft). 

Citalopram is commonly prescribed for the treatment of major depressive disorder but is also used off-label for the treatment of other mental health conditions, including panic disorder, obsessive-compulsive disorder, premenstrual dysphoric disorder, and alcohol use disorder (AUD).

What are the risks of using citalopram with alcohol?

The FDA reports that although taking citalopram does not increase the effects of alcohol, the combination of the two substances can cause a potential overdose or other potentially deadly reactions. 

Much of the danger associated with the combination of citalopram and alcohol is linked to the potential for the medication to cause abnormal heart rhythms, particularly when taken in doses that exceed 40 mg per day.

While all SSRIs, including citalopram, are dangerous when combined with alcohol, citalopram is particularly problematic. SSRIs like citalopram work to improve the symptoms of common mental health conditions like depression and anxiety by blocking the reuptake or reabsorption of serotonin, which causes the levels of this neurotransmitter to rise in the brain. 

As levels of serotonin rise, the brain is better able to efficiently send messages back and forth between the brain cells, which can help to improve the mood.

On the other hand, alcohol is classified as a central nervous system (CNS) depressant and works to slow down the communication between the brain cells and neurological symptoms. This provides the calming, relaxing effect that many people are accustomed to when drinking.

When using citalopram with alcohol, both substances are working to change the activity of neurotransmitters in the brain. The side effects of both substances may be amplified when the substances are taken together.

What side effects can occur when using citalopram with alcohol?

Citalopram is known to have adverse effects on the heart rhythm, particularly when taken in high doses.

These side effects are exacerbated when using citalopram with alcohol, and the results can be deadly. 

Even if patients drink several hours after taking their medication, they can still experience dangerous side effects of citalopram and alcohol. 

Common side effects associated with using citalopram with alcohol include:

  • Irregular heart rate
  • Dry mouth
  • Coma (loss of consciousness)
  • Behavior changes such as agitation
  • Coordination impairment
  • Hyperventilation
  • Amnesia
  • Convulsions
  • Severe heart issues
  • Death

Unlike other SSRIs, using citalopram with alcohol is associated with a serious risk of overdose. Overdose can occur even when citalopram is taken at the prescribed dose. 

Symptoms of overdose that can occur when using citalopram with alcohol include:

  • Nausea
  • Sleepiness
  • Vomiting
  • Sweating
  • Tremors in the limbs
  • Rapid heartbeat

Overdose caused by the use of citalopram and alcohol requires emergency medical treatment and can be fatal. Combining citalopram and alcohol can cause a severe irregular heart rhythm called torsades de pointes (TdP) that can contribute to sudden death. Other symptoms of TdP include fainting, chest pain, and shortness of breath. 

Talk to your doctor immediately if you exhibit any of these symptoms. Patients should never combine citalopram and alcohol.

Summary

Using citalopram with alcohol is incredibly dangerous and can cause overdose, severe heart problems, and even death.

There is no safe way to combine citalopram and alcohol, and doing so even once can be deadly. 

Patients who experience serious side effects like nausea, sleepiness, vomiting, sweating, tremors, confusion, or a racing heart rate while using citalopram and drinking alcohol should seek emergency medical attention, as they could be experiencing an overdose. 

Additionally, tell your pharmacist if you are taking any other medications before starting citalopram, as certain drug interactions can be life-threatening.

You should not take citalopram within 14 days of monoamine oxidase inhibitor (MAOI) use. Taking citalopram at the same time as lithium or tricyclic antidepressants can increase your risk of serotonin syndrome. 

Serotonin syndrome is another uncommon but serious side effect of citalopram use marked by headache, hallucinations, rapid heartbeat, rigid or twitching muscles. 

Contact your healthcare provider immediately if you or a loved one begin experiencing any of these serotonin syndrome symptoms.

Sources:

https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressants-and-alcohol/faq-20058231

https://pubs.niaaa.nih.gov/publications/aa63/aa63.htm

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2592697

https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-revised-recommendations-celexa-citalopram-hydrobromide-related

https://www.medicinenet.com/citalopram/article.htm#do_i_need_a_prescription_for_citalopram_celexa

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