Major
citalopram × Lithium
SSRI (selective serotonin reuptake inhibitor)×Psycholeptics. Lithium
Mechanism
Additive serotonergic effect of SSRIs and lithium (lithium enhances synaptic serotonergic transmission). SSRI-related lithium level rises have also been reported.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia. Autonomic features: sweating, tachycardia, hypertension, fever. First signs appear within hours of co-administration.
Management
The combination is possible with careful monitoring. Check lithium level at 2 and 4 weeks after starting citalopram. If agitation, tremor, or diarrhoea appears, reassess lithium level and serotonergic status.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.