Major
citalopram × Sertraline
SSRI (selective serotonin reuptake inhibitor)×Selective serotonin reuptake inhibitors (SSRIs)
Mechanism
Two SSRIs simultaneously – serotonin syndrome without therapeutic rationale. Citalopram itself prolongs QT.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia. Autonomic features: sweating, tachycardia, fever.
Management
The combination is not prescribed. When switching SSRIs, allow a 1-week washout. For augmentation: mirtazapine or agomelatine (different class).
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.