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Drug Interactions between Celexa and nebivolol

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

citalopram nebivolol

Applies to: Celexa (citalopram) and nebivolol

MONITOR: Limited clinical data suggest that selective serotonin reuptake inhibitors (SSRIs) may potentiate the pharmacologic effects of some beta-blockers. There have been case reports of patients stabilized on beta-blocker therapy who developed bradycardia, hypotension, and complete heart block following the addition of a SSRI, subsequently requiring discontinuation of one or both agents and/or institution of a permanent pacemaker. The interaction is also corroborated by data from in vitro and clinical studies involving paroxetine and metoprolol conducted by one group of investigators. The proposed mechanism is SSRI inhibition (competitive and/or noncompetitive) of CYP450 2D6, the isoenzyme responsible for the metabolic clearance of beta-blockers such as carvedilol, labetalol, metoprolol, nebivolol, propranolol, and timolol. Paroxetine and norfluoxetine (the active metabolite of fluoxetine), in particular, are potent inhibitors of CYP450 2D6 and may be more likely than other SSRIs to cause the interaction. On the other hand, fluvoxamine is a potent inhibitor of CYP450 1A2 and may significantly interact with propranolol, which is a substrate of both CYP450 2D6 and 1A2.

MANAGEMENT: During concomitant therapy with SSRIs, a lower initial dosage and more cautious titration of the beta-blocker may be appropriate. Cardiac function should be closely monitored and the beta-blocker dosage adjusted accordingly, particularly following initiation, discontinuation or change of dosage of SSRI in patients who are stabilized on their beta-blocker regimen. Due to the long half-life of fluoxetine and its active metabolite, norfluoxetine, the risk of an interaction may exist for an extended period (up to several weeks) after discontinuation of fluoxetine. To avoid the interaction, use of beta-blockers that are primarily eliminated by the kidney such as atenolol, acebutolol, betaxolol, carteolol, and nadolol may be considered.

References

  1. Walley T, Pirmohamed M, Proudlove C, Maxwell D (1993) "Interaction of metoprolol and fluoxetine." Lancet, 341, p. 967-8
  2. Otton SV, Wu D, Joffe RT, Cheung SW, Sellers EM (1993) "Inhibition by fluoxetine of cytochrome P450 2D6 activity." Clin Pharmacol Ther, 53, p. 401-9
  3. Brosen K, Skjelbo E, Rasmussen BB, Poulsen HE, Loft S (1993) "Fluvoxamine is a potent inhibitor of cytochrome P4501A2." Biochem Pharmacol, 45, p. 1211-4
  4. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  5. Drake WM, Gordon GD (1994) "Heart block in a patient on propranolol and fluoxetine." Lancet, 343, p. 425-6
  6. Perucca E, Gatti G, Spina E (1994) "Clinical pharmacokinetics of fluvoxamine." Clin Pharmacokinet, 27, p. 175-90
  7. Crewe HK, Lennard MS, Tucker GT, Woods FR, Haddock RE (1992) "The effect of selective serotonin re-uptake inhibitors on cytochrome P4502D6 (CYP2D6) activity in human liver microsomes." Br J Clin Pharmacol, 34, p. 262-5
  8. (2001) "Product Information. Luvox (fluvoxamine)." Solvay Pharmaceuticals Inc
  9. Riesenman C (1995) "Antidepressant drug interactions and the cytochrome p450 system: a critical appraisal." Pharmacotherapy, 15, s84-99
  10. Nemeroff CB, Devane CL, Pollock BG (1996) "Newer antidepressants and the cytochrome p450 system." Am J Psychiatry, 153, p. 311-20
  11. Ereshefsky L (1996) "Treating depression: potential drug-drug interactions: commentary." J Clin Psychopharmacol, 16 (suppl, s50-3
  12. Richelson E (1998) "Pharmacokinetic interactions of antidepressants." J Clin Psychiatry, 59, p. 22-6
  13. Kashuba ADM, Nafziger AN, Kearns GL, Leeder JS, Gotschall R, Rocci ML, Kulawy RW, Beck DJ, Bertino JS (1998) "Effect of fluvoxamine therapy on the activities of CYP1A2, CYP2D6, and CYP3A as determined by phenotyping." Clin Pharmacol Ther, 64, p. 257-68
  14. Hemeryck A, Lefebvre RA, DeVriendt C, Belpaire FM (2000) "Paroxetine affects metoprolol pharmacokinetics and pharmacodynamics in healthy volunteers." Clin Pharmacol Ther, 67, p. 283-91
  15. Amchin J, Ereshefsky L, Zarycranski W, Taylor K, Albano D, Klockowski PM (2001) "Effect of venlafaxine versus fluoxetine on metabolism of dextromethorphan, a CYP2D6 probe." J Clin Pharmacol, 41, p. 443-51
  16. Hemeryck A, DeVriendt CA, Belpaire FM (2001) "Metoprolol-paroxetine interaction in human liver microsomes: Stereoselective aspects and prediction of the in vivo interaction." Drug Metab Disposition, 29, p. 656-63
View all 16 references

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Drug and food interactions

Moderate

citalopram food

Applies to: Celexa (citalopram)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 4 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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