Can you take Akynzeo for Injection with Citalopram?
2 drug interactions and 27 additional warnings found for the following 2 drugs:
- Akynzeo for Injection (fosnetupitant/palonosetron)
- citalopram
Drug interactions
Major drug interactions
Major:
citalopram palonosetron
Applies to: citalopram and Akynzeo for Injection (fosnetupitant / palonosetron)
Using palonosetron together with citalopram can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should contact your doctor immediately if you experience these symptoms during treatment. In addition, combining these medications can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Minor drug interactions
Minor:
citalopram fosnetupitant
Applies to: citalopram and Akynzeo for Injection (fosnetupitant / palonosetron)
Information for this minor interaction is available on the professional version.
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
citalopram Food/Lifestyle
Applies to: citalopram
Alcohol can increase the nervous system side effects of citalopram such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with citalopram. Do not use more than the recommended dose of citalopram, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.
Disease interactions
26 potential interactions Applies to: 20 conditions, including Depression, Bipolar Disorder, Seizures, Psychosis, and Mania.
Anorexia/Feeding Problems
Minor:
citalopram
Citalopram has a minor potential interaction with Anorexia/Feeding Problems.
The use of selective serotonin reuptake inhibitors (SSRIs) may occasionally cause significant weight loss, which may be undesirable in patients suffering from anorexia, malnutrition or excessive weight loss. Anorexia may occur in approximately 5% to 10% of patients. Weight change should be monitored during therapy if an SSRI is used in these patients.
Bipolar Disorder
Moderate:
citalopram
Citalopram has a moderate potential interaction with Bipolar Disorder.
Selective serotonin reuptake inhibitors (SSRIs), like other antidepressants, may occasionally cause or activate mania or hypomania. The reported incidence ranged from 0.1% to 2% in premarketing testing of several SSRIs. Patients with bipolar disorder are generally more likely to experience mania from antidepressants. Therapy with SSRIs should be administered cautiously in patients with a history of mania or bipolar disorder. Prior to initiating treatment, it is recommended to adequately screen patients for bipolar disorder, including a family history of suicide, bipolar disorder, and depression.
Bleeding Disorder
Moderate:
citalopram
Citalopram has a moderate potential interaction with Bleeding Disorder.
The use of selective serotonin reuptake inhibitors (SSRIs) has been associated with altered platelet function. Petechiae, purpura, ecchymosis, increased bleeding times, epistaxis and gastrointestinal hemorrhage have been reported. Therapy with SSRIs should be administered cautiously in patients with severe active bleeding or a hemorrhagic diathesis.
Coagulation Defects and Disorders
Moderate:
citalopram
Citalopram has a moderate potential interaction with Coagulation Defects and Disorders.
The use of selective serotonin reuptake inhibitors (SSRIs) has been associated with altered platelet function. Petechiae, purpura, ecchymosis, increased bleeding times, epistaxis and gastrointestinal hemorrhage have been reported. Therapy with SSRIs should be administered cautiously in patients with severe active bleeding or a hemorrhagic diathesis.
Dehydration
Moderate:
citalopram
Citalopram has a moderate potential interaction with Dehydration.
The use of selective serotonin reuptake inhibitors (SSRIs) has rarely been associated with hyponatremia, sometimes secondary to development of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). These events have generally been reversible following discontinuation of SSRI therapy and/or medical intervention. SSRI-related hyponatremia may be more common in elderly female patients and those who are volume-depleted or receiving concomitant diuretic therapy. Caution may be warranted when SSRI therapy is administered in these patients and patients with preexisting hyponatremia or SIADH. Serum electrolytes, especially sodium as well as BUN and plasma creatinine, should be monitored regularly.
Depression
Major:
citalopram
Citalopram has a major potential interaction with Depression.
Adult and pediatric patients with depression and other psychiatric disorders may experience worsening of their symptoms and may have the emergence of suicidal thoughts and behavior. Patients should be monitored appropriately and observed closely for worsening of their symptoms, suicidality or changes in their behavior, especially during the first few months of treatment, and at times of dose changes. Families and caregivers should be advised of the need for close observation and communication with the treating physician. Discontinuing the medication should be considered if symptoms are persistently worse, or abrupt in onset. It may be prudent to refrain from dispensing large quantities of medication to these patients.
Moderate:
citalopram
Citalopram has a moderate potential interaction with Depression.
Selective serotonin reuptake inhibitors (SSRIs), like other antidepressants, may occasionally cause or activate mania or hypomania. The reported incidence ranged from 0.1% to 2% in premarketing testing of several SSRIs. Patients with bipolar disorder are generally more likely to experience mania from antidepressants. Therapy with SSRIs should be administered cautiously in patients with a history of mania or bipolar disorder. Prior to initiating treatment, it is recommended to adequately screen patients for bipolar disorder, including a family history of suicide, bipolar disorder, and depression.
Failure to Thrive
Minor:
citalopram
Citalopram has a minor potential interaction with Failure to Thrive.
The use of selective serotonin reuptake inhibitors (SSRIs) may occasionally cause significant weight loss, which may be undesirable in patients suffering from anorexia, malnutrition or excessive weight loss. Anorexia may occur in approximately 5% to 10% of patients. Weight change should be monitored during therapy if an SSRI is used in these patients.
Hyponatremia
Moderate:
citalopram
Citalopram has a moderate potential interaction with Hyponatremia.
The use of selective serotonin reuptake inhibitors (SSRIs) has rarely been associated with hyponatremia, sometimes secondary to development of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). These events have generally been reversible following discontinuation of SSRI therapy and/or medical intervention. SSRI-related hyponatremia may be more common in elderly female patients and those who are volume-depleted or receiving concomitant diuretic therapy. Caution may be warranted when SSRI therapy is administered in these patients and patients with preexisting hyponatremia or SIADH. Serum electrolytes, especially sodium as well as BUN and plasma creatinine, should be monitored regularly.
Moderate:
citalopram
Citalopram has a moderate potential interaction with Hyponatremia.
Treatment with SSRI antidepressants can cause hyponatremia. Caution should be used when treating patients with hyponatremia or at greater risk of hyponatremia such as the elderly, patients taking diuretics or who are volume depleted.
Liver Disease
Moderate:
Akynzeo for Injection
The fosnetupitant in Akynzeo for Injection has a moderate potential interaction with Liver Disease.
Limited data are available with fosnetupitant (only available in combination with palonosetron in the US) in patients with severe hepatic impairment (Child-Pugh score greater than 9), therefore, its use should be avoided in these patients. No dosage adjustment is necessary for patients with mild to moderate hepatic impairment (Child-Pugh score 5 to 8).
Moderate:
Akynzeo for Injection
The palonosetron in Akynzeo for Injection has a moderate potential interaction with Liver Disease.
No dosage adjustment for palonosetron is necessary for patients with mild to moderate hepatic impairment (Child-Pugh score 5 to 8). Limited data are available in patients with severe hepatic impairment (Child-Pugh score greater than 9). It is recommended to avoid use of palonosetron in patients with severe hepatic impairment.
Moderate:
citalopram
Citalopram has a moderate potential interaction with Liver Disease.
Selective serotonin reuptake inhibitors (SSRIs) are primarily metabolized by the liver. The plasma concentrations of SSRIs and their metabolites may be increased and the half-lives prolonged in patients with impaired hepatic function. Dosage adjustments may be necessary in accordance with the individual product package labeling.
Long QT Syndrome
Moderate:
citalopram
Citalopram has a moderate potential interaction with Long QT Syndrome.
Some SSRI antidepressants such as fluoxetine and citalopram have shown to cause QT interval prolongation and ventricular arrhythmias including Torsade de Pointes. These drugs should be used with caution in patients with congenital QT syndrome, a previous personal or family history of QT prolongation, and ventricular arrhythmia. Consider periodic EKG assessment on these patients. Treatment should be discontinued and a cardiac evaluation should be considered if a patient develops signs or symptoms of ventricular arrhythmia.
Malnourishment
Minor:
citalopram
Citalopram has a minor potential interaction with Malnourishment.
The use of selective serotonin reuptake inhibitors (SSRIs) may occasionally cause significant weight loss, which may be undesirable in patients suffering from anorexia, malnutrition or excessive weight loss. Anorexia may occur in approximately 5% to 10% of patients. Weight change should be monitored during therapy if an SSRI is used in these patients.
Mania
Moderate:
citalopram
Citalopram has a moderate potential interaction with Mania.
Selective serotonin reuptake inhibitors (SSRIs), like other antidepressants, may occasionally cause or activate mania or hypomania. The reported incidence ranged from 0.1% to 2% in premarketing testing of several SSRIs. Patients with bipolar disorder are generally more likely to experience mania from antidepressants. Therapy with SSRIs should be administered cautiously in patients with a history of mania or bipolar disorder. Prior to initiating treatment, it is recommended to adequately screen patients for bipolar disorder, including a family history of suicide, bipolar disorder, and depression.
Psychosis
Major:
citalopram
Citalopram has a major potential interaction with Psychosis.
Adult and pediatric patients with depression and other psychiatric disorders may experience worsening of their symptoms and may have the emergence of suicidal thoughts and behavior. Patients should be monitored appropriately and observed closely for worsening of their symptoms, suicidality or changes in their behavior, especially during the first few months of treatment, and at times of dose changes. Families and caregivers should be advised of the need for close observation and communication with the treating physician. Discontinuing the medication should be considered if symptoms are persistently worse, or abrupt in onset. It may be prudent to refrain from dispensing large quantities of medication to these patients.
Renal Dysfunction
Moderate:
Akynzeo for Injection
The palonosetron in Akynzeo for Injection has a moderate potential interaction with Renal Dysfunction.
Mild to moderate renal impairment does not significantly affect palonosetron pharmacokinetic parameters. However, total systemic exposure increased approximately 28% in patients with severe renal impairment. Additionally, the pharmacokinetics of palonosetron have not been studied in patients with end-stage renal disease. Caution is advised.
Moderate:
Akynzeo for Injection
The fosnetupitant in Akynzeo for Injection has a moderate potential interaction with Renal Dysfunction.
No dosage adjustment for netupitant/fosnetupitant (only available in combination with palonosetron in the US), is necessary in patients with mild to moderate renal impairment (creatinine clearance of 30 to 60 mL/min). The pharmacokinetics and safety of netupitant/fosnetupitant have not been studied in patients with severe renal impairment. Severe renal impairment (creatinine clearance < 30 mL/min) did not substantially affect pharmacokinetics of palonosetron. The pharmacokinetics for netupitant and palonosetron were not studied in patients with end-stage renal disease requiring hemodialysis, therefore, avoid the use of this drug in patients with severe renal impairment or end-stage renal disease.
Moderate:
citalopram
Citalopram has a moderate potential interaction with Renal Dysfunction.
Citalopram (racemic) and escitalopram (the more pharmacologically active S-enantiomer) are extensively metabolized and only small amounts are excreted unchanged in the urine. No dosage adjustments are necessary in patients with mild to moderate renal impairment, as the oral clearance of citalopram has been shown to decrease only modestly (17%) in these patients compared to those with normal renal function. There is no information on the pharmacokinetics of citalopram or escitalopram in patients with severe renal impairment (CrCl < 20 mL/min). Therapy with these agents should be administered cautiously in such patients.
Seizures
Moderate:
citalopram
Citalopram has a moderate potential interaction with Seizures.
Selective serotonin reuptake inhibitors (SSRIs) may trigger seizures in approximately 0.2% of patients, and some of them are not recommended in patients with unstable epilepsy. Therapy with SSRIs should be administered cautiously in patients with seizure disorders.
SIADH
Moderate:
citalopram
Citalopram has a moderate potential interaction with SIADH.
The use of selective serotonin reuptake inhibitors (SSRIs) has rarely been associated with hyponatremia, sometimes secondary to development of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). These events have generally been reversible following discontinuation of SSRI therapy and/or medical intervention. SSRI-related hyponatremia may be more common in elderly female patients and those who are volume-depleted or receiving concomitant diuretic therapy. Caution may be warranted when SSRI therapy is administered in these patients and patients with preexisting hyponatremia or SIADH. Serum electrolytes, especially sodium as well as BUN and plasma creatinine, should be monitored regularly.
Thrombocytopathy
Moderate:
citalopram
Citalopram has a moderate potential interaction with Thrombocytopathy.
The use of selective serotonin reuptake inhibitors (SSRIs) has been associated with altered platelet function. Petechiae, purpura, ecchymosis, increased bleeding times, epistaxis and gastrointestinal hemorrhage have been reported. Therapy with SSRIs should be administered cautiously in patients with severe active bleeding or a hemorrhagic diathesis.
Thrombocytopenia
Moderate:
citalopram
Citalopram has a moderate potential interaction with Thrombocytopenia.
The use of selective serotonin reuptake inhibitors (SSRIs) has been associated with altered platelet function. Petechiae, purpura, ecchymosis, increased bleeding times, epistaxis and gastrointestinal hemorrhage have been reported. Therapy with SSRIs should be administered cautiously in patients with severe active bleeding or a hemorrhagic diathesis.
Ventricular Arrhythmia
Moderate:
citalopram
Citalopram has a moderate potential interaction with Ventricular Arrhythmia.
Some SSRI antidepressants such as fluoxetine and citalopram have shown to cause QT interval prolongation and ventricular arrhythmias including Torsade de Pointes. These drugs should be used with caution in patients with congenital QT syndrome, a previous personal or family history of QT prolongation, and ventricular arrhythmia. Consider periodic EKG assessment on these patients. Treatment should be discontinued and a cardiac evaluation should be considered if a patient develops signs or symptoms of ventricular arrhythmia.
Vitamin K Deficiency
Moderate:
citalopram
Citalopram has a moderate potential interaction with Vitamin K Deficiency.
The use of selective serotonin reuptake inhibitors (SSRIs) has been associated with altered platelet function. Petechiae, purpura, ecchymosis, increased bleeding times, epistaxis and gastrointestinal hemorrhage have been reported. Therapy with SSRIs should be administered cautiously in patients with severe active bleeding or a hemorrhagic diathesis.
More resources
Akynzeo for Injection
A total of 588 drugs are known to interact with Akynzeo for Injection.
- Akynzeo for injection is in the drug class miscellaneous antiemetics.
- Akynzeo for injection is used to treat Nausea/Vomiting, Chemotherapy Induced.
citalopram
A total of 752 drugs are known to interact with citalopram.
- Citalopram is in the drug class selective serotonin reuptake inhibitors.
-
Citalopram is used to treat the following conditions:
- Agitation (off-label)
- Anxiety and Stress
- Bipolar Disorder (off-label)
- Body Dysmorphic Disorder (off-label)
- Borderline Personality Disorder (off-label)
- Depression
- Dissociative Identity Disorder (off-label)
- Excoriation Disorder (off-label)
- Generalized Anxiety Disorder (off-label)
- Hot Flashes (off-label)
- Neuralgia (off-label)
- Obsessive Compulsive Disorder (off-label)
- Occipital Neuralgia (off-label)
- Panic Disorder (off-label)
- Persistent Depressive Disorder (off-label)
- Postpartum Depression
- Premenstrual Dysphoric Disorder (off-label)
- Severe Mood Dysregulation (off-label)
- Somatoform Pain Disorder (off-label)
- Trichotillomania (off-label)
- Vulvodynia (off-label)
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.