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Drug interactions between Celexa and hyoscyamine / methenamine / methylene blue / phenyl salicylate

Results for the following 2 drugs:
Celexa (citalopram)
hyoscyamine/methenamine/methylene blue/phenyl salicylate

Interactions between your drugs


methylene blue citalopram

Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate and Celexa (citalopram)

If you are currently being treated with citalopram, let your doctor know before you receive methylene blue. Combining these medications 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. Depending on your condition, your doctor may want you to discontinue citalopram for at least two weeks before you start treatment with methylene blue, or prescribe an alternative medication. Otherwise, you will need to be closely monitored by your doctor during treatment. 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.

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phenyl salicylate citalopram

Applies to: hyoscyamine / methenamine / methylene blue / phenyl salicylate and Celexa (citalopram)

Consumer information for this interaction is not currently available.

MONITOR: Serotonin reuptake inhibitors (SRIs) may potentiate the risk of bleeding in patients treated with ulcerogenic agents and agents that affect hemostasis such as anticoagulants, platelet inhibitors, thrombin inhibitors, thrombolytic agents, or agents that commonly cause thrombocytopenia. The tricyclic antidepressant, clomipramine, is also a strong SRI and may interact similarly. Serotonin release by platelets plays an important role in hemostasis, thus SRIs may alter platelet function and induce bleeding. Published case reports have documented the occurrence of bleeding episodes in patients treated with psychotropic agents that interfere with serotonin reuptake. Bleeding events related to SRIs have ranged from ecchymosis, hematoma, epistaxis, and petechiae to life-threatening hemorrhages. Additional epidemiological studies have confirmed the association between use of these agents and the occurrence of upper gastrointestinal bleeding, and concurrent use of NSAIDs or aspirin was found to potentiate the risk. Preliminary data also suggest that there may be a pharmacodynamic interaction between SSRIs and oral anticoagulants that can cause an increased bleeding diathesis. Concomitant administration of paroxetine and warfarin, specifically, has been associated with an increased frequency of bleeding without apparent changes in the disposition of either drug or changes in the prothrombin time. Bleeding has also been reported with fluoxetine and warfarin, while citalopram and sertraline have been reported to prolong the prothrombin time of patients taking warfarin by about 5% to 8%. In the RE-LY study (Randomized Evaluation of Long-term anticoagulant therapy), SRIs were associated with an increased risk of bleeding in all treatment groups.

MANAGEMENT: Caution is advised if SRIs or clomipramine are used in combination with other drugs that affect hemostasis. Close clinical and laboratory observation for hematologic complications is recommended. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.


  1. "Product Information. Savella (milnacipran)." Forest Pharmaceuticals, St. Louis, MO.
  2. Krivy J, Wiener J "Sertraline and platelet counts in idiopathic thrombocytopenia purpura." Lancet 345 (1995): 132
  3. Bannister SJ, Houser VP, Hulse JD, Kisicki JC, Rasmussen JG "Evaluation of the potential for interactions of paroxetine with diazepam, cimetidine, warfarin, and digoxin." Acta Psychiatr Scand Suppl 350 (1989): 102-6
  4. Ottervanger JP, Stricker BH, Huls J, Weeda JN "Bleeding attributed to the intake of paroxetine." Am J Psychiatry 151 (1994): 781-2
  5. Settle EC "Antidepressant drugs: disturbing and potentially dangerous adverse effects." J Clin Psychiatry 59 Suppl 16 (1998): 25-30
  6. Skop BP, Brown TM "Potential vascular and bleeding complications of treatment with selective serotonin reuptake inhibitors." Psychosomatics 37 (1996): 12-6
  7. Cerner Multum, Inc. "Australian Product Information." O 0
  8. "Product Information. Paxil (paroxetine)." GlaxoSmithKline, Research Triangle Park, NC.
  9. "Product Information. Prozac (fluoxetine)." Dista Products Company, Indianapolis, IN.
  10. Layton D, Clark DWJ, Pearce GL, Shakir SAW "Is there an association between selective serotonin reuptake inhibitors and risk of abnormal bleeding? Results from a cohort study based on prescription event monitoring in England." Eur J Clin Pharmacol 57 (2001): 167-76
  11. de Abajo FJ, Jick H, Derby L, Jick S, Schmitz S "Intracranial haemorrhage and use of selective serotonin reuptake inhibitors." Br J Clin Pharmacol 50 (2000): 43-7
  12. "Product Information. Luvox (fluvoxamine)." Solvay Pharmaceuticals Inc, Marietta, GA.
  13. de Maistre E, Allart C, Lecompte T, Bollaert PE "Severe bleeding associated with use of low molecular weight heparin and selective serotonin reuptake inhibitors." Am J Med 113 (2002): 530-2
  14. Leung M, Shore R "Fluvoxamine-associated bleeding." Can J Psychiatry 41 (1996): 604-5
  15. Claire RJ, Servis ME, Cram DL Jr "Potential interaction between warfarin sodium and fluoxetine." Am J Psychiatry 148 (1991): 1604
  16. Tata LJ, Fortun PJ, Hubbard RB, et al. "Does concurrent prescription of selective serotonin reuptake inhibitors and non-steroidal anti-inflammatory drugs substantially increase the risk of upper gastrointestinal bleeding?" Aliment Pharmacol Ther 22 (2005): 175-81
  17. "Product Information. Brintellix (vortioxetine)." Takeda Pharmaceuticals America, Lincolnshire, IL.
  18. "Product Information. Lexapro (escitalopram)." Forest Pharmaceuticals, St. Louis, MO.
  19. Alderman CP, Moritz CK, Ben-Tovim DI "Abnormal platelet aggregation associated with fluoxetine therapy." Ann Pharmacother 26 (1992): 1517-9
  20. Hergovich N, Aigner M, Eichler HG, Entlicher J, Drucker C, Jilma B "Paroxetine decreases platelet serotonin storage and platelet function in human beings." Clin Pharmacol Ther 68 (2000): 435-42
  21. de Abajo FJ, Rodriguez LA, Montero D "Association between selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: population based case-control study." BMJ 319 (1999): 1106-9
  22. "Product Information. Fetzima (levomilnacipran)." Forest Pharmaceuticals, St. Louis, MO.
  23. Yaryura-Tobias JA, Kirschen H, Ninan P, Mosberg HJ "Fluoxetine and bleeding in obsessive-compulsive disorder." Am J Psychiatry 148 (1991): 949
  24. Alderman CP, Seshadri P, Ben-Tovim DI "Effects of serotonin reuptake inhibitors on hemostasis." Ann Pharmacother 30 (1996): 1232-4
  25. Humphries JE, Wheby MS, VandenBerg SR "Fluoxetine and the bleeding time." Arch Pathol Lab Med 114 (1990): 727-8
  26. Ciraulo DA, Shader RI "Fluoxetine drug-drug interactions. II." J Clin Psychopharmacol 10 (1990): 213-7
  27. "Product Information. Effexor (venlafaxine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  28. Pai VB, Kelly MW "Bruising associated with the use of fluoxetine." Ann Pharmacother 30 (1996): 786-8
  29. "Product Information. Viibryd (vilazodone)." Trovis Pharmaceuticals LLC, New Haven, CT.
  30. Dent LA, Orrock MW "Warfarin-fluoxetine and diazepam-fluoxetine interaction." Pharmacotherapy 17 (1997): 170-2
  31. "Product Information. Pristiq (desvenlafaxine)." Wyeth Laboratories, Philadelphia, PA.
  32. "Product Information. Celexa (citalopram)." Forest Pharmaceuticals, St. Louis, MO.
  33. Woolfrey S, Gammack NS, Dewar MS, Brown PJ "Fluoxetine-warfarin interaction." BMJ 307 (1993): 241
  34. Messiha FS "Fluoxetine - adverse effects and drug-drug interactions." J Toxicol Clin Toxicol 31 (1993): 603-30
  35. Ford MA, Anderson ML, Rindone JP, Jaskar DW "Lack of effect of fluoxetine on the hypoprothrombinemic response of warfarin." J Clin Psychopharmacol 17 (1997): 110-2
  36. "Product Information. Zoloft (sertraline)." Roerig Division, New York, NY.
  37. Dalton SO, Johansen C, Mellemkjaer L, Norgard B, Sorensen HT, Olsen JH "Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding: a population-based cohort study." Arch Intern Med 163 (2003): 59-64
  38. "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company, Indianapolis, IN.
  39. Aranth J, Lindberg C "Bleeding, a side effect of fluoxetine." Am J Psychiatry 149 (1992): 412
View all 39 references

Drug and food interactions


citalopram food

Applies to: Celexa (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.

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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.

Drug Interaction Classification

The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.
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 information available.

Do not stop taking any medications without consulting your healthcare provider.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.