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Drug Interaction Report

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

  • citalopram
  • Ritalin (methylphenidate)

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Interactions between your drugs

Moderate

methylphenidate citalopram

Applies to: Ritalin (methylphenidate), citalopram

MONITOR: Coadministration with methylphenidate may increase the plasma concentrations and effects of selective serotonin reuptake inhibitors (SSRIs). Human pharmacologic studies have shown that methylphenidate may inhibit the metabolism of some antidepressants including SSRIs. There have been isolated reports of adverse reactions such as hallucinations, confusion, seizures, and serotonin syndrome during concomitant use of methylphenidate with an SSRI, which resolved following discontinuation of one or both drugs. Nevertheless, the combination has been used therapeutically to improve clinical response in the treatment of attention-deficit hyperactivity disorder and to augment the effects of SSRIs in the treatment of depression.

MANAGEMENT: Pharmacologic response to SSRIs should be monitored more closely whenever methylphenidate (racemic) or dexmethylphenidate (the more pharmacologically active d-enantiomer) is added to or withdrawn from therapy, and the dosage of one or both drugs adjusted as necessary.

References

  1. Stoll AL, Pillay SS, Diamond L, Workum SB, Cole JO "Methylphenidate augmentation of serotonin selective reuptake inhibitors: a case series." J Clin Psychiatry 57 (1996): 72-6
  2. Findling RL "Open-label treatment of comorbid depression and attentional disorders with co-administration of serotonin reuptake inhibitors and psychostimulants in children, adolescents, and adults: a case series." J Child Adolesc Psychopharmacol 6 (1996): 165-75
  3. Gammon GD, Brown TE "Fluoxetine and methylphenidate in combination for treatment of attention deficit disorder and comorbid depressive disorder." J Child Adolesc Psychopharmacol 3 (1993): 1-10
  4. "Product Information. Concerta (methylphenidate)." Alza, Palo Alto, CA.
  5. Lavretsky H, Park S, Siddarth P, Kumar A, Reynolds CF 3rd "Methylphenidate-enhanced antidepressant response to citalopram in the elderly: a double-blind, placebo-controlled pilot trial." Am J Geriatr Psychiatry 14 (2006): 181-5
  6. Lavretsky H, Kumar A "Methylphenidate augmentation of citalopram in elderly depressed patients." Am J Geriatr Psychiatry 9 (2001): 298-303
  7. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc, Atlanta, GA.
  8. Ishii M, Tatsuzawa Y, Yoshino A, Nomura S "Serotonin syndrome induced by augmentation of SSRI with methylphenidate." Psychiatry Clin Neurosci 62 (2008): 246
View all 8 references

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Drug and food interactions

Moderate

methylphenidate food

Applies to: Ritalin (methylphenidate)

GENERALLY AVOID: Alcohol may exacerbate the adverse central nervous system effects of psychoactive drugs, including methylphenidate.

GENERALLY AVOID: Consumption of alcohol while taking certain sustained-release formulations of methylphenidate may cause rapid release of the drug, resulting in increased systemic levels of methylphenidate. In vitro studies have been conducted using Metadate CD 60 mg and Ritalin LA 40 mg capsules, as well as Concerta 18 mg tablet. At an alcohol concentration of 40%, an increase in the release rate of methylphenidate was observed in the first hour for Metadate CD and Ritalin LA, resulting in 84% and 98% of the methylphenidate being released, respectively. In contrast, there was no increased release of methylphenidate in the first hour for Concerta. These results are considered to be representative of the other available strengths of the corresponding product.

MANAGEMENT: Patients treated with methylphenidate should be advised to avoid alcohol or medications that contain alcohol.

References

  1. "Product Information. Ritalin LA (methylphenidate)." Quality Care Products/Lake Erie Medical , Temperance, MI.
  2. "Product Information. Concerta (methylphenidate)." Alza, Palo Alto, CA.
  3. "Product Information. Metadate CD Capsules (methylphenidate)" Celltech Pharmaceuticals, Inc, Applegate, WI.

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Moderate

citalopram food

Applies to: 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 "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. "Product Information. Fycompa (perampanel)." Eisai Inc, Teaneck, NJ.
  3. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc, Rockville, MD.
  4. Gilman AG, Rall TW, Nies AS, Taylor P, eds. "Goodman and Gilman's the Pharmacological Basis of Therapeutics. 8th ed." New York, NY: Pergamon Press Inc. (1990):
View all 4 references

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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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