Citalopram and alcohol – is that compatible?

Introduction

Citalopram and alcohol have relatively little interaction compared to other antidepressant drugs. The possible side effects should nevertheless be taken seriously. Citalopram is a drug that is used in the treatment of depressive disorders.

It is one of the most frequently prescribed psychotropic drugs. The effect is based on its selective serotonin reuptake inhibition (SSRI). Serotonin is a messenger substance that not only brightens the mood but also has an anxiety-relieving effect.

Increasing its concentration in the gap between the cells has a positive effect on mood. Citalopram is taken in the form of a tablet and reaches its highest concentration in the blood after two to four hours. Its half-life, i.e. the time after which half of the active ingredient is still present in the blood, can be up to 30 hours.

Most of it is broken down in the liver and only a small proportion is excreted with the urine. The liver is also the central organ in the breakdown of alcohol. The simultaneous intake of alcohol and citalopram can have a negative effect on the effectiveness of the antidepressant.

So far, the definitive interactions have not yet been proven. There is nothing wrong with occasional consumption of alcohol when taking citalopram at the same time. However, this should be discussed with the treating physician.

Which interactions occur?

Taking citalopram and alcohol at the same time may cause interactions. These are primarily dose-dependent and are related to individual liver function. Alcohol is first converted to acetaldehyde by the alcohol dehydrogenase.

In a second step acetate is produced with the help of another enzyme. If the supplied alcohol concentration is high, a further system is added. This is an enzyme of the cytochrome P-450 family.

Not only alcohol but also citalopram can be broken down in this way. The two agents compete for the binding sites of the degrading enzymes. The consequence is an increased effectiveness of the psychotropic drug and a longer half-life.

For this reason, side effects can occur more intensively. The psychotropic drug also inhibits the function of certain CYP enzymes, which in turn delay the breakdown of alcohol and are associated with an increased effect. Citalopram is effective in the central nervous system and in high concentrations leads, among other things, to pronounced fatigue and effects on the mental state.

In addition to an intensification of the depressive symptoms, hallucinations can occur. In low concentrations alcohol is broken down to acetate with the help of alcohol dehydrogenase and acetaldehyde dehydrogenase. If, on the other hand, high amounts of alcohol are added, the degradation also takes place with the aid of an enzyme from the cytochrome P450 family.

Citalopram is also metabolised in the liver by enzymes of this family and causes an inhibition of certain CYP enzymes. Alcohol consumption in large quantities, in combination with the intake of citalopram, thus causes a delayed breakdown of alcohol. Its intoxicating effect is enhanced.

The probability of a film tear, i.e. a period of lack of memory, increases. Aggression is one of the possible side effects of citalopram. Mostly it is not the only side effect, but can occur together with mood swings, dry mouth, digestive problems, increased anxiety symptoms and nightmares.

In connection with alcohol consumption, the tendency to aggressive behaviour can be increased. Citalopram may cause changes in heartbeat as a result of overdose. These appear, among other things, as cardiac dysrhythmia, a greatly increased heart rate and, in the worst case, in the form of cardiac arrest.

A drop in blood pressure can also be observed. An overdose of citalopram as a consequence of a delayed reduction in alcohol consumption is generally not to be expected. Since the sole intake of citalopram can already influence the heart rhythm and blood pressure, a combination with alcohol is not recommended.