Are there any interactions between citalopram and bromocriptine, dextropropoxyphene or ibuprofen?/n

Fråga: Are there any interactions between citalopram and bromocriptine, dextropropoxyphene or ibuprofen?

A 34-year-old woman with depression is treated with citalopram 40 mg daily. Her gynecologist has prescribed bromocriptine (dose and indication are unknown) and she also takes Distalgesic (paracetamol and dextropropoxyphene) and ibuprofen as needed.

Sammanfattning: We have found no information concerning interactions between citalopram and bromocriptine or ibuprofen. Citalopram and dextropropoxyphene may interact by inhibiting the liver enzyme CYP 2D6, but the clinical importance of this possible interaction is unclear.

Svar: A question concerning possible interactions between naproxen and citalopram has previously been answered negatively on Drugline (1). A follow up Medline search has not revealed any reports concerning any of the non-steroidal antiinflammatory drugs in combination with citalopram.

Another Drugline question concerns a 42-year-old woman treated with citalopram and Paraflex comp (dextropropoxyphene, chlorzoxazone and acetylsalicylic acid), who got hallucinations. It is stated that citalopram and dextropropoxyphene theoretically may interact by inhibiting the liver enzyme CYP 2D6 which is partly responsible for the metabolism of both substances. Another case of hallucinations in an elderly woman treated with the same combination was found in the files of the Swedish Adverse Drug Reactions Committee (2).

Nothing has been found in the literature concerning bromocriptine and citalopram. A known bromocriptine interaction involves erythromycin which indicates that the CYP 3A4 enzyme is, at least partly, responsible for the metabolism of bromocriptine. This makes a citalopram - bromocriptine metabolic interaction less likely.

Tricyclic antidepressants have been associated with elevated serum prolactin levels (3) and this effect has also been shown for serotonin reuptake inhibitors (4). A serum prolactin check-up may be indicated, should hyperprolactinemia be the indication for the bromocriptine treatment. 1 Drugline nr 11041 (year 1994) 2 Drugline nr 11736 (year 1994) 3 Drugline nr 11610 (year 1994) 4 Drugline nr 12137 (year 1995)