Which Drugs For GERD Are Safe With Celexa (Citalopram)?

In our latest question and answer, the pharmacist discusses which medications commonly used to treat GERD symptoms are safe to take with the antidepressant Celexa.

Which Drugs For GERD Are Safe With Celexa (Citalopram)?
Dec 28, 2019

MeMe asked

I'm currently taking Celexa for depression and anxiety. I have GERD and was wondering what over the counter medicines I can take with Celexa?

At a glance

  • There are a number of medications used to treat the symptoms of GERD and choice of a specific one will depend on a number of factors including severity of symptoms and whether or not you have erosive esophagitis.
  • Most drugs used to treat GERD are safe with Celexa (citalopram). However, all of the over the counter PPIs (proton pump inhibitors) will at least to some extent increase concentrations of Celexa since they inhibit the metaboizing enzyme CYP2C19, which is responsible for the metabolism of the drug. This increases the risk of side effects, like QT prolongation.
  • The FDA approved labeling for Celexa recommends to take no more than 20mg per day if using along-side a CYP2C19 inhibitor (which all OTC PPIs are).
  • Some prescription-only PPI drugs are less likely to have an interaction with Celexa, including Protonix and Dexilant, since they are weaker inhibitors of CYP2C19.

Answer

African man suffering from acid reflux or GERD

Thank you for your question!

Asking which medications you could take for GERD (Gastroesophageal Reflux Disease) that won't interact with Celexa (citalopram) is difficult to give a specific answer to simply because the treatment of GERD is a broad topic and there are a number of medications that could be prescribed/recommended for you.

Choice of medication to help alleviate your symptoms depends on many factors, including:

  • Frequency and severity of symptoms
  • Whether or not there is the presence of erosive esophagitis

As a first step, you will want to make an appointment with your doctor (if you haven't already) so you can be properly assessed and diagnosed. From there, they can recommend or prescribe appropriate therapy for the condition.

Having said the above, the most commonly used medications to treat GERD are:

Other drugs can be used as well (e.g. sucralfate), but I'll focus on the ones I've listed above in regard to whether or not there are any issues with Celexa.

Antacids

Antacids, like Tums and Rolaids, aren't a mainstay of therapy for GERD, but can help to treat mild and infrequent symptoms.

If you are going to take an antacid, that is fine, they are safe to take with Celexa.

Antacids, in general, may seem like a fairly innocuous class of drugs where drug interactions are concerned, but they can significantly impair the absorption of a number of medications, including many antibiotics (e.g. doxycycline), cholesterol medications (e.g. Crestor) and ones for blood pressure (e.g. propranolol).

If you are taking prescription medication, it is always a good idea to ask your pharmacist whether or not antacids are safe to take at the same time.

H2 Receptor Antagonists

H2 receptor antagonists, also known as H2 blockers, include drugs like Zantac (ranitidine), Pepcid (famotidine) and Tagamet (cimetidine).

They can be beneficial in treating mild, intermittent symptoms of GERD, but generally aren't that useful if you have erosive esophagitis.

Two drugs in this class, Zantac and Pepcid, are safe to take with Celexa.

However, you do want to avoid Tagamet (cimetidine) with it.

Tagamet (cimetidine) inhibits an enzyme (CYP2C19) that is responsible for metabolizing Celexa. Inhibition of this enzyme can increase concentrations in the blood of Celexa, increasing the risk of side effects. The prescribing information for Celexa discusses this:

In subjects who had received 21 days of 40 mg/day Celexa, combined administration of 400 mg/day cimetidine for 8 days resulted in an increase in citalopram AUC [area under the curve] and Cmax [maximum concentrations] of 43% and 39%, respectively. The clinical significance of these findings is unknown.

So, again, if you are going to be taking an H2 receptor antagonist with Celexa, stick with Pepcid or Zantac (as a side note, Zantac may be tough to find due to all the recalls).

Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are generally used in those who don't respond well to H2 receptor antagonists or have erosive esophagitis. Studies show that they are the most effective drugs for treating GERD symptoms.

The problem with PPIs, in regard to taking them with Celexa, is that all PPI drugs, to some extent, inhibit CYP2C19, the enzyme responsible for Celexa metabolism.

As discussed above when I talked about cimetidine, taking a CYP2C19 inhibitor with Celexa increases the risk of side effects.

In fact, the prescribing information states that if you are taking a drug that inhibits CYP2C19, the maximum daily recommended dose of Celexa is only 20mg:

Celexa 20 mg/day is the maximum recommended dose in patients taking concomitant cimetidine or another CYP2C19 inhibitor, because of the risk of QT prolongation.

QT prolongation increases the risk of dangerous arrhythmias.

Since all PPI drugs inhibit CYP2C19 to some extent (including all of the ones available over the counter), they should be taken cautiously with Celexa.

There are two PPI drugs that are far less likely to cause clinically significant interaction with CYP2C19 drugs, Protonix (pantoprazole) and Dexilant (dexlansoprazole).

Protonix is a very weak inhibitor of CYP2C19 and Dexilant may not even inhibit the enzyme at all (even though it is metabolized by it itself).

Therefore, if a PPI is warranted in those taking Celexa, Protonix and Dexilant would most likely be the safest options. Unfortunately, both are available only via a prescription (i.e. not over the counter).

References
  1. Proton pump inhibitors: Overview of use and adverse effects in the treatment of acid related disorders. UpToDate (Subscription Required)
  2. Celexa Prescribing Information. AccessFDA
  3. Medical management of gastroesophageal reflux disease in adults. UpToDate (Subscription Required)
  4. Tagamet Prescribing Information. AccessFDA
  5. Clinical Application of CYP2C19 Pharmacogenetics Toward More Personalized Medicine. PubMed

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