Supplements and Citalopram.
Citalopram, sold under the brand names Cipramil, Celexa, is a selective serotonin reuptake inhibitor (SSRI): it raises synaptic serotonin by blocking its reuptake.
Citalopram is the second most prescribed SSRI in England after sertraline, used for depression and anxiety. Mechanism mirrors sertraline (serotonin transporter inhibition) but the metabolic profile differs. Citalopram is metabolised by CYP2C19, CYP3A4, and CYP2D6, which makes it more sensitive to PPI co-prescription. Omeprazole raises citalopram exposure modestly. The MHRA dose cap is the operative point. 40mg maximum in adults under 65. 20mg in adults over 65 or with hepatic impairment. The cap exists because QT prolongation rises with dose. That QT signal matters when citalopram stacks with anything else extending QT: certain antibiotics (clarithromycin, levofloxacin), some antiemetics, and a small number of supplements. Serotonergic interactions are the same as sertraline (St John's Wort, 5-HTP, tryptophan, saffron extract). Escitalopram, the S-enantiomer, sits in a similar class but with a separate dose schedule.
Below are the 6 documented pairs we have explicitly assessed against Citalopram in the Distil database: 2 red and 4 amber. The pairs cluster around 1 mechanism: Additive serotonergic activity. Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not on this list is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by supplement, and the missing-item form at the bottom of the page routes any uncatalogued supplement into our next curation pass.
Documented interactions
Additive serotonergic activity
5-HTP is the precursor your body uses to make serotonin. Combined with an SSRI like citalopram, it can cause serotonin syndrome. Do not combine.
St John's Wort and citalopram both raise serotonin levels. Combined, they can cause serotonin syndrome. Do not combine.
Ashwagandha has mild effects on serotonin pathways that overlap with citalopram. Most people tolerate the combination but watch for restlessness, jaw tension, or sleep disruption.
Rhodiola has mild effects on serotonin pathways that can add to citalopram's. Most people tolerate the combination, but watch for restlessness, sweating, tremor, or a racing heart, and talk to your GP before stacking them, especially if your dose has recently changed.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
SAMe has its own antidepressant, serotonin-related activity, which may add to citalopram's. Most people tolerate the combination, but watch for restlessness, sweating, tremor, shivering, or a racing heart, and tell your GP before stacking them, especially if your citalopram dose has recently changed.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Saffron extract has its own antidepressant effect, possibly via serotonin-receptor modulation. Combined with citalopram, the serotonergic effect may stack. Watch for restlessness, sweating, or muscle twitching, and tell your GP if you start saffron while on citalopram.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope (food-supplement interactions only; for drug-drug interactions, the BNF is authoritative). Use the checker below to surface any supplement, and submit a missing item if you take something we have not catalogued.
For adults over 18.
This tool gives evidence-graded information, not medical advice. Always discuss changes with your GP, pharmacist, or specialist before making them, especially if you take any medication, are pregnant, breastfeeding, or have a serious health condition.
How we grade severity, choose what's in scope, and what we exclude.
Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.
Read the full methodologySomething missing?
If a supplement or medication you take isn't in our autocomplete, tell us. We go through what people flag every week and add what's missing.