MajorSSRI (selective serotonin reuptake inhibitor)×SNRI
Updated · Methodology
Mechanism
SSRI + SNRI – serotonergic load rises, serotonin syndrome risk. Duloxetine also prolongs QT at high doses, summing with citalopram's QT effect.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia. Autonomic features: sweating, tachycardia, hypertension, fever. First signs appear within hours of co-administration.
Management
The combination is not prescribed. When switching antidepressants, allow a 2-week washout. Alternative monotherapy: mirtazapine or agomelatine.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Cymbalta section 7 (2017)– ; DailyMed setid 2f7d4d67-10c1-4bf4-a7f2-c185fbad64ba