Can you mix citalopram with escitalopram?

Answer 1

At therapeutic levels it is a relatively safe combination. Both drugs have multiple paths of metabolism so the ones that they have in common aren't too big of a deal. However! There are people with certain genotypes that have to potential to be extremely sensitive to escitalopram and other SSRIs. In this case, the combination could be potentially fatal. If you have been taking escitalopram for at least 6 weeks then its entire effects should be present, and you'll have a good idea of whether or not you're in that rare situation. If that is the case, you'll most likely have significant side effects and may need to consider other options for depression or anxiety treatment. In any case, make sure each prescribing doctor is aware of the combination, time of administration, and dosage.

Also, at high doses experiments have found that this combination changes gene expression in a way similar to cocaine. So you probably won't want to make this a long term plan. Sorry I can't find the links to these studies, but I assure you they come from legitimate sources. I have a neuropharmacology obsession.

Answer 2

Yes. Depending on how you mix it, you will get different ratios of R-citalopram and S-citalopram. Note: Citalopram contains 50% R-citalopram and 50% S-citalopram, whereas Escitalopram contains 100% S-citalopram. If you combine the two, let's say, 1/2 tab citalopram 20mg and 1/2 tab escitalopram 10mg, what you will get is roughly 66.6% S-citalopram (10mg) and 33.3% R-citalopram (5mg). Now, R-citalopram is known to attenuate the effects of S-citalopram, the active enantiomer. Let's look at it again. pure Escitalopram 10mg - 10mg S-citalopram, no R-citalopram 50-50 combination - 10mg S-citalopram, 5mg R-citalopram (a 2:1 ratio) pure Citalopram - 10mg S-citalopram, 10mg R-citalopram (a 1:1 ratio) Now, how would that affect treatment is another question. Personally, I think that the combination would be a good compromise. You'll save money bec Citalopram is much cheaper than Escitalopram. And, you'll (probably) have a combination that can be close to the effectiveness of pure S-citalopram since the the higher S:R ratio may offset the attenuation effects.