Celexa and Contrave Drug Interactions: What to Know

Celexa (citalopram) and Contrave (bupropion-naltrexone) are medications used for different purposes—Celexa to treat depression and Contrave for chronic weight management for compatible individuals.

However, Celexa and Contrave drug interactions can occur if these two medications are taken together, affecting safety and efficacy. Understanding these risks is essential before combining these medications.

Key Takeaways

• Celexa and Contrave drug interactions can increase the risk of serious adverse reactions such as seizures and high blood pressure.
• Taking Contrave with Celexa may require dose adjustment to minimize the risk of seizures and other side effects.
• Patients with bipolar disorder, a seizure disorder, eating disorders, or other risk factors should consult their doctor before taking these medications together.

Understanding Celexa and Contrave Drug Interactions

Celexa (citalopram) is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed to treat depression and other mood disorders. It works by increasing serotonin levels in the brain, improving mood regulation and emotional stability. Contrave, on the other hand, is a weight loss medication that combines naltrexone and bupropion to influence appetite and cravings by acting on the brain’s reward system. Naltrexone is an opioid antagonist used to treat alcohol and opioid dependence, while bupropion is an atypical antidepressant that affects dopamine and norepinephrine levels. Contrave helps promote weight loss in certain individuals.

When Celexa and Contrave are taken together, their interaction can have unintended effects due to the way both medications alter neurotransmitter activity. Bupropion, a key component of Contrave, inhibits the reuptake of dopamine and norepinephrine, while Celexa primarily affects serotonin. The combination can create an imbalance in neurotransmitter regulation, increasing the likelihood of adverse reactions such as serotonin syndrome, nervous system overstimulation, and mood instability.

One of the most significant concerns with this combination is the lower seizure threshold caused by bupropion. Since Celexa may also contribute to mild excitatory effects in the nervous system, the concurrent use of these drugs increases the risk of seizures, particularly in individuals with a history of seizure disorder, bipolar disorder, or brain trauma.

Dr. Matthew Olesiak, MD, Chief Medical Director of SANE MD, states:

“Bupropion, a key ingredient in Contrave, is known to reduce seizure threshold. When combined with an SSRI like Celexa, the risk of seizures may further increase, especially in patients with preexisting risk factors.”

In addition to seizure risk, the interaction between Celexa and Contrave can contribute to serotonin syndrome, a potentially life-threatening condition characterized by confusion, rapid heart rate, high blood pressure, sweating, muscle stiffness, and agitation. This occurs when excessive serotonin accumulates in the nervous system, often as a result of combining multiple drugs that influence serotonin levels.

Celexa and Contrave Drug Interaction Summary

Category	Details
Primary Medications	– Celexa (Citalopram): SSRI antidepressant increasing serotonin levels – Contrave: Weight loss drug (naltrexone + bupropion) acting on dopamine/norepinephrine
Main Interaction Concerns	– Increased seizure risk due to bupropion – Risk of serotonin syndrome – Blood pressure elevation – CNS overstimulation
High-Risk Groups	– Individuals with: – Seizure disorders – Bipolar disorder – Brain injuries – Eating disorders
Neurological Side Effects	– Dizziness or vertigo – Confusion or poor concentration – Tremors or twitching – Insomnia or restlessness – Blurred vision
Cardiovascular Risks	– High blood pressure – Severe headaches – Chest pain or palpitations – Shortness of breath
Opioid Interaction Risks	– Naltrexone blocks opioid receptors – May cause withdrawal if taken with opioids – Risk of overdose after stopping Contrave and resuming opioids
Suicidal Thoughts Risk	– Both drugs can increase suicidal ideation, especially in those <25 – Watch for sudden mood changes, aggression, or withdrawal
Serious Allergic Reactions	– Rash or hives – Dark urine (possible liver issue) – Chest pain or difficulty breathing

Increased Risk of Seizures and CNS Toxicity

Taking Contrave with Celexa can significantly increase the risk of seizures, especially for individuals who have a seizure disorder, bipolar disorder, a history of traumatic brain injury, or a brain tumor. According to research published in Pharmacy & Therapeutics Journal, Bupropion, one of the main components of Contrave, is known to lower seizure threshold, making seizures more likely when combined with other medications that impact the central nervous system (CNS), such as Celexa.

Additionally, naltrexone and bupropion both influence neurotransmitter activity in the brain, which can contribute to CNS toxicity when taken with Celexa. This may lead to symptoms such as:

• Dizziness or vertigo
• Confusion or difficulty concentrating
• Tremors or muscle twitching
• Increased nervous system stimulation, leading to restlessness or insomnia
• Headaches and blurred vision

Because these side effects can affect cognitive function, patients should avoid activities requiring mental alertness, such as driving or operating heavy machinery, until they fully understand how the combination of medications affects them.

Dr. Olesiak notes: “Patients taking both Celexa and Contrave should be cautious of potential neurological side effects, including dizziness and tremors, which may impair motor function and decision-making.”

In individuals predisposed to seizures, even small changes in dosage or missed doses can trigger an episode. The FDA emphasizes the importance of following a healthcare provider’s guidance on dose adjustments to minimize the risk of seizures.

Blood Pressure and Cardiovascular Concerns

Both Celexa and Contrave can impact blood pressure, but taking Contrave increases the likelihood of developing high blood pressure or severely high blood pressure, particularly in individuals who have preexisting cardiovascular conditions. Bupropion, a stimulant-like drug, can elevate blood pressure, while naltrexone can also contribute to fluctuations in heart rate and blood pressure or heart function.

Patients who already have hypertension, heart disease, or a history of stroke are at an even higher risk of developing hypertensive reactions, which may present as:

• Severe headaches
• Dizziness and vision changes
• Chest pain or palpitations
• Shortness of breath

For individuals on both Celexa and Contrave, frequent monitoring of blood pressure is essential to prevent dangerous spikes.

Dr. Olesiak advises: “Because bupropion can cause an increase in blood pressure, patients taking Contrave should regularly monitor their readings, especially if they are also on SSRIs like Celexa.”

If a patient develops severely high blood pressure or experiences chest pain, they should seek immediate medical attention. In some cases, a dose adjustment or alternative treatment may be necessary to lower the risk of cardiovascular complications.

Additional Risks and Considerations

Opioid Withdrawal & Accidental Overdose

Since naltrexone and bupropion block opioid receptors, individuals using opioid-based medications or struggling with opioid dependence must avoid taking Contrave. This is because naltrexone prevents opioids from binding to receptors, which can trigger opioid withdrawal symptoms if the individual is physically dependent.

Common symptoms of opioid withdrawal include:

• Severe nausea and vomiting
• Sweating and chills
• Increased heart rate and blood pressure
• Muscle aches and restlessness

Additionally, individuals who stop taking Contrave and later use opioids may have a reduced tolerance, making them susceptible to an accidental overdose, which could be fatal. Patients should tell their doctor if they are taking opioids before starting Contrave treatment.

Increased Risk of Suicidal Thoughts

As with most antidepressants, Celexa carries an FDA warning for suicidal thoughts in young adults, particularly during the initial weeks of treatment. Bupropion, while not a traditional SSRI, also alters brain chemistry, and its stimulating effects may increase the risk of anxiety, restlessness, or impulsivity. When used together, these drugs may elevate the likelihood of:

• Suicidal ideation
• Self-harm thoughts
• Severe mood swings or aggression

Patients (especially those under the age of 25) and their families should monitor for behavioral changes, including sudden agitation, social withdrawal, or unexplained mood shifts. Tell your doctor immediately if these symptoms occur.

Serious Allergic Reaction

Though uncommon, some individuals may experience a serious allergic reaction to Celexa, Contrave, or their combined effects.

Symptoms of a severe allergic reaction include:

• Skin rash or hives
• Dark urine, indicating possible liver issues
• Severe chest pain or difficulty breathing

If any of these symptoms occur, seek immediate medical attention to prevent serious complications. Tell your doctor about any history of allergies before taking these medications.

Understanding these side effects and safety guidelines can help you take these medications safely.

Safe Use Guidelines

To reduce the potential risks associated with Celexa and Contrave drug interactions, patients should follow these essential safety guidelines:

1. Tell Your Doctor About All Other Drugs and Over-the-Counter Drugs You Are Taking

Many other drugs, including over-the-counter drugs, herbal supplements, and prescription medications, can interact with Celexa and Contrave, potentially increasing the risk of adverse reactions.

Some medications that require special attention include:

• Other antidepressants (e.g., SSRIs, SNRIs, MAOIs)
• Antipsychotic medications (may further lower seizure threshold)
• Blood pressure medications (as Contrave may cause fluctuations in blood pressure)
• Opioid pain relievers, Codeine such as , (which Contrave blocks due to its naltrexone component)
• Over-the-counter drugs like decongestants or nonsteroidal anti-inflammatory drugs (NSAIDs), which may elevate blood pressure

Additionally, stimulants like Modafinil can also interact with Contrave.

Since some interactions may increase the risk of seizures, hypertensive reactions, or serotonin syndrome, it is critical to tell your doctor about all medications you are taking before starting Contrave treatment.

2. Avoid High-Fat Meals When Taking Contrave

Taking Contrave with high-fat meals can increase systemic exposure to bupropion, leading to a higher risk of adverse effects, including:

• Increased blood pressure or heart rate
• Nausea, dizziness, or agitation
• Lower seizure threshold, heightening the risk of seizures

To minimize these risks, Contrave tablets should be taken with a reduced-calorie diet, but without excessive dietary fat.

Patients should focus on balanced meals and avoid consuming high-fat meals around their dosing schedule.

3. Do Not Suddenly Stop Drinking Alcohol

Abruptly stopping alcohol consumption while taking Contrave or Celexa can increase the risk of withdrawal symptoms, including:

• Seizures (due to bupropion lowering seizure threshold)
• Severe agitation or anxiety
• Sleep disturbances and mood instability

However, if you’re not a regular drinker, you should avoid drinking alcohol while on either of these drugs. (Contrave and alcohol drug interactions can be particularly severe.)

Patients who regularly consume alcohol should discuss a safe reduction plan with their healthcare provider before starting Contrave treatment.

Tell your doctor if you have a history of heavy alcohol use, as you may require a dose adjustment or closer monitoring.

4. Swallow Contrave Tablets Whole—Do Not Crush, Chew, or Split Them

Contrave tablets are extended-release tablets, meaning the medication is designed to be released into the body gradually over time.

Crushing, chewing, or splitting the tablets can:

• Cause a sudden spike in drug levels, leading to adverse reactions
• Increase the risk of seizures, particularly in individuals predisposed to them
• Alter how the medication is absorbed, reducing effectiveness

Patients should swallow Contrave tablets whole with water and follow the prescribed dosing schedule. If a dose is missed, take the next scheduled dose rather than doubling up.

5. Follow the Prescribed Dose Range and Take Contrave in Divided Doses

To minimize the risk of hypertensive reactions, seizures, and other side effects, Contrave should be taken exactly as prescribed. Typically, Contrave is started at a lower dose and gradually increased to help the body adjust.

Taking too much too quickly can increase the risk of:

• Severely high blood pressure (Combining Contrave with Propranolol, a beta-blocker, can further affect blood pressure.
• Nervous system overstimulation (e.g., restlessness, jitteriness)
• Lower seizure threshold, increasing seizure risk

Patients should never exceed the recommended dose range or change their dosing schedule without consulting a healthcare provider.

6. Monitor for Trouble Sleeping, as Contrave Can Cause Insomnia

Contrave contains bupropion, a stimulant-like drug, which can cause trouble sleeping, particularly if taken too close to bedtime.

Patients who experience persistent insomnia should:

• Take Contrave earlier in the day to reduce its impact on sleep
• Avoid caffeine and other stimulants, which may worsen restlessness
• Discuss potential dose adjustments with their doctor if sleep disturbances become severe

If insomnia persists, tell your doctor, as alternative treatment strategies may be needed to ensure safe and effective chronic weight management without disrupting sleep quality.

FAQ: Celexa and Contrave Drug Interactions

When considering Celexa and Contrave drug interactions, it’s important to understand how these medications may interact with each other and with other drugs. Both Celexa (citalopram) and Contrave (naltrexone-bupropion) affect neurotransmitters, meaning their combination can lead to an increased risk of side effects, including seizures, high blood pressure, and serotonin syndrome.

Below are answers to some of the most common questions regarding their safe use.

1. Can you take Contrave while on antidepressants?

Taking Contrave while on antidepressants can be risky due to potential interactions between bupropion (a component of Contrave) and other antidepressants. Bupropion can increase serotonin and dopamine levels, which, when combined with SSRIs or SNRIs, may raise the risk of serotonin syndrome—a dangerous condition characterized by agitation, rapid heartbeat, and high fever.

Additionally, bupropion can lower the seizure threshold, making seizures more likely, especially if combined with medications that have similar effects. Patients currently on antidepressants should consult their doctor before starting Contrave, as a dose adjustment or alternative treatment may be necessary.

2. Can Celexa and buPROPion be taken together?

Celexa (citalopram) and bupropion are sometimes prescribed together, but this combination requires careful monitoring. While both medications are used to treat depression, they act on different neurotransmitters—Celexa primarily affects serotonin, while bupropion impacts dopamine and norepinephrine. Taking them together may increase the risk of seizures, especially in patients with seizure disorder, bipolar disorder, or other neurological conditions. There is also a potential for high blood pressure or mood instability.

If these medications are prescribed together, patients should be monitored for trouble sleeping, restlessness, and changes in blood pressure. Always tell your doctor about any side effects that arise.

3. What medications should not be taken with Contrave?

Several medications should not be taken with Contrave due to the risk of severe drug interactions.

These include:

• Opioid medications (e.g., oxycodone, morphine, fentanyl) – Contrave contains naltrexone, which blocks opioid receptors, potentially causing opioid withdrawal if taken together.
• Monoamine oxidase inhibitors (MAOIs) (e.g., phenelzine, selegiline) – These drugs can lead to dangerous blood pressure spikes and serotonin syndrome when combined with Contrave.
• Other drugs that lower seizure threshold (e.g., antipsychotics, steroids, certain antibiotics) – Combining them with Contrave may increase the risk of seizures.
• Stimulants and amphetamines (e.g., Adderall, Ritalin) – These can exacerbate Contrave’s effects on blood pressure and the central nervous system, increasing the likelihood of hypertension, anxiety, or heart issues.
  Because Contrave contains bupropion and naltrexone, it’s crucial to tell your doctor about all other drugs and over-the-counter medications you’re taking.

4. What Cannot be taken with Celexa?

Several medications should not be taken with Celexa due to the risk of dangerous interactions.

These include:

• Other antidepressants, especially MAOIs – Combining Celexa with MAOIs or other SSRIs/SNRIs can lead to serotonin syndrome, a life-threatening condition.
• NSAIDs and blood thinners (e.g., aspirin, warfarin) – Celexa can increase the risk of bleeding, particularly in patients using blood thinners.
• Certain heart medications – Drugs that prolong the QT interval (e.g., amiodarone, sotalol) can increase the risk of irregular heart rhythms when taken with Celexa.
• St. John’s Wort – This herbal supplement can increase serotonin levels, heightening the risk of serotonin syndrome.
  Patients should always tell their doctor about all medications and supplements they are taking before starting Celexa.

5. Can you take citalopram with Contrave?

Taking citalopram (Celexa) with Contrave can be dangerous due to their combined effects on neurotransmitters and blood pressure. Bupropion in Contrave lowers the seizure threshold, while citalopram can prolong the QT interval, increasing the risk of serious heart rhythm issues. Additionally, both drugs impact serotonin levels, which may increase the risk of serotonin syndrome if taken together.

Patients with a history of seizures, heart conditions, or high blood pressure should avoid taking these medications together unless advised by their doctor. If prescribed both, close monitoring of blood pressure, heart function, and neurological symptoms is essential to reduce the risk of serious side effects.

Conclusion

The Contrave interactions with Celexa pose risks that require careful monitoring. Individuals considering this combination should consult a healthcare professional to determine if a dose adjustment is needed or if alternative medications should be considered. Tell your doctor immediately if experiencing severe hepatic impairment, eye pain, or signs of an allergic reaction.

Understanding these interactions before starting Contrave treatment is crucial to ensuring a safe and effective treatment regimen for chronic weight management while minimizing the risk of seizures and high blood pressure.

References

Pharmacy & Therapeutics Journal

FDA

FDA