Drug Interactions

  I am on the following medications, Lipitor 10mg, Corgard 20mg,
  Lactulose syrup at 2 tlb per day, Premarin .625 mg and norpramin at 25mg per day for panic attacks ( for the last 15 years)
  In the last year the doctor reduced dose of norpramin from 50 to
   25 mg because I complain of 30 pound weight gain over the years. I am doing well with the panic even on this smaller dose.
  The doctor would like to take me off the norpramin and try the drug Celexa. He wants me to start taking Celexa at 20mg per day
  and continue the norpramin for 2 weeks while the celexa kicks in.
  My concern is can you take these two drugs together for 2 weeks?
  And is there any problems taking Corgard ( a beta-blocker) with the Celexa? I've think I read about Celexa and Metoprolol (beta- blocker) having a problem.  Thank-you for your answer.

[HFHS M.D.-HG]

_
Dear  Kathy,
                     Celexa (Citalopram) is the newest antidepressant among the SSRI's ( Serotonin Specific  Reuptake Inhibitors).It is indicated for the treatment of depression. It may have efficacy for panic attacks    and  obsessive compulsive disorder like the  other SSRI"s. It is usually started at a  dose of 20mg per day  and the dose will be increased depending upon the symptoms. The most frequent side effects reported with celexa are nausea, dry mouth, insomnia  and  diarrhea.    
                      Combination of imipramine , a tricyclic antidepressant ( TCA)  with celexa has shown that the concentration of imipramine's metabolite( Desipramine, marketed  as Norpramin) was increased by approximately 50%. The clinical significance of this is unknown. Neverthless, caution is indicated in the co-administration of  TCA's with celexa as the serum levels of the  TCA often  increase . You are on a low dose of Norpramin (25 mg ). You and your physician can decide if a serum level of Norpramin should be taken. Eventhough co-administration of celexa and metoprolol has increased plasma levels of metoprolol, it had no clinically significant effects on blood pressure or  heart rate. There are no known studies  done with a combination of celexa and corgard.    
                       I would recommend you to discuss with your  physician in detail about  your concern regarding the medications. I hope this information is helpful to you. This information is provided for general  educational purposes only and should not be replaced by evaluation with a physician.
Sincerely,
HFHS  M.D.
Key words: celexa, norpramin.