Can I take Citalopram and Co-codamol together?

Why this happens

Both drugs affect a chemical in the brain called serotonin; when levels get too high, it causes side effects. Citalopram can also block the liver enzyme (CYP2D6) needed to convert codeine into its active form (morphine), potentially making the painkiller less effective. Both drugs also have 'depressant' effects on the central nervous system, which increases sleepiness.

What you should do

You can take these together if your doctor has prescribed them, but you should be aware of the signs of serotonin syndrome (such as shivering, diarrhoea, confusion, muscle stiffness, or a high temperature). If you feel very drowsy or find the co-codamol isn't helping your pain, speak to your GP. Avoid alcohol while taking these medicines.

Important precautions

Depression and anxiety disorders

You may experience an increase in suicidal thoughts or the urge to self-harm when first starting this medicine or changing the dose. This is more common in young adults under 25. Contact your doctor or go to hospital immediately if this happens.

Serotonin syndrome

Taking these medicines together increases the risk of serotonin syndrome, a potentially life-threatening condition. Seek immediate medical help if you experience agitation, hallucinations, fast heartbeat, or severe muscle stiffness.

Heart rhythm disorders (Long QT syndrome)

Citalopram can affect your heart rhythm. You must not take it if you have a pre-existing heart rhythm problem or are taking other medicines that affect the heart's electrical activity.

Low sodium levels (Hyponatraemia)

Citalopram can cause a serious drop in blood sodium levels, especially in the elderly. Seek medical help if you experience extreme tiredness, confusion, or muscle twitching.

Breathing problems (e.g. asthma, COPD)

The codeine in co-codamol can dangerously slow down your breathing. Do not take this if you have severe lung disease or are having an asthma attack.

Addiction and dependency

Co-codamol contains an opioid which can be highly addictive. Do not use it for more than 3 days at a time without medical supervision, as this can lead to withdrawal symptoms and 'medication-overuse' headaches.

Food and drink warnings

Alcohol

You should avoid or strictly limit alcohol while taking these medicines. Both citalopram and the codeine in co-codamol can cause drowsiness and dizziness. Alcohol significantly increases these effects, making you feel much sleepier and increasing the risk of falls or accidents. In the case of co-codamol, alcohol also increases the risk of dangerous breathing problems.

Caffeine (Coffee, tea, energy drinks)

Be cautious with high amounts of caffeine. Some versions of co-codamol already contain caffeine as an extra ingredient. Adding more caffeine from drinks can make you feel shaky, anxious, or cause a racing heart.

Citalopram can sometimes cause feelings of restlessness or jitteriness, especially when you first start taking it. Caffeine is a stimulant that can worsen these side effects and may increase feelings of anxiety. It is advisable to monitor your caffeine intake.

Using other medicines

Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Disclaimer

This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.