Propranolol and Citalopram (A brief guide)

Propranolol and Citalopram

In this guide, we will discuss Propranolol and Citalopram benefits, side effects and some special considerations when using them separately or combined. 

Propranolol and Citalopram

Using propranolol and citalopram together may increase the effects of propranolol.

It is important to contact your doctor if you experience uneven heartbeats, shortness of breath, bluish-colored fingernails, if you feel dizzy or about to faint.

Also, do not attempt to stop the medication suddenly, talk to your doctor first. 

A combination of Propranolol and Sertraline will produce the same effects as Propranolol and Citalopram.

Propranolol and Citalopram (A brief guide)

According to the website rxlist.com, citalopram oral brand names include:

  • Celexa Oral

Propranolol oral brand names and other generic formulas include:

  • Betachron Oral
  • Hemangeol Oral
  • Inderal LA Oral
  • Inderal XL Oral
  • InnoPran XL Oral
  • Lorol Oral
  • Procard Oral
  • Pronol Oral

What is Propranolol?

Propranolol is a beta-blocker used to treat high blood pressure, irregular rhythms, pheochromocytoma (tumor on a small gland near the kidneys), certain types of tremors, and hypertrophic subaortic stenosis (a heart muscle disease).

It is also used to prevent angina (chest pain), migraine headaches, and to improve survival after a heart attack (medlineplus.gov).

Propranolol and Citalopram (A brief guide)

In addition, it is known that beta-blockers work by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.

When high blood pressure is left untreated, it can cause damage to the brain and other organs such as the heart, blood vessels, kidneys and other parts of the body.

Which in term can cause heart diseases, heart attacks, heart failure, strokes, kidney failure, loss of vision and other medical problems? 

What is Citalopram?

Citalopram is a Selective Serotonin Reuptake Inhibitor or (SSRI), which is considered an antidepressant medication commonly prescribed to treat people with major depressive disorder, anxiety and obsessive-compulsive disorder.

In the United Kingdom is more commonly known by its brand name Cipramil and it is manufactured by the pharmaceutical company Lundbeck. 

There is a variation of Citalopram called Escitalopram known by its brand name Cipralex, also made by Lundbeck.

It is commonly prescribed to treat major depressive episodes, panic disorder with or without agoraphobia, anxiety disorders, and obsessive-compulsive disorder.

Safety advise from the NHS

“The safety advice for citalopram and escitalopram was issued to healthcare professionals by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA). Included in the safety warning were updated recommendations about new maximum daily dose restrictions, as well as warnings and contraindications (which indicate when it is not advisable to prescribe the drug).”

The European Medicines Agency or EMA, through randomized controlled trial (RCT), found that citalopram and escitalopram were associated with increased electrical abnormalities of the heart or known also as QT interval prolongation, and these abnormalities increased if the dose was increased. 

The risk of QT interval prolongation has been known for some time and they were included in the product information of both drugs. 

The new recommended daily doses for Citalopram are:

  • 40 mg a day for adults, where it was previously 60 mg
  • 20 mg a day for patients older than 65 years, where previously was 40 mg
  • 20 mg a day for people with poor liver function, where previously was 30 mg

Beta-blockers vs SSRIs

Propranolol is considered a beta-blocker, while Citalopram is classed as a Selective Serotonin Reuptake Inhibitor (SSRI).

Beta-blockers are usually prescribed to treat high blood pressure and congestive heart failure, to prevent kidney failure in patients with high blood pressure or diabetes, to reduce the risk of stroke, abnormal heart rhythms, chest pain (angina), tremors, pheochromocytoma, hypertrophic subaortic stenosis, and to prevent migraines (Medicinenet.com). 

Propranolol and Citalopram (A brief guide)

On the other hand, SSRIs are considered a type of antidepressant used to treat depression. 

What they do have in common is that some beta-blockers and some SSRIs may be used to treat anxiety disorders.

In addition, a shared side effect would be insomnia and common side effects of beta-blockers that differ from SSRIs can include:

  • Cold hands and feet
  • Tiredness or depression
  • Slow heartbeat
  • Symptoms of asthma
  • Impotence

On the other hand, some of the common side effects of SSRIs that differ from beta-blockers include:

  • Headaches
  • Nausea
  • Vomiting
  • Diarrhea
  • Restlessness
  • Agitation
  • Sexual dysfunction
  • Weight gain or loss

The main question is, what are beta-blockers and what are SSRIs? Beta-blockers are also known as beta-adrenergic blocking agents that block norepinephrine and epinephrine (adrenaline) from binding to beta receptors or nerves.

These hormones we just mentioned, are the ones responsible for causing the symptoms related to anxiety and by blocking them, the manifestation is reduced as well as controlling some of the physical symptoms. 

In contrast, SSRIs work by increasing the amount of neurotransmitter serotonin in the brain, which can impact your mood positively.

What are the side effects of beta-blockers and SSRIs?

Every drug comes with risks of having side effects and every person reacts differently to them.

Some manifest some or all the side effects, some others don’t, it tends to vary. 

Beta-Blockers

Beta-blockers may cause:

  • Diarrhea
  • Stomach cramps
  • Nausea
  • Vomiting

Other important side effects include:

  • Rash
  • Blurred vision
  • Disorientation
  • Insomnia
  • Hair loss
  • Weakness
  • Muscle cramps
  • Fatigue

As another benefit of the treatment, they can slow heart rate and reduce blood pressure which can eventually cause heart failure or heart block in people with heart problems.  

Propranolol and Citalopram (A brief guide)

Beta-blocker medication should not be stopped suddenly, because the withdrawal can worsen chest pain or angina and cause heart attacks, serious abnormal heart rhythms, or even sudden death.

In addition, Central nervous system effects of beta-blockers include:

  • Headache
  • Depression
  • Confusion
  • Dizziness
  • Nightmares
  • Hallucinations

It is important to consider that Beta-blockers that block β2 receptors may cause shortness of breath in asthmatics.

And as with other drugs used for treating high blood pressure, sexual dysfunction may occur.

Beta-blockers may cause low or high blood glucose and mask the symptoms of low blood glucose (hypoglycemia) in people with diabetes.

Other serious side effects of beta-blockers include:

  • Toxic epidermal necrolysis
  • Raynaud’s phenomenon
  • Lupus erythematosus
  • Bronchospasm
  • Serious allergic reactions
  • Erythema multiform
  • Steven Johnson Syndrome
  • Toxic epidermal necrolysis

SSRIs

SSRIs can cause headaches and dose-related nausea, vomiting, and diarrhea that improve with continued treatment.

Insomnia, restlessness, agitation: Insomnia, restlessness, and agitation-which decrease over time-also are associated with SSRIs.

Insomnia can be treated with low dose (50-100 mg) trazodone (Desyrel) at bedtime and agitation may be managed by reducing the SSRI dose or treating with anti-anxiety drugs.

In addition, SSRIs have also been associated with sexual dysfunction. Symptoms of sexual dysfunction in men may be treated with sildenafil (Viagra), yohimbine (Pausinystalia Yohimbe), amantadine (Symmetrel), cyproheptadine, or neostigmine (Prostigmin).

Also, weight loss or weight gain has been associated with SSRIs in short and long term treatment.

Patients may experience weight loss initially but quickly regain the weight.

Katy’s story on taking sertraline and propranolol for anxiety

Katy’s GP diagnosed her with panic disorder and recommended to start on a low dosage of propranolol.

She was suffering from regular panic attacks and extreme anxiety. This is what she thinks about her experience after taking both medicines. 

One of her main symptoms was heart palpitations so she stated: “The benefits of propranolol are that it stops heart palpitations, and the 10mg doses can be taken whenever you need them.” This seems to be backed up by science with Jones and Tackett (1988)  when they studied central monoaminergic mechanisms that are believed to be involved in cardiovascular regulation. 

Specifically, this study was designed to evaluate the involvement of central serotoninergic pathways (regulation of blood pressure) in the antihypertensive action of propranolol.

They found a decreased serotonin turnover and a significant reduction in mean arterial pressure and heart rate.  

In contrast, there are some side effects and she thinks through her experience that “The negatives of taking propranolol are that you can build up a resistance to it, making it gradually less effective, and when you first start taking them you can feel really sick. I have not found them effective for reducing the psychological effects of anxiety and depression, so I am also taking sertraline alongside it for this side of things.”

She adds how, “Changing medication can be scary, especially when you don’t know what the consequences will be. When I started taking sertraline along with the propranolol, I became very tired and my mood became slightly erratic.”

It is important to ask your doctor as many questions as possible to understand and weigh the benefits and side effects of the medication, especially when you are taking more than one drug at a time. 

Why is this blog about propranolol and citalopram important?

Here we discussed the possible drug interaction when taking propranolol and citalopram together.

However, it is not recommended to stop the medication suddenly, always consult with your doctor before you cease the intake.

Additionally, any symptoms should also be reported to your physician.

Also, we understand what propranolol does as a beta-blocker and citalopram as an SSRI, plus their differences and some of the most common side effects.

For any other related questions about taking propranolol and citalopram talk to your doctor.

Please feel free to comment in the comments section below!

Frequently Asked Questions (FAQs) about propranolol and citalopram

How do I stop taking citalopram 10mg?

It is not recommended to stop abruptly Citalopram 10 mg or any other dose you have been prescribed, your doctor should give you the instructions on how to gradually stop the treatment to avoid withdrawal symptoms.

Can you drink alcohol while taking citalopram?

You can drink alcohol while taking citalopram but in moderation.

You may feel how alcohol makes you feel more sleepy or you can probably lose your concentration or focus.

It is recommended to stop drinking alcohol until you see how the medicine affects you.

How quickly does propranolol work for anxiety?

Propanolol takes 30-60 minutes for the effects to become noticeable.

People who take it for performance anxiety use this medication about one hour before the stressful event. 

Does citalopram make you gain weight?

Citalopram can cause you to gain or to lose weight.

Celexa (brand name) has been associated with a slight weight gain but it is thought that the drug itself is not responsible for weight gain.

Instead, it has been linked to an improved appetite from taking the drug. 

Recommended reading

  • Propranolol Hydrochloride; A Clear and Concise Reference
  • Propranolol: Webster’s Timeline History, 1924 – 2007
  • The Pill That Steals Lives – One Woman’s Terrifying Journey to Discover the Truth About Antidepressants
  • Citalopram Hydrobromide; A Clear and Concise Reference 
  • Citalopram 598 Questions to Ask that Matter to You

Propranolol and Citalopram (A brief guide)

Juanita Agboola

Juanita Agboola is the editor in chief of HFNE and an expert in mental health online. She has been writing about online behavior, mental health and psychology issues since 2012. All Guides are reviewed by our editorial team which constitutes various clinical psychologists, PhD and PsyD colleagues.