Hi Doctor: I Wondering If There Is A Cumulative Effect

Posted on Fri, 10 May 2019

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Fri, 10 May 2019 Answered on

Last reviewed on

Question : Hi Doctor:

I wondering if there is a cumulative effect of CYP450 2C19 and other inhibitors...

I am taking omeprazole 20mg and citalopram 15mg. I have been having increased daytime sedation and confusion, and sexual side effects...so have added 100mgs modafinil. I know omeprazole and modafinil separately will increase citalopram levels, but I'm not sure if it is multiplied when both are taken together. How should I adjust my dosing?

I am also taking 25-50mgs trazodone at night.

thanks

Answered by Dr. Seikhoo Bishnoi (14 hours later)

Brief Answer:
The effect is not multiplied.

Detailed Answer:
Hello thanks for asking

I don't think the effect has multiplied the levels of Citalopram. Both are independently increasing the levels to some extent but that would not affect much in clinical response and side effects.

You are taking Trazodone too and this should help in achieving good erection too. You can skip Omeprazole for few days if there is day time sedation and Modafinil will compensate to increase alertness.

Thanks

Please let me know if there is any unclear thing.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (2 days later)

according to my DNA results, I am a slow metabolizer of both celexa and trazodone, if that matters.

two nights in row I took no trazodone, and woke with terrible fever and then freezing cold, sweating, racing uncomfortable thoughts, confusion, and shaking. Very little sleep. It seems like an intense serotirnon side effect for such a low dose of Celexa.

Answered by Dr. Seikhoo Bishnoi (11 hours later)

Brief Answer:
I don't think this will affect the levels

Detailed Answer:
Hello again

No I don't think even if you are slow metaboliser this shall affect the levels much. Minor change in levels can be seen considering that you are slow metaboliser and also you are taking the drugs which increase the levels to some extent. But the dose of Celexa you are taking that is 15 mg is not a high dose and even if the slow metaboliser status and the drugs are increasing its levels even then this is not a thing to get worried.

Remain relaxed.

The symptoms you had when you skipped the doses of Trazodone are probably due to anxiety or could be due to mild withdrawal. I don't think this was serotonin syndrome.

Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj