Punkie's Mom asked
I'm taking Celexa 10 mcg. When picking up the RX I asked the pharmacist if I could have a glass of wine with my dinner, he said it was ok as long as I was only having 1 drink. He also said Advil was ok,(not with alcohol) take it with food. Now I'm reading the contraindications & it says avoid alcohol & NSAIDs. Who's correct?
Answer
There are a few interactions to be concerned about here, and we discuss below:
Alcohol And NSAID Use
Drinking alcohol while taking NSAIDs such as ibuprofen (Advil) can increase the risk of GI irritation and bleeding. While this would be especially problematic in chronic alcohol and/or NSAID use, even one drink could cause an increased risk for GI irritation. This is due to the fact that alcohol causes mucosal irritation in the gut lining and NSAIDs decrease platelet aggregation.
Combining the use of alcohol with ibuprofen (Advil) or other NSAIDs can increase the risk of GI irritation and bleeding even after just one drink. Ibuprofen does have a short half-life and should be completely cleared within 10-20 hours. Waiting at least 10 hours after your last dose of ibuprofen to drink alcohol may reduce the risk of experiencing GI irritation.
Alcohol With Celexa (Citalopram)
Celexa And NSAIDs
Lastly, the combined use of selective serotonin reuptake inhibitors (SSRIs) like Celexa and nonsteroidal antiinflammatory drugs (NSAIDs) like Advil may increase the risk of bleeding.
Celexa can augment the antiplatelet effects of ibuprofen. Additionally, NSAIDs impair gastric mucus protection by inhibiting prostaglandin formation.
One study found that SSRI use alone increased the risk of a GI bleed 3.6-fold. When an SSRI was combined with an NSAID, the risk was increased by more than 12.2-fold. The absolute risk of a GI with both medications is still relatively low but needs to be considered with other risk factors (e.g. alcohol use, other medications that thin the blood etc...)
Information About Alcohol
Alcohol is primarily metabolized via alcohol dehydrogenase, aldehyde dehydrogenase, cytochrome P450 (CYP2E1), and catalase. The byproducts of alcohol include acetaldehyde and acetate and contribute to many of the negative effects. Genetic variation of these enzymes causes varying degrees of alcohol metabolism—which is why everyone tolerates alcohol differently. This metabolism takes place mostly in the liver. CYP enzymes play a particularly important role in drug metabolism and drug interactions occur via the inhibition or induction of these enzymes. Alcohol does impact CYP enzymes, especially CYP2E1.
Some drugs may cause a “disulfiram-like reaction” when taken
with alcohol. This can cause flushing, nausea, vomiting, and general “hangover
effects”. These drugs inhibit aldehyde dehydrogenase which is crucial in
metabolism of alcohol. Some of these drugs include disulfiram and
chloramphenicol. Disulfiram is actually used clinically to treat alcohol
dependence since it makes drinking alcohol much less desirable. NSAIDs do not cause a disulfiram-like
reaction.
Information About Advil
NSAIDs work by inhibiting an enzyme known as cyclooxygenase (COX). There are two types of COX, known as COX-1 and COX-2. COX-2 has a more prominent in the inflammation cascade. Ibuprofen is considered non-selective and inhibits both COX-1 and COX-2. Drugs within the NSAID class differ based on the difference in selectivity, which can make a difference in the side effect profile and utility of these drugs.
All NSAIDs, including ibuprofen (Advil), can cause upset
stomach, diarrhea, heartburn, and constipation (usually in less than 10% of
patients). Also, caution is advised in patients with previous cardiac and GI
conditions which may increase risk for worsening their condition. Additionally,
caution should be taken while taking other blood thinners like warfarin,
apixaban (Eliquis), clopidogrel (Plavix), or heparin products.
Celexa Information
Celexa is a SSRI (selective serotonin reuptake inhibitor) that works by blocking the reuptake of serotonin in the brain, increasing levels of the neurotransmitters. Most SSRI drugs take at least 2 to 6 weeks to see full effects from the start of therapy.
While effective for many, they are associated with certain side effects such as weight gain, sexual dysfunction and gastrointestinal irritation.
