Caroline asked
I am currently taking 20mg of Citalapram and 20mg of Amitryptiline per day. I am thinking of taking the following supplements to help with my menopause symptoms; Calcium with Vitamin D3 for bone health and Black Cohosh for hot flushes and night sweats. Please can you tell me if it is safe to take these supplements with my prescribed medication. Many thanks!
Answer
Neither calcium with vitamin D or black cohosh directly interact with citalopram or amitriptyline and are most likely safe to take together if indicated.
Calcium With Vitamin D
Calcium With Vitamin D is a supplement taken most commonly to prevent or treat osteoporosis. Vitamin D is added to calcium because the vitamin D aids in the absorption of the calcium from the digestive tract. Calcium is a vital building block of the body and in addition to bone structure it plays an important role in both the nervous and muscular system health.
Calcium should be administered within ninety minutes after eating as food also helps aid in calcium absorption. There are a few types of foods including spinach and dairy products that actually decrease calcium absorption.
Black Cohosh
Black Cohosh is a herbal product most commonly marketed and used in treating a wide variety of menopausal symptoms. Although the exact mechanism of action is not fully understood, black cohosh does not appear to affect hormone levels in the body. Black Cohosh should be taken with a full glass of water without regard to food.
Celexa (Citalopram)
Citalopram is a selective serotonin reuptake inhibitor (SSRI). It is used most commonly for the treatment of depression and anxiety disorders. Citalopram may be taken without regard to food but is best when taken either in the morning or in the evening; whichever is better tolerated or fits better with other medication you may be taking. Common side effects of citalopram include:
- Drowsiness
- Nausea
- Dizziness
- Diarrhea
- Insomnia
Amitriptyline
Amitriptyline is a tricyclic antidepressant that is approved to treat major depressive disorder. Amitriptyline can be given with or without food. It is generally better tolerated at night as it can have severe sedating effects, a small percentage of individuals may have the opposite reaction and have problems with insomnia. In this case the dose of amitriptyline should be moved to the morning.
In addition to sedation and insomnia, taking amitriptyline may also commonly cause:
- Blurred vision
- Lethargy
- Weight gain
- Constipation
- Memory impairment.
Black Cohosh Drug Interactions
The are a variety of active compounds in black cohosh, including:
- Phytosterin
- Fukinolic acid
- Caffeic acid
- Salicylic acid
- Cimicifugic acid
As black cohosh has many different active constituents, there certainly is a chance of drug interactions.
However, there haven't been many studies that have evaluated drug interaction with black cohosh. Some preliminary studies have suggested that black cohosh can inhibit certain liver metabolizing enzymes, such as CYP2D6, but this hasn't been confirmed. There have been no published reports of black cohosh interacting with Celexa (citalopram) or amitriptyline.
At the very least, be sure to let your doctor know of all the supplements you currently take so you can be monitored appropriately.
