Citalopram and hydroxy

[Camelian]

Hi all just wanted to ask if anyone is taking hydroxy and citalopram? And if so are they best taken together or separately, morning or evening? ?

I currently take aspirin, vit D, lansoprazole and have recently been prescribed bisoprolol for an eptopic heart beat and potential high BP. I saw my heomotologist recently and in light of a potential underlying heart issue causing the ectopic heart beat, for which I'm awaiting an echocardiogram, and potential high BP, although I seem to only read high systolic BP and this is only at the GP surgery all my home readings have been ok??, The heomotologist suggested I start hydroxyurea because of the potential increased risks and as I'm almost 59 and will be starting at 60 anyway. I have ET jak2+ and in addition to the above my platelets have increased since my last review 3 months ago from 470 to 530.

I'm very scared of starting the hydroxy in spite of reading on this site that people have fared ok. It was decided with the heamotologist that I will wait to find out the results of the echocardiogram before starting the hydroxy as if there's no underlying heart problem maybe stick to the original plan of starting hydroxy at 60??

I feel the ectopic heartbeat maybe a result of current high stress and anxiety levels hence why I'm considering, taking citalopram-with the consent of the GP and heamotologist.

I have read the contraindications and had discussions with the gp and heamotologist and their both happy for me to take citalopram.

[Applesnpears]

Given that you are taking several different medications it might be worth arranging for a meeting with your pharmacist to review how best to take your different medications, including hydroxy. Pharmacists have a better understanding of potential interactions than most GPs.

Dont dismiss the high blood pressure readings. Having ET increases your risk of clotting and strokes so managing your BP becomes even more important.

[Camelian in reply to Applesnpears]

Thanks Applesnpears that's a good idea.

With regards the BP you're absolutely right and i definitely wouldn't dismiss high BP and agree it is even more important to manage BP with ET my point was I may not have high BP as it was only high at the surgery? the 3 weeks of monitoring I've done at home were all more or less within normal ranges so I was thinking maybe I have white coat syndrome? anyway the GP decided to go on the home readings and hasn't started me on any BP lowering medication other than the low dose bisoprolol.

It's the eptopic heartbeat I thought may be related to high stress and anxiety but thankfully I'm having an echocardiogram soon so hopefully I'll find out and fingers crossed 🤞there isn't an underlying problem with my heart and my symptoms are related to high stress.

Thanks for your reply

[Applesnpears in reply to Camelian]

My father had problems with heart rhythm while he was on citalopram. It is a well known side effect ( check the patient leaflet) Dad was on the point of having a pacemaker fitted but the problem went away when the citalopram was stopped.

Don't stop the citalopram on your own but ask your doctor if it might be a factor for you.

[Camelian in reply to Applesnpears]

It's funny you should say that because I was on citalopram for many years initially to help with symptoms related to menopause but it also helped with anxiety which also started around the menopause. I gradually reduced and then stopped citalopram a couple of months ago a decision I made in anticipation of starting hydroxy with a view to reducing the amount of meds I'll be taking in the future. I also did wonder if the citalopram might be having any impact on my heart because I've read bits and pieces over the years. I haven't restarted citalopram yet because I am trying to eliminate potential causes for this ectopic heart beat and I thought I'd wait till after the echocardiogram. The reason I've thought of restarting citalopram is I'm under a lot of stress at the moment and feeling quite anxious obviously health problems are a big part of my anxiety at the moment.

If the echocardiogram finds no problems I think I'll do a little more research before restarting citalopram because if the truth be known I am apprehensive about re starting citalopram.

As a matter of interest how long after stopping citalopram did your dad stop having heart rythym problems?

Thanks again Applesnpears for replying.

[Applesnpears in reply to Camelian]

I don't know precisely as he was taken off the citalopram while in hospital and without my knowledge but it can't have been more than 4 weeks. Dad had a heart trace while on citalopram. This triggered two separate actions, one to stop the citalopram, the other a decision to install a pacemaker. Fortunately the another trace was done before the pacemaker had been installed and the abnormality had gone.

[Camelian in reply to Applesnpears]

Thanks Applesnpears that's interesting and it certainly makes you think🤔

Like I said my plan is to wait and see what the outcome of the echo is and if all is well I think I'll look at alternative therapies to try and manage the stress and anxiety as oppose to anti depressants.

Thanks for your reply.

[Hidden]

Hi Camelian I also had to have a echo because of palpitations, I ended up in ED twice. My heart echo was performed and my heart was fine. These episodes was all put down to stress and anxiety. I was not depressed so I found Citalopram did not stop ectopic beats. The best drug is metoprolol, you can start on a low dose like 23.5mg then up it if no relief. I was not good on this med so the Drs put me on Diltazen. Worked a dream. I was certainly stressed at that time. I dont need that medication anymore. But I do still get the odd bout of ectopic beats., generally when I am tired and overwork my brain!!! Try and rid yourself of stress. I know easy said than done. Your platelets are still reasonably low so dont worry about them to much at present. I know in the UK they tend to like their patients on HU. Its 65 here in NZ. I am 68 and havent started it yet!! Haha. Sort out your heart first. I am sure your BP is fine. White coat syndrome is very common. Lyn x

[Camelian in reply to Hidden]

Thanks for your reply Lyn thats very reassuring. I am 90% sure the ectopic heart beats are due to stress and anxiety as I've noticed they get worse when I'm in a stressful situation but I'll keep an open mind and pray the echo doesn't. Identify anything sinister.

The GP has prescribed bisoprolol to try and address the ectopic heartbeat and it has been effective in reducing them but it hasn't stopped them completely. To be honest if I knew they weren't dangerous I think I could put up with the sensations.

Your right about addressing the stress and i definitely am going to try and reduce the stress in my life but most of the time it's me that causes the stress because I'm an overthinker and worry about everything ☹️ I envy people who just take things in their stride how lovely that would be.

As for the BP like I said my home readings have all been ok ish it is only when the doctor takes it that it's raised and even then it's only the systolic. The only thing that's making me think I could have experience Spike's in my BP is during a recent eye test the optician said I had tortuous blood vessels behind my eyes 🤔 she said they were only slightly tortuous and she didn't seem over concerned she just told me to mention it to my GP as it could be a sign of hypertension??

It's interesting in NZ they don't start you on hydroxy till you're 65 makes you wonder why it's different in the UK although I have read different heamotologist even in the UK have different opinions on when to start the meds. How is it if it's 65 in NZ you haven't started yet at 68? Have you made the decision to wait?

[Hidden in reply to Camelian]

Yes I have, my platelets have been stable around 600, to 700 for 5 years. I am happy to take aspirin to help prevent clotting. Definitely if they went up to million I would consider. My Haematologist said that looking after your cardiovascular health is the most important thing. I did find with stress the platelets went up to 907. Sorted that out and went back down to 601. Let me know how echo goes. Lyn x

[Camelian in reply to Hidden]

Wow that's a really brave decision I was panicking for not starting the hydroxy the other day after my heamotologist suggested it at my review last week I kept thinking have I done the right thing 🤔 but then that's me I worry about not taking it and worry about taking it??? I love to hear from people like you who who have made an informed choice about their treatment. My decision to wait was based on if the echo doesn't find a heart problem and the ectopic heartbeat is related to stress and anxiety and poses no risk then I'm not at any more risk than I was at my last review with the heomotologist and there was no mention at that review of me starting hydroxy well not until I'm 60.

I certainly will let you know the outcome of the echo Lyn how do I private message on here??

Kind regards

[krotsida in reply to Hidden]

Hi Lindiloo3.

I am new here and I dont know what ia a HU.

Can you please explain me?

[Hidden in reply to krotsida]

Hydroxyurea

[ChattyPanda]

I take both. I started Citalopram when my specialists INSISTED I stop my HRT. My hot flashes are horrible. It helps, but not sweats were still an annoying problem and interfering with sleep. Doctors did not tell me when to take the meds. I take the C. after breakfast, and HU at night before bed (bc it helps me be more consistent, and I found brushing my teeth right after taking it keeps mouth sores away. I started HU 2 months before turning 59. I’m SO GLAD I finally agreed. This past year with it has been a really good year for me!

Best of luck getting your heart issues resolved.

Btw, I agree, your platelet counts aren’t bad if you’re taking aspirin.

[Camelian in reply to ChattyPanda]

Thanks for your reply it's reasuring you've been ok on hydroxy and brushing your teeth after taking hydroxy is a good tip for when I do start taking the hydroxy I've been really anxious about the thought of mouth ulcers. With regards the citalopram i think I'm going to go down the alternative therapy route to manage stress and anxiety but I'm glad it's working for you we're all different and what works for one doesn't for another. I'm really glad you've had a good year and long may it last.

[beetle]

Hi Camelian. Whenever I am prescribed a new med or thinking of taking a supplement I run all my meds through Medscape Drug Interaction Tracker. Doctors often don’t know the interactions and even pharmacists sometimes miss things. Once I had been prescribed two drugs that the interaction checker warned “danger of death”! Needless to say I got back to my GP pretty quickly on that one! It is a very useful tool ans seems to have a vast database

[Camelian in reply to beetle]

Thank you I'll have a look at that it sounds like a good resource.

[Arty16]

Hi I was on Hydroxicarbomide than prescribed citalopram. Took both together and had a bad reaction. I developed an essential tremor. The neurologist is convinced that the citalopram was to blame. Stopped it and had to stop Hydroxicarbomide due to lowering white blood cells. Just really watch citalopram my neurologist said he would never prescribe it due to what he has seen. Hydroxicarbomide works for loads of people you need to find out which one is best for u. Deffo speak to a pharmacist for advise.

[Camelian in reply to Arty16]

Thank you Arty16 the replies I've had about citalopram have certainly given me food for thought. Like I said I have had nagging doubts about the long term use of citalopram and it's certainly concerning if the neurologist told you they wouldn't prescribe it. Hopefully I can find a more natural alternative to help with stress and anxiety. If you don't mind me asking what do you now take as an alternative to citalopram?

Kind regards

[hunter5582]

It is actually the interactions with aspirin that you may need to pay attention to. Here is the info from ePocrates.

bisoprolol(generic) + Ecotrin Low Strength(aspirin)

Monitor/Modify Tx

bisoprolol +aspirin

caution advised, monitor BP, especially w/ high dose aspirin or salicylates:combo may decr. antihypertensive efficacy (antagonistic effects; salicylate-induced inhibition of renal prostaglandins, sodium and fluid retention)

citalopram(generic) + Ecotrin Low Strength(aspirin)

Monitor/Modify Tx

citalopram +aspirin

monitor bleeding s/sx:combo may incr. risk of GI or other bleeding, incl. life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

Checking with your doc and pharmacist would be a good idea for clarification of these issues. As Applesnpears indicated, the citalopram may alter heart rhythm. Wellbutrin did that to me. May not be an issue for you, but a good thing to stay aware of.

Hydroxyurea did not flag with interactions with any of the other meds. I doubt it matters how you time the meds together, but

best to check with your pharmacist/doc.

[Camelian in reply to hunter5582]

Thanks hunter thats quite worrying really isn't it? And as I said before the risks should be discussed prior to the meds being prescribed. I know we can go away and research ourselves but that's not the point and most people just put their trust in the doctor and assume it's completely safe or the GP wouldn't of prescribed the medication.

[hunter5582 in reply to Camelian]

I learned the hard way the assertive patients receive higher quality care. Passive patients do not. You do have to always ask questions and advocate for yourself. It is never valid to assume that any medication is completely safe. If something is biologically active enough to help you, it can also hurt you. That applies to supplements too. Fish oil + aspirin is contraindicated because they can be too blood thinning when taken together. I used to work with docs who told me that they simply cannot remember all of the interactions between meds because there are just too many meds these days.

Having said that, we always have to weight the risks vs the benefits of any treatment we use. Likewise, the risks vs benefits of not treating something. It is rarely a black and white kind of issue. It does really help when the prescribers actually share all of the information we need to make good decisions. That way we can make informed choices guided by facts rather than fear and supposition.

All the best.

[Camelian in reply to hunter5582]

Thanks Hunter I'm learning very quickly that it's important to be your own advocate and become assertive with regards treatment for whatever condition you have.

The post from jointpain got me thinking about being prescribed lansoprazole and on researching I see its long term use is being linked to an increased risk of stomach cancer😵 and the risk is even higher if you've been treated in the past for Helicobacta pylori which I have☹️. I was prescribed lansoprazole for a long time but only took it as and when required. When I saw my GP recently he suggested because I am now taking aspirin daily and bisoprolol and was thinking of restarting citalopram I should start taking lansoprazole daily to protect my stomach ? He did say take 15mg daily not 30mg as I was previously prescribed. On his advice I have been taking the lansoprazole daily now for a few weeks but I've now decided I'm not going to take the citalopram so I was thinking of stopping the lansoprazole because on reflection I've been taking aspirin for a couple of years since being diagnosed with ET without taking lansoprazole so why start now?

Hunter do you know if it's necessary to take lansoprazole if you're taking aspirin and bisoprolol? Because if it's not necessary I'd rather stop taking it??

If I wasn't stressed and anxious before I certainly will be now with all the worry about taking these meds.

I currently take, low dose aspirin for ET, bisoprolol for ectopic heartbeat and vit D. Ive also been taking lansoprazole for a few weeks to reduce the risks to my stomach???

Any advice would be grateful.

[hunter5582 in reply to Camelian]

It is all a matter of weighing risks and benefits. There is not a right or wrong answer to your question. Aspirin definately can be hard on your stomach. If you have a hx of GERD, ulcers, h pylori, etc. Then aspirin would be a concern re. GI irritation. Since your stomach may already be vulnerable, using a proton pump inhibitor may be in your best interest. You have to weigh the risk of ulcers etc. vs the risk of adverse effects from the lansoprazole.

I have been taking Nexium for many years due to GERD and all the damage it has done. I believe that the systemmic inflammation from the JAK2 contributes to the GERD. I know for a fact when my stomach gets inflammed, I go into reactive thrombocytosis. So I see controlling gastric inflammation as part of my strategy to control thrombocytosis. The GERD is bad enough to have created a hiatal hernia and bouts of esophagitis and gastritis. The Nexium is worth the risks to me.

It seems to me a low dose proton pump inhibitor is a reasonable thing to consider. Do bear in mind that stress also has negative impact on the stomach and increases your risk. You might want to look at all of the options as lansoprazole is not the only nor necessarily the best choice. Can't say what is best for you, but it be worth a trip to the gastroenterologist for a consult.

I hope that helps.

[Camelian in reply to hunter5582]

Thank you for your reply Hunter I think for now I will continue to take the lansoprazole with a view to discussing it further with my GP with a view to looking for an alternative. I might Evan find out how much it would cost to have a consultation with a gastroenterologist.

I went to see a herbalist today she appeared to be very knowledgeable. I informef her about the ailments I have ET, ectopic heartbeat, high systolic bp, stress and anxiety. With regards the ectopic heartbeat she thinks it's stress and anxiety related. She said I'm probably magnesium deficient as stress and anxiety affect the levels which results in palpitations and can raise systolic BP. She asked me if I experience eye twiches, which I do, she said this is also a symptom. She suggested I start taking magnesium daily? With regards ET she appreciates the need to take aspirin however she did suggest herbs do the same thing she mentioned gingko and a couple of others. I mentioned as I take aspirin I take lansoprazol to protect the stomach lining and she said bananas do a good job she wasn't an advocate of lansoprazol. What she was saying did make a lot of sense. She also told me my vitD tab won't be working and said it's vitD oil you should take for obsortion?

Anyway hunter the reason I'm mentioning this is I remember reading a post you wrote saying you see an alternative therapist, at least I think that's what you said? If this is the case what do think about using alternative therapy in addition to conventional meds ?

It's definitely a route I'd like to explore? The lady I spoke to appeared to have the relevant qualifications and runs a well established shop??

[hunter5582 in reply to Camelian]

I do see an Integrative Medicine/Functional Medicine physician. She is a traditionally trained physician, but also very knowledgeable about complimentary heath practices. This includes herbal remedies, nutrition and exposure to toxins. Since I have pursued these approaches to health in addition to more traditional Western medicine, I sought consultation to ensure that I took everything into account. I believe that if something is biologically active enough to help you, then it can also hurt you. Supplements and herbals can and do interact with the meds we take. (e.g. aspirin + fish oil is contraindicated due to potentiation-excessive blood thinning).

My own health situation is complex due to cooccurring medical conditions that include neurofibromatosis type 1. I also have significant GERD and have taken Nexium or other proton-pump inhibitor for over 20 years. I was found to be Vitamin D deficient (NF1 related), Vitamin B/Folate Deficient as well a Magnesium Deficient (likely due to the Nexium). So - I am taking Vit D, Vit B/Folate, and Magnesium supplements. The good news is that they are working and bringing my levels back where they should be. I also take a Curcumin supplement that works better than NSAIDs for inflammation-osteoarthritis. The doc recommended a resolvin called SPM Active to help with the anti-inflammatory needs. Just started a trial of glutathione to see if that will help as well. We are monitoring C-reactive protein and TF Growth Factor Beta as objective markers of inflammation. May add TNF-alpha to the list of cytokines to monitor - we will see.

That was a really long-winded version of saying that there is benefit to combining the best of Western medicine with complimentary health approaches; however, you have to be careful and look to the underlying science of anything you use.

It really does sound like you are on the right track. Please let us know what you learn as you move forward.

[jointpain]

Hi, I see you are on lansoprazole which lowers your stomach acid, did you have heart rhythm problems before taking this drug? as it is a known serious side effect. Make sure of the reasons for taking the lansoprazole before taking them long term, as they really are for short term use.

[Camelian in reply to jointpain]

Hi jointpain yes I did have the ectopic heartbeat prior to taking lansoprazole daily although I have taken lansoprazole as and when required over the years. My GP is prescribing me 10mg and told me to take them daily to protect me from a gastric bleed as I'm taking aspirin, Bisopralol and was considering restarting citalopram which also has a gastric bleed risk. I must admit I do worry about long term use as my thoughts were well I'm going to be taking aspirin for life because of ET and I think the Bisopralol is also for long term use to reduce the ectopic heartbeats I'm experiencing. I am concerned how meds are prescribed with no or little explantation about potential side effects.

[Planting]

Hi

Yes I have taken citalopram for years and have now been on hydroxy urea for nearly 3 years. My haematologist knows this and I am fine. I take 10 x 500 mg per week of HU. I wish I wasn’t on the citalopram but efforts to come off it have failed due to withdrawal effects. Hope it all works out for you

planting

.

[Camelian in reply to Planting]

Hi planting thanks for your reply. If you don't mind me asking what side effects have you experienced when trying to come off citalopram?

[Planting]

Generally feeling rubbish. Anxiety, not coping weepiness shaky depression etc . If you go on them for any length of time come off slowly under guidance from your doctor

Planting

[Camelian in reply to Planting]

Thanks for your reply planting much appreciated.

[RazB]

hi, I’m on Hydroxy and citalipram and don’t have a problem at all. I take 10mg citalipram (baby dose!) in morning and Hydroxy with food throughout the day. No probs at all. I also have an ectopic heartbeat which I had monitored over 4 days about 8 yrs ago. I was offered a drug for it but declined as I can live with it atm. Citalipram hadn’t made it worse. X