Citalopram and Liver Enzymes: What You Need to Know

When working with Citalopram, a selective serotonin reuptake inhibitor (SSRI) prescribed for depression and anxiety. Also known as Celexa, it works by increasing serotonin levels in the brain, which can improve mood but also engages the liver’s metabolic pathways. One of the most talked‑about safety concerns is its effect on liver enzymes, biomarkers like ALT and AST that signal how the liver is coping with a drug. Elevated levels don’t always mean serious damage, but they are a red flag that clinicians watch closely.

How Citalopram Interacts with Hepatic Function

The liver processes SSRI, a class of drugs that share a common metabolic route through cytochrome P450 enzymes. Because citalopram is mainly broken down by CYP2C19 and CYP3A4, any factor that alters these enzymes—like other meds, alcohol, or genetic variants—can shift the balance and push liver enzymes higher. In practice, doctors follow a simple rule: citalopram liver enzymes monitoring should begin within the first few weeks of therapy and repeat if symptoms arise. If ALT or AST rise more than three times the upper limit of normal, the typical response is to lower the dose, switch to another SSRI, or pause treatment while checking for other causes such as viral hepatitis or fatty liver disease. Studies show that most enzyme elevations are mild and resolve when the drug is adjusted, but rare cases of clinically significant hepatitis have been reported, especially when citalopram is combined with strong CYP inhibitors.

Beyond the lab numbers, patients often wonder whether they’ll feel any physical signs. Common complaints include fatigue, abdominal discomfort, or a vague sense of “not right,” which can overlap with depression itself. That’s why a holistic view of hepatic function, the liver’s overall ability to detoxify and synthesize proteins is essential. Lifestyle tweaks—reducing alcohol, maintaining a balanced diet, and staying active—support liver health while on citalopram. If you’re starting therapy, ask your prescriber about a baseline liver panel and set a reminder for follow‑up testing. The next section of resources will walk you through real‑world case studies, dosage adjustments, and alternative antidepressants that pose less risk to the liver.