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. 2016 Jun 29;6(4):165-170.
doi: 10.9740/mhc.2016.07.165. eCollection 2016 Jul.

Evaluation of QTc prolongation and dosage effect with citalopram

Justine McClelland  1 , Monica Mathys  2
Affiliations

Evaluation of QTc prolongation and dosage effect with citalopram

Justine McClelland et al. Ment Health Clin. .

Abstract

Introduction: Recently, controversy has surrounded a 2011 Food and Drug Administration warning against using citalopram at doses >40 mg/day due to QTc prolonging effects.

Methods: Patients ≥18 years old at the VA North Texas Health Care System were included in this retrospective review if they had received at least 1 prescription for a 30-day supply of citalopram between January 1, 2007, and February 29, 2012, and had a baseline electrocardiogram (ECG) within 1 year before initiation or dose increase of citalopram and at least 1 repeat ECG within 3 months after citalopram initiation or dose increase. The primary endpoint was the prevalence of QTc prolongation (QTc interval ≥470 ms for men and ≥480 ms for women) after initiation or a dose increase of citalopram. For secondary objectives, Fisher exact tests were used determine if there was a dose-dependent difference in prevalence of QTc prolongation among the whole study sample and among the subgroup of patients ≥60 years old.

Results: Among the entire study sample, QTc prolongation was identified in 12 patients (16.4%) after initiation or a dose increase of citalopram. In the subgroup of patients ≥60 years old, QTc prolongation was identified in 7 patients (21.9%). Prevalence of QTc prolongation increased with dose in the entire study population (P = .016) and in patients ≥60 years (not significant).

Discussion: This retrospective study suggests that citalopram produces a dose-dependent increase in QTc interval.

Keywords: QT interval; QTc prolongation; SSRI; antidepressant; citalopram; elderly; ventricular arrhythmia.

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Conflict of interest statement

Disclosures: The authors have no disclosures of interest.

Figures

FIGURE:
FIGURE:
Reasons for citalopram discontinuation; Rx = prescription; f/u = follow-up
See this image and copyright information in PMC

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