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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Citalopram and QT interval

The manufacturer of citalopram (Cipramil®) has written to healthcare professionals to raise awareness of a dose dependent association between this drug and prolongation of the QT interval. The letter, written in collaboration with the Medicines and Healthcare products Regulatory Agency (MHRA), contains some new recommendations.

This new information comes from electrocardiogram (ECG) studies designed to assess QT interval in adults taking citalopram or placebo as well as from spontaneous reporting of QT interval prolongation and ventricular arrhythmias. Additionally, efficacy studies have failed to show additional benefits at doses above 40mg per day.

The new recommendations are as follows:

  • The maximum dose of citalopram is now 40mg daily
  • In the elderly and in patients with reduced hepatic function the maximum dose is lowered to 20mg daily
  • Citalopram is contraindicated in patients with known QT interval prolongation or congenital long QT syndrome
  • Use of citalopram with other medicinal products known to prolong QT interval is contraindicated
  • Caution is advised in patients at higher risk of developing Torsade de Pointes

It is suggested that patients who are now on doses above those being recommended are reviewed and gradually reduced. Other selective serotonin reuptake inhibitors (SSRIs) including escitalopram (Cipralex) have also been associated with prolongation of QT interval so simply changing treatment may be unwise.

Action: Clinicians should be aware of these new recommendations. Patients who are on higher doses will need to be identified, reviewed and gradually reduced.

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3 Comments to “Citalopram and QT interval”

  1. Hi, is it good practice to do an ECG before commencing citalopram?

    Comment by ruth ambrose — August 1, 2018 #

    1. @Ruth,

      The manufacturer suggests doing an ECG if considering treatment in a patient with stable heart disease. I would think it would be wise to expand that out to include anyone with risks for prolonged QT syndrome, for example renal and hepatic impairment and increasing age. For younger patients without other obvious problems it may not be necessary.

      Comment by Matthew Robinson — August 1, 2018 #

  2. [...] recently reported safety warnings regarding a dose dependent prolongation QT interval with citalopram and escitalopram and the new requirement to assess renal function before starting [...]

    Pingback by Prescribing Advice for GPs » MeReC Extra 52 — February 17, 2012 #

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