Although citalopram is considered to be a safe antidepressant drug, some cases of arrhythmic disorders, syncope, or intoxication leading to lethal outcomes have been described over the last few years. We report the case of citalopram-induced long QT syndrome complicated by torsade de pointes in a young woman, in whom the role for antihypertensive treatment with diuretics and intercurrent flu-like syndrome is discussed.
[Show abstract][Hide abstract] ABSTRACT: Objective:
In the light of the recent United States Food and Drug Administration (FDA) warning to clinicians on using previously approved doses of citalopram because of the purported higher risk of torsade de pointes (TdP), we pursued the broader question: are selective serotonin reuptake inhibitor (SSRI) antidepressant agents as a group unsafe because they might induce QTc interval prolongation and TdP?
We reviewed the literature and found only 15 case reports (6 of fluoxetine, 1 of sertraline and 8 of citalopram) of SSRI-associated QTc interval prolongation linking to TdP.
A total of 13 cases contained sufficient information for analysis. In the setting of TdP, QTc interval prolongation does not clearly relate to SSRI dose.
Applying conventional statistics as the FDA does may not be the best tool to study this phenomenon because SSRI-associated TdP is a very rare event and hence best understood as an 'extreme outlier'. Despite the limitations inherent in case report material, case reports on drug-associated QTc interval prolongation and TdP provide valuable information that should be considered along with other sources of information for clinical guidance.
Therapeutic Advances in Drug Safety 10/2013; 4(5):189-198. DOI:10.1177/2042098613492366
[Show abstract][Hide abstract] ABSTRACT: Selective serotonin-reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants and are generally well tolerated. Specifi cally, less cardiovascular toxicity has been reported in comparison with tricyclic antidepressants. However, an increasing number of case reports and reviews of pharmacovigilance and toxicology databases describes an association of life-threatening cardiac arrhythmias known as torsade de pointes (TdP) with the use of citalopram and fl uoxetine in therapeutic and toxic doses. In therapeutic doses, SSRI-associated Tdp concerned patients with additional risk factors such as concomitant cardiovascular disease, age over 65 years, female sex, hypokalemia and hypomagnesemia. Prolongation of the QTc interval predisposing to the occurrence of TdP has been observed with all SSRIs in supratherapeutic concentrations.
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