Towards limiting QT interval prolongation and arrhythmia risk in citalopram use

Zhang, Y.H.; Baranchuk, Adrián; Hancox, Jules C.

doi:10.5603/cj.2014.0076

Cited by 5 publications

(5 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…41 CIT, S-CIT, and R-CIT block hERG potassium channels, and at higher clinical concentrations, this can result in delayed ventricular repolarization. 18,19,42 However, in this study, no significant relationships were found between plasma concentrations of the CIT enantiomers and QTc intervals after treatment with 40-60 mg/d CIT.…”

Section: Discussioncontrasting

confidence: 75%

See 1 more Smart Citation

Plasma Concentrations and Cardiovascular Effects of Citalopram Enantiomers After Oral Versus Infusion Citalopram Therapy in Dextromethorphan-Mephenytoin-Phenotyped Patients With Major Depression

Baumann

Bertschy

Ramseier³

et al. 2021

Therapeutic Drug Monitoring

View full text Add to dashboard Cite

Background: Authors compared plasma concentrations of citalopram (CIT) enantiomers and their metabolites in patients with depression administered either intravenously (IV) or as oral racemic CIT. Then, plasma concentrations were related to the metabolism of probes used for phenotyping patients with depression for CYP2C19 and CYP2D6 activity and cardiovascular functions.Methods: Dextromethorphan-mephenytoin-phenotyped patients with depression were administered racemic CIT (days 1 and 2: 20 mg/d; days 3-10: 40 mg/d) either orally or as a slow-drop infusion for 10 days and were then orally administered the drug for another 32 days. Blood probes were collected at the time of minimal and maximal concentrations on day 10, immediately before and 2 hours after drug administration, and on days 21 and 42. Plasma CIT and its metabolites were assayed by stereoselective high-performance liquid chromatography. Results:The following concentrations (ng/mL) were noted in the group receiving active IV infusion (IV-POS group, n = 27) of racemic CIT on day 10, before drug administration: escitalopram (S-

show abstract

Section: Discussioncontrasting

confidence: 75%

“…CIT, S-CIT, R-CIT, and DCIT have been shown to inhibit the hERG potassium channels to a similar extent. 18,19 In our previous study, 3 the administration of either form of CIT resulted in bradycardia, with no significant differences between groups, even with regard to QTc.…”

mentioning

confidence: 80%

Plasma Concentrations and Cardiovascular Effects of Citalopram Enantiomers After Oral Versus Infusion Citalopram Therapy in Dextromethorphan-Mephenytoin-Phenotyped Patients With Major Depression

Baumann

Bertschy

Ramseier³

et al. 2021

Therapeutic Drug Monitoring

View full text Add to dashboard Cite

show abstract

“…Experimental data suggests that the effect of escitalopram on the QT interval is about half of that of citalopram for therapeuticallyrelevant doses. 85,86 Therefore, in patients with additional risk factors, escitalopram should be favoured over citalopram to reduce the proarrhythmic risk.…”

Section: Antipsychotic and Antidepressant Drugsmentioning

confidence: 99%

Drug-induced proarrhythmia: risk factors and electrophysiological mechanisms

2015

View full text Add to dashboard Cite

Drug-induced ventricular tachyarrhythmias can be caused by cardiovascular drugs, noncardiovascular drugs, and even nonprescription agents. They can result in arrhythmic emergencies and sudden cardiac death. If a new arrhythmia or aggravation of an existing arrhythmia develops during therapy with a drug at a concentration usually considered not to be toxic, the situation can be defined as proarrhythmia. Various cardiovascular and noncardiovascular drugs can increase the occurrence of polymorphic ventricular tachycardia of the 'torsade de pointes' type. Antiarrhythmic drugs, antimicrobial agents, and antipsychotic and antidepressant drugs are the most important groups. Age, female sex, and structural heart disease are important risk factors for the occurrence of torsade de pointes. Genetic predisposition and individual pharmacodynamic and pharmacokinetic sensitivity also have important roles in the generation of arrhythmias. An increase in spatial or temporal dispersion of repolarization and a triangular action-potential configuration have been identified as crucial predictors of proarrhythmia in experimental models. These studies emphasized that sole consideration of the QT interval is not sufficient to assess the proarrhythmic risk. In this Review, we focus on important triggers of proarrhythmia and the underlying electrophysiological mechanisms that can enhance or prevent the development of torsade de pointes.

show abstract

“…Citalopram, escitalopram, and sertraline are the most frequently initiated SSRIs in Denmark 3 . However, the use of citalopram and escitalopram has been linked to prolongation of the QT interval 4–7 . A prolonged QT interval is caused by irregularities in the heart’s electrical conduction, either congenital or acquired.…”

Section: Introductionmentioning

confidence: 99%

“… 3 However, the use of citalopram and escitalopram has been linked to prolongation of the QT interval. 4 , 5 , 6 , 7 A prolonged QT interval is caused by irregularities in the heart’s electrical conduction, either congenital or acquired. Prolonged QT increases the risk of serious arrhythmia, including Torsade des Pointes, ventricular tachycardia, and ventricular fibrillation.…”

Section: Introductionmentioning

confidence: 99%

Serious arrhythmia in initiators of citalopram, escitalopram, and other selective serotonin reuptake inhibitors: A population‐based cohort study in older adults

Aakjær

Werther

Bruin

et al. 2022

Clinical Translational Sci

View full text Add to dashboard Cite

The selective serotonin reuptake inhibitors (SSRIs) citalopram and escitalopram are associated with QT prolongation, which increases the risk of serious arrhythmia. Consequently, regulatory agencies issued safety warnings in 2011. This study aimed to investigate the risk of serious arrhythmia following initiation of citalopram or escitalopram compared to other SSRIs and the risk in the periods before and after the warnings were issued. We conducted a series of nationwide cohort studies emulating a target trial using Danish healthcare register data from January 1, 2002, to December 31, 2016. We included patients (aged ≥65 years) who filled an SSRI prescription with a 1‐year washout period before the index date. The outcome was an event of serious arrhythmia. Individuals were followed for a maximum of 6 months using an intention‐to‐treat approach. Log‐binomial regression analyses were performed, estimating risk ratios (RRs) and 95% confidence intervals (CIs) adjusting for age and sex, comorbidities, and comedications with propensity scores. Dose–response effects were not investigated because dosage instructions were not available. We included 167,366 (146,014 individuals), 40,113 (37,069 individuals), and 50,281 (44,754 individuals) person‐trials of citalopram, escitalopram, and other SSRIs, respectively. In total, there were 228 events of serious arrhythmia. No difference in risk was observed in the entire study period for either citalopram (0.87 [0.62–1.22]) or escitalopram (0.85 [0.53–1.40]). We identified lower point estimates after the safety warning, RR 0.54 (95% CI 0.31–0.93) for citalopram and 0.58 (0.20–1.63) for escitalopram. Initiation of citalopram and escitalopram was not associated with an increased risk of serious arrhythmia. However, lower point estimates were observed after the safety warning.

show abstract

Towards limiting QT interval prolongation and arrhythmia risk in citalopram use

Cited by 5 publications

References 27 publications

Plasma Concentrations and Cardiovascular Effects of Citalopram Enantiomers After Oral Versus Infusion Citalopram Therapy in Dextromethorphan-Mephenytoin-Phenotyped Patients With Major Depression

Plasma Concentrations and Cardiovascular Effects of Citalopram Enantiomers After Oral Versus Infusion Citalopram Therapy in Dextromethorphan-Mephenytoin-Phenotyped Patients With Major Depression

Drug-induced proarrhythmia: risk factors and electrophysiological mechanisms

Serious arrhythmia in initiators of citalopram, escitalopram, and other selective serotonin reuptake inhibitors: A population‐based cohort study in older adults

Contact Info

Product

Resources

About