Citalopram, QTc Prolongation, and Torsades de Pointes

Area of Science:

• Pharmacology
• Cardiology
• Clinical Toxicology

Background:

• Selective serotonin reuptake inhibitors (SSRIs) like citalopram are widely prescribed for depression and anxiety disorders.
• Cardiac adverse events, including QTc prolongation and torsades de pointes, are potential risks associated with certain medications.
• Understanding the incidence and characteristics of these events with citalopram is crucial for patient safety.

Purpose of the Study:

• To systematically review and identify case reports detailing citalopram-induced QTc prolongation, torsades de pointes, or both.
• To synthesize data from identified case reports to characterize the circumstances surrounding these adverse events.

Main Methods:

• A comprehensive literature search was performed across major databases: PubMed, MEDLINE, EMBASE, Scopus, and PsycINFO.
• Case reports published in any language linking citalopram use to QTc prolongation or torsades de pointes were included.
• Additional cases were sought through bibliographic searches of relevant published articles.

Main Results:

• Eighteen case reports of citalopram use associated with QTc prolongation were identified.
• Ten of these cases also reported the occurrence of torsades de pointes.
• The majority of cases (14) involved female patients, and 7 cases resulted from citalopram overdose. Hypertension was the most frequent comorbidity.

Conclusions:

• QTc prolongation and torsades de pointes are infrequently reported adverse effects of citalopram.
• These cardiac events, while rare, represent significant potential risks associated with citalopram use.
• Clinicians should remain vigilant for these adverse effects, particularly in at-risk populations or overdose scenarios.