Risk of Ventricular Arrhythmia with Citalopram and Escitalopram: A Population-Based Study
Elena Qirjazi1, Eric McArthur2, Danielle M Nash2
1Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
Insights
Citalopram use in older adults was linked to a small but significant increase in ventricular arrhythmia risk. Escitalopram did not show this increased risk, though both drugs were associated with higher mortality.
Area of Science:
- Pharmacology
- Cardiology
- Geriatrics
Background:
- The cardiac safety of selective serotonin reuptake inhibitors (SSRIs), specifically citalopram and escitalopram, remains a subject of debate.
- Previous research has yielded conflicting results regarding their association with ventricular arrhythmia.
Purpose of the Study:
- To investigate the association between citalopram and escitalopram use and the risk of ventricular arrhythmia in older adults.
- To compare these risks against commonly prescribed referent antidepressants, sertraline and paroxetine.
Main Methods:
- A population-based retrospective cohort study was conducted in Ontario, Canada, from 2002 to 2012.
- Older adults newly prescribed citalopram, escitalopram, sertraline, or paroxetine were included. Propensity score weighting was used to balance baseline characteristics.
- The primary outcome was hospital admission for ventricular arrhythmia within 90 days of new prescription. All-cause mortality was a secondary outcome.
Main Results:
- Citalopram was associated with a statistically significant increase in the risk of ventricular arrhythmia compared to referent antidepressants (RR 1.53, 95% CI 1.03-2.29).
- Escitalopram was not significantly associated with an increased risk of ventricular arrhythmia compared to referent antidepressants (RR 0.84, 95% CI 0.42-1.68).
- Both citalopram and escitalopram were associated with a higher risk of all-cause mortality within 90 days compared to referent antidepressants.
Conclusions:
- Initiation of citalopram in older adults is associated with a small but statistically significant increase in the 90-day risk of ventricular arrhythmia.
- Escitalopram did not demonstrate an increased risk of ventricular arrhythmia in this population.
- Both citalopram and escitalopram showed a higher risk of mortality, underscoring the need for careful patient selection and monitoring.
Background:
The risk of ventricular arrhythmia with citalopram and escitalopram is controversial. In this study we investigated the association between these two drugs and the risk of ventricular arrhythmia.
Methods:
We conducted a population-based retrospective cohort study of older adults (mean age 76 years) from 2002 to 2012 in Ontario, Canada, newly prescribed citalopram (n = 137 701) or escitalopram (n = 38 436), compared to those prescribed referent antidepressants sertraline or paroxetine (n = 96 620). After inverse probability of treatment weighting using a propensity score, the baseline characteristics of the comparison groups were similar. The primary outcome was a hospital encounter with ventricular arrhythmia within 90 days of a new prescription, assessed using hospital diagnostic codes. The secondary outcome was all-cause mortality within 90 days.
Results:
Citalopram was associated with a higher risk of a hospital encounter with ventricular arrhythmia compared with referent antidepressants (0.06% vs. 0.04%, relative risk [RR] 1.53, 95% confidence intervals [CI]1.03 to 2.29), and a higher risk of mortality (3.49% vs. 3.12%, RR 1.12, 95% CI 1.06 to 1.18). Escitalopram was not associated with a higher risk of ventricular arrhythmia compared with the referent antidepressants (0.03% vs. 0.04%, RR 0.84, 95% CI 0.42 to 1.68), but was associated with a higher risk of mortality (2.86% vs. 2.63%, RR 1.09, 95% CI 1.01 to 1.18).
Conclusion:
Among older adults, initiation of citalopram compared to two referent antidepressants was associated with a small but statistically significant increase in the 90-day risk of a hospital encounter for ventricular arrhythmia.
