Letters were sent to healthcare professionals in October and December 2011 to inform of new safety information and advice in relation to citalopram and escitalopram. The new recommendations are a result of an assessment of an ECG study and review of data which indicate that both citalopram and escitalopram may cause a dose-dependent prolongation of the QT interval.
The summary of product characteristics for both product products are currently being amended and your attention is drawn to the following changes.
- Caution is advised when prescribing these medicines in patients at higher risk of developing Torsade de Pointes.
- Both drugs are now contraindicated in patients with known QT interval prolongation or congenital long QT syndrome. Co-administration with another medicinal product that can prolong the QT interval is also contraindicated.
Recommended maximum dose in adults has been lowered to 40mg
Recommended maximum dose in elderly has been lowered to 20mg
Recommended maximum dose is 20mg in reduced hepatic function
Recommended maximum dose in adults has been lowered to 20mg
Recommended maximum dose in elderly has been lowered to 10mg
Recommended maximum dose is 10mg in reduced hepatic function
Many psychotropic medicines are associated with QT prolongation including antipsychotics (especially in 'high dose') and tricyclic antidepressants. Methadone is also known to prolong the QT interval at higher doses.
GPs and consultant Psychiatrists are advised to review patients who fall into the above categories.
It would be advisable to consider obtaining a baseline ECG in pateints, who for clinical risk/benefit reasons require to continue on a higher dose or on concomitant medicines that can prolong the QT interval. Where treatment is to continue the reasons for this decision should also be documented in the patients notes.
The full advice from the MHRA can be read via these links:
Advice on choice and swapping/stopping antidepressants can found on the LJF website Chapter 4 and via these links:
LJF Appendix 4 - Antidepressants - swapping and stopping
LJF Appendix 5 - Notes on prescribing other antidepressants