August 24, 2011 — The antidepressant citalopram (Celexa, Forest Laboratories)
should not be used in doses higher than 40 mg per day because of concerns that
it can cause potentially fatal changes in heart rhythm, the US Food and Drug
Administration warns.
An alert issued to healthcare professionals and patients
cautions that the drug has been linked to prolonged QT interval in a
dose-dependent manner. Patients at particular risk for developing the condition
include those with underlying heart disease and individuals who are predisposed
to low levels of potassium and magnesium in the blood.
"Citalopram should not be used in patients with
congenital long QT syndrome. Patients with congestive heart failure,
bradyarrhythmias, or predisposition to hypokalemia or hypomagnesemia because of
concomitant illness or drugs, are at higher risk of developing Torsade de
Pointes, a rare type of ventricular tachycardia," the alert states.
According to the alert, research has shown that doses of
citalopram of greater than 40 mg/day confer no additional benefit on depression
outcomes. However, the citalopram drug label previously stated that certain
patients may require a dose of 60 mg per day.
The drug label has since been revised to include the new
drug dosage and usage recommendations, as well as information about the
potential for QT interval prolongation and Torsade de Pointes.
Adverse events or quality concerns related to the affected
products should be reported to MedWatch by telephone at 1-800-332-1088, by fax
at 1-800-332-1078, online at https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm,
or by mail to MedWatch, 5600 Fishers Lane, Rockville, Maryland 20857.
Authors and
DisclosuresJournalistCaroline CasselsA veteran health and medical journalist,
Caroline is the News Editor for Medscape Psychiatry. During her career she has
edited and written for publications aimed at both physician and consumer
audiences. She helped launch, and was the Editor of Health Digest, a national,
award-winning Canadian consumer health publication. She was also National
Editor of the Heart & Stroke Foundation of Canada`s Web site before joining
Medscape Medical News in 2005. She is the recipient of the 2008 American
Academy of Neurology Journalism Fellowship Award and the 2010 National Press
Foundation Alzheimer`s Disease Fellowship.
