Celexa and Abnormal Heart Rhythms

June 14, 2012

FDA is clarifying dosing recommendations and warnings for the antidepressant Celexa (citalopram hydrobromide). In August 2011, the agency issued a Drug Safety Communication stating that citalopram should no longer be used at doses greater than 40 milligrams (mg) per day because it could cause potentially dangerous abnormalities in the heart’s electrical activity. Use of citalopram is discouraged at any dose for people with certain medical conditions. However, because some patients may lack viable alternatives, the citalopram label (the package insert that comes with a prescription medicine) has been changed to describe precautions they should take when using it. The revised label also describes lower doses that should be taken by people over 60 years old.

Risk: Changes in the electrical activity of the heart—specifically, prolongation of the QT interval, a measure of the heart’s electrical activity— can lead to a risk of a potentially fatal abnormal heart rhythm called Torsades de Pointes. People at risk for developing QT prolongation include those with underlying heart conditions and those who tend to have low levels of potassium and magnesium in their blood.

Recommendations

  • Do not stop taking citalopram or change your dose without talking to your health care professional. Stopping citalopram suddenly can cause withdrawal effects.
  • If you are currently taking a citalopram dose greater than 40 mg per day, talk to your healthcare professional.
  • Seek immediate care if you experience an irregular heartbeat, shortness of breath, dizziness, or fainting while taking citalopram.
  • If you are taking citalopram, your health care professional may occasionally order an electrocardiogram (ECG, EKG) to monitor your heart rate and rhythm.
  • Your health care professional may also order tests to check levels of potassium and magnesium in your blood.
  • Read the Medication Guide for citalopram carefully and discuss any questions you have with your health care professional.
  • Health care professionals and patients are encouraged to report any side effects related to the use of these products to MedWatch.
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