The effectiveness and limitations of regulatory warnings for the safe prescribing of citalopram

Drug, Healthcare and Patient Safety
Kevin J Friesen, Shawn C Bugden

Abstract

Citalopram is the most commonly prescribed antidepressant in Canada. Concerns have been raised about its cardiac safety, and a dose-dependent prolongation of the QT interval has been documented. Drug interactions involving concomitant use of other medications that prolong the QT interval or increase citalopram levels by interfering with its metabolism increase the cardiac risk. Regulatory bodies (Health Canada and the US Food and Drug Administration) issued warnings and required labeling changes in 2011/2012, suggesting maximum citalopram doses (<40 mg for those <65 years; <20 mg for those ≥65 years) and avoiding drug interactions that increase cardiac risk. The purpose of this study is to assess the impact of these warnings on citalopram prescribing practices. A quasi-experimental interrupted time series analysis was conducted using all citalopram prescribing data from the population of Manitoba, Canada from 1999 to 2014. This allowed for the examination of high-dose prescribing (above regulatory warning levels) and the number of interacting medications per citalopram prescription. There was a dramatic decline in the prescribing of high doses in both age groups, with a 64.8% decline in those <65 years and 33.6% in those ≥65 ye...Continue Reading

Citations

Feb 12, 2020·Pharmacoepidemiology and Drug Safety·Ulrike GeorgiStefanie Deckert
Jun 15, 2016·Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie·Helga Krinzinger
Sep 28, 2021·Expert Opinion on Drug Safety·Janne Kaergaard Mortensen, Grethe Andersen

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