Citalopram hydrobromide (Celexa) is an serotonin reuptake inhibitor (SSRI) that can cause prolongation of the QT interval. In order to avoid complications the drug should be avoided in some patients and be prescribed at a reduced dose in others.
Contraindications to taking citalopram:
(1) therapy with another drug that prolongs the QT interval
(2) congenital long QT syndrome
(3) QT interval above the upper limit of normal
(4) bradycardia
(5) hypokalemia
(6) hypomagnesemia
(7) history of recent acute myocardial infarction
(8) decompensated heart failure
Risk factors for prolongation of the QT interval while on citalopram:
(1) age > 60 years
(2) hepatic dysfunction
(3) poor CYP2C19 metabolizer
(4) therapy with a drug that inhibits CYP2C19 (cimetidine, other)
Number of Risk Factors
Maximum Daily Dose
none
40 mg
1 or more
20 mg
where:
• A patient with 3 or 4 risk factors should be considered for an alternative drug with less risk.
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