Gabrielle Crépeau-Gendron1, Hilary K Brown2, Carrie Shorey3, Robert Madan4, Claudia Szabuniewicz3, Samantha Koh3, Shelley Veinish5, Linda Mah6. 1. Département de psychiatrie et d'addictologie, Division de gérontopsychiatrie, Université de Montréal; Hôpital en santé mentale Albert-Prévost, Montréal, Québec, Canada. Electronic address: gabrielle.crepeau-gendron@umontreal.ca. 2. Interdisciplinary Centre for Health & Society, University of Toronto Scarborough and Dalla Lana School of Public Health, University of Toronto; Women's College Research Institute, Women's College Hospital, Canada. 3. Rotman Research Institute, Baycrest Health Sciences Centre, Canada. 4. Department of Psychiatry, Baycrest Health Sciences Centre; Department of Psychiatry, Division of Geriatric Psychiatry, University of Toronto, Canada. 5. Geriatric and Internal Medicine, Baycrest Health Sciences Centre; Department of Medicine, University of Toronto, Canada. 6. Department of Psychiatry, Baycrest Health Sciences Centre; Department of Psychiatry, Division of Geriatric Psychiatry, University of Toronto, Canada; Rotman Research Institute, Baycrest Health Sciences Centre; Department of Psychiatry, Division of Geriatric Psychiatry, University of Toronto, Canada. Electronic address: lmah@research.baycrest.org.
Abstract
BACKGROUND: Although the US Food and Drug Administration (FDA) recommended upper limits for citalopram dosing in older adults due to risk of corrected-QT (QTc) prolongation, which was adopted, and extended to escitalopram by Health Canada, the scientific basis is unclear. The objective of this study was to assess the relationship between citalopram/escitalopram dosages and QTc interval in a real-world geriatric setting. METHODS: We reviewed electronic health records at a university-affiliated geriatric health care center, over a 7-year period, to identify patients prescribed citalopram and escitalopram, who had an ECG within 90 days of initiation or dosage change. Linear regression analyses were conducted to assess the relationship between antidepressant dosage and QTc interval. RESULTS: 137 patients were identified (citalopram=97, escitalopram=40). No association was found between citalopram, escitalopram and QTc, in unadjusted or adjusted analyses. Among covariates, older age was significantly associated with QTc prolongation in the escitalopram group. LIMITATIONS: Limitations to the current study include its retrospective design and the small sample size. CONCLUSIONS: These data do not support the FDA or Health Canada's recommended maximum dosages of citalopram or escitalopram in the elderly. Therefore, for patients already on higher doses of these medications, the risk of QTc prolongation may not always outweigh the risk of dose lowering, such as relapse. Until larger prospective studies become available, the decision to comply or not with these federal agencies' recommendations should be weighed on an individual basis, taking into consideration all potential risk factors.
BACKGROUND: Although the US Food and Drug Administration (FDA) recommended upper limits for citalopram dosing in older adults due to risk of corrected-QT (QTc) prolongation, which was adopted, and extended to escitalopram by Health Canada, the scientific basis is unclear. The objective of this study was to assess the relationship between citalopram/escitalopram dosages and QTc interval in a real-world geriatric setting. METHODS: We reviewed electronic health records at a university-affiliated geriatric health care center, over a 7-year period, to identify patients prescribed citalopram and escitalopram, who had an ECG within 90 days of initiation or dosage change. Linear regression analyses were conducted to assess the relationship between antidepressant dosage and QTc interval. RESULTS: 137 patients were identified (citalopram=97, escitalopram=40). No association was found between citalopram, escitalopram and QTc, in unadjusted or adjusted analyses. Among covariates, older age was significantly associated with QTc prolongation in the escitalopram group. LIMITATIONS: Limitations to the current study include its retrospective design and the small sample size. CONCLUSIONS: These data do not support the FDA or Health Canada's recommended maximum dosages of citalopram or escitalopram in the elderly. Therefore, for patients already on higher doses of these medications, the risk of QTc prolongation may not always outweigh the risk of dose lowering, such as relapse. Until larger prospective studies become available, the decision to comply or not with these federal agencies' recommendations should be weighed on an individual basis, taking into consideration all potential risk factors.
Authors: Raquel Díez; Raquel Cadenas; Julen Susperregui; Ana M Sahagún; Nélida Fernández; Juan J García; Matilde Sierra; Cristina López Journal: Int J Environ Res Public Health Date: 2022-04-04 Impact factor: 3.390