Prescribe Escitalopram Instead of Citalopram

I would like to respond to the recently published review entitled “Citalopram, QTc Interval Prolongation, and Torsade de Pointes. How Should We Apply the Recent FDA Ruling?” A revised Drug Safety Communication on Celexa was posted on the US Food and Drug Administration (FDA) Web site on March 28, 2012, which included data obtained from randomized double-blind placebo-controlled cross-over studies of the effects of citalopram and escitalopram on the corrected QT [QTc] intervals in adults. Citalopram 20 mg caused an average QTc prolongation of 8.5 ms (95% confidence interval [CI], 6.2-10.8 ms), while the therapeutically equivalent dose of escitalopram (10 mg) prolonged QTc by an average of only 4.5 ms (95% CI, 2.5-6.4 ms). Similarly, citalopram 60 mg prolonged QTc by 18.5 ms (95% CI, 16.0-21.0 ms), while the therapeutically equivalent dose of escitalopram (30 mg) prolonged QTc by only 10.7 ms (95% CI, 8.7-12.7 ms). These data demonstrate that the harmful effect on QTc interval prolongation is nearly double for each dose of citalopram compared with its therapeutically equivalent dose of escitalopram. It is known that only the S isomer of citalopram (escitalopram) has antidepressant effects; so, while the R isomer of citalopram confers no antidepressant benefit, it does cause a harmful effect on QTc prolongation roughly equivalent to that of the S isomer. In addition, the widely used over-the-counter antacid omeprazole has a major interaction with citalopram that further incr...
Source: The American Journal of Medicine - Category: Journals (General) Authors: Tags: Letters Source Type: research