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New Warning About Citalopram Causing Heart Arrhythmia


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8 replies to this topic

#1 historymum

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Posted 19 December 2011 - 01:38 PM

I saw my psychiatrist today and she told me that a warning had been issued that taking citalopram with an anitpsychotic increases the risk of heart arrhythmia.

This has particular importance for me as there is a history of long QT syndrome (heart arrythmia) and sudden adult death in my family. (My brother died in his sleep aged 25, 3 other relatives died in their sleep at a young age, my Great Grandmother died in her sleep in her mid 30s, my Dad has this condition......I won't go on.) Suffice to say, I have been totally freaked out by this. My doc thought that it would be OK to keep taking the citalopram for now, but said that it would need to be changed at some point. Even so, my brother's death casts a long shadow and I'm ready to ditch the stuff.

I have searched the web, but I can't find any information on this new warning. Can anyone help?
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#2 Ferdy

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Posted 19 December 2011 - 02:32 PM

I saw my psychiatrist today and she told me that a warning had been issued that taking citalopram with an anitpsychotic increases the risk of heart arrhythmia.

This has particular importance for me as there is a history of long QT syndrome (heart arrythmia) and sudden adult death in my family. (My brother died in his sleep aged 25, 3 other relatives died in their sleep at a young age, my Great Grandmother died in her sleep in her mid 30s, my Dad has this condition......I won't go on.) Suffice to say, I have been totally freaked out by this. My doc thought that it would be OK to keep taking the citalopram for now, but said that it would need to be changed at some point. Even so, my brother's death casts a long shadow and I'm ready to ditch the stuff.

I have searched the web, but I can't find any information on this new warning. Can anyone help?


Here is the FDA warning: http://www.fda.gov/D...y/ucm269086.htm

Essentially what the warning says is that doses over 40mg/day could cause heart arrythmias---I don't think it says anything about this condition when combined with some other drug---it's just the high dose Celexa (citalopram) by itself. It is, however, fairly well known that some of the AAP's (atypical antipsychotics) cause elongated QT syndrome by themselves---so I would imagine that combining over 40mg/day citalopram AND adding in an AAP would certainly increase the risks.

Hope this helps---

Edited by Ferdy, 19 December 2011 - 02:34 PM.

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BRAIN DX: Treatment resistant unipolar MDD (major depressive disorder), GAD (generalized anxiety disorder), PD (panic disorder) w/severe agoraphobia, PTSD (post traumatic stress disorder), OCD (obsessive/compulsive disorder)

 

PHYSICAL DX:  hypertension, diabetes, hyperlipidemia (this all adds up to metabolic syndrome X---yeah, I'm a walking heart attack)

CURRENT BRAIN MEDS: 15mg/night Remeron (mirtazapine), 3mg/day Klonopin (clonazepam), 20mg/day Prozac (fluoxetine), 25mg/night Atarax (hydroxyzine)

CURRENT PHYSICAL MEDS: 25mg/night  Tenormin (atenolol), 100/25/day Hyzaar (losartan/hctz), 1250mg/day Glucophage (metformin), 20mg/day //@lipitor// (atorvastatin), 1000mg/day Niacin (nicotinic acid)

 

PRIOR UNCONVENTIONAL BRAIN TREATMENT MEDS:  Seroquel (quetiapine), Abilify (aripiprazole), Namenda (memantine HCl---yes, I've even tried an Alzhiemer's med---for it's action on the glutamatergic system as a glutamate antagonist)

PRIOR CONVENTIONAL BRAIN MEDS: YES, MY MEDICINE CABINET LOOKS LIKE A PHARMACY!  All the SSRI's (completely intolerable) except Lexapro (escitalopram---barely tolerable) and Prozac (fluoextine---best of the bunch, far from great, but it's the one I've gone back to), all the SNRI's (intolerable)---and now add Viibryd (vilazodone) to the list, Desyrel (trazodone) (caused severe hypotension and palpitations, PVCs, PACs), Neurontin (gabapentin---ineffective), Atarax  (hydroxyzine----ineffective but good as a sleep agent), BuSpar (buspirone---probably the nastiest poison I've ever taken), and the med shown in my avatar...OMG WATTA DRUG---lucky for me they outlawed that one...it's now classified Schedule I in the USA...it is sorely missed cause I know for damned sure IT would work...it's hard to be anxious and depressed when you're taking what is essentially heroin in pill form...and if you don't know what it is, you're showing your youth, lol!  And before you comment or ask why, the TCAs (tricyclic antidepressants) and the MAOIs (monoamine oxidase inhibitors) are OUT of the question for me, due to the high risk of potential cardiac side effects...


#3 historymum

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Posted 19 December 2011 - 02:59 PM

Thank you for that link. I've just managed to find this: http://www.mhra.gov....pdate/CON137769 It
states that "coadministration of citalopram and escitalopram with medicines that prolong the QT interval is therefore contraindicated," including antipsychotics. (I should have pointed out that I'm in the UK) Which is pretty much, as you say, combining two drugs that prolong QT interval together isn't a good idea.

So...am I overreacting by wanting to come off citalopram NOW? I've been getting heart palpitations on and off since I started taking quetiapine, and especially over the last few weeks. I realise my pdoc said it was a low risk, but any risk is freaking me out, given what my family's been through over the last few years.
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Previous dx: postnatal depression

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#4 notfred

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Posted 19 December 2011 - 05:32 PM

I would want an ECG if I were on those 2 meds.

nf
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I am in full remission (296.36) from Depression. Insomnia, ADHD-PI, Epilepsy, and the Pseudoparkinsonian tremor are well controlled.

 

Psyc Meds: Forfivo XL 450 mg (Wellbutrin XL), Abilify 15 mg, (Aripiprazole), Eszopiclone 6 mg (Lunesta), Vyvance 70 mg, (dextroamphetamine) Levetiracetam 2,000 mg (Keppra), Propranolol ER 60 mg (Inderal)
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#5 Serpens

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Posted 20 December 2011 - 01:17 AM

Thank you for that link. I've just managed to find this: http://www.mhra.gov....pdate/CON137769 It
states that "coadministration of citalopram and escitalopram with medicines that prolong the QT interval is therefore contraindicated," including antipsychotics. (I should have pointed out that I'm in the UK) Which is pretty much, as you say, combining two drugs that prolong QT interval together isn't a good idea.

So...am I overreacting by wanting to come off citalopram NOW? I've been getting heart palpitations on and off since I started taking quetiapine, and especially over the last few weeks. I realise my pdoc said it was a low risk, but any risk is freaking me out, given what my family's been through over the last few years.


To quote the FDA warning:

Do not stop taking citalopram or change your dose without talking to your healthcare professional. Stopping citalopram suddenly can cause unwanted side effects.


However, making a point about getting proper care, respectfully, would be important here. Basically -

- You have a family history of cardiac problems relating to long QT, including a very young death.
- You are taking Seroquel, a drug with several precaution warnings regarding long QT and Torsades, including a warning against using it with other drugs that have such problems.
- You are taking Citalopram which has recently been issued a warning relating to the above. (In the US)

Now, you're taking citalopram at 20mg/d - 1/3rd the dose of what was warned against. Personally, I rarely see citalopram prescribed at doses above 40mg/d. Once in a blue moon I will see 60mg, or 80mg - but this is typically in severe, refractory cases with multiple comorbid conditions, people who have generally been involved with the US' publicly funded health systems for a long time and have exhausted many treatment options.

As Notfred states, an EKG (Or ECG depending on your preference) would be exceptionally prudent. Contact both your psychiatrist and PCP - a PCP will likely be better suited for diagnosing and gathering data on this sort of thing, and coordinating care as necessary.

As per usual, do NOT stop or alter taking your medications unless you have been directed to do so by a healthcare professional - your pharmacist, your doctors, or their staff. However, DO consult with them, express your concerns and pursue proper care. Mention these palpitations.
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#6 historymum

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Posted 20 December 2011 - 02:59 PM


As per usual, do NOT stop or alter taking your medications unless you have been directed to do so by a healthcare professional - your pharmacist, your doctors, or their staff. However, DO consult with them, express your concerns and pursue proper care. Mention these palpitations.


Thanks for those replies. I'm going to get in touch with my MH team tomorrow and ask for my next appointment with the psychiatrist to be brought forward and will ask about an ECG.

Also, I should have been clearer in my last post - I didn't mean that I would stop the citalopram myself, but that I don't want to wait a while before sorting this out, as my psychiatrist suggested. She thought that this warning wasn't a particularly big deal; she told me it was just one study and more of a 'cover your back' warning than anything else.
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#7 VAL

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Posted 20 December 2011 - 08:44 PM

I think Serpens gave very wise advice and you're doing the right thing to contact your healthcare professionals sooner rather than later. I just ran all my drugs through the interaction checker and there were some warnings about combining certain drugs and the QT issue but though I'm a genetic time bomb for heart disease in general, you have very specific genetic history with sudden death. I'll be going off my anti-psychotic soon...probably next month so I'm not worrying in my own case.
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Current Meds: Lamictal 325mg, Wellbutrin XL 450mg, Neurontin 900mg, Klonopin 1.5mg, Saphris 10mg, Trazodone up to 200mg, Prozosin 2mg, Zyprexa 5mg PRN and Inderal 20mg PRN
Past Meds: Siniquan, Elavil, Imipramine, Zoloft, Seroquel, Abilify, Nardil, Emsam, Rozerem and Ambien
Current Non-psych: Soma 350mg PRN, Norco 10mg/325 PRN, Percocet 10mg/325 PRN, Advair, Nasonex, Ventolin PRN, Allegra, Avalide, Dexilant, Levothroxine, Pravachol


#8 magenta

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Posted 10 March 2012 - 07:17 AM

Thank you for that link. I've just managed to find this: http://www.mhra.gov....pdate/CON137769 It
states that "coadministration of citalopram and escitalopram with medicines that prolong the QT interval is therefore contraindicated," including antipsychotics. (I should have pointed out that I'm in the UK) Which is pretty much, as you say, combining two drugs that prolong QT interval together isn't a good idea.

The FDA did not indicate that the cardiac effects were an issue with escitalopram (Lexapro), which is the S-enantiomer of citalopram -- suggesting that the arrhythmias stem from the latter's R-enantiomer.
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#9 KarenRB53

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Posted 02 April 2012 - 07:41 PM

One of the articles I've read re: above is that if taking dosages of 40mg Celexa, you should have potassium and magnesium levels checked. Short article and I don't remember where I read it but I'm going to mention to my dr when I see him next about checking my levels even though I'm only taking 30mg.
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