Do not give citalopram more than 40 mg

Health Care, Medicine 177 Comments

Doctors should not give citalopram at doses that exceed 40 mg per day because of dose-dependent QT interval prolongation.

The US FDA issued a safety alert in August 2011 that the antidepressant citalopram should no longer be used at doses exceeding 40 mg per day because higher doses have been associated with an increased risk for potentially fatal cardiac rhythm disturbances, including Torsade de Pointes.

In a randomized trial, the maximum mean corrected QT interval prolongation was greater in patients assigned to receive citalopram 60 mg per day compared with 20 mg per day.

No evidence is available that escitalopram causes dose-dependent QT prolongation. Other SSRIs can also cause QT prolongation, but are safe in usual recommended doses.

[FDA Drug Safety Communication: Abnormal heart rhythms associated with high doses of citalopram hydrobromide. http://www.fda.gov/Drugs/DrugSafety/ucm269086.htm]