FDA revises recommendations for citalopram

The FDA has revised recommendations for the antidepressant citalopram (Celexa) to address doses in older patients and to urge caution in patients with certain heart conditions.

Last August, the FDA issued a statement that citalopram shouldn't be used at doses greater than 40 mg/d due to the risk of potentially dangerous abnormalities in the heart's electrical activity. Current recommendations confirm the 40 mg/d limit, and also say the drug isn't recommended for patients taking other drugs that prolong the QT interval, or for those with congenital long QT syndrome, bradycardia, hypokalemia, hypomagnesemia, recent acute myocardial infarction, or uncompensated heart failure.

The maximum recommended dose is 20 mg/d for patients older than age 60, patients with hepatic impairment, those who are CYP2C19 poor metabolizers, or those who are taking concomitant cimetidine (Tagamet) or another CYP2C19 inhibitor. These factors lead to increased blood levels of citalopram, which increases the risk of QT interval prolongation and torsade de pointes, the agency said in a safety alert.