This Just In: Revised FDA Warning About Citalopram

There’s a newly revised FDA warning about Citalopram based on rethinking the indication for treating psychiatric illness, the benefits of which might outweigh the relatively small risk for cardiac arrhythmia in some patients who lack the criteria which might lead doctors to avoid prescribing the antidepressant altogether. The new warning, excerpted from the article in HealthDay (see link below):

  • “Celexa should not be used at doses greater than 40 milligrams (mg).
  • Celexa is not recommended for use in patients with congenital long QT syndrome, bradycardia, hypokalemia, hypomagnesemia, recent heart attack, or uncompensated heart failure.
  • Use of the Celexa is also not recommended in patients who are taking other drugs that prolong the QT interval, a measure of a heart’s electrical activity.
  • The maximum recommended dose of Celexa is 20 mg per day for patients with liver impairment, patients who are older than 60, patients who are CYP 2C19 poor metabolizers, or patients who are also taking cimetidine (Tagamet) or another CYP 2C19 inhibitor. All of these factors lead to increased blood levels of Celexa, increasing the risk of QT interval prolongation and Torsade de Pointes, the FDA said.”

Other links to the story:

FDA Adds More Warnings to Antidepressant’s Label

Medical News:FDA Softens Celexa Arrhythmia Warning – in Psychiatry, Depression from MedPage Today

Safety Alerts for Human Medical Products > Celexa (citalopram hydrobromide) – Drug Safety Communication: Revised Recommendations, Potential Risk of Abnormal Heart Rhythms

One of my posts with related information at short link


Author: Jim Amos

Dr. James J. Amos is Clinical Professor of Psychiatry in the UI Carver College of Medicine at The University of Iowa in Iowa City, Iowa. Dr. Amos received a B. S. degree in Distributed Studies (Zoology, Chemistry, and Microbiology) in 1985 from Iowa State University and an M.D. from The University of Iowa in Iowa City, Iowa in 1992. He completed his psychiatry residency, including a year as Chief Resident, in 1996 at the Department of Psychiatry at The University of Iowa. He has co-edited a practical book about consultation psychiatry with Dr. Robert G. Robinson entitled Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry. As a clinician educator, among Dr. Amos’s most treasured achievements is the Leonard Tow Humanism in Medicine Award.

2 thoughts on “This Just In: Revised FDA Warning About Citalopram”

  1. Jesus. I just went up to 20 mg and understand folks w/ what i have take 40 mg. I’m in that older group. Have no idea whether i have any of those cardiac issues. Am assuming not. I fought going to 20, was a good girl and did it, then the new shrink who pushed me to do it said she was leaving. Gee…thanks. So i may need to rethink the celexa thing. Glad I saw this!


    1. You are so welcome, and I hope you and your next psychiatrist have a frank, open, and balanced discussion about the risks and benefits of any treatment you undertake.

      Best wishes,

      Jim Amos, MD


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