Abstract

Recently, Forest Laboratories warned about QTc prolongation associated with the use of citalopram. After these reports, the FDA warned that citalopram should no longer be used at doses greater than 40 mg/day for patients ≤ 60 years of age or greater than 20 mg/day in patients over 60 years of age. As a result, providers and formulary managers were advised to reevaluate the use of citalopram to conform to current FDA guidelines. Clinicians have the option to: (1) maintain the patient on the current dose (no change), document that the current EKG (with QTc) is within a normal range and inform the patient of the current recommendations or (2) change the therapy, which consists of either a dose reduction or change to an alternate agent. It may be appropriate to keep a patient on current therapy above the FDA recommended maximum if proper documentation is maintained (e.g., past history of severe depression, normal EKG). Citalopram should be discontinued in patients who have persistent QTc measurements greater than 500 ms.

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