Citalopram and escitalopram in older adults and associated QTc prolongation : a clinical audit

Abstract

Background: Citalopram and escitalopram are commonly used serotonin-specific reuptake inhibitors (SSRIs) for the treatment of depression and anxiety; which are known to cause corrected QT interval (QTc) prolongation. Methods: In a sample of patients in older adult psychiatry who were prescribed citalopram or escitalopram, the doses, history of QTc prolongation, concurrent medications that may prolong QTc, electrocardiogram (ECG) reviews, and any discussion about the risk were audited. Results: The sample consisted of 17 older adult patients aged 65 years or more. Most of the patients (94.1%) were prescribed citalopram and only one patient was on escitalopram. Citalopram was prescribed commonly at 20mg (64.7%), and two (1.8%) patients were above the recommended dose for older adults. Escitalopram was within the recommended dose. There was no history of QTc prolongation in any patient. Concurrent medications that could prolong QTc were identified in 35.3% of the patients; all of these were antipsychotics. A small proportion (11.8%) of the patients had documentation stating QTc prolongation and arrhythmia risks for citalopram or escitalopram. A review of ECG when initiating or adjusting treatment was noted in only one patient. Conclusion: Although citalopram and escitalopram dosages were within the recommended limit, a considerable proportion of patients had concurrent medications with an additional risk of prolonging QTc. It is essential for health professionals to discuss and provide written information about the cardiac risk associated with citalopram and escitalopram with older patients and their caregivers.