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bradycardia and presyncope.
Isbister GK, Prior FH,
Department of Clinical Toxicology and Pharmacology,
Newcastle Mater Misericordiae Hospital, Locked Bag 7, Hunter Region Mail
Centre, NSW 2310, Newcastle, Australia.
OBJECTIVE: To report a case of symptomatic
bradycardia and hypotension that resulted from the therapeutic use of
citalopram and to review any previous reports in the literature, from
the manufacturer, and the Australian Drug Reaction Advisory Committee
(ADRAC). CASE SUMMARY: A 60-year-old white woman who had been taking
citalopram 20 mg/d for two weeks presented to the hospital with a heart
rate of 39 beats/min, mild hypotension (systolic BP 105 mm Hg), and a
normal electrocardiogram (QTc < 440 msec), following a presyncopal
episode. The patient was admitted for cardiac monitoring, and citalopram
was discontinued. The bradycardia and hypotension resolved in the
48-hour period following cessation of citalopram. No other medical or
pharmacologic cause was found for the adverse drug reaction. DISCUSSION:
Bradycardia has been reported rarely with citalopram in therapeutic
doses, but this is the first detailed case with a dose of only 20 mg.
The manufacturer reports bradycardia as an infrequent adverse effect
(0.1-1%) of citalopram. There have been no reports to ADRAC or to the
manufacturer in postmarketing surveillance. There is a case report of
asymptomatic bradycardia in a patient whose dose was increased to 40 mg.
In the case reported here, there was no QTc prolongation consistent with
previous reports. The sinus bradycardia reported more often with
therapeutic doses would appear to be distinct to QT abnormalities seen
with citalopram overdose. CONCLUSIONS: Citalopram should be used with
care in the elderly and in persons with a history of heart disease.
Heart rate and blood pressure should be monitored in the first week of
therapy and when doses are modified.
PMID: 11793617 [PubMed - indexed for