Key result
Available evidence indicates a dose-related lengthening of the QT interval with both antidepressants, with no clear advantage to using escitalopram in place of citalopram to minimize arrhythmia risk.
Why the study?
Does escitalopram reduce the risk of QT prolongation and fatal arrhythmias compared to citalopram?
Does escitalopram reduce the risk of QT prolongation and fatal arrhythmias compared to citalopram?
Both citalopram and escitalopram are associated with dose-dependent QT prolongation, and there is no evidence that escitalopram offers a safer profile regarding fatal arrhythmias.
Should not prompt switch to escitalopram for QT safety; leaves open need for randomized arrhythmia outcome trials.
Recent health advisories have identified a risk of QT prolongation with the commonly used antidepressants citalopram (Celexa®) and escitalopram (Cipralex®). Pertinent literature was searched for, uncovered, and critically assessed to determine the comparative risk of arrhythmias or death between citalopram and escitalopram. No data were found directly addressing our clinical question by evaluating the two antidepressants for their comparative risk. However, several randomized and crossover trials, as well as a cohort study, were found to address questions regarding the cardiovascular risk of each agent. Available studies indicate a dose-related lengthening of the QT interval with both antidepressants, suggesting that these agents should be used at lower doses in patients with risk factors for arrhythmias. Overall, the evidence suggests that there is no clear advantage to using escitalopram in place of citalopram to minimize the risk of QT prolongation resulting in fatal arrhythmias.
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Pollmann et al. (2014) conducted a review in Depression with cardiovascular risk factors. Escitalopram vs. Citalopram was evaluated on QTc prolongation and fatal arrhythmias. Available evidence indicates a dose-related lengthening of the QT interval with both antidepressants, with no clear advantage to using escitalopram in place of citalopram to minimize arrhythmia risk.
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