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March 4, 2013Pharmacoepidemiology and Drug Safety

The adjusted risk of adverse cardiac events, relative to fluoxetine, was significantly higher for citalopram (HR 3.53, 95% CI 1.09–11.46) and escitalopram (HR 3.30, 95% CI 1.08–10.14).

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Why the study?

Do specific SSRIs increase the risk of adverse cardiac events compared to fluoxetine in pediatric patients?

Population

113,714 new pediatric users of selective serotonin reuptake inhibitor monotherapy identified from US claims…

Comparison

Individual SSRI monotherapy vs Fluoxetine monotherapy

Design

Cohort

Follow-up

up to 12 months

Authors

ACAngela S. CzajaRVRobert J. ValuckHAHeather Anderson

Discussion

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Overview

Citalopram and escitalopram were associated with higher pediatric cardiac risk than fluoxetine; observational data leaves open causality and needs prospective confirmation.

Structured PICO

Do specific SSRIs increase the risk of adverse cardiac events compared to fluoxetine in pediatric patients?

P
Population
113,714 new pediatric (age < 18 years) users of selective serotonin reuptake inhibitor (SSRI) monotherapy identified from US claims data (1997-2009).
I
Intervention
Individual SSRI monotherapy (citalopram, escitalopram, paroxetine, or sertraline)
C
Comparator
Fluoxetine monotherapy
O
Outcome
Composite of ventricular arrhythmia, cardiac arrest, or sudden death occurring within 12 months of SSRI initiationsafety

Although the absolute incidence of adverse cardiac events among pediatric SSRI users is low, citalopram and escitalopram are associated with a significantly higher risk compared to fluoxetine.

Cite This Study

Czaja et al. (2013) studied this question.

synapsesocial.com/papers/6a7fbbffa9500df4273e88d1https://doi.org/10.1002/pds.3420
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Pharmacovigilance of SSRIs in Children and Adolescents withDepression: Disproportionality Analysis of Serotonin Adverse EventsUsing the FAERS Database2026
  2. 2Safety of antidepressants commonly used in 6–17-year-old children and adolescents: A disproportionality analysis from 2014–2023 on the basis of the FAERS database2025 · 5 citations
  3. 3Serious arrhythmia in initiators of citalopram, escitalopram, and other selective serotonin reuptake inhibitors: A population‐based cohort study in older adults2022 · 17 citations
  4. 4Cardiac Valvular Incompetence Associated With Selective Serotonin Reuptake Inhibitors (SSRIs): A Disproportionality and Risk Factor Analysis From Global Safety Reports2026
  5. 5Risk of Ventricular Arrhythmia with Citalopram and Escitalopram: A Population-Based Study2016 · 31 citations