Citalopram-induced bradycardia and presyncope.
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).


METHODS
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.


CONCLUSIONS
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.
Isbister
G K
GK
Department of Clinical Toxicology and Pharmacology, Newcastle Mater Misericordiae Hospital, Locked Bag 7, Hunter Region Mail Centre, NSW 2310, Newcastle, Australia. gsbite@bigpond.com
Prior
F H
FH
Foy
A
A
D001794:Blood Pressure; D001919:Bradycardia / Q000139:chemically induced*; D015283:Citalopram / Q000009:adverse effects*; D005260:Female; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D013575:Syncope / Q000139:chemically induced*
D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors