Risk of Ventricular Arrhythmia with Citalopram and Escitalopram: A Population-Based Study

Elena Qirjazi; Eric McArthur; Danielle M Nash; Stephanie N Dixon; Matthew A Weir; Akshya Vasudev; Racquel Jandoc; Lorne J Gula; Matthew J Oliver; Ron Wald; Amit X Garg

doi:10.1371/journal.pone.0160768

Risk of Ventricular Arrhythmia with Citalopram and Escitalopram: A Population-Based Study

PLoS One. 2016 Aug 11;11(8):e0160768. doi: 10.1371/journal.pone.0160768. eCollection 2016.

Authors

Elena Qirjazi¹, Eric McArthur², Danielle M Nash², Stephanie N Dixon^{2

3}, Matthew A Weir^{1

3}, Akshya Vasudev^{4

5}, Racquel Jandoc², Lorne J Gula⁶, Matthew J Oliver⁷, Ron Wald^{8

9}, Amit X Garg^{1

2

3}

Affiliations

¹ Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
² Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
³ Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.
⁴ Division of Geriatric Psychiatry, Department of Psychiatry, Western University, London, Ontario, Canada.
⁵ Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada.
⁶ Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada.
⁷ Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
⁸ Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
⁹ Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Abstract

Background: The risk of ventricular arrhythmia with citalopram and escitalopram is controversial. In this study we investigated the association between these two drugs and the risk of ventricular arrhythmia.

Methods: We conducted a population-based retrospective cohort study of older adults (mean age 76 years) from 2002 to 2012 in Ontario, Canada, newly prescribed citalopram (n = 137 701) or escitalopram (n = 38 436), compared to those prescribed referent antidepressants sertraline or paroxetine (n = 96 620). After inverse probability of treatment weighting using a propensity score, the baseline characteristics of the comparison groups were similar. The primary outcome was a hospital encounter with ventricular arrhythmia within 90 days of a new prescription, assessed using hospital diagnostic codes. The secondary outcome was all-cause mortality within 90 days.

Results: Citalopram was associated with a higher risk of a hospital encounter with ventricular arrhythmia compared with referent antidepressants (0.06% vs. 0.04%, relative risk [RR] 1.53, 95% confidence intervals [CI]1.03 to 2.29), and a higher risk of mortality (3.49% vs. 3.12%, RR 1.12, 95% CI 1.06 to 1.18). Escitalopram was not associated with a higher risk of ventricular arrhythmia compared with the referent antidepressants (0.03% vs. 0.04%, RR 0.84, 95% CI 0.42 to 1.68), but was associated with a higher risk of mortality (2.86% vs. 2.63%, RR 1.09, 95% CI 1.01 to 1.18).

Conclusion: Among older adults, initiation of citalopram compared to two referent antidepressants was associated with a small but statistically significant increase in the 90-day risk of a hospital encounter for ventricular arrhythmia.

MeSH terms

Aged
Aged, 80 and over
Canada / epidemiology
Citalopram / adverse effects*
Female
Humans
Male
Retrospective Studies
Risk Factors
Selective Serotonin Reuptake Inhibitors / adverse effects*
Tachycardia, Ventricular / chemically induced*
Tachycardia, Ventricular / epidemiology*

Substances

Serotonin Uptake Inhibitors
Citalopram

Grants and funding

The Institute for Clinical Evaluative Sciences (ICES) is a non-profit research corporation funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of the material in the current report are based on data and information compiled and provided by the Canadian Institute of Health Information (CIHI). The research was conducted at the ICES Western facility, which receives financial support from the Academic Medical Organization of Southwestern Ontario, the Schulich School of Medicine and Dentistry at Western University and the Lawson Health Research Institute. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES, the Ontario MOHLTC or CIHI is intended or should be inferred. Dr. Amit Garg was supported by the Dr. Adam Linton Chair in Kidney Health Analytics. Research personnel who worked on this project were supported by the Lilibeth Caberto Kidney Clinical Research Unit.