english.prescrire.org > Spotlight > Archives : 2020 > Depression: cardiac risks with citalopram (Seropram° and other brands), even greater if combined with omeprazole (Mopral° and other brands)

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Depression: cardiac risks with citalopram (Seropram° and other brands), even greater if combined with omeprazole (Mopral° and other brands)

Citalopram (Seropram° and other brands), an antidepressant, carries a risk of cardiac rhythm disorders and sudden death, all the more so when combined with omeprazole (Mopral° and other brands), which is often used for gastric reflux and peptic ulcers.

Citalopram (Seropram° and other brands) and its derivative escitalopram (Seroplex° and other brands) are so-called selective serotonin reuptake inhibitors (SSRI), and are known to carry a risk of cardiac rhythm disorders. Omeprazole (Mopral° and other brands), a drug frequently used to reduce gastric acidity in gastric reflux or peptic ulcer disease, interferes with the metabolism of these antidepressants, creating a risk of drug accumulation and hence increased adverse effects.

A study using a Taiwanese health insurance database, published in 2019, investigated whether combining these frequently used drugs increased the risk of cardiac arrest. This study compared four groups of patients: 3882 patients exposed to citalopram alone, 31 090 exposed to omeprazole alone, 405 exposed to citalopram + omeprazole, and a control group of 141 508 patients.

The risk was no greater with omeprazole alone than in the control group. The risk of sudden cardiac arrest was greater with citalopram alone, and the combination of omeprazole with citalopram was associated with an even greater risk of sudden cardiac death.

Citalopram and escitalopram are both drugs to avoid. Compared to other SSRI antidepressants they offer no advantage and carry a risk of sudden death. Patients who are nevertheless taking them should be warned to avoid combining these antidepressants with omeprazole or esomeprazole (Inexium° and other brands), which increase this risk.

©Prescrire 1 December 2020

Source: "Citalopram + omeprazole: sudden cardiac death" Prescrire International 2020; 29 (221): 298. Subscribers only.

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See also:

"Citalopram and
escitalopram: opt for other
SSRI antidepressants"
(August 2020)
Free

Citalopram, escitalopram:
no more effective than
other SSRIs, but more toxic
Prescrire Int 2016;
25 (170): 98.
Pdf, subscribers only

Towards better patient
care: drugs to avoid in 2020
29 (212): 51-53.
Pdf, free

Numerous other texts
available via the "Search"
function, using the name
of the drug or the keyword
"antidepressant"
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