What is it about?
Citalopram carries the risk of QTc prolongation which can lead to a life threatening arrhythmia known as torsades de pointes. Doses in excess of 20 mg per day are not recommended in patients over the age of 60 due to increased risk. The FDA released recommendations advocating that this medication should not be prescribed at doses greater than 20 mg for this patient population. This study assesses the impact of the FDA warning on prescribing practices.
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Why is it important?
It is important to understand the impact that recommendations from regulatory bodies have on prescribing patterns. This study showed that the recommendations had limited impact on prescribing practices. In order to achieve meaningful changes, other approaches need to be explored.
Perspectives
While this FDA warning did not appear to be effective on its own, there may be opportunities to achieve the underlying intent by improving awareness of the risk. With the broad use of electronic health records, there may be opportunities to leverage clinical decision support modalities to inform clinicians and advocate for changes in practice. These types of changes should be balanced against the risk of alert fatigue that plagues many systems.
Christopher Dennis
ECU Health
Read the Original
This page is a summary of: Evaluation of Changes in Citalopram Prescribing Patterns Following a US Food and Drug Administration Alert, The Primary Care Companion For CNS Disorders, February 2015, Physicians Postgraduate Press, Inc,
DOI: 10.4088/pcc.14m01657.
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