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A Comparison of the Risk of QT Prolongation Among SSRIs.
MedLine Citation:
PMID:  24259697     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVE: To report QT prolongation potential in selective serotonin reuptake inhibitors (SSRIs) in order to advise clinicians on safe use of SSRIs other than citalopram in light of citalopram warnings.
DATA SOURCES: Primary literature and case reports were identified through a systematic search. Data from drug manufacturers, package inserts, and the ArizonaCERT database were also utilized.
STUDY SELECTION AND DATA EXTRACTION: English-language studies and case reports were included.
DATA SYNTHESIS: Studies demonstrate possible dose-related clinically significant QT prolongation with escitalopram. Fluoxetine, fluvoxamine, and sertraline at traditional doses demonstrate a lack of clinically significant increases in QTc in the majority of studies. Further, paroxetine monotherapy shows a lack of clinically significant QTc prolongation in all studies. However, case reports or reporting tools still link these SSRIs with QTc prolongation. Fluoxetine, escitalopram, and sertraline used in post-acute coronary syndrome patients did not demonstrate risk of QTc prolongation.
CONCLUSION: For clinicians who choose not to use citalopram due to recent Food and Drug Administration (FDA) recommendations, other antidepressants within this class may be considered. When citalopram is not utilized based on risk factors for TdP, use of escitalopram is not likely the safest alternative. Based on current literature, fluoxetine, fluvoxamine, and sertraline appear to have similar, low risk for QT prolongation, and paroxetine appears to have the lowest risk. However, there are significant limitations in interpreting the studies, including varying definitions of significant QT prolongation. Therefore, choice of an alternative SSRI should be based on individual risk factors for arrhythmias and other patient-specific factors.
Kylee A Funk; Jolene R Bostwick
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Publication Detail:
Type:  Journal Article     Date:  2013-10-21
Journal Detail:
Title:  The Annals of pharmacotherapy     Volume:  47     ISSN:  1542-6270     ISO Abbreviation:  Ann Pharmacother     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-11-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203131     Medline TA:  Ann Pharmacother     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1330-41     Citation Subset:  IM    
University of Michigan Health System, Ann Arbor, MI, USA.
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