Clinical Guidance: Safety of Citalopram Doses Above 40 mg/day
Veterans Health Administration records for more than 300,000 depressed patients during 2004–2009 indicate that citalopram daily doses above 40 mg are not associated with a higher risk of ventricular arrhythmia or death from either cardiac or noncardiac causes. These results do not support the 2011 FDA warning that doses above 40 mg may cause abnormal heart rhythms, which was based on individual cases and one study of 119 patients. Zivin et al. (p. 642) also compared citalopram with sertraline, not subject to the FDA warning, and found that sertraline has a similar risk pattern.