From the Guidelines
Azithromycin and citalopram should be used with caution together due to the potential risk of QT interval prolongation, and patients should be closely monitored for signs of abnormal heart rhythms, particularly those with pre-existing risk factors 1. When considering the interaction between azithromycin and citalopram, it's essential to weigh the benefits of treatment against the potential risks.
- Azithromycin, a widely used antibiotic, has been recognized as a rare cause of QT interval prolongation, which can lead to serious arrhythmias and increased risk for sudden death 1.
- Citalopram, an SSRI antidepressant, also has a dose-dependent effect on QT interval, further increasing the risk of abnormal heart rhythms when combined with azithromycin. Key factors to consider when prescribing these medications together include:
- Patient risk factors, such as advanced age, female sex, heart disease, and electrolyte abnormalities, which can increase the likelihood of QT interval prolongation 1.
- The potential for other medications to also prolong the QT interval, exacerbating the risk of abnormal heart rhythms.
- The importance of monitoring patients for symptoms like dizziness, fainting, or palpitations, and seeking medical attention promptly if these occur. Given the potential risks, it is crucial for healthcare providers to carefully assess the need for both medications and consider alternative treatments or close monitoring with an ECG before or during treatment 1.
From the Research
Interaction between Azithromycin and Citalopram
- There is no direct evidence of an interaction between azithromycin and citalopram in the provided studies.
- However, it is known that both azithromycin 2, 3 and citalopram 4 can prolong the QT interval, which may increase the risk of Torsades de Pointes (TdP), a potentially life-threatening cardiac arrhythmia.
- The risk of QT prolongation and TdP is higher in patients with certain risk factors, such as female sex, age >65 years, uncorrected electrolyte disturbances, and concomitant use of other QT-prolonging medications 5, 4.
- Pharmacists play an important role in minimizing the risk of drug-induced QTc interval prolongation and TdP through knowledge of drugs that are associated with a known or possible risk of TdP, individualized assessment of risk of drug-induced QTc interval prolongation, and awareness of drug interactions most likely to result in TdP 4.
- If concomitant use of azithromycin and citalopram is necessary, patients should be monitored for signs of QT prolongation and TdP, and electrolyte disturbances should be corrected promptly 4, 3.
- It is also important to note that the US Food and Drug Administration issued a warning regarding the use of azithromycin and the risk of fatal dysrhythmias 2.