HYPERTENSION ASSOCIATED WITH CITALOPRAM
Afsin Sagduyu and Vesile Sentürk

OBJECTIVE: To report a case of hypertension resulting from the therapeutic use of citalopram and review previous reports in the literature.

CASE SUMMARY: An 87-year-old white woman who had taken a single dose of citalopram 20 mg presented to the hospital on the same day with hypertension (BP 200/100 mm Hg) following a presyncopal episode and headache. Citalopram was discontinued; the hypertension resolved in 24 hours and remained stable for 8 days. She had multiple systemic illnesses, including hypertension; however, they were under control, and no electrocardiogram abnormality shown at this time was different from previous recordings. No other medical or pharmacologic cause was found for the adverse reaction.

DISCUSSION: The manufacturer reports hypotension and bradycardia as being infrequent adverse effects of citalopram. To our knowledge, there have been no previous reports of hypertension after the first dose of citalopram. Multiple physical illnesses and drugs used may have interfered with findings obtained in this case. However, an acute increase in blood pressure after the first dose, which had been within normal levels with antihypertensive treatment for 4 years, as well as the low drug interaction profile of citalopram suggest that this adverse drug reaction was probable according to the Naranjo probability scale.

CONCLUSIONS: Future research should address the cardiovascular and autonomic effects of selective serotonin reuptake inhibitors, including citalopram, in the older population and in persons with any known heart disease. Citalopram should be used with care in elderly patients unless more data are obtained from well-designed studies.

J Pharm Technol 2004;20:14-6.