Background The use of citalopram and escitalopram has been associated with QT interval prolongation. Therefore, AEMPS published an alert in October 2011, recommending that the highest dose used in patients with liver dysfunction and patients >65 years should be 20 mg/day and 10 mg/day, respectively.
Purpose To evaluate if this recommendation was accomplished in our public health centres and the effect of pharmaceutical intervention.
Material and methods In January 2015, we searched MicroStrategy software in the area of the health centres to analyse patients over 65 years receiving more than 20 mg of citalopram or escitalopram 10 mg doses. A letter to primary care physicians was sent informing patients exceeding the recommended dose to have a re-evaluation of their treatment. In January 2016, patients were reviewed to assess whether there had been a change in dosage and to check if the recommendations of the pharmacist had been accepted. Acceptance of pharmacist recommendation was considered when the dose exceeding the maximum recommended was decreased. The reasons for discontinuation of treatment were suspension or death.
Results The public health centres provide services to 255 000 inhabitants. Patients receiving higher than recommended doses: 292 (180 citalopram, escitalopram 112); patients treated with citalopram: 2 patients received 60 mg, 14 patients received 45 mg, 3 patients received 40 mg and 161 received patients 30 mg; for escitalopram: 2 patients received 30 mg, 53 patients received20 mg and 57 patients received 15 mg. In January 2015: patients were treated with doses that exceeded the recommended: 292 (180 citalopram, escitalopram 112); patients treated with citalopram: 2 patients with 60 mg, 14 patients with 45 mg , 3 patients with 40 mg and 161 patients with 30 mg; for escitalopram: 2 patients with 30 mg, 53 patients with 20 mg and 57 patients with 15 mg. After the recommendation: 109/292 (37%) had the recommended dose. Patients receiving higher than recommended doses: 132/292 (45%) of which 75/180 (42%) patients were receiving citalopram and 57/112 (51%) escitalopram. 3/292 (1%) had their dose increased and 13/292 (4%) their dose decreased but the dose was still above the maximum recommended. In 35/292 (12%) patients treatment was suspended and 16/292 (6%) patients died.
Conclusion Work in multidisciplinary teams promotes the proper use of medicines, thus increasing patient safety. Therefore, it would be appropriate to enhance the joint efforts between pharmacists and physicians.
References and/or acknowledgements ANNA ON FAYET.
No conflict of interest
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