Citalopram

Citalopram

PEP Topic 
Hot Flashes
Description 

Citalopram is an antidepressant in the class of drugs that are serotonin reuptake inhibitors that has been studied in patients with cancer for management of depressive symptoms and hot flashes.   

Effectiveness Not Established

Research Evidence Summaries

Barton, D.L., LaVasseur, B.I., Sloan, J.A., Stawis, A.N., Flynn, K.A., Dyar, M., ... & Loprinzi, C.L. (2010). Phase III, placebo-controlled trial of three doses of citalopram for the treatment of hot flashes: NCCTG trial N05C9. Journal of Clinical Oncology, 28, 3278-3283.

doi: 10.1200/JCO.2009.26.6379
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Study Purpose:

To evaluate three different doses of citalopram for management of hot flashes

Intervention Characteristics/Basic Study Process:

Women were randomly assigned to receive 10, 20, or 30 mg citalopram or corresponding number of placebo pills daily for six weeks. Treatment was titrated weekly to achieve the target dose.

Sample Characteristics:

  • N = 196  
  • MEAN AGE = 55.6 years
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: 55% were on aromatase inhibitors, and 38% were on naloxifene or tamoxifen.
  • OTHER KEY SAMPLE CHARACTERISTICS: The majority had over four hot flash episodes per day.  

Setting:

  • SITE: Multi-site  
  • SETTING TYPE: Outpatient  
  • LOCATION: United States of America

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Multiple phases of care

Study Design:

Placebo controlled RCT

Measurement Instruments/Methods:

  • Hot flash scores calculated by assigning 1 (mild) to 4 (severe) points for severity of each daily hot flash episode and adding these scores for a daily hot flash score. 
  • Profile of Mood States
  • Hot Flash Related Daily Interference Scale
  • National Cancer Institute Common Toxicity Criteria version 3.0

Results:

There was some improvement in hot flash interference with several areas, and those on 20 and 30 mg of citalopram had significant improvement in sleep interference compared to placebo (p ≤ .01). There were no group differences in overall POMS scores. Adverse effects on sexual health were greater with 30 mg compared to placebo, but this difference was not statistically significant.

Conclusions:

Findings show that citalopram in a dose as low as 10 mg daily can significantly improve hot flash symptoms and is not associated with toxicity. Further benefits were seen with higher doses.

Limitations:

  • Risk of bias (no blinding)
  • Measurement validity/reliability questionable
  • Other limitations/explanation: Relatively short duration of treatment, particularly for adverse effects

Nursing Implications:

Findings show that citalopram was beneficial to reduce hot flash severity. The duration of treatment in this study was only six weeks, so longer term efficacy is not clear. Patients on any longer term management with citalopram need to be monitored for side effects of the medication.

Kelly, C., Juurlink, D., Gomes, T., Duong-Hua, M., Pritchard, K., Austin, P., & Paszat, L. (2010). Selective serotonin reuptake inhibitors and breast cancer mortality in women. BMJ, 340, c693.

doi:10.1136/bmj.c693
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Study Purpose:

Researchers sought to show that  some SSRI antidepressants reduce tamoxifen’s effectiveness by inhibiting its bioactivation by cytochrome P450 2D6 (CYP2D6).

Intervention Characteristics/Basic Study Process:

The study enrolled postmenopausal women with breast cancer using tamoxifen therapy and a single SSRI antidepressant (paroxetine fluoxetine, sertraline, citalopram, fluvoxamine, or venlafaxine.)

Sample Characteristics:

The study included women living in Ontariowho were 66 years or olderand treated with tamoxifen for breast cancer between 1993 and 2005 and with a single SSRI. (24,430 women were identified; 2,430 entered into study; mean age was 74 years).

Inclusion criteria: Postmenopausal women with breast cancer newly treated with tamoxifen (defined as no tamoxifen prescription in the preceding year) and a single SSRI antidepressant (paroxetine fluoxetine, sertraline, citalopram, fluvoxamine, or venlafaxine)

Exclusion criteria: Antidepressant use of duloxetine or escitalopram

Setting:

Ontario Cancer Registry provided the data.

Study Design:

This was a retrospective cohort study.

Measurement Instruments/Methods:

The study examines the total duration of tamoxifen therapy (index date: date tamoxifen was last dispensed plus an additional 60 days) and the extent to which co-prescription of potentially interacting medications occurred during the course of treatment. The primary outcome was death from breast cancer

Results:

Of 2,430 women treated with tamoxifen and single SSRI, 374 (15%) died of breast cancer during follow up. Absolute increases of 25%, 50%, and 75% in the proportion of time on tamoxifen overlappingthe  use of paroxetine were associated with 24%, 54%, & 91% increases in the risk of death from breast cancer. (p < 0.05) No such risk was seen with other antidepressants

Limitations:

Reported study limitations included lack of information on breast cancer stage and lack of information on indication for antidepressant use.


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