CriticalSSRI (selective serotonin reuptake inhibitor)×Non-selective beta blocker with class III antiarrhythmic activity
Updated · Methodology
Mechanism
Sotalol is a class III antiarrhythmic, and its SmPC contraindicates concomitant QT-prolonging drugs. That list names SSRIs explicitly, citalopram and escitalopram among them. The citalopram SmPC lists ongoing treatment with any drug capable of prolonging the QT interval among its contraindications, with no exceptions.
Symptoms
QTc prolongation on ECG, palpitations, dizziness, syncope. The end point is polymorphic ventricular tachycardia of the torsade type progressing to ventricular fibrillation. The risk is higher with hypokalaemia, hypomagnesaemia, bradycardia, decompensated heart failure and in women.
Management
The pair sits in the citalopram SmPC contraindications, so the question is which drug stays, not how far to cut the dose. A rare case where both labels name each other outright: sotalol lists SSRIs by name, the citalopram label bans class III antiarrhythmics. Sotalol, meanwhile, is prescribed for vital indications more often than the antidepressant is.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Betapace (sotalol) prescribing information (2011)
- AEMPS: Ficha técnica de Seropram 30 mg (citalopram) (2024)– AEMPS CIMA, nregistro 63564, revisión 01/2024, secciones 4.2, 4.3 y 4.4
- AEMPS: Ficha técnica de Sotapor 80 mg (sotalol) (2022)– AEMPS CIMA, nregistro 62001, revisión 11/2022, secciones 4.3 y 4.5