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Proton pump inhibitors may enhance the risk of citalopram- and escitalopram-associated sudden cardiac death among patients receiving hemodialysis.

Publication ,  Journal Article
Assimon, MM; Pun, PH; Al-Khatib, SM; Brookhart, MA; Gaynes, BN; Winkelmayer, WC; Flythe, JE
Published in: Pharmacoepidemiol Drug Saf
June 2022

PURPOSE: Polypharmacy is common in the hemodialysis population and increases the likelihood that patients will be exposed to clinically significant drug-drug interactions. Concurrent use of proton pump inhibitors (PPIs) with citalopram or escitalopram may potentiate the QT-prolonging effects of these selective serotonin reuptake inhibitors through pharmacodynamic and/or pharmacokinetic interactions. METHODS: We conducted a retrospective cohort study using data from the U.S. Renal Data System (2007-2017) and a new-user design to examine the differential risk of sudden cardiac death (SCD) associated with citalopram/escitalopram initiation vs. sertraline initiation in the presence and absence of PPI use among adults receiving hemodialysis. We studied 72 559 patients:14 983 (21%) citalopram/escitalopram initiators using a PPI; 26 503 (36%) citalopram/escitalopram initiators not using a PPI;10 779 (15%) sertraline initiators using a PPI; and 20 294 (28%) sertraline initiators not using a PPI (referent). The outcome of interest was 1-year SCD. We used inverse probability of treatment weighted survival models to estimate weighted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Compared with sertraline initiators not using a PPI, citalopram/escitalopram initiators using a PPI had the numerically highest risk of SCD (HR [95% CI] = 1.31 [1.11-1.54]), followed by citalopram/escitalopram initiators not using a PPI (HR [95% CI] = 1.22 [1.06-1.41]). Sertraline initiators using a PPI had a similar risk of SCD compared with those not using a PPI (HR [95% CI] = 1.03 [0.85-1.26]). CONCLUSIONS: Existing PPI use may elevate the risk of SCD associated with citalopram or escitalopram initiation among hemodialysis patients.

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Published In

Pharmacoepidemiol Drug Saf

DOI

EISSN

1099-1557

Publication Date

June 2022

Volume

31

Issue

6

Start / End Page

670 / 679

Location

England

Related Subject Headings

  • Sertraline
  • Selective Serotonin Reuptake Inhibitors
  • Retrospective Studies
  • Renal Dialysis
  • Proton Pump Inhibitors
  • Pharmacology & Pharmacy
  • Humans
  • Escitalopram
  • Death, Sudden, Cardiac
  • Citalopram
 

Citation

APA
Chicago
ICMJE
MLA
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Assimon, M. M., Pun, P. H., Al-Khatib, S. M., Brookhart, M. A., Gaynes, B. N., Winkelmayer, W. C., & Flythe, J. E. (2022). Proton pump inhibitors may enhance the risk of citalopram- and escitalopram-associated sudden cardiac death among patients receiving hemodialysis. Pharmacoepidemiol Drug Saf, 31(6), 670–679. https://doi.org/10.1002/pds.5428
Assimon, Magdalene M., Patrick H. Pun, Sana M. Al-Khatib, M Alan Brookhart, Bradley N. Gaynes, Wolfgang C. Winkelmayer, and Jennifer E. Flythe. “Proton pump inhibitors may enhance the risk of citalopram- and escitalopram-associated sudden cardiac death among patients receiving hemodialysis.Pharmacoepidemiol Drug Saf 31, no. 6 (June 2022): 670–79. https://doi.org/10.1002/pds.5428.
Assimon MM, Pun PH, Al-Khatib SM, Brookhart MA, Gaynes BN, Winkelmayer WC, et al. Proton pump inhibitors may enhance the risk of citalopram- and escitalopram-associated sudden cardiac death among patients receiving hemodialysis. Pharmacoepidemiol Drug Saf. 2022 Jun;31(6):670–9.
Assimon, Magdalene M., et al. “Proton pump inhibitors may enhance the risk of citalopram- and escitalopram-associated sudden cardiac death among patients receiving hemodialysis.Pharmacoepidemiol Drug Saf, vol. 31, no. 6, June 2022, pp. 670–79. Pubmed, doi:10.1002/pds.5428.
Assimon MM, Pun PH, Al-Khatib SM, Brookhart MA, Gaynes BN, Winkelmayer WC, Flythe JE. Proton pump inhibitors may enhance the risk of citalopram- and escitalopram-associated sudden cardiac death among patients receiving hemodialysis. Pharmacoepidemiol Drug Saf. 2022 Jun;31(6):670–679.

Published In

Pharmacoepidemiol Drug Saf

DOI

EISSN

1099-1557

Publication Date

June 2022

Volume

31

Issue

6

Start / End Page

670 / 679

Location

England

Related Subject Headings

  • Sertraline
  • Selective Serotonin Reuptake Inhibitors
  • Retrospective Studies
  • Renal Dialysis
  • Proton Pump Inhibitors
  • Pharmacology & Pharmacy
  • Humans
  • Escitalopram
  • Death, Sudden, Cardiac
  • Citalopram