"ESCITALOPRAM: PROLONGACIÓN DEL INTERVALO QT DEL ELECTROCARDIOGRAMA"
Nota informativa MUH (FV), 23 /2011
Una vez finalizada la evaluación de citalopram y su relación con la prolongación del intervalo QT del electrocardiograma (ECG) (ver nota informativa 19/2011 de la AEMPS
), se ha revisado la información disponible a este respecto para escitalopram, enantiómero de citalopram con indicaciones similares.En base a los resultados de la evaluación realizada, la AEMPS ha informado a los profesionales sanitarios de lo siguiente:
- Debido al riesgo de prolongación del intervalo QT del ECG a dosis altas, en pacientes mayores de 65 años, la dosis máxima recomendada de escitalopram pasa a ser de 10 mg al día.
- Se contraindica el uso de escitalopram en las siguientes situaciones:
- Pacientes con antecedentes de intervalo QT alargado o síndrome congénito del segmento QT largo.
- Uso concomitante con medicamentos con capacidad para prolongar el intervalo QT del electrocardiograma.
- Escitalopram se debe utilizar con precaución en pacientes en los que coexistan otros factores de riesgo de desarrollar Torsade de Pointes, por ejemplo aquellos con insuficiencia cardiaca congestiva descompensada, infarto de miocardio, bradiarritmias o predisposición a hipopotasemia o hipomagnesemia por enfermedad o medicación concomitante.
- Los médicos deberán reevaluar a los pacientes mayores de 65 años tratados con una dosis superior a la que acaba de ser establecida, e iniciar la reducción de la misma de modo gradual con el objeto de evitar la aparición de síntomas de retirada.
- Se debe informar a los pacientes para que:
- Contacten con su médico inmediatamente, si durante el tratamiento con escitalopram experimentan signos y/o síntomas relacionados con alteración de la frecuencia o el ritmo cardiaco.
- No interrumpan, modifiquen o reduzcan la dosis de escitalopram por su cuenta, sin consultar previamente a un médico.
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