Does the FDA's Celexa Warning Affect Lexapro?

Washington, DCThe US Food and Drug Administration (FDA) recently made an announcement regarding the use of Celexa in some patients, but that warning did not include information about potential Lexapro side effects, even though Lexapro is closely related to Celexa. Lexapro, an SSRI used to treat anxiety and major depressive disorder, is part of a class of drugs that has been linked to newborn birth defects including persistent pulmonary hypertension.

The FDA's announcement concerned Celexa, known generically as citalopram. Celexa is another SSRI and has reportedly been linked to an increased risk of potentially deadly changes to a patient's heart rhythm. The FDA recommends in its Drug Safety Communication (08/24/11) that Celexa not be used at doses greater than 40 mg per day, "because it can cause abnormal changes in the electrical activity of the heart." Furthermore, the FDA notes, studies have not shown a benefit to using doses higher than 40 mg per day. Celexa had previously been available to some patients at 60 mg per day.

Patients with congestive heart failure, congenital long QT syndrome, bradyarrhythmias, or predisposition to hypokalemia or hypomagnesemia are not recommended to use Celexa. Patients who are currently taking more than 40 mg daily doses of Celexa are advised to speak to their doctor about changing the dose.

The FDA made its announcement after studies found that patients who took 60 mg per day of citalopram had a higher risk of changes to the heart's electrical activity than patients who took a much lower dose or took a placebo. The label for Celexa is being changed to reflect the new information.

Lexapro, known generically as escilatopram, is similar to Celexa in chemical design. The FDA's announcement, however, did not mention Lexapro or whether the drug might have similar side effects to Celexa, indicating that current data does not suggest a link between Lexapro and the same heart problems.

Both Lexapro and Celexa are in a class of drugs known as selective serotonin reuptake inhibitors (SSRI) and both are manufactured by Forest Laboratories. Some SSRI medications were linked in a study to an increased risk of autism spectrum disorder. The study, published in the Archives of General Psychiatry (07/04/11) suggested that when women took an SSRI medication during the 12 months prior to delivery, they had double the risk of having a baby diagnosed with autism spectrum disorder compared with mothers who did not take an SSRI. When the SSRI was taken during the first trimester of pregnancy, the risk quadrupled.

That study did not specifically mention Lexapro but did include other drugs in the SSRI class.