Pyschonephrology

Journal Article Annotations
2022, 2nd Quarter

Pyschonephrology

Annotations by Sahil Munjal, MD
July, 2022

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

PUBLICATION #1 — Pyschonephrology

Proton pump inhibitors may enhance the risk of citalopram- and escitalopram-associated sudden cardiac death among patients receiving hemodialysis.
Magdalene M Assimon, Patrick H Pun, Sana M Al-Khatib, M Alan Brookhart, Bradley N Gaynes, Wolfgang C Winkelmayer, Jennifer E Flythe

Annotation

The finding:
In this retrospective cohort study analysing a national database, authors report an increased risk of sudden cardiac death (SCD) in haemodialysis patients on citalopram/escitalopram with concurrent PPI (Proton Pump Inhibitor) use. Compared with sertraline initiators not using a PPI, citalopram/escitalopram initiators using a PPI had the highest risk of SCD (weighted HR [95% CI] = 1.31 [1.11–1.54]), followed by citalopram/escitalopram initiators not using a PPI (1.22 [1.06–1.41]). Sertraline initiators using versus not using a PPI had similar risks of SCD (1.03 [0.85–1.26]).

Strength and weaknesses:
Secondary outcomes as well as several sensitivity analyses showed consistent results.  Residual confounding may remain, and there is a risk of misclassifying PPI exposure because various PPIs are available over the counter.

Relevance:
patients. This study highlights the pharmacokinetic and pharmacodynamic drug interactions of citalopram/escitalopram with concurrent PPIs in haemodialysis patients. PPIs are competitive inhibitors of the cytochrome P450 2C19 isoenzyme and can increase citalopram/escitalopram levels 50% to 120%. PPIs can also induce hypomagnesemia which can prolong the QT. In these patients, authors suggest conducting a baseline EKG prior to medication initiation and monitoring every 3 to 6 months. Sertraline may be a safer choice in such situations.

Type of study:
Cohort study