Reversal of citalopram-induced junctional bradycardia with intravenous sodium bicarbonate

• Published in: Pharmacotherapy Vol. 25; no. 1; p. 119
• Main Authors: Brucculeri, Michael, Kaplan, Joy, Lande, Leah
• Format: Journal Article
• Language: English
• Published: United States 01.01.2005
• Subjects: Aged; Aged, 80 and over; Arrhythmia, Sinus - chemically induced; Arrhythmia, Sinus - complications; Arrhythmia, Sinus - drug therapy; Bradycardia - chemically induced; Bradycardia - complications; Bradycardia - drug therapy; Citalopram - administration & dosage; Citalopram - adverse effects; Depression - diagnosis; Depression - drug therapy; Drug Overdose; Electrocardiography; Female; Humans; Injections, Intravenous; Sodium Bicarbonate - administration & dosage; Sodium Bicarbonate - pharmacokinetics; Sodium Bicarbonate - therapeutic use; Suicide, Attempted; Treatment Outcome
• ISSN: 0277-0008
• DOI: 10.1592/phco.25.1.119.55630

The cardiotoxicity of tricyclic antidepressants is a well-described phenomenon requiring serious consideration in patients who have taken an overdose. In patients who are at high risk for suicide attempts, selective serotonin reuptake inhibitors (SSRIs) were thought to constitute a safe alternative. However, evidence is accumulating that they, too, possess proarrhythmic properties, which must be reconciled in the setting of an overdose. An 82-year-old woman intentionally ingested citalopram 1.6 g. Several hours after presentation, she developed sinus arrest and junctional bradycardia that resolved after infusion of intravenous sodium bicarbonate solution. Thereafter, she demonstrated no further electrocardiographic abnormalities and was safely transferred to the psychiatry service without the need for a temporary transvenous pacemaker. The dramatic effect of the sodium bicarbonate on the arrhythmia represents a probable event according to the Naranjo probability scale. Intravenous sodium bicarbonate may serve as an effective antidote to SSRI-induced bradyarrhythmias.