Are severe fatigue and itching described as side-effects to citalopram treatment?/nA woman with a l

Fråga: Are severe fatigue and itching described as side-effects to citalopram treatment? A woman with a long history of depression was started on citalopram treatment, 10 mg daily for one week and thereafter 20 mg daily. The treatment was very successful and after 2-3 weeks the patient felt revealed of her melancholia for the first time in many years. At about the same time, she experienced itching, especially around the waistline. After four weeks of treatment, she got increasingly tired and the treatment had to be stopped after six weeks. The following week she became more alert, but the itching continued.

Sammanfattning: Both pruritus and fatigue have been reported as side-effects to citalopram treatment, as well as to other serotonin uptake inhibitors. With this case, the relation in time between effect and possible side-effects is unusual. A rechallenge may be tried, and citalopram concentration measured for furter information, even though no therapuetic interval has been established.

Svar: Citalopram, a selective serotonin uptake inhibitor, was registered in Sweden in October 1992. Until today, 249 possible side-effects have been reported to the Swedish Adverse Drug Reactions Advisory Committee (SADRAC) which most frequently included: nausea, headache and exanthema. Six cases of pruritus and five of fatigue have been reported. Itching began early in the course of treatment in four cases and was associated with swollen hands, feet or tongue in at least two of these. In one case, pruritus began when the dose was increased from 20 to 40 mg and resolved on lowering of the dose.

Pruritus has also been reported for paroxetine in seven patients - six of which had exanthema as well - and for fluvoxamine in eight patients. In four of these cases itching was localized to the the face, arms or palms. One patient had urticaria all over the trunk. In three cases no exanthema is reported and localisation of pruritus is not specified.

Fatigue is reported in three elderly patients on citalopram treatment: one 37-year-old woman on concommitant neuroleptic and anxiolytic treatment and one 45-year-old woman. Tiredness seems to have occurred early in treatment in all of these cases.

In the present case, severe fatigue occurred later in treatment and after a positive effect was seen on depressive symptoms. In the light of earlier reports and known pharmacological mechanisms, it seems less probable that the fatigue is caused directly by citalopram.

However, if no other reason for the symptoms is found, we recommend that this case be reported to SADRAC.