Can citalopram cause hair loss or hirsutism?/nThe question concerns a 75-year-old woman treated wit

Fråga: Can citalopram cause hair loss or hirsutism?

The question concerns a 75-year-old woman treated with citalopram 20 mgx1. She has been bothered with hair loss (from her head) and more hair growth in her face.

Other drugs: warfarin (Waran), diltiazem (Cardizem Retard) and atenolol.

Sammanfattning: Only two case reports of citalopram associated hair loss has been published in the literature. Looking at the whole group of SSRIs, some more reports have been found, and a connection cannot be ruled out. However, in the present case the patient was also treated with warfarin, which is known to cause hair loss. No reports of hirsutism have been found for any of the SSRIs.

Svar: One question of a 53-year-old woman treated with citalopram and risperidone who developed alopecia areata one month after initiating therapy has been published in Drugline (1). At that time, no other reports of citalopram induced hair loss had been published. For other serotonin uptake inhibitors (SSRIs), mostly fluoxetine, a few reports had been published (1, 2).

An updated literature search revealed only one additional case of hair loss in connection to citalopram treatment. A woman in her fifties was treated with citalopram for bipolar disorder. One month after increasing the dose from 20 mg/d to 40 mg/d she reported losing clumps of her hair while shampooing. After multivitamin treatment was started, the hair loss stopped (3).

No reports of hirsutism or virilism have been found for any of the SSRIs in Drugline, Medline or standard pharmacological literature.

In the Swedish adverse drug reaction register there are four reports of defluvium and one report of hypertrichosis on thighs and buttocks in connection to citalopram treatment (out of 942 reports). For the whole group of SSRIs there are 16 reports of defluvium/alopecia and three reports of hypertrichosis (out of 2289 reports) (4).

Warfarin is known to cause hair loss (5). In FASS it is listed as an unusual side effect, and in the Swedish adverse drug reaction register there are 20 reports of alopecia and 24 of defluvium (out of 1914 reports). Hair loss is also listed in FASS as an adverse effect of atenolol treatment, and seven reports of alopecia/defluvium were found in the Swedish adverse drug reaction register (out of 363 reports) (4, 6).

We recommend that this case should be reported to the regional adverse drug reaction monitoring centre.