Frågedatum: 2006-10-20
RELIS database 2006; id.nr. 23020, DRUGLINE
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Are photophobia and headache described as side effects of citalopram (Cipramil)? If they are, can a



Fråga: Are photophobia and headache described as side effects of citalopram (Cipramil)? If they are, can another antidepressant be suggested? The question concerns a man with depression (born 1978) who developed photophobia, but not mydriasis, and headache after increasing the dose of citalopram from 20 mg/d to 40 mg/d.

Sammanfattning: The evidence of citalopram causing photophobia is extremely limited and no evidence of citalopram causing headache more often than placebo has been found. Headache may occur as a withdrawal symptom though.

Svar: Headache is listed as a common side effect of Cipramil in Fass 2006 (1). When the pharmaceutical company Lundbeck was contacted about the evidence for this listing, the reply was that the incidence is not higher than placebo and it is not listed as a side effect in other countries (2). The text in Fass and in the SPC is going to be changed in the next edition. Headache is, according to Lundbeck, a withdrawal symptom and not a side-effect.

Some antidepressants are used in the treatment of headache and searching PubMed, eg. an article where mirtazapine is suggested for treatment of headache was found (3).

Regarding photophobia, little data was found. It is not mentioned in textbooks and we have found no articles in PubMed on the subject. In the Swedish adverse drug reaction register (4), there is only one report about photophobia for citalopram out of a total of 1095 reports. The information about the case is very limited but the patient had several symptoms including yawning, sweating, shivering, nausea, vomiting and photophobia for one day after the first dose of citalopram. The symptoms disappeared the next day. The causal relationship was judged possible. There are no reports of photophobia for other SSRI:s in the same register.

Searching WHO:s register of side-effects (5), reports of photophobia were found for all SSRI:s. The reports are often not judged as to the causal relationship. For citalopram there were 15 reports of photophobia out of a total of 11714 reports (0.1%). The relationship between reports of photophobia and total number of reports were similar for the other SSRI:s (fluoxetine 0.1%, fluvoxamine 0.07%, paroxetine 0.17%, escitalopram 0.001 % and sertraline 0.002%).

When discussing photophobia as a side effect of citalopram with Lundbeck (6), the reply was that it is not known as a side effect.

Other causes for the symptoms should be investigated but if the suspicion remains after consulting an opthalmologist and if the symptoms disappear when Cipramil is withdrawn, we recommend that the case is reported to the regional adverse drug reaction monitoring centre.

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