Recommendation Against Continued Use: March 28, 2012
– Citalopram Hydrobromide (CELEXA®): new changes have been made to the citalopram
product label, specifically: ECG and/or electrolyte monitoring should be performed
in patients prescribed citalopram who have relative contraindications to citalopram
use, such as in those with comorbid conditions predisposing a risk of QT prolongation;
Previous label recommendations that “contraindicated” citalopram use in patients
with congenital QT syndrome because of the risk for QT prolongation have been changed
to less stringent terminology of “not recommended” to recognize patients with this
condition who could benefit from citalopram or who cannot tolerate other alternatives;
The maximum dose of citalopram remains at 20mg/day for patients greater than the
age of 60 years; Citalopram should be discontinued in patients with QTc measurements
persistently above 500ms.
The guideline describes the critical decision points in the Management of Concussion/mild Traumatic Brain Injury (mTBI) and provides clear and comprehensive evidence based recommendations incorporating current information and practices for practitioners throughout the DoD and VA Health Care systems. The guideline is intended to improve patient outcomes and local management of patients with concussion/mTBI.
Disclaimer:This Clinical Practice Guideline is intended for use only as a tool to assist a clinician/healthcare professional and should not be used to replace clinical judgment.