Does Citalopram cause photosensitivity? (+2 precautions)

In this article, we will discuss whether Citalopram causes photosensitivity. We will also explore the mechanisms of photosensitivity associated with Citalopram, its symptoms, management, and the precautions that should be taken to avoid it.

Does Citalopram cause photosensitivity?

Yes, Citalopram does cause photosensitivity. However, the photosensitive reaction associated with Citalopram is not very frequent (1). During post-marketing evaluation, it was observed that photosensitivity associated with Citalopram occurred only in 1 out of every 100 to 1 out of every 1,000 patients. (2).

Drug-induced photosensitivity refers to the development of skin disease due to chemical agents or sunlight exposure. 8% of all the cases of cutaneous adverse effects were reported to occur during the use of drugs. Drugs that are associated with photosensitivity include (3,4):

• Antibiotics.
• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Cardiovascular drugs.
• Anti-hyperlipidemic drugs.
• Anti-fungals.
• Anti-malarials.

In addition to Citalopram, the other SSRIs that have the potential to cause photosensitivity include Paroxetine, Fluvoxamine, Fluoxetine, Sertraline, and Escitalopram (4).

Citalopram-induced photosensitivity: a case report

There are a limited number of cases that report Citalopram-induced photosensitive reactions. One such case includes a 71-year-old woman who had been prescribed Citalopram to manage major depressive disorder. Initially, she was prescribed a dose of 10 mg/day (5).

The woman developed a rash three days after taking Citalopram, which was resolved using a cortisone cream within two weeks. As her depression got better, she discontinued Citalopram for three months. Her depression worsened during this period, and Citalopram was reinitiated at 20 mg/day (5).

After two days of taking Citalopram at 20 mg/day, the woman developed fever, malaise, itching, erythema with infiltration, and blisters all over her trunk. The woman was diagnosed with SCLE (subacute cutaneous lupus erythematosus) (5).

Based on the laboratory findings, it was suggested that SCLE was associated with using Citalopram. Therefore, Citalopram was discontinued, and within two weeks, her symptoms improved. The woman’s medication was changed to Mirtazapine to effectively manage the symptoms of depression. (5).

Mechanism of Citalopram-induced photosensitivity

The mechanism of Citalopram-induced photosensitivity involves transporting one of the metabolites of Citalopram into the skin cells. This results in the formation of a photosensitive complex. This complex causes damage through the following pathways (5):

• This photosensitive complex activates upon exposure to UV light, causing cellular damage. 
• Triggering the release of interleukin-1 and tumor necrosis factor-alpha leading to cell degeneration.
• The complex also leads to autoimmunity by translocating the Ro/SSA antigen and causing surface expression in keratinocytes.

All these pathways ultimately lead to apoptosis of the skin, thus resulting in photosensitive skin reactions.

Symptoms of Citalopram-induced Photosensitivity

Erythema is one of the most common symptoms of drug-induced photosensitivity. However, other diagnostic symptoms of Citalopram-induced photosensitivity include the following (4):

• Pustules.
• Eczematous eruption.
• Edema.
• Brownish-black pigmentation.
• Itching.

It is recommended to immediately contact your healthcare provider if you experience any of the symptoms mentioned above while using Citalopram or any other SSRI agent.

During the physical examination of patients with photosensitivity, it is observed that body areas that are more exposed to the sun, such as the face, neck, forearm, and hands, show more damage. While the non-sun-exposed areas, like breasts and genitalia, remain unaffected (3).

How to manage Citalopram-induced photosensitivity?

If you develop photosensitivity while using Citalopram, your healthcare provider will take the following measures to manage it:

• Discontinuing the photosensitive drug will ultimately resolve the symptoms of the photosensitive reaction.
• Your healthcare provider will switch you to an antidepressant other than an SSRI, as most SSRIs are associated with photosensitivity.
• For some reason, if you cannot discontinue Citalopram, your healthcare provider will prescribe you a topical steroid to manage the symptoms of photosensitivity.

Precautions to avoid Citalopram-induced photosensitivity

It is recommended to take the following precautions to prevent photosensitivity while taking Citalopram:

• Citalopram-induced photosensitivity is dose-dependent; therefore, it is recommended that your healthcare provider prescribe you the lowest possible dose of Citalopram to prevent a photosensitive reaction.
• It is recommended to avoid direct sun exposure while using Citalopram or any other photosensitive drug.
• Wear sunscreen on UV-exposed areas to prevent the photosensitivity associated with Citalopram.
• It is also recommended to wear protective clothing to avoid skin exposure to UV radiation.

Other skin-related adverse effects of Citalopram

There are several cutaneous adverse effects reported with the use of Citalopram. Some of them are listed below (2):

• Rash.
• Pruritus.
• Urticaria.
• Acne.
• Eczema.
• Alopecia.
• Dry skin.
• Psoriasis.

Some adverse effects, like rash and pruritus, are more common with the use of Citalopram, while the rest of the side effects are less frequent and may occur in some individuals (2).

Therefore, it is recommended to be aware of all these adverse effects of Citalopram and immediately report to your healthcare provider if you experience any of them.

Conclusion

In this article, we have discussed “Does Citalopram cause photosensitivity?” We have also discussed the mechanism of photosensitivity associated with Citalopram, its symptoms, management, and the precautions that should be taken to avoid it.

References