Sertraline vs Citalopram
## Overview
Sertraline and citalopram are both first-line SSRIs in major guidelines, favored for their tolerability and minimal drug interactions. The key difference is citalopram's dose-dependent QTc prolongation, which limits its use in cardiac patients.
## Mechanism of Action
Both selectively inhibit SERT. Citalopram's R-enantiomer is pharmacologically inactive at SERT; only the S-form contributes. Both have minimal off-target effects.
## Pharmacokinetics
Sertraline: half-life 26 h, mainly CYP2C19/2C9/2D6/3A4 (no single enzyme dominant), minimal CYP inhibition. Citalopram: half-life 35 h, mainly CYP2C19, minimal CYP inhibition. Both are clean from a drug interaction standpoint.
## QTc and Cardiac Safety
The FDA's 2011 safety communication limited citalopram to 40 mg/day due to QTc-prolonging effects. This differentiates it from sertraline, which does not carry this restriction. In patients on other QTc-prolonging agents, citalopram should be used with caution. Sertraline is the preferred SSRI in cardiac patients who also require other medications that may affect QTc.
## Clinical Evidence
Both are recommended as first-line antidepressants by NICE, APA, and CANMAT guidelines. Sertraline has somewhat broader FDA indications (PTSD, PMDD), while citalopram is indicated only for MDD (FDA) though widely used off-label for anxiety.
## Key Takeaways
- Both clean from drug interaction standpoint
- Citalopram: QTc risk, dose limited to 40 mg; sertraline no QTc concern
- Sertraline: broader FDA indications, preferred in cardiac patients
- Citalopram: slightly longer half-life (35 vs. 26 h)
Kesimpulan
Both are excellent first-line SSRIs. Sertraline is preferred in patients with cardiac disease, those on other QTc-prolonging drugs, and when doses above 40 mg may be needed. Citalopram is a reasonable choice in standard-risk patients when slightly longer half-life is preferred.