Research

Use of venlafaxine compared with other antidepressants and the risk of sudden cardiac death or near death: a nested case-control study

BMJ 2010; 340 doi: 10.1136/bmj.c249 (Published 5 February 2010)
Cite this as: BMJ 2010;340:c249
  1. Carlos Martinez, adjunct professor1, consultant epidemiologist2,
  2. Themistocles L Assimes, assistant professor of medicine3,
  3. Daniel Mines, pharmacoepidemiologist4,
  4. Sophie Dell’Aniello, research assistant1,
  5. Samy Suissa, professor and director1
  1. 1Centre for Clinical Epidemiology, Jewish General Hospital, and Departments of Epidemiology and Biostatistics and of Medicine, McGill University, Montreal, Canada
  2. 2Carlos Martinez, Frankfurt, Germany
  3. 3Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
  4. 4Wyeth Research, Philadelphia, USA
  1. Correspondence to: S Suissa, Centre for Clinical Epidemiology, Jewish General Hospital, 3755 Cote Ste-Catherine, Suite H4, Montreal, Québec, Canada H3T 1E2 samy.suissa{at}mcgill.ca
  • Accepted 25 November 2009

Abstract

Objective To assess whether use of the antidepressant venlafaxine is associated with an increased risk of sudden cardiac death or near death compared with other commonly used antidepressants.

Design Population based observational study.

Setting We did a nested case-control analysis within a new user cohort formed using the United Kingdom General Practice Research Database.

Participants New users of venlafaxine, fluoxetine, citalopram, or dosulepin on or after 1 January 1995, aged 18 to 89 years, with a diagnosis of depression or anxiety. Participants were followed-up until February 2005, or the occurrence of sudden cardiac death or near death, identified from medical records indicating non-fatal acute ventricular tachyarrhythmia, sudden death due to cardiac causes, or out of hospital deaths from acute ischaemic cardiac events. For each case, 30 controls were selected matched for age, sex, calendar time, and indication. We used conditional logistic regression to calculate the adjusted odds ratio of sudden cardiac death or near death associated with current use of venlafaxine compared with current use of fluoxetine, citalopram or dosulepin.

Results 207 384 participants were followed-up for an average of 3.3 years. There were 568 cases of sudden cardiac death or near death, which were matched to 14 812 controls. The adjusted odds ratio of sudden cardiac death or near death associated with venlafaxine use was 0.66 (95% confidence interval 0.38 to 1.14) relative to fluoxetine use, whereas compared with citalopram it was 0.89 (0.50 to 1.60) and with dosulepin 0.83 (0.46 to 1.52).

Conclusions In this large, population based study, the use of venlafaxine was not associated with an excess risk of sudden cardiac death or near death compared with fluoxetine, dosulepin, or citalopram, in patients with depression or anxiety.

Footnotes

  • Contributors: CM, DM, SS were responsible for the conception and design of the study. SD was responsible for the statistical analysis. CM and TA adjudicated cases of non-fatal ventricular arrhythmias. All authors contributed to the interpretation of results and manuscript preparation and granted final approval of this report. CM and SS are guarantors.

  • Funding: This study was sponsored by Wyeth, which produces and markets venlafaxine. The contract for this research specified that the non-company authors had ultimate control over all aspects of the study, including control over publication. During the course of the study, however, any differences about the presentation or interpretation of findings that arose between the company author and external investigators were resolved through honest scientific debate. All authors had access to the statistical reports and tables supporting the publication.

  • Competing interests: DM is a employee of Wyeth and owns company stock options. SS has participated in advisory board meetings and conferences, participated as a speaker in scientific meetings by various companies (AstraZeneca, Boehringer Ingelheim, Glaxo SmithKline, Pfizer, and Sepracor), and received research grants from AstraZeneca, Wyeth, and GlaxoSmithKline. TA, SD, and CM have nothing to declare.

  • Ethical approval: The study protocol was approved by the Independent Scientific Advisory Committee for GPRD studies (Protocol 06_054).

  • Data sharing: Read/OXMIS code lists used to identify outcomes are available from the corresponding author at samy.suissa{at}mcgill.ca.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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