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The Medicines and Healthcare products Regulatory Agency (MHRA) has recalled a batch of a commonly prescribed antidepressant as a precautionary measure after an error at the manufacturing site led to the wrong drug being included in a pack.
In a class two recall notice published on 28 April 2026, the MHRA said that a pack of sertraline 100mg film-coated tablets (batch number V2500425) — manufactured by Amarox Limited — has been found to contain one blister strip of citalopram 40mg film-coated tablets inside the sealed carton.
Following the publication, some community pharmacies have called for compensation from manufacturers to reimburse their time spent managing recalls.
The error appears have occurred during secondary packaging of the blister strips into the cartons, as both products were manufactured at the same site, the recall notice said.
The report also added that a patient affected by the error reported an adverse event of headache. According to the recall notice, the affected batch was first distributed on 28 November 2025.
The MHRA has instructed pharmacists to stop supplying the affected batch immediately, quarantine all remaining stock and return it to the supplier.
If possible, pharmacists should identify and immediately contact all patients who have been dispensed the impacted product and ask them to return any remaining stock, the recall notice added.
The notice warned that patients who have consumed the citalopram may experience increased serotonergic effects, which can occur following overexposure to selective serotonin re-uptake inhibitors. The notice listed patients with pre-existing cardiac conditions, those aged over 65 years, or those taking concomitant serotonergic or QT prolonging medication as being at increased risk.
“Additionally, as some patients may require monitoring, including patients [aged] over 65 years old or under 18 years old, those with hepatic impairment and individuals who are known to be, or predicted to be a poor metaboliser for CYP2C19 substrates, and therefore, other clinicians and healthcare professionals may need to be involved,” it said.
Pharmacy teams should prioritise contacting patients dispensed the item in the last 28 days, as the majority of the affected stock was distributed in 2025, “and therefore it is expected that many of these packs will have been dispensed to patients and consumed”, it added.
The recall notice also noted that the patient who experienced a headache found that it was resolved upon discontinuation; however, patients who experience adverse reactions should seek medical attention and report symptoms to the MHRA Yellow Card scheme.
Commenting on the recall, Henry Gregg, chief executive of the National Pharmacy Association, said: “This has potentially serious consequences for patients and is deeply frustrating for pharmacies.
“Hard-pressed pharmacy teams spend hours of their time contacting patients who have received these prescriptions, as well as quarantining stock, time they could be spending delivering patient care instead.
“Pharmacies, who bare the brunt of any recall, should be reimbursed for the cost of these mistakes by the manufacturers who make them.”
