Cipramil pills 20 mg 28 pcs
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Active ingredients
Citalopram
Release form
Pills
Composition
Active ingredient: Citalopram (Citalopram) Active ingredient concentration (mg): 20
Pharmacological effect
Antidepressant. selectively inhibits serotonin reuptake; increases the concentration of neurotransmitter in the synaptic cleft, strengthens and prolongs the action of serotonin on postsynaptic receptors. escitalopram practically does not bind to serotonin (5-ht), dopamine (d1 and d2) receptors, α-adreno-, m-cholinergic receptors, and also to benzodiazepine and opioid receptors. The antidepressant effect usually develops after 2-4 weeks. after starting treatment. The maximum therapeutic effect of treating panic disorders is reached approximately 3 months after the start of treatment.
Pharmacokinetics
Suction does not depend on food intake. Bioavailability - 80%. The time to reach Cmax in plasma is 4 h. The kinetics of escitalopram is linear. Css is reached after 1 week. The average Css is 50 nmol / l (from 20 to 125 nmol / l) and is achieved at a dose of 10 mg / day. Seeming Vd - from 12 to 26 l / kg. Plasma protein binding - 80%. Metabolized in the liver to active demethylated and dimethylated metabolites. After repeated use, the average concentration of demethyl and dimethylmetabolites is 28–31% and less than 5%, respectively, of the concentration of escitalopram. The metabolism of escitalopram with the formation of a demethylated metabolite occurs mainly with the participation of the isoenzymes CYP2C19, CYP3A4 and CYP2D6. In persons with a weak activity of the CYP2C19 isoenzyme, the concentration of escitalopram can be 2 times higher than in individuals with a high activity of this isoenzyme. Significant changes in the concentration of the drug with a weak activity of the isoenzyme CYP2D6 is not observed. T1 / 2 after repeated use - 30 h. The major metabolites of escitalopram T1 / 2 are longer. Clearance - 0.6 l / min. Escitalopram and its major metabolites are excreted by the liver and most of it by the kidneys, partially excreted in the form of glucuronides. T1 / 2 and AUC increases in elderly patients.
Indications
Therapy of depression of various etiologies and structures in adults. Treatment of panic disorder with / without agoraphobia. Treatment of obsessive compulsive disorder (OCD).
Contraindications
CYPRAMIL is contraindicated in case of hypersensitivity to citalopram or any of the excipients. The drug should not be used in combination with monoamine oxidase inhibitors (MAO), including selegiline, and also for 14 days after stopping their administration. Treatment with MAO inhibitors can be started no earlier than 7 days after discontinuation of CYPRAMIL. Do not assign TsIPRAMIL to pregnant and lactating women, if the potential clinical benefit does not prevail over the theoretical risk, since safety of the drug during pregnancy and lactation in humans has not been established.
Precautionary measures
Keep out of the reach of children.
Use during pregnancy and lactation
Contraindicated use during pregnancy and lactation (breastfeeding).
Dosage and administration
Cipramil is administered orally once a day. The drug can be taken at any time of the day, regardless of the meal. Tablets of 20 and 40 mg can be divided in half. Depression: treatment of depression starts with taking 20 mg of CYPRAMIL per day. Depending on the individual response of the patient and the severity of depression, the dose may be increased to a maximum of 60 mg per day. Panic disorder: during the first week of treatment, a dose of 10 mg CYPRAMIL per day is recommended, then the dose is increased to 20 mg per day. The daily dose, depending on the individual response of the patient, can be further increased. The maximum dose is 60 mg / day. Obsessive compulsive disorder: the initial dose of CYPRAMIL is 20 mg per day. If necessary, the dose may be increased. The maximum dose is 60 mg per day. Elderly patients (over 65). The recommended daily intake for the elderly is 20 mg. Depending on the individual response and the severity of depression, the dose may be increased to a maximum of 40 mg per day. In case of hepatic insufficiency, the use of the drug should be limited to the minimum recommended doses. The maximum dose is 30 mg per day. With small and moderate renal insufficiency, dose adjustment is not required.
Side effects
The unwanted effects of CIPRAMILA are transient in nature and weakly expressed. They are observed during the first one to two weeks of treatment and usually weaken significantly as the condition of the patients improves. Perhaps the appearance of dry mouth, nausea, drowsiness, weakness, increased sweating, tremor, agitation, insomnia, diarrhea, sexual dysfunction.CYPRAMIL may cause a slight decrease in heart rate, which usually has no clinical significance. However, in patients with initially low heart rate, this can lead to bradycardia. In exceptional cases, the use of large doses of the drug may develop convulsive seizures. Extremely rarely, hyponatremia, manifestations of serotonin syndrome, withdrawal syndrome, extrapyramidal disorders, purpura can occur. With phase inversion and development of the manic state, CYPRAMIL should be canceled.
Overdose
Data on escitalopram overdose is limited, in many such cases there was an overdose of other drugs. In most cases, the symptoms of overdose do not manifest or are mild. Cases of overdose of escitalopram (without taking other drugs) with a fatal outcome are rare, in most cases there is also an overdose of other drugs. Symptoms: mainly from the central nervous system (from dizziness, tremor and agitation to rare cases of serotonin syndrome, convulsive disorders, coma ), from the gastrointestinal tract (nausea / vomiting), cardiovascular disease (hypotension, tachycardia, prolongation of the QT interval and arrhythmia) and electrolyte imbalance (hypokalemia, hyponatremia). Treatment: the specific antidote of the drug does not exist. It is necessary to ensure normal airway, oxygenation and ventilation of the lungs. It should hold a gastric lavage and assign activated charcoal. Gastric lavage should be carried out as soon as possible after taking the drug. It is recommended to monitor the performance of the heart and other vital organs and to carry out symptomatic and supportive therapy.
Interaction with other drugs
With simultaneous use with MAO inhibitors increases the risk of serotonin syndrome and serious adverse reactions. Combined use with serotonergic drugs (including tramadol, triptanami) can lead to the development of serotonin syndrome. When used simultaneously with drugs that reduce the threshold of convulsive readiness, increases the risk of seizures. Estsitalopram enhances the effects of tryptophan and lithium preparations, increases the toxicity of Hypericum drugs, the effects of drugs that affect clotting blood (control of blood coagulation indices is necessary). Drugs that are metabolized with the participation of the isoenzyme CYP2C19 (including omeprazole), as well as being strong inhibitors of CYPZA4 and CYP2D6 (includingFlekainid, propafenone, metoprolol, desipramine, clomipramine, nortriptilin, risperidone, thioridazine, haloperidol), increase the concentration of escitalopram in the blood plasma. Escitalopram increases the concentration of desipramine and metoprolol in plasma 2 times.
special instructions
Caution should be used in patients with renal insufficiency (CC less than 30 ml / min), hypomania, mania, with pharmacologically uncontrolled epilepsy, with depression with suicidal attempts, diabetes mellitus, in elderly patients, with cirrhosis of the liver, with a tendency to bleed, simultaneously with taking medications that reduce the threshold of convulsive readiness, causing hyponatremia, with ethanol, with drugs that are metabolized with the participation of isoenzymes of the CYP2C19 system. Escitalopram should be prescribed only es 2 weeks. after discontinuation of irreversible MAO inhibitors and 24 hours after cessation of therapy with a reversible MAO inhibitor. Non-selective MAO inhibitors can be prescribed no earlier than 7 days after withdrawal of escitalopram. In some patients with panic disorder, at the beginning of treatment with escitalopram, an increased anxiety may occur, which usually disappears within the next 2 weeks. treatment. To reduce the likelihood of anxiety, it is recommended to use low initial doses. Escitalopram should be canceled if epileptic seizures develop or their frequency increases with pharmacologically uncontrolled epilepsy. Escitalopram should be discontinued when a manic state develops. correction of doses of hypoglycemic drugs. Clinical experience of using escitalopram indicates a possible increased and the risk of suicidal attempts in the first weeks of therapy, and therefore it is very important to carefully monitor patients during this period. Hyponatremia associated with a decrease in the secretion of ADH, while receiving escitalopram, occurs rarely and usually disappears when it is canceled. With the development of serotonin syndrome escitalopram should be immediately canceled and symptomatic treatment prescribed. Impact on the ability to drive vehicles and control mechanisms. During the period of treatment, patients should avoid driving vehicles. ort and other activities that require high concentration and speed of psychomotor reactions.