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Cipramil (Citalopramum, Citalopram) - is an antidepressant, a selective serotonin reuptake inhibitor (SSRI).
Pharmacodynamics. Cipramil has no or very poor ability to bind to a number of receptors, including histamine, muscarinic and adrenergic receptors. This is largely due to the lack of cardiotoxicity tsipramil and side effects in the form of orthostatic hypotension, sedation, dry mouth. Cipramil only to a very small extent it inhibits cytochrome R450IID6, and therefore does not interact with drugs metabolized by this enzyme.
The antidepressant effect usually develops after 2-4 weeks of treatment. Cipramil no influence on the conductive system of the heart and blood pressure, hematologic parameters, liver and kidney function, does not cause weight gain.
Pharmacokinetics. Bioavailability when administered citalopram is about 80%. Maximum plasma concentration is achieved 2-4 hours after administration. Protein binding - below 80%. Metabolism is accomplished by demethylation, deamination and oxidation. Unmodified citalopram base compound is in the blood plasma; its kinetics is linear. Constant plasma concentration is set after 1-2 weeks of treatment. The half-life of 1.5 days. Withdrawal is carried out with the urine and feces.
Cipramil 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 (MAOIs) including selegiline and for 14 days after cessation of administration. Treatment of MAO inhibitors can be started no earlier than 7 days after you stop taking Cipramil.
Cipramil should not be prescribed to pregnant and lactating women, if the potential clinical benefit prevails over theoretical risk, since safety of the drug during pregnancy and lactation has not been established in humans.
The risk of suicide is characteristic of depression and may persist until significant improvement, the come spontaneously or as a result of the therapy. Careful monitoring of patients being treated with antidepressants especially in early treatment because of the possibility of clinical deterioration and / or the emergence of suicidal events (thoughts and behavior). This precaution should be observed in the treatment of other psychiatric disorders because of the simultaneous disease depressive episode.
The use of SSRIs in the third trimester of pregnancy can have a negative impact on the psycho-physical development of the newborn. Registered by the following disorders in newborns whose mothers took an SSRI until delivery: irritability, tremor, hypertension, increased muscle tone, constant crying, difficulty sucking, poor sleep. Violations may indicate serotonergic effects or the occurrence of withdrawal syndrome. In the case of SSRI use during pregnancy should not be taking them abruptly interrupted.
Cipramil should be used with caution in patients whose activities are connected with machinery or a vehicle control. Cipramil does not diminish the intellectual capacity and speed of psychomotor reactions. However, it can be expected that the patients who received treatment TSIPRAMILOM, inherent in a decreased attention and concentration as a result of existing disease, the treatment, or both together.
Cipramil is prescribed once a day. The drug can be used at any time of the day regardless of the meal.
Depression: Depression therapy begins with receiving 20 mg Cipramil per day. Depending on the individual response of the patient and the severity of depression, the dose may be increased to a maximum - 60 mg per day.
Panic Disorder: during the first weeks of treatment is recommended dose of 10 mg per day tsipramil, then the dose increased to 20 mg per day. The daily dose, depending on the individual patient's response, can be further increased. The maximum dose - 60 mg / day.
Obsessive-compulsive disorder: an initial dose of Cipramil is 20 mg per day. the dose may be increased if necessary. The maximum dose - 60 mg per day.
Elderly patients (over 65 years). The recommended daily dose for the elderly is 20 mg. Depending on the individual response and the severity of depression, the dose may be increased to a maximum - 40 mg per day.
When liver failure receiving the drug should be limited to the minimum recommended dose. The maximum dose - 30 mg per day.
At low and moderate renal insufficiency correction dose is not required.
Cipramil Undesirable effects are transient in nature and are mild. They are observed within the first one or two weeks of treatment and usually substantially diminish with improvement of the patients.
Occurrence of dry mouth, nausea, drowsiness, weakness, sweating, tremor, agitation, insomnia, diarrhea, sexual disorders.
Cipramil can cause a slight decrease in heart rate, which usually has no clinical significance. However, patients with an initially low heart rate it may cause bradycardia. In exceptional cases, the use of large doses of the drug may develop seizures. Very rarely can occur hyponatremia, symptoms of serotonin syndrome, withdrawal symptoms, extrapyramidal disorders, purpura.
When phase inversion and the development of mania Cipramil should be abolished.
Chemically incompatible combination has been established.
Concomitant use of Cipramil and MAO inhibitors may cause hypertensive crises (serotonin syndrome).
Cipramil can enhance the effects of sumatriptan and other serotonergic drugs.
With simultaneous application of cimetidine causes a moderate increase tsipramil equilibrium concentration in the blood. Therefore, caution is advised when assigning maximum doses tsipramil simultaneously with high doses of cimetidine.
There was no interaction with lithium tsipramil and alcohol. However, the simultaneous use of Cipramil, and alcohol is not recommended.
Not established clinically significant pharmacokinetic interaction with phenothiazines and tricyclic antidepressants.
In clinical studies revealed no pharmacodynamic interaction Cipramil and benzodiazepines, neuroleptics, analgesics, lithium, antihistamine, antihypertensive agents, beta-blockers and other drugs kardiotropnyh.
Symptoms. The following signs and symptoms may occur: drowsiness, coma, articulation disorders, episodes of large seizures (grand mal), sinus tachycardia, sometimes nodal rhythm, sweating, nausea, vomiting, cyanosis, hyperventilation. The clinical picture is not characteristic.
Treatment. There is no specific antidote. Treatment is symptomatic and supportive. Following oral administration of Cipramil gastric lavage should be performed as soon as possible. Recommended medical surveillance.
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