Citalopram 20mg Danapha treats depression, panic disorders (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Citalopram
Ingredient Danapha

Ingredient

Composition information	Content
Citalopram	20mg

Uses

Indications

treatment of early stage depression, maintenance treatment for recurrence.

Treatment of panic disorders with or without fear of the crowd.

Pharmacokology

citalopram is an antidepressant that has a strong inhibition effect and selects serotonin absorption. The ability to inhibit the serotonin absorption of citalopram is not caused by long -term treatment. Citalopram almost does not affect the absorption of Noradrenalin, dopamine and gamma aminobutyric acid of nerve cells.

Contrary to many three -round antidepressants and some newer SSRIs, citalopram does not have or have very low affinity with other receptors such as cholinergic resistance, adrenergic resistance, antihistamine, benzodiazepine and opioid receptors, so citalopram causes less traditional side effects such as dry mouth, bladder disorders and intestinal, matte stand.

The main metabolites of citalopram are also selective inhibitors of serotonin absorption, although the rate is effective and lower selective. However, the selective rate of metabolites is still higher than that of many newer SSRIs. The metabolites do not produce anti -depression effects.

citalopram does not reduce awareness and ability to exercise, without or have very little sedative properties, both when used alone or in combination with alcohol.

citalopram does not reduce the amount of saliva, does not affect cardiovascular parameters, does not affect the level of prolactin and growth hormone.

pharmacokinetics

absorption:

citalopram is quickly absorbed in the digestive tract after drinking, reaching a maximum concentration after 3.8 hours. The absorption is almost completely, oral bioavailability is about 80 %, the food does not affect the absorption process of the drug.

Distribution:

The volume of distribution and about 12.3 l/kg. The ability to bind to plasma proteins must not exceed 80 % for citalopram and its metabolites.

Metabolism:

citalopram is converted into active forms such as Demethylcitalopram, Didemethylcitalopram, Citalopram-N-OXID and a nhz reduction of propionic acid inactive. Active metabolites are also SSRIs but weaker than the original compound. Citalopram is originally the main compound in plasma.

The metabolic enzyme is CYP2C19.

Era:

The sale time of citalopram is about 1.5 days. Citalopram is excreted mainly through the liver (85 %), the rest through the kidneys. About 12 % of daily dose is excreted in urine in the original form. The clearance of the liver is about 0.35 l/min, the kidney is about 0.068 l/min. Stable drug concentration is achieved in 1-2 weeks. At daily doses of 40 mg, the average plasma concentration in plasma is about 250 - 300 nmol/l. There is no clear connection between plasma cymopram concentration with treatment or side effects.

In elderly patients, increased waste sale time and decreased clearance due to decrease in metabolic rate.

citalopram is eliminated slower in patients with impaired liver function. The sale time is about 2 times longer and the drug concentration is stable at a certain dose 2 times higher than in patients with normal liver function.

citalopram is eliminated more slowly in patients with a mild to moderate renal function, but there is no great impact on the pharmacokinetics of the drug. There is no information on treatment in patients with severe impaired renal function (CLCR

Before taking Citalopram 20mg Danapha treats depression, panic disorders (3 blisters x 10 tablets)

How to use

citalopram should take a single dose of the day, drink in the morning or evening, not care about the amount of food.

Dosage

depression

The recommended dose is 20 mg/day. Typically, the patient's improvement begins after 1 week of treatment but clearly indicates that at the 2nd week. If after a few weeks of recommendations do not respond, the dose can be increased to 40 mg/day depending on the response of the patient.

Dose adjustment should be done carefully in each patient, to maintain at the lowest dose effectively.

Patients with depression should be treated for at least 4-6 months to ensure no more symptoms.

Panic disorders

The starting dose of 10 mg/day, increasing gradually every 10 mg depending on the patient's response. The recommended dose is 20 - 30 mg/day. The low starting dose is recommended to minimize the deterioration of panic symptoms, which often occur early during this disorder treatment.

Although there is a higher side effect, if after a few weeks of treatment with the recommended dose is not responded, it may increase the dose to up to 40 mg/day depending on the patient's response. Adjusting the dose should be done carefully in each patient, to maintain at the lowest dose effectively.

Children and adolescents (

citalopram should not be used in treatment for children and minors under 18 years of age.

Elderly patients (65 years old)

For elderly patients, the dose should be reduced to half of the recommended dose.

Maximum dose recommended for the elderly is 20 mg/day.

Liver function reduction

The initial dose is 10 mg daily in the first two weeks of treatment recommended in patients with mild or medium liver failure. Depending on the response of each patient, the dose may increase to a maximum of 20 mg/day. Caution should be careful and carefully increased the dose in patients with serious impaired liver function.

Person of renal function

Dosage adjustment is unnecessary in case of mild or medium renal failure.

There is no information in case of severe renal failure (creatinine clearance

Symptoms of lack of drugs occur when stopping citalopram

Avoid sudden coding citalopram. When stopping treatment with citalopram, the dose should gradually reduce the dose for at least 1 to 2 weeks to reduce the risk of lack of drugs. If the symptoms cannot be tolerated after a decrease in the dose or stopping the drug, the re -use of the previous dose may be considered. The doctor may then reduce the dose, at a slower speed.

Poor metabolism CYP2C19

The initial dose is 10 mg daily in the first two weeks of treatment recommended for patients to be known to be poor metabolism for CYP2C19. The maximum to 20 mg/day can be increased depending on the response of each patient.

What to do when overdose?

Symptoms

convulsions, vomiting, tremor, cardiac arrest, agitation, hypertension, pupils, torsion, stunning, sweating, cyanosis, arrhythmia, nausea, dizziness, fast heartbeat, drowsiness may occur. At higher doses, convulsions may occur within hours after drinking. Increasing ventilation, high fever, coma has been reported. Prolonging QT interval, wide QRS complex can occur, pattern pattern rarely occurs. Death has been reported.

prolonged slow heart rate with severe hypotension, fainting is also reported.

Serotonin syndrome rarely occurs in severe poisoning.

Handling

There is no specific antidote, electrocardiogram and the signs of life that need to be monitored.

Activated carbon, osmotic laxative and gastric laxative should be considered. Use activated carbon 30 minutes after taking citalopram, reducing drug absorption by 50 %.

Intentication if the patient is impaired.

Controlling convulsions with intravenous diazepam if convulsions often or prolonged.

Monitoring the electrocardiogram in case of overdose in patients with congestive heart failure, slow heart rate, patients use simultaneously the drug extends the QT distance or in patients with metabolic changes such as liver failure.

What to do when you forget 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double dose to compensate for missed dose.

Side Effects

Side effects of citalopram are usually light and transient. The most prominent in the first 1 or 2 weeks of treatment and usually reduced later. Common reactions after a response: nausea, drowsiness, dry mouth, insomnia, diarrhea, fatigue, increased sweating, trembling.

Compared to three -round antidepressants, the incidence of side effects occurs with lower citalopram. The lack of drugs has been reported: dizziness, paresthesia, headache, anxiety, nausea.

Most of the drug shortages are not serious and self -limit.

The harmful reactions of the drug are grouped by frequency and conventions as follows: Very common (ADR> = 1/10), common (1/100

ADR ADR is very common Weight Increase the appetite
weight gain blood sodium hypoglycet

Insomnia

Headache

Run

Perpetual

Dizziness

Attention disorders

Faint

unconscious

Severe epileps

movement disorders

Disorders of taste

Nausea

diarrhea

vomiting

Constipation

urticaria

rash

Bleva board

Light sensitive reaction

Reduce libido

Anxiety

Stress

Confusion state

Causes

Loss of personality

Illusion

Heart

heart

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

Contraindicated

Hypersensitivity to citalopram and the ingredients of the drug.

Patients are taking Mao inhibitors (using these two drugs must be at least 2 weeks apart).

Citalopram is contraindicated in combination with Linezolid unless it is closely monitored and monitoring blood pressure.

Contraindicated in patients extending the QT range or congenital QT syndrome.

Contraindications for drugs is considered to extend the QT range such as anti -arrhythmia group IA and III, anti -psychotic drugs (for example, phenothiazin derivatives, pimozid, haloperidol), three -round antidepressants, antibiotics such as sparfloxacin, moxifloxacin, erythromycin IV, Pentamidin, Halofantrin Antihistamines (Astemizol, Mizolastin).

Be cautious when using

children and teenagers under 18 years of age: Do not use citalopram in children and teenagers under 18 years of age because of increased risk of acts related to suicidal and anti -opposition. If based on clinical, treatment decisions are still implemented, patients should be carefully monitored the symptoms of suicide.

Be cautious when using citalopram in the elderly, people with impaired liver and kidney function.

Panic disorders: Some patients with panic disorders may experience intensified anxiety at the beginning of treatment with antidepressants. This reaction usually drops within the first two weeks of starting treatment. Low starting dose is recommended.

Hypotenia hyponatremia, which may be due to the inappropriate anti -hormone hormone (SIADH) has been reported as a rare adverse reaction when using SSRI drugs and often reversed when stopped treatment. Elderly female patients are people with particularly high risk.

The risk of suicide may increase in the early stages of recovery. It is necessary to closely monitor patients, especially those at high risk, in the early treatment stage and change the dosage.

Mental insecurity: The use of SSRI/SNRI drugs is associated with the development of insecurity, characterized by restlessness, discomfort, and standing still. This may occur within the first few weeks of treatment. In patients with these symptoms, increasing the dose may be harmful.

citalopram should be used carefully in patients with a history of manic/mild manic.

citalopram should be stopped in any patient entering a mighty stage.

Caution for patients with a history of epilepsy. Citalopram should stop in any patient appearing seizures.

citalopram may change blood sugar control in diabetics. Insulin or dosage of hypoglycemic medication may need to be adjusted.

Caution in patients with glaucoma or a history of glaucoma.

Serotonin syndrome rarely occurs: agitation, tremor, muscle vibration, body temperature can be a manifestation of this condition. Citalopram immediately and start symptomatic treatment.

Do not simultaneously use citalopram with drugs that have serotonin effects such as sumatriptan, tramadol, oxitriptan, tryptophan.

The risk of gastrointestinal bleeding can increase in the elderly when treated with SSRI, especially when used simultaneously with drugs known to affect platelet function such as anti -psychotic drugs, phenothiazine, three -round antidepressants, aspirin, nsaid, ...

ECT: Caution.

Not simultaneously used Citalopram and preparations containing St. John's Wort.

Symptoms of drug shortage when stopping treatment are quite common, especially if sudden stopped. Common reactions: dizziness, sensory disorders, sleep disorders, agitation, anxiety, nausea, vomiting, tremor, sweating, diarrhea, headache, chest drum, visual disorders.

Mental disorders: Treatment of mental illness combined with depression may increase symptoms of psychosis.

extends the QT interval: the concentration of auxiliary metabolites (DidemethylcitalPram) Theoretically can cause a long -distance QT in patients at risk, patients with congenital QT syndrome or in patients with hypoglycemia/hypoglycemia. Monkey monitoring is recommended in case of overdose or metabolic disorders such as liver failure.

Caution in patients with heartbeat slow, patients with acute myocardial infarction or loss of heart failure.

electrolyte disorders such as hypotension, blood magomesi increases the risk of malignant arrhythmia.

Need to handle before treatment with citalopram.

For cardiovascular patients being treated stably, checking the electrocardiogram before starting treatment. If signs of arrhythmia occur when treated with citalopram, the treatment should be stopped.

The drug contains lactose, so if the patient has a rare genetic problem such as galactose intolerance, lactase deficiency, or poor absorption of glucose-galactose, it should not be used.

The drug contains Sunset Yellow Lake, Tartrazin Yellow Lake can cause allergic reactions.

The effect of the drug on the ability to drive and operate machinery

citalopram has a slight or medium impact on the ability to drive, operate machinery and people working on high. Psychotropic drugs can reduce the ability to make judgments and react to emergency situations. Need to be cautious for drivers, operating machines and people working on high.

Using drugs for women during pregnancy and lactation

Pregnancy:

A large number of data on pregnant women shows that citalopram does not cause fetal malformations. Citalopram may be used during pregnancy if necessary in terms of clinical. Babies should be observed if mothers use citalopram in the later stage of pregnancy, especially in the last three months. Avoid stopping the drug suddenly during pregnancy.

The following symptoms can occur in newborns after mothers use SSRI/SNRI in the later period of pregnancy: respiratory failure, cyanosis, apnea, convulsions, body temperature unstable, difficult to eat, vomiting, hypoglycemia, increase/decrease, increase reflexes, tremble, restless, uncomfortable, indifferent, non -stop crying, sleepy and difficult to sleep. These symptoms may be caused by serotonin syndrome or drug condenser symptoms. In most cases, complications started immediately or early (

Epidemiological data has shown that the use of SSRIs during pregnancy, especially at the end of pregnancy, may increase the risk of persistent lung hypertension in infants (PPHN).

Breastfeeding period:

citalopram is excreted into breast milk (about 5 %). There is currently not enough information to assess risks for children. Caution should be used when used in breastfeeding women.

Drug interaction

Unbeliminated citalopram with monoamine oxidase inhibitors because it can cause serious side effects, including serotonin syndrome. Cases of serious reactions, sometimes fatal caused.

Simultaneous use of 40 mg/day Citalopram and single dose Pimozid 2 mg, increasing the AUC, CMAX of pimozid and extending QT. Contraindicated for combination Citalopram and Pimozid.

Simultaneous use of citalopram with lithium or tryptophan increases blood concentration.

Need to be cautious, monitor the level of lithium in the blood.

Use citalopram with serotonin release stimulants such as tramadol, sumatriptan that can cause serotonin energy syndrome. Unable to simultaneously use Citalopram and these drugs.

Concentrated with blood hypokalemia, blood hypoglycemia increases the risk of malignant arrhythmia.

citalopram reduces seizures. Caution should be taken when used simultaneously with drugs that are likely to lower seizures such as antidepressants, nerve drugs (Butyrophenon, thioxanthin), Mefloquin, Bupropion and Tramadol.

citalopram inhibits weak CYP 2D6, does not exclude interactive when used simultaneously with metabolic drugs thanks to this enzyme.

Be cautious when used simultaneously with CYP 2C19 inhibitors (Omeprazol, Esomeprazol, Fluvoxamin, Lansoprazol, Ticlopidin) or cimetidine because it can increase the citalopram level in plasma.

Storage

Leave a cool place, avoid light, temperature below 30⁰C.

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