Citalopram Stella 20mg Treatment of severe depression, panic disorders (3 blisters x 10 tablets)

citalopram has almost no effect on the absorption of noradrenalin, dopamine and gamma-aminobutyric acid on nerve cells. Citalopram does not have, or have very little affinity with Cholinergic, Histaminergic and a range of adrenergic, serotonergic and dopaminergic receptors. Citalopram is two -round ISobenzophuran derivatives, which are not related to three -round antidepressants and four rounds or existing antidepressants. The main metabolites of citalopram also selectively inhibit the serotonin absorption at a lower level. Other metabolites are not reported to have antidepressant effects.

Dynamic pharmacy

citalopram is well absorbed through the gastrointestinal tract and the peak concentration in plasma reaches about 2-4 hours after drinking. Citalopram is widely distributed throughout the body; Less than 80% associated with plasma proteins. Citalopram is metabolized by demethylation, deaminization, and oxidation processes that produce active and non -activity metabolites. The demethylation process of citalopram produces the active metabolic substance is demethylcitalopram, thanks to the isoenzyme CYP3A4 and CYP2C19 of Cytochrom P450; The metabolism of citalopram also depends partly on CYP2D6. Didemethylcitalopram has also been identified as a metabolite of citalopram. The sale time of citalopram is about 36 hours. The drug is excreted mainly through the liver (85%), the rest through the kidneys. About 12% of daily dose is excreted in urine in constant form. Citalopram is distributed into breast milk at very low concentrations.

Elderly (≥ 65 years): Elderly people have longer -selling time and decreased clearance value due to reduction in metabolic speed.

Patients with impaired liver function: Citalopram is eliminated slower in patients with impaired liver function. Citalopram's waste time lasts about twice and the citalopram concentration in a stable state at the dose will be about twice in patients with normal liver function.

Patients with impaired renal function: Citalopram is eliminated slower in patients with mild to medium impaired renal function, without any great impact on the pharmacokinetics of citalopram. Currently there is no information on treatment for patients with severe renal function (creatinine clearance

Notify the physician with unwanted effects when using the drug.

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

citalopram has a small and medium impact on the ability to drive and operate machinery. Mental drugs can reduce the ability to judge and respond to emergency situations. It is necessary to notify the patient about these effects on the ability to drive or operate machinery.

Use drugs for women during pregnancy and lactation

Pregnant women

Do not use citalopram during pregnancy unless really needed, only used when the benefits and risks are considered.

breastfeeding women

citalopram is excreted into breast milk. It is estimated that babies will receive about 5% of the mother's daily medication (mg/kg). No or only a few small phenomena are observed in infants. However, the existing information is not enough to assess risks to children. Be cautious when taking medicine for breastfeeding women.

Drug interaction

Contraindicated in combination with:

Mao inhibitors: Citalopram's simultaneous use and Mao inhibitors can cause serious unwanted effects, including serotonin syndrome. Cases of serious and sometimes fatal reactions have been reported in patients treated with citalopram combined with Mao inhibitors, including non -reversible Mao inhibitors such as Selegilin, reversible inhibitors such as Linezolid, Moclobemid and in patients who have just stopped Citalopram and have begun with MAO inhibitors. In some cases, there are serotonin syndrome. The symptoms of drug interaction with Maoi include: agitation, tremor, muscle convulsions and increased body temperature. Citalopram should not be used within 14 days after stopping the use of non -reversible Mao inhibitors or a specialized period after stopping the use of reversible Mao inhibitors. Mao inhibitors should not be used within 7 days after stopping citalopram.

The drug extends the QT interval: There are no pharmacokinetic studies and pharmacokinetic energy between citalopram and drugs that extend the QT range. The other effect of citalopram with these drugs cannot be excluded. Therefore, contraindicated use of citalopram with drugs that extend the QT interval such as anti -arrhythmia IA and Group III, anti -psychotic drugs (such as phenothiazin derivatives, pimozid, haloperidol), three -round antidepressants, antibiotics (such as sparfloxacin, moxifloxacin, erythromycin iv halofantrin), antihistamine (Astemizol, Mizolastin).

Pimozid: The simultaneous use of Pimozid and Citalopram leads to an increase in QT approximately 10 milliseconds. Because the interaction is recorded in low doses of Pimozid, contraindicated use of Citalopram and Pimozid should be contraindicated.

Be cautious when combined with:

Selegilin (Selective Mao-B): Contraindicated use of Citalopram and Selegilin (at a dose of over 10 mg/day).

Lithi and Tryptophan: There is no pharmacokinetic interaction found in clinical studies when using simultaneously Citalopram and Lithi. However, there has been a report on the effect of drugs when citalopram is used with lithium or tryptophan. Therefore, it is necessary to be cautious when using citalopram and these drugs. Need to regularly monitor the lithium concentration.

Used in combination with drugs with serotonin activity (such as tramadol, sumatriptan) can lead to an increase in the impact of 5-HT. The simultaneous use of citalopram and 5-HT antagonists such as Sumatriptan and other triptan is not recommended until other information is available.

European measles (John's Wort): The outstanding interactions between citalopram and herbs containing European measles (St. John's Wort) can occur, increasing unwanted effects.

Hemorrhage: Be careful for patients being treated simultaneously with anticoagulants, drugs that affect platelet function, such as NSAID anti -inflammatory drugs, acetylsalicylic acid, dipyridamol and ticlopidine or other drugs (such as anti -psychotic drugs) may increase the risk of bleeding.

Treatment with electrical shock therapy: There is no clinical research on the benefits or risks of the use of combined electric shock and citalopram therapy.

Alcohol: There is no pharmacokinetic or pharmacokinetic interaction proved between citaloptam and alcohol. However, citalopram and alcohol should not be combined.

Medications that cause potassium/meteri blood: Caution should be careful when using the drugs that cause potassium/magnesium hypotension because these drugs increase the risk of malignant arrhythmia.

Medications reduces convulsions: citalopram may reduce convulsions. Be careful when used simultaneously with other drugs capable of reducing seizures, (such as antidepressants (SSRI groups), sedatives (butyrophenon, thioxanthen), mefloquin, bupropion and tramadol).

The effect of other drugs on pharmacokinetics of citalopram:

cimetidin (CYP2D6, 3A4, 1A2 inhibitors): Increases the average concentration of citalopram. Caution should be used when using citalopram in combination with cimetidine. Adjust the dose when needed.

Omeprazol and CYP2C19 inhibitors: Concomitance use of Escitalopram (active ingredient of citalopram) with 30 mg of omeprazol 1 time/day (CYP2C19 inhibitors) leads to a moderate (about 50%) of Escitalopram level (about 50%) in plasma. Caution should be taken when used simultaneously with CYP2C19 inhibitors (such as omeprazol, esomeprazol, fluvoxamine, lansoprazol, ticlopidin). Citalopram dose is needed based on monitoring unwanted effects during combined treatment.

Metoprolol: Concomitant use with Metoprolol leads to a doubling of plasma metoprolol levels in plasma, but according to statistics, Metoprolol's effects on blood pressure and heart rate.

The influence of citalopram on other drugs:

Desipramin, Imipramin: In pharmacokinetics research, there is no impact on citalopram or imipramin levels, although the desipramine concentration, the main metabolic substance of imipramin is increased. When desipramine is combined with citalopram, the desipramine level in plasma increases. Reduce desipramin if necessary.