Citopam 20 Sun Pharma Treatment Treatment of depression, panic disorders (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Citalopram
Ingredient Anxiety, depression

Ingredient

Composition information	Content
Citalopram	20mg

Uses

indications

Citopam 20 drugs are indicated in the following cases:

Treatment of depression in the early stages as well as the treatment of anti-recurrence maintenance. Serotonin) of central nerve cells. No tolerance for Citalopram's inhibitory effects on 5-HT absorption during long-term treatment.

citalopram inhibits the reabsorption of high selective serotonin, minimum effect on the reabsorption of norepinephrine, dopamine, doopamine d1 and d2, alpha-1, alpha-1, α-wordoceptors, histamine H1, Muscarine Cholinergic, Benzodiazepine, and other OPIID ...

pharmacokinetic

absorption

Good absorption after drinking. The peak concentration in plasma is usually achieved in 4 hours. Absolute bioavailability is 80%. Food does not affect the absorption.

Distribution

Widely distributed throughout the body. The drug can pass the bloody barrier, placenta and distribution in breast milk. The distribution volume is about 12 l/kg.

The ability to bond with plasma proteins is about 80%.

Metabolism

Metabolic in the liver by CYP3A4 and CYP2C19 into less active metabolites. Demethylcitalopram and Didemethylcitalopram are identified as a metabolic of citalopram.

Elimination

mainly through urine (75%) and feces (10%). The clearance of citalopram is about 330 ml/min. The sale time of the drug is about 35 hours.

Before taking Citopam 20 Sun Pharma Treatment Treatment of depression, panic disorders (3 blisters x 10 tablets)

How to use

Take oral use, only once a day (morning or evening) and regardless of the meal.

Dosage

Adults

Severe depression stages

recommended dose: 20 mg per day. Depending on the response of the patient, the dose may increase to 40 mg daily. In general, the disease improves after a week, but may only be improved from the second week after treatment.

Consider and adjust the citalopram dose within 3–4 weeks after the appropriate starting of treatment and clinical evaluation, although it may increase unwanted effects at higher doses. Should adjust the dose carefully with each patient to maintain at the lowest dose effectively. Patients with depression should be treated at least 6 months to ensure the termination of symptoms.

Panic disorders

Dosage recommended 10 mg per day for the first week before increasing the dose to 20 mg daily. Depending on the response of each patient, the maximum dose may be increased by 40 mg/day.

Patients should be started 10 mg per day and gradually increase every 10 mg according to the response of the patient to the recommended dose. Low -dose starting to minimize the risk of panic symptoms, they often occur early in the treatment of this disorder. Although it may increase unwanted effects at higher doses, if after a few weeks of treatment with recommended dose but not enough response, some patients may get benefits if the dose increases to 40 mg daily. Should adjust the dose carefully with each patient to maintain at the lowest dose effectively. Patients with panic disorders should be treated enough time to ensure the termination of symptoms. This period may be several months or even longer.

children and teenagers (

citalopram is not recommended for children and teenagers under 18 years old.

Other objects

Elderly

Should reduce the dose to 10–20 mg/day. The maximum dosage recommends for the elderly is 20 mg/day.

People with liver failure

Starting for a dose of 10 mg/day for the first 2 weeks in patients with mild to moderate liver failure. Depending on the response, the dose may increase to 20 mg/day. Be careful and carefully adjust the dose in patients with severe liver failure.

Renal failure

No dose adjustment in patients with mild to moderate renal failure. There is no information on drug use for patients with severe renal impairment (CrCl

Poor metabolic people through CYP2C19

The starting dose of 10 mg/day for the first 2 weeks. Can increase the dose to up to 20 mg/day depending on the response of the patient.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.

What to do when using overdose?

Convulsions, fast/slow heartbeat, drowsiness, prolonged qt, coma, vomiting, tremor, hypertension, cardiac arrest, serotonnin syndrome, agitation, dizziness, pupil dilate, twisted, sweating, cyanosis, reducing ventilation, increased oxygen, ventricular arrhythmia, atrial arrhythmia.

How to deal with overdose

There is no specific antidote when overdose Citalopram.

Symptomatic treatment and support, maintain good ventilation, monitor the electrocardiogram and the signs of survival until stable.

Consider taking activated carbon in adults and children who used more than 5 mg/kg citalopram within 1 hour.

Sodium sulfate and stomach laxative should be considered.

If the consciousness is reduced, the patient must be intubated.

Controlling convulsions with intravenous diazepam if convulsions are regular and prolonged.

What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.

Side Effects

When using Citopam 20, you may experience unwanted effects (ADR).

Common (1/100

Mental: Gim cravings, weight loss, sleep disorders, agitation, reduced libido, anxiety, nervousness,

Neurology: Drowsy, insomnia, headache, tremor, paresthes, dizziness, migraine, forgetting,

ears and mesmerizing: tinnitus.

Breast empty light.

Respiratory, chest and mediastinum: yawning, rhinitis.

digestive: dry mouth, nausea, diarrhea, constipation, flatulence, increased salivation.

Skin and subcutaneous tissue: increase sweating, itching.

musculoskeletal: muscle pain, joint pain.

Reproduction system: ejaculation disorders.

Uncommon (1/1000

Increase appetite, weight gain.

Mental: Loss of personality, hallucinations, mania, increase libido.

nerve: fainting.

Eye: Delonged pupils

Cardiovascular: tachycardia/slow heart.

Skin and subcutaneous tissue: urticaria, rash, hair loss, light sensitivity.

General and on -site: edema.

Rare 1/10000

Metabolism and nutrition: Hypoglycemia.

nerve: movement disorders, taste disorders.

Respiratory: Ho.

liver: hepatitis.

Not determined frequency

Blood: platelets.

immune: Hypersensitivity, anaphylactic reaction.

Endocrine: ADH is not appropriate.

Metabolism and nutrition: Hypotension.

Mental: The intention of suicide, suicide behavior.

nerve: convulsions, serotonin syndrome, pagoda disorders, Akathisia syndrome. Eye: visual disorders. Cardiovascular: extends the distance of qt, ventricular arrhythmia, torsion, hypotension. digestive: gastrointestinal bleeding.

Instructions on how to handle ADR

When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Warnings

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

Contraindicated

Citopam 20 contraindications in the following cases:

Too hypersensitivity to citalopram, escitalopram or any ingredient of the drug.

In some cases, there are similar symptoms to Serotonin syndrome.

Patients who have been treated (within the last 2 weeks) or are being treated with Monoamine Oxidase inhibitors (MAII), including Selegilin, at a dose exceeding 10 mg daily.

Use maoi within 7 days after stopping Citalopram.

Combining citalopram with Linezolid unless there are strict monitoring facilities and blood pressure monitoring.

Patients with a history of extension of QT or congenital syndrome extending the QT range.

Citalopram combination with drug products is known to extend QT.

Use simultaneously with pimozide.

Citalopram coordination with 5-Ht agonist (5-HT Agonist), such as Sumatriptan.

Precautions when using

suicide/suicide or clinical thoughts

Psychological conditions treated with citalopram can be stuck with depression disorders, which may increase the risk of suicide -related phenomena. Therefore, it is necessary to be cautious when treating patients with other psychological disorders. Strict monitoring, especially in patients at high risk in the early stage of treatment and when changing the dosage. Patients and caregivers should be notified to promptly detect and notify the doctor when the clinical signs worsens, when committing acts or suicidal intent and abnormal changes in behavior.

Used in children and teenagers under 18 years old

Do not use for children under 18 years of age due to many signs related to suicidal and hostile behavior. If treated, careful monitoring to promptly detect suicide signs. In addition, there is not enough long -term safety data on the effects of drugs on growth, growth, cognitive development and behavior of children.

Elderly patients or liver function impairment

Be cautious when taking drugs in the elderly and patients with impaired liver and kidney function.

Paradoxical anxiety

Some patients with panic disorders may experience anxiety increase when they start taking antidepressants. This paradoxical reaction decreased within the first 2 weeks of treatment. Starting with low doses to reduce the possibility of paradoxical worries.

Hypothensi

Hypotenia hypoglycatry, may be due to the inappropriate anti -urinary hormone excretion (SIADH), which has been reported as a rare adverse reaction when using selective Serotonin reabsorption inhibitors (SSRIs) and often recovered when stopped treatment. The risk of hypoglycemia in older female patients.

Sitting restlessly

Akathisia syndrome (lying restless, restless, worried) can occur in the first few weeks when taking the drug. In patients who experience this symptom, increasing the dose may be disadvantageous.

Heart

In patients with the disease, the sympathy can change to the stage of manic. Stop using citalopram for patients switching to Hung Cam stage.

epilepsy

Epilepsy is a potential risk to antidepressants. Stop using citalopram in patients with convulsions or increasing the frequency of seizures. Avoid using drugs for people with epilepsy unstable and carefully monitor patients with control epilepsy.

diabetes

SSRI treatment may change the ability to control blood sugar of diabetes. May need to adjust insulin and/or hypoglycemic drugs.

Object increase

citalopram can affect the size of the pupil, leading to the dilatation of the pupils. Precautions when taking medication for patients with glaucoma angle or a history of glaucoma.

Serotonin syndrome

Stop treatment with citalopram immediately when serotonin syndrome appears and symptomatic treatment (agitation, tremor, muscle and body temperature).

The drugs have a serotonin secretion

Not simultaneously used citalopram with drugs that work on serotonin such as triptan, tramadol, oxitryptan and tryptophan drugs.

Bleeding

Be cautious when taking SSRIs, especially in patients who are taking drugs that affect platelet function, drugs increase the risk of bleeding as well as patients with a history of bleeding disorders.

Symptoms of quitting smoking when stopping SSRI treatment

The cessation reaction usually occurs in the first few days after stopping the drug, especially when stopping the drug suddenly, and usually ends within 2 weeks. Symptoms of cessation include dizziness, sensory disorders (inductance), visual disorders, sleep disorders, agitation, nausea, vomiting, diarrhea, headache, chest drum, sweating, nervousness, tremor and anxiety. Therefore, it is necessary to gradually reduce the dose of citalopram when stopping treatment for a few weeks or a few months depending on the patient needs.

extends the range of qt

citalopram extends the QT distance depending on the dose of treatment. Be careful when taking medication for patients with slow heart rate, acute myocardial infarction or loss of heart failure.

Electrolyte disorders (hypotension, hypoglycemia) increase the risk of malignant arrhythmia, so it is necessary to restore electrolytes before using citalopram.

Must review the electrocardiogram before conducting treatment for patients with stable heart disease.

If there are signs of arrhythmia, should stop taking the drug and conduct an electrocardiogram.

The ability to drive and operate machinery

citalopram has a slight or medium impact to the ability to drive and operate machinery. Patients who use psychotropic drugs may reduce their attention and concentration due to the disease, and psychotropic drugs can reduce the ability to judge and react to emergencies.

Pregnancy

A large number of data on pregnant women (more than 2500 exposure results) shows that there is no pregnancy/toxicity in infants, however, should not use citalopram during pregnancy unless clear and only after careful consideration of risk/benefit.

Babies should be monitored if the mother continues to use citalopram at the end of pregnancy, especially in the third quarter. Should avoid sudden stopping drugs during pregnancy.

The following symptoms can occur in newborns when mothers use SSRI/SNRI in the final stages of pregnancy: respiratory failure, cyanosis, apnea, seizures, unstable temperatures, difficulty feeding, vomiting, hypoglycemia, muscle tone, reflexes, tremor, stimulation, indifference, non -crying, sleepy and difficult to sleep. These symptoms may be caused by serotonin secretion or smoking symptoms. In most cases, complications start immediately or early (

Breastfeeding period

The drug is excreted into breast milk. Recommendations should be cautious. If you have to take the drug, you should consider stopping breastfeeding.

Drug interaction

Pharmacological interaction

Contraindications combinations

maoi:

Simultaneous use of citalopram with Maoi inhibitors can lead to serious unwanted effects, including serotonin syndrome. SSRI has been stopped recently and has been started with a Maoi. Interactive symptoms of active ingredients with Maoi include: agitation, tremor, muscle contraction and body temperature. (Sparfloxacin, moxifloxacin, erythromycin IV, pentamidine, malaria treatment, especially halofantrin, antihistamine (Astemizole, Mizolastine). Dipyridamole ...), can increase the risk of bleeding.

pimozid:

Not used simultaneously with pimozid. Combining 2 drugs in 11 days increases the AUC and CMAX of Pimozid, increasing the average QTC time about 10 milliseconds. Simultaneous use of citalopram and pimozid is contraindicated.

5-Ht agonist (5-HT Agonist):

Serotonin secretion effects of Sumatriptan can be enhanced by selective Serotonin reabsorption inhibitors (SSRI). Do not simultaneously use citalopram with a 5-HT shipping owner, like Sumatriptan.

The combination should be cautious

Selegiline:

Serotonin syndrome is life -threatening so it should be avoided simultaneously. Allows at least 2 weeks to pass from the stopgiline until starting to use citalopram, or vice versa. The simultaneous use of citalopram and Selegilin (with a dose of over 10 mg per day) is contraindicated.

Serotonin secretion:

Lithi and Tryptophan: No pharmacological interaction has been found in clinical studies, of which Citalopram has been used simultaneously with lithium. However, there have been increased effects when using SSRIs with lithium or tryptophan and thus simultaneous use of citalopram with these drugs must be cautious. Periodically monitor the lithium concentration should be continued as usual. fox.

Bleeding:

Be cautious in patients taking anticoagulant drugs, drugs that affect platelet function, such as nonsteroidal anti -inflammatory drugs (NSAIDs), acetylsalicylic acid, dipyridamole, ticlopidine, or other drugs (non -typical anti -chaos) can increase the risk of bleeding.

Medications that cause blood potassium/ hypoglycemia:

It is necessary to be cautious when using simultaneously medications that lower blood potassium/hypoglycemia due to the potential to increase the risk of malignant arrhythmia.

pharmacokinetic interaction

citalopram converted into dimethyl citalopram via CYP2C19 intermediaries (about 38%), CYP3A4 (about 31%) and CYP2D6 (about 31%) the iszyme of Cytochrome P450. In essence, citalopram is metabolized by more than one CYP, which means that the metabolic inhibition of the drug is less than the inhibition of a enzyme that can be offset by another enzyme. Therefore, simultaneous use of citalopram with other drugs in clinical practice has very little ability to cause pharmacokinetic interaction.

Interaction with food

Interactions between Citalopram and St John's Wort (Hypericum Perforatum) may increase unwanted effects.

Storage

Where dry, less than 30 ° C.

Other drugs

Disclaimer

Every effort has been made to ensure that the information provided by Drugslib.com is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Drugslib.com information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Drugslib.com does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Drugslib.com's drug information does not endorse drugs, diagnose patients or recommend therapy. Drugslib.com's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Drugslib.com does not assume any responsibility for any aspect of healthcare administered with the aid of information Drugslib.com provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.