Symptoms: nausea, dizziness, drowsiness, dysarthria, abnormal heart rhythm and conduction (prolongation of the QT interval, sinus tachycardia, nodal rhythm), increased sweating, cyanosis, tremor, amnesia, confusion, rhabdomyolysis, convulsions, coma.
Treatment: gastric lavage, symptomatic and supportive therapy, no specific antidote.
Symptoms: nausea, dizziness, drowsiness, dysarthria, sinus tachycardia, nodal rhythm, increased sweating, cyanosis, tremor, amnesia, confusion, abnormal heart rhythm and conduction (prolongation of the QT interval), rhabdomyolysis, convulsions, coma.
Treatment: gastric lavage, symptomatic and supportive therapy, no specific antidote.
hypersensitivity to citalopram or to any component of the drug,
concomitant use with MAO inhibitors, as well as within 14 days after discontinuation of their use, treatment with MAO inhibitors can be initiated no earlier than 7 days after discontinuation of citalopram,
children's age (efficacy and safety of use have not been established).
With caution:
insufficient liver and/or kidney function,
the presence of convulsive seizures in the anamnesis,
patients over 65 years of age,
the presence of drug dependence (including in the anamnesis),
mania, hypomania.
hypersensitivity to citalDalsan (Citalopram)mu or to any component that is part of the drug,
children's age (up to 18 years),
the drug should not be used in combination with MAO inhibitors, as well as for 14 days after stopping their use. Treatment with MAO inhibitors can be initiated no earlier than 7 days after discontinuation of citalDalsan (Citalopram)ma.
With caution:
liver and / or kidney failure,
a history of convulsive seizures,
old age.
Increases the effect of sumatriptan and other serotonergic drugs. It does not affect the effect of ethanol, lithium preparations, benzodiazepines, antipsychotic drugs (neuroleptics), narcotic analgesics, beta-blockers, phenothiazines, tricyclic antidepressants, antihistamines and antihypertensive drugs.
To a small extent, it inhibits cytochrome P4502D6, and therefore weakly interacts with drugs that are metabolized with its participation.
When taken simultaneously with MAO inhibitors, a hypertensive crisis (serotonin syndrome) may develop.
Cimetidine increases the concentration in the blood and enhances the effect of citalopram.
When co-administered with warfarin, the PV increases by 5%.
Enhances the effect of sumatriptan and other serotonergic drugs. It does not affect the effect of ethanol, lithium preparations, benzodiazepines, antipsychotic drugs( neuroleptics), narcotic analgesics, beta-blockers, phenothiazines, tricyclic antidepressants, antihistamines and antihypertensive drugs. To a small extent, it inhibits cytochrome CYP2D6, and therefore weakly interacts with drugs that are metabolized with its participation. With simultaneous administration with MAO inhibitors, a hypertensive crisis may develop (serotonin syndrome). Cimetidine increases the concentration in the blood and enhances the effect of citalDalsan (Citalopram)ma. When co-administered with warfarin, the prothrombin time increases by 5%
From the nervous system: rarely-asthenia, drowsiness or insomnia, anxiety, tremor, agitation, amnesia, apathy, extrapyramidal effects, mood changes, aggressive behavior, depersonalization, emotional lability, euphoria, manic and / or psychotic (including hallucinations) disorders, panic reactions, serotonin syndrome (agitation, confusion, diarrhea, hyperthermia, hyperreflexia, ataxia).
From the digestive tract: rarely — dry mouth, nausea, vomiting, hypersalivation, flatulence, diarrhea, abdominal pain, anorexia.
From the cardiovascular system: rarely-bradycardia, decreased blood pressure, orthostatic hypotension, arrhythmia.
From the side of the hematopoietic organs: rarely-thrombocytopenia, bleeding.
On the part of the senses: rarely-mydriasis, paresis of accommodation, violation of taste.
On the part of the reproductive system: violation of sexual function (violation of ejaculation, decreased libido, impotence, menstrual disorders).
Allergic reactions: skin rash, rarely-epidermal necrolysis, rhinitis, sinusitis.
Other: rarely-hyperthermia, polyuria, mastodynia, galactorrhea, hyponatremia, impaired urination, arthralgia, myalgia, yawning, gnashing of teeth, weight gain or loss, dyspnea.
From the nervous system: rarely — asthenia, fatigue, drowsiness or insomnia, anxiety, tremor, agitation, amnesia, apathy, extrapyramidal effects, mood changes, aggressive behavior, hallucinations, depersonalization, emotional lability, euphoria, mania, hypomania, panic behavior, paranoid reaction, psychosis, serotonin syndrome (agitation, confusion, diarrhea, hyperthermia, hyperreflexia, ataxia, extreme fatigue, tremor, increased sweating, agitation, uncontrolled behavior).
From the digestive tract: rarely — dry mouth, nausea, vomiting, hypersalivation, flatulence, diarrhea, abdominal pain, anorexia.
From the cardiovascular system: rarely-bradycardia, decreased blood pressure, orthostatic hypotension, arrhythmia.
From the side of the hematopoietic organs: rarely-thrombocytopenia, bleeding.
On the part of the senses: rarely-mydriasis, paresis of accommodation, violation of taste.
On the part of the reproductive system: violation of sexual function (violation of ejaculation, decreased libido, impotence), menstrual cycle disorders.
Allergic reactions: skin rash, rarely-epidermal necrolysis, rhinitis, sinusitis.
depression of various etiologies (treatment and prevention),
panic disorders (including those with agoraphobia),
obsessive-compulsive disorder (obsessive-compulsive disorder).
treatment of depressive diseases and prevention of relapses,
treatment of panic disorder with/or without fear of open space,
treatment of obsessive-compulsive disorder (obsessive-compulsive disorder).
Citalopram is an antidepressant that belongs to the group of selective serotonin reuptake inhibitors. Having a pronounced ability to inhibit the reuptake of serotonin, it does not or has a very weak ability to bind to a number of receptors, including histamine, muscarinic and adrenoreceptors. Citalopram inhibits cytochrome P4502D6 to a very small extent and, therefore, does not interact with drugs metabolized by this enzyme (the risk of side effects and toxic effects is lower).
The antidepressant effect usually develops after 2-4 weeks of treatment. Citalopram has practically no effect on the conducting system of the heart and blood pressure, on hematological parameters, liver and kidney function, and does not cause an increase in body weight.
Citalopram does not interfere with human cognitive functions, does not cause a sedative effect, in experimental studies, the drug has no teratogenic effect, no effect on reproductive function and perinatal development of offspring.
CitalDalsan (Citalopram)m, having a pronounced ability to suppress serotonin reuptake, has no or little ability to bind to a number of receptors, including histamine, muscarinic and adrenoreceptors. It inhibits cytochrome P4502D6 only to a small extent and, therefore, does not interact with drugs metabolized by this enzyme. Thus, the side effects and toxic effects are much less pronounced. The antidepressant effect usually develops after 2-4 weeks of treatment. CitalDalsan (Citalopram)m practically does not affect the cardiac conduction system and blood pressure, hematological parameters, liver and kidney function, does not cause an increase in body weight. CitalDalsan (Citalopram)m does not interfere with human cognitive functions, does not cause a sedative effect. In experimental studies, the drug has no teratogenic effect, no effect on reproductive function and perinatal development of offspring
The bioavailability of citalopram is about 80% and is almost independent of food intake. Cmax in plasma, it is reached in 2-4 hours after administration. Binding to plasma proteins-less than 80%. In plasma, it is present in an unchanged form. At doses of 10-60 mg/day, the pharmacokinetic parameters have a linear relationship. The volume of distribution is 12 l/kg. The equilibrium concentration with a daily single dose is established after 7-14 days. Penetrates into breast milk.
It is metabolized by demethylation, deamination and oxidation with the participation of cytochrome P450 (isoenzymes CYP3A4 and CYP2C19) to form less pharmacologically active metabolites.
T1/2 - 1.5 days. Excretion is carried out by the kidneys and with feces.
Patients aged over 65 years
There is a longer biological T1/2 (1.5-3.75 days) and lower Cl values (0.08-0.3 l / min). The concentrations observed at steady state in elderly patients were almost 2 times higher than those observed in younger patients receiving the same dose.
Liver failure
In patients with reduced liver function, citalopram is excreted more slowly. The biological half-life of citalopram is almost 2 times longer and the equilibrium plasma concentrations of citalopram are almost 2 times higher compared to patients with normal liver function after administration of the same dose.
Insufficiency of kidney function
The elimination of citalopram proceeds more slowly in patients with a small to moderate degree of decrease in renal function without significant effect on pharmacokinetics.
The bioavailability of citalDalsan (Citalopram)ma when taken orally is about 80% and practically does not depend on food intake. Cmax in plasma, it is reached in 2-4 hours after administration. Binding to plasma proteins-less than 80%. In plasma, it is present in an unchanged form. At doses of 10-60 mg/day, the pharmacokinetic parameters have a linear relationship. The volume of distribution is 12 l/kg. The equilibrium concentration with a daily single dose is established after 7-14 days. Penetrates into breast milk. It is metabolized by demethylation, deamination and oxidation with the participation of cytochrome P450 (isoenzymes CYP3A4 and CYP2C19) to form less pharmacologically active metabolites. T1/2 the preparation is 1.5 days. Excretion is carried out by the kidneys and with feces.
Patients aged over 65 years. There is a longer biological half–life (1.5–3.75 days) and lower clearance values (0.08-0.3 l/min). The concentrations observed at steady state in elderly patients were almost 2 times higher than those observed in younger patients receiving the same dose.
Insufficient liver function. In patients with reduced liver function, citalDalsan (Citalopram)m is excreted more slowly. The biological half-life of citalDalsan (Citalopram)ma is almost 2 times increased and the equilibrium plasma concentrations of citalDalsan (Citalopram)ma are almost 2 times higher compared to patients with normal liver function after administration of the same dose.
Insufficiency of kidney function. Elimination of citalDalsan (Citalopram)ma proceeds more slowly in patients with a small to moderate degree of decreased renal function without significant effect on pharmacokinetics. Currently, the experience of treating patients with severe renal insufficiency (creatinine Cl <20 ml / min) is insufficient.
Dalsan (Citalopram)
Citalopram
Inside, at any time of the day, regardless of the meal, once.
Depression: the recommended daily dose of Dalsan (Citalopram) a is 20 mg. Depending on the individual patient's response to treatment and the severity of the disease, the dose can be increased, the maximum daily dose is 60 mg. Usually the antidepressant effect of the drug is observed after 2-4 weeks of treatment. Treatment with antidepressants should be carried out for a long time. Usually, to prevent a relapse, treatment should be carried out for 6 months or even a longer period of time. In patients with recurrent depression, maintenance treatment should be carried out for several years to prevent the onset of subsequent phases of the disease. If treatment is completed, Dalsan (Citalopram) should be discontinued gradually over several weeks
Panic disorders: the recommended daily dose is 10 mg during the first week of treatment, after which the dose is increased to 20 mg / day, the maximum daily dose is 60 mg. In the treatment of panic disorder, the maximum effect of citalopram is observed after 3 months of treatment. This effect persists throughout the entire period of maintenance therapy.
Obsessive-compulsive disorder: the recommended daily dose is 20 mg. Depending on the individual response of the patient to treatment and the severity of the disease, the dose can be increased, the maximum daily dose is 60 mg. In the treatment of obsessive-compulsive disorder, the effect of the drug appears after 2-4 weeks of treatment, with continued treatment, further improvement may be observed.
In patients aged 65 years and older, the maximum daily dose is no more than 40 mg.
Impaired renal function: patients with slightly or moderately impaired renal function can use the drug in normal doses. Currently, the experience of treating patients with severe renal insufficiency (creatinine Cl below 20 ml/mol) is insignificant.
Impaired liver function: patients with impaired liver function should not be prescribed more than 30 mg/day.
Inside, 1 time a day at any time, either with food or on an empty stomach.
Depression. The recommended daily dose is 20 mg citalDalsan (Citalopram)ma. Depending on the individual patient's response to treatment and the severity of the disease, the dose can be increased to a maximum of 60 mg/day.
Panic disorders. It is recommended to use 10 mg citalDalsan (Citalopram)ma 1 time per day during the first week of treatment, after which the dose is increased to 20 mg/day. Depending on the individual patient's response to treatment and the severity of the disease, the dose can be increased to a maximum of 60 mg/day.
Obsessive-compulsive disorder. The recommended daily dose is 20 mg once a day. Depending on the individual patient's response to treatment, the dose can be increased by 20 mg to a maximum of 60 mg/day.
Patients aged 65 years and older. The recommended starting dose can be increased to 40 mg / day.
Impaired kidney function. Patients with slightly or moderately impaired renal function can use the drug in normal doses. Information about the treatment of citalDalsan (Citalopram)iom of patients with severe renal insufficiency (creatinine Cl up to 20 ml/min) is not available.
Impaired liver function. Patients with impaired liver function should not be prescribed more than 30 mg/day.
Duration of treatment. Usually the antidepressant effect of the drug is observed after 2-4 weeks of treatment. Treatment with antidepressants is symptomatic and should be carried out for a long time. Usually, to prevent a relapse, treatment should be carried out for 6 months or even a longer period of time. In the case of patients with recurrent depression, maintenance treatment should be carried out for several years to prevent the onset of subsequent phases of the disease. If treatment is completed, the drug should be discontinued gradually over several weeks. In the treatment of panic disorder, the maximum effect of citalDalsan (Citalopram)ma is observed after 3 months of treatment and persists throughout the entire period of maintenance therapy. In the treatment of obsessive-compulsive disorder, the effect of the drug appears after 2-4 weeks of treatment, with continued treatment, further improvement may be observed
