Citol

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Citol: instructions for use and reviews

1. Release form and composition
2. Pharmacological properties
3. Indications for use
4. Contraindications
5. Method of application and dosage
6. Side effects
7. Overdose
8. Special instructions
9. Application during pregnancy and lactation
10. Use in childhood
11. In case of impaired renal function
12. For violations of liver function
13. Use in the elderly
14. Drug interactions
15. Analogs
16. Terms and conditions of storage
17. Terms of dispensing from pharmacies
18. Reviews
19. Price in pharmacies

Latin name: Citol

ATX code: N06AB04

Active ingredient: citalopram (Citalopram)

Manufacturer: Abdi Ibrahim Ilyach Sanayi ve Tijaret A. Sh. (Abdi Ibrahim Ilac Sanayi ve Ticaret AS) (Turkey)

Description and photo update: 2020-13-04

Citol is an antidepressant.

Release form and composition

Dosage form - film-coated tablets: white, elliptical, on one side there is a logo of the company (AI), on the other - risk (in blisters made of PVC film and aluminum foil, 14 pcs., In a cardboard box, 2 packaging and instructions for use of Citol).

One film-coated tablet contains:

active ingredient: citalopram - 20/40 mg (in the form of citalopram hydrobromide - 24.98 / 49.96 mg);
additional components: MCC (microcrystalline cellulose) (Avicel RN 200) - 35 / 68.3 mg; corn starch - 38.1 / 76.2 mg; magnesium stearate - 0.87 / 1.74 mg; lactose monohydrate - 23.05 / 46.1 mg; povidone K90 - 3 / 7.7 mg;
film shell: macrogol 400 - 0.4 / 0.8 mg; hypromellose - 2/4 mg; titanium dioxide (E171) - 0.7 / 1.4 mg.

Pharmacological properties

Pharmacodynamics

Citol is an antidepressant, SSRI (selective serotonin reuptake inhibitor), the active ingredient of which is citalopram, which has a pronounced ability to suppress serotonin reuptake. It practically does not affect the neuronal uptake of GABA (gamma-aminobutyric acid), dopamine and norepinephrine. Citalopram has very little or no affinity for histaminergic, cholinergic and most dopaminergic, adrenergic and serotonergic receptors. The effect of the substance on blood pressure (blood pressure), the conduction system of the heart, kidney and liver function, hematological parameters is minimal. The development of the antidepressant effect is noted 14–28 days after the start of drug therapy.

Pharmacokinetics

Citalopram, taken orally, is absorbed quickly enough, T _Cmax (time to reach the maximum concentration) of the substance in the blood plasma averages 4 hours. The degree of absorption does not depend on food intake. The oral bioavailability of the substance is approximately 80%. The connection of citalopram and its metabolites with blood plasma proteins is below 80%. V _d (apparent volume of distribution) varies from 12 to 17 l / kg.

Citalopram is metabolized to citalopram-14-oxide, didemethylcitalopram, demethylcitalopram and deaminated propionic acid derivatives. The latter have no pharmacological activity. Demethylcitalopram, citalopram-14-oxide and didemethylcitalopram, although they are SSRIs, have a weaker effect compared to citalopram itself.

The half-life of the drug from plasma is approximately 36 hours. The clearance of citalopram in plasma after oral administration of the drug is 0.4 l / min.

Citalopram is excreted mainly (85%) through the intestines, the rest (15%) through the kidneys. With urine, unchanged form is removed from the body from 12 to 23% of the taken dose of Cytol. The clearance of citalopram in the kidneys is approximately 0.05–0.08 l / min, in the liver - 0.3 l / min. In patients with impaired liver function, elderly patients, plasma concentrations and half-life increase approximately 2 times.

Equilibrium plasma concentrations of citalopram are observed after 7-14 days. There is a linear relationship between the taken dose of Cytol and the equilibrium concentrations of its active substance in blood plasma. When taken in a dose of 40 mg per day, the average concentration of citalopram in blood plasma is about 300 nmol / L.

Indications for use

Citol is prescribed for the treatment of depression of various origins, as well as panic disorders (including agoraphobia).

Contraindications

Absolute:

glucose-galactose malabsorption syndrome, lactase deficiency or hereditary galactose intolerance;
severe renal failure [CC (creatinine clearance) <20 ml / min];
children and adolescents under 18 years of age (due to the lack of data on the effectiveness and safety of use);
combined intake with MAO (monoamine oxidase) inhibitors, including a two-week period after the end of their intake;
combined use with drugs that have a serotonergic effect (for example, with tramadol, sumatriptan, oxytriptan, tryptophan);
hypersensitivity to the active substance of the drug or any of the auxiliary components in its composition.

Relative (Citol tablets must be taken, taking precautions):

mild / moderate renal and hepatic impairment;
diabetes mellitus (it is necessary to control the concentration of glucose in the blood);
epilepsy, including pharmacologically uncontrollable;
seizures;
mania, history of hypomania;
depression with suicidal attempts;
pregnancy and lactation (provided that the benefits to the mother exceed the possible risks to the health of the fetus / child);
combined use with drugs that reduce the threshold of convulsive readiness, causing hyponatremia;
elderly age.

Citol, instructions for use: method and dosage

Citol tablets are taken orally, 1 time a day (in the morning or evening), regardless of the meal.

The therapeutic effect begins to manifest itself 14 days after the start of treatment. It is recommended to take Citol after the disappearance of symptoms for another 4-6 months.

Recommended dosage:

panic disorder: in the first week - 10 mg once a day, in the future the dose can be increased to 20 mg per day. If necessary, the daily dose can be increased to 60 mg (maximum dose);
depression: the usual dose is 20 mg once a day, the maximum daily dose is 60 mg.

For elderly patients, Citol is prescribed at a dose of 10 mg once a day, if necessary, the daily dose can be increased to 30 mg (maximum dose).

In patients with impaired liver function, the recommended daily dose is 10 mg, if necessary, it can be increased to 30 mg (maximum dose).

Individuals with impaired renal function of mild to moderate severity do not need to adjust the dose of Citol.

Cancellation of the antidepressant is carried out slowly, gradually reducing the dose over 7-14 days.

Side effects

The incidence of side effects is classified as follows: very common (> 10%); common (> 1% and 0.1% and 0.01% and <0.1%); extremely rare (<0.01%).

When taking Citol tablets, the development of undesirable phenomena is possible:

from the side of the central nervous system (central nervous system): very common - nervousness, insomnia, agitation, drowsiness, tremor, headache, dizziness; common - sleep disorders, paresthesia, migraine, impaired concentration, apathy, confusion of thoughts, anxiety, amnesia, increased appetite, anorexia, decreased libido, suicidal attempts; rare - emotional lability, asthenia, anxiety, psychosis, mood changes, panic behavior, aggressive behavior, agitation, hypomania, mania, paranoid reaction, excessive fatigue, euphoria, extrapyramidal disorders, convulsions, increased libido, serotonin syndrome (ataxia, agitation, agitation, tremor, confusion, hyperthermia, increased sweating, hyperreflexia, uncontrolled behavior); extremely rare - panic attacks,depersonalization, hallucinations;
from the respiratory system: common - sinusitis, rhinitis; rare - cough;
on the part of the heart and blood vessels: very common - heart rhythm disturbances (atrial flutter); common - tachycardia; rare - an increase or decrease in blood pressure, orthostatic hypotension, bradycardia; extremely rare - ventricular and supraventricular arrhythmias;
on the part of the hematopoietic system: rare - thrombocytopenia, development of bleeding (for example, ecchymosis, bleeding of the gastrointestinal tract, bleeding due to gynecological reasons);
from the digestive system: very common - diarrhea, constipation, dry mouth, nausea; common - increased salivation, vomiting, anorexia, dyspepsia, flatulence, abdominal pain; rare - an increase in the activity of liver enzymes;
metabolic disorders: common - increase / decrease in body weight;
on the part of the urinary system: common - polyuria, frequent urination;
on the part of the reproductive system: common - female anorgasmia, menstrual irregularities, dysmenorrhea, ejaculation disorders, impotence, decreased libido; extremely rare - galactorrhea;
on the part of the skin: very common - increased sweating; common - itching, rash; rare - epidermal necrolysis, photosensitivity; extremely rare - angioedema;
on the part of the musculoskeletal system: very common - myalgia; very rare - arthralgia;
from the senses: common - taste disturbance;
on the part of the organ of vision: very common - violation of accommodation; common - visual impairment; extremely rare - mydriasis;
on the part of the auditory and vestibular apparatus: common - tinnitus;
others: very common - asthenia; common - fatigue; rare - malaise, fainting, yawning, teeth grinding, hyponatremia, mastodynia, shortness of breath, hyperthermia, allergic reactions; extremely rare - anaphylactoid reaction.

Overdose

In case of an overdose of Cytol, dizziness, drowsiness, amnesia, confusion, vomiting, cyanosis, increased sweating, tremor, dysarthria, sinus tachycardia, prolongation of the QT interval, nodal rhythm on the ECG (electrocardiogram), ventricular arrhythmia, arrhythmia, hyperventilation type lungs, changes in the electroencephalogram (junctional rhythm), rhabdomyolysis, seizures, coma.

As a treatment, gastric lavage is prescribed, and in the future - symptomatic and supportive therapy. There is no specific antidote.

special instructions

Clinical experience with the use of citalopram in combination with electroconvulsive therapy is extremely small.

Citol needs to be canceled if a manic state develops during therapy.

In breastfed children, whose mothers took Citol tablets during lactation, drowsiness, weight loss, and weakening of the sucking reflex may occur.

Influence on the ability to drive vehicles and complex mechanisms

Patients undergoing Citol therapy should be careful when engaging in potentially hazardous activities that require increased concentration of attention and speed of reaction, including driving and other vehicles.

Application during pregnancy and lactation

Pregnant and breastfeeding women should be prescribed Citol tablets only if the potential benefit to the mother outweighs the possible risks to the health of the fetus / child.

Patients who use Citol during gestation should take it in a reduced dose and complete therapy no later than a week before childbirth.

Pediatric use

For children and adolescents under 18 years of age, due to the lack of data on the efficacy and safety of the use, Cytol therapy is contraindicated.

With impaired renal function

Severe renal failure (CC <20 ml / min) is a contraindication to taking the drug.

With mild to moderate renal failure, Citol is taken with caution. No dose adjustment is necessary.

For violations of liver function

With mild to moderate liver failure, Citol is taken with caution. The recommended daily dose for patients in this category is 10 mg, it can be increased to 30 mg (maximum daily dose).

Use in the elderly

Elderly patients should be careful when taking Citol.

The recommended daily dose for patients in this category is 10 mg, it can be increased to 30 mg (maximum daily dose).

Drug interactions

MAO (monoamine oxidase) inhibitors: concomitant use is not recommended, as this can lead to the development of serotonin syndrome; for the same reason, drugs should not be combined in patients who have recently stopped using SSRIs and have started therapy with MAO inhibitors;
drugs with serotonergic action (oxytriptan, tramadol, sumatriptan, tryptophan): combined use with citalopram is not recommended;
anticoagulants; drugs that affect platelet function, such as ASA (acetylsalicylic acid), NSAIDs (non-steroidal anti-inflammatory drugs), ticlopidine, dipyridamole; other drugs [for example, antipsychotics (antipsychotic drugs), including phenothiazines; tricyclic antidepressants]: caution should be exercised while taking with citalopram due to the increased risk of bleeding;
herbal preparations containing St. John's wort (Hypericum perforatum): combination therapy can cause an increase in the frequency of adverse reactions;
ethanol: pharmacodynamic and pharmacokinetic interactions of citalopram with ethanol have not been identified, despite this, during the period of drug therapy, the use of alcoholic beverages should be avoided;
drugs metabolized by the CYP2D6 isoenzyme: since citalopram is a weak inhibitor of the CYP2D6 isoenzyme, in combination therapy, its interaction with other drugs metabolized by the CYP2D6 isoenzyme cannot be excluded. So in the case of simultaneous administration with metoprolol (a substrate of the isoenzyme CYP2D6), the plasma content of the latter increases 2 times. No clinically significant effect on heart rate (heart rate) and blood pressure was found;
cimetidine: increases the average plasma concentration of citalopram by 40%, therefore, with the simultaneous use of high doses of cimetidine and citalopram, care must be taken;
lithium preparations: the interaction of citalopram with lithium preparations was not observed, however, there is evidence that when other SSRIs were prescribed against the background of lithium preparations, their serotonergic effect increased; in such a situation, it is necessary to monitor the lithium content in the blood plasma;
imipramine: no interaction with citalopram was detected, however, the plasma content of desipramine (the main metabolite of imipramine) increases; since the combined use of citalopram with desipramine increases the plasma concentration of the latter, a decrease in the dose of desipramine may be required;
levomepromazine, carbamazepine, digoxin: no interaction with citalopram was observed;
warfarin: when taken together with citalopram, prothrombin time increases by 5%.

Analogs

The analogues of Tsitol are Oprah, PRAM, Siozam, Umoral, Tsipramil, Tsitalift, Tsitalon, Tsitalopram, Tsitalopram-ALSI, etc.

Terms and conditions of storage

Store in a place protected from light and moisture, at a temperature not exceeding 25 ° C. Keep out of the reach of children.

The shelf life is 3 years. After the expiration date, it is prohibited to use the drug.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews of Citola

Citol, according to patients, has a mild antidepressant effect, which develops by the end of the second or the beginning of the third week of the course. Sometimes, to achieve a tangible effect, it was necessary to adjust the dosage regimen with a gradual increase in the dose to the maximum.

Daytime sleepiness and episodic mood swings are indicated as the main disadvantages.

The price of Citol in pharmacies

The price of Citol is unknown, since the drug is not available for sale in pharmacy chains. Its analogues can be purchased at the following prices: Citalopram ALSI - from 322 rubles. (in a package of 30 tablets of 20 mg each), Tsipramil - from 829 rubles. (in a package of 14 tablets of 20 mg).

Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!