Citramon P

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

Latin name: Citramon

ATX code: N02BA71

Active ingredient: acetylsalicylic acid (acetylsalicylic acid) + paracetamol (paracetamol) + caffeine (caffeine)

Manufacturer: BIOSYNTEZ, JSC (Russia), ATOLL, LLC (Russia), PHARMSTANDART-TOMSKHIMFARM, JSC (Russia), MOSKHIMFARMPREPARATY them. N. A. Semashko, JSC (Russia), JSC "Medisorb" (Russia), etc.

Description and photo update: 2018-23-10

Prices in pharmacies: from 5 rubles.

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Citramon P is a combined analgesic drug.

Release form and composition

Citramon P is produced in the form of flat-cylindrical round tablets of light brown color, with a chamfer on both sides and a line on the front side. Tablets have a characteristic odor and may contain inclusions (3, 4, 6 or 10 pcs. In blisters / blisters / strips, in a cardboard box 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 20, 30, 40, 50, 60, 70, 80, 90 or 100 blisters; 10, 20, 30, 40, 50, 60, 70, 80, 90 or 100 pcs. In polypropylene / polyethylene terephthalate cans, in cardboard box 1 can).

1 tablet contains:

active ingredients: acetylsalicylic acid (ASA) - 240 mg, paracetamol - 180 mg, caffeine - 30 mg;
excipients: cocoa bean powder, citric acid monohydrate, magnesium stearate, croscarmellose sodium, microcrystalline cellulose, povidone-K25.

Due to the large number of manufacturers of Citramon P, other types of packaging and changes in the composition of the auxiliary components of the drug are possible, different from those described above.

Pharmacological properties

Pharmacodynamics

Citramon P is a combined medicinal product containing ASA, paracetamol and caffeine.

The effect of the drug is due to the effectiveness of its active ingredients:

ASA: has anti-inflammatory and antipyretic effects; reduces pain (in particular, caused by inflammatory processes), stimulates blood microcirculation in the focus of inflammation, inhibits platelet aggregation and thrombus formation;
paracetamol: has antipyretic, analgesic, and also an extremely weak anti-inflammatory effect, which is due to its effect on the center of thermoregulation in the hypothalamus, as well as a weak ability to inhibit the synthesis of prostaglandins in peripheral tissues;
caffeine: increases the reflex excitability of the spinal cord; has an exciting effect on the respiratory and vasomotor centers; promotes the expansion of blood vessels in the brain, skeletal muscles, kidneys, heart; reduces platelet aggregation; reduces drowsiness and fatigue, increasing physical and mental performance. Citramon P contains a small dose of caffeine, so it has almost no stimulating effect on the central nervous system, but it increases the tone of the cerebral vessels and promotes blood flow acceleration.

Pharmacokinetics

ASK:

absorption: when ingested, it is completely absorbed, during absorption it undergoes elimination: in the intestinal wall - presystemic; in the liver - systemic, by deacetylation. It is rapidly hydrolyzed by albuminesterase and cholinesterases, therefore T _1/2 (half-life) is no more than 20 minutes;
distribution: circulates in the body by 75–90%, binding with blood proteins (mainly albumin) and is distributed in tissues in the form of the salicylic acid anion; Cmax (maximum concentration) is reached after 2 hours.
metabolism: occurs mainly in the liver, with the formation of four metabolites, which are found in urine and many tissues;
excretion: excreted mainly by the kidneys through active tubular secretion of salicylate (60%) or its metabolites. When urine is alkalized, the ionization of salicylates increases, which leads to a deterioration in their reabsorption and a significant increase in excretion. The rate of excretion is influenced by the dose: T _1/2 when using small doses is 2-3 hours, with an increase in the dose it increases to 15-30 hours. Elimination of salicylates in newborns is much slower.

Paracetamol:

absorption: High absorption. The maximum concentration (5–20 μg / ml) is reached in 0.5–2 hours;
distribution: 15% of the substance binds to plasma proteins. Penetration through the blood-brain barrier was recorded. No more than 1% of the dose taken by a nursing mother passes into breast milk. Achievement of a therapeutic effective concentration of paracetamol in plasma occurs at a dose of 10-15 mg / kg;
metabolism: occurs in the liver (up to 95%). As a result of conjugation reactions, in which 80% of metabolites enter, inactive glucuronides and sulfates are formed. Another 17% is hydroxylated to form eight active metabolites, conjugated with glutathione, as a result of which inactive metabolites are formed. In the case of a lack of glutathione, these substances block the enzyme systems of hepatocytes and cause their necrosis. Also, isoenzymes CYP1A2, CYP2E1 and, to a lesser extent, CYP3A4 are involved in the metabolism of paracetamol;
excretion: excreted by the kidneys in the form of metabolites (mainly conjugates), less than 5% is excreted unchanged. T _1/2 - 1-4 hours. In elderly patients, the clearance of the drug decreases, and the half-life increases.

Caffeine:

absorption: when taken orally, absorption is good, occurs along the entire length of the intestine, mainly due to lipophilicity. Achievement of Cmax (1.6-1.8 mg / l) occurs 50-75 minutes after administration;
distribution: quickly distributed in tissues and organs, easily penetrates the placenta and the blood-brain barrier, and also binds to blood proteins by 25–36%. In adults, the volume of distribution is 0.4-0.6 l / kg, in newborns - 0.78-0.92 l / kg;
metabolism: mainly occurs in the liver - over 90%, but in children of the first years of life - no more than 10-15%. In adults, about 80% of the substance is metabolized into paraxanthine, 10% into theobromine, 4% into theophylline. Further, these compounds are demethylated to monomethylxanthines and methylated uric acids;
excretion: caffeine, mainly in the form of metabolites, is excreted mainly by the kidneys; in adult patients, 1–2% is excreted unchanged, T _1/2 - 3.9–5.3 hours (sometimes up to 10 hours).

Indications for use

febrile syndrome (for example, with acute respiratory infections, flu);
pain syndrome of mild and moderate severity of various etiologies (migraine, headache or toothache, neuralgia, myalgia, arthralgia, algodismenorrhea).

Contraindications

Absolute:

gastrointestinal bleeding or perforation;
erosive and ulcerative lesions of the gastrointestinal tract (GIT) in the acute phase;
history of peptic ulcer;
hypoprothrombinemia, hemorrhagic diathesis;
portal hypertension;
avitaminosis K;
chronic heart failure of III and IV functional class according to the classification of the New York Heart Association (NYHA);
arterial hypertension (III degree);
incomplete or complete combination of bronchial asthma, recurrent polyposis of the paranasal sinuses and nose, as well as intolerance to non-steroidal anti-inflammatory drugs (NSAIDs), for example, ASA;
severe hepatic and / or renal impairment;
glaucoma;
hemophilia and other blood clotting disorders;
operations that are accompanied by profuse bleeding;
simultaneous administration of methotrexate in an amount of more than 15 mg per week;
sleep disturbance, increased nervous irritability;
deficiency of glucose-6-phosphate dehydrogenase;
During pregnancy and breastfeeding;
age up to 18 years (with febrile syndrome) or up to 15 years (with pain syndrome);
hypersensitivity to the components of Citramon P.

The drug is prescribed with caution in the following cases:

renal and / or hepatic impairment of moderate and mild degree;
chronic obstructive pulmonary disease;
gout;
cardiac ischemia;
cerebrovascular diseases;
peripheral arterial disease;
chronic heart failure (NYHA functional class I and II);
epilepsy, tendency to seizures;
simultaneous administration of methotrexate in an amount of less than 15 mg per week, as well as glucocorticosteroids, NSAIDs, antiplatelet agents, anticoagulants, selective serotonin reuptake inhibitors;
alcoholism;
smoking;
elderly age.

Instructions for the use of Citramon P: method and dosage

Citramon P tablets are taken orally with a sufficient amount of liquid, after or during a meal.

Recommended dosing regimen according to indications:

headache: single dose - 1-2 tablets. In case of severe headaches, it is recommended to take the drug again after 4-6 hours;
migraine symptoms: single dose - 2 tablets. If necessary, the drug is recommended to be taken again after 4–6 hours;
pain syndrome: single dose for adult patients - 1-2 tablets, daily dose - 3-4 tablets, maximum daily dose - 8 tablets.

The course of treatment with Citramon P as an analgesic should not exceed 5 days, as an antipyretic - 3 days, in the treatment of headache or migraine - 4 days.

Side effects

cardiovascular system: infrequently - the development of arrhythmias, increased heart rate (HR); rarely - hyperemia, impaired peripheral circulation;
digestive system: often - nausea and abdominal discomfort; infrequently - dry mouth, diarrhea, vomiting; rarely - belching, flatulence, increased salivation, paresthesia in the mouth, dysphagia;
respiratory system: rarely - hypoventilation, rhinorrhea, nosebleeds;
metabolism and nutrition: rarely - decreased appetite;
infections, invasions: rarely - pharyngitis;
nervous system: often - the development of dizziness; infrequently - the appearance of headache, paresthesia, tremor; rarely - taste disorder, hyperesthesia, amnesia, attention disorder, impaired coordination of movements, pain in the paranasal sinuses;
psyche: often - nervousness; infrequently - insomnia; rarely - a euphoric state, anxiety, internal tension;
hearing: infrequently - the appearance of noise in the ears;
vision: rarely - visual impairment;
musculoskeletal system: rarely - pain in the back and / or neck, muscle spasms, musculoskeletal stiffness;
skin: hyperhidrosis, urticaria, itching;
general disorders: infrequently - the occurrence of increased excitability or fatigue; rarely - heaviness in the chest, the development of asthenia.

During the post-registration observation period, the following side effects of Citramon P were recorded:

immune system: hypersensitivity;
nervous system: development of migraine, drowsiness;
mental disorders: anxiety;
respiratory system: development of shortness of breath, bronchospasm;
cardiovascular system: lowering blood pressure (BP), heartbeat;
liver, biliary tract: development of liver failure;
digestive system: abdominal pain and epigastric pain, dyspepsia, gastrointestinal bleeding, erosive and ulcerative lesions of the gastrointestinal tract;
skin: erythema, angioedema, rash;
general disorders: feelings of discomfort, malaise.

After taking ASA for 4-8 days, there is an increased likelihood of bleeding. Very rarely, severe bleeding can occur, including life-threatening (for example, cerebral hemorrhage). This effect is most often found with the combined use of anticoagulants and / or in patients with arterial hypertension.

Many of these side effects are dose-dependent, and their severity varies from patient to patient.

Overdose

ASK

Due to mild intoxication (plasma concentration from 150 to 300 μg / ml), dizziness, deafness, tinnitus, nausea, vomiting, increased sweating, headache, confusion may occur. Treatment is carried out by canceling Citramon P or reducing its dose.

Reception of ASA at a concentration of more than 300 μg / ml promotes the development of more severe intoxication, which is manifested by anxiety, fever, hyperventilation, ketoacidosis, respiratory alkalosis, metabolic acidosis. Due to the depression of the central nervous system, there is a risk of coma, cardiovascular collapse and respiratory failure.

When taking more than 100 mg / kg for several days in elderly patients and children, the risk of developing chronic intoxication is greatly increased.

The following overdose therapy is recommended, depending on the expected plasma concentration:

> 120 mg / kg salicylates during the last hour: multiple oral administration of activated charcoal is recommended. It is also necessary to determine the plasma concentration of salicylates, although it is impossible to predict the severity of an overdose on the basis of this indicator - it is necessary to additionally take into account biochemical and clinical indicators;
> 500 mcg / ml (for children under 5 years old at> 350 mcg / ml): removal of salicylates from plasma is carried out by intravenous administration of sodium bicarbonate;
> 700 mcg / ml (in elderly patients and children, lower concentrations) or with the development of severe metabolic acidosis: hemoperfusion or hemodialysis is the therapy of choice.

Paracetamol

In case of an overdose, intoxication is possible, especially in children and the elderly, patients with liver diseases (including due to chronic alcoholism), in case of malnutrition, while taking inducers of microsomal liver enzymes. As a result of intoxication, the development of liver failure, fulminant, cytolytic or cholestatic hepatitis can be observed (in these cases, sometimes a lethal outcome is possible).

The clinical picture of an acute overdose of paracetamol develops within a day after taking it. The main symptoms: pallor of the skin, gastrointestinal disorders (decreased appetite, nausea, vomiting, abdominal discomfort, abdominal pain).

After a single injection of paracetamol, adults at a dose of 7.5 g and children at a dose of 140 mg / kg develop cytolysis of hepatocytes, complete and irreversible liver necrosis, liver failure, metabolic acidosis, encephalopathy, which can result in coma and death. In 0.5–2 days after administration, the concentration of bilirubin, the activity of lactate dehydrogenase, microsomal liver enzymes increase, and the content of prothrombin also decreases. The manifestation of clinical symptoms of liver damage occurs after 2 days and reaches a maximum on 4-6 days.

In case of an overdose of paracetamol, immediate hospitalization is required.

After an overdose and before starting treatment, the quantitative content of paracetamol in blood plasma should be determined. During the first 8 hours, the most effective is therapy with SH-group donors and precursors of glutathione synthesis - acetylcysteine and methionine.

The decision on additional therapeutic measures (further administration of methionine, intravenous administration of acetylcysteine) is made on the basis of data on the content of paracetamol in the blood and the time elapsed after its administration.

In case of symptomatic treatment of an overdose with paracetamol, the activity of liver microsomal enzymes should be monitored at the beginning of therapy, and then every 24 hours. In most cases, this indicator will return to normal within 1-2 weeks. In severe cases, a liver transplant may be necessary.

Caffeine

Most often, with an overdose of caffeine, the following symptoms develop: agitation, gastralgia, anxiety, delirium, anxiety, nervousness, mental agitation, insomnia, confusion, muscle twitching, convulsions, frequent urination, dehydration, hyperthermia, increased tactile or pain sensitivity, tinnitus, headache, nausea, vomiting (including blood). In case of severe overdose, hyperglycemia may develop. The manifestations of cardiac disorders are tachycardia and arrhythmia.

For the treatment of the condition, a dose reduction or withdrawal of caffeine is required.

special instructions

General special instructions

Citramon P should not be administered in conjunction with other drugs that contain paracetamol or ASA.

It is recommended to be careful when using Citramon P for the first time for the treatment of migraines or with atypical symptoms of this disease, in order to avoid the development of potentially severe neurological disorders. If migraine symptoms persist after taking 2 tablets, see your doctor.

You should not use the drug for headache if more than 10 attacks per month have been observed in the last three months. This effect may be the result of excessive drug intake and requires medical advice. Citramon P is not recommended for the treatment of migraine if bed rest is required in more than half of the cases or if more than 20% of the patient's attacks are accompanied by vomiting.

The drug is used with caution in patients with risk factors for dehydration (diarrhea, vomiting, pre- or postoperative period).

Citramon P can mask signs of infection.

Special instructions due to the presence of ASK

Citramon P is required to be taken with caution in patients with diabetes mellitus, gout, uncontrolled arterial hypertension, dehydration, glucose-6-phosphate dehydrogenase deficiency.

Since ASA inhibits platelet aggregation, bleeding time may increase during surgery (including minor surgery) and in the postoperative period.

Without medical supervision, the drug should not be used in conjunction with drugs that affect the blood coagulation process (in particular, with anticoagulants). In the presence of a blood clotting disorder during therapy with Citramon P, patients should be closely monitored. You also need to be careful in the case of uterine bleeding of various etiologies or hypermenorrhea.

If ulceration or bleeding of the gastrointestinal tract develops on the background of therapy with Citramon P, the drug should be stopped immediately. The use of NSAIDs increases the risk of potentially fatal bleeding, ulceration, or perforation of the gastrointestinal tract, including in the absence of a history of precursors or severe gastrointestinal complications. These effects are especially pronounced in elderly patients.

Taking glucocorticosteroids, NSAIDs, and alcohol together may increase the likelihood of gastrointestinal bleeding.

Due to a false-positive low concentration of levothyroxine or triiodothyronine, taking ASA can distort the data of laboratory tests of thyroid function.

Citramon P can lead to the development of bronchospasm and exacerbation of bronchial asthma, as well as other hypersensitivity reactions. Risk factors include: chronic obstructive pulmonary disease, chronic respiratory tract infections, seasonal allergic rhinitis, nasal polyposis, bronchial asthma. These phenomena can also occur in patients with allergic reactions to other substances. In such cases, special care is required.

Special instructions due to the presence of paracetamol

The use of Citramon P increases the risk of severe skin reactions (toxic epidermal necrolysis, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome with a possible fatal outcome). The patient should be informed about these reactions, and warned that if they occur, the drug should be stopped immediately.

Concomitant use of other potentially hepatotoxic drugs that induce microsomal liver enzymes (isoniazid, rifampicin, chloramphenicol, hypnotics and anticonvulsants, including carbamazepine, phenytoin, phenobarbital, etc.) increases the likelihood of paracetamol poisoning.

In patients with alcohol dependence, there is a risk of liver damage, therefore, caution should be exercised during therapy with Citramon P.

Special instructions due to the presence of caffeine

Citramon P should be used with caution to treat patients with hyperthyroidism, arrhythmia, and gout. In order to prevent an increase in heart rate and the development of nervousness, insomnia, irritability, during therapy, it is necessary to limit the consumption of caffeinated products.

Influence on the ability to drive vehicles and complex mechanisms

Studies of the effect of Citramon P on the ability to drive vehicles and complex mechanisms have not been conducted. But such undesirable reactions as dizziness and drowsiness require refraining from activities that require increased concentration of attention and speed of reactions. You should inform your doctor about these effects.

Application during pregnancy and lactation

During pregnancy and lactation, Citramon P is prohibited to use.

Pediatric use

According to the instructions, Citramon P is prohibited from using in pediatric practice:

As a pain reliever: for the treatment of children and adolescents under 15 years of age.
As an antipyretic: for the treatment of children and adolescents under 18 years of age. In the presence of a viral infection, taking ASA increases the likelihood of developing Reye's syndrome, the symptoms of which are manifested by hyperpyrexia (an increase in temperature above 41.1 ° C), prolonged vomiting, metabolic acidosis, disorders of the nervous system and psyche, hepatomegaly and liver dysfunction, acute encephalopathy, respiratory failure, convulsions, coma.

With impaired renal function

Citramon P should be used with caution in patients with impaired renal function.

For violations of liver function

Citramon P should be used with caution in patients with impaired liver function.

Use in the elderly

Citramon P should be used with caution in elderly patients, especially in the case of underweight.

Drug interactions

With the interaction of ASA contained in Citramon P with other drugs, the following effects may develop:

NSAIDs: the appearance of gastrointestinal bleeding and damage to the gastrointestinal mucosa. In case of joint use, it is recommended to take gastroprotectors;
oral anticoagulants (in particular, coumarin derivatives): taking ASA can potentiate the effect of these drugs, therefore, it is recommended to carry out clinical and laboratory monitoring of bleeding time and prothrombin time. The combined use of oral anticoagulants and Citramon P is not recommended;
glucocorticosteroids: damage to the gastrointestinal mucosa, the development of bleeding. In the case of joint use, it is recommended to take gastroprotectors, and if possible, such a combination should be avoided, especially when treating elderly patients;
heparin: development of bleeding, which requires laboratory and clinical monitoring of bleeding time. The combined use of heparin and Citramon P is not recommended;
thrombolytics: the possibility of bleeding. It is not recommended to prescribe Citramon P in the first 24 hours after an acute stroke. The combined use of thrombolytics and ASA is unacceptable;
selective serotonin reuptake inhibitors: the development of bleeding due to the effect on platelet function and the blood coagulation process. Combined use with Citramon P is not recommended;
inhibitors of platelet aggregation (clopidogrel, cilostazol, ticlopidine, paracetamol): the development of bleeding, requiring laboratory and clinical monitoring of the bleeding time. Combined use with Citramon P is not recommended;
valproic acid: due to disruption of bonds with plasma proteins, ASA increases the toxicity of valproic acid. When used together, it is necessary to ensure control of the plasma concentration of valproic acid;
phenytoin: increased plasma concentration of phenytoin; it is necessary to ensure control of this indicator;
loop diuretics (for example, furosemide): a decrease in their activity due to inhibition of prostaglandin synthesis and disruption of the glomerular filtration process. Taking NSAIDs can cause acute renal failure (particularly in dehydrated patients). The combined use of diuretics and Citramon P requires sufficient rehydration, monitoring of renal function and blood pressure control (especially at the initial stage of diuretic therapy);
aldosterone antagonists (spironolactone, canrenoate): decreased activity of these drugs due to impaired sodium excretion. It is recommended to ensure blood pressure control;
uricosuric agents (for example, sulfinpyrazone, probenecid): a decrease in the activity of these drugs due to an increase in the plasma concentration of ASA due to inhibition of tubular reabsorption;
antihypertensive drugs (ACE inhibitors, angiotensin II receptor antagonists, slow calcium channel blockers): a decrease in their activity due to inhibition of prostaglandin synthesis in the kidneys. Co-administration in the treatment of dehydrated or elderly patients can lead to acute renal failure. Requires adequate rehydration, control of renal function and blood pressure;
sulfonylurea derivatives, insulin: increased hypoglycemic effect. A high dose of ASA requires a decrease in the dose of hypoglycemic agents and control of blood glucose;
methotrexate (at a dose of up to 15 mg per week): a decrease in the tubular secretion of methotrexate, an increase in its plasma concentration and an increase in toxicity due to the development of these processes. The use of Citramon P is not recommended for the treatment of patients receiving high concentrations of methotrexate. When taking low concentrations of methotrexate, it is necessary to take into account the likelihood of interaction with ASA, especially in cases of impaired renal function. The use of methotrexate and Citramon P requires monitoring the function of the kidneys, liver, performing a general blood test (especially on the first day of such therapy);
alcohol: an increase in the likelihood of gastrointestinal bleeding. Sharing should be avoided.

With the interaction of paracetamol contained in the composition of Citramon P with other drugs, the following effects may develop:

inducers of microsomal liver enzymes, potentially hepatotoxic substances (for example, alcohol, a combination of rifampicin and isoniazid, antiepileptic drugs, hypnotics, including carbamazepine, phenytoin, phenobarbital): increased toxicity of paracetamol and liver damage even when taking non-toxic doses of the drug, which requires monitoring of liver function … It is not recommended to use these drugs simultaneously;
zidovudine: increased risk of neutropenia. Monitoring of hematological parameters is required. Simultaneous administration of the drug is possible only as directed by a doctor;
chloramphenicol: increased risk of increased concentration of the latter. It is not recommended to use these drugs together;
indirect anticoagulants: an increase in the anticoagulant effect after repeated (over 1 week or longer) intake of paracetamol. Occasional intake of paracetamol does not give a significant effect;
probenecid: a decrease in the clearance of paracetamol, which requires a decrease in its dose. It is not recommended to use these drugs together;
metoclopramide and other drugs that accelerate the evacuation from the stomach: increasing the rate of absorption of paracetamol, increasing the effectiveness and approaching the onset of the analgesic effect;
propantheline and other drugs that slow down the evacuation from the stomach: decrease the rate of absorption of paracetamol, decrease or delay the rapid relief of pain;
colestriamine: decrease in the rate of absorption of paracetamol. If necessary, the maximum level of anesthesia, colesteramine should be prescribed 1 hour after taking Citramon P.

When the caffeine contained in Citramon P interacts with other drugs, the following effects may develop:

hypnotics (for example, blockers of H1-histamine receptors, barbiturates, benzodiazepines): reducing their hypnotic effect, reducing the anticonvulsant effect of barbiturates. The combined use of drugs is not recommended. If it is necessary to simultaneously take Citramon P with the indicated drugs, the combination of caffeine should be taken in the morning;
disulfiram: increased risk of worsening alcohol withdrawal syndrome due to the stimulating effect of caffeine on the cardiovascular or central nervous system;
lithium: an increase in its plasma concentration due to an increase in renal clearance due to withdrawal of caffeine. Cancellation of Citramon P may require a reduction in the dose of lithium. It is not recommended to use drugs together;
sympathomimetics or levothyroxine: an increase in the chronotropic effect due to the mutual potentiation of drugs. Combined use with Citramon P is not recommended;
ephedrine-like substances: increased risk of drug dependence. It is not recommended to use drugs together;
antibacterial agents from the quinolone group (ciprofloxacin, enoxacin, pipemidic acid), terbinafine, cimetidine, fluvoxamine, oral contraceptives: an increase in the half-life of caffeine due to inhibition of liver cytochrome P450. In case of violations of the heart rhythm, liver function, latent epilepsy, the use of caffeine should be avoided;
theophylline: decrease in its excretion;
clozapine: an increase in its serum concentration, which requires control of this indicator. It is not recommended to use drugs together;
phenylpropanolamine, phenytoin, nicotine: decrease in the terminal half-life of caffeine.

The influence of the active ingredients of Citramon P on laboratory data:

paracetamol: can alter the results of determining uric acid by the phosphotungstic acid method, as well as glycemia using the glucose oxidase / peroxidase method;
ASA: when taking high doses, it can distort the data of clinical and biochemical studies;
Caffeine: May reverse the effect of dipyridamole on myocardial blood flow. If investigated, you should stop taking caffeine within 8-12 hours.

Analogs

Analogs of Citramon P are: Askofen-P, AquaCitramon, Migrenol Extra, Kofitsil-plus, Citramon P Forte, Citramarine, Excedrin, Citrapar, etc.

Terms and conditions of storage

Store in a dark place out of the reach of children at temperatures up to 25 ° C.

Shelf life is 3 years.

Terms of dispensing from pharmacies

Available without a prescription.

Reviews of Citramone P

Reviews of Citramone P confirm its effectiveness for headaches and migraines, the drug is described as an inexpensive proven remedy.

But, patients note the need for strict adherence to the dosage regimen of the drug, since there is evidence of the harm of Citramon P for the liver, gastrointestinal tract and the likely development of dependence in the case of prolonged use.

Price for Citramon P in pharmacies

The price for Citramon P for a pack of 6 tablets is from 4 rubles; 10 tablets - from 7 rubles, 20 tablets - from 30 rubles.

Citramon P: prices in online pharmacies

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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!