Citralex( escitalopram) analogues:
Cipralex( escitalopram) Instruction:
Active ingredient of Cypralex
Forms of production of Cypralex
To whom is shown Cipralex
- Treatment of depressive episodes of varying severity.
- Treatment of panic disorders with or without agoraphobia.
- Treatment of social anxiety disorders( social phobia).
- Treatment of generalized anxiety disorders.
How to use Cipralex
Method of administration and dose
Large depressive episode of
Usually prescribe 10 mg, once a day. Depending on the individual sensitivity of the patient, the dose may be increased to 20 mg. Antidepressant effect usually comes in 2-4 weeks. After the disappearance of the symptoms, treatment should be continued usually within 6 months in order to consolidate the effect.
Panic disorder with or without agoraphobia
During the first week, an initial dose of 5 mg is recommended, after which the dose can be increased to 10 mg. The
Social anxiety disorders( social phobia)
Usually prescribe 10 mg, once a day. Depending on the individual sensitivity of the patient, a dose increase of up to 20 mg per day is recommended. Relief of symptoms usually occurs after 2-4 weeks of treatment. It is recommended to continue treatment within 3 months. Long-term treatment for 6 months is prescribed to prevent relapse, taking into account individual manifestations of the disease;The effectiveness of treatment is regularly assessed.
Generalized anxiety disorders.
Usually prescribe 10 mg, once a day. Depending on the individual sensitivity, the dose may be increased to a maximum of 20 mg per day. It is recommended to continue treatment within 3 months. Long-term treatment for 6 months is prescribed to prevent relapse, taking into account individual manifestations of the disease;The effectiveness of treatment is regularly assessed.
Older patients( over 65 years of age)
The initial dose should be half the usual dose, which is recommended. The recommended daily dose for the elderly is 5 mg. Depending on the individual sensitivity and severity of depression, the dose may be increased to a maximum of 10 mg per day.
If there is a mild to moderate degree of renal failure, there are no restrictions. Caution is necessary to take the drug to patients with severe renal failure( creatinine clearance <30ml / min).
Decreased liver function.
The recommended initial dose for the first two weeks of treatment is 5 mg / day. Depending on the individual reaction of the patient, the dose may be increased to 10 mg / day.
Reduced activity of cytochrome isoenzyme CYP2C19
For patients with a weak activity of the isoenzyme CYP2C19, the recommended initial dose for the first two weeks of treatment is 5 mg / day. Depending on the individual reaction of the patient, the dose may be increased to 10 mg / day.
treatment When discontinuing treatment with Cipralex, the dose should gradually decrease within 1-2 weeks in order to avoid a reaction to discontinuation of the drug.
Features of application of
Administration of the drug to children and adolescents younger than 18 years is not recommended, since the safety and efficacy of the drug in this population have not been studied.
Some patients with panic disorders at the start of treatment with selective serotonin reuptake inhibitors( SSRIs) may experience increased anxiety. Such a paradoxical reaction usually disappears within two weeks of treatment. To reduce the likelihood of an anxiogenic effect, low initial doses are recommended.
It is necessary to cancel the drug in case of convulsive seizures.
SSRIs should be used with caution in the treatment of patients with a history of mania / hypomania. When a manic condition appears, the SSRIs must be abolished.
In patients with diabetes, SSRIs can alter glycemic control( hypoglycemia or hyperglycemia).Insulin and / or oral hypoglycemic dosing may need to be regulated. Suicide
The possibility of suicidal attempts is typical for depression and can exist up to achieving persistent remission both spontaneously and as a result of therapy. Against the backdrop of treatment with antidepressants, patients should be carefully monitored, especially at the beginning of therapy, regarding clinical deterioration and / or the appearance of suicidal thoughts and behavior. Such caution is also appropriate in the treatment of patients with other psychiatric disorders in view of the possible presence of a concomitant major depressive disorder.
Hyponatremia may be associated with a violation of the secretion of antidiuretic hormone( ADH), with the SSRIs rarely occurs and usually disappears when therapy is withdrawn.
SSRIs may develop hemorrhage( ecchymosis and purpura).It is necessary to carefully appoint SSRIs to patients with a tendency to bleeding, as well as patients who take anticoagulants and medications that affect blood clotting.
Reversible selective MAO inhibitor type A
Combining escitalopram and MAO inhibitor type A is not recommended because of the risk of developing a serotonin syndrome.
Patients who take SSRIs concomitantly with serotonergic drugs may, in rare cases, develop a serotonin syndrome. It is necessary to use caution with escitalopram simultaneously with drugs that have a serotonergic effect. The combination of such symptoms as agitation, tremor, myoclonus, hyperthermia, may indicate the development of serotonin syndrome. If such a situation arises, SSRIs and serotonergic drugs should be urgently discontinued and symptomatic treatment should be prescribed.
Pregnancy and lactation
Clinical evidence for the use of escitalopram in the treatment of pregnancy is limited. Because of this, Cipralex should not be given to pregnant women. An exception is when, after careful consideration of all the shortcomings and advantages, the need to prescribe the drug has been clearly demonstrated. The use of SSRIs in the third trimester may adversely affect, including neurobehavioral dysfunction of newborns. There are data on such disorders in newborns whose mothers used SSRIs during pregnancy: agitation, tremor, hypertension, increased muscle tone, constant crying, difficulties with breastfeeding or sleeping. SIZOS may be the cause of serotonergic effect or withdrawal syndrome. When used during pregnancy, care should be taken to follow recommendations for the gradual cessation of therapy.
Because escitalopram is excreted in breast milk, it is not recommended for women who are breast-feeding to prescribe the drug or whether breast-feeding should be abolished.
Effect on ability to drive or drive
Although escitalopram does not affect intellectual or psychomotor functioning, it should nevertheless be taken into account that any psychoactive remedy can potentially violate these functions.
Side effects of zipralex
To whom is contraindicated Cipralex
Interaction of Zipralex
- Pharmacodynamic interaction.
- Negative combinations.
- Non-selective MAO inhibitors.
- Cipralex should not be used by patients who take non-selective irreversible inhibitors of monoamine oxidase( MAO) and within two weeks after discontinuation. Treatment with MAO inhibitors should begin no earlier than 7 days after stopping the use of Zipralex.
As a result of the risk of developing serotonin syndrome, the combination of escitalopram with an MAO inhibitor of type A moclobemide is not recommended. If the appointment of this combination is considered necessary, first prescribe the minimum recommended dose under careful medical supervision.
Combinations that need caution
- Serotonergic medications
- Simultaneous use with serotonergic medications( eg tramadol, sumatriptan and other triplanes) can lead to the development of serotonin syndrome. Lithium, tryptophan
- Since there have been reported cases of increased effects in the general use of SSRIs and lithium or tryptophan, caution should be exercised while simultaneously prescribing these drugs. Alcohol
- Escitalopram does not enter with pharmacodynamic or pharmacokinetic interaction with alcohol.
Co-administration of escitalopram and omeprazole( CYP2C19 inhibitor) as a result increases the concentration of escitalopram in plasma by an average of approximately 50%.
Compatible assignment of escitalopram and cimetidine( moderately strong basic inhibitor of enzymes) as a result, on average( approximately 70%) increases the concentration of escitalopram in the blood plasma. Thus, when escitalopram is combined with CYP2C19 inhibitors( eg, omeprazole, fluoxetine, fluvoxamine, lansoprazole, ticlopidine) and with cimetidine, caution should be exercised in prescribing the upper limiting doom of escitalopram. A decrease in the dose of escitalopram may be necessary, depending on the clinical evaluation.
Symptoms and signs: dizziness, tremor, agitation, dizziness, convulsions, sinus tachycardia, vomiting, rhabdomyolysis, metabolic acidosis, hypokalemia.
There is no specific clinical manifestation of the syndrome of overdose. There were no lethal cases.
Treatment. There is no specific antidote. Treatment is symptomatic and supportive. Should be imposed gastric lavage after oral administration of the drug. We need constant medical supervision.