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Hypersensitivity to citalopram or to any component, part of the drug; simultaneous application of inhibitors of monoamine oxidaseproviron side effects and for 14 days after termination of reception; Children’s age (efficacy and safety have not been established). Treatment of M inhibitors can be started no earlier than 7 days after discontinuation of citalopram.

With careful preparation should be used when there is insufficient liver and / or kidney problems, if you have a history of seizures, in patients older than 65 years, in the presence of drug dependence (including history), mania, hypomania.

Pregnancy and lactation

Citalopram should not be prescribed to pregnant and lactating women, if the potential clinical benefit prevails over theoretical risk, since safety of the drug during pregnancy and lactation has not been established in humans.

Dosing and Administration

Inside, once a day, at any time, regardless of the meal. Depression The recommended daily dose is 20 mg Siozama. Depending on the individual patient’s response to treatment and the severity of the dose can be increased disease. The maximum daily dose of 60 mg. Panic Disorder recommended daily dose Siozama – 10 mg for the first week of treatment, after which the dose was increased to 20 mg per day.The maximum daily dose is 60mg. Obsessive-compulsive disorder The recommended daily dose Siozama – 20 mg. Depending on the individual patient’s response to treatment and the severity of the dose can be increased disease. The maximum daily dose is 60 mg.

Patients aged 65 years and older
Impaired kidney function
Patients with mild proviron side effects or moderate renal impairment may use the drug at normal doses. At present, experience in treating patients with severe renal insufficiency (creatinine clearance below 20 ml / mol) is not sufficient. Impaired liver function Patients with impaired liver function should not be given more than 30 mg per day.

 

Duration of treatment
Usually, the antidepressant effect of the drug observed after 2-4 weeks of treatment. Treatment with antidepressants should be performed for a long time. Typically, to prevent relapse treatment should be carried out for 6 months or even longer period of time. In the case of patients with intermittent (recurrent) depression supportive treatment should be carried out for several years to prevent the onset of disease following phases. In the case of completion of treatment Siozam must be lifted gradually over several weeks.
In the treatment of panic disorder citalopram maximum effect is observed after 3 months of treatment. This effect was maintained throughout the period of maintenance therapy.
In the treatment of obsessive-compulsive disorder drug effect appears after 2-4 weeks of treatment; with a further extension of the treatment further improvement can be observed.

Side effect

From the nervous system: rarely – fatigue, drowsiness or proviron side effects insomnia, anxiety, tremor, agitation, amnesia, apathy, extrapyramidal effects, mood changes, aggressive behavior, depersonalization, emotional lability, euphoria, mania and / or psychotic (including hallucinations) disorder, panic reactions, serotonin syndrome (agitation, confusion, diarrhea, hyperthermia, hyperreflexia, ataxia). From the digestive system: rarely – dry mouth, nausea, vomiting, hypersalivation, bloating, diarrhea, abdominal pain, anorexia . Since the cardiovascular system: rarely – bradycardia, decreased blood pressure (BP), orthostatic hypotension, arrhythmia. From the side of hematopoiesis: rarely – thrombocytopenia, bleeding. From the sensory organs: rarely – mydriasis, accommodation paresis, taste disturbance. From the reproductive system: sexual dysfunction: abnormal ejaculation, decreased libido, impotence, menstrual disorders. Allergic reactions: skin rash, rarely – epidermal necrosis, rhinitis, sinusitis. Other: rarely – hyperthermia, polyuria, mammalgia, galakroteya, hyponatremia, violation of urination, arthralgia, myalgia, yawning, gnashing of teeth, increase or decrease in body weight, dyspnea.

 

Overdose

Symptoms: Nausea, dizziness, drowsiness, dysarthria, disturbance of heart rhythm and conduction (lengthening of the interval QT, sinus tachycardia, nodal rhythm), increased sweating, cyanosis, tremor, amnesia, confusion, rhabdomyolysis, seizures, coma. Treatment: gastric lavage, symptomatic and supportive therapy; there is no specific antidote.

Interaction with other drugs

Enhances the effect of sumatriptan and other serotonergic drugs.
Does not affect the action of ethanol, lithium drugs, benzodiazepines, antipsychotics (neuroleptics), narcotic analgesics, beta-blockers, phenothiazines, tricyclic antidepressants, antihistamines and gipotenzivyh drugs.
The slightly inhibits cytochrome  in this connection, weakly interacts with drugs that are metabolized with his participation.
When concomitantly with  inhibitors may develop a hypertensive crisis (serotonin syndrome).
Cimetidine increases the concentration in the blood and increases the citalopram effect.
When concomitant administration with warfarin the prothrombin time increases 5%.

special instructions

With the development of mania drug should be discontinued.
Patients with drug dependence (including history), it is required to monitor and supervise the use of the drug.
The treatment of proviron side effects inhibitors can be started no earlier than 7 days after discontinuation of citalopram.
Caution must be exercised the appointment during lactation due to the risk of drowsiness in infants, reduce the sucking reflex, loss of body weight.
in elderly patients require a dose reduction of citalopram.
citalopram is generally not affect the intellectual and psychomotor functions and capabilities. Nevertheless, it is advisable to inform patients taking psychotropic medications that their ability to focus and attention may be compromised to some degree as a result of their illness or medications taken action, or by a combination of these two factors.

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