Cipralex - instructions for use, reviews, analogs and formulations (5 mg, 10 mg and 20 mg tablets) of an antidepressant drug for the treatment of depression, panic disorders in adults, children and pregnancy. Withdrawal syndrome and alcohol

In this article, you can read the instructions for using the drug Cipralex. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors specialists on the use of Cipraplex in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Cipralex in the presence of existing structural analogues. Use to treat depression, panic disorders, phobias in adults, children, as well as during pregnancy and lactation.Development and prevention of withdrawal syndrome and interaction of the drug with alcohol.

Cipralex - an antidepressant, a selective serotonin reuptake inhibitor (SSRI). Inhibition of reuptake of serotonin leads to an increase in the concentration of this neurotransmitter in the synaptic cleft, enhances and prolongs its effect on postsynaptic receptor sites.

Escitalopram has no or very little ability to bind to a number of receptors, including: serotonin 5-HT1A-, 5-HT2 receptors, dopamine D1 and D2 receptors, alpha1, alpha2, beta adrenoreceptors, histamine H1 receptors , m-cholinergic receptors, benzodiazepine and opioid receptors.

Composition

Escitalopram (in the form of oxalate) + auxiliary substances.

Pharmacokinetics

Absorption does not depend on food intake. Bioavailability of Escitalopram is about 80%. The binding of escitalopram and its major metabolites with blood plasma proteins is below 80%. Escitalopram is metabolized in the liver to demethylated and demodetylated metabolites, which are pharmacologically active. The basic substance and its metabolites are partially isolated in the form of glucuronides.Escitalopram and its major metabolites are excreted by the liver (the metabolic pathway) and the kidneys. Most of it is excreted in the form of metabolites with urine.

Indications

• Depressive episodes of any severity;
• panic disorder with / without agoraphobia;
• social anxiety disorder (social phobia);
• generalized anxiety disorder;
• obsessive-compulsive disorder.

Forms of release

Tablets coated with 5 mg, 10 mg and 20 mg.

Instructions for use and dosing regimen

Cipralex is prescribed 1 time per day, regardless of food intake.

With depressive episodes, the drug is usually prescribed at a dose of 10 mg per day. Depending on the individual reaction of the patient, the dose can be increased to a maximum of 20 mg per day.

The antidepressant effect usually develops in 2-4 weeks after the start of treatment. After the disappearance of the symptoms of depression for at least another 6 months, it is necessary to continue therapy to fix the effect.

In panic disorders with / without agoraphobia, a dose of 5 mg per day is recommended during the first week of treatment, followed by an increase to 10 mg per day.Depending on the individual reaction of the patient, the dose can be increased to a maximum of 20 mg per day.

The maximum therapeutic effect is achieved approximately 3 months after the start of treatment. The therapy lasts for several months.

With a social anxiety disorder (social phobia), 10 mg once a day is prescribed. Symptom weakening usually develops 2-4 weeks after the start of treatment. Depending on the individual reaction of the patient, the dose can subsequently be reduced to 5 mg per day or increased to a maximum of 20 mg per day.

Because social anxiety disorder is a disease with chronic course, the minimum recommended duration of a therapeutic course is 12 weeks. To prevent recurrence of the disease, the drug can be given within 6 months or longer depending on the individual reaction of the patient.

With a generalized anxiety disorder, the recommended initial dose is 10 mg once a day. Depending on the individual reaction of the patient, the dose can be increased to a maximum of 20 mg per day. Long-term administration of the drug (6 months and longer) is allowed at a dose of 20 mg per day.

When obsessive-compulsive disorder is prescribed 10 mg once a day. Depending on the individual reaction of the patient, the dose can subsequently be increased to a maximum of 20 mg per day.

Because obsessive-compulsive disorder is a disease with chronic course, treatment should be long enough to ensure complete relief from symptoms and last at least 6 months. To prevent relapse, treatment is recommended for at least 1 year.

In elderly patients (over 65 years of age), it is recommended that half of the recommended dose be used (ie, only 5 mg per day) and a lower maximum dose (10 mg per day).

With renal failure of mild to moderate severity, dose adjustment is not required. Patients with severe renal insufficiency (CC <30 mL / min) should be given caution.

If discontinuation of treatment with Cipralex dosage should be reduced gradually within 1-2 weeks to avoid the development of withdrawal syndrome.

Side effect

• insomnia or drowsiness;
• dizziness;
• violation of taste;
• sleep disturbance;
• sinusitis;
• yawn;
• nausea, vomiting;
• diarrhea;
• constipation;
• decreased appetite;
• increased sweating;
• decreased libido;
• anorgasmia (in women);
• impotence;
• violation of ejaculation;
• weakness;
• hyperthermia;
• hallucinations;
• mania;
• confusion of consciousness;
• anxiety;
• panic attacks;
• increased irritability;
• convulsive seizures;
• visual impairment;
• orthostatic hypotension;
• dry mouth;
• anorexia;
• skin rash;
• itching;
• angioedema;
• increased sweating;
• arthralgia;
• myalgia;
• retention of urine;
• anaphylactic reactions.

In addition, after prolonged use, a sharp discontinuation of the therapy with Cipralex in some patients can lead to a withdrawal reaction. With a sharp discontinuation of escitalopram, unwanted reactions such as dizziness, headaches and nausea, which are not significant, and duration - are limited. To avoid the occurrence of withdrawal reactions, gradual withdrawal of the drug within 1-2 weeks is recommended.

Contraindications

• simultaneous administration of MAO inhibitors;
• pregnancy;
• lactation period (breastfeeding);
• children and adolescents under 18;
• increased sensitivity to escitalopram and other components of the drug.

Application in pregnancy and lactation

Cipralex is contraindicated in pregnancy and lactation (breastfeeding).

The use of selective serotonin reuptake inhibitors in the 3 trimester of pregnancy can negatively affect the psychophysical development of the newborn. The following disorders were registered in newborns whose mothers took selective inhibitors of serotonin reuptake up to delivery: irritability, tremor, hypertension, increased muscle tone, constant crying, difficulty sucking, poor sleep. Violations may indicate serotonergic effects or the onset of withdrawal syndrome. In the case of the use of selective inhibitors of serotonin reuptake during pregnancy, their reception should not be abruptly interrupted.

Use in children

Antidepressants should not be given to children and adolescents under the age of 18 because of the increased risk of suicidal behavior (suicidal attempts and thoughts), hostility (with a predominance of aggressive behavior, a tendency to confrontation and irritation).If a decision is made to initiate antidepressant therapy, the patient should be carefully monitored.

special instructions

Cipralex can not be administered simultaneously with MAO inhibitors. Escitalopram can be prescribed 14 days after discontinuation of treatment with irreversible MAO inhibitors and at least 1 day after discontinuation of therapy with a reversible MAO inhibitor of type A, incl. moclobemide. At least 7 days must pass after the end of taking escitalopram before treatment with nonselective MAO inhibitors can begin.

Some patients with panic disorders at the start of treatment with selective serotonin reuptake inhibitors (including escitalopram) may experience increased anxiety. Such a paradoxical reaction usually disappears within 2 weeks of treatment. To reduce the likelihood of anxiogenic effect, it is recommended to use the drug in low initial doses.

It should be canceled escitalopram in case of convulsive seizures. It is not recommended to use the drug in patients with unstable epilepsy; with controlled seizures careful monitoring is necessary.With an increase in the frequency of convulsive seizures, selective serotonin reuptake inhibitors, including escitalopram, must be eliminated.

Caution should be used escitalopram in patients with anamnesis for mania / hypomania. With the development of the manic state of escitalopram must be abolished.

In the treatment of escitalopram in patients with diabetes mellitus, a change in the level of glucose in the blood is possible. Therefore, it may be necessary to adjust the dosages of insulin and / or oral hypoglycemic drugs.

The risk of committing suicide is inherent in depression and can persist until a significant improvement in the condition occurs spontaneously or as a result of ongoing therapy. Careful observation of patients on antidepressant medication is necessary, especially at the beginning of treatment because of the possibility of clinical deterioration and / or the appearance of suicidal manifestations (thoughts and behavior). This precaution should be followed in the treatment of other mental disorders due to the possibility of concurrent depressive episode.

Hyponatremia, possibly associated with a violation of ADH secretion, against the background of taking escitalopram occurs rarely and usually disappears when therapy is withdrawn.Caution should be given to escitalopram and other selective serotonin reuptake inhibitors in patients at risk of developing hyponatremia: elderly, with cirrhosis of the liver and taking drugs that can cause hyponatremia.

When taking escitalopram, it is possible to develop skin hemorrhages (ecchymosis and purpura). Escitalopram should be used with caution in patients with a tendency to bleeding, and also taking oral anticoagulants and drugs that affect blood clotting.

The clinical experience of using escitalopram in combination with electroconvulsive therapy is limited, so caution should be used in this case.

It is not recommended simultaneous use of escitalopram and MAO type A inhibitors because of the risk of developing serotonin syndrome.

In patients taking escitalopram and other selective inhibitors of serotonin reuptake simultaneously with serotonergic drugs, in rare cases, a serotonin syndrome may develop. 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 this occurs, selective serotonin reuptake inhibitors and serotonergic drugs should be immediately withdrawn and symptomatic therapy should be prescribed.

Impact on the ability to drive vehicles and manage mechanisms

Although escitalopram does not affect psychomotor activity, it is not recommended to drive or operate machinery during the treatment period.

Drug Interactions

Pharmacodynamic interaction

With the simultaneous use of Zipraplex with MAO inhibitors, as well as the initiation of MAO inhibitors, patients who have recently stopped taking Ziprapex, serious serious adverse reactions may occur. In such cases, a serotonin syndrome may develop.

Joint use of Cipralex with serotonergic drugs (eg tramadol, Sumatriptan and other triptans) can lead to the development of serotonin syndrome.

Cipralex can reduce the threshold of convulsive readiness.Caution is necessary when simultaneous appointment of Cipralex and other drugs that reduce the threshold of convulsive readiness (tricyclic antidepressants, SSRIs, antipsychotics-phenothiazines, thioxanthenes and butyrophenones, mefloquine and tramadol).

Since there have been reported cases of increased effects when co-prescribing Cypralex and lithium or tryptophan, caution should be exercised while prescribing these drugs simultaneously.

Simultaneous administration of Cipralex and preparations containing St. John's Wort (Hypericum perforatum) may lead to an increase in the number of side effects.

When concomitant administration of escitalopram with oral anticoagulants and drugs that affect blood clotting (eg, atypical antipsychotics and phenothiazines, most tricyclic antidepressants, Acetylsalicylic acid and non-steroidal anti-inflammatory drugs (NSAIDs), ticlopidine and dipyridamole), clotting may occur. In such cases, at the beginning or after the end of escitalopram therapy, careful monitoring of blood clotting is necessary.

With the simultaneous use of alcohol, escitalopram does not enter into pharmacodynamic or pharmacokinetic interaction. However, as with other psychotropic drugs, simultaneous use of escitalopram and alcohol is not recommended.

Pharmacokinetic interaction

Simultaneous application of Cypralex and Omeprazole in a dose of 30 mg 1 time per day (inhibitor of the isoenzyme CYP2S19) leads to a moderate (about 50%) increase in the concentration of escitalopram in the blood plasma.

Simultaneous reception of escitalopram and cimetidine at a dose of 400 mg twice a day (inhibitor of isoenzymes CYP2D6, CYP3A4, CYP1A2) leads to an increase (approximately 70%) of escitalopram concentration in the blood plasma.

Therefore, escitalopram should be administered with caution at the same time as CYP2C19 isoenzyme inhibitors (eg, omeprazole, esomeprazole, fluvoxamine, lansoprazole, ticlopidine) and cimetidine. With the simultaneous administration of escitalopram and the above drugs, a dose reduction of escitalopram may be required based on monitoring the occurrence of side effects.

Escitalopram is an inhibitor of the CYP2D6 isoenzyme.Care should be taken when concomitantly administering escitalopram and drugs metabolized with this isoenzyme and having a small therapeutic index, for example, flecainide, propafenone and Metoprolol (in cases of heart failure) or drugs that are mainly metabolized by the CYP2D6 isoenzyme and acting on the CNS , for example antidepressants of desipramine, clomipramine, nortriptyline or antipsychotics risperidone, thioridazine, haloperidol. In these cases, dose adjustment may be required.

Simultaneous administration of Cipralex and desipramine or metoprolol leads to a twofold increase in the concentration of the last two drugs.

Escitalopram can slightly inhibit the isoenzyme CYP2C19. Therefore, caution should be exercised while using escitalopram and drugs metabolized with the participation of this isoenzyme.

Analogues of the drug Cipralex

Structural analogs for the active substance:

• Lenuksin;
• Miracitol;
• Sanctipam;
• Selektra;
• Eisipi;
• Elicia;
• Escitalopram.

Analogues for the pharmacological group (antidepressants):

• Agomelatine;
• Adress;
• Azona;
• Amizole;
• Amide;
• Amirol;
• Amitriptyline;
• Anaphranil;
• Asentra;
• Aurorix;
• Valdoxane;
• Velaxin;
• Velafax;
• Venlafaxine hydrochloride;
• Heptor;
• Heptral;
• Depres;
• Deprim;
• Doxepine;
• Duloxetine;
• Zoloft;
• Ixelles;
• Clomipramine;
• Coaxyl;
• Lerivon;
• Lyudomil;
• Miansan;
• Mirzaten;
• Mirtazapine;
• Mirtalan;
• Nerustin;
• Neuroplant;
• Oprah;
• Paxil;
• Paroxetine;
• Plizil;
• Prozac;
• Rexetin;
• Seralin;
• Sertraline;
• Triptysole;
• Févarine;
• Floxet;
• Fluval;
• Fluxonil;
• Fluoxetine;
• Citalopram;
• Elivel;
• Ephevelone.

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