Cipram - General Information:A furancarbonitrile that is one of the serotonin uptake inhibitors used as an antidepressant. The drug is also effective in reducing ethanol uptake in alcoholics and is used in depressed patients who also suffer from tardive dyskinesia in preference to tricyclic antidepressants, which aggravate this condition. [PubChem]
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Celexa (Citalopram) is a selective Serotonin Reuptake Inhibitor used to treat depression. It may also be used to treat other conditions as determined by your doctor.
Pharmacology:Cipram is one of a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). It is used to treat the depression associated with mood disorders. It is also used on occassion in the treatment of body dysmorphic disorder and anxiety. The antidepressant, antiobsessive-compulsive, and antibulimic actions of Cipram are presumed to be linked to its inhibition of CNS neuronal uptake of serotonin. In vitro studies show that Cipram is a potent and selective inhibitor of neuronal serotonin reuptake and has only very weak effects on norepinephrine and dopamine neuronal reuptake. Cipram has no significant affinity for adrenergic (alpha1, alpha2, beta), cholinergic, GABA, dopaminergic, histaminergic, serotonergic (5HT1A, 5HT1B, 5HT2), or benzodiazepine receptors; antagonism of such receptors has been hypothesized to be associated with various anticholinergic, sedative, and cardiovascular effects for other psychotropic drugs. The chronic administration of Cipram was found to downregulate brain norepinephrine receptors, as has been observed with other drugs effective in the treatment of major depressive disorder. Cipram does not inhibit monoamine oxidase.
Cipram for patients
Physicians are advised to discuss the following issues with patients for whom they prescribe Celexa.
Although in controlled studies Celexa has not been shown to impair psychomotor performance, any psychoactive drug may impair judgment, thinking, or motor skills, so patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that Celexa therapy does not affect their ability to engage in such activities.
Patients should be told that, although Celexa has not been shown in experiments with normal subjects to increase the mental and motor skill impairments caused by alcohol, the concomitant use of Celexa and alcohol in depressed patients is not advised.
Patients should be advised to inform their physician if they are taking, or plan to take, any prescription or over-the-counter drugs, as there is a potential for interactions.
Patients should be cautioned about the concomitant use of Celexa and NSAIDs, aspirin, or other drugs that affect coagulation since the combined use of psychotropic drugs that interfere with serotonin reuptake and these agents has been associated with an increased risk of bleeding.
Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during therapy.
Patients should be advised to notify their physician if they are breastfeeding an infant.
While patients may notice improvement with Celexa therapy in 1 to 4 weeks, they should be advised to continue therapy as directed.
Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with Celexa and should counsel them in its appropriate use. A patient Medication Guide About Using Antidepressants in Children and Teenagers is available for Celexa. The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document.
Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking Celexa.
Clinical Worsening and Suicide Risk: Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should be advised to observe for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patient's prescriber or health professional, especially if they are severe, abrupt in onset, or were not part of the patient's presenting symptoms. Symptoms such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication.
About Using Antidepressants in Children and Teenagers What is the most important information I should know if my child is being prescribed an antidepressant?
Parents or guardians need to think about 4 important things when their child is prescribed an antidepressant:
1.There is a risk of suicidal thoughts or actions
2.How to try to prevent suicidal thoughts or actions in your child
3.You should watch for certain signs if your child is taking an antidepressant
4.There are benefits and risks when using antidepressants
1.There is a Risk of Suicidal Thoughts or Actions
Children and teenagers sometimes think about suicide, and many report trying to kill themselves.
Antidepressants increase suicidal thoughts and actions in some children and teenagers. But suicidal thoughts and actions can also be caused by depression, a serious medical condition that is commonly treated with antidepressants. Thinking about killing yourself or trying to kill yourself is called suicidality or being suicidal.
A large study combined the results of 24 different studies of children and teenagers with depression or other illnesses. In these studies, patients took either a placebo (sugar pill) or an antidepressant for 1 to 4 months. No one committed suicide in these studies, but some patients became suicidal. On sugar pills, 2 out of every 100 became suicidal. On the antidepressants, 4 out of every 100 patients became suicidal.
For some children and teenagers, the risks of suicidal actions may be especially high. These include patients with
· Bipolar illness (sometimes called manic-depressive illness)
· A family history of bipolar illness
· A personal or family history of attempting suicide
If any of these are present, make sure you tell your healthcare provider before your child takes an antidepressant.
2. How to Try to Prevent Suicidal Thoughts and Actions
To try to prevent suicidal thoughts and actions in your child, pay close attention to changes in her or his moods or actions, especially if the changes occur suddenly. Other important people in your child's life can help by paying attention as well (e.g., your child, brothers and sisters, teachers, and other important people). The changes to look out for are listed in Section 3, on what to watch for.
Whenever an antidepressant is started or its dose is changed, pay close attention to your child.
After starting an antidepressant, your child should generally see his or her healthcare provider:
· Once a week for the first 4 weeks
· Every 2 weeks for the next 4 weeks
· After taking the antidepressant for 12 weeks
· After 12 weeks, follow your healthcare provider's advice about how often to come back
· More often if problems or questions arise
You should call your child's healthcare provider between visits if needed.
3. You Should Watch for Certain Signs If Your Child is Taking an Antidepressant
Contact your child's healthcare provider right away if your child exhibits any of the following signs for the first time, or if they seem worse, or worry you, your child, or your child's teacher:
· Thoughts about suicide or dying
· Attempts to commit suicide
· New or worse depression
· New or worse anxiety
· Feeling very agitated or restless
· Panic attacks
· Difficulty sleeping (insomnia)
· New or worse irritability
· Acting aggressive, being angry, or violent
· Acting on dangerous impulses
· An extreme increase in activity and talking
· Other unusual changes in behavior or mood
Never let your child stop taking an antidepressant without first talking to his or her healthcare provider.
Stopping an antidepressant suddenly can cause other symptoms.
4. There are Benefits and Risks When Using Antidepressants
Antidepressants are used to treat depression and other illnesses. Depression and other illnesses can lead to suicide. In some children and teenagers, treatment with an antidepressant increases suicidal thinking or actions. It is important to discuss all the risks of treating depression and also the risks of not treating it. You and your child should discuss all treatment choices with your healthcare provider, not just the use of antidepressants.
Other side effects can occur with antidepressants.
Of all the antidepressants, only fluoxetine (Prozac™) has been FDA approved to treat pediatric depression.
For obsessive compulsive disorder in children and teenagers, FDA has approved only fluoxetine (Prozac™), sertraline (Zoloft™), fluvoxamine, and clomipramine (Anafranil™).
Your healthcare provider may suggest other antidepressants based on the past experience of your child or other family members.
Is this all I need to know if my child is being prescribed an antidepressant?
No. This is a warning about the risk for suicidality. Other side effects can occur with antidepressants. Be sure to ask your healthcare provider to explain all the side effects of the particular drug he or she is prescribing. Also ask about drugs to avoid when taking an antidepressant. Ask your healthcare provider or pharmacist where to find more information.
*Zoloft™ is a registered trademark of Pfizer Pharmaceuticals
*Anafranil™ is a registered trademark of Mallinckrodt Inc.
This Medication Guide has been approved by the U.S. Food and Drug Administration for all antidepressants.
Central nervous system depressant (CNS) drugs including alcohol, antidepressants,
antihistamines, antipsychotics, blood pressure medications (reserpine, methyldopa,
beta-blockers), motion sickness medications, muscle relaxants, narcotics, sedatives,
sleeping pills and tranquilizers
Concomitant use in patients taking monoamine oxidase inhibitors (MAOIs) is contraindicated.
Concomitant use in patients taking pimozide is contraindicated.
Celexa is contraindicated in patients with a hypersensitivity to citalopram or any of the inactive ingredients in Celexa.
Additional information about CipramCipram Indication: For the treatment of depression.
Mechanism Of Action: The antidepressant, antiobsessive-compulsive, and antibulimic actions of Cipram are presumed to be linked to its inhibition of CNS neuronal uptake of serotonin. Cipram blocks the reuptake of serotonin at the serotonin reuptake pump of the neuronal membrane, enhancing the actions of serotonin on 5HT1A autoreceptors. SSRIs bind with significantly less affinity to histamine, acetylcholine, and norepinephrine receptors than tricyclic antidepressant drugs.
Drug Interactions: Almotriptan Increased risk of CNS adverse effects
Anisindione The SSRI increases the effect of anticoagulant
Carvedilol The SSRI increases the effect of the beta-blocker
Clarithromycin Possible serotoninergic syndrome with this combination
Clozapine The antidepressant increases the effect of clozapine
Dicumarol The SSRI increases the effect of anticoagulant
Eletriptan Increased risk of CNS adverse effects
Erythromycin Possible serotoninergic syndrome with this combination
Frovatriptan Increased risk of CNS adverse effects
Isocarboxazid Possible severe adverse reaction with this combination
Josamycin Possible serotoninergic sydrome with this combination
Linezolid Combination associated with possible serotoninergic syndrome
Metoprolol The SSRI increases the effect of the beta-blocker
Moclobemide Possible serotoninergic syndrome
Naratriptan Increased risk of CNS adverse effects
Acenocoumarol The SSRI increases the effect of anticoagulant
Oxycodone Increased risk of serotonin syndrome
Phenelzine Possible severe adverse reaction with this combination
Pimozide This SSRI increases the effect and toxicity of pimozide
Propranolol This SSRI increases the effect of the beta-blocker
Rasagiline Possible severe adverse reaction with this combination
Rizatriptan Increased risk of CNS adverse effects
Selegiline Possible severe adverse reaction with this combination
Sibutramine Risk of serotoninergic syndrome
St. John's Wort St. John's Wort increases the effect and toxicity of the SSRI
Sumatriptan Increased risk of CNS adverse effects
Zolmitriptan Increased risk of CNS adverse effects
Tramadol Increased risk of serotonin syndrome
Tranylcypromine Possible severe adverse reaction with this combination
Troleandomycin Possible serotoninergic syndrome with this combination
Warfarin The SSRI increases the effect of anticoagulant
Food Interactions: Avoid alcohol.
Avoid St.John's Wort.
Take without regard to meals.
Generic Name: Citalopram
Synonyms: Citalopramum [Inn-Latin]; Citalopram Hydrobromide
Drug Category: Antidepressants; Selective Serotonin Reuptake Inhibitors (SSRIs)
Drug Type: Small Molecule; Approved
Other Brand Names containing Citalopram: Celexa; Cipram; Nitalapram;
Absorption: Bioavailability is 80% following oral administration.
Toxicity (Overdose): Symptoms most often accompanying citalopram overdose, alone or in combination with other drugs and/or alcohol, included dizziness, sweating, nausea, vomiting, tremor, somnolence, and sinus tachycardia. In more rare cases, observed symptoms included amnesia, confusion, coma, convulsions, hyperventilation, cyanosis, rhabdomyolysis, and ECG changes (including QTc prolongation, nodal rhythm, ventricular arrhythmia, and very rare cases of torsade de pointes). Acute renal failure has been very rarely reported accompanying overdose.
Protein Binding: 50%
Half Life: 35 hours
Dosage Forms of Cipram: Tablet Oral
Chemical IUPAC Name: 1-(3-dimethylaminopropyl)-1-(4-fluorophenyl)-3H-2-benzofuran-5-carbonitrile
Chemical Formula: C20H21FN2O
Citalopram on Wikipedia: http://en.wikipedia.org/wiki/Citalopram
Organisms Affected: Humans and other mammals
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