Cipralex

Tablets Cipralex is an antidepressant from the group of selective serotonin reuptake inhibitors (SSRIs), thanks to this biochemical effect, which provides a pharmacological and clinical effect of taking the drug.

The active substance is escitalopram, it is similar to the main binding element and the alosteric element of the serotonin transporter, is practically unable to bind to the abundance of receptors. Maximum concentrations after repeated visits are achieved on average over 4 hours. The half-life of the drug is about 30 hours.

In patients older than 65 years, escitalopram is excreted at a lower rate than in younger patients. The amount of substance entering the systemic circulation, which is calculated using the pharmacokinetic parameter AUC ("area under the curve"), in elderly patients is 50% greater than in healthy young volunteers.

Clinical and pharmacological group

Antidepressant.

Terms of sale from pharmacies

Can buyby prescription.

Price

How much does Cipralex cost in pharmacies? The average price is at the level of1 100 rubles.

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Composition and form of release

The preparation is issued in the form of round or oval biconvex tablets of white color, covered with a film membrane with various dosage:

5 mg of the active ingredient (marking "EC") - in a contoured cell package (usually aluminum foil or PVC) 14 tablets, in a carton 2 packs.
Cipralex 10 mg (symmetric markers "E"And"L"Relative to the risks on one of the surfaces) - in the blister 14 tablets, 1, 2 or 4 contours in the box.
20 mg of biologically active component (marking "E"And"N"On either side of the dash on one side of the tablet) - in the box there are 2 blisters with 14 filled cells.

1 tablet contains:

active ingredient: escitalopram (in the form of oxalate) - 5, 10 or 20 mg;
auxiliary components: croscarmellose sodium, silicon dioxide colloid, magnesium stearate, microcrystalline cellulose, talc;
film sheath: macrogol 400, titanium dioxide (E 171), hypromellose 5cP.

Pharmacological effect

The mechanism of the effect of Zipraplex is due to the properties of escitalopram (the active substance of the drug) and consists of selective inhibition re-uptake of serotonin, which leads to an increase in the synaptic gap level of the concentration of this neurotransmitter substance. Also, under the influence of escitalopram, the effect of serotonin on the receptor zones of the postsynaptic region is increased.

The high effectiveness of the drug is due to the fact that escitalopram has an extremely high selectivity and does not enter into a relationship with other receptors, in particular, it does not bind with opioid, dopamine, serotonin 5-HT1A- and 5-HT2-receptors, as well as with adrenergic, H1-histamine, benzodiazepine receptors and M-cholinergic receptors. Thus, the drug can have a powerful, purposeful effect on the human body.

Indications for use

An antipsychotic drug is indicated for use in the treatment of the following psychiatric disorders:

Depression of varying degrees;
panic attacks;
agoraphobia;
social disorders;
systemic anxiety disorder;
obsessive-compulsive disorder.

Contraindications

age to 18 years;
simultaneous administration of pimozide or nonselective irreversible monoamine oxidase inhibitors (MAO);
hypersensitivity to any component of the drug.

According to the instructions, Cipralex should be used with caution in the following cases:

cirrhosis of the liver;
the period of electroconvulsive therapy;
pregnancy and lactation;
elderly age;
pronounced suicidal behavior;
mania and hypomania;
epilepsy, not amenable to medical correction;
tendency to bleeding;
diabetes;
severe renal insufficiency (creatinine clearance below 30 ml / minute);
simultaneous use with ethanol; drugs metabolized with the participation of the isoenzyme CYP2C19; oral anticoagulants and agents affecting on blood coagulability; tryptophans and lithium; St. John's wort perforated; serotonergic drugs; inhibitors of MAO A (eg, moclobemide) and MAO B inhibitors (e.g., selegiline); drugs that can cause hyponatremia or reduce the threshold of convulsive readiness.

Intended use for pregnancy and lactation

There are limited data on the use of escitalopram during pregnancy.

In studies of reproductive toxicity of escitalopram performed on rats, embryo and fetotoxic effects were observed, but without increasing the number of malformations.

In the case of the mother of SSRIs / SSRIs in late pregnancy, the newborn can develop the following side effects: respiratory depression, cyanosis, apnea, convulsive disorders, unstable temperature, difficulty with feeding, vomiting, hypoglycemia, hypertension, hypotension, hyperreflexia, tremor, increased nervous reflex excitability, irritability, lethargic sleep, constant crying, drowsiness, poor sleep. These symptoms can occur due to the development of the syndrome of "withdrawal" or serotonergic action. In most cases, such complications occur immediately or within 24 hours after birth.

Data from epidemiological studies suggest that the use of SSRIs during pregnancy, especially at late stages, may increase the risk of developing persistent pulmonary hypertension in a newborn.

It is expected that escitalopram will be excreted in breast milk, therefore, during treatment with escitalopram, breast-feeding is not recommended.

Animal studies indicate that citalopram can affect the quality of sperm. The use of certain SSRIs by humans has shown that the effect on sperm quality is reversible. So far, no impact on human fertility has been observed.

Dosage and route of administration

As indicated in the instructions for use, cipralex is taken internally, regardless of food intake. Depending on the indications, a single dose of 10-20 mg / day. The maximum daily dose is 20 mg. Duration of treatment is several months. At the termination of treatment the dose should gradually decrease within 1-2 weeks. in order to avoid the occurrence of the "cancellation" syndrome.

For elderly patients (over 65 years) the recommended dose is 5 mg / day, the maximum daily dose is 10 mg.

If the liver function is impaired, the recommended initial for the first 2 weeks. treatment is 5 mg / day. Depending on the individual reaction, the dose can be increased to 10 mg / day.

For patients with a weak activity of the isoenzyme CYP2S19, the recommended initial dose for the first 2 weeks. treatment - 5 mg / day. Depending on the individual reaction, the dose can be increased to 10 mg / day.

Canceling Zipraplex

The abolition of Zipralex is done gradually to minimize manifestations of withdrawal syndrome. Usually the dosage is reduced by 5 mg every week, bringing it up to 5 mg. That is, with 20 mg in the first week, the dosage is reduced to 15 mg per day, in the second week the dose is reduced to 10 mg, and in the third - to 5 mg. Then drink the drug at 5 mg per day for another 1 to 2 weeks and completely cancel the reception.

If in the process of reducing the dosage a person has withdrawal syndrome, then they return to the usual dosage and take the drug for 2-3 weeks. Then start to reduce the dosage also at 5 mg, but not every week, and once every 2 to 3 weeks. Thus, gradually cancel the drug completely.

Adverse Reactions

Side effects usually occur within the first two weeks of taking the drug and become less intense, and also less likely to occur as the therapy continues.

Gastrointestinal tract: nausea, diarrhea, constipation, vomiting, dry mouth, gastrointestinal bleeding (including rectal);
liver and biliary tract: hepatitis, impaired liver function;
skin and subcutaneous tissues: increased sweating, urticaria, alopecia, itching, ecchymosis, angioedema;
cardiovascular system: tachycardia, bradycardia, prolongation of QT interval on ECG, orthostatic hypotension;
respiratory system, chest and mediastinal organs: sinusitis, yawning, nosebleeds;
musculoskeletal and connective tissue: arthralgia, myalgia;
kidney and urinary tract: urinary retention;
blood and lymphatic system: thrombocytopenia;
immune system: anaphylactic reactions;
endocrine system: decreased secretion of antidiuretic hormone (ADH);
Metabolism: decreased or increased appetite, weight gain, weight loss, hyponatremia, anorexia;
psyche: anxiety, anxiety, unusual dreams, decreased libido, anorgasmia (in women), nervousness, agitation, bruxism, panic attacks, confusion, aggression, depersonalization, hallucinations, mania, suicidal thoughts and behavior (disappear after drug withdrawal);
nervous system: tremor, paresthesia, drowsiness, insomnia, dizziness, dyspnoea, syncopal conditions, disorders sleep, serotonin syndrome, dyskinesia, motor disorders, psychomotor agitation / akathisia, convulsive disorders;
organs of vision: mydriasis (dilated pupil), visual impairment;
the organ of hearing: tinnitus;
reproductive system and mammary gland: impotence, ejaculation, metrorrhagia (uterine bleeding), menorrhagia, galactorrhea, priapism;
general disorders: hyperthermia, weakness, swelling.

In the postgrade period there were cases of prolongation of the QT interval, mainly in patients with concomitant diseases of the heart. In double-blind, placebo-controlled studies of ECG in healthy volunteers, the change from baseline QT c (correction according to Frederick's formula) was 4.3 msec at a dose of 10 mg / day and 10.7 msec at 30 mg / day.

Studies involving patients older than 50 years have shown an increased risk of bone fracture in patients taking SSRIs and tricyclic antidepressants.

With the abrupt withdrawal of drugs, SSRIs and SSRIs often lead to the withdrawal syndrome, its symptoms: sensitivity disorders, dizziness, sleep disorders, anxiety, agitation, nausea, vomiting, tremor, confusion, headache, increased sweating, diarrhea, palpitation, emotional instability, irritability, visual disturbances. Usually, these effects have a weak intensity and quickly pass, however, their manifestation in a more acute form and for a longer time is possible. Recommended gradual withdrawal of the drug by reducing its dose.

Overdose

Overdose of Cipralex manifests itself with the development of the following symptoms:

Decrease in pressure;
Tachycardia;
Extension of the QT interval on the ECG;
Arrhythmia;
Dizziness;
Tremor;
Agitation (agitation);
Convulsions;
Nausea;
Vomiting;
Decrease in the concentration of potassium and sodium in the blood;
Coma.

Since there is no specific antidote, the treatment of an overdose of Zipraplex is to provide airway patency, oxygen supply and ventilation. Immediately after fixing the fact of an overdose, it is necessary to wash the stomach and give the person a sorbent. Then symptomatic therapy is carried out, aimed at maintaining the normal functioning of vital organs.

special instructions

Before you start using the drug, read the special instructions:

Clinical experience with the use of escitalopram indicates a possible increase in the risk of suicide attempts in the first weeks of therapy, in connection with which it is very important to carry out careful monitoring of patients during this period.
Escitalopram should be administered only after 2 weeks. after the cancellation of irreversible MAO inhibitors and 24 hours after discontinuation of therapy with a reversible MAO inhibitor. Non-selective MAO inhibitors can be prescribed no earlier than 7 days after the withdrawal of escitalopram.
In some patients with panic disorder at the beginning of treatment with escitalopram, anxiety can be increased, which usually disappears during the next 2 weeks. treatment. To reduce the likelihood of an alarm, it is recommended to use low initial doses.
Escitalopram should be withdrawn in the event of epileptic seizures or their increase in pharmacologically uncontrolled epilepsy.
When developing the manic state of escitalopram should be discarded.
Escitalopram is able to increase the concentration of glucose in the blood in diabetes mellitus, which may require correction of doses of hypoglycemic drugs.
Hyponatremia, associated with a decrease in ADH secretion, against the background of escitalopram is rare and usually disappears when it is withdrawn.
With the development of serotonin syndrome, escitalopram should be immediately withdrawn and symptomatic treatment should be prescribed.
Caution should be used in patients with renal insufficiency (KC less than 30 ml / min), hypomania, mania, with pharmacologically uncontrolled epilepsy, with depression with suicide attempts, diabetes, in elderly patients, with cirrhosis of the liver, with a tendency to bleeding, while taking medications, reducing the threshold of convulsive readiness, causing hyponatremia, with ethanol, with drugs metabolized with the participation of isoenzymes of the CYP2C19 system.

Compatibility with other drugs

When using the drug, it is necessary to take into account the interaction with other drugs:

Escitalopram increases the plasma concentration of desipramine and metoprolol by a factor of 2.
When used simultaneously with MAO inhibitors, the risk of developing serotonin syndrome and serious adverse reactions increases.
Joint application with serotonergic drugs (including tramadol, triptans) may lead to the development of serotonin syndrome.
With simultaneous use with drugs that reduce the threshold of convulsive readiness, increases the risk of seizures.
Escitalopram enhances the effects of tryptophan and lithium preparations, increases the toxicity of St. John's Wort preparations, effects drugs that affect blood clotting (monitoring blood coagulation indices is necessary).
Drugs metabolized with the participation of the isoenzyme CYP2S19 (including omeprazole), and also are potent inhibitors of CYPZA4 and CYP2D6 (including flecainide, propafenone, metoprolol, desipramine, clomipramine, nortriptyline, risperidone, thioridazine, haloperidol), increase the concentration of escitalopram in the blood plasma.

Reviews

We offer to read reviews of people who used Cipralex:

Sasha. A smart drug. In combination with Lamictal - changed my whole life. At home, silence, tranquility, harmony and order. The head does not hum. Bad thoughts are gone. I feel pre-kra-sno! And all suffering bipolar and manic depression - I wish the same.
Olga. Many people have problems in their lives that are driven into depression, panic appears. So I had such a misfortune. I had to take the drug tsipraleks. Took it in the afternoon, because it felt lethargic. It helps very well. Only if I stop receiving, then the state returns. Moreover, for some reason the husband as a man has completely ceased to interest him. For me pobochki more than good.
Martha. Her husband started panic attacks, depression. Appealed to a psychiatrist, he insisted on hospitalization. My husband was against hospitalization. Tiprapale just saved us! Began to drink 10 mg in the morning. I noticed the changes after 10 days. Now it's been 2 months since the reception, everything seems to be working out, the husband's condition has returned to normal, but we will drink at least 6 months. Depression of a native person is scary. Thank you!

According to doctors involved in the treatment of mental disorders, Cipralex is a modern and highly effective antidepressant. Cipralex is well tolerated, very rarely causing side effects, and this quality is highly appreciated by psychiatrists and psychotherapists, since it allows prescribing the drug in the home without mandatory hospitalization in the hospital for 2 - 3 weeks to monitor the behavior of a person in the process of entering the treatment.

However, doctors do not consider the drug ideal, because some people do not fit it, others are poorly tolerated, and the third is not enough of its effect. Therefore, appointing Tipralex, doctors know that it may be ineffective, and therefore are ready for a quick replacement with another drug from the group of antidepressants.

Analogues

Structural analogs for the active substance:

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

Before buying an analogue, consult your doctor.

Cipralex or Zoloft?

Preparations Cipralex and Zoloft belong to the same pharmacological group of SSRIs, and therefore have similar therapeutic effects. According to doctors and patients, the effectiveness, tolerability and severity of side effects in Zoloft and Cipralex approximately identical, therefore preparations differ exclusively individual reaction of an organism of the person on them. This means that someone is more suitable Zoloft, and someone, on the contrary, Cipralex. Unfortunately, it is impossible to predict which drug is best for this particular person. You can understand this only by trying to take both. Usually doctors prescribe any one drug, and if it is poorly tolerated, replace it with another.

Paxil or Cipralex?

Both drugs are classified as selective inhibitors of serotonin reuptake, that is, they have approximately the same therapeutic effect and have the same contraindications. However, subjective sensations of people and observations of psychiatrists Paxil acts faster than Cipralex, so it can be preferred to people with vivid and painful symptoms that require a speedy reduction. But Cipralex rarely causes side effects and is more easily tolerated, so it is more comfortable to treat than Paxil. Therefore, if a person is inclined to develop side effects, then it is better to prefer Cipralex.