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Pharmaenergy  ::  Anti Depressant  ::  Cipramil  ::  Cipramil 20 mg x50

CIPRAMIL 20 MG X50 #1030
Cipramil 20 mg x50
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Weight 20mg
Set 50tab
PerPillPrice $4.50
Price: $225.00

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Main Use: Depression
Active Ingredient: Citalopram

How does it work?
Cipramil tablets and drops contain the active ingredient citalopram hydrochloride, which is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). (NB. Citalopram is also available without a brand name, ie as the generic medicine.)

Antidepressant medicines act on nerve cells in the brain. In the brain there are numerous different chemical compounds called neurotransmitters. These act as chemical messengers between the nerve cells. Serotonin is one such neurotransmitter and has various functions that we know of.

When serotonin is released from nerve cells in the brain it acts to lighten mood. When it is reabsorbed into the nerve cells, it no longer has an effect on mood. It is thought that when depression occurs, there may be a decreased amount of serotonin released from nerve cells in the brain.

SSRIs work by preventing serotonin from being reabsorbed back into the nerve cells in the brain. This helps prolong the mood lightening effect of any released serotonin. In this way, citalopram helps relieve depression, panic and fear.

It may take between two to four weeks for the benefits of this medicine to appear, so it is very important that you keep taking it, even if it doesn't seem to make much difference at first. If you feel your depression or anxiety has got worse, or if you have any distressing thoughts or feelings in these first few weeks, then you should talk to your doctor.

What is it used for?
- Depression
- Panic disorder with or without agoraphobia

Warning!
Depression and other psychiatric illnesses are associated with an increased risk of suicidal thoughts, self-harm, and suicide. You should be aware that this medicine may not start to make you feel better for at least two to four weeks. However, it is important that you keep taking it in order for it to work properly and for you to feel better. If you feel your depression or anxiety has got worse, or if you have any distressing thoughts, or feelings about suicide or harming yourself in these first few weeks, or indeed at any point during treatment or after stopping treatment, then it is very important to talk to your doctor.

This medicine may reduce your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance.

It is recommended that you avoid drinking alcohol while taking this medicine.

SSRI antidepressants have been associated with the development of unpleasant or distressing restlessness and the need to move, often accompanied by an inability to sit or stand still. This is most likely to occur within the first few weeks of treatment. If you experience these symptoms you should consult your doctor.

Antidepressants may cause the amount of sodium in the blood to drop - a condition called hyponatraemia. This can cause symptoms such as drowsiness, confusion, muscle twitching or convulsions. Elderly people may be particularly susceptible to this effect. You should consult your doctor if you develop any of these symptoms while taking this medicine, so that your blood sodium level can be checked if necessary.

If you experience seizures (convulsions or fits) while taking this medicine, consult your doctor immediately, as you will need to stop treatment with this medicine. This also applies if you suffer from epilepsy and experience more seizures than normal after starting this medicine.

You should not suddenly stop taking this medicine, as this can cause withdrawal symptoms such as dizziness, sleep disturbances (including intense dreams), nausea, headache, a feeling of weakness, pins and needles and anxiety. Withdrawal symptoms are temporary and are not due to addiction or dependence on the medicine. They can usually be avoided by stopping the medicine gradually, usually over a period of weeks or months, depending on your individual situation. Follow the instructions given by your doctor when it is time to stop treatment with this medicine. On very rare occasions some people have experienced withdrawal symptoms after accidentally missing a dose of this medicine.

Following a review of the safety and efficacy of SSRIs to treat depression in children under 18 years of age (unlicensed use), the Committee on Safety of Medicines (CSM) has concluded that the risks of citalopram outweigh the benefits for treating depressive illness in this age group. If you are under 18 and taking citalopram for depression you should consult your doctor for advice, but do not suddenly stop taking it as this can cause withdrawal symptoms. Citalopram is not licensed and not recommended for any uses in children and adolescents under 18 years of age.

Use with caution in
- Elderly people
- Young adults
- History of suicidal behaviour or thoughts
- History of mania or hypomania
- People also receiving electroconvulsive therapy (ECT)
- People taking antipsychotic medicines
- Decreased liver function
- Severely decreased kidney function
- Diabetes
- Epilepsy
- History of bleeding disorders
- People taking medicine that affects blood clotting (eg anticoagulants such as warfarin)

Not to be used in
- Children and adolescents under 18 years of age
- People who have taken a monoamine-oxidase inhibitor antidepressant (MAOI) in the last 14 days
- Manic episodes of manic depression (bipolar affective disorder)
- Uncontrolled epilepsy

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

- The safety of this medicine in pregnancy has not been established. It should therefore be used with caution during pregnancy, and only if the benefits to the mother outweigh any risks to the foetus. Seek medical advice from your doctor if you get pregnant or plan to have a baby while taking this medicine.

- This medicine passes into breast milk, however the effect of this on the nursing infant is unknown. Mothers who need to take this medicine should discuss the risks and benefits of breastfeeding with their doctor.

Side effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

- Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
- Sleepiness (somnolence)
- Dry mouth
- Increased sweating
- Headache
- Shaking, usually of the hands (tremor)
- Dizziness
- Weakness or loss of strength (asthenia)
- Difficulty in sleeping (insomnia)
- Agitation
- Nervousness
- Awareness of your heart beat (palpitations)
- Visual disturbances
- Loss of memory (amnesia)
- Appetite and weight changes
- Sexual problems

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

Citalopram should not be taken at the same time as monoamine oxidase inhibitor medicines (MAOIs). These include monoamine oxidase inhibitor antidepressants such as phenelzine, tranylcypromine and moclobemide, the antibiotic linezolid and the anti-Parkinson's medicine selegiline. Citalopram should not be started until at least at least a day after stopping moclobemide or linezolid, and until at least two weeks after stopping other monoamine oxidase inhibitors. Similarly, treatment with any MAOIs should not be started until at least one week after citalopram has been stopped.

Treatment with this medicine may alter control of blood sugar in people with diabetes, who may need an adjustment in their dose of insulin or antidiabetic tablets. People with diabetes should discuss this with their doctor.

As SSRIs have been associated with bleeding abnormalities, the following medicines, which are known to affect the ability of the blood to clot, should be used with caution with citalopram:

- tricyclic antidepressants
- some antipsychotic medicines
- some antisickness medicines, eg prochlorperazine
- aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
- anticoagulants such as warfarin
- ticlopidine
- dipyridamole.

There may be an increased risk of side effects if citalopram is taken with the following, which also enhance the activity of serotonin in the brain:

- lithium
- triptans for migraine, eg sumatriptan
- tramadol
- tryptophan.

The herbal remedy St John's wort should not be taken with citalopram for the same reason.

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