Citramon P, tablets 10 pcs

A combination drug.

Acetylsalicylic acid has antipyretic and anti-inflammatory effects, reduces pain, especially caused by inflammation, and moderately inhibits platelet aggregation and thrombosis, improves microcirculation in the inflammation focus.

Caffeine increases reflex excitability of the spinal cord, excites respiratory and vasomotor centers, dilates blood vessels of skeletal muscles, brain, heart and kidneys, decreases platelet aggregation; it reduces sleepiness and fatigue. In this combination, low-dose caffeine has practically no stimulating effect on the central nervous system, but helps to regulate the tone of the brain vessels.

Paracetamol has analgesic, antipyretic and weak anti-inflammatory effects, due to its effect on the thermoregulation center in the hypothalamus and a weak ability to inhibit the synthesis of prostaglandins (Pd) in peripheral tissues.

Indications

Active ingredient

Composition

Active ingredients:

acetylsalicylic acid – 240 mg,

paracetamol – 180 mg,

caffeine monohydrate or caffeine (caffeine anhydrous) – 30 mg.

Auxiliary substances:

cocoa – 14 mg,

citric acid – 5 mg,

How to take, the dosage

Citramon-P is taken orally (during or after meals) 1 tablet every 4 hours, 1-2 tablets for pain syndrome; the average daily dose is 3-4 tablets, the maximum daily dose is 8 tablets.

The course of treatment is not more than 3-5 days.

The drug should not be taken for more than 5 days as an analgesic and for more than 3 days as an antipyretic (without a physician’s prescription and supervision).

Other dosages and routes of administration are determined by the physician.

Interaction

It enhances the effect of heparin, indirect anticoagulants, reserpine, steroid hormones and hypoglycemic drugs.

The simultaneous use with other NSAIDs, methotrexate increases the risk of side effects.

Decreases the effectiveness of spironolactone, furosemide, hypotensive drugs, and antipodagic drugs that promote uric acid excretion.

Barbiturates, rifampicin, salicylamide, antiepileptic drugs and other stimulants of microsomal oxidation contribute to the formation of toxic metabolites of paracetamol, affecting liver function.

Methoclopramide accelerates absorption of paracetamol.

The T1/2 of chloramphenicol is increased by a factor of 5 under the influence of paracetamol. When repeatedly taking paracetamol may increase the effect of anticoagulants (dicumarin derivatives).

The simultaneous use of paracetamol and ethanol increases the risk of hepatotoxic effects.

Caffeine accelerates absorption of ergotamine.

Special Instructions

With caution the drug should be prescribed to patients with bronchial asthma and gout.
It is not recommended to prescribe the drug in children, especially in chickenpox and flu, because of the high risk of Reye’s syndrome.

Citramon should not be prescribed concomitantly with barbiturates, anticonvulsants, salicylates, and rifampicin.

Patients taking Citramon should refrain from drinking alcohol.

If the drug must be prescribed during pregnancy, the anticipated benefit to the mother must be weighed against the potential risk to the fetus. There is no need to stop breastfeeding if short-term prescribing of Citramon during lactation is necessary.

Contraindications

Gastric and duodenal ulcer in the acute phase; gastrointestinal bleeding (including in anamnesis); expressed liver and/or kidney dysfunction, gout; hemorrhagic diathesis, hypocoagulation; surgical interventions with abundant bleeding; pregnancy (I and III trimesters), lactation; glucose-6-phosphate dehydrogenase deficiency; glaucoma; hypersensitivity to the drug components; asthma, induced by taking acetylsalicylic acid, salicylates and other non-steroidal anti-inflammatory drugs; childhood age (under 15 – risk of Reye syndrome in children with hyperthermia caused by viral diseases); hyperexcitability, sleep disorders; organic diseases of cardiovascular system (including acute myocardial infarction).including acute myocardial infarction, atherosclerosis); significant arterial hypertension; portal hypertension; avitaminosis K; hypoproteinemia.

With caution

Mild to moderate renal failure, hepatic insufficiency with elevated transaminases, benign hyperbilirubinemia (including Gilbert syndrome).

Hypatic impairment with mild to moderate hepatic impairment with elevated transminins, benign hyperbilirubinemia (including Gilbert syndrome and alcoholic liver injury), alcoholism, epilepsy and proneness to seizures, advanced age, gout, arterial hypertension.

Side effects

Immune system disorders: hypersensitivity reactions, including anaphylaxis, anaphylactic shock, rhinitis, nasal congestion.

Skin and subcutaneous tissue disorders: itching, skin and mucous membrane rash, including erythematous rash; urticaria, angioedema, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis.

Gastrointestinal disorders: Dyspeptic disorders, including nausea, vomiting, epigastric discomfort and pain, heartburn, abdominal pain; gastrointestinal inflammation, gastrointestinal erosive and ulcerative lesions, which may in rare cases cause gastrointestinal bleeding and perforations with associated laboratory and clinical manifestations.

Hepatobiliary disorders: increased activity of liver enzymes, usually without the development of jaundice, hepatonecrosis (dose-dependent effect).

Endocrine disorders: hypoglycemia, up to hypoglycemic coma.

Neurological disorders: headache, dizziness, tremor, paresthesias, anxiety, agitation, irritability, sleep disorders, insomnia, anxiety, general weakness, tinnitus.

Cardiac disorders: tachycardia, palpitations, arterial hypertension.

The blood and lymphatic system disorders: anemia, sulfatehemoglobinemia and methemoglobinemia (cyanosis, shortness of breath, pain in the heart area), hemolytic anemia; due to the antiplatelet antiaggregant effect on platelets, acetylsalicylic acid may increase the risk of bleeding. Bleeding has been observed, such as intraoperative hemorrhages, hematomas, bleeding from the genitourinary system, nasal bleeding, bleeding from the gums, gastrointestinal bleeding and brain hemorrhages.

Other: bleeding may lead to acute and chronic post-hemorrhagic anemia/iron deficiency anemia (due to so-called hidden microbleeding) with associated laboratory manifestations and clinical symptoms such as asthenia, pale skin, hypoperfusion; noncardiogenic pulmonary edema.

Overdose

Symptoms (caused by acetylsalicylic acid): in mild intoxication – nausea, vomiting, gastralgia, dizziness, tinnitus; severe intoxication – lethargy, drowsiness, collapse, seizures, bronchospasm, difficult breathing, anuria, bleeding. Initially, central pulmonary hyperventilation leads to respiratory alkalosis (dyspnea, choking, cyanosis, sweating). As intoxication increases, progressive respiratory paralysis and dissociation of oxidative phosphorylation cause respiratory acidosis.

Treatment: continuous monitoring of acid-base balance and electrolyte balance; depending on the state of metabolism – administration of sodium hydrocarbonate, sodium citrate or sodium lactate. Increasing reserve alkalinity enhances excretion of acetylsalicylic acid by alkalizing the urine.

Pregnancy use

It is contraindicated in pregnancy (I and III trimesters), during lactation.

Acetylsalicylic acid has teratogenic action; when used in the first trimester of pregnancy leads to malformation – cleft palate; in the third trimester – inhibition of labor (inhibition of prostaglandin synthesis), to closure of the fetal arterial duct, which causes pulmonary hyperplasia and hypertension in the small circle of blood circulation.

It is excreted with breast milk, which increases the risk of bleeding in the baby due to impaired platelet function.

Children under 15 years of age should not be prescribed medicines containing acetylsalicylic acid because they can increase the risk of Reye’s syndrome if they have a viral infection. Symptoms of Reye syndrome include prolonged vomiting, acute encephalopathy, and enlarged liver.

Similarities