Download instructions for citramon p pharmstandard. Old friend: Citramon

Description

Tablets of light brown color with white patches, with the smell of cocoa, with a flat surface, a notch and a chamfer.

Compound

One tablet contains: active ingredients: acetylsalicylic acid - 220 mg, paracetamol - 200 mg, caffeine - 27 mg, Excipients: cocoa powder, citric acid monohydrate, potato starch, talc, stearic acid.

Pharmacotherapeutic group

Other analgesics and antiperetics. Acetylsalicylic acid, combinations, excluding psycholeptics.
ATX code: N02BA51.

Pharmacological properties

Pharmacodynamics
Acetylsalicylic acid has analgesic, antipyretic and anti-inflammatory properties, primarily due to inhibition of the biosynthesis of prostaglandins and thromboxanes from arachidonic acid by irreversible acetylation of the cyclooxygenase (COX) enzyme.
Paracetamol has analgesic and antipyretic properties, but unlike acetylsalicylic acid, it does not inhibit platelet aggregation.
The addition of caffeine increases the antinociceptive effects of acetylsalicylic acid and paracetamol.
Pharmacokinetics
Acetylsalicylic acid
After oral administration, absorption usually occurs quickly and in full. Acetylsalicylic acid is largely hydrolyzed to salicylates in the gastrointestinal tract, liver and blood, and then further metabolized, primarily in the liver.
Paracetamol
Paracetamol is readily absorbed from the gastrointestinal tract with maximum plasma concentrations. This occurs within 30 minutes to 2 hours after ingestion. Paracetamol is metabolized in the liver and excreted in the urine mainly as glucuronide and sulfate conjugates. Less than 5% of paracetamol is excreted unchanged from the body. The half-life is from 1 to 4 hours. Plasma protein binding is negligible at usual therapeutic concentrations, but increases with increasing concentrations.
The hydroxylated metabolite, which is usually formed in very small amounts in the liver by mixed-function oxidases and which is usually detoxified by conjugation with hepatic glutathione, can accumulate as a result of paracetamol overdose and cause liver damage.
Caffeine
Caffeine is completely and rapidly absorbed after oral administration at maximum concentrations. This occurs within 5-90 minutes after taking a dose on an empty stomach. There is no evidence for first pass metabolism.
In adults, there is a pronounced individual variability in the rate of excretion. The mean plasma half-life is 4.9 hours with a range of 1.9-12.2 hours. Caffeine is distributed to all body fluids. The average binding of caffeine to plasma proteins is 35%.
Caffeine is almost completely metabolized by oxidation, demethylation and acetylation and excreted in the urine. The main metabolites are 1-methylxanthine, 7-methylxanthine, 1,7-dimethylxanthine (paraxanthine). Minor metabolites include 1-methyluric acid and 5-acetylamino-6-formylamino-3-methyluracil (AMFU).
Combination
In a combination of three active ingredients, the amount of each substance is low. Therefore, there is no suppression of elimination processes with subsequent risks of increased half-life and toxicity.
Pharmacokinetic data for the fixed combination of acetylsalicylic acid, paracetamol and caffeine correspond to the pharmacokinetic profiles established either for each substance separately or for the combination of each analgesic component with caffeine.
Critical drug interactions between acetylsalicylic acid, paracetamol and caffeine, or any increased risks of interactions with other drugs when used together, are not known. Interactions between the three active substances were not observed.

Indications for use

Citramon-Borimed is indicated for adults for the treatment of acute headache.

Contraindications

Hypersensitivity to acetylsalicylic acid (aspirin), paracetamol, caffeine or any of the excipients listed in the "Composition" section.
Patients in whom acetylsalicylic acid (aspirin) or other non-steroidal anti-inflammatory drugs such as diclofenac or ibuprofen may provoke the development of asthma attacks, urticaria or acute rhinitis.
exacerbation of stomach or intestinal ulcers, gastrointestinal bleeding or perforation, as well as patients with a history of stomach ulcers;
hemophilia or other hemorrhagic diseases;
severe liver or kidney failure;
severe heart failure;
taking methotrexate at a dose of more than 15 mg per week (see section "Interaction with other drugs");
last trimester of pregnancy (see Precautions section).

Dosage and administration

adults
The usual recommended dose is 1 tablet; you can take an additional tablet, the interval between doses should be from 4 to 6 hours. In case of very severe pain, if necessary, you can take 2 more tablets, the interval between doses should be from 4 to 6 hours.
Citramon-Borimed is intended for intermittent use, with a headache it can be taken up to 4 days.
For headaches, the medication should be limited to no more than 6 tablets per 24 hours. The drug should not be used for a longer period of time or at a higher dosage without first consulting a doctor.
Each dose should be taken with a full glass of water.
Children and teenagers (under 18)
The safety and efficacy of Citramon-Borimed in children and adolescents have not been evaluated. Therefore, the use of the drug in children and adolescents is not recommended (see section "Precautions").
Elderly patients
Based on general medical recommendations, caution should be exercised when taking the drug in elderly patients, especially elderly patients with low body weight.
Liver and kidney failure
The effect of hepatic or renal insufficiency on the pharmacokinetics of Citramon-Borimed has not been evaluated. Due to the mechanism of action of acetylsalicylic acid (aspirin) and paracetamol, renal or hepatic failure may increase. Thus, Citramon-Borimed is contraindicated in patients with severe hepatic or renal insufficiency (see section "Contraindications"). It should be used with caution in patients with mild or moderate hepatic or renal insufficiency.

Side effect

Many of the following adverse reactions are dose dependent and vary from one person to another.
Adverse reactions are listed below in accordance with organ systems, as well as the frequency of occurrence. The following principles are used: very often (≥1/10), often (≥ 1/100 to<1/100), редко (≥ 1/10000 до <1/1000), очень редко (<1/10000), включая отдельные отчеты и не известно (не может быть оценено по имеющимся данным).
Infections and infestations: rarely - pharyngitis.
Immune system disorders: not known - hypersensitivity, anaphylactic reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis (very rare cases of serious skin reactions have been reported).
Metabolic and nutritional disorders: rarely - loss of appetite.
Psychiatric disorders: very often - nervousness; often - insomnia; rarely - anxiety, euphoria, tension; not known - excited state.
Nervous System Disorders: very often - dizziness; often - tremor, paresthesia, headache; rarely - dysgeusia, impaired attention, amnesia, impaired coordination, hyperesthesia, headache in the paranasal sinuses; not known - migraine, drowsiness.
Visual disturbances: rarely - pain in the eyes, blurred vision.
Hearing and balance disorders: often - ringing in the ears.
Cardiac disorders: often - arrhythmia; not known - rapid pulse.
Vascular disorders: rarely - hyperemia, disorders of the peripheral vessels; not known - hypotension.
Respiratory, thoracic and mediastinal disorders: rarely - epistaxis, hypoventilation, rhinorrhea; not known - shortness of breath, asthma.
Gastrointestinal disorders: very often - nausea, discomfort in the abdomen; often - dry mouth, diarrhea, vomiting; rarely - belching, flatulence, dysphagia, oral paresthesia, salivary hypersecretion; not known - pain in the upper abdomen, dyspepsia, abdominal pain, gastrointestinal bleeding (including bleeding in the upper gastrointestinal tract, gastric bleeding, bleeding stomach ulcer, bleeding intestinal ulcer, rectal bleeding), gastrointestinal ulcer -intestinal tract (including gastric ulcer, duodenal ulcer, colon ulcer, peptic ulcer).
Hepatobiliary system disorders: not known - liver failure, increased liver enzymes.
Skin and subcutaneous tissue disorders: rarely - hyperhidrosis, itching, urticaria.
Musculoskeletal and connective tissue disorders: rarely - musculoskeletal stiffness, neck pain, back pain, muscle spasms.
General diseases and disorders at the injection sites: often - fatigue, feeling of anxiety; rarely - asthenia, chest discomfort; not known - erythema, rash, angioedema, erythema multiforme, malaise, unusual sensations.
There is no information to suggest that the side effects of individual substances increase or the range of side effects expands when using the fixed combination in accordance with the instructions, there is no.
The increased risk of bleeding may persist for 4-8 days after taking acetylsalicylic acid. Very rarely, severe bleeding (eg, intracerebral bleeding) is possible, especially in patients with hypertension, in the absence of treatment, and / or concomitant treatment with anticoagulants. In some cases, death may occur.

Interaction with other drugs

The interactions of the individual components that make up Citramon-Borimed with other substances are well known. There are no conditions leading to the fact that the nature of interactions will change when used together. There are no interactions between acetylsalicylic acid and paracetamol that could adversely affect safety.

Paracetamol

Caffeine

Precautionary measures

General:
Citramon-Borimed should not be taken together with medicines containing acetylsalicylic acid or paracetamol.
Patients who experience vomiting attacks in more than 20% of migraine cases or need bed rest in more than 50% of migraine attacks should not use Citramon-Borimed.
If the migraine does not subside in the patient after taking the first two tablets of Citramon-Borimed, then the patient should seek medical help.
Prolonged use of any type of pain reliever for headaches can make the condition worse. If such a situation occurs or is expected, medical advice should be sought and treatment should be discontinued. The diagnosis of headache due to overuse of drugs should be suspected in patients with chronic headaches (15 days or more per month) with concomitant overuse of headache drugs for more than 3 months. Therefore, Citramon-Borimed cannot be used for more than 10 days per month for more than 3 months.
Caution should be exercised in patients at risk of dehydration (eg due to illness, diarrhea, before or after major surgery).
Citramon-Borimed may mask signs and symptoms of infection due to its pharmacodynamic properties.
Due to the presence of acetylsalicylic acid:
Citramon-Borimed should be used with caution in patients suffering from gout, as well as in patients with impaired renal or hepatic function, dehydration, uncontrolled hypertension and diabetes mellitus.
Citramon-Borimed should be used with caution in patients with severe glucose-6-phosphate dehydrogenase (G6PD) deficiency, since acetylsalicylic acid can cause hemolysis or hemolytic anemia. Factors that may increase the risk of hemolysis are, for example, high doses, fever or acute infections.
Citramon-Borimed may lead to an increased risk of bleeding during and after surgical operations (including minor operations, such as tooth extraction) due to the inhibitory effect of acetylsalicylic acid on platelet aggregation, which persists for many days after administration.
Citramon-Borimed should not be taken together with anticoagulants or other drugs that inhibit platelet aggregation without medical supervision (see section "Interaction with other drugs"). Patients with impaired hemostasis should be carefully monitored. Caution should be exercised in metrorrhagia or menorrhagia.
Citramon-Borimed should be discontinued immediately if patients receiving this medicinal product experience gastric bleeding or ulceration of the gastrointestinal tract (GIT). Gastrointestinal bleeding, ulceration or perforation, which can be fatal, has been reported with all NSAIDs. They can occur at any time during treatment with or without symptoms, or with a history of serious gastrointestinal disease. As a rule, they carry more serious consequences for older patients. The risk of gastrointestinal bleeding may be increased by alcohol, corticosteroids and NSAIDs (see section "Interaction with other drugs").
Citramon-Borimed can cause bronchospasm and exacerbation of asthma (so-called analgesic intolerance) or other hypersensitivity reactions. Risk factors are bronchial asthma, seasonal allergic rhinitis, nasal polyps, chronic obstructive pulmonary disease or chronic respiratory infection (especially if associated with allergic rhinitis-like symptoms). This also applies to patients who have allergic reactions (eg skin reactions, itching, urticaria) to other substances. For such patients, special precautions are recommended (emergency readiness).
Citramon-Borimed should not be prescribed to children and adolescents under the age of 18, unless there are special indications, since there is an association between acetylsalicylic acid and Reye's syndrome. Reye's syndrome is a very rare disease that affects the brain and liver and can be fatal.
Acetylsalicylic acid may interfere with thyroid function studies due to falsely low concentrations of levothyroxine (T4) or triiodothyronine (T3) (see section "Interaction with other drugs").
Due to the presence of paracetamol:
Citramon-Borimed should be administered with caution to patients with impaired renal or hepatic function, or alcohol dependence.
The risk of paracetamol toxicity may be increased in patients taking other potentially hepatotoxic drugs or drugs that induce microsomal liver enzymes (eg, rifampicin, isoniazid, chloramphenicol, hypnotics, and antiepileptics, including phenobarbital, phenytoin, and carbamazepine). Patients who abuse alcohol in the past are at particular risk of liver damage (see section "Interaction with other drugs").
Patients should be warned not to take other medicinal products containing paracetamol at the same time due to the risk of serious liver damage in case of overdose (see section "Overdose").
While taking this drug, you should avoid drinking alcoholic beverages, since the use of alcohol in combination with paracetamol can lead to liver damage (see section "Interaction with other drugs"). Paracetamol should be used with caution in patients with alcohol dependence.
Due to the presence of caffeine:
Citramon-Borimed should be used with caution in patients with gout, hyperthyroidism and arrhythmias.
When taking Citramon-Borimed, patients should limit the use of products containing caffeine, since excess caffeine can cause nervousness, irritability, insomnia and sometimes an accelerated heartbeat.

Use during pregnancy and lactation

Pregnancy
Information on the use of Citramon-Borimed in pregnant women is not available. Animal studies have not been conducted on the combination of acetylsalicylic acid (aspirin), paracetamol and caffeine.
Acetylsalicylic acid
Due to the presence of acetylsalicylic acid in the drug, its use is contraindicated in the third trimester of pregnancy (see section "Contraindications"), care should be taken when using the drug in the first two trimesters of pregnancy.
Inhibition of prostaglandin synthesis may adversely affect pregnancy and/or embryonic/fetal development. Epidemiological data suggest an increased risk of miscarriage, heart failure, and gastroschisis following the use of prostaglandin synthesis inhibitors in early pregnancy. It is believed that the risk increases with increasing dose and duration of treatment. It has been shown that the administration of prostaglandin synthesis inhibitors in animals leads to an increase in pre-implantation losses, post-implantation losses, and embryo/fetal death. In addition, an increase in the number of cases of the development of various disorders, including cardiovascular, was recorded in animals that were injected with prostaglandin synthesis inhibitors during the organogenetic period. During the first and second trimesters of pregnancy, acetylsalicylic acid (aspirin) should not be prescribed unless clearly necessary. If acetylsalicylic acid (aspirin) is used by a woman trying to conceive or during the first and second trimesters of pregnancy, the dose should be as low as possible and the duration of treatment as short as possible.
During the third trimester of pregnancy, all prostaglandin synthesis inhibitors may have the following effects:
Regarding the fetus:
- cardiopulmonary toxicity (with premature closure of the ductus arteriosus and pulmonary hypertension);
- renal dysfunction, which can progress to renal failure with oligohydroamniosis;
For mother and newborn:
- at the end of pregnancy - a possible prolongation of bleeding time, an antiplatelet effect that can occur even when taking very low doses;
- inhibition of uterine contractions, leading to delayed or prolonged labor.
Therefore, acetylsalicylic acid is contraindicated during the third trimester of pregnancy.
Paracetamol
Epidemiological studies show that therapeutic doses of paracetamol can be used during pregnancy. However, it should only be used after a careful assessment of the risk/benefit ratio.
Caffeine
Pregnant women are advised to limit caffeine intake to a minimum, as available data on the effects of caffeine on the fetus indicate a potential risk.
Lactation
Salicylates, paracetamol and caffeine are excreted in breast milk. Caffeine may affect the behavior of an infant (anxiety, poor sleep). Salicylates can also have a potentially harmful effect on infant platelet function (may cause minor bleeding), although no cases have been reported. In addition, the use of acetylsalicylic acid has the potential to influence the development of Reye's syndrome in infants. Therefore, Citramon-Borimed is not recommended during breastfeeding.
Fertility
Acetylsalicylic acid
There is some evidence that drugs that inhibit cyclooxygenase/prostaglandin synthesis may cause reproductive harm in women due to effects on ovulation. This effect is reversible upon discontinuation of treatment.

Surely many people have Citramon in their home medicine cabinet. This drug is the development of Soviet pharmacologists. If, being abroad, a person asks for Citramon, they simply will not understand him. After all, this medicine is registered only in post-Soviet countries. What helps Citramon in tablets and how to take it correctly?

Composition of Citramon

Citramon is produced by many domestic pharmaceutical companies. This is a combination drug from the group, which consists of several medicinal components at once. The initial composition of Citramon included the substance phenacetin, however, due to its high toxicity, it was no longer added to the drug at all. Classic Citramon consists of three components:

1. at a concentration of 180 mg;
2. - 240 mg;
3. Caffeine - 30 mg.

Paracetamol has antipyretic, analgesic and, to a lesser extent, anti-inflammatory effects.. Paracetamol is recognized worldwide as one of the safest and most effective antipyretic drugs.

Acetylsalicylic acid also has analgesic, antipyretic (antipyretic), and anti-inflammatory effects. In addition, the medicinal substance reduces the aggregation (gluing) of platelets, thereby preventing thrombosis.

Caffeine improves blood circulation in tissues, reduces drowsiness, significantly increases efficiency. b. The dosage of caffeine in Citramon is quite small, and therefore it does not have a stimulating effect on the central nervous system. But the substance normalizes the tone of the vessels of the brain, and also accelerates blood flow. All three components harmoniously reinforce each other's action.

Various pharmaceutical companies also produce all kinds of variations of Citramon. As a rule, these variations differ in the concentration of active substances:

• The composition of Citramon Extra includes paracetamol 500 mg, as well as caffeine 50 mg;
• The composition of Citramon Forte includes paracetamol at a concentration of 240 mg, caffeine 40 mg, acetylsalicylic acid 320 mg;
• The composition of Citramon plus (Citrapak) includes paracetamol at a concentration of 180 mg, caffeine 30 mg, acetylsalicylic acid 240 mg, and also 40 mg.

Note! On the shelves of pharmacies you can also find Citramon-P, this is the most common Citramon.

Indications for use

Citramon is available in tablets. The main indication for its use is mild or moderate pain of any origin. So, Citramon helps against, arthralgia,. Also, as an antipyretic (antipyretic) agent, Citramon is taken for diseases accompanied by high fever, for example, with.

The medicine is prescribed for adults one tablet two to three times a day after meals. A maximum of six tablets per day is allowed (in three doses), an overdose will occur in a larger amount. The drug must be taken with a sufficient amount of water. According to the instructions, Citramon can be taken as an antipyretic medicine for no more than three days, and as an anesthetic - no more than five.

Side effects

In general, Citramon is well tolerated by patients. However, it is worth considering the possible side effects of the drug. Citramon contains acetylsalicylic acid, which can lead to the formation of ulcers on the mucous membranes of the stomach and intestines, ulcerative bleeding.

Due to the antiplatelet action of acetylsalicylic acid, the risk of internal, gingival bleeding may increase. Given this, it is not recommended to use drugs containing acetylsalicylic acid on the eve of surgical interventions, dental procedures.

In addition, it is known that the use of acetylsalicylic acid in children as an antipyretic drug for acute viral infections can lead to the development of Reye's syndrome. This is a pathological condition, manifested by the rapid damage to the brain and liver. Reye's syndrome is characterized by high mortality. That's why Children should not take Citramon.

It is also possible the appearance of such side effects as anxiety, irritability, headaches, dizziness, ringing in the ears (), heart palpitations, allergic reactions. Many people are interested in whether Citramon can raise blood pressure, because it contains caffeine. Among the side effects indicated in the instructions, there are also. Caffeine is contained in Citramon in a low concentration, and therefore does not cause pronounced rises in pressure. But at the same time, people with high blood pressure need to be careful with Citramon.

Contraindications

Citramon is a very popular drug. But few people think about the cases in which it can not be taken. Among the contraindications are:

• Hypersensitivity to the components of the drug;
• Blood diseases (leukopenia,);
• Aggravation;
• Hepatic,;
• Severe form expressed

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Compound

• acetylsalicylic acid 0.24 g (aspirin, lat. Acidum acetylsalicylicum) - non-steroidal anti-inflammatory drug that affects the processes occurring in the focus of inflammation, reduces capillary permeability, limits the energy supply of the inflammatory process, affects the hypothalamic centers of thermoregulation and centers of pain sensitivity, thins the blood;
• phenacetin 0.18 g - this drug is now withdrawn from circulation due to serious side effects;
• caffeine (Caffeine) 0.03 g - a purine alkaloid, to a reasonable extent stimulates the central nervous system, respiration and the work of the heart muscle, while expanding blood vessels, improves their tone and blood flow, increases urination, speeds up the pulse, reduces drowsiness and fatigue, but increases physical and mental activity, working capacity;
• cocoa 0.015 g - has an antidepressant and stimulating effect on the body;
• citric acid 0.02 g - plays an important role in the system of biochemical reactions of cellular respiration.

Release form

Citramon P

Citramon Forte (Citramonum-forte)

Citramon Darnitsa

Citramon Ultra

Citramon Borimed

Citramon Lekt

Dosage form

Pharmacological group

pharmachologic effect

Indications for use

• headache;
• migraine;
• increased body temperature with influenza, colds and rheumatic diseases.

Citramon tablets - instructions for use

Purpose features

Citramon raises or lowers blood pressure?

During pregnancy

Citramon in early pregnancy - what you need to know
In the first 3 months, all the vital organs and systems of the child are laid, and acetylsalicylic acid in the composition of Citramon (having a teratogenic effect) can cause congenital anomalies - splitting of the hard palate (cleft palate) and upper lip (cleft lip). Even if the second trimester of pregnancy is not officially contraindicated, the appointment of this drug must be justified by serious motives, because the "construction" of the fetal body continues, and there is already the possibility of premature birth, which Citramon will complicate (due to a decrease in blood clotting). In the last 3 months, the intake must be justified by serious motives so that there is no threat of bleeding and blood loss during childbirth due to the action of acetylsalicylic acid, as well as weakness of labor or closure of the aortic duct in an infant. Thus, Citramon during pregnancy is a drug that is best removed for a while in the closet away.

When breastfeeding

For a headache

Citramon for children

Contraindications

• Hypersensitivity to the components of the drug;
• Hypocoagulation, hemorrhagic diathesis, hemophilia, hypoprothrombinemia;
• A combination (incomplete or complete) of diseases such as bronchial asthma, nasal polyposis, intolerance to acetylsalicylic acid and other NSAIDs;
• Erosive and ulcerative lesions of the gastrointestinal tract, gastrointestinal bleeding, peptic ulcer of the duodenum and stomach in the acute phase;
• Surgical interventions that are accompanied by bleeding;
• Severe coronary heart disease, severe arterial hypertension;
• portal hypertension;
• Pregnancy (1st and 3rd trimesters), lactation;
• Children's age (up to 14-15 years), since there is a risk of developing Reye's syndrome in children with hyperthermia in viral diseases;
• Overdose Mild form of intoxication: stomach pain, nausea, vomiting, skin pallor, tinnitus, sweating, tachycardia.
  Severe form of intoxication: lethargy, convulsions, collapse, bleeding, drowsiness, bronchospasm.

  Storage

  The drug should be stored in a cool place, isolated from children, and not used after the expiration date indicated on the package (from 3 to 5 years).

  special instructions

  During long-term use of Citramon, it is necessary to regularly undergo medical supervision, do blood and fecal tests for occult blood, check the condition of the liver, and control blood pressure.

  Interaction with other drugs

  Due to the fact that the components of Citramon in one way or another affect the effectiveness and efficiency of other drugs and medicines, it is very important to inform the attending physician about all existing diseases and pathologies before prescribing it. Also, other substances can change the effect of Citramon on the body.

  The drug Citramon P enhances the action of anticoagulants and the side effects of glucocorticoid hormones. Weakens the effect of diuretic, anti-gout and antihypertensive drugs.

  Abuse of tea or coffee while taking Citramon Darnitsa may cause symptoms of a caffeine overdose. Large doses are recommended to drink alkaline mineral water. Enhances the effect of agents that reduce blood clotting and platelet aggregation, side effects of sulfonylurea, corticosteroids, methotrexate. Citramon-Darnitsa should not be taken in combination with rifampicin, barbiturates, salicylates, anticonvulsants.

  Is it possible to drink Citramon with alcohol?

  This combination is not recommended, as the risk of gastrointestinal bleeding increases, and the toxicity of ethanol increases.

  Analogues

  Citramon's analogs:
  • Hl-payne
  • Alka-Seltzer
  • Alka-prim
  • Antigripocaps
  • Aspicod
  • Citropack
  • Askofen
  • Asprovit
  • Copacil
  • Aspirin
  • Upsarin
  • Excedrin
  • Citrapar
  • Farmadol and other drugs, the content of paracetamol, caffeine and acetylsalicylic acid.

  Citramon P is a combined antipyretic and analgesic agent.

  Active ingredients - Acetylsalicylic acid + Paracetamol + Caffeine.

  Acetylsalicylic acid (aspirin) relieves fever and inflammation, relieves pain (especially if the pain is caused by an inflammatory process), has a moderate antiplatelet effect, prevents the formation of blood clots, improves microcirculation in the inflammation site.

  Paracetamol reduces the intensity of pain, reduces fever, and has a weak anti-inflammatory effect. The properties of this substance are associated with its effect on the thermoregulatory center located in the hypothalamic region and a weakly expressed ability to inhibit the formation of Pg in peripheral tissues.

  As part of Citramon P, caffeine is present in low concentrations. Because of this, it has practically no stimulating effect on the central nervous system, however, it improves the tone of the brain vessels and helps to accelerate blood flow.

  The combination of acetylsalicylic acid and paracetamol enhances the analgesic effect of the drug. Both the analgesic and antipyretic effects of aspirin and paracetamol are enhanced by the simultaneous use of these substances with caffeine.

  What is the difference between Citramon P and Citramon?

  The composition of the tablets of the usual Citramon includes - 240 mg of acetylsalicylic acid, 180 mg phenacetin, 30 mg caffeine. And Citramon P contains several other active ingredients: acetylsalicylic acid 240 mg, paracetamol 180 mg, caffeine - 30 mg.

  As can be seen from the composition, phenacetin was replaced by paracetamol - this is due to the better tolerance of the latter and fewer side effects. However, the drug has become more aimed at relieving fever and pain symptoms, with a weaker effect on the common cold, especially allergic.

  Currently, the "regular" Citramon with phenacetin is not produced.

  Indications for use

  What helps Citramon P? According to the instructions, the drug is prescribed in the following cases:

  • Increased body temperature in acute respiratory viral pathology and influenza.
  • Headache of moderate severity of various origins.
  • Toothache.
  • Pain in the muscles (myalgia) and joints (arthralgia).
  • Pain, the development of which is provoked by aseptic inflammation of the peripheral nerves (neuralgia).
  • To reduce the discomfort of painful menstruation in women.

  Instructions for use Citramon P, dosage

  The tablet is taken orally with a sufficient amount of liquid, after or during a meal.

  Standard dosages of Citramon P according to the instructions for use:

  • Headache: single dose - 1-2 tablets. In case of severe headaches after 4-6 hours, the drug is recommended to be taken again;
  • Migraine: single dose - 2 tablets. If necessary, the drug is recommended to be taken again after 4-6 hours;
  • Pain syndrome: single dose for adult patients - 1-2 tablets, daily dose - 3-4 tablets, maximum daily dose - 8 tablets.

  The course of treatment is no more than 7-10 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 doctor's prescription and supervision). Other dosages and regimens are set by the doctor.

  Side effects

  The instruction warns of the possibility of developing the following side effects when prescribing Citramon P:

  • Gastralgia, nausea, vomiting, hepatotoxicity, nephrotoxicity, erosive and ulcerative lesions of the gastrointestinal tract, allergic reactions, tachycardia, increased blood pressure, bronchospasm.

  With prolonged use of Citramon P:

  • dizziness, headache, visual disturbances, tinnitus, decreased platelet aggregation, hypocoagulation, hemorrhagic syndrome (nosebleeds, bleeding gums, purpura, etc.), kidney damage with papillary necrosis;
  • deafness;
  • malignant exudative erythema (Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell's syndrome), Reye's syndrome in children (hyperpyrexia, metabolic acidosis, disorders of the nervous system and psyche, vomiting, abnormal liver function).

  Children should not be prescribed Citramon P tablets (containing aspirin), because in the case of a viral infection they can increase the risk of Reye's syndrome. Symptoms are prolonged vomiting, acute encephalopathy, liver enlargement.

  Contraindications

  It is contraindicated to prescribe Citramon P in the following cases:

  • full or partial combination of recurrent nasal polyposis / paranasal sinuses, bronchial asthma and intolerance to NSAIDs or ASA (including history);
  • hypersensitivity to the components of the tablets;
  • erosive and ulcerative lesions of the gastrointestinal tract in the acute phase;
  • stomach or intestinal bleeding;
  • portal hypertension;
  • hemophilia;
  • hypoprothrombinemia;
  • hemorrhagic diathesis;
  • avitaminosis K;
  • IHD of severe course;
  • severe arterial hypertension;
  • kidney failure;
  • deficiency of the cytosolic enzyme G6PD;
  • pregnancy (especially its first and last trimesters);
  • lactation;
  • increased excitability;
  • glaucoma;
  • dissecting aortic aneurysm;
  • sleep disorders;
  • surgical interventions accompanied by bleeding;
  • children's age (in children under fifteen years of age with hyperthermia against a viral infection, the likelihood of developing Reye's syndrome is high);
  • concomitant use of anticoagulants.

  The drug is prescribed with caution in the following cases:

  • renal and / or hepatic insufficiency of moderate and mild degree;
  • chronic obstructive pulmonary disease;
  • gout;
  • cardiac ischemia;
  • cerebrovascular diseases;
  • peripheral arterial disease;
  • chronic heart failure (I and II functional class according to NYHA);
  • epilepsy, tendency to convulsive seizures;
  • simultaneous use of methotrexate in an amount of less than 15 mg per week, as well as glucocorticosteroids, NSAIDs, antiplatelet agents, anticoagulants, selective serotonin reuptake inhibitors;
  • elderly age.

  Overdose

  Symptoms of mild intoxication - nausea, vomiting, gastralgia, dizziness, ringing in the ears; severe intoxication - lethargy, drowsiness, collapse, convulsions, bronchospasm, shortness of breath, anuria, bleeding.

  Initially, central hyperventilation of the lungs leads to respiratory alkalosis (shortness of breath, suffocation, cyanosis, perspiration). As intoxication increases, progressive respiratory paralysis and uncoupling of oxidative phosphorylation cause respiratory acidosis.

  Constant monitoring of CBS and electrolyte balance is required. Depending on the state of metabolism - the introduction of sodium bicarbonate, sodium citrate or sodium lactate. Increasing reserve alkalinity enhances the excretion of ASA due to alkalinization of urine.

  Citramon P analogues, price in pharmacies

  If necessary, you can replace Citramon P with an analogue of the active substance - these are drugs:

  1. Askofen-P,
  2. AquaCitramon,
  3. Migrenol Extra,
  4. Coficil-plus,
  5. Citramon P Forte,
  6. Citramarine,
  7. Excedrin,
  8. Citrapar.

  When choosing analogues, it is important to understand that the instructions for use of Citramon, the price and reviews of drugs of similar action do not apply. It is important to consult a doctor and not to make an independent replacement of the drug.

  Price in Russian pharmacies: Citramon P tablets 10 pcs. - from 8 to 17 rubles, Citramon Ultra - from 85 rubles, according to 720 pharmacies.

  Store in a dark place, out of the reach of children, at temperatures up to 25 °C. Shelf life - 3 years. Terms of dispensing from pharmacies - without a prescription.

  According to Wikipedia data, traditionally Citramon tablets included 240 mg acetylsalicylic acid (ASA), 180 mg, 30 mg caffeine , 15 mg cocoa, 20 mg citric acid.

  However, at present, the classic recipe for the manufacture of the drug is not used due to the withdrawal from circulation of one of its active components - phenacetin (This is due to the high substance nephrotoxicity ).

  Numerous manufacturers produce medicines with the word "Citramon" in the name, but they all have a slightly modified composition, in which, as analgesics and antipyretic instead of phenacetin used .

  In tablets from different manufacturers, the uniformity of active substances is maintained, however, the concentration of each of them may differ.

  Citramon P, Citramon U and Citramon M contain active ingredients (ASA, paracetamol and caffeine ), for example, are contained in the same concentration as in the original preparation. But in the composition of Citramon-Forte, their concentration is already different: each tablet contains 320 mg of ASA, 240 mg paracetamol and 40 mg caffeine .

  The composition of the tablets Citramon Borimed includes 220 mg ASA, 200 mg paracetamol and 27 mg caffeine . The concentration of these substances in Citramon-LekT tablets is 240 mg, 180 mg and 27.5 mg, respectively.

  But the main difference between Citramon Ultra and Citramon is the presence of a film shell, which facilitates the swallowing of the tablet, acts as a reliable barrier between the mucosa of the digestive canal and the active ingredients contained in the tablets (in particular, the shell protects the stomach from the aggressive effects of ASA) and accelerates the absorption of the drug.

  Release form

  All manufacturers produce Citramon in the form of light brown tablets with a cocoa smell. The tablets are heterogeneous in appearance, have blotches and inclusions.

  They are produced packed in strips (6 pieces each) or blisters (10 pieces each). Packing No. 10*1, No. 6*1 and No. 10*10.

  pharmachologic effect

  The action of the drug is aimed at relief of pain, fever and inflammation .

  Pharmacodynamics and pharmacokinetics

  Pharmacodynamics

  Citramon is a combined remedy, the action of which is due to the properties of the components contained in it ( non-narcotic analgesic , Psycostimulator and NSAIDs).

  ASA relieves fever and inflammation, relieves pain (especially if the pain is caused by an inflammatory process), has a moderate antiplatelet action , prevents the formation blood clots , improves microcirculation in the focus of inflammation.

  Paracetamol reduces the intensity of pain, knocks down the heat, has a weak anti-inflammatory action . The properties of this substance are associated with its effect on the thermoregulatory center located in the hypothalamic region and a weakly expressed ability to inhibit the formation of Pg in peripheral tissues.

  Caffeine has a direct stimulating effect on the central nervous system, which manifests itself in the form of increased excitation processes in the cerebral cortex, vasomotor and respiratory centers, increased motor activity and strengthening of positive conditioned reflexes.

  Stimulates mental activity, temporarily reducing or eliminating drowsiness and fatigue, shortens reaction time. Reduces platelet aggregation .

  As part of Citramon tablets caffeine present in low concentration. Because of this, the substance has practically no stimulating effect on the central nervous system, however, it improves the tone of the brain vessels and helps to accelerate blood flow.

  Combination of ACK and paracetamol potentiates analgesic effect drug. How anesthetic , and antipyretic effects ACK and paracetamol increase with the simultaneous use of these substances with caffeine .

  Pharmacokinetics

  After oral administration, the components contained in the tablets are absorbed quickly and almost completely. Caffeine at the same time, it helps to increase F (bioavailability) of ASA and paracetamol .

  During absorption, he and ASA are intensively biotransformed with the formation of pharmacologically active metabolites. From ASA in the process of deacetylation in the liver and intestinal wall is formed .

  Under the influence of the hepatic CYP1A2 isoenzyme, caffeine forms dimethylxanthines ( paraxanthine and theophylline ).

  TSmax of all active components of Citramon - from 0.3 to 1 hour. In blood plasma from 10 to 15% paracetamol and approximately 80% of the accepted dose of ASA are associated with albumin condition.

  All components of the tablets easily penetrate into any fluids and tissues of the body (including easily overcome the placental barrier and enter breast milk). Minor concentrations of salicylates are found in brain tissues, while levels caffeine and paracetamol comparable to plasma levels of these substances.

  With the development acidosis ASA passes into a non-ionized form, due to which its penetration into the tissues of the NS increases.

  Metabolism of the active substance occurs in the liver. ASA has 4 metabolites (gentisuronic and gentisic acids, salicylovophenol glucuronide, salicylurat). Paracetamol forms sulfate (80% of the total) and paracetamol-glucuronide (both pharmacologically inactive), as well as a potentially toxic substance - N-acetyl-benziminoquinone (about 17% of the total).

  Metabolites caffeine - derivatives of uridine, mono- and dimethylxanthines, mono- and dimethyluric acid, di- and trimethylallantoin.

  Caffeine affects the pharmacokinetics paracetamol , slightly increasing (up to 20-25%) the formation of N-acetyl-benziminoquinone.

  Metabolites are excreted by the kidneys. About 5% paracetamol, about 10% caffeine and about 60% of salicylates are excreted unchanged.

  The elimination half-life is from 2 to 4.5 hours (all components of the drug are excreted at approximately the same rate). An increase in the dose of Citramon leads to a slowdown in the excretion of ASA in comparison with other substances up to 15 hours.

  In smokers, on the contrary, there is an acceleration of excretion caffeine in comparison with other components of the drug.

  Indications for Citramon's use

  Why Citramon P?

  When asked what Citramon P helps with, the manufacturer in the annotation to the drug replies that the use of tablets is advisable to relieve pain of mild and moderate severity, as well as to alleviate the patient's condition when febrile syndrome , which are accompanied and .

  Effective Citramon from the head (including migraine attacks), with joint and muscle pain, algomenorrhea .

  What are Citramon-LekT tablets for?

  Indications for the use of Citramon-LekT are the same as for other drugs, which are based on ASK , paracetamol and caffeine , namely: pain syndrome at algomenorrhea , neuralgia , myalgia , arthralgia , head and toothache , migraine .

  The drug can also be used as a remedy for fever with fever against the background and .

  Does Citramon help with toothache?

  Toothache is one of the indications for the use of the drug. The effectiveness of Citramon is due to the properties of its constituent NSAIDs, non-narcotic analgesic and psychostimulant .

  Reinforcing the action of each other, these components have a complex effect on the body, relieving any (including toothache) pain, especially if this pain is associated with inflammation. With an exacerbation chronic pulpitis , against which the temperature often rises, Citramon helps not only to relieve pain and reduce the severity of inflammation, but also has antipyretic action .

  Contraindications

  The instructions list the following contraindications for Citramon:

  • full or partial combination recurrent nasal/sinus polyposis , and intolerance to NSAIDs or ASA (including history);
  • hypersensitivity to the components of the tablets;
  • erosive and ulcerative lesions of the gastrointestinal tract in the acute phase;
  • gastric or intestinal bleeding ;
  • portal hypertension ;
  • hemophilia ;
  • hypoprothrombinemia ;
  • hemorrhagic diathesis ;
  • beriberi K ;
  • IHD of severe course;
  • pronounced arterial hypertension ;
  • kidney failure ;
  • deficiency of the cytosolic enzyme G6PD;
  • pregnancy (especially its first and last trimesters);
  • lactation;
  • increased excitability;
  • dissecting aortic aneurysm ;
  • sleep disorders;
  • surgical interventions accompanied by bleeding;
  • children's age (in children under fifteen years of age with hyperthermia against the background of a viral infection, there is a high probability of developing Reye's syndrome );
  • concomitant use anticoagulants .

  Relative contraindications are and existing liver pathology .

  Side effects

  Side effects of Citramon:

  • gastralgia , anorexia , nausea, the formation of erosions and ulcerative elements on the mucous membrane of the digestive canal, gastric and intestinal bleeding;
  • liver failure ;
  • hypersensitivity reactions (including the development of symptoms Fernand-Vidal triads );
  • interstitial nephritis , nephrotic syndrome , necrotic papillitis , with long-term use - ;
  • anemia , thrombocytopenia , leukopenia ;
  • acute fatty liver , toxic hepatitis , acute hepatic encephalopathy (Reye's syndrome );
  • aggravation heart failure , manifestation of its latent forms (with prolonged use);
  • dizziness, insomnia, agitation, anxiety, headache, tinnitus, hearing and vision disorders, aseptic meningitis ;
  • increase in blood pressure, , ;
  • development of tolerance and weak psychological dependence (with prolonged use of high doses of the drug);
  • drug headache after the abolition of Citramon (if the drug has been used for a long time).

  In animal experiments, the teratogenic effect of the drug on the fetus was also proven.

  Citramon tablets: instructions for use

  Preparations from different manufacturers have an excellent composition, and since the active substances in them are often contained in different concentrations, you should read the instructions very carefully so as not to mistakenly exceed the permissible daily dose.

  Common to all drugs is that as an analgesic, they can be used for a maximum of five, as an antipyretic - three days.

  Instructions for use Citramon P and Citramon-LekT

  Citramon P and Citramon-LekT can be taken from the age of fifteen. Tablets are drunk one at a time 2-4 rubles / day (during or after meals). The break between doses should be at least four hours. The average dose is 3-4 tablets per day.

  Citramon from headache high intensity (as well as in other cases when it is necessary to relieve severe pain) you can take 2 pieces at once. The permissible upper limit of the daily dose is 8 tablets.

  Treatment lasts from one week to ten days.

  If necessary, the doctor may prescribe a different dose of the drug or choose a different treatment regimen.

  Instructions for use Citramon forte

  Citramon-Forte is used in patients older than sixteen years. Daily dose - 2-3 tablets. You need to take them one at a time, 2 or 3 rubles / day. To stop an attack of acute pain, you should immediately drink two tablets.

  The permissible upper limit of the daily dose is 6 tablets.

  Citramon-Darnitsa is taken according to a similar scheme (the only difference between the drug is the age limit - these tablets are prescribed from the age of 15).

  Instructions for use Citramon-Borimed

  Citramon-Borimed is preferably taken immediately after meals or between meals. The drug can be used in adults and adolescents over fifteen years of age. Tablets are taken one at a time 2-3 times a day, maintaining intervals between doses of at least 6-8 hours. The highest single dose - 2 tablets, daily - 4.

  As antipyretic used at temperatures exceeding 38.5 ° C (with a tendency to febrile seizures - at a temperature of more than 37.5 ° C). Single dose - 1-2 tablets.

  Instructions for use Citramon Ultra

  Citramon Ultra is prescribed from the age of fifteen. Daily dose - 1-3 tablets. If necessary, up to 6 tablets can be taken during the day.

  Overdose

  A slight overdose manifests itself in the form of nausea, dizziness, increased pallor of the skin, gastralgia , vomiting, ringing in the ears.

  Symptoms of severe intoxication of the body: circulatory and respiratory disorders, anuria , anxiety, dizziness, nausea, headache, hyperthermia , tremor , drowsiness, restlessness, sweating, collapse , bleeding, convulsions (with pathological enhancement of tendon reflexes), .

  If signs of overdose appear, the tablets should be discontinued. to prevent the absorption of the drug in the digestive canal, the patient is washed with a stomach, given enterosorbents and a saline laxative.

  If the plasma concentration of salicylates in a child exceeds 300 mg / l, and in an adult - 500 mg / l, it is advisable to carry out forced alkaline diuresis. To maintain the pH of urine at the level of 7.5-8, alkalizing agents are introduced.

  Carry out activities to restore the bcc and acid-base balance.

  At cerebral edema IVL is prescribed with an oxygen-enriched mixture in the mode of creating PEEP (positive end-expiratory pressure). Hyperventilation should be combined with osmotic diuretics .

  If there are signs of liver damage, N-acetylcysteine, which is a specific antidote, should be administered. paracetamol . The solution is used orally and injected into a vein. In total, the patient is required to enter seventeen doses: the first - 140 mg / kg, all subsequent doses - 70 mg / kg.

  The most effective is the therapy started in the first ten hours after the development of intoxication. If more than 36 hours have passed, treatment is ineffective.

  With an increase in the value of the prothrombin index (PTI) to 1.5-3, the use of phytomenadione (vitamin K ) at a dose of 1 to 10 mg. If the PTI is greater than 3.0, infusion of clotting factor concentrate or native plasma should be initiated.

  Carry out hemodialysis antihistamines , GKS or acetazolamide (for alkalization of urine) in case of intoxication with Citramon is contraindicated.

  These activities may lead to the development acidemia and enhance the toxic effect of ASA on the patient's body.

  Interaction

  In combination with Citramon it is strictly forbidden to prescribe with:

  • MAO inhibitors (when used simultaneously with caffeine these drugs can lead to a dangerous increase blood pressure );
  • methotrexate at a dose exceeding 15 mg / week. (this combination increases hematological toxicity methotrexate ).

  Citramon also enhances toxicity barbiturates and valproic acid , effects opioid analgesics , oral hypoglycemic and sulfa drugs , digoxin and triiodothyronine .

  Long-term use of painkillers for treatment headache often leads to chronic headache .

  Reception of Citramon may distort such indicators of laboratory studies as: plasma concentration of uric acid, plasma concentration heparin , plasma concentration theophylline , blood sugar level, concentration of amino acids in urine.

  The drug may alter doping control tests in athletes. Complicates the diagnosis of "acute abdomen".

  In case of long-term treatment with Citramon before taking a doctor's consultation is necessary.

  The use of drugs containing ASA during surgical interventions (including dental operations) increases the likelihood of occurrence / intensification of bleeding.

  The drug may affect the rate of neuromuscular transmission, and therefore during the period of treatment they should refrain from driving and working with dangerous mechanisms.

  The effect of the drug on pressure: do Citramon tablets increase or decrease blood pressure?

  Headaches are a fairly common occurrence in people prone to changes in blood pressure . Therefore, questions naturally arise here: is it possible to drink medicine at elevated pressure, is the drug harmful for hypotensive patients, how are Citramon and pressure related?

  Pain relief effect at headache provided primarily due to the presence of ASA and paracetamol .

  The third component of the drug is caffeine - increases the flow of oxygen to the tissues, stimulates blood circulation in the brain and rise in blood pressure , thus contributing to a decrease in the intensity headache and enhancing the effects of other components of Citramon.

  High doses caffeine provoke

  For some viral infections (in particular, infections caused by the virus chicken pox or influenza A viruses or B-type ) there is a possibility of development acute hepatic encephalopathy (Reye's syndrome ) that requires immediate medical attention. One of the signs Reye's syndrome is prolonged vomiting.

  Given the above reasons, the use of tablets in patients under the age of sixteen is contraindicated.

  Since the drug has a large number of side effects, it is better for children with a headache or when a toothache hurts to choose safer remedies.

  Alcohol compatibility

  During the period of treatment with Citramon, the use of alcoholic beverages should be avoided, since alcohol increases the likelihood of toxic effects. paracetamol on the liver and ASA on the gastrointestinal tract.

  The use of ethyl alcohol with ASA contributes to damage to the mucosa of the digestive canal. Synergism between alcohol and ASA also results in prolonged bleeding time.

  Citramon for a hangover

  Citramon for a hangover is not the most advantageous option, since the use of this drug makes it possible to alleviate headache only for a while, but does not eliminate the main causes of poor health - a violation of the balance of water and electrolytes, as well as intoxication.

  The headache that accompanies the hangover syndrome is associated with a violation of the venous outflow from the head, tissue edema (in particular, with swelling of the meninges ) and inhibition of the analgesic (antinociceptive) system, of which the action is serotonin and dopamine .

  ASC partially unloads the membranes of the brain, caffeine stimulates metabolism in neurons and has an invigorating effect, cocoa reduces the relative deficiency intracerebral serotonin and dopamine , citric acid reduces the severity of symptoms of alcohol intoxication.

  Citramon during pregnancy and lactation

  Can pregnant women drink Citramon?

  During pregnancy, you should avoid taking Citramon tablets, since the ASA contained in them has teratogenic influence .

  The use of Citramon during pregnancy in the 1st trimester can cause splitting of the upper palate , the use of the drug in the 3rd trimester leads to a deterioration in labor activity (suppression of Pg synthesis) and closure of the ductus arteriosus at the fetus. This in turn provokes pulmonary vascular hyperplasia and pressure increase in the vessels of the small (pulmonary) circulation.

  Thus, the answer to questions like “Is it possible to drink Citramon during pregnancy?” and “Can pregnant women take Citramon?” unequivocally - it is impossible.

  Can Citramon be taken by a nursing mother while breastfeeding?

  The use of the drug in HB is contraindicated. The active components of the tablets and their metabolites are excreted into breast milk, which increases the likelihood platelet dysfunction and the occurrence of bleeding in the child.