Medication "Citramon Ultra" - an anti-inflammatory and analgesic agent based on a combined composition.
The active elements of this drug are acetylsalicylic acid, caffeine and paracetamol. The medicine is produced by the Russian pharmaceutical company PharmVILAR. Dosage form - film-coated tablets: biconvex, oblong, with rounded ends, on one side - risk, shell - light brown, core - white. The carton box contains 5, 6, 10, 15 or 20 tablets in blisters and instructions for use.
The excipients in Citramon Ultra are: hydroxypropyl methylcellulose, colloidal silicon dioxide, potato starch, microcrystalline cellulose, crospovidone, citric acid, lactose monohydrate monohydrate, stearic acid, polyethylene glycol. Filmthe shell consists of the following components: polyvinyl alcohol, Opadry II (series 85), macrogol, talc, titanium dioxide, iron oxide (black, red and yellow).
Pharmacological action
As indicated in the instructions, "Citramon Ultra" is a combined medical product, the effects of which are due to the properties of the main components:
- Acetylsalicylic acid: has anti-inflammatory and antipyretic effects, helps to reduce pain, especially associated with inflammatory processes, and also helps to suppress platelet aggregation, reduce the likelihood of thrombosis and normalize microcirculation in inflammation foci.
- Paracetamol: has an antipyretic, analgesic and weak anti-inflammatory effect, which is due to the influence of this substance on the thermoregulatory center of the hypothalamus and a weak property to quickly inhibit the biological synthesis of prostaglandins in peripheral tissues.
- Caffeine: enhances the reflex excitability of the structures of the spinal cord, excites the vasomotor and respiratory centers, weakens platelet aggregation, dilates the blood vessels of the brain, kidneys, skeletal muscles, heart. The substance helps to reduce the feeling of drowsiness, fatigue, increase mental and physical performance, normalize the tone of cerebral vessels and accelerate blood flow. In small doses in this combination, caffeine has almost no stimulating effect on the central nervous system.
Pharmacokinetic characteristics
According to the instructions for Citramon Ultra, acetylsalicylic acid is completely absorbed after oral administration. During this, presystemic elimination is observed in the walls of the intestine and liver (deacetylization processes). The absorbed part of the substance is rapidly hydrolyzed by cholinesterases and plasma albuminesterase. Communication with plasma proteins - at the level of up to 90%. The maximum concentration of the substance in the tissues is reached after about 2 hours. Biotransformation takes place in the liver, with the formation of 4 metabolites.
Ascorbic acid is eliminated mainly by active work in the tubules of the kidneys: 60% - in the form of salicylic acid. Paracetamol is rapidly absorbed from the digestive tract. Its maximum concentration is 5–20 µg/ml. Communication with plasma proteins - up to 15%. Metabolism occurs in the liver by conjugation with glucuronides and sulfates. In addition, paracetamol may be partially oxidized by microsomal liver enzymes. In this case, the formation of intermediate toxic metabolites conjugating with glutathione, cysteine and mercapturic acid occurs.
Indications for the use of "Citramon Ultra"
The drug is prescribed to relieve pain of various origins of moderate and mild severity:
- headache;
- algodysmenorrhea;
- neuralgia;
- migraine;
- arthralgia;
- toothache;
- febrile conditions with SARS (flu).
Adoes this drug have any contraindications?
Contraindications
Absolute contraindications to the appointment of this medication are:
- bleeding in the digestive tract, erosion and ulcers of the gastrointestinal tract;
- partial or complete combination of bronchial asthma and nasal polyposis with intolerance to acetylsalicylic acid and other non-steroidal anti-inflammatory drugs;
- arterial hypertension, severe coronary artery disease;
- surgical interventions accompanied by bleeding;
- hemorrhagic diathesis;
- portal hypertension;
- hypocoagulation, hemophilia, hypoprothrombinemia;
- kidney failure;
- avitaminosis K;
- glaucoma;
- anxiety disorders (panic attacks, agoraphobia), irritability, sleep disturbance;
- I and III trimesters of pregnancy, lactation process;
- age less than 15 years (due to the likelihood of developing Reye's syndrome with fever due to viral diseases);
- individual intolerance.
Among the relative contraindications of "Citramon Ultra" (use under medical supervision) are:
- gout;
- liver disease, liver failure, alcohol abuse;
- benign hyperbilirubinemia;
- II trimester of pregnancy;
- alcoholism;
- old age.
Brief instruction. How to take the drug?
According towith instructions for "Citramon Ultra", the medicine is taken orally with or after meals. The following doses are recommended: 3-4 times a day, 1-2 tablets. The interval between single doses is 4-8 hours. The maximum amount is 8 tablets per day.
How to take "Citramon Ultra", it is important to find out in advance. Without medical supervision, the duration of the course should not be more than 5 days as an anesthetic or antipyretic.
The price of "Citramon Ultra" is quite acceptable.
Adverse reactions
The following side effects may occur while taking this medication:
- Blood clotting system: anemia, thrombocytopenia, hypocoagulation, methemoglobinemia, hemorrhagic syndrome (nosebleeds, bleeding gums, purpura, etc.), reduced platelet aggregation.
- Digestive system: vomiting, gastralgia, nausea, hepatotoxicity.
- Vascular system and heart: tachycardia, increased blood pressure.
- Urinary system: nephrotoxicity, kidney damage combined with papillary necrosis.
- Sense organs: visual disturbances, tinnitus, deafness.
- Allergic reactions: skin rashes, bronchospasm, itching, skin flushing, angioedema.
- CNS: cephalgia, dizziness.
In childhood, Reye's syndrome may occur, which manifests itself in the form of metabolic acidosis, hyperpyrexia, vomiting, impaired liver function, disorderswork of the central nervous system.
Possible side effects associated with the properties of the main components of the drug "Citramon Ultra": paracetamol can cause nausea, epigastric pain, allergies, anemia, methemoglobinemia, thrombocytopenia; acetylsalicylic acid - provokes the development of dyspeptic phenomena; caffeine - tinnitus, insomnia, trembling limbs, palpitations, vomiting, shortness of breath, drug dependence. For any manifestations, the reception should be discontinued.
The difference between "Citramon Ultra" and "Citramon P"
Similar names often cause a lot of questions from patients. The drug "Citramon P" is an absolutely identical drug with "Citramon Ultra". Both medicines have a similar effect, they contain the same active elements. However, there is one minor difference between these remedies, which is the effect on the stomach. The medicine "Citramon Ultra" is produced in film-coated tablets, so this form of the drug is safe for people suffering from gastric diseases. Tablets of the drug "Citramon P" do not have such a shell, as a result of which they can have a negative effect on the gastric mucosa.
Overdose
The main symptoms of a mild overdose of this pharmacological agent can be: pallor of the skin, dizziness, ringing in the ears, gastralgia, vomiting, nausea. In more severe cases, metabolic acidosis, anorexia, impaired metabolicprocesses involving glucose, bronchospasm, collapse, lethargy, drowsiness, shortness of breath, convulsions, anuria, bleeding. So the dosage of Citramon Ultra must be strictly observed.
Symptoms of liver dysfunction after an overdose may occur after a maximum of 48 hours. In severe situations, it is possible to develop liver failure with progressive encephalopathy, then coma and death are possible. Other possible disorders: arrhythmia, acute kidney failure with tubular necrosis, pancreatitis. Therapy: it is necessary to constantly monitor the acid-base and electrolyte balance. After the necessary diagnosis of the condition, the patient may be prescribed citrate, sodium bicarbonate or sodium lactate. Against the background of increasing reserve alkalinity against the background of alkalinization of urine, there is an increase in the excretion of acetylsalicylic acid.
Special Recommendations
So, we found out what helps "Citramon Ultra". Having de alt with this, it is worth studying the features of the reception. Most importantly, it is impossible to prescribe this drug to children under 15 years of age. The fact is that Citramon Ultra contains acetylsalicylic acid, which, in the presence of a viral infection, increases the likelihood of Reye's syndrome. Signs of this pathology include acute encephalopathy, prolonged repeated vomiting, and an increase in the size of the liver. With long-term therapy, monitoring of peripheral blood and liver function is necessary. In the case of the use of the drug "Citramon Ultra" by patients with hypersensitivity or asthmaticresponse to salicylates or other derivatives of acetylsalicylic acid, special precautions must be observed.
While taking acetylsalicylic acid, blood clotting slows down, and therefore, when planning a surgical intervention, it is recommended to warn the doctor in advance about the use of this medication. Low doses of this substance help to slow down the excretion of uric acid, which in patients with a similar predisposition can provoke an attack of gout. Due to the increased risk of bleeding in the digestive tract during the treatment period, it is recommended to refrain from drinking alcohol.
What else does the instructions for use for Citramon Ultra tell us?
Drug Interactions
With the combined use of the drug "Citramon Ultra" with heparin, indirect anticoagulants, reserpine, steroid hormones and hypoglycemic drugs, their effect is enhanced. Along with non-steroidal anti-inflammatory drugs, methotrexate, the risk of side effects increases. With prolonged combined use of these drugs, there is also an increased risk of papillary necrosis of the kidneys and analgesic nephropathy, the development of end-stage kidney failure.
When taking Citramon Ultra tablets with salicylates and high doses of paracetamol, there is a possibility of oncological pathologiesbladder and kidneys.
When taking furosemide, spironolactone, antihypertensive drugs, uricosuric drugs that promote the natural excretion of uric acid, together with Citramon Ultra, their effectiveness decreases.
When combined with "Citramon Ultra" drugs such as phenylbutazone, rifampicin, barbiturates, ethanol, tricyclic antidepressants, hepatotoxic drugs, there is an increase in the production of hydroxylated metabolites, which causes the risk of severe intoxication even with a slight overdose. Instructions for use for "Citramon Ultra" confirms this.
With long-term barbiturate therapy, the effectiveness of paracetamol is reduced. When taking inducers of microsomal liver enzymes (including cimetidine), the likelihood of a hepatotoxic effect of paracetamol decreases. When used in conjunction with metoclopramide, the absorption of paracetamol is accelerated, with chloramphenicol, its half-life increases significantly.
Other consequences of drug interactions with Citramon Ultra:
- Anticoagulants, coumarin derivatives with simultaneous repeated use of paracetamol: their effect is enhanced due to a decrease in the biological synthesis of procoagulant hepatic factors.
- When taken in parallel with ethanol, there is a risk of developing acute pancreatitis.
- Diflunisal: Plasma paracetamol levels increase but risk of hepatotoxicity increases.
- Ergotamine: its absorption is accelerated.
- Myelotoxic agents: the hematotoxicity of the drug is increased.
In the instructions for "Citramona Ultra" analogues of the product are not indicated. Check them out below.
Generics
The following are considered analogues of a medical product:
- AquaCitramon;
- "Coficil-plus";
- "Askofen-P";
- "Migrenol Extra";
- "Citramine";
- "Citramon P";
- "Excedrin";
- Citrapar and others.
But changing the product yourself is not recommended. It is better to consult a doctor.
Drug cost
The price of "Citramon Ultra" is approximately from 50 to 170 rubles. It depends on the region and pharmacy chain.
Reviews
On the forums you can find a lot of reviews about this medication, among which there are both positive and negative. Some patients consider this medicine indispensable for the occurrence of various pains. They note that "Citramon Ultra" quickly relieves discomfort, does not have a harmful effect on the stomach and is easily tolerated.
Negative reviews contain information about the side effects of taking this medication. Among them, the most pronounced are dyspeptic symptoms, digestive disorders, severe dizziness.
