The medication “Citramon Ultra” is an anti-inflammatory and analgesic agent based on the combined composition.
The active elements of this medication are acetylsalicylic acid, caffeine and paracetamol. The drug is produced by the Russian pharmaceutical company FarmVILAR. Dosage form - film-coated tablets: biconvex, oblong, with rounded ends, on one side is risk, the shell is light brown in color, the core is white. A cardboard box contains 5, 6, 10, 15 or 20 tablets in blisters and instructions for use.
The auxiliary substances in Citramon Ultra are: hydroxypropyl methyl cellulose, colloidal silicon dioxide, potato starch, microcrystalline cellulose, crospovidone, citric acid, lactose monohydrate, stearic acid, polyethylene glycol. The film coating consists of the following components: polyvinyl alcohol, Opadry II (85 series), macrogol, talc, titanium dioxide, iron oxide (black, red and yellow).
pharmachologic effect
As indicated in the instructions, Citramon Ultra is a combined medical product whose effects 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 the foci of inflammation.
- Paracetamol: has an antipyretic, analgesic, and weak anti-inflammatory effect, due to the effect of this substance on the hypothalamic thermoregulation center and a mild property to rapidly inhibit the biological synthesis of prostaglandins in peripheral tissues.
- Caffeine: enhances the reflex excitability of the structures of the spinal cord, stimulates the vasomotor and respiratory centers, weakens platelet aggregation, dilates the blood vessels of the brain, kidneys, skeletal muscles, heart. The substance helps to reduce feelings 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 practically does not have a stimulating effect on the central nervous system.
Pharmacokinetic characteristics
According to the instructions for "Citramon Ultra", acetylsalicylic acid after oral administration is quite fully absorbed. During this, presystemic elimination is observed in the walls of the intestine and liver (deacetylation processes). The absorbed portion of the substance is rapidly hydrolyzed by cholinesterase and plasma albumin esterase. Communication with plasma proteins - up to 90%. The maximum concentration of a substance in the tissues is reached after about 2 hours. Biotransformation occurs in the liver, while 4 metabolites are formed.
Excretion of ascorbic acid occurs 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 through conjugation with glucuronides and sulfates. In addition, paracetamol may be partially oxidized by microsomal hepatic enzymes. In this case, the formation of intermediate toxic metabolites conjugating with glutathione, cysteine and mercapturic acid.
Indications for use of "Citramona Ultra"
A medication is prescribed to relieve pain of various origin of moderate and weak severity:
- headache;
- algodismenorea;
- neuralgia;
- migraine;
- arthralgia;
- toothache;
- fever with ARVI (flu).
Are there any contraindications to this drug?
Contraindications
Absolute contraindications to the appointment of this medication are:
- bleeding in the digestive tract, erosion and gastrointestinal ulcers;
- partial or complete combination of bronchial asthma and polyposis in the nose with intolerance to acetylsalicylic acid and other non-steroidal anti-inflammatory drugs;
- arterial hypertension, ischemic heart disease in severe cases;
- surgical procedures accompanied by bleeding;
- hemorrhagic diathesis;
- portal hypertension;
- hypocoagulation, hemophilia, hypoprothrombinemia;
- renal failure;
- vitamin deficiency K;
- glaucoma;
- anxiety disorders (panic attacks, agoraphobia), increased 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 an increase in temperature against a background of viral diseases);
- individual intolerance.
Among the relative contraindications of Citramon Ultra (use under medical supervision) are:
- gout;
- liver disease, liver failure, alcohol damage;
- benign hyperbilirubinemia;
- II trimester of pregnancy;
- alcoholism;
- elderly age.
Brief instruction. How to take the drug?
In accordance with the instructions for “Citramon Ultra”, the medicine is taken orally during meals or after it. The following doses are recommended: 3-4 times a day for 1-2 tablets. The interval between doses of 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 the supervision of a doctor, the duration of the course should not be more than 5 days as an anesthetic or antipyretic.
The price of Citramone Ultra is quite reasonable.
Adverse reactions
The following side effects may occur while taking the medication:
- Blood coagulation system: anemia, thrombocytopenia, hypocoagulation, methemoglobinemia, hemorrhagic syndrome (nosebleeds, bleeding gums, purpura, etc.), decreased platelet aggregation.
- Digestive system: vomiting, gastralgia, nausea, hepatotoxicity.
- Vascular system and heart: tachycardia, increased blood pressure.
- Urinary system: nephrotoxicity, kidney damage in combination with papillary necrosis.
- Sense organs: visual impairment, tinnitus, deafness.
- Allergic reactions: skin rashes, bronchospasm, itching, flushing of the skin, angioedema.
- CNS: cephalalgia, dizziness.
In childhood, Reye's syndrome may occur, which manifests itself in the form of metabolic acidosis, hyperpyrexia, vomiting, impaired liver function, disorders of the central nervous system.
Possible side effects associated with the properties of the main components of Citramon Ultra: paracetamol can cause nausea, epigastric pain, allergies, anemia, methemoglobinemia, thrombocytopenia; acetylsalicylic acid - provokes the development of dyspeptic phenomena; caffeine - ringing in the ears, insomnia, trembling limbs, palpitations, vomiting, shortness of breath, drug dependence. With any manifestations, the reception should be discontinued.
The difference between Citramone Ultra and Citramone P
Similar names often cause a lot of questions in patients. The drug Citramon P is an absolutely identical drug with Citramon Ultra. Both medicines have a similar effect, in the composition they have the same active elements. Nevertheless, there is one slight difference in these agents, which is the effect on the stomach. The medicine “Citramon Ultra” is produced in film-coated tablets, which makes this form of the drug safe for people suffering from gastric diseases. Tablets of the Citramon P medication do not have such a membrane, as a result of which they can have a negative effect on the mucous membrane of the stomach.
Overdose
The main symptoms of a mild overdose with this pharmacological agent may be: pallor of the skin, dizziness, ringing in the ears, gastralgia, vomiting, nausea. In more severe cases, metabolic acidosis, anorexia, metabolic disturbances involving glucose, bronchospasm, collapse, lethargy, drowsiness, shortness of breath, convulsions, anuria, bleeding develop. So the dosage of Citramone Ultra should be strictly observed.
Symptoms of liver dysfunction after an overdose can occur after a maximum of 48 hours. In severe situations, the development of liver failure with progressive encephalopathy is possible, then a coma, a fatal outcome are possible. Other possible disorders: arrhythmia, acute renal failure with tubular necrosis, pancreatitis. Therapy: constant monitoring of the acid-base and electrolyte balance is necessary. 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 alkalization of urine, there is an increase in the excretion of acetylsalicylic acid.
Special recommendations
So, we found out what helps Citramon Ultra. Having dealt with this, it is worth studying the features of the reception. The most important thing is that it is impossible to prescribe this medication to children under 15 years of age. The fact is that the composition of 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, an increase in liver size. With long-term therapy, control of peripheral blood and liver functionality is necessary. If Citramon Ultra is used by patients with hypersensitivity or an asthmoid response to salicylates or other acetylsalicylic acid derivatives, special precautions must be observed.
While taking acetylsalicylic acid, blood coagulation slows down, and therefore, when planning an surgical intervention, it is recommended to warn the doctor in advance about the use of this medication. Low doses of this substance 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 treatment, it is recommended to refrain from drinking alcohol.
What else does the instructions for use for Citramone Ultra tell us?
Drug interaction
With the combined use of 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 the terminal stage of kidney failure.
When taking Citramon Ultra tablets with salicylates and high doses of paracetamol, there is a chance of oncological pathologies of the bladder and kidneys.
When taking furosemide, spironolactone, drugs with antihypertensive effects, uricosuric medicines that contribute to the natural excretion of uric acid, together with Citramon Ultra, their effectiveness decreases.
When combined with Citramon Ultra such drugs as phenylbutazone, rifampicin, barbiturates, ethanol, tricyclic antidepressants, hepatotoxic drugs, an increase in the production of hydroxylated metabolites is observed, which leads to the risk of severe intoxication even with a slight overdose. Instructions for use with Citramone Ultra confirms this.
With prolonged therapy with barbiturates, the effectiveness of paracetamol decreases. When taking inducers of microsomal hepatic enzymes (including cimetidine), the likelihood of hepatotoxic effects of paracetamol decreases. When used in conjunction with metoclopramide, the absorption of paracetamol is accelerated, with chloramphenicol, its half-life is significantly increased.
Other effects of drug interactions with Citramone Ultra:
- Anticoagulants, coumarin derivatives with the simultaneous reuse of paracetamol: their effect is enhanced, due to a decrease in the biological synthesis of procoagulant hepatic factors.
- In parallel with ethanol, there is a risk of developing acute pancreatitis.
- Diflunisal: plasma levels of paracetamol increase, but the risk of hepatotoxicity increases.
- Ergotamine: its absorption is accelerated.
- Myelotoxic drugs: the hematotoxicity of the drug is enhanced.
In the instructions for "Citramona Ultra" analogues are not indicated. Consider them below.
Generics
Analogues of a medicinal product are:
- “AquaCitramon”;
- "Coficil Plus";
- Askofen-P;
- Migrenol Extra;
- "Citramarine";
- "Citramon P";
- Exedrine
- "Citrapar" and others.
But changing the remedy alone is not recommended. It is better to consult a doctor.
Drug cost
The price of Citramon Ultra is approximately 50 to 170 rubles. It depends on the region and the pharmacy network.
Reviews
On the forums you can find a lot of reviews about this medication, among which there are both positive and negative. Some patients find this medicine indispensable in the event of various pains. They note that Citramon Ultra quickly removes unpleasant sensations, does not have a harmful effect on the stomach and is easily tolerated.
Negative reviews contain information about side effects from taking this medication. Among them, the most pronounced are dyspeptic symptoms, digestive disorders, severe dizziness.