Cipramil Consumer Medicine Information

Citalopram hydrobromide

WHAT IS IN THIS LEAFLET

This leaflet answers some common questions about Cipramil. It does not contain all the information that is known about Cipramil.

It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you using Cipramil against the benefits they expect it will have for you.

If you have any concerns about using this medicine ask your doctor or pharmacist.

Keep this leaflet with the medicine.
You may need to read it again.

WHAT CIPRAMIL IS USED FOR

Cipramil is used for the treatment of depression. Cipramil belongs to the group of medicines known as antidepressants.

Cipramil works by relieving the symptoms of depressed mood. It acts on certain chemicals in specific areas of the brain.

Your doctor, however, may prescribe Cipramil for another purpose. Ask your doctor if you have any questions about why Cipramil has been prescribed for you.

BEFORE YOU TAKE CIPRAMIL

When you must not take it.

Do not take Cipramil if you have ever had an allergic reaction to Cipramil or any of the ingredients listed at the end of this leaflet.

If you have an allergic reaction you may get a skin rash, have difficulty in breathing, get symptoms of hayfever or feel faint.

Cipramil can interact with the group of drugs called the monoamine oxidase inhibitors (MAOIs) and therefore they should not be taken together. It is recommended that you do not start taking Cipramil until at least 14 days after you have finished taking any of these MAOIs medicines such as phenelzine and tranylcypromine. Similarly Cipramil should not be taken until at least one day after you have finished taking moclobemide or selegiline.

The herbal remedy St John's wort (Hypericum perforatum) should not be taken at the same time as this medicine.

Do not take Cipramil after the expiry date printed on the bottle/pack.

It may have no effect at all or, an entirely unexpected effect if you take it after the expiry date.

Do not take Cipramil if the packaging is torn or shows signs of having been tampered with.

Do not take Cipramil to treat any other complaints unless your doctor has instructed you to do so.

Before you start to take it

Your doctor must know about all the following before you start to take Cipramil.

You must tell your doctor if:

  1. you are allergic to any other medicines or any foods, dyes or preservatives.
  2. you have any medical conditions, including:
    heart disease
    epilepsy
    liver disease
    kidney disease
    diabetes
    bleeding disorder

    Your doctor will take the necessary precautions to ensure safe use of Cipramil if you have any of these medical conditions.
  3. you are taking any other medicines, including medicines that you buy without a prescription from a pharmacy, supermarket or health food shop

    Some of the medicines in common use that may interfere with Cipramil include cimetidine, tramadol and sumatriptan (Imigran®. Drugs that increase bleeding tendency should also be avoided. You may need to take different amounts of your medicine or you may need to take different medicines.

    Your doctor or pharmacist can tell you what to do if you are taking this or any other medicines.
  4. you are pregnant or plan to become pregnant.

    Do not take Cipramil if you are pregnant or breastfeeding unless you and your doctor have discussed the risks and benefits involved.

    It is not recommended that you do breastfeed while taking Cipramil as it is excreted in breast milk.

    If you have not told your doctor about any of these things, tell them before you take Cipramil.
  5. you have heart disease.
    Cipramil may decrease your heart rate.

Use in children and adolescents

Do not give Cipramil to children and adolescents.

Cipramil is not recommended for children and adolescents under the age of 18 years as the safety and efficacy of Cipramil in this age group has not been established.

Use in elderly

Cipramil can be given to elderly patients. The effects of Cipramil in elderly patients are similar to that in other patients.

HOW TO TAKE CIPRAMIL

How much to take

Your doctor will tell you how much Cipramil to take. Take the amount your doctor tells you to.

The usual adult dose of Cipramil is between 20mg and 60mg per day (one to three tablets per day).

For the elderly, the usual dose of Cipramil is 20mg to 40mg per day (one to two tablets per day).

How to take it

Take Cipramil as a single dose either in the morning or in the evening. Cipramil may be taken with or without food.

It is best if the tablet is swallowed whole. Do not chew the tablets.

How long to take it

Continue to take your tablets for as long as your doctor recommends. Do not stop taking them even if you begin to feel better, unless you are told to do so by your doctor. Never change the dose of your medicine without talking to your doctor first.

What to expect

You will not usually feel the full benefit of Cipramil straight away.

Individuals will vary greatly in their response to Cipramil. Your doctor will check your progress at regular intervals.

If you forget to take it

If you miss a dose and remember in less than 12 hours, take it straight away, then continue as normal the next day. Otherwise, skip that day's dose but be sure to take the next day's dose when it is due.

Do not try to make up for missed doses by taking more than one dose at a time.

If you have trouble remembering when to take your medicine, ask your pharmacist for some hints.

If you take too much (Overdose)

Immediately telephone your doctor or Poisons Information Centre (in New Zealand, phone 0800 POISON or 0800 764 766) for advice, or go to Casualty or the Accident and Emergency department at your nearest hospital if you think that you or anyone else may have taken too much Cipramil. Do this even if there are no signs of discomfort or poisoning. Keep telephone numbers for these places handy.

Symptoms of overdosage may include:

  • nausea (feeling sick)
  • vomiting
  • sweating
  • drowsiness
  • blue discolouration of the skin
  • convulsions
  • unconsciousness
  • fast heart beats
  • tremor

WHILE YOU ARE TAKING CIPRAMIL

Things you must do

Take Cipramil exactly as your doctor has prescribed.

If you do not follow your doctor's instructions, you may not get relief from your depression.

Try not to miss any doses and continue to take the medicine even if you feel well.

Tell your doctor immediately if you become pregnant while taking Cipramil.

Tell all doctors, dentists and pharmacists who are treating you that you are using Cipramil, especially if you are being started on any new medicines.

Tell your doctor immediately if you have any suicidal thoughts or other mental/mood changes.

All mentions of suicide or violence must be taken seriously. If you or someone you know demonstrates any of the following warning signs of suicide-related behaviour while taking Cipramil, then it is important to contact a health care provider right away or even to go to the nearest hospital for treatment:

  • thoughts or talk of death or suicide
  • thoughts or talk of self-harm or harm to others
  • any recent attempts of self-harm
  • increase in aggressive behaviour, irritability or agitation

Things you must not do

Do not give this medicine to anyone else even if their symptoms seem similar to yours.

Things to be aware of

As with any new medicines you should take care when driving or operating machinery until you know how Cipramil affects you.

As with all antidepressants, caution is advised if alcohol is consumed while on Cipramil.

SIDE EFFECTS

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Cipramil.

Cipramil helps most people with depression, but it may have unwanted side effects in some people. All medicines have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.

Ask your doctor or pharmacist to answer any questions you may have.

The side effects of Cipramil are, in general, mild and disappear after a short period of time.

Tell your doctor if you notice any of the following and they worry you:

  • nausea (feeling sick)
  • dry mouth
  • drowsiness
  • tremor
  • sweating
  • headache
  • dizziness
  • visual disturbances
  • agitation
  • nervousness
  • anxiety
  • constipation
  • poor concentration
  • diarrhoea
  • trouble when urinating
  • fast heart beats
  • weak body

Less frequent side effects may include:

  • rash
  • itching
  • migraine
  • numbness or tingling
  • unusual taste
  • decreased sex drive
  • abnormal dreaming
  • loss of appetite
  • a sense of indifference to everything
  • confusion
  • yawning
  • impotence
  • vomiting
  • difficulty in digestion
  • stomach pain
  • excessive amount of air or gas in the stomach or intestine
  • increased saliva
  • weight increase
  • weight decrease
  • fast heart beat
  • inflammation of the nasal lining
  • increase in the amount of urine excreted
  • ejaculation failure
  • fatigue
  • for females, problems with periods

Rare side effects may include:

  • rash caused by light
  • convulsions
  • ringing in the ears
  • aggressive behaviour
  • for females, failure to achieve an orgasm
  • euphoria
  • coughing
  • shortness of breath
  • bodily discomfort
  • slow heart beat

Tell your doctor if you notice anything else that is making you feel unwell.

Some people may get other side effects while using Cipramil.

There is no evidence that Cipramil is addictive, however, if you suddenly stop taking Cipramil, you may get side effects. Tell your doctor if you get any side effects.

AFTER TAKING CIPRAMIL

Storage

Keep Cipramil in a cool place where the temperature stays below 25°C.

Keep Cipramil in the blister pack/bottle until it is time to take them.

Do not freeze Cipramil.

Do not leave Cipramil in the car on hot days.

Keep Cipramil away from direct sunlight.

Do not store Cipramil or any other medicine in the bathroom or near a sink or stove.

Heat, light and dampness can destroy some medicines.

Keep Cipramil where young children cannot reach it.
A locked cupboard at least one-and-a-half metre above ground is a good place to store medicines.

Disposal

Dispose of the tablets where children cannot reach them.

Ask your pharmacist what to do with any Cipramil you may have left over if your doctor tells you to stop using it, or you find that the tablets have passed the expiry date.

CIPRAMIL DESCRIPTION

What Cipramil looks like

Cipramil is presented as 20mg tablets.

The 20mg tablets are white, oval, scored, film-coated, marked with "C" and "N".

Cipramil is available in cartons of 7's and 28's.

Ingredients

Each Cipramil 20mg tablet contains 20mg citalopram (as hydrobromide salt).

Cipramil tablets also contain:

  • maize starch
  • lactose
  • cellulose - microcrystalline
  • PVP/VA copolymer
  • glycerol
  • croscarmellose sodium
  • magnesium stearate
  • hypromellose
  • macrogol
  • titanium dioxide

This leaflet was prepared on 1 November 2004.

Cipramil® is the registered trademark of Lundbeck.