Citramon dosage. Is it possible to give citramon to a child? When is citramon contraindicated?

Citramon P is a combined analgesic drug.

Release form and composition

Citramon P is produced in the form of flat-cylindrical round tablets of light brown color, with a chamfer on both sides and a risk on the front side. Tablets have a characteristic odor and may contain inclusions (3, 4, 6 or 10 pieces in blisters / blisters / strips, in a carton box 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 , 20, 30, 40, 50, 60, 70, 80, 90 or 100 blisters, 10, 20, 30, 40, 50, 60, 70, 80, 90 or 100 pieces in polypropylene / polyethylene terephthalate cans, in cardboard box 1 bank).

1 tablet contains:

• active ingredients: acetylsalicylic acid (ASA) - 240 mg, paracetamol - 180 mg, caffeine - 30 mg;
• excipients: cocoa bean powder, citric acid monohydrate, magnesium stearate, croscarmellose sodium, microcrystalline cellulose, povidone-K25.

Due to the large number of manufacturers of Citramon P, other types of packaging and changes in the composition of the auxiliary components of the drug are possible, other than those described above.

Pharmacological properties

Pharmacodynamics

Citramon P is a combined drug containing ASA, paracetamol and caffeine.

The action of the drug is due to the effectiveness of its active components:

• ASA: has anti-inflammatory and antipyretic effect; relieves pain (in particular, caused by inflammatory processes), stimulates blood microcirculation in the focus of inflammation, inhibits platelet aggregation and thrombosis;
• paracetamol: has an antipyretic, analgesic, and also an extremely weak anti-inflammatory effect, due to its effect on the thermoregulatory center in the hypothalamus, as well as a weak ability to inhibit the synthesis of prostaglandins in peripheral tissues;
• caffeine: increases the reflex excitability of the spinal cord; has a stimulating effect on the respiratory and vasomotor centers; promotes the expansion of blood vessels of the brain, skeletal muscles, kidneys, heart; reduces platelet aggregation; reduces drowsiness and fatigue, increasing physical and mental performance. The composition of Citramon P includes a small dose of caffeine, so it has almost no stimulating effect on the central nervous system, however, it increases the tone of the cerebral vessels and helps to accelerate blood flow.

Pharmacokinetics

• absorption: when taken orally, it is completely absorbed, during absorption it undergoes elimination: in the intestinal wall - presystemic; in the liver - systemic, by deacetylation. It is quickly hydrolyzed by albuminesterase and cholinesterases, therefore T 1/2 (half-life) is no more than 20 minutes;
• distribution: circulates in the body by 75–90% binding to blood proteins (mainly albumin) and is distributed in tissues in the form of salicylic acid anion; Cmax (maximum concentration) is reached after 2 hours.
• Metabolism: occurs predominantly in the liver, with four metabolites that are found in the urine and many tissues;
• excretion: excreted mainly by the kidneys through active tubular secretion of salicylate (60%) or its metabolites. Alkalinization of urine increases the ionization of salicylates, which leads to a deterioration in their reabsorption and a significant increase in excretion. The rate of excretion is affected by the dose: T 1/2 when using small doses is 2-3 hours, with increasing doses it increases to 15-30 hours. Elimination of salicylates in newborns is much slower.

Paracetamol:

• absorption: Absorption is high. Achievement of the maximum concentration (5-20 mcg / ml) occurs after 0.5-2 hours;
• distribution: 15% of the substance binds to plasma proteins. Penetration through the blood-brain barrier was recorded. V breast milk no more than 1% of the dose taken by the nursing mother gets. Achieving a therapeutic effective concentration of paracetamol in plasma occurs at a dose of 10-15 mg / kg;
• metabolism: occurs in the liver (up to 95%). As a result of conjugation reactions, in which 80% of metabolites enter, inactive glucuronides and sulfates are formed. Another 17% is hydroxylated to form eight active metabolites conjugated with glutathione, resulting in the formation of already inactive metabolites. In case of lack of glutathione, these substances block the enzyme systems of hepatocytes and cause their necrosis. Also involved in the metabolism of paracetamol isoenzymes CYP1A2, CYP2E1 and to a lesser extent CYP3A4;
• excretion: excreted by the kidneys in the form of metabolites (mainly conjugates), less than 5% is excreted unchanged. T 1/2 - 1-4 hours. In elderly patients, the clearance of the drug is reduced, and the half-life is increased.

• suction: at oral intake absorption is good, occurs along the entire length of the intestine, mainly due to lipophilicity. Achieving Cmax (1.6-1.8 mg / l) occurs 50-75 minutes after ingestion;
• distribution: rapidly distributed in tissues and organs, easily crosses the placenta and the blood-brain barrier, and is also 25–36% bound to blood proteins. In adults, the volume of distribution is 0.4-0.6 l / kg, in newborns - 0.78-0.92 l / kg;
• metabolism: predominantly occurs in the liver - over 90%, but in children of the first years of life - no more than 10-15%. In adults, about 80% of the substance is metabolized to paraxanthine, 10% to theobromine, 4% to theophylline. Further, these compounds are demethylated into monomethylxanthines and methylated uric acids;
• excretion: caffeine, mainly in the form of metabolites, is excreted mainly by the kidneys; in adult patients, 1-2% is excreted unchanged, T 1/2 - 3.9-5.3 hours (sometimes up to 10 hours).

Indications for use

• febrile syndrome (for example, with acute respiratory infections, influenza);
• pain syndrome of mild and moderate severity of various etiologies (migraine, headache or toothache, neuralgia, myalgia, arthralgia, algomenorrhea).

Contraindications

Absolute:

• gastrointestinal bleeding or perforation;
• erosive and ulcerative lesions gastrointestinal tract(GIT) in the acute phase;
• history of peptic ulcer;
• hypoprothrombinemia, hemorrhagic diathesis;
• portal hypertension;
• avitaminosis K;
• chronic heart failure III and IV functional class according to the classification of the New York Heart Association (NYHA);
• arterial hypertension (III degree);
• incomplete or complete combination of bronchial asthma, recurrent polyposis of the paranasal sinuses and nose, as well as intolerance to non-steroidal anti-inflammatory drugs (NSAIDs), for example, ASA;
• severe hepatic and / or renal failure;
• glaucoma;
• hemophilia and other blood clotting disorders;
• operations that are accompanied by heavy bleeding;
• simultaneous reception of methotrexate in an amount of more than 15 mg per week;
• sleep disturbance, increased nervous excitability;
• deficiency of glucose-6-phosphate dehydrogenase;
• During pregnancy and breastfeeding;
• age up to 18 years (with febrile syndrome) or up to 15 years (with pain syndrome);
• hypersensitivity to the components of Citramon P.

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;
• alcoholism;
• smoking;
• elderly age.

Instructions for use Citramon P: method and dosage

Citramon P tablets are taken orally with a sufficient amount of liquid, after or during a meal.

• headache: single dose - 1-2 tablets. In case of severe headaches after 4-6 hours, the drug is recommended to be taken again;
• migraine symptoms: 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 with Citramon P as an analgesic should not exceed 5 days, as an antipyretic - 3 days, in the treatment of headache or migraine - 4 days.

Side effects

• cardiovascular system: infrequently - the development of arrhythmias, increased heart rate (HR); rarely - hyperemia, impaired peripheral circulation;
• digestive system: often - nausea and abdominal discomfort; infrequently - dry mouth, diarrhea, vomiting; rarely - belching, flatulence, increased salivation, paresthesia in the mouth, dysphagia;
• respiratory system: rarely - hypoventilation, rhinorrhea, nosebleeds;
• metabolism and nutrition: rarely - loss of appetite;
• infections, invasions: rarely - pharyngitis;
• nervous system: often - the development of dizziness; infrequently - the appearance of headache, paresthesia, tremor; rarely - taste disorder, hyperesthesia, amnesia, attention disorder, impaired coordination of movements, pain in the paranasal sinuses;
• psyche: often - nervousness; infrequently - insomnia; rarely - euphoric state, anxiety, internal tension;
• hearing: infrequently - the appearance of tinnitus;
• vision: rarely - visual impairment;
• musculoskeletal system: rarely - pain in the back and / or neck, muscle spasms, musculoskeletal stiffness;
• skin: hyperhidrosis, urticaria, itching;
• general disorders: infrequently - the occurrence of increased excitability or fatigue; rarely - heaviness in the chest, the development of asthenia.

During the period of post-registration observation, the following side effects of Citramon P were recorded:

• immune system: hypersensitivity;
• nervous system: development of migraine, drowsiness;
• mental disorders: anxiety;
• respiratory system: development of shortness of breath, bronchospasm;
• cardiovascular system: lowering blood pressure (BP), palpitations;
• liver, biliary tract: development of liver failure;
• digestive system: abdominal and epigastric pain, dyspepsia, gastrointestinal bleeding, erosive and ulcerative lesions of the gastrointestinal tract;
• skin: erythema, angioedema, rash;
• general disturbances: feelings of discomfort, malaise.

After taking ASA for 4-8 days, there is an increased likelihood of bleeding. Very rarely, severe bleeding, including life-threatening (for example, cerebral hemorrhage), can occur. This effect is most common with the combined use of anticoagulants and / or in patients with arterial hypertension.

Many of the given side effects are dose-dependent, and their severity varies from patient to patient.

Overdose

ASK

Due to mild intoxication (plasma concentration from 150 to 300 mcg / ml), dizziness, deafness, tinnitus, nausea, vomiting, increased sweating, headache, confusion may occur. Treatment is carried out by canceling Citramon P or reducing its dose.

Taking ASA at concentrations above 300 μg/ml contributes to the development of more severe intoxication, which is manifested by anxiety, fever, hyperventilation, ketoacidosis, respiratory alkalosis, and metabolic acidosis. Due to the oppression of the central nervous system there is a risk of coma, cardiovascular collapse and respiratory failure.

When taking more than 100 mg / kg for several days in elderly patients and children, the risk of developing chronic intoxication is greatly increased.

• > 120 mg/kg of salicylates during the last hour: repeated oral administration of activated charcoal is recommended. It is also necessary to determine the plasma concentration of salicylates, although the prediction of the severity of an overdose based on this indicator is impossible - it is necessary to additionally take into account biochemical and clinical parameters;
• > 500 mcg / ml (for children under 5 years old at > 350 mcg / ml): removal of salicylates from plasma is carried out by intravenous administration of sodium bicarbonate;
• > 700 mcg/ml (lower concentrations in older patients and children) or if severe metabolic acidosis develops: hemoperfusion or hemodialysis is the treatment of choice.

Paracetamol

In case of an overdose, intoxication is possible, especially in children and the elderly, patients with liver diseases (including due to chronic alcoholism), with malnutrition, while taking inducers of microsomal liver enzymes. As a result of intoxication, the development of liver failure, fulminant, cytolytic or cholestatic hepatitis can be observed (in these cases, death is sometimes possible).

The clinical picture of an acute overdose of paracetamol develops during the day after its administration. Main symptoms: pallor skin, gastrointestinal disorders (loss of appetite, nausea, vomiting, abdominal discomfort, abdominal pain).

After the simultaneous administration of paracetamol to adults at a dose of 7.5 g and to children at a dose of 140 mg / kg, hepatocyte cytolysis develops, complete and irreversible liver necrosis, liver failure, metabolic acidosis, encephalopathy, which can result in coma and death. In 0.5-2 days after administration, the concentration of bilirubin, the activity of lactate dehydrogenase, microsomal liver enzymes increase, and the content of prothrombin decreases. Manifestation clinical symptoms liver damage occurs after 2 days and reaches a maximum at 4–6 days.

An overdose of paracetamol requires immediate hospitalization.

After an overdose and before starting treatment, the quantitative content of paracetamol in the blood plasma should be determined. During the first 8 hours, the most effective therapy is SH-group donors and precursors of glutathione synthesis - acetylcysteine ​​and methionine.

Decision on additional therapeutic measures (further administration of methionine, intravenous administration acetylcysteine) is taken based on data on the content of paracetamol in the blood and the time elapsed after taking it.

At symptomatic treatment overdose of paracetamol, the activity of microsomal liver enzymes should be monitored at the beginning of therapy, and then every 24 hours. In most cases this indicator normalizes within 1-2 weeks. In severe cases, a liver transplant may be needed.

Caffeine

The most common symptoms of caffeine overdose are: agitation, gastralgia, anxiety, delirium, restlessness, nervousness, mental agitation, insomnia, confusion, muscle twitching, convulsions, frequent urination, dehydration, hyperthermia, increased tactile or pain sensitivity, tinnitus , headache, nausea, vomiting (including with blood). In case of severe overdose, hyperglycemia may develop. The manifestations of cardiac disorders are tachycardia and arrhythmia.

For the treatment of the condition, a dose reduction or caffeine withdrawal is required.

special instructions

General special instructions

Citramon P should not be administered in conjunction with other drugs containing paracetamol or ASA.

Caution is advised when using Citramon P for the first time for the treatment of migraine or for atypical symptoms of this disease, in order to avoid the development of potentially severe neurological disorders. If migraine symptoms persist after taking 2 tablets, you should consult a doctor.

You should not use the drug for headaches if more than 10 attacks per month have been observed in the last three months. This effect may be due to excessive intake of drugs and requires a doctor's consultation. Citramon P is not recommended for the treatment of migraine if more than half of the cases require bed rest or more than 20% of the patient's attacks are accompanied by vomiting.

The drug is used with caution in patients with risk factors for dehydration (diarrhea, vomiting, pre- or postoperative period).

Citramon P may mask signs of infection.

Special instructions due to the presence of ASA

Citramon P is required to be taken with caution in patients suffering from diabetes, gout, uncontrolled arterial hypertension, dehydration, deficiency of glucose-6-phosphate dehydrogenase.

Since ASA inhibits platelet aggregation, bleeding time may increase during surgery (including minor surgery) and in the postoperative period.

Without the supervision of a physician, the drug should not be used in conjunction with drugs that affect the blood coagulation process (in particular, with anticoagulants). If there is a violation of blood coagulation during therapy with Citramon P, careful monitoring of patients should be ensured. You also need to be careful if uterine bleeding various etiologies or hypermenorrhea.

With the development of ulceration or bleeding of the gastrointestinal tract during therapy with Citramon P, you should immediately stop taking the drug. The use of NSAIDs increases the risk of potentially fatal bleeding, ulceration or perforation of the gastrointestinal tract, including in the absence of a history of precursors or severe gastrointestinal complications. These effects are especially pronounced in elderly patients.

Co-administration of glucocorticosteroids, NSAIDs and alcohol may increase the likelihood of gastrointestinal bleeding.

Due to false-positive low concentrations of levothyroxine or triiodothyronine, ASA administration may distort data laboratory research thyroid function.

Citramon P can lead to the development of bronchospasm and exacerbation of bronchial asthma, as well as other hypersensitivity reactions. Risk factors include: chronic obstructive pulmonary disease, chronic infections respiratory tract, seasonal allergic rhinitis, nasal polyposis, bronchial asthma. These phenomena can also occur in patients who have allergic reactions to other substances. In such cases, special care is required.

Special instructions due to the presence of paracetamol

The use of Citramon P increases the risk of severe skin reactions (toxic epidermal necrolysis, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome with possible lethal outcome). The patient should be informed about these reactions, and warned that if they occur, the drug should be discontinued immediately.

Simultaneous use of other potentially hepatotoxic drugs that induce microsomal liver enzymes (isoniazid, rifampicin, chloramphenicol, hypnotics and anticonvulsants, including carbamazepine, phenytoin, phenobarbital, etc.) increases the likelihood of paracetamol poisoning.

In patients with alcohol dependence, there is a risk of liver damage, therefore, caution should be exercised during therapy with Citramon P.

Special instructions due to the presence of caffeine

Citramon P should be used with caution in the treatment of patients with hyperthyroidism, arrhythmia, gout. In order to prevent an increase in heart rate and the development of nervousness, insomnia, irritability, it is necessary to limit the consumption of caffeinated products during therapy.

Influence on the ability to drive vehicles and complex mechanisms

Studies of the effect of Citramon P on the ability to drive vehicles and complex mechanisms have not been conducted. But such undesirable reactions as dizziness and drowsiness require refraining from activities that require an increased concentration of attention and speed of reactions. The appearance of these effects should be reported to the doctor.

Use during pregnancy and lactation

It is forbidden to use Citramon P during pregnancy and lactation.

Application in childhood

According to the instructions, Citramon P is forbidden to be used in pediatric practice:

1. As an anesthetic: for the treatment of children and adolescents under 15 years of age.
2. As an antipyretic: for the treatment of children and adolescents under 18 years of age. In the presence of viral infection taking ASA increases the likelihood of developing Reye's syndrome, the symptoms of which are manifested by hyperpyrexia (fever above 41.1 ° C), prolonged vomiting, metabolic acidosis, disorders of the nervous system and psyche, hepatomegaly and abnormal liver function, acute encephalopathy, respiratory failure, convulsions , coma.

For impaired renal function

Citramon P should be used with caution in patients with impaired renal function.

For impaired liver function

Citramon P should be used with caution in patients with hepatic impairment.

Use in the elderly

Citramon P should be used with caution in elderly patients, especially in cases of underweight.

drug interaction

When interacting with ASA, contained in the composition of Citramon P, with other drugs, the following effects may develop:

• NSAIDs: the appearance of gastrointestinal bleeding and damage to the gastrointestinal mucosa. In the case of joint use, it is recommended to take gastroprotectors;
• oral anticoagulants (in particular, coumarin derivatives): taking ASA can potentiate the action of these drugs, therefore it is recommended to carry out clinical and laboratory monitoring of bleeding time and prothrombin time. The combined use of oral anticoagulants and Citramon P is not recommended;
• glucocorticosteroids: damage to the gastrointestinal mucosa, the development of bleeding. In the case of joint use, the use of gastroprotectors is recommended, and if possible, this combination should be avoided, especially in the treatment of elderly patients;
• heparin: the development of bleeding, which requires the implementation of laboratory and clinical control of bleeding time. The combined use of heparin and Citramon P is not recommended;
• thrombolytics: the possibility of bleeding. It is not recommended to prescribe Citramon P in the first 24 hours after an acute stroke. The combined use of thrombolytics and ASA is unacceptable;
• selective serotonin reuptake inhibitors: the development of bleeding due to the effect on platelet function and the blood coagulation process. Joint use with Citramon P is not recommended;
• platelet aggregation inhibitors (clopidogrel, cilostazol, ticlopidine, paracetamol): development of bleeding requiring laboratory and clinical monitoring of bleeding time. Joint use with Citramon P is not recommended;
• valproic acid: due to a violation of the bonds with plasma proteins, ASA increases the toxicity of valproic acid. When used together, it is necessary to ensure control of the plasma concentration of valproic acid;
• phenytoin: increased plasma concentration of phenytoin; it is necessary to ensure the control of this indicator;
• loop diuretics (for example, furosemide): a decrease in their activity due to inhibition of prostaglandin synthesis and disruption of the glomerular filtration process. Taking NSAIDs can cause acute renal failure (particularly in dehydrated patients). The combined use of diuretics and Citramon P requires the provision of sufficient rehydration, monitoring of kidney function and control of blood pressure (especially on initial stage diuretic therapy)
• aldosterone antagonists (spironolactone, canrenoate): a decrease in the activity of these drugs due to impaired sodium excretion. It is recommended to ensure the control of blood pressure;
• uricosuric agents (for example, sulfinpyrazone, probenecid): a decrease in the activity of these drugs by increasing the plasma concentration of ASA due to inhibition of tubular reabsorption;
• antihypertensive drugs (ACE inhibitors, angiotensin II receptor antagonists, slow calcium channel blockers): a decrease in their activity due to inhibition of prostaglandin synthesis in the kidneys. Co-administration in the treatment of dehydrated or elderly patients may lead to acute kidney failure. It is required to ensure sufficient rehydration, control of kidney function and blood pressure;
• sulfonylurea derivatives, insulin: increased hypoglycemic effect. A high dose of ASA requires a reduction in the dose of hypoglycemic agents and control of blood glucose;
• methotrexate (at a dose of up to 15 mg per week): a decrease in tubular secretion of methotrexate, an increase in its plasma concentration and an increase in toxicity due to the development of these processes. The use of Citramon P is not recommended for the treatment of patients receiving high concentrations of methotrexate. When taking low concentrations of methotrexate, it is necessary to take into account the possibility of interaction with ASA, especially in cases of impaired renal function. The use of methotrexate and Citramon P requires monitoring of the function of the kidneys, liver, general analysis blood (especially on the first day of such therapy);
• alcohol: increased likelihood of gastrointestinal bleeding. Sharing should be avoided.

When interacting with paracetamol, contained in the composition of Citramon P, with other drugs, the following effects may develop:

• inducers of microsomal liver enzymes, potentially hepatotoxic substances (for example, alcohol, a combination of rifampicin and isoniazid, antiepileptics, hypnotics, including carbamazepine, phenytoin, phenobarbital): increased toxicity of paracetamol and liver damage even when taking non-toxic doses of the drug, which requires monitoring of liver function . It is not recommended to use these drugs at the same time;
• zidovudine: increased risk of neutropenia. Monitoring of hematological parameters is necessary. Simultaneous administration of the drug is possible only on prescription;
• chloramphenicol: increased risk of increasing the concentration of the latter. It is not recommended to use these drugs together;
• indirect anticoagulants: an increase in the anticoagulant effect after repeated (for 1 week or longer) administration of paracetamol. Episodic use of paracetamol does not give a significant effect;
• probenecid: decrease in the clearance of paracetamol, which requires a reduction in its dose. It is not recommended to use these drugs together;
• metoclopramide and other drugs that accelerate the evacuation from the stomach: increase the rate of absorption of paracetamol, increase efficiency and approach the onset of analgesic action;
• propaneline and other drugs that slow down the evacuation from the stomach: a decrease in the rate of absorption of paracetamol, a decrease or delay in the rapid relief of pain;
• colestriamin: decrease in the rate of absorption of paracetamol. If the maximum level of pain relief is required, cholesteramine should be administered 1 hour after taking Citramon P.

When interacting with caffeine, contained in the composition of Citramon P, with other drugs, the following effects may develop:

• hypnotics (for example, H1-histamine receptor blockers, barbiturates, benzodiazepines): a decrease in their hypnotic effect, a decrease in the anticonvulsant effect of barbiturates. The combined use of drugs is not recommended. If it is necessary to take Citramon P simultaneously with these drugs, the combination of caffeine should be taken in the morning;
• disulfiram: increased risk of exacerbation of alcohol withdrawal syndrome due to the stimulating effect of caffeine on the cardiovascular or central nervous system;
• lithium: an increase in its plasma concentration due to an increase in renal clearance due to caffeine withdrawal. Cancellation of Citramon P may require a reduction in the dose of lithium. Joint use of drugs is not recommended;
• sympathomimetics or levothyroxine: increased chronotropic effect due to the mutual potentiation of drugs. Sharing with Citramon P is not recommended;
• ephedrine-like substances: increased risk of developing drug dependence. Joint use of drugs is not recommended;
• antibacterial agents from the group of quinolones (ciprofloxacin, enoxacin, pipemidic acid), terbinafine, cimetidine, fluvoxamine, oral contraceptives: an increase in the half-life of caffeine due to inhibition of liver cytochrome P450. With violations of the heart rhythm, liver function, latent epilepsy, the use of caffeine should be avoided;
• theophylline: decrease in its excretion;
• clozapine: an increase in its serum concentration, which requires control of this indicator. Joint use of drugs is not recommended;
• phenylpropanolamine, phenytoin, nicotine: Decreased terminal half-life of caffeine.

The influence of the active substances of Citramon P on the data of laboratory studies:

• paracetamol: may change the results of the determination of uric acid by the phosphotungstic acid method, as well as glycemia using the glucose oxidase / peroxidase method;
• ASA: when taking high doses, it can distort the data of clinical and biochemical studies;
• caffeine: may reverse the effect of dipyridamole on myocardial blood flow. Caffeine should be discontinued within 8 to 12 hours if appropriate research has been done.

Analogues

The analogues of Citramon P are: Askofen-P, AquaCitramon, Migrenol Extra, Cofitsil-plus, Citramon P Forte, Citramarin, Excedrin, Citrapar, etc.

Terms and conditions of storage

Store in a dark place, out of the reach of children, at temperatures up to 25 °C.

Shelf life - 3 years.