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corresponde a uma dose de 15 mg/dia. Pacientes<br />

com depressão não-endógena, entretanto, obtiveram<br />

remissão mesmo com níveis de 15 a 25<br />

μmol/L. Não foi observada uma relação entre níveis<br />

séricos e a ocorrência de efeitos colaterais.<br />

PRECAUÇÕES<br />

1. Evitar a associação com IMAOs.<br />

2. Reduzir as doses em pacientes com insuficiência<br />

renal ou hepática graves.<br />

3. Ficar atento para sintomas de hiponatremia<br />

(confusão, letargia, mal-estar, podendo ocorrer<br />

inclusive convulsões), particularmente em<br />

pacientes idosos.<br />

REFERÊNCIAS BIBLIOGRÁFICAS<br />

1. Milne RJ, Goa K. Citalopram – a review of its pharmacodynamic<br />

and pharmacokinetic properties and therapeutic<br />

potential in depressive illness. Drugs 1991; 3: 450-477.<br />

2. Preskorn SH. Clinically relevant pharmacology of selective<br />

serotonin reuptake inhibitors. An overview with enphasis<br />

on pharmacokinetics and effects on oxidative metabolism.<br />

Clin Pharmacokin 1997; 32: (suppl.1):1-21.<br />

3. Rosenberg C, Damsbo N, Fuglum E, Jacobsen LV, Horsgard<br />

S.Citalopram and imipramine in the treatment of depressive<br />

patients in general practice. A Nordic multicentre clinical<br />

study.Int Clin Psychopharmacol 1994 ;9 (Suppl 1):41-8<br />

4. Feighner JP, Overo K. Multicenter, placebo-controlled,<br />

fixed-dose study of citalopram in moderate-to-severe<br />

depression. J Clin Psychiatry 1999; 60(12):824-30.<br />

5. Hochstrasser B, Isaksen PM, Koponen H, Lauritzen L,<br />

Mahnert FA, Rouillon F, Wade AG, Andersen M, Pedersen<br />

SF, Swart JC, Nil R. Prophylactic effect of citalopram in<br />

unipolar, recurrent depression: placebo-controlled study of<br />

maintenance therapy. Br J Psychiatry 2001;178:304-10.<br />

6. Perna G, Bertani A, Caldirola D, Smeraldi E, Bellodi L.A<br />

comparison of citalopram and paroxetine in the treatment<br />

of panic disorder: a randomized, single-blind study.<br />

Pharmacopsychiatry 2001; 34(3):85-90.<br />

7. Lepola UM, Wade AG, Leinonen EV, Koponen HJ, Frazer J,<br />

Sjodin I, Penttinen JT, Pedersen T, Lehto HJ.A controlled,<br />

prospective, 1-year trial of citalopram in the treatment of<br />

panic disorder. J Clin Psychiatry 1998; 59(10):528-34.<br />

8. Montgomery SA, Kasper S, Stein DJ, Bang Hedegaard K,<br />

Lemming OM. Citalopram 20 mg, 40 mg and 60 mg are all<br />

effective and well tolerated compared with placebo in<br />

obsessive-compulsive disorder. Int Clin Psychopharmacol<br />

2001;16(2):75-86.<br />

9. Furmark T, Tillfors M, Marteinsdottir I, Fischer H, Pissiota<br />

A, Langstrom B, Fredrikson M. Common changes in cerebral<br />

blood flow in patients with social phobia treated with<br />

citalopram or cognitive-behavioral therapy. Arch Gen<br />

Psychiatry 2002; 59(5): 425-33.<br />

10. Stahl SM. Basic Psychopharmacology of antidepressants,<br />

part 1: antidepressants have seven distinct mechanisms of<br />

action. J Clin Psychiatry 1998: 59 (4): 5-14.<br />

11. Koran LM, Chuong HW, Bullock KD, Smith SC. Citalopram<br />

for compulsive shopping disorder: an open-label study<br />

followed by double-blind discontinuation. J Clin Psychiatry<br />

2003; 64(7):793-8.<br />

12. McElroy SL, Hudson JI, Malhotra S, Welge JA, Nelson<br />

EB, Keck PE Jr. Citalopram in the treatment of binge-eating<br />

disorder: a placebo-controlled trial. J Clin Psychiatry 2003;<br />

64(7):807-13.<br />

13. Anderberg UM, Marteinsdottir I, von Knorring L. Citalopram<br />

in patients with fibromyalgia—a randomized, doubleblind,<br />

placebo-controlled study. Eur J Pain 2000; 4(1): 27-35.<br />

14. Ostrom M, Eriksson A, Thorson J e cols. Fatal overdose<br />

with citalopram. Lancet 1996; 348 (3): 339-340.<br />

15. Laine K, Heikkinen T, Ekblad U, Kero P. Effects of exposure<br />

to selective serotonin reuptake inhibitors during pregnancy<br />

on serotonergic symptoms in newborns and cord blood<br />

monoamine and prolactin concentrations. Arch Gen<br />

Psychiatry 2003; 60(7):720-6.<br />

16. Spigset O, Carieborg L, Ohman R e cols. Excretion of<br />

citalopram in breast milk. Br J Clin Pharmacol 1997; 44<br />

(3):285-298.<br />

17. Karlsson I, Godderis J, Augusto De Mendonca Lima C,<br />

Nygaard H, Simanyi M, Taal M, Eglin M.A randomised,<br />

double-blind comparison of the efficacy and safety of<br />

citalopram compared to mianserin in elderly, depressed<br />

patients with or without mild to moderate dementia. Int J<br />

Geriatr Psychiatry. 2000;15(4):295-305.<br />

CLOBAZAM<br />

FRISIUM (Lab. Aventis Pharma)<br />

• Embalagens com 20 comprimidos de 10 mg e<br />

20 mg.<br />

URBANIL (Lab. Aventis Pharma)<br />

• Embalagens com 20 comprimidos de 10 e 20<br />

mg.<br />

FARMACOCINÉTICA<br />

E MODO DE USAR<br />

O clobazam é um benzodiazepínico com propriedades<br />

ansiolíticas e anticonvulsivantes, miorrelaxantes<br />

e hipnóticas, provocando um pouco menos<br />

sedação e comprometimento motor que o diazepam.<br />

O clobazam em si tem uma meia-vida de 18<br />

horas, mas a meia-vida do seu principal metabólito,<br />

o n-desmetilclobazan, é de 50 horas. A eliminação<br />

é predominantemente renal (90%). Ligase<br />

às proteínas plasmáticas em 85 a 90%. Como<br />

os demais benzodiazepínicos, tem uma ampla<br />

margem de segurança 1 .<br />

Ensaios clínicos indicam que o clobazam é eficaz<br />

no tratamento da ansiedade 2-4 .Parece ter um efei-<br />

CLOBAZAM<br />

MEDICAMENTOS: INFORMAÇÕES BÁSICAS<br />

69

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