Fevarin pills 50 mg 15 pcs
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Active ingredients
Fluvoxamine
Release form
Pills
Composition
Active ingredient: Fluvoxamine (Fluvoxaminum) Active ingredient concentration (mg): 50
Pharmacological effect
Antidepressant. The mechanism of action is associated with selective inhibition of serotonin reuptake by brain neurons and is characterized by minimal effect on noradrenergic transmission. Fluvoxamine has a weak ability to bind to α- and β-adrenergic receptors, histamine, m-cholinergic receptors, dopamine and serotonin receptors.
Pharmacokinetics
Data on the pharmacokinetics of the drug is not provided.
Indications
Depression of various origins; obsessive-compulsive disorders.
Contraindications
Hypersensitivity to fluvoxamine maleate or to one of the excipients that make up the drug; simultaneous administration of tizanidine and MAO inhibitors. Treatment with fluvoxamine can be started 2 weeks after discontinuation of an irreversible MAO inhibitor or the next day after taking a reversible MAO inhibitor. The time interval between discontinuation of fluvoxamine and the start of therapy with any MAO inhibitor should be at least a week.
Precautionary measures
Do not exceed recommended doses.
Use during pregnancy and lactation
If you need to use fluvoxamine during pregnancy, you should evaluate the expected benefits of therapy for the mother and the possible risk to the fetus. Fluvoxamine should not be used during lactation, because This active substance in a small amount is excreted in breast milk.
Dosage and administration
Inside, without chewing and washing down with a small amount of water. Depression. The recommended starting dose is 50 or 100 mg (once, in the evening). A gradual increase in the starting dose to an effective level is recommended. An effective daily dose, usually 100 mg, is selected individually, depending on the patient's response to treatment. The daily dose can reach 300 mg. Daily doses over 150 mg should be divided into several doses. In accordance with official WHO recommendations, antidepressant treatment should continue for at least 6 months of remission after a depressive episode.To prevent recurrence of depression, it is recommended to take 100 mg of Fevarin 1 time per day. Obsessive-compulsive disorders. It is recommended to start with a dose of 50 mg of Fevarin per day for 3-4 days. The effective daily dose is usually from 100 to 300 mg. Doses should be increased gradually until an effective daily dose is reached, which should not exceed 300 mg in adults. Doses up to 150 mg can be taken as single, preferably in the evening. Daily doses of more than 150 mg are recommended to be divided into 2 or 3 doses. Doses for children over 8 years old and adolescents: the initial dose is 25 mg / day for 1 dose, and the maintenance dose is 50–200 mg / day. The daily dose should not exceed 200 mg. Daily doses of more than 100 mg are recommended to be divided into 2 or 3 doses. In case of a good response to the drug, treatment can be continued in an individually selected daily dose. If improvement is not achieved after 10 weeks of treatment, fluvoxamine should be withdrawn. Until now, systematic studies have been organized that could answer the question of how long fluvoxamine can be treated, but obsessive-compulsive disorders are chronic, and therefore it may be considered expedient to extend treatment with Fevarin over 10 weeks in patients who responded well on this drug. Selection of the minimum effective maintenance dose should be carried out with caution individually. Some clinicians recommend concomitant psychotherapy in patients who respond well to pharmacotherapy. Treatment of patients with hepatic or renal failure should be started with the lowest doses under strict medical supervision. Due to the lack of clinical experience, Fevarin is not recommended for the treatment of depression in children.
Side effects
The most commonly observed symptom associated with Fevarin is nausea, sometimes accompanied by vomiting. This side effect usually disappears in the first 2 weeks of treatment. Some of the side effects observed during the clinical trials were often associated with symptoms of depression, rather than with treatment with Fevarin. General: often (1-10%) - asthenia, headache, indisposition. From the side of cardiovascular system: often (1-10%) - heartbeat,tachycardia; sometimes (less than 1%) - postural hypotension. For the gastrointestinal tract: often (1-10%) - abdominal pain, anorexia, constipation, diarrhea, dry mouth, dyspepsia; rarely (less than 0.1%) - abnormal liver function (increased level of liver transaminases). On the CNS side: often (1-10%) - nervousness, anxiety, agitation, dizziness, insomnia or drowsiness, tremor; sometimes (less than 1%) - ataxia, confusion, extrapyramidal disorders, hallucinations; rarely (less than 0.1%) - convulsions, manic syndrome. From the skin: often (1-10%) - sweating; sometimes (less than 1%) - skin hypersensitivity reactions (rash, itching, angioedema); rarely (less than 0.1%) - photosensitivity. From the musculoskeletal system: sometimes (less than 1%) - arthralgia, myalgia. From the reproductive system: sometimes (less than 1%) - delayed ejaculation; rarely (less than 0.1%) - galactorrhea. Others: rarely (less than 0.1%) - change in body weight; serotonergic syndrome, a condition similar to neuroleptic malignant syndrome, hyponatremia and syndrome of insufficient secretion of antidiuretic hormone; very rarely - paresthesia, anorgasmia, and taste perversion. When you stop taking fluvoxamine, you may develop withdrawal symptoms - dizziness, paresthesia, headache, nausea, anxiety (most of the symptoms are mild and stop themselves). With the abolition of the drug is recommended a gradual dose reduction. Hemorrhagic manifestations - ecchymosis, purpura, gastrointestinal bleeding.
Overdose
No cases of overdose have been reported.
Interaction with other drugs
With simultaneous use with MAO inhibitors, there is a likelihood of serotonin syndrome, especially when used simultaneously with irreversible non-selective MAO inhibitors. With simultaneous use, plasma plasma concentrations of alprazolam, bromazepam, diazepam increase and their side effects increase because fluvoxamine inhibits metabolism of these benzodiazepines. With simultaneous use, the plasma concentration of amitriptyline, clomipramine, imipramine, maprotiline, increases, of trimipramine, which is apparently due to the fact that fluvoxamine is a noncompetitive inhibitor of the isoenzyme CYP1A2,with the participation of which the process of N-demethylation of these antidepressants occurs. When used simultaneously with c buspirone, its effectiveness may be reduced; with valproic acid - may increase the effects of valproic acid; with warfarin - possibly increasing the concentration of warfarin in the blood plasma and the risk of bleeding; with galantamine - increases the likelihood of increased side effects of galantamine; with haloperidol - increases the concentration of lithium in the blood plasma. With simultaneous use, the concentration of carbamazepine in the blood plasma increases due to inhibition of its metabolism in the liver, mainly due to the suppression of the activity of the CYP2D6 isoenzyme under the influence of fluvoxamine. With simultaneous use, the concentration of clozapine in the plasma increases significantly blood, which in some patients is accompanied by the development of the toxic effects of clozapine. With simultaneous use, caffeine clearance may be reduced and the strength of its effects. This interaction is due to the fact that fluvoxamine significantly inhibits the CYP1A2 isoenzyme, which is the main enzyme responsible for caffeine metabolism. When used simultaneously with metoclopramide, a case of extrapyramidal disorders is described. Concurrent use with olanzapine increases plasma concentration of olanzapine; with propranolol - increases the concentration of propranolol in the blood plasma, which, apparently, is due to inhibition of fluvoxamine isoenzymes of the cytochrome P450 system involved in propranolol metabolism. When used simultaneously with theophylline, the concentration of theophylline in the blood plasma increases, which leads to the development of toxic reactions. This interaction is due to the fact that fluvoxamine significantly inhibits the CYP1A2 isoenzyme, which is the main enzyme responsible for theophylline metabolism. With simultaneous use, clearance of tolbutamide and its metabolites decreases, due to inhibition of the CYP2C isoenzyme. simultaneous use with fluvoxamine. With simultaneous use, metabolism slows down and quinidine clearance decreases.
special instructions
With depression, as a rule, there is a high probability of suicide attempts, which can persist until a sufficient remission is achieved. With caution used in patients with indications of a history of convulsions. With the development of an epileptic seizure, treatment with fluvoxamine should be discontinued. Patients with hepatic or renal insufficiency should receive fluvoxamine in low doses under the strict supervision of a physician at the beginning of treatment. Fluvoxamine should be discontinued if symptoms arise due to increased liver enzymes. always increase more slowly and with greater caution. There are reports of the development of ecchymosis and purpura when using selective inhibitors of inverse serotonin uptake. With this in mind, it is necessary to prescribe such drugs with caution, especially simultaneously with drugs that affect platelet function (for example, with atypical antipsychotics and phenothiazines, many tricyclic antidepressants, NSAIDs, including acetylsalicylic acid), as well as patients with bleeding in history. The period of treatment is not allowed to use alcohol. Due to the lack of clinical experience, fluvoxamine is not recommended for the treatment of depression in children. The effect on the ability to drive For example, for patients whose activity is related to the need for concentration and high speed of psychomotor reactions, fluvoxamine should be used with caution before the final determination of the individual response to treatment. Treatment with MAO inhibitors should be stopped 2 weeks before the start of fluvoxamine use. Fluvoxamine can slow down the excretion drugs metabolized by microsomal liver enzymes.