Remeron, tablets 30 mg, 10 pcs.

Remeron has an antidepressant effect.

Blocks presynaptic alpha₂-adrenoceptors in CNS and increases noradrenergic transmission of nerve impulses. It also enhances serotonergic transmission (the effect is realized only through 5-NT₁ receptors, because 5-NT₂– and 5-NT₃-receptors are blocked.

Pharmacodynamics

The two spatial enantiomers of mirtazapine are involved in the antidepressant activity, with the S(+)-enantiomer blocking alpha₂– and 5-NT₂-receptors, and the R(-)-enantiomer blocks 5-NT₃-receptors.

Blocks H₁ receptors and has a sedative effect. In therapeutic doses has almost no anticholinergic effect and does not affect the function of the cardiovascular system.

Pharmacokinetics

After oral administration, it is rapidly absorbed, bioavailability is about 50%, C_max in blood is reached after about 2 hours. Binding to plasma proteins is about 86%. Equilibrium concentration in blood is established after 3-4 days of continuous use. Pharmacokinetic parameters in the recommended dose range have a linear dependence on the dose. It is actively metabolized in the liver by demethylation and oxidation with subsequent conjugation. Demethylmirtazapine is as pharmacologically active as the parent substance. It is excreted with urine and feces, T_1/2 is 20-40 h, sometimes up to 65 h (which allows the drug to be taken once daily), T_1/2 is shorter in young people than in the elderly. Clearance may decrease in renal or hepatic insufficiency.

Indications

Depressive states.

Active ingredient

Composition

Active ingredient:

mirtazapine

How to take, the dosage

Orally (tablets swallowed without chewing, with liquids if necessary), preferably in a single dose, before bedtime; also in divided doses throughout the day (once in the morning and once in the evening) are acceptable.

In adults, the initial dose is 15 mg/day with possible gradual increase until optimal clinical effect is achieved, usually the effective dose is 15-45 mg/day. The recommended doses for the elderly are the same as those for adults.

The treatment should preferably be continued for 4-6 months until clinical symptoms have completely disappeared. If there is no improvement during 2-4 weeks of therapy, the dose may be increased; if there is no clinical effect during the next 2-4 weeks the treatment should be stopped.

Interaction

It increases the sedative effect of benzodiazepines (caution should be exercised when taking them simultaneously), the CNS depressant effect of alcohol. Incompatible with MAO inhibitors.

Special Instructions

Should not be administered concomitantly with MAO inhibitors and within 2 weeks after their withdrawal. It should be borne in mind that suppression of hematopoiesis (usually in the form of granulocytopenia or agranulocytosis) is more common after 4-6 weeks and usually disappears after stopping treatment. If symptoms such as fever, sore throat, stomatitis and other signs of an infectious disease occur, treatment should be stopped and a clinical blood test performed. If jaundice occurs, treatment should also be stopped.

With caution use in patients with epilepsy and organic brain lesions (development of convulsive seizures is possible), with hepatic or renal failure, cardiac diseases with conduction disorders, angina pectoris and acute myocardial infarction, arterial hypotension, patients with disorders of urination, including.including prostatic hypertrophy, in patients with acute closed-angle glaucoma, diabetic patients.

It should be taken into account that during therapy in patients with schizophrenia psychotic symptoms may increase. When treating the depressive phase of bipolar affective psychosis, mania may develop.

Abrupt withdrawal after long-term use may lead to nausea, headache and general worsening of well-being.

Patients should refrain from drinking alcohol during treatment. Safe contraceptive methods should be used during treatment.

During treatment, potentially hazardous activities requiring high psychomotor reactions should be avoided, such as driving and operating machinery (may impair concentration and alertness levels).

Contraindications

Hypersensitivity

Side effects

Nervous system and sensory organs: somnolence/drowsiness (usually manifested during the first weeks of treatment), rarely – mania, convulsions, tremor, myoclonus.

The cardiovascular system and blood (hematopoiesis, hemostasis): rarely – orthostatic hypotension, eosinophilia, granulocytopenia, agranulocytosis, aplastic anemia, thrombocytopenia.

Others: increased appetite and weight gain, rarely fluid retention and associated weight gain, increased plasma transaminase activity, skin reactions.

Overdose

Symptoms: pronounced sedative effect.

Treatment: gastric lavage, symptomatic treatment to maintain the function of vital organs and systems.

Pregnancy use

Pregnancy is possible only in case of emergency (safety of use in pregnant women has not been studied). Breast-feeding should be stopped during the treatment (no data on penetration into the breast milk).

Similarities