Fevarine

A medicine prescribed primarily for depressive mental disorders: when the patient almost never gets pleasure from his activities, feels inner emptiness and is in a depressed state of mind almost constantly. A modern and relatively easily tolerated third-generation antidepressant. Drugs of this group (selective serotonin reuptake inhibitors) are currently the most in demand and most often prescribed by psychiatrists for the treatment of depression.

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Indications Fevarina

It is prescribed to patients with mental disorders that are characterized by depression of various origins, as well as obsessive thoughts (obsessions), actions (compulsions), or a combination of both.

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Release form

It is produced in film-coated tablets containing a dose of the active substance Fluvoxamine maleate of 0.05 g and 0.1 g.

Pharmacodynamics

The action of the active component is based on the selective inhibition of the reuptake of serotonin, the so-called hormone of happiness, by the neurons of the brain that secrete it. As a result, serotonin accumulates in the synaptic cleft, eliminating its deficiency, which is the cause of depression. Fevarin is characterized by a fairly powerful effect, especially in cases of outpatient depression. Therapy with this drug corrects low mood, reduces anxiety, restlessness, melancholy, headache, which often accompanies depressive states (the drug has a slight analgesic effect). At the same time, there is practically no significant change in the level of norepinephrine and dopamine. Fluvoxamine maleate has a minimal ability to bind to serotonin, histamine, m-cholinergic receptors and adrenergic receptors (α and β).

Pharmacokinetics

After oral administration, the active component is rapidly absorbed into the mucous membrane of the digestive tract. This drug has presystemic metabolism, with the absolute absorption capacity reaching 53%. This indicator and the absorption rate do not depend on food intake. The maximum value of the drug concentration in the blood serum is recorded after an interval of three to eight hours after oral administration. Therapeutic concentrations of the active substance are determined on the tenth day of therapy with the drug, and sometimes after two weeks. The connection with serum proteins reaches 80%. In patients aged 6-11 years, equilibrium concentrations in the blood serum are almost twice as high as this indicator in adolescence and adulthood.

The active substance of the drug is a potent inhibitor of the activity of the isoenzymes CYP1A2, CYP2C and CYP3A4.

T _1/2 after a single dose is approximately 13-15 hours, after repeated administration the figure increases to 17-22 hours.

Fluvoxamine maleate is broken down in the liver. Metabolic products are not characterized by significant pharmacological activity and are excreted in the urine. In patients with functional disorders of the liver, a slow metabolism process is noted.

Dosing and administration

Depression. In this case, the drug is intended for the treatment of patients over 18 years of age only. The dosage is 0.05 or 0.1 g per day at the beginning of the therapeutic course, and if the effectiveness is insufficient, the dosage is gradually increased. No more than 0.3 g of the drug can be prescribed per day.

When a positive treatment result is achieved, it is recommended to continue taking Fevarin for at least another six months to prevent exacerbation. During this period, the standard dosage is 0.1 g.

Obsessive-compulsive disorders. In these mental disorders, the drug is used to treat adult patients, as well as children aged 8-18 years. If a ten-day therapy with Fevarin does not result in a significant positive effect, the drug is discontinued.

The standard dosage for adults is 0.05 g, if the effectiveness is insufficient during the first 3-4 days, it is gradually increased. No more than 0.3 g of the drug can be prescribed per day.

The pediatric dosage is usually 0.025 g, if the effectiveness is insufficient during the first three to four days, it is gradually increased. No more than 0.2 g of the drug can be prescribed per day.

At doses of no more than 0.15 g per day, the drug is taken once in the evening. A daily dose of more than 0.15 g is taken in two doses - in the morning and before bedtime. The tablet is swallowed regardless of food intake, without crushing or chewing. The duration of administration and dosage are prescribed individually.

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Use Fevarina during pregnancy

At present, the effect of Fluvoxamine Maleate on the fetus has not been sufficiently studied, but no teratogenic effect has been identified. The drug may be prescribed to a pregnant woman taking into account the benefit to the mother/risk to the fetus ratio.

If the expectant mother has undergone treatment with Fevarin in the last three months of pregnancy, careful monitoring of the baby's condition is necessary, since there is a risk of the baby developing withdrawal syndrome.

Women of childbearing age are advised to make sure they are not pregnant before taking this drug and to use reliable contraceptives throughout the course of treatment.

When prescribing Fevarin treatment to a nursing mother, the question of interrupting or stopping breastfeeding is raised.

Contraindications

Fevarin therapy is not recommended:

• persons sensitized to its ingredients;
• taking tizanidine or drugs from the MAO inhibitor group as prescribed by a doctor;
• prescribe to chronic alcoholics;
• minors for the treatment of depression;
• age group of patients from birth to eight years of age.

Therapy is carried out with caution in cases where the patient has:

• epilepsy;
• functional renal and/or hepatic disorders;
• tendency to bleeding or cramps;
• work that requires concentration and focus.

Caution should also be exercised when prescribing this drug to pregnant and lactating women, and people over 65. For children from eight to 18 years old, the drug is prescribed only in cases of obsessive-compulsive disorders and the minimum doses that provide a therapeutic effect are used.

Side effects Fevarina

The following adverse effects may develop in association with therapy with this drug.

Digestive organs: dyspepsia, feeling of dry mouth, gastroduodenal hemorrhages (isolated cases).

Nervous system and psyche: dizziness, asthenia, agitation, headache, drowsiness, insomnia, increased anxiety, static or dynamic ataxia, tremors in the extremities, extrapyramidal disorders. There are isolated cases of development of convulsive, manic and serotonin syndrome, hallucinations, paresthesia and taste perversion.

Allergic reactions: urticaria, rash, itching, increased sensitivity to ultraviolet radiation, Quincke's edema.

Heart and blood vessels: arrhythmia, slight bradycardia, tachycardia, orthostatic hypotension.

Others: galactorrhea, myalgia, arthralgia, hyperhidrosis, purpura, ejaculation disorder, lack of orgasm, weight gain (loss), urination disorders, development of hyponatremia (goes away after discontinuation).

The drug is addictive. The drug is stopped by gradually reducing the dose, abrupt cessation of the drug may cause withdrawal symptoms: nausea, dizziness, paresthesia, increased anxiety and headache.

Suicidal intent, which often accompanies depressive disorders, may persist for a long time before sufficient remission occurs (such patients should be monitored regularly).

Symptoms of serotonin syndrome (which develops extremely rarely) include hyperthermia, muscle rigidity, mental disorders, lability of the autonomic nervous system, and the development of a comatose state.

Overdose

Exceeding the dose of the drug causes dyspepsia, rapid fatigue, weakness, dizziness, drowsiness, insomnia. With significant excess of the recommended dose, arrhythmia, hypotension, muscle cramps, liver dysfunction and the development of hepatic coma may be observed. Several cases of death are known as a result of taking doses of the drug that exceed the permissible ones.
A specific antidote is unknown. Therapeutic measures to relieve the effects of an overdose are gastric lavage, taking enterosorbent drugs and symptomatic treatment (it is possible to use laxatives with osmotic properties). Such detoxification methods as forced diuresis or hemodialysis are not effective when the permissible dose of Fluvoxamine Maleate is exceeded.

Interactions with other drugs

Concomitant administration of oral hypoglycemic drugs may require a change in their dosage.

Fevarin is not compatible with MAO inhibitors; after taking them, it is necessary to wait a two-week interval. After that, start taking the antidepressant. Taking medications in reverse order is carried out as follows: a course of Fevarin, a week later - a course of MAO inhibitors.

In combination with astemizole, terfenadine and cisapride, serum concentrations of the latter increase.

The pharmacokinetic properties of drugs, in the breakdown of which the isoenzymes CYP1A2, CYP2C, CYP3A4 participate, may change under the influence of Fluvoxamine maleate, and in combination of this substance with warfarin, caffeine, propranolol, ropinirole, alprazolam, midazolam, triazolam and diazepam their serum concentrations increase. If such a combination is necessary, it may be necessary to revise the dosages of these drugs.

Serum concentrations of digoxin and atenolol are not changed in combination with Fevarin.

Concomitant use with tramadol and triptans enhances the effect of Fluvoxamine maleate, and with oral anticoagulants, the likelihood of hemorrhage increases.

Prescribing to patients taking lithium-containing medications requires a balanced approach.

During treatment with Fevarin, it is not recommended to consume alcoholic beverages and alcohol-containing medications and herbal preparations.

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Storage conditions

Store at a temperature of 15-25℃, in places inaccessible to children and protected from sunlight.

Shelf life

3 years.