Fevarin

A drug prescribed primarily for depressive disorders of the psyche: when the patient almost never gets pleasure from his activity, he feels an internal devastation and is in an oppressed state of mind almost constantly. Modern and relatively easily tolerated antidepressant III generation. Drugs of this group (selective inhibitors of serotonin reuptake) are currently most in demand and are most often prescribed by psychiatrists for the treatment of depression.

[1], [2]

Indications of the fevarina

It is prescribed for patients with mental disorders that are characterized by depressions of different genesis, as well as obsessive thoughts (obsessions), actions (compulsions) or a combination of them.

[3]

Release form

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

Pharmacodynamics

The action of the active component is based on the selective inhibition of the re-uptake of serotonin, the so-called happiness hormone, that secretes it by neurons of the brain. As a result, cumulation of serotonin occurs in the synaptic cleft, its deficiency is eliminated, which is the cause of depression. Fevarin is characterized by a rather powerful effect, especially in cases of ambulatory depression. Therapy with this drug corrects a decreased mood, reduces anxiety, anxiety, melancholy, headache, often accompanying 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 minimal ability to bind to serotonin, histamine, m-cholinergic receptors and adrenoreceptors (α and β).

Pharmacokinetics

After oral administration, the active ingredient is rapidly absorbed into the mucosa of the digestive tract. This drug is inherent in the systemic metabolism, while the absolute ability to digest up to 53%. This indicator and the rate of absorption does not depend on the intake of food. The maximum value of the concentration of the drug in the blood serum is fixed after a period of time from three to eight hours after ingestion. Therapeutic concentrations of the active substance are determined on the tenth day of therapy with the drug, and sometimes in two weeks. The connection with serum proteins reaches a value of 80%. In patients of the age group 6-11 years, the equilibrium concentrations in serum almost double that in adolescence and adulthood.

The active substance of the preparation 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 h, after repeated intake, the indicator increases to 17-22 h.

Splitting Fluvoxamine maleate occurs in the liver. Metabolism products are not characterized by significant pharmacological activity and excreted in the urine. In patients with functional disorders of the liver, slow metabolism is observed.

Dosing and administration

Depression. In this case, the drug is intended to treat only patients older than 18 years. Dosage at the beginning of the therapeutic course of 0.05 or 0.1 g per day, with insufficient effectiveness, the dosage is gradually increased. In a day, you can prescribe not more than 0.3 g of the drug.

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

 Obsessive-compulsive disorder. With these disorders of the psyche, the drug is used to treat adult patients, as well as children aged 8-18 years. If as a result of a ten-day treatment with fevarin there is no significant positive effect, the drug is canceled.

The standard dosage for adults is 0.05 g, with insufficient effectiveness during the first 3-4 days, it is gradually increased. In a day, you can prescribe not more than 0.3 g of the drug.

The child's dosage is usually 0.025 g, with insufficient effectiveness during the first three to four days, it is gradually increased. In a day, you can prescribe not more than 0.2 g of the drug.

At dosages no more than 0.15 g per day - the drug is taken once in the evening hours. A daily dose of more than 0.15 g taken in two stages - in the morning and at bedtime. The tablet is swallowed regardless of the meal, without crushing or chewing. Duration of admission and dosing is assigned individually. 

[4], [5]

Use of the fevarina during pregnancy

At present, the effect of fluvoxamine maleate on the fetus has not been adequately studied, but there has been no teratogenic effect. The drug can be administered to a pregnant woman, taking into account the benefit for the mother / risk to the fetus.

If the future mother was treated with Fevarin in the last three months of pregnancy, careful monitoring of the baby's condition is necessary, since there is a possibility of developing a withdrawal syndrome.

Women of fertile age before the course of taking this drug are advised to make sure of the absence of pregnancy and during the therapeutic course to use reliable contraceptives.

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

Contraindications

Therapy by Fevarin is not recommended:

• Persons sensitized to its ingredients;
• taking as prescribed by the doctor tizanidine or drugs from a number of MAO inhibitors;
• prescribe chronic alcoholics;
• a minor for the treatment of depression;
• age group of patients from birth to the age of eight.

Precautions are taken when the patient has:

• epilepsy;
• functional renal and / or hepatic disorders;
• propensity to bleed or convulsions;
• Work that requires concentration and focus.

Also, care should be taken when prescribing this medication to pregnant and lactating women, persons over 65 years of age. Children from eight to 18 years of age are prescribed medication only in cases of obsessive-compulsive disorders and the minimum doses that give a therapeutic effect are applied. 

Side effects of the fevarina

Possible development of the following undesirable effects associated with therapy with this drug.

Organs of digestion: indigestion, a feeling of dryness in the oral cavity, gastroduodenal hemorrhages (isolated cases).

Nervous system and psyche: dizziness, asthenia, agitation, headache, drowsiness, insomnia, increased anxiety, static or dynamic ataxia, trembling in the extremities, extrapyramidal disorders. Single cases of development of convulsive, manic and serotonin syndrome, hallucinations, paresthesias and taste distortion are known.

Allergic manifestations: urticaria, rashes, itching, hypersensitivity to ultraviolet radiation, angioedema.

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

Other: galactorrhea, myalgia, arthralgia, hyperhidrosis, purpura, ejaculation, lack of orgasm, weight loss, urination disorders, development of hyponatremia (passes after cancellation).

The drug is addictive. The medication is stopped, gradually reducing the dose, a sudden discontinuation may cause withdrawal symptoms: nausea, dizziness, paresthesia, increased anxiety and headache.

Suicidal intentions, often accompanying depressive disorders, can persist for a long time before a sufficient remission (such patients should be regularly monitored).

Symptoms of serotonin syndrome (extremely rarely developing) are expressed in hyperthermia, muscular rigidity, mental disorders, lability in the autonomic nervous system, development of coma.

Overdose

Exceeding the dose of the drug causes dyspepsia, rapid fatigue, weakness, dizziness, drowsiness, insomnia. At Significant excess of the recommended dose, arrhythmia, hypotension, convulsive muscle contractions, impaired liver function and development of hepatic coma may be observed. There are several cases of death as a result of taking doses of the drug that exceed the permissible levels.
The specific antidote is unknown. Therapeutic measures that stop the effects of an overdose are gastric lavage, intake of enterosorbent drugs and symptomatic treatment (laxatives with osmotic properties may be used). Such detoxification methods as forced diuresis or hemodialysis are not effective if the permissible dose of Fluvoxamine maleate is exceeded. 

Interactions with other drugs

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

Fevarin is not combined with MAO inhibitors, after their intake it is necessary to maintain a time interval of two weeks. After that, start taking an antidepressant. Reception of medicines in the reverse order is carried out as follows: the course of Fevarin, in a week - the course of MAO inhibitors.

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

The pharmacokinetic properties of the preparations, in which the isozymes CYP1A2, CYP2C, CYP3A4 participate in the cleavage, can change under the action of Fluvoxamine maleate, and in combination with warfarin, caffeine, propranolol, ropinirole, alprazolam, midazolam, triazolam and diazepam their serum concentrations increase. If this combination is necessary, it may be necessary to review the dosages of these drugs.

Serum concentrations of digoxin and atenolol do not change in combination with Fevarin.

Simultaneous reception with tramadol and tryptans increases the action of Fluvoxamine maleate, and with oral anticoagulants - the probability of hemorrhage increases.

Prescribing to patients taking medicines containing lithium requires a balanced approach.

During treatment with Fevarin it is not recommended to drink alcohol and alcohol-containing medicinal and phytopreparations.

[6], [7]

Storage conditions

Keep in accordance with the temperature range of 15-25 ℃, in places that are inaccessible to children and protected from sunlight.

Shelf life

3 years.