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Testosterone cypionate reviews is well absorbed after oral administration and undergoes first pass metabolism through the liver. Isolation from urine unchanged paroxetine is generally less than 2% of the dose, and metabolites constitute about 64% of the dose. Through the intestine appears about 36% of the dose (less than 1% – unchanged paroxetine). Excretion of metabolites of paroxetine two-phase (as a result of first-pass metabolism through the liver and systemic elimination). The half-life varies, but is usually about one day.
The equilibrium concentration is achieved in 7-14 day after the start of treatment.
An increase in the dose and / or duration of treatment is observed nonlinear dependence on the dose pharmacokinetic parameters.
It is metabolized in the liver to inactive metabolites. Is an inhibitor of the isoenzyme CYP2D6.
Paroxetine is extensively distributed in tissues (1% it is present in the plasma), communication with proteins – 95%.
In severe chronic renal failure and hepatic failure, as well as in elderly patients, paroxetine increases plasma concentration.

Indications

 

  • Depression of all types, including reactive, anxiety, severe endogenous;
  • obsessive-compulsive disorder (OCD);
  • panic disorder, including agoraphobia;
  • social-anxiety disorder / social phobia;
  • generalized anxiety disorder;

    Contraindications

  • hypersensitivity to the drug;
  • concomitant use with MAO inhibitors and within 14 days after their cancellation;
  • unstable epilepsy;
  • pregnancy and lactation;
  • childhood.

    Precautions: hepatic impairment; renal failure; angle-closure glaucoma; prostatic hyperplasia; mania; Pathology of the heart; epilepsy; convulsive conditions; appointment of cardioversion; taking medications that increase the risk of bleeding; the presence of risk factors for increased bleeding and disorders that increase the risk of bleeding.

    Dosing and Administration
    Inside, 1 time a day, in the morning, while eating. The tablet is swallowed whole with water. The dose is adjusted individually for the first two to three weeks after initiation of therapy and subsequently adjusted if necessary. When depression – 20 mg 1 time per day. If necessary, gradually increase the testosterone cypionate reviews dose to 10 mg / day. the maximum daily dose should not exceed 50 mg. In obsessive compulsive disorders initial therapeutic dose – 20 mg / day followed by weekly increases of 10 mg. The recommended average therapeutic dose – 40 mg / day. if necessary, the dose may be increased to 60 mg / day. In panic disorders the initial dose – 10 mg / day (to reduce the possible risk of exacerbation of symptoms of panic), followed by a weekly increase of 10 mg. The average therapeutic dose – 40 mg / day. . The maximum dose – 50 mg / day social-anxiety disorder / social phobia: the initial dose is 20 mg per day, with no effect for at least two weeks may increase the dose to a maximum of 50 mg per day. The dose should be increased by 10 mg at intervals of not less than a week in accordance with the clinical effect. Generalized Anxiety Disorder: . The initial and the recommended dose – 20 mg per day In renal and / or hepatic insufficiency the recommended dose is 20 mg a day. For elderly patients daily dose should not exceed 40 mg. In order to prevent the syndrome of “lifting” the cessation of the drug is carried out gradually. The use of paroxetine in children is not recommended since its safety and efficacy have not been established in this population.

    Side effect On the part of the nervous system: drowsiness, tremor, fatigue, insomnia, dizziness, fatigue, convulsions, extrapyramidal disorders, serotonin syndrome, hallucinations, delusions, confusion, agitation, anxiety, depersonalisation, panic attacks, anxiety, amnesia, myoclonus. With the musculoskeletal system: arthralgia. myalgia, muscle weakness, myopathy. From the senses: blurred vision With the genitourinary system: sexual dysfunction, including impotence and ejaculation disorders, urinary retention, hyperprolactinemia / galactorrhea, anorgasmia. From the digestive system: decrease or increase in appetite, change in taste , nausea, vomiting, dry mouth, and constipation or diarrhea, in very rare cases – hepatitis. Since the cardiovascular system: orthostatic hypotension. Other: increased sweating, frequent urination, rhinitis, allergic reactions (rash, urticaria, ecchymosis itching. . angioedema), hyponatremia, inappropriate secretion of antidiuretic hormone syndrome “cancel” at the abrupt cancellation of the drug.

    Interaction with other medicinal products
    Eating and antacids does not affect the absorption and pharmacokinetic parameters of the drug.
    Paroxetine is incompatible with MAO inhibitors.
    When concomitant administration of paroxetine increases concentration protsiklidina.
    During treatment with paroxetine should refrain from drinking alcohol in connection with the strengthening of the toxic effect of alcohol .
    due to the inhibition of cytochrome P450 paroxetine possible strengthening effect of barbiturates, phenytoin. indirect anticoagulants, tricyclic antidepressants. phenothiazine neuroleptics and anti-arrhythmic drugs class 1C. metoprolol testosterone cypionate reviews and increased risk of side effects of these drugs. When concomitant administration with drugs Ibirá liver enzymes may require dose reduction of paroxetine.
    Paroxetine increases bleeding time in patients receiving warfarin, the prothrombin time at a constant.
    When concomitant administration of paroxetine with atypical antipsychotics, phenothiazines. tricyclic antidepressants, nonsteroidal anti-inflammatory agents (including acetylsalicylic acid) is recommended to exercise caution due to possible bleeding disorders.
    Co-administration with serotonergic drugs (tramadol, sumatriptan) may lead to increased serotonergic effect. Noted mutual reinforcement of action of tryptophan, drugs lithium and paroxetine. When concomitant administration of paroxetine with phenytoin and other antiepileptic drugs may increase the frequency of side effects.

    Overdosing Symptoms: nausea, vomiting, tremor, mydriasis, dry mouth, irritability, nystagmus, agitation, sweating, drowsiness, coma, sinus tachycardia, convulsions, bradycardia, increased blood pressure, nodal rhythm. In very rare cases, while admission to other psychotropic drugs and / or alcohol may be changes in the electrocardiogram, coma. In severe overdose – “serotonin” syndrome, rarely – rhabdomyolysis. Treatment: gastric lavage, activated charcoal. If necessary, symptomatic therapy. No specific antidote.

    Cautions
    To prevent the development of neuroleptic malignant syndrome with caution appoint patients taking antipsychotics.
    Paroxetine does not impair cognitive and psychomotor functions, however, as in the treatment of other psychotropic drugs patients should be careful when driving and moving machinery.
    During treatment It should refrain from the use of ethanol and from activities potentially hazardous activities that require high concentration and psychomotor speed reactions.
    Treatment with paroxetine administered 2 weeks after discontinuation of MAO inhibitors. Elderly patients can hyponatremia.
    In some cases, a dose adjustment of insulin and / or oral hypoglycemic drugs.
    With the development of seizures, treatment with paroxetine was stopped.
    At the first sign of mania should be discontinued treatment with paroxetine.
    During the first few weeks should be carefully testosterone cypionate reviews monitored for the patient’s condition due with possible suicide attempts.

 

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