Buy Velafax

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For the treatment of depression, the recommended initial dose of Velafax® is 37.5 mg 2 times daily. If after several weeks of treatment there is no significant improvement, the dose can be increased to 150 mg / day - 75 mg twice a day.

If it is necessary to use the drug at a higher dose in severe depressive disorder or other conditions requiring in-patient treatment, 75 mg twice a day can be immediately prescribed. After this, the daily dose can be increased by 75 mg every 2-3 days until the desired therapeutic effect is achieved. The maximum daily dose of Velafax® is 375 mg. After achieving the necessary therapeutic effect, the daily dose can be gradually reduced to a minimum effective level.

Supportive treatment lasts for 6 months or more. The drug is prescribed in the minimum effective dose used in the treatment of a depressive episode.

With mild renal insufficiency (glomerular filtration rate more than 30 ml / min) correction of the dosing regimen is not required.

For renal failure of moderate severity (glomerular filtration rate 10-30 ml / min), the dose should be reduced by 25-50%. In connection with the elongation of venlafaxine T1 / 2 and its active metabolite, such patients should take the entire dose 1 time per day.

In case of severe renal failure (glomerular filtration rate less than 10 ml / min), the use of Velafax® is not recommended, since the experience of such therapy is limited.

Patients on hemodialysis can receive 50% of the usual daily dose of venlafaxine after completion of hemodialysis.

With mild hepatic insufficiency (MF less than 14 s), correction of the dosing regimen is not required.

With moderate hepatic insufficiency (IV 14 to 18 s), the dose should be reduced by 50%.

In severe hepatic insufficiency, the use of Velafax® is not recommended, since the experience of such therapy is limited.

Older patients are not required to adjust the dose, however, as with the prescription of other medications, caution is required in the treatment, for example, in connection with the possibility of impaired renal function. Therefore, in elderly patients, the lowest effective dose of the drug should be used; If you need to increase the dose shown by careful medical supervision.

Termination of Velafax®

At the end of treatment, the dose is recommended to be reduced gradually. When applied at a dose equal to or exceeding 75 mg, with a course of 7 days or more, the drug is canceled for at least a week, gradually reducing the dose. When used in high doses for more than 6 weeks, the period required to completely stop the drug is at least 2 weeks. The appearance of symptoms of recurrence of the disease during the period of withdrawal of the drug Velafax® requires the appointment of the initial dose of the drug or a more gradual and prolonged reduction.

The simultaneous use of MAO inhibitors and venlafaxine is contraindicated. Venlafaxine can be taken at least 14 days after the end of therapy with MAO inhibitors. If a reversible MAO inhibitor (moclobemide) was used, this interval may be shorter (24 h). Therapy with MAO inhibitors can be started no earlier than 7 days after the cancellation of venlafaxine.

With the simultaneous use of venlafaxine with lithium preparations, it is possible to increase the level of lithium in the blood.

With simultaneous use with imipramine, the pharmacokinetics of venlafaxine and its metabolite EFA does not change. Venlafaxine does not affect the metabolism of imipramine and its metabolite 2-hydroxyimipramine, but it increases the AUC and Cmax values ​​in the plasma of desipramine (the main metabolite of imipramine), and also reduces the renal clearance of 2-hydroxydesipramine. The clinical significance of this phenomenon is unknown.

With simultaneous use with neuroleptics, the appearance of symptoms resembling a malignant neuroleptic syndrome is possible.

Venlafaxine reduces the kidney clearance of haloperidol by 42%, while the AUC and Cmax values ​​increase by 70 and 88%, respectively. It is possible to enhance the effects of haloperidol.

With simultaneous use with diazepam, the pharmacokinetics of drugs and their major metabolites do not change significantly.

With simultaneous use with clozapine, there may be an increase in its level in the blood plasma and the development of side effects (eg epileptic seizures).

With simultaneous use with risperidone, despite the increase in the AUC of the drug, the pharmacokinetics of the sum of the active components (risperidone and its active metabolite) did not change significantly.

Simultaneous intake of ethanol and venlafaxine was not accompanied by a decrease in mental and motor activity. Despite this (as in the case of taking other drugs that affect the central nervous system) during the treatment with venlafaxine, ethanol is not recommended.

Cimetidine suppresses the metabolism of venlafaxine during the first passage through the liver and does not affect the pharmacokinetics of EFA. In most patients, only a slight increase in the overall pharmacological activity of venlafaxine and EFA is expected (more pronounced in elderly patients and in liver failure). In elderly patients and patients with impaired liver function, simultaneous use of cimetidine and venlafaxine should be performed under medical supervision.

There was no clinically significant interaction of venlafaxine with antihypertensive (including beta-blockers, ACE inhibitors and diuretics) and hypoglycemic drugs.

Since binding to venlafaxine and EFA plasma proteins is 27 and 30%, respectively, no drug interaction due to competitive release of other drugs from the plasma protein bonds is contemplated.

The metabolism of venlafaxine occurs with the participation of the cytochrome P450 system, the isoenzymes CYP2D6 and CYP3A4. The administration of the drug with inhibitors of the isoenzyme CYP2D6 or patients with a genetically caused decrease in the activity of the isoenzyme CYP2D6 was not accompanied by significant changes in concentrations of the active substance and metabolite (venlafaxine and EFA), which does not reduce the dose of antidepressant. However, simultaneous administration with inhibitors of the isoenzyme CYP3A4 is accompanied by an increase in venlafaxine concentration in the plasma. Therefore, special care should be taken when administering venlafaxine with drugs that are inhibitors of the isoenzyme CYP3A4 (ketoconazole, erythromycin) or both isoenzymes (CYP2D6 and CYP3A4).

Venlafaxine is a relatively weak inhibitor of the CYP2D6 isoenzyme and does not suppress the activity of the isoenzymes CYP1A2, CYP2C9 and CYP3A4. In vivo studies, the effect of venlafaxine on the metabolism of alprazolam (isoenzyme CYP3A4), caffeine (isoenzyme CYP1A2), carbamazepine (isoenzyme CYP3A4) and diazepam (isoenzymes CYP3A4 and CYP2C19) was not detected in vivo.

With simultaneous use with warfarin, the anticoagulant effect of the latter can be enhanced, while PV, expressed through MHO, is prolonged.

With concurrent administration with indinavir, indinavir AUC decreases by 28% and its Cmax reduction in plasma by 36%, while the pharmacokinetic parameters of venlafaxine and EFA do not change. The clinical significance of this effect is unknown.

Venlafaxine may affect the pharmacodynamics of other drugs acting at the level of the serotonergic neurotransmitter system, therefore caution should be exercised when it is administered simultaneously with triptans, other SSRIs, and lithium preparations.