Buy Velaxin

Inside, with food. Each capsule should be swallowed whole and washed down with liquid. Capsules can not be divided, chopped, chewed or placed in water. The daily dose should be taken at one time (in the morning or in the evening), each time at about the same time.

Depression. The recommended initial dose is 75 mg once a day.

If the doctor thinks that a higher dose (severe depressive disorder or other conditions requiring hospital treatment) is needed, 150 mg once a day can be immediately prescribed. Subsequently, the daily dose can be increased by 75 mg at intervals of 2 weeks or more (but no more than 4 days later), until the desired therapeutic effect is achieved. The maximum daily dose is 350 mg.

After achieving the necessary therapeutic effect, the daily dose can be gradually reduced to a minimum effective level.

Supportive therapy and prevention of relapse. Treatment of depression should last at least 6 months. With stabilizing therapy, as well as therapy for the prevention of recurrence or new episodes of depression, doses that have demonstrated their effectiveness are usually used. The physician should regularly (at least once every 3 months) monitor the effectiveness of long-term therapy with Velaxin®.

Transfer of patients from Velaxin® tablets. Patients taking the drug Velaxin® in the form of tablets can be transferred to receive the drug in the form of capsules of prolonged action, with the appointment of an equivalent dose 1 time per day. However, an individual dose adjustment may be required.

Renal failure. With mild renal failure (GFR more than 30 ml / min), correction of the dosing regimen is not required. With moderate renal failure (GFR 10-30 ml / min), the dose should be reduced by 50%. In connection with the lengthening of venlafaxine T1 / 2 and EFA, such patients should take the entire dose 1 time per day. It is not recommended to use venlafaxine in severe renal failure (GFR less than 10 ml / min), since there is no reliable data on such therapy. Patients on hemodialysis can receive 50% of the usual daily dose of venlafaxine after completion of hemodialysis.

Liver failure. 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%. It is not recommended to use venlafaxine in severe hepatic insufficiency, since there are no reliable data on such therapy.

Elderly patients. The old age of the patient does not require a dose change, however, as with the prescription of other medications, caution is required in the treatment of elderly patients, for example due to the possibility of impaired renal function. The lowest effective dose should be used. When the dose is raised, the patient should be under careful medical supervision.

Children and adolescents (under the age of 18). The safety and efficacy of venlafaxine in children and adolescents under the age of 18 years is not established.

Withdrawal of Velaxin®. As with other antidepressant medications, abrupt withdrawal (especially high doses) of venlafaxine can cause withdrawal symptoms (see "Side effects" and "Special instructions"). Therefore, before the complete cancellation of the drug, a gradual dose reduction is recommended. If high doses were used for more than 6 weeks, it is recommended to reduce doses for at least 2 weeks. The length of the period necessary to reduce the dose depends on the size of the dose, the duration of therapy, and also the patient's reactions.

The simultaneous use of MAO inhibitors and venlafaxine is contraindicated. The preparation of Velaxin® can be started 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 begin at least 7 days after the withdrawal of Velaxin®.

The simultaneous use of venlafaxine with lithium can increase the level of the latter.

With simultaneous use with imipramine, the pharmacokinetics of venlafaxine and EFA do not change. At the same time, their simultaneous use enhances the effects of desipramine, the main metabolite of imipramine-and its other metabolite, 2-OH-imipramine, although the clinical significance of this phenomenon is unknown.

Haloperidol: combined use increases the level of haloperidol in the blood and enhances its effects.

With simultaneous use with diazepam, the pharmacokinetics of drugs and their major metabolites do not change significantly. Also, there was no effect on the psychomotor and psychometric effects of diazepam.

When used simultaneously with clozapine, there may be an increase in its level in the blood plasma and the development of side effects (eg convulsive seizures).

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

Reduction of mental and motor activity under the influence of alcohol was not enhanced after prima venlafaxine. Despite this, as in the case of taking other drugs that affect the central nervous system, during the treatment with venlafaxine, the use of alcoholic beverages is not recommended.

On the background of taking venlafaxine, special care should be taken with electroconvulsive therapy. experience with venlafaxine in these conditions is absent.

Drugs metabolized by cytochrome P450 isoenzymes: the enzyme CYP2D6 of the cytochrome P450 system converts venlafaxine to the active metabolite of EFA. Unlike many other antidepressants, the dose of venlafaxine can not be reduced with simultaneous administration with drugs that inhibit CYP2D6 activity or in patients with a genetically determined decrease in CYP2D6 activity, since the total concentration of venlafaxine and EFA will not change at the same time.

The main way to eliminate venlafaxine involves metabolism involving CYP2D6 and CYP3A4; therefore, special care should be taken with the appointment of venlafaxine in combination with drugs that depress both of these enzymes. Such drug interactions have not yet been investigated.

Venlafaxine is a relatively weak inhibitor of CYP2D6 and does not suppress the activity of the isoenzymes CYP1A2, CYP2C9 and CYP3A4; therefore, its interaction with other drugs in the metabolism of which these hepatic enzymes are involved should not be expected.

Cimetidine suppresses the metabolism of the first passage of venlafaxine 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).

Clinical studies have not found clinically significant interactions of venlafaxine with antihypertensive (including beta-blockers, ACE inhibitors and diuretics) and antidiabetic drugs.

Drugs associated with blood plasma proteins: binding to plasma proteins is 27% for venlafaxine and 30% for EFA, so drug interactions due to binding to proteins should not be expected.

With simultaneous administration with warfarin, the anticoagulant effect of the latter can be enhanced, while the PV is lengthened and MHO is increased.

With simultaneous admission with indinavir, the pharmacokinetics of indinavir changes (with a 28% reduction in AUC and a 36% decrease in Cmax), and the pharmacokinetics of venlafaxine and EFA do not change. However, the clinical significance of this effect is unknown.