Buy Calixta tabs 30mg N30 online.
Active substance:
Mirtazapine.
Manufacture: Belupo.
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Buy Calixta
Depression.
Tablets should be taken orally, if necessary, washed down with liquid, and swallowed without chewing.
Adults:
The effective daily dose is usually between 15 mg and 45 mg; the initial dose is 15 mg or 30 mg.
Elderly patients:
The recommended dose is the same as for adults. In elderly patients, in order to achieve a satisfactory and safe response to treatment, an increase in the dose should be made under the direct supervision of a physician.
Dysfunction of the liver and kidneys:
In patients with renal or hepatic insufficiency, the clearance of mirtazapine may be reduced. This should be taken into account when appointing Kalikst in this category of patients.
Kalikst preparation can be taken 1 time / day, preferably at the same time, before bedtime. Kalikst can also be prescribed for admission 2 times / day, dividing the daily dose in half (once in the morning and once a night, a higher dose should be taken at night).
Treatment should, if possible, continue for 4-6 months until the symptoms disappear completely. After that, the treatment can be gradually canceled. Mirtazapine begins to act normally after 1-2 weeks of treatment. Treatment with an adequate dose should lead to a positive result in 2-4 weeks. If necessary, the dose can be increased to the maximum dose (up to 45 mg). In the absence of positive dynamics of treatment, after 2-4 weeks treatment should be discontinued.
Pharmacokinetic interaction
Mirtazapine is extensively metabolized with the participation of CYP2D6 and CYP3A4 isoenzymes, and to a lesser extent with the participation of the CYP1A2 isoenzyme. The study of interaction in healthy volunteers showed that paroxetine, an inhibitor of the isoenzyme CYP2D6, does not affect the pharmacokinetics of mirtazapine in the equilibrium state. Introduction in combination with a potent inhibitor of the isoenzyme CYP3A4, ketoconazole increased the maximum plasma concentration and AUC of mirtazapine by approximately 40% and 50%, respectively. Caution should be exercised when using mirtazapine in combination with potent inhibitors of the CYP3A4 isoenzyme, HIV protease inhibitors, azole
antifungal drugs, erythromycin or nefazodone.Carbamazepine and phenytoin, inductors of the CYP3A4 isoenzyme, increased the clearance of mirtazapine by approximately half, which resulted in a 45-60% decrease in the plasma mirtazapine concentrations. When adding carbamazepine or other inducer of microsomal liver enzymes (eg rifampicin) to mirtazapine therapy, the dose of mirtazapine should be increased if necessary. When discontinuing treatment with such a drug, it may be necessary to reduce the dose of mirtazapine.
When mirtazapine is used in combination with cimetidine, the bioavailability of mirtazapine may increase by more than 50%. The dose of mirtazapine, if necessary, should be reduced at the beginning of treatment in combination with cimetidine or increased when cimetidine is discontinued.
In studies on in vivo interactions, mirtazapine had no effect on the pharmacokinetics of risperidone or paroxetine (the substrate of the isoenzyme CYP2D6), carbamazepine (substrate of the isoenzyme CYP3A4), amitriptyline, cimetidine or phenytoin.
There were no significant clinical effects or changes in pharmacokinetics in humans when treated with mirtazapine in combination with lithium.
Pharmacodynamic interaction
Mirtazapine should not be used in combination with MAO inhibitors or within two weeks after discontinuation of treatment with an MAO inhibitor.
Mirtazapine can enhance the sedative properties of benzodiazepines and other sedatives. Caution should be exercised when prescribing these medicines together with mirtazapine.
Mirtazapine can enhance the depressive effect of alcohol on the central nervous system. Therefore, patients should be warned about the need to avoid drinking alcohol.
In the case of other serotonergic drugs (for example, selective inhibitors of serotonin and venlafaxine seizure) in combination with mirtazapine, there is a risk of interaction that may lead to the development of serotonin syndrome.
Mirtazapine at a dose of 30 mg 1 time / day caused a small but statistically significant increase in MHO (international normalized ratio) in subjects treated with warfarin. You can not exclude a more pronounced effect with a higher dose of mirtazapine. It is recommended to monitor MHO in case of treatment with warfarin in combination with mirtazapine.