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With depression and OCD in adults, the average initial dose is 50 mg once a day, in the morning or in the evening. Daily dose can be gradually, not earlier than a week, increase from 50 mg to a maximum daily dose of 200 mg.

In panic and post-traumatic stress disorders, the initial dose of Asentra is 25 mg once a day, in the morning or in the evening. In a week, you can increase the dose to 50 mg once a day, and then gradually, not earlier than a week, raise to a maximum daily dose of 200 mg.

A satisfactory therapeutic result is achieved usually after 7 days from the start of treatment. However, in order to achieve a complete therapeutic effect, the drug should be taken regularly for 2-4 weeks. In patients with OCD, it may take 8-12 weeks to achieve a good result. The minimum dose providing the therapeutic effect is preserved as a supporting one in the future.

The initial dose of Asentra for children aged 6 to 12 years is 25 mg sertraline once a day, in the morning or in the evening. After a week, you can increase the dose to 50 mg once a day. For children aged 12 to 17 years, the initial dose is 50 mg once a day in the morning or evening. If necessary, the daily dose can be gradually, not earlier than a week, increased from 50 mg to a maximum daily dose of 200 mg. To avoid overdose, less weight in children should be taken into account compared with adults, and with a dose increase of more than 50 mg / day, careful monitoring of this category of patients is necessary and at the first signs of an overdose, the drug should be discontinued.

In elderly patients, there is no need for a special dose selection.

For violations of liver function, the drug should be administered with caution. In case of severe violations of the liver function, the dose of the drug should be reduced or the intervals between doses should be increased.

In patients with impaired renal function, no special correction of the dosing regimen is required.

MAO inhibitors. There are serious complications with the simultaneous use of sertraline and MAO inhibitors (including selective MAO inhibitors with a reversible type of action - selegiline and moclobemide). Perhaps the development of serotonin syndrome. Similar complications, sometimes fatal, occur with the appointment of MAO inhibitors against the background of treatment with antidepressants that depress the neuronal capture of monoamines or immediately after their withdrawal.

With the simultaneous use of selective inhibitors of reverse neuronal seizure of serotonin and MAO inhibitors, hyperthermia, rigidity, convulsions, myoclonus, lability in the autonomic nervous system (rapid fluctuations in the parameters of the respiratory and cardiovascular system), changes in mental status, including increased irritability, marked agitation, confusion consciousness, which in some cases can go into a delirious state or to whom.

Drugs that depress the central nervous system and ethanol. Combined use of sertraline and substances depressing the central nervous system requires close attention, it is also forbidden to drink alcohol during treatment with sertraline.

Derivatives of coumarin. When they are co-administered with sertraline, there is a significant increase in PT. In these cases, it is recommended to monitor the PV at the beginning of treatment with sertraline and after its withdrawal.

Pharmacokinetic interaction

Sertraline binds to blood plasma proteins. Therefore, it is necessary to consider the possibility of its interaction with other drugs that bind to proteins (for example, diazepam, tolbutamide and warfarin).

Cimetidine. Simultaneous use significantly reduces the clearance of sertraline.

LS metabolized by isoenzyme 2D6 cytochrome P450. Long-term treatment with sertraline at a dose of 50 mg / day is accompanied by an increase in the concentration of desipramine.

LS, metabolized by other enzymatic systems of cytochrome P450. Experiments on in vitro interaction showed that the isoenzyme CYP3A3 / 4 beta-hydroxylation of endogenous cortisol, as well as the metabolism of carbamazepine and terfenadine, do not change with the long-term administration of sertraline at a dose of 200 mg / day. The concentration in the blood plasma of tolbutamide, phenytoin and warfarin in the long-term administration of sertraline in the same dose also does not change. Thus, it can be concluded that sertraline does not inhibit the isoenzyme CYP2C9.

Sertraline does not affect the concentration of diazepam in the serum, indicating that there is no inhibition of isoenzyme CYP 2C19. According to in vitro studies, sertraline has virtually no effect or minimally inhibits the isoenzyme CYP 1A2.

Lithium. The pharmacokinetics of lithium does not change with the concomitant administration of sertraline. However, when combined, tremor is more common. As well as the appointment of other selective inhibitors of reverse neuronal seizure of serotonin, the joint use of sertraline with drugs that affect serotonergic transmission (eg, lithium) requires increased caution.

Drugs affecting serotonergic transmission. When replacing one inhibitor of neuronal seizure of serotonin with another, there is no need for a period of "laundering". However, care must be taken when changing the course of treatment. Tryptophan or fenfluramine should be avoided together with sertraline.

Induction of microsomal enzymes in the liver. Sertraline causes minimal induction of liver enzymes. Simultaneous administration of sertraline and antipyrine at a dose of 200 mg leads to a significant decrease in T1 / 2 antipyrine, (differs only 5% of observations).

Atenolol. With the co-administration of sertraline does not change its beta-adrenergic blocking effect.

Glibenclamide and digoxin. With the introduction of sertraline in a daily dose of 200 mg of drug interaction with these drugs is not revealed.