Buy Valdoxan

Inside. Tablets of the drug Valdoxan® can be taken regardless of food intake.

The tablet should be swallowed whole, without chewing.
If you miss a dose of the next dose, the next dose of Valdoxane is taken in the usual dose (do not take the missed dose).

To improve the patient's control of taking the drug, a calendar is printed on the blister containing the tablets.

The recommended daily dose is 25 mg (1 tablet) once in the evening. In the absence of clinical dynamics after a two-week treatment, the dose may be increased to 50 mg (2 tablets of 25 mg) once in the evening.

It is recommended to monitor liver function at the beginning of therapy and then periodically, after 3 weeks, after 6 weeks (end of the period of therapy), 12 weeks and 24 weeks (end of maintenance period) after initiation of therapy, and subsequently in accordance with the clinical situation. With increasing doses, liver function should be monitored at the same frequency as at the beginning of the drug. Drug therapy for depression should be performed for at least 6 months to completely stop the symptoms.

 

Discontinuation of treatment

In the event of discontinuation of treatment, there is no need for a gradual dose reduction.

Potentially possible effects of other drugs

Agomelatine is 90% metabolized in the liver with cytochrome P450 1A2 (CYP1A2) and 10% with CYP2C9 / 19. Therefore, any drugs whose metabolism depends on these isoenzymes may increase or decrease the bioavailability of agomelatine.
Fluvoxamine is a strong inhibitor of the CYP1A2 isoenzyme and a moderate inhibitor of the CYP2C9 isoenzyme and significantly slows the metabolism of agomelatine, while the concentration of agomelatine increases approximately 60 (12 - 412) times. Therefore, the simultaneous use of agomelatine and strong inhibitors of the isoenzyme CYP1A2 (such as fluvoxamine, ciprofloxacin) is contraindicated. Simultaneous administration of agomelatine and estrogens, which are moderate inhibitors of the isoenzyme CYP1A2, leads to an increase in the concentration of agomelatine several fold. Although combined use of agomelatine and estrogens has not been associated with a worsening of the safety profile of the therapy, caution should be exercised when concomitantly administering agomelatine with other moderate inhibitors of the CYP1A2 isoenzyme (such as propranolol, grepafloxacin, enoxacin) until sufficient clinical experience is gained (see section "Special instructions"). .
Rifampicin, as an inducer of both cytochromes involved in the metabolism of agomelatine, may lower the bioavailability of agomelatine.
It is shown that smoking, inducing the isoenzyme CYP1A2, lowers the bioavailability of agomelatine, especially in patients who abuse smoking (> 15 cigarettes / day) (see section "Pharmacokinetics").

Potentially possible effects of agomelatine on other drugs

In vivo, agomelatine does not induce cytochrome P450 isoenzymes. Agomelatine does not inhibit the isoenzyme CYP1A2 in vivo and other cytochrome P450 isoenzymes in vitro.
Therefore, agomelatine does not affect the concentration of drugs whose metabolism is associated with these isoenzymes.

Drugs that largely bind to plasma proteins
Agomelatine did not change the free concentration of drugs that largely bind to plasma proteins and, in turn, they did not affect the concentration of agomelatine.

Other medicines

The absence of pharmacokinetic and pharmacodynamic interaction of agomelatine and drugs often used in the target population of patients: benzodiazepines, lithium preparations, paroxetine, fluconazole and theophylline has been revealed.

Alcohol

It is not recommended to use agomelatine together with alcohol.

Electroconvulsive therapy (ECT)

There is no data on the use of agomelatine concomitantly with ECT. Since agomelatine has not contributed to the occurrence of seizures in animal experiments, the undesirable consequences of the combined use of agomelatine and ECT seem unlikely.