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Velaxin (Venlafaxinum, Venlafaxine) - an antidepressant.
According to the chemical structure of venlafaxine can not be attributed to any known class of antidepressants (tricyclic, tetracyclic, or other). It has two enantiomeric active racemic forms.
Venlafaxine Antidepressant effect associated with increased activity in the CNS neurotransmitter. Venlafaxine and its main metabolite O-desmetilvenlafaksin (EFA) are potent inhibitors of the reuptake of serotonin and norepinephrine, and weakly inhibit the reuptake of dopamine neurons. Venlafaxine and EFA equally effective influence on the reuptake of neurotransmitters. Venlafaxine and EFA reduced beta adrenergic response.
Venlafaxine has no affinity for m-and n nicotinic acetylcholine receptor, histamine H 1 receptors and α 1 adrenoretseptoram brain. Venlafaxine does not inhibit MAO activity. No affinity to opioid, benzodiazepine, fentsiklidinovym or N-methyl-d-aspartate (NMDA) receptors.
Precautions should be prescribed in the following cases:
Cancel Velaxin preparation: as with treatment with other antidepressants, venlafaxine abrupt cessation of therapy, particularly after high doses, can cause withdrawal symptoms, and therefore it is recommended to gradually reduce the dose before discontinuing the drug. The length of time required to reduce the dose depends on the dose, duration of therapy, as well as individual patient sensitivity.
The recommended starting dose is 75 mg in 2 divided doses (37.5 mg of 2 times / day) daily. If after several weeks of treatment, no significant improvement is observed, the daily dose can be increased to 150 mg (75 mg of 2 times / day). If the opinion of the physician, a higher dose (major depression or other conditions that require hospital treatment), you can immediately assign 150 mg in 2 divided doses (75 mg 2 times / day). Thereafter, the daily dose may be increased to 75 mg every 2-3 days until the desired therapeutic effect. The maximum daily dose Velaxin drug is 375 mg. After achieving the desired therapeutic effect, the daily dose can be gradually reduced to the minimum effective level. The length of time required to reduce the dose depends on the dose, duration of therapy, as well as individual patient sensitivity.
After receiving Velaxin recommended to gradually reduce the dosage of the drug, at least for a week and observe the patient's condition, to minimize the risk associated with the abolition of the drug. The length of time required to reduce the dose depends on the dose, duration of therapy, as well as individual patient sensitivity.
Supportive therapy and relapse prevention.
Supportive therapy can continue for 6 months or more. The drug is prescribed at the lowest effective doses used in the treatment of depressive episodes.
Application for violations of liver function:
For mild hepatic insufficiency (prothrombin time less than 14 seconds) correction mode is not required. In moderate hepatic insufficiency (prothrombin time of 14 to 18 seconds), the dose should be reduced by 50%. Not recommended for venlafaxine in severe hepatic insufficiency, since reliable data on the safety of this therapy are not available.
Application for violations of poche functions:
In renal insufficiency mild (creatinine clearance (CC) more than 30 ml / min) correction mode is not required. In renal failure of moderate severity (CC 10-30 ml / min), the dose should be reduced by 25-50%. In connection with the extension of T 1/2 of venlafaxine and its active metabolite (EFA) in such patients should take the entire dose of 1 times / day. Not recommended for venlafaxine with severe renal insufficiency (creatinine clearance less than 10 ml / min), since reliable data on the safety of this therapy are not available.
Patients on hemodialysis may receive 50% of the usual daily dose of venlafaxine after completion of the hemodialysis session.
Use in elderly patients:
In elderly patients the drug should be used with caution due to the possibility of renal impairment. Use the smallest effective dose. When the dose the patient should be under close medical supervision.
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