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Zoloft (Sertralinum, Sertraline) - antidepressant, a powerful specific inhibitor of the reuptake of serotonin (5-HT) neurons. It has very little effect on the reuptake of noradrenaline and dopamine. At therapeutic doses, blocks the uptake of serotonin in human platelets. He has no stimulating, sedative or anticholinergic action. Due to the selective inhibition of 5-HT capture, sertraline does not enhance adrenergic activity. Sertraline has no affinity for muscarinic, serotonin, dopamine, histamine, GABA-, benzodiazepine and adrenoceptor. Sertraline not cause drug dependence, causes an increase in body weight during chronic administration.
With care use in patients with organic brain diseases (including mental retardation), of epilepsy, liver and / or kidney failure, marked reduction in body weight.
Sertraline should not be administered together with MAO inhibitors and within 14 days after discontinuation of treatment MAO inhibitors. Similarly, after the abolition of sertraline for 14 days did not prescribe MAOIs.
With the use of selective serotonin reuptake inhibitors are described cases of serotonin syndrome and NMS, the risk of which is increased when combining SSRIs with other serotonergic drugs (including triptans with), as well as drugs that affect the metabolism of serotonin (including. h. with MAO inhibitors), antipsychotics and other dopamine receptor antagonists. Manifestations of serotonin syndrome may be mental status changes (eg, agitation, hallucinations, coma), autonomic lability (tachycardia, blood pressure fluctuations, hyperthermia), changes in neuromuscular transmission (hyperreflexia, incoordination) and / or disorders of the gastrointestinal tract (nausea, vomiting and diarrhea). Some symptoms of serotonin syndrome, including hyperthermia, muscle rigidity, autonomic lability with rapid fluctuations of vital signs parameters, and changes in mental status, may resemble symptoms developing at NSA. Required monitoring patients for the development of clinical manifestations serotoninovgo syndrome and NMS.
Zoloft is prescribed 1 time / day. in the morning or evening. The tablets can be taken without food. For depression and OCD, treatment begins with doses of 50 mg / day. Treatment of panic disorder, PTSD, and social phobia begins with a dose of 25 mg / day, which increased after 1 week to 50 mg / day. Use of the drug for such a scheme to reduce the frequency of early treatment of adverse effects characteristic of panic disorder. With little effect of application of sertraline in patients at a dose of 50 mg / day. the daily dose can be increased. The dose should be increased at intervals of not more than 1 time per week to a maximum recommended dose of 200 mg / day. Some effect can be observed 7 days after beginning treatment, but the overall effect is usually achieved after 2-4 weeks (or even for a longer time in OCD). During the long-term maintenance therapy, the drug administered in a minimum effective dose which subsequently change depending on clinical effect. In children and adolescents aged 13-17 years, suffering from OCD, treatment with Zoloft should start with a dose of 50 mg / day. In children aged 6-12 years OCD therapy is started with a dose of 25 mg / day., 1 week, it increased to 50 mg / day. Subsequently, with little effect dose can be increased in steps of 50 mg / day. to 200 mg / day. as needed. To avoid overdosing with increasing doses of 50 mg to take into account the smaller body weight in children as compared to adults. The dose should be changed at intervals of not less than 1 week. In elderly patients the drug is used in the same dose as younger patients.
When the joint application of sertraline and pimozide pimozide concentration showed an increase when it is administered in a single low dose (2 mg). Increased pimozide concentration was not associated with any changes in ECG. Since the mechanism of this interaction is not known, and pimozide different narrow therapeutic range, concomitant use of pimozide and sertraline is contraindicated. There have been severe complications, while the use of sertraline and MAO inhibitors including selective effect (selegiline) and a reversible type of action (moclobemide and linezolid). Perhaps the development of serotonin syndrome: hyperthermia, rigidity, myoclonus, lability of the autonomic nervous system (rapid fluctuations in the parameters of the respiratory and cardiovascular system), mental status changes, including increased irritability, marked agitation, confusion, which in some cases can go into delirious state or coma. Similar complications are sometimes associated with the appointment of MAO inhibitors during treatment with antidepressants, depressing neuronal uptake of monoamines or immediately after their withdrawal. There was no potentiation of the effects of ethanol, carbamazepine, haloperidol or phenytoin on cognitive and psychomotor performance in healthy subjects; however, the combined use of sertraline and ethanol should be deleted. The joint appointment of warfarin with sertraline been a slight but statistically significant increase in prothrombin time - in these cases it is recommended to monitor the prothrombin time at the beginning of treatment with sertraline and after its cancellation.
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