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Remeron (Mirtazapinum, Mirtazapine) - Antidepressant. Remeron blocking presynaptic alpha 2-adrenergic receptors in the central nervous system and enhances noradrenergic transmission of nerve impulses. Also amplifies serotonergic transmission (this effect is realized only via the 5-HT1 receptors, since NT2--5 and 5-HT3 receptors are blocked.
In applying the drug Remeron, it should be understood that the deterioration of psychotic symptoms can occur when using antidepressants for the treatment of patients with schizophrenia and other psychotic disorders; could increase paranoid ideas; the depressive phase of manic-depressive psychosis during treatment can transform into the manic phase.
Young people (under 24 years) with depression and other mental disorders, antidepressants compared to placebo, increased the risk of suicidal thoughts or suicidal behavior. Therefore, when appointing the drug Remeron in young people (under 24 years) should be related to the risk of suicide and the use of the drug. In short-term studies in people older than 24 years, the risk of suicide did not increase, and in people over 65 years - is somewhat reduced. Any depressive disorder in itself increases the risk of suicide. Therefore, during treatment the patient should be monitored in order to detect irregularities or changes in behavior, and suicidal tendencies.
Hhotya drug Remeron is not addictive, post-marketing experience based on it turned out that the abrupt cessation of treatment after prolonged use can sometimes cause withdrawal symptoms. Most of cancellation of the reactions are mild and self-limiting. The most frequently reported the following withdrawal symptoms: dizziness, agitation, anxiety, headache and nausea. Although they are reported as withdrawal symptoms, it should be understood that these symptoms may be related to the primary disease. It is recommended to stop treatment mirtazapine gradually.
Elderly patients are generally more sensitive, especially in relation to side effects. In clinical studies, the drug Remeron is not noted that elderly patients the side effects are more likely than other age groups, but they may be more pronounced; however, the data is still limited.
If signs of jaundice, treatment should be interrupted.
Patients recommend avoiding the use of alcohol in the treatment of drug Remeron.
Inhibition of bone marrow function, usually manifested as granulocytopenia or agranulocytosis, rarely seen with the drug Remeron. It appears mostly after 4-6 weeks of treatment and is reversible after discontinuation of treatment. The physician should carefully consider (and to inform the patient) to symptoms such as fever, sore throat, stomatitis, and other signs of influenza-like syndrome; the appearance of these symptoms should stop treatment and a blood test.
Based on post-marketing experience, it appears that serotonin syndrome occurs very rarely in patients receiving treatment only drug Remeron.
Effects on ability to drive and work with mehanizmami.Preparat Remeron® can reduce the concentration of attention. In the treatment of patients with antidepressants should avoid the performance of potentially hazardous activities that require high speed of psychomotor reactions, such as driving a car or operating machinery.
Remeron is taken orally (tablets swallowed without chewing, with some liquid if necessary), preferably in one go, before going to bed; assume also receiving divided doses distributed over the day (once in the morning and one time in the evening 1). For adults, the initial dose - 15 mg / day, with the possible gradual increase to achieve optimal clinical effect is usually effective dose is 15-45 mg / day. Recommended doses correspond to doses of elderly adults. Desirable to continue treatment for 4-6 months to complete disappearance of clinical symptoms. If no improvement within 2-4 weeks of treatment dose can be increased in the absence of clinical effect over the next 2-4 weeks, treatment should cease.
Experience regarding drug overdose only Remeron indicates that symptoms are usually mild. It has been reported about the oppression of the central nervous system, accompanied by disorientation and prolonged sedation in combination with tachycardia and a slight increase or decrease in blood pressure. However, there is a possibility of heavier results (including death) at doses much higher than the therapeutic dose, particularly multiple drug overdose taken simultaneously. In case of overdose should be symptomatic therapy to maintain vital body functions. It is necessary to introduce an activated UHL or stomach wash.
With simultaneous use of Remeron may enhance the sedative effects of benzodiazepines, as well as a depressing effect on the central nervous system of ethanol and ethanol-preparations.
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