Fevarin (fluvoxamine) pharmacologically belongs to the group of antidepressants. Manufactured by Abbot.
The composition includes the active substance fluvoxamine maleate - 50 mg or 100 mg, as well as auxiliary components mannitol, corn starch, as well as pregelatinized stearyl fumarate in the form of sodium salt, silicon dioxide in the form of a colloid.
The shell is made of hypromellose, macrogol, talc, titanium dioxide.
Externally, the 50 mg tablets are coated, round and biconvex in shape, white in color, have a line on one side, engraved with 291 on the sides, and on the back of the tablet there is the letter S above the triangle icon.
Tablets of 100 mg are also film-coated, oval in shape, biconvex, white, scored, engraved on both sides with 313, on the reverse side there is also the letter S above the triangle icon
Pharmacodynamically, the mechanism of action of Fevarin is based on the ability of the active substance fluvoxamine to selectively inhibit the reuptake of serotonin produced by brain neurons.
At the same time, Fevarin has a weak degree of binding to alpha, beta-adrenergic, m-cholinergic receptors, histaminergic, dopaminergic or serotonergic receptors.
Pharmacokinetically, after administration, fluvoxamine is completely absorbed from the gastrointestinal tract. Its maximum concentration in plasma occurs approximately 5-7 hours after administration.
After passing through the stage of primary metabolism in the liver, absolute bioavailability reaches 53%. Eating simultaneously with the drug does not affect the pharmacokinetics.
The binding of fluvoxamine to plasma proteins reaches 80%. Metabolism of fluvoxamine occurs predominantly in the liver, the resulting metabolites are excreted by the kidneys.
The average half-life of Fevarin from the body is 13-15 hours for a single dose and increases slightly with a course of administration (up to twenty-two hours), the equilibrium concentration in plasma is usually achieved within two weeks.
Two of the nine main metabolites formed as a result of hepatic metabolism have negligible pharmacological activity. Other metabolites do not appear to have pharmacological activity.
Fevarin significantly inhibits cytochrome P450 subtype 1A2, moderately inhibits cytochrome P450 subtype 2C and P450 subtype ZA4, and to a small extent inhibits cytochrome P450 subtype 2D6. The pharmacokinetics of a single dose of Fevarin is linear.
The steady-state concentration of fluvoxamine is higher than that of a single dose and is not linearly higher at higher daily doses.
The pharmacokinetics of fluvoxamine does not change in the elderly, or in patients with renal failure.
The metabolism of Fevarin tends to decrease in liver diseases. The equilibrium concentration of Fevarin in plasma is twice as high in children (6-11 years old) than in adolescents (12-17 years old), having similar concentrations as in adults.
Content:
The drug Fevarin is intended for the treatment of various origins, obsessive-compulsive disorders (OCD). Can be used in complex therapy of chronic pain syndrome.
Contraindications include hypersensitivity to fluvoxamine or any of the auxiliary components.
Concomitant use of tizanidine and MAO inhibitors is contraindicated.
Fluvoxamine therapy should begin the day after using a reversible MAO inhibitor, and in the case of using an irreversible MAO inhibitor, only 2 weeks after stopping use.
At the same time, the use of any MAO inhibitors after stopping the use of fluvoxamine should begin no earlier than a seven-day period.
Fevarin should be used with caution in case of existing renal or liver failure, in the presence of a history of epilepsy and seizures.
In old age, as well as in patients with a tendency to bleeding (thrombocytopenia).
Due to insufficient observations, no adverse effects of Fevarin on pregnancy were identified; the potential risk is unknown. In the same time,
Caution is necessary, as there are isolated cases of withdrawal syndrome in newborns after using fluvoxamine during pregnancy.
Fluvoxamine has the ability to pass into breast milk in small quantities. In this regard, Fevarin therapy is not recommended during breastfeeding.
Fevarin is taken orally, but the tablet should not be chewed; it must be taken with a sufficient amount of water.
Depression:
Obsessive-compulsive disorders (OCD):
If a good therapeutic effect has been obtained from treatment with Fevarin, therapy can be continued, with the daily dose selected for each case. The use of Fevarin should be reconsidered if there is no improvement after 10 weeks of treatment.
No systematic studies have been conducted, as a result of which the issue of the permissible duration of treatment with Fevarin was resolved.
At the same time, since obsessive-compulsive disorders are chronic, it is permissible to extend therapy beyond 10 weeks for those patients in whom the use of Fevarin has given a positive therapeutic response.
The minimum effective maintenance dose should be selected individually and with great care. The need for continued therapy should be periodically assessed. Some experts recommend sessions of concomitant psychotherapy in patients who have had a good response to pharmacotherapy.
Treatment of patients with liver or kidney failure is recommended to begin with the use of low doses and always under strict medical supervision.
During clinical trials, some side effects were noted that depended on the symptoms of existing depression and were not related to the drug therapy.
All side effects are divided into common (> 1%), uncommon (> 0.1%), rare (> 0.01%).
Frequent: malaise, asthenia, palpitations with tachycardia, sweating may increase, manifestations of anorexia.
Gastrointestinal disorders: dyspepsia, dry mouth, abdominal pain, nausea and vomiting, diarrhea or constipation.
Nervous system disorders: increased excitability, tremor, agitation, anxiety, headache, dizziness, drowsiness or insomnia.
Uncommon: orthostatic hypotension, myalgia and arthralgia, ataxia and extrapyramidal disorders, impaired (delayed) ejaculation may occur.
A state of confusion, hallucinations, and hypersensitivity skin reactions may occur (rash, itching, possible angioedema).
Rare: liver dysfunction, in the form of increased activity of liver enzymes.
The appearance of seizures, galactorrhea, photosensitivity reactions. Mania may develop.
Side effects have also been reported during post-marketing use of fluvoxamine. The exact frequency is not provided.
Hemorrhages were observed (gastrointestinal, ecchymosis, purpura), suppression of antidiuretic hormone secretion and hyponatremia were noted, and changes in body weight could occur, both in the direction of decrease and increase.
Effects from the nervous system could occur: serotonin syndrome, neuroleptic malignant syndrome, akathisia, skin sensitivity disorders, taste disorders.
Cases of suicidal behavior have been reported during fluvoxamine therapy and shortly after its completion.
Also noted were urinary disorders (expressed as urinary retention, urinary incontinence, or increased frequency of urination, nocturia), and the phenomenon of anorgasmia.
Cases of Fevarin withdrawal syndrome, including withdrawal syndrome in newborns. Symptoms noted upon withdrawal: headache, dizziness, nausea, anxiety, paresthesia. In most cases, these symptoms are mild and self-limiting. Upon completion of therapy, the dose should be reduced gradually.
The most characteristic symptoms include gastrointestinal disorders (nausea up to vomiting and diarrhea), drowsiness and non-vestibular dizziness. There is also evidence of cardiac dysfunction (various rhythm changes, arterial hypotension), liver dysfunction, convulsions and depression of consciousness.
However, overdose is possible only with sufficiently large doses of Fluvoxamine. Since its introduction, there have been extremely rare reports of deaths believed to be due to overdose of fluvoxamine alone.
The highest dose recorded was 12 grams of fluvoxamine taken by a patient. At the same time, the patient was completely cured. More serious complications have been reported in cases where fluvoxamine overdose was intentional and combined with other drugs.
There is no specific antidote for Fevarin. In case of overdose, gastric lavage is necessary as early as possible.
Symptomatic therapy, repeated intake of activated carbon, and, if necessary, the prescription of osmotic laxatives are also recommended. At the same time, dialysis or forced diuresis are not effective.
Interaction with other drugs
Fluvoxamine is significantly capable of inhibiting the cytochrome P450 1A2 isoenzyme, and to a lesser extent the P450 2C and P 450 3A4 isoenzymes. Drugs metabolized by these isoenzymes are eliminated more slowly and may reach higher plasma concentrations when used concomitantly with Fevarin.
This is significant for drugs with a narrow therapeutic dose range. In these cases, patients should be closely monitored, and if necessary, the dose of these drugs should be adjusted.
Let's take a closer look at each.
With simultaneous use of fluvoxamine, it was noted that the concentrations of antipsychotics (olanzapine, clozapine), as well as tricyclic antidepressants (primarily amitriptyline, as well as less commonly used imipramine and clomipramine) increased.
It is known that these drugs are largely metabolized by the cytochrome P450 1A2 isoenzyme. Based on this, if fluvoxamine therapy is started, it is necessary to review the doses of these drugs downward.
Patients who simultaneously take fluvoxamine and drugs that have a narrow therapeutic range of action and are metabolized by the cytochrome P450 1A2 isoenzyme (for example, tacrine, mexiletine, theophylline, methadone) must be under the supervision of a specialist.
It is recommended to adjust the dose of these drugs. There are isolated cases of cardiotoxicity with the simultaneous use of thioridazine and fluvoxamine. When fluvoxamine and propranolol interact, an increase in the concentrations of propranolol in the blood plasma has been recorded.
With simultaneous therapy of fluvoxamine and ropinirole, an increase in the concentration of ropinirole in plasma is possible, and therefore, the development of an overdose of ropinirole becomes possible. Monitoring, dose reduction or discontinuation of ropinirole during fluvoxamine therapy is necessary.
Constant monitoring is required, and, if necessary, dose reduction in patients who take fluvoxamine together with drugs with a narrow range of therapeutic effects, and if these drugs are metabolized by the cytochrome P450 2C isoenzyme (for example, phenytoin).
When using Fevarin together with warfarin, a significant increase in the concentration of warfarin in plasma and an increase in prothrombin time were noted.
Terfenadine, cisapride, astemizole: when used in combination with fluvoxamine, plasma concentrations of terfenadine, cisapride or astemizole may increase, thereby increasing the risk of an increase in the QT interval - ventricular paroxysmal tachycardia of the "pirouette" type. The use of fluvoxamine in combination with these medications is not recommended.
Patients simultaneously taking fluvoxamine and drugs that have a narrow therapeutic range of action require monitoring and dose adjustment of these drugs if these drugs are metabolized by the cytochrome P450 3A4 isoenzyme (for example, cyclosporine, carbamazepine).
With the simultaneous use of fluvoxamine and benzodiazepines that undergo oxidative metabolism, for example, triazolam, diazepam, midazolam, alprazolam, there is a possibility of increasing their concentration in the blood plasma. Therefore, the dose of these benzodiazepines should be reduced while fluvoxamine is being used.
Pharmacodynamic interactions of the drug are also important during Fevarin therapy. When combined with fluvoxamine and serotonergic drugs (tramadol, triptans, SSRI antidepressants, and St. John's wort), the serotonergic effects of fluvoxamine may be enhanced.
Fevarin in some cases was used in combination with lithium drugs to treat severely drug-resistant patients. It should be noted that lithium (and probably the amino acid tryptophan) enhances the serotonergic effects of fluvoxamine, so such combination pharmacotherapy should be used with caution.
With the simultaneous use of Fevarin and oral anticoagulant drugs, the risk of hemorrhage may increase. Such patients require medical supervision and supervision.
During treatment with Fevarin, you should stop drinking alcoholic beverages.
Depression is associated with an increased risk of suicidal thoughts or acts. The risk remains until the patient's condition has significantly improved.
In this regard, careful monitoring and monitoring of the patient's condition is necessary until sustainable improvement occurs, since improvement may not occur during the first few weeks of therapy or longer.
However, in clinical practice, an increase in the risk of suicide in the early stages of recovery is common.
The risk of suicidal events is also increased in cases of OCD. Also, OCD can be accompanied by major depression. In this regard, when treating patients with such disorders, the same precautions should be taken as when treating patients with major depression.
Constant monitoring of patients, especially those at high risk, is necessary throughout the entire duration of therapy, as well as in the early stages of therapy and after dose changes.
Adults (from 18 to 24 years old). A meta-analysis of placebo-controlled clinical observations of the use of antidepressants in adult patients with mental disorders found an increased risk of suicidal behavior with antidepressants compared with placebo in patients younger than 25 years.
When prescribing fluvoxamine, it is necessary to weigh the benefits of its use against the possible risk of suicide.
Patients of the older age group. Although data obtained from monitoring the treatment of elderly patients and younger patients showed the absence of any clinically significant differences between their usual daily doses, increasing doses of Fevarin in elderly patients should be done more slowly and with more caution.
Akathisia (psychomotor agitation). The development of akathisia while taking Fevarin is characterized by subjectively unpleasant and painful anxiety. In this case, the need for movement is often accompanied by the inability to stand or sit in a calm state.
This occurrence is more likely to occur during the first few weeks of therapy. If the dose of Fevarin is increased in patients with such symptoms, there is a possibility of a deterioration in their well-being.
It is important to start therapy for patients with a history of liver or kidney failure with low doses of Fevarin, and in these cases strict monitoring should be carried out by the attending physician.
In rare cases, the use of Fevarin can lead to an increase in the activity of liver enzymes, most often accompanied by corresponding clinical symptoms, and discontinuation of Fevarin is necessary.
Nervous system disorders that require attention during Fevarin therapy. Caution is required when prescribing Fevarin to patients with a history of seizures. Fevarin should not be used in patients with unstable epilepsy, and patients with stable epilepsy require strict monitoring.
Fevarin therapy should be discontinued if epileptic seizures occur or their frequency increases.
During therapy with Fevarin, blood glucose levels may change (hypo- or hyperglycemia may occur, as well as impaired glucose tolerance), especially at an early stage of use. Based on these facts, when prescribing Fevarin to patients suffering from diabetes mellitus, the dose of antidiabetic drugs should be adjusted.
There is information about intradermal hemorrhages (ecchymosis and purpura), hemorrhagic manifestations (gastrointestinal bleeding) observed with the use of SSRI antidepressants.
Caution is required when prescribing these drugs in the elderly, in patients simultaneously receiving drugs that affect platelet function (atypical antipsychotics and phenothiazines, tricyclic antidepressants, acetylsalicylic acid, NSAIDs), drugs that increase the risk of bleeding, as well as in patients with a history of bleeding or prone to bleeding (in particular, thrombocytopenia).
When combined with Fevarin with terfenadine or astemizole or cisapride, due to an increase in the concentration of the latter in plasma, the risk of increasing the QT interval increases, as well as the development of ventricular paroxysmal tachycardia of the “pirouette” type in the patient. In this regard, Fevarin is not recommended to be prescribed together with these drugs.
Fevarin, administered to healthy volunteers in doses up to 150 mg, had no or only a slight effect on the ability to drive a car and control machinery. At the same time, there were reports of a feeling of drowsiness noted during the use of Fevarin.
Based on this, caution is necessary until the individual response to the drug is definitively determined.
Fevarin should be stored in its original packaging, in a dry, dark place at a temperature not exceeding 25°C. Protect access for children. Shelf life: 3 years.
Fevarin is an original drug that has no analogues at the time of publication. It is inappropriate to call other antidepressants and serotonin reuptake inhibitors analogues of Fevarin, although from time to time the author of the site comes across this point of view.
Fevarin is a prescription drug available with a doctor's prescription (the prescription or a copy thereof must be kept at the pharmacy). Average prices may vary among pharmacies and are approximately:
You should not self-medicate. Before using Fevarin, consult your doctor!
Some facts about the product:
Price in online pharmacy website:
from 930The drug Fevarin is a psychotropic drug intended for the treatment of a patient’s depressive state. This drug belongs to the group of third-generation antidepressants, which distinguishes it from medications of earlier years of production. The main advantages of this type of antidepressants include their easier tolerance by the body compared, for example, with tricyclics. It should also be noted that the drug has a selective effect on the body, which avoids interaction with receptors for adrenergic, histaminergic, and serotonergic substances. Its effect is mainly to capture serotonin released by the body and transport it into the bloodstream. Interactions with norepinephrine and the neurotransmitter dopamine are minimal.
During the use of the medication, there is no stimulating or calming effect on the body. Long-term use of the drug, as a rule, is not addictive.
After taking the medication, its absorption from the digestive system begins. It reaches its maximum content in the blood within eight hours. The drug has average bioavailability, which does not increase when taken with food. Metabolic transformation of the active substance occurs in the liver. The half-life averages fifteen hours. The processes of absorption, distribution, binding, biotransformation and excretion of the drug do not depend on the patient’s age and the condition of his kidneys and occur in the same way. At the same time, there is a slowdown in metabolic transformation processes in patients suffering from acute liver diseases. Half-life products are eliminated by the kidneys and intestines in approximately the same ratio.
The following set of components is used to manufacture the drug:
The drug is produced in the form of tablets with a volume of the active ingredient of fifty and one hundred milligrams.
Tablets with a volume of active ingredient of fifty milligrams are round in shape with bulges on both sides. On one side there is an engraving with the numbers “291”, on the other there is an English letter “S”. The color of the tablets is white. The primary packaging of the drug is polyvinyl chloride blister plates, which contain fifteen or twenty tablets. From one to four blister plates, depending on the dosage, together with instructions for use are placed in cardboard packs.
Tablets with a volume of active ingredient of one hundred milligrams are oval in shape with convexities on both sides. On one side there is an engraving with the numbers “313”, on the other there is an English letter “S”. The color of the tablets is white. The primary packaging of the drug is polyvinyl chloride blister plates, which contain fifteen or twenty tablets. One, two, three or four blister plates, depending on the dosage, are placed in cardboard packs, arriving in this form for sale at pharmacies.
The drug Fevarin is prescribed in the following cases:
Side effects after using the drug can occur from various body systems. Below they are presented depending on the frequency of occurrence.
Nausea and vomiting are the most common side effects compared to others. As a rule, they completely disappear within the first fourteen days of the therapeutic course.
The following side effects often occur:
The following side effects occur rarely:
If one of the above symptoms occurs, it is recommended to immediately consult your doctor for appropriate therapy.
You should not use Fevarin if you have one of the following contraindications:
Prescribing medication should be approached with caution in the following cases:
There is not enough clinically established data regarding the use of medication during pregnancy and breastfeeding. At the same time, it is known that the active substance of the drug is excreted along with mother's milk and can have a negative effect on the child. In this regard, it is recommended to suspend breastfeeding while using the medication.
During pregnancy, the drug should be used with caution in cases where the expected benefit to the mother is higher than the potential threat to the embryo.
The prescription of the drug Fevarin is carried out by the attending physician individually, depending on the severity and course of the disease. As a rule, at the beginning of the therapeutic course, a minimum dose is set equal to fifty milligrams over twenty-four hours. It is recommended to take the tablet before bedtime. If necessary, the dosage may be increased. If a dose of more than one hundred milligrams is prescribed, it is recommended to divide it into at least two doses. The maximum dose per day should be no more than three hundred milligrams. According to the recommendations of the World Health Organization, psychotropic medications should be continued for at least six months.
When used together with antidepressants that influence the inhibition of monoamine oxidase activity, unpleasant consequences may occur, including an increase in body temperature, a slower response of the body to external stimuli, spasms of the arm muscles, increased agitation, and absent-mindedness.
It is prohibited to use drugs that have a depressant effect on the central nervous system and contain ethanol. These medications, when interacting with fluvoxamine, can have a negative effect on the psychomotor function of the body.
Combined use with carboxamide-based antiepileptic drugs slows down metabolic processes in the liver, thereby increasing the carboxamide content in the body.
In case of overdose, the following symptoms occur:
To eliminate these symptoms, it is necessary to immediately stop taking the medication, use activated carbon in the prescribed dosages, repeat gastric lavage and maintenance therapy.
It is forbidden to prescribe Fevarin together with antidepressants that affect the inhibition of monoamine oxidase activity. After stopping the use of the latter, fluvoxamine can be prescribed no earlier than two weeks later.
When used together with drugs of a similar spectrum of action, the development of serotonin syndrome is possible, which is manifested by disturbances in the rhythm of the heart muscle, changes in blood pressure, perception disorders, uncoordinated movements, nausea, loose stools, and vomiting. In this case, constant monitoring of the patient by the attending physician is required.
Caution should be exercised when switching from one serotonin reuptake antidepressant to another. It is recommended to take a break, especially when using long-acting medications.
Due to the fact that patients with mental disorders belong to a suicidal risk group, they should be under constant medical supervision until remission occurs.
The drug should be prescribed with caution to patients suffering from diseases accompanied by convulsions and seizures. If necessary, it is recommended to change the dosage.
The drug has the following analogue agents similar in spectrum of action: Azafen, Amizol, Velkasin, Heptor, Deprim, Zoloft, Efevelon, Clomipramine, Lerivon, Mirzaten, Negrustin, Pipofezin, Citol, Portal, Selectra, Sertraline, Thorin.
According to the International Classification of Diseases (ICD-10), the diagnoses for which this medication is used are coded as follows:
In pharmacies, the drug is sold in accordance with the instructions of the attending physician.
The medication should be stored in a place away from sunlight at a temperature of less than twenty-five degrees Celsius for no more than three years.
Suicide/suicidal ideation or clinical worsening Depression is associated with an increased risk of suicidal ideation, self-harm and suicide attempts (suicidal behavior). This risk persists until the condition significantly improves. Since improvement may not occur within the first few weeks of treatment or longer, patients should be closely monitored until such improvement occurs. Increased risk of suicide in the early stages of recovery is widespread in clinical practice. Other psychiatric disorders for which fluvoxamine is prescribed may also be associated with an increased risk of suicidal behavior. In addition, these conditions may accompany depression. Therefore, patients with other mental disorders should be closely monitored. Patients with a history of suicidal behavior or a significant degree of suicidal ideation before treatment are known to be at greater risk of suicidal ideation or suicide attempts and should be closely monitored during treatment. Careful monitoring of patients, especially those at high risk, should accompany drug therapy, especially in its early stages and after dose changes. Patients (and their caregivers) should be warned to monitor for any clinical deterioration, suicidal behavior or thoughts, or unusual changes in behavior, and to immediately seek professional advice if such symptoms occur. Pediatric population: Fluvoxamine should not be used to treat children and adolescents under 18 years of age, with the exception of patients with obsessive-compulsive disorder. Due to lack of clinical experience, fluvoxamine should not be used to treat depression in children. In clinical studies conducted among children and adolescents, suicidal behavior (suicidal attempts and thoughts) and hostility (mainly aggression, oppositional behavior and anger) were observed more often in patients receiving an antidepressant compared to those receiving placebo. If a treatment decision is made based on clinical need, the patient should be closely monitored for the emergence of suicidal symptoms. In addition, long-term safety data for children and adolescents regarding growth, maturation, cognitive and behavioral development are lacking. Adults (18 to 24 years): A meta-analysis of placebo-controlled clinical trials of antidepressants in adult patients with mental disorders found an increased risk of suicidal behavior with antidepressants compared with placebo in patients younger than 25 years. Elderly patients: Data obtained from the treatment of elderly patients and younger patients indicate that there are no clinically significant differences between the daily doses usually used in them. However, dose increases in elderly patients should always be done more slowly and with caution. Akathisia/psychomotor agitation: The development of akathisia associated with fluvoxamine is characterized by subjectively unpleasant and distressing restlessness. The need to move was often accompanied by an inability to sit or stand still. The development of this condition is most likely during the first few weeks of treatment. Increasing the dose of the drug in patients with such symptoms may worsen their condition. Treatment of patients suffering from hepatic or renal failure should begin with low doses, and such patients should be under strict medical supervision. In rare cases, treatment with fluvoxamine may lead to increased activity of liver enzymes, most often accompanied by corresponding clinical symptoms, and in such cases Fevarin should be discontinued. Nervous system disorders: Caution should be exercised when prescribing the drug to patients with a history of seizures. Fluvoxamine should be avoided in patients with unstable epilepsy, and patients with stable epilepsy should be closely monitored. Treatment with the drug should be discontinued if epileptic seizures occur or their frequency increases. Rare cases of the development of serotonin syndrome or a condition similar to neuroleptic malignant syndrome have been described, which may be associated with the use of fluvoxamine, especially in combination with other serotonergic and/or antipsychotic drugs. Since these syndromes can lead to potentially life-threatening conditions manifested by hyperthermia, muscle rigidity, myoclonus, lability of the autonomic nervous system, with possible rapid changes in vital parameters (pulse, respiration, blood pressure, etc.), changes in mental status, including confusion, irritability, extreme agitation leading to delirium or coma - in such cases, treatment with fluvoxamine should be discontinued and appropriate symptomatic treatment should be initiated. Metabolic and nutritional disorders: as with the use of other selective serotonin reuptake inhibitors, in rare cases, hyponatremia may occur, which is reversible after discontinuation of fluvoxamine. Some cases have been caused by syndrome of inappropriate antidiuretic hormone secretion. These cases were mainly observed in elderly patients. Blood glucose control may be impaired (ie, hyperglycemia, hypoglycemia, impaired glucose tolerance), especially early in treatment. If fluvoxamine is prescribed to patients with a history of diabetes mellitus, dosage adjustment of antidiabetic drugs may be required. The most commonly observed symptom associated with the use of the drug is nausea, sometimes accompanied by vomiting. This side effect usually disappears within the first two weeks of treatment. Visual impairment: Cases of mydriasis have been reported with the use of SSRIs such as fluvoxamine. Therefore, patients with elevated intraocular pressure or patients at increased risk of acute angle-closure glaucoma should be prescribed fluvoxamine with caution. Hematological disorders: There are reports of intradermal hemorrhages such as ecchymosis and purpura, as well as other hemorrhagic manifestations (for example, gastrointestinal bleeding or gynecological bleeding) observed with the use of selective serotonin reuptake inhibitors. Caution should be exercised when prescribing these drugs in elderly patients and patients concomitantly receiving drugs that affect platelet function (for example, atypical antipsychotics and phenothiazines, many tricyclic antidepressants, acetylsalicylic acid, non-steroidal anti-inflammatory drugs) or drugs that increase the risk of bleeding , as well as in patients with a history of bleeding or bleeding proneness (for example, with thrombocytopenia or coagulation disorders). Cardiac disorders: an increased risk of prolongation of the QT interval on the ECG and the risk of paroxysmal ventricular tachycardia of the “pirouette” type was noted during combination therapy of fluvoxamine with terfenadine, or astemizole, or cisapride, due to an increase in the concentration of the latter in the blood plasma. Therefore, fluvoxamine should not be coadministered with these drugs. Fluvoxamine may cause a slight decrease in heart rate (2-6 beats per minute). Electroconvulsive therapy (ECT): Clinical experience with fluvoxamine in conjunction with ECT is limited and should be used with caution. Withdrawal syndrome: When you stop taking fluvoxamine, withdrawal syndrome may develop, although available data from preclinical and clinical studies have not revealed dependence on fluvoxamine treatment. The most common symptoms noted in case of drug withdrawal: dizziness, sensory disturbances (including paresthesia, visual disturbance and sensation of electric shock), sleep disturbances (including insomnia and vivid dreams), agitation, irritability, confusion, emotional lability, headache, nausea and/or vomiting, diarrhea, sweating, palpitations, tremors and anxiety. Most of these symptoms are mild or moderate and self-limiting, but in some patients they can be severe and/or prolonged. These symptoms usually occur within the first few days after stopping treatment. For this reason, it is recommended to gradually reduce the dose of fluvoxamine before complete discontinuation according to the patient's condition. Mania/Hypomania: Fluvoxamine should be used with caution in patients with a history of mania/hypomania. If the patient develops a manic phase, fluvoxamine should be discontinued. Effect on the ability to drive vehicles and machines: fevarin, administered to healthy volunteers in doses up to 150 mg, did not affect or had a slight effect on the ability to drive a car and control machines and did not affect the psychomotor skills associated with driving vehicles and machines. At the same time, there are reports of drowsiness noted during treatment with fluvoxamine. Therefore, caution is recommended until the individual response to the drug is definitively determined.
Instructions for use
Pills
Active ingredient: Fluvoxamine (Fluvoxaminum) Concentration of active ingredient (mg): 50
Antidepressant. The mechanism of action is associated with selective inhibition of serotonin reuptake by brain neurons and is characterized by minimal effects on noradrenergic transmission. Fluvoxamine has a weak ability to bind to α- and β-adrenergic receptors, histamine, m-cholinergic receptors, dopamine and serotonin receptors.
Data on the pharmacokinetics of the drug are not provided.
Depression of various origins; obsessive-compulsive disorders.
Hypersensitivity to fluvoxamine maleate or to one of the excipients included in the drug; simultaneous use of tizanidine and MAO inhibitors. Treatment with fluvoxamine can be started 2 weeks after stopping taking an irreversible MAO inhibitor or the day after taking a reversible MAO inhibitor. The time interval between stopping fluvoxamine and starting therapy with any MAO inhibitor should be at least a week.
If it is necessary to use fluvoxamine during pregnancy, the expected benefit of therapy for the mother and the possible risk to the fetus should be assessed. Fluvoxamine should not be used during lactation, because This active substance is excreted in small quantities in breast milk.
Orally, without chewing and with a small amount of water. Depression. The recommended starting dose is 50 or 100 mg (once, in the evening). It is recommended to gradually increase the starting dose to the effective level. The effective daily dose, usually 100 mg, is selected individually, depending on the patient's response to treatment. The daily dose can reach 300 mg. Daily doses above 150 mg should be divided into several doses. According to official WHO recommendations, treatment with antidepressants should be continued for at least 6 months of remission after a depressive episode. To prevent relapses of depression, it is recommended to take 100 mg of Fevarin once a day. Obsessive-compulsive disorders. It is recommended to start with a dose of 50 mg Fevarin per day for 3-4 days. The effective daily dose is usually from 100 to 300 mg. Doses should be increased gradually until an effective daily dose is reached, which should not exceed 300 mg in adults. Doses up to 150 mg can be taken as single doses, preferably in the evening. Daily doses over 150 mg are recommended to be divided into 2 or 3 doses. Doses for children over 8 years of age and adolescents: initial - 25 mg/day for 1 dose, maintenance - 50–200 mg/day. The daily dose should not exceed 200 mg. Daily doses above 100 mg are recommended to be divided into 2 or 3 doses. If there is a good response to the drug, treatment can be continued at an individually selected daily dose. If improvement is not achieved after 10 weeks of treatment, fluvoxamine should be discontinued. So far, no systematic studies have been organized that could answer the question of how long treatment with fluvoxamine can be carried out, however, obsessive-compulsive disorders are chronic in nature, and therefore it can be considered advisable to extend treatment with Fevarin beyond 10 weeks in patients who have responded well for this drug. The selection of the minimum effective maintenance dose should be done with caution on an individual basis. Some clinicians recommend concomitant psychotherapy in patients who have responded well to pharmacotherapy. Treatment of patients suffering from liver or kidney failure should begin with the lowest doses under strict medical supervision. Due to the lack of clinical experience, Fevarin is not recommended for the treatment of depression in children.
The most commonly observed symptom associated with the use of Fevarin is nausea, sometimes accompanied by vomiting. This side effect usually disappears in the first 2 weeks of treatment. Some side effects observed in clinical trials were often associated with symptoms of depression, and not with treatment with Fevarin. General: often (1–10%) - asthenia, headache, malaise. From the cardiovascular system: often (1–10%) - palpitations, tachycardia; sometimes (less than 1%) - postural hypotension. From the gastrointestinal tract: often (1–10%) - abdominal pain, anorexia, constipation, diarrhea, dry mouth, dyspepsia; rarely (less than 0.1%) - impaired liver function (increased levels of liver transaminases). From the central nervous system: often (1–10%) - nervousness, anxiety, agitation, dizziness, insomnia or drowsiness, tremor; sometimes (less than 1%) - ataxia, confusion, extrapyramidal disorders, hallucinations; rarely (less than 0.1%) - convulsions, manic syndrome. From the skin: often (1–10%) - sweating; sometimes (less than 1%) - skin hypersensitivity reactions (rash, itching, angioedema); rarely (less than 0.1%) - photosensitivity. From the musculoskeletal system: sometimes (less than 1%) - arthralgia, myalgia. From the reproductive system: sometimes (less than 1%) - delayed ejaculation; rarely (less than 0.1%) - galactorrhea. Other: rarely (less than 0.1%) - change in body weight; serotonergic syndrome, neuroleptic malignant syndrome-like condition, hyponatremia and antidiuretic hormone deficiency syndrome; very rarely - paresthesia, anorgasmia and taste perversion. When you stop taking fluvoxamine, withdrawal symptoms may develop - dizziness, paresthesia, headache, nausea, anxiety (most symptoms are mild and self-limiting). When discontinuing the drug, a gradual dose reduction is recommended. Hemorrhagic manifestations - ecchymosis, purpura, gastrointestinal bleeding.
No cases of overdose have been reported.
When used simultaneously with MAO inhibitors, there is a possibility of developing serotonin syndrome, especially when used simultaneously with irreversible non-selective MAO inhibitors. With simultaneous use, the plasma concentration of alprazolam, bromazepam, diazepam increases and their side effects increase due to the fact that fluvoxamine inhibits metabolic processes these benzodiazepines. With simultaneous use, the plasma concentration of amitriptyline, clomipramine, imipramine, maprotiline, trimipramine increases, which is apparently due to the fact that fluvoxamine is a non-competitive inhibitor of the CYP1A2 isoenzyme, with the participation of which the process of N-demethylation of these antidepressants occurs. simultaneous use with buspirone may reduce its effectiveness; with valproic acid - the effects of valproic acid may be enhanced; with warfarin - it is possible to increase the concentration of warfarin in the blood plasma and create a risk of bleeding; with galantamine - the likelihood of increased side effects of galantamine increases; with haloperidol - the concentration of lithium in the blood plasma increases. With simultaneous use, the concentration of carbamazepine in the blood plasma increases, which is due to inhibition of its metabolism in the liver, mainly due to the suppression of the activity of the CYP2D6 isoenzyme under the influence of fluvoxamine. With simultaneous use, the concentration of clozapine in plasma increases significantly blood, which in some patients is accompanied by the development of toxic effects of clozapine. With simultaneous use, it is possible to reduce the clearance of caffeine and enhance its effects. This interaction is due to the fact that fluvoxamine significantly inhibits the CYP1A2 isoenzyme, which is the main enzyme responsible for the metabolism of caffeine. When used simultaneously with metoclopramide, a case of the development of extrapyramidal disorders has been described. When used simultaneously with olanzapine, the concentration of olanzapine in the blood plasma increases; with propranolol - the concentration of propranolol in the blood plasma increases, which is apparently due to the inhibition by fluvoxamine of isoenzymes of the cytochrome P450 system involved in the metabolism of propranolol. When used simultaneously with theophylline, the concentration of theophylline in the blood plasma increases, which leads to the development of toxic reactions. This interaction is due to the fact that fluvoxamine significantly inhibits the CYP1A2 isoenzyme, which is the main enzyme responsible for the metabolism of theophylline. With simultaneous use, the clearance of tolbutamide and its metabolites decreases, which is due to inhibition of the CYP2C9 isoenzyme. There are isolated reports of increased side effects of phenytoin when used simultaneously with fluvoxamine. With simultaneous use, metabolism slows down and the clearance of quinidine decreases.
With depression, as a rule, there is a high likelihood of attempting suicide, which may persist until sufficient remission is achieved. Use with caution in patients with a history of seizures. If an epileptic seizure develops, treatment with fluvoxamine should be discontinued. In patients with hepatic or renal insufficiency, at the beginning of treatment, fluvoxamine should be prescribed in low doses under strict medical supervision. If symptoms due to increased liver enzyme activity occur, fluvoxamine should be discontinued. In elderly patients, the dose of fluvoxamine should be always increase more slowly and with greater caution. There are reports of the development of ecchymosis and purpura with the use of selective serotonin reuptake inhibitors. Given this, such drugs should be prescribed with caution, especially concomitantly with drugs that affect platelet function (for example, with atypical antipsychotics and phenothiazines, many tricyclic antidepressants, NSAIDs, including acetylsalicylic acid), as well as in patients with a history of bleeding. During the treatment period, alcohol consumption is not allowed. Due to the lack of clinical experience, fluvoxamine is not recommended for the treatment of depression in children. Effect on the ability to drive vehicles and operate machinery In patients whose activities require concentration and high speed of psychomotor reactions, fluvoxamine should be used with caution until the individual response to treatment is fully determined. Treatment with MAO inhibitors should be discontinued 2 weeks before starting fluvoxamine. Fluvoxamine may slow down the elimination of drugs metabolized with the participation of microsomal liver enzymes.
Stress, difficult life problems, worries, losses of loved ones and loved ones significantly affect the human nervous system. Sometimes external problems can drive you into a severe depressive state, from which it is very difficult to find a way out.
Many people, unable to get out of the shackles of anxiety and sadness, see only one way - suicide. However, doctors have found a method to combat depression. Antidepressant medications can help the patient bring back the joy of life. Fevarin is one of those saviors of the human soul that can be found on pharmacy shelves.
But for many it is unattainable in terms of acquisition - the price for a package of antidepressant is more than high. Fortunately, a wide range of pharmaceutical drugs allows you to find more affordable analogues of Fevarin, which have a similar method of influencing the human nervous system, while having an attractive price.
The American-made drug belongs to the group of antidepressants included in list B (potent drugs dispensed from pharmacies strictly according to a doctor’s prescription).
Let's pay attention to brief instructions for using Fevarin and prices in pharmacies.
The basis of the antidepressant is the substance fluvoxamine. Each tablet also contains excipients - silicon dioxide, mannitol, sodium and starch.
An antidepressant is prescribed for severe forms of disturbances in a person’s psycho-emotional state:
It is used not only directly during the period of a nervous disorder, but also as a preventive measure to prevent relapse after treatment.
An antidepressant has a serious effect on a person’s well-being, therefore in some cases, its use is strictly prohibited. The list of contraindications includes:
During pregnancy and breastfeeding, the drug can be prescribed in extreme cases and treatment should be accompanied by the close attention of a doctor.
Antidepressant may cause a deterioration in the psycho-emotional state of a patient with suicidal tendencies. In this case, the attending physician may refrain from prescribing this drug to the patient or prescribe it in a minimal dosage.
In addition, taking Fevarin can cause a number of side effects:
As can be seen from the impressive list of side effects, an antidepressant cannot be perceived as an easy and safe panacea for a bad mood. Even with strict adherence to all recommendations for use, the medication can have an extremely negative impact on human health.
Fevarin is available in tablet form. The cost depends on the content of the main active ingredient in the tablet:
An antidepressant has a powerful effect not only on a person’s nervous system, but also on his financial condition. It is also necessary to take into account that treatment requires completion of a full course, only in this case can you count on a positive result. Since one package contains only 15 tablets, you will have to pay a significant amount for the treatment of depression.
In order not to once again disturb your nervous system, shrouded in depression and anxiety, it is recommended to refrain from purchasing such an expensive drug.
And there is a significant reason for this - in the extensive stocks of any pharmacy you can find a number of drugs that are not inferior to Fevarin in effectiveness, but at the same time you will pay a significantly smaller amount of money for them.
A German-made antidepressant, listed on list B and sold in pharmacies strictly according to a doctor’s prescription.
Compound. The main active ingredient of the antidepressant is fluvoxamine.
Indications. Prescribed for depressive syndrome and obsessive-compulsive conditions. Effective in eliminating panic attacks, anxiety and unreasonable fears.
Contraindications. The main contraindication is individual intolerance to the active ingredient included in the drug. Also, Deprivox should not be combined with other psychotropic drugs.
Price. The antidepressant is available in tablet form. For a package of the drug containing 20 tablets (100 milligrams of active substance each), you will have to pay in the range of 500 rubles.
Comparison with the original. The two drugs contain the same active substance – fluvoxamine. The indications for use are also absolutely identical. The analogue has significantly fewer contraindications, as well as a much more attractive price (500 rubles for 20 tablets containing 100 milligrams of fluvoxamine, versus 910 rubles for 15 tablets of Fevarin).
An antidepressant made in India, it belongs to list B (potent drugs that are dispensed from pharmacies with a doctor’s prescription).
Compound. The basis of the drug is the substance fluvoxamine.
Indications. Prescribed for mental disorders:
Contraindications. Taking the drug is contraindicated if:
Price. You can buy an antidepressant for an average of 400 rubles (10 tablets, each containing 100 milligrams of the active substance).
Comparison with the original. The two drugs are based on the substance fluvoxamine. The two antidepressants are also very similar in indications and contraindications. The main difference is that the analogue is much cheaper.
One of the most effective Russian antidepressants, which has a very long history of existence. Refers to drugs from list B (potent drugs dispensed from pharmacies only with a prescription).
Compound. The composition is based on the active ingredient of the same name – fluoxetine.
Indications. The antidepressant is aimed at combating such pathologies of the central nervous system as:
Contraindications. An antidepressant should not be taken if:
Price. You can buy Fluoxetine for an average of 60 rubles (20 capsules, each containing 20 milligrams of the main active ingredient). Of course, finding a cheaper analogue will not be easy!
Comparison with the original. Despite the different substances in the drugs, both antidepressants have a similar focus. Significant difference in price. Despite the low cost, Fluoxetine is recognized as one of the most powerful antidepressants in the history of pharmacology.
If you are overcome by severe depression, you should not give up and lose the colors of life. It is necessary to contact an experienced neurologist or psychotherapist who will select an effective medication and draw up a course of treatment.
It is important to remember that psychotropic drugs and medications used to normalize the functioning of the nervous system should absolutely not be prescribed to oneself! By unauthorizedly diagnosing yourself with depression and buying an antidepressant illegally, without a doctor’s prescription, you can significantly harm your health!
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