In recent years, there has been increasing attention to impairments in cognitive processes in recurrent depressive disorder (RDD) [1–3], which play an important role in the pathogenesis of this disease. Cognitive disorders are observed not only during a depressive episode, but also in the interictal period [4, 5]. They complicate the psychosocial adaptation of patients and increase their sensitivity to situational stress. In addition, the presence of cognitive impairment in depression worsens the therapeutic prognosis [6]. In this regard, when selecting drug treatment for depression, it is advisable to take into account the presence of cognitive dysfunction [7, 8]. This task is especially relevant if antidepressants are prescribed for the purpose of long-term anti-relapse therapy.
There is evidence that some antidepressants have a positive effect on cognitive processes [9–11]. Other medications used for depression may have a similar effect [12]. However, the mechanisms of this action remain largely unexplored. In the most general terms, we can still talk about their influence on neurotransmitter and neuroplastic processes. It is also assumed that the corresponding mechanisms affect the cytoarchitecture and functional connections of brain systems.
Sigma-1 receptors appear to play an important role in ensuring cognitive processes, which influence the neurotransmitter apparatus, prevent the degradation of neurons and, possibly, have a neuroplastic effect [13]. As has been shown experimentally [14], sigma-1 receptor agonists can have antiamnestic and neuroprotective effects.
Of the currently existing sigma-1 receptor agonists approved for clinical use, the most active is fluvoxamine, which at the same time belongs to the class of selective serotonin reuptake inhibitors. Fluvoxamine is clinically effective in a number of psychopathological conditions associated with cognitive deficits [14–16].
The purpose of this study was to examine the possible procognitive effects of fluvoxamine in patients with RDD who are in incomplete therapeutic remission (ITR).
The main objective of the study was to evaluate cognitive functions in patients with RDD who were in the NTR during 24 weeks of preventive therapy with fluvoxamine. Additional objectives were to assess the stability of the achieved remission, the level of social adaptation, and to identify any other relationships between the cognitive, affective and social characteristics of patients and changes in cognitive functions and drug dosage.
Precautions and interactions[ | ]
Prescribe the drug with caution to pregnant women and people whose work requires a quick mental reaction[5]. Patients taking fluvoxamine should never drink alcohol. When fluvoxamine is combined with antithrombotics or vitamin K antagonists, it is necessary to monitor prothrombin time and, if necessary, adjust the dose of antithrombotics or vitamin K antagonists[11]:633.
Fluvoxamine should not be taken simultaneously with MAO inhibitors; treatment with drugs of this group must be stopped 2 weeks before starting fluvoxamine [5] to avoid the risk of serotonin syndrome. An interval of one week should be maintained between the discontinuation of fluvoxamine and the administration of MAO inhibitors[12]. Prescribing SSRIs with other serotonergic drugs should also be avoided[13]. In addition, serotonin syndrome can occur when SSRI antidepressants are combined with buspirone, levodopa[14], herbal antidepressant drugs containing St. John's wort[15], with 5-hydroxytryptophan, S-adenosylmethionine (SAM, heptral)[16] and tryptophan[17 ], dextromethorphan, tramadol[13] and other opioid analgesics[18], carbamazepine, lithium preparations[13], metoclopramide[19] and some other drugs.
The drug slows down the metabolism of haloperidol and other neuroleptics of the group of butyrophenone derivatives, increasing their concentration in the blood by 2 times (at the same time the concentration of fluvoxamine increases by 2-10 times)[20], as a result of which it can reach a toxic level[21]. When fluvoxamine is combined with atypical antipsychotics olanzapine [22] or clozapine, the metabolism of this antipsychotic also slows down and its concentration in the blood increases [20] (when combined with clozapine - several times [22]).
Fluvoxamine also slows down the metabolism of some tricyclic antidepressants with a possible increase in their concentration in the blood and the development of intoxication; The combined use of fluvoxamine with beta-blockers, theophylline, caffeine, alprazolam, carbamazepine[20], phenytoin[12], warfarin[5] leads to similar effects. Increases the blood concentration of immunosuppressants[23], some benzodiazepines, propranolol[12]. It is not recommended to combine fluvoxamine with amitriptyline, clomipramine, imipramine, desipramine, carbamazepine[5], theophylline[12]. The drug potentiates the effect of alcohol[5], barbiturates[6]. Increases the side effects of cardiac glycosides, tryptophan[11]:633. In combination with warfarin, it can lead to increased bleeding[23]. In combination with benzodiazepines, fluvoxamine may increase the severity of psychomotor impairment. It is dangerous to combine fluvoxamine with lithium preparations, since this increases the effect of neurotoxicity [22] and increases the side effects of lithium preparations [11]: 633.
Fluvoxamine: reviews, analogues, instructions
Fluvoxamine is a modern antidepressant from the SSRI group. The medication has a pronounced antidepressant effect, the mechanism of its action is associated with the specific inhibition of serotonin reuptake by neurons in the brain.
Main characteristics
The drug is available in the form of film-coated tablets containing 50 or 100 mg of fluvoxamine maleate;
Pharmacotherapeutic effect
The drug is an antidepressant from the group of selective serotonin reuptake inhibitors.
Indications for use
The medication is intended to treat the following conditions:
Contraindications
- the presence of hypersensitivity to any components included in the medication;
- the presence of renal or liver failure;
- galactose intolerance, lactase deficiency.
Directions for use and dosage
Tablets can be divided beyond the dispensing line; They should be swallowed without chewing, with a sufficient amount of liquid.
Recommended initial dosage for the treatment of depressive disorders for adults: 50 – 100 mg/day once, the drug is usually taken at night. The dosage is increased gradually until the desired therapeutic effect occurs.
The optimal dosage is 100 mg/day and is directly related to the individual characteristics of each individual patient. The maximum permissible dosage is 300 mg/day. If the dosage is above 150 mg, it can be taken in 2-3 doses.
Treatment with this antidepressant should be carried out for at least six months after the disappearance of any manifestations of depressive disorders in patients.
For preventive purposes, the drug is taken in 1 dose in the amount of 100 mg/day.
Adults with obsessive-compulsive disorder are initially prescribed only 50 mg/day for 3-5 days. The dosage is increased gradually until the desired result is obtained. Effective dose – 100 – 300 mg/day.
As written in the instructions for use, after achieving the desired therapeutic effect, therapy is continued according to an individually developed scheme. If after 10 weeks from the start of use there is no improvement, the drug is discontinued.
Rules of treatment in pediatric practice
This drug and its analogues are not prescribed to children under 18 years of age as a treatment for depressive disorders.
In the presence of obsessive-compulsive disorders in children over 8 years of age, the initial dosage is 25 mg/day in one dose, as maintenance therapy – 50–200 mg/day.
To prescribe such a drug, it is necessary to know exactly the cause of mental disorders.
Side effects and complications
As a rule, the drug is well tolerated by patients, but if abused, systemic side effects may occur due to the action of fluvoxamine maleate, which is part of the composition, for example:
- The most common side effect associated with taking Fluvoxamine and its analogues is nausea, which is often accompanied by vomiting (usually resolves within the first 2 weeks of therapy).
- From the side of the central nervous system: insomnia, excessive agitation, headache, sometimes ataxia, tremor, hallucinations, confusion;
- From the cardiovascular system: rapid heartbeat, progressive hypotension, tachycardia;
- Gastrointestinal tract: epigastric pain, dry mouth, dyspeptic symptoms (bloating, constipation, diarrhea), anorexia; liver disorders (increased aminotransferase levels);
- From the urinary and reproductive system: impaired urination (enuresis) and ejaculation, anorgasmia is quite rarely observed.
- Musculoskeletal system: development of arthralgia, myalgia;
- From the skin and mucous membrane: rash, urticaria, increased sweating, angioedema.
- Others: asthenia, hyponatremia, weight loss or gain, serotonin syndrome, hemorrhage, seizures, manic syndrome, photophobia.
Use during pregnancy and lactation
Since the drug can negatively affect the condition of the fetus, treatment during pregnancy is not recommended. The medication can be used only in cases where the expected effect for the mother outweighs the risk for the fetus. It is excreted in breast milk, so feeding is prohibited during treatment.
Before use, it is important to consult with a specialist and take into account all the side effects of such a product, in order to avoid causing even more harm to the body.
Additional information about the drug
Depressive disorders are dangerous because they can have pronounced suicidal tendencies; therefore, in the first weeks of treatment, as well as until stable remission is achieved, the medication should be used with extreme caution,
During Fluvoxamine therapy, cases of akathisia (excitement syndrome) have been reported. Due to the fact that increasing the dose is unacceptable for patients with such symptoms, the drug is discontinued.
At the beginning of treatment, you need to monitor the level of glycemia in the blood (dose adjustment of antidiabetic drugs).
It is necessary to prescribe medication with extreme caution to patients with epileptic seizures. The medication is not prescribed in the presence of unstable epilepsy, and when treating patients with controlled seizures, their condition should be monitored. If epileptic seizures develop, the medication should be discontinued.
The drug can be prescribed for elderly people, but the dosage is selected individually for each patient.
For patients with impaired kidney and liver function, therapeutic treatment is carried out under the strict supervision of a specialist; the dosage for such patients should be minimal.
The effect of the drug on the reaction rate when controlling moving mechanisms
When taking the medication in doses up to 150 mg, no negative effects on the ability to drive were observed. At the same time, there were reviews of drowsiness during Fluvoxamine therapy.
Interaction with other drugs
Fluvoxamine and structural analogues are not prescribed in combination with monoamine oxidase inhibitors. You can start taking the medication only two weeks after stopping such medications. Before starting Fluvoxamine, it is necessary to reduce the dosage of antipsychotics (clozapine, olanzapine) and tricyclic antidepressants (clomipramine, imipramine, amitriptyline).
In patients who use anticoagulants, the drug can cause bleeding, so you need to carefully monitor the condition of such patients. During treatment with Fluvoxamine and other psychotropic drugs, patients are prohibited from drinking alcohol.
Fluvoxamine analogues
Structural analogues of the active substance:
- Avoxin KRKA, Slovenia;
- Fevarin PEJA SNEMIE, Netherlands.
These drugs have the same composition; for more detailed information, you can study patient reviews.
Reviews about the drug
This medication is widely used in medical practice, as it has a pronounced antidepressant effect and does not cause lethargy. You can purchase medicine only with a prescription.
Reviews about Fluvoxamine are very diverse. Some believe that its effectiveness is very low, while for others it is a panacea for depression. Negative reviews are possible due to self-treatment without consulting a doctor.
All the above information is for informational purposes only. Before carrying out therapy, study the reviews in detail and be sure to consult with a specialist; do not self-medicate. Take into account the individual characteristics of the body and follow the rules of treatment.
Source: //indepress.ru/antidepressantyi/fluvoksamin.html
Side effects of the drug Fluvoxamine Sandoz
The most common symptom associated with the use of the drug is nausea, sometimes accompanied by vomiting (usually disappears during the first 2 weeks of treatment). General condition: asthenia, discomfort. Cardiovascular system: palpitations, tachycardia, sometimes postural hypotension. Musculoskeletal system: sometimes - myalgia, arthralgia. Digestive system: abdominal pain, anorexia, constipation, diarrhea, dry mouth, dyspepsia; sometimes - impaired liver function (increased activity of liver transaminases); in very rare cases - a violation of taste. Nervous system: dizziness, headache, insomnia, drowsiness, tremor, nervousness, psychomotor irritability, anxiety; sometimes - ataxia, extrapyramidal symptoms, confusion, hallucinations. Skin: increased sweating; sometimes - rash, urticaria, angioedema. Genitourinary system: sometimes - delayed ejaculation, in very rare cases - anorgasmia. Other: increase/decrease in body weight, serotonin syndrome, phenomena resembling neuroleptic malignant syndrome, hyponatremia, syndrome of inappropriate secretion of antidiuretic hormone, hemorrhage, convulsions, manic state, galactorrhea, photosensitivity. The results of preclinical and clinical observations do not confirm that the drug can cause addiction. After stopping fluvoxamine, a withdrawal reaction is possible. Symptoms - dizziness, headache, nausea, vomiting, diarrhea, paresthesia, increased excitability, tremor, confusion, anxiety, palpitations, increased sweating, blurred vision, sleep. They usually occur in the first few days after discontinuation of the drug, in some cases - in case of violation of the recommended treatment regimen (skipping a dose). In general, the symptoms are mild and go away on their own; if treatment with Fluvoxamine Sandoz is stopped, it is recommended to gradually reduce the dose of the drug (over several weeks or months).
Fevarin tablets instructions for use - analogues - side effects - reviews
Fevarin is an antidepressant with the same mechanism of action as fluoxetine. As you know, the latter is the most used antidepressant on the domestic market.
Fevarin has a number of advantages. It is less likely to cause agitation, improves sleep, affects libido to a lesser extent, and has a mild sedative effect.
In some countries it has gained wide popularity among doctors and patients.
Release form
Fevarin is available in the form of white, round or oval tablets. One blister contains 15 tablets; one package can contain one or two blisters. Each tablet contains 50 or 100 mg of active ingredient. The dosage is indicated on the packaging. Tablets of different dosages vary in shape, 50 mg are round, 100 mg are oval.
Compound
Fevarin tablets contain the main active ingredient and auxiliary components. The main active ingredient of fevarin is fluvoxamine - it determines the mechanism of action of the drug, the therapeutic effect and the drug group.
//www.youtube.com/watch?v=zhrhRj6dmsk
Excipients include mannitol, starch, sodium, silicon, titanium compounds, hypromellose, macrogol and talc. The listed components do not affect the body, but play a role in the absorption of the drug in the gastrointestinal tract.
Pharmacological group
Fevarin is a psychotropic drug with antidepressant activity. The drug group is selective serotonin reuptake inhibitors (SSRIs). Fevarin, like its main active ingredient, is the representative of the group that has anti-anxiety activity.
Pharmacological properties
The mechanism of action of the drug is based on the selective blockade of the re-entry of serotonin into the cell after its release.
Normally, serotonin, as one of the mediators of the central nervous system, exits the neuron into the synaptic cleft between cells, binds to the receptors of the neighboring neuron, thus transmits information, and then returns back to its neuron. At the same time, this process occurs with thousands of serotonin molecules.
It has been proven that in people with depression and obsessions, the level of serotonin in brain cells is reduced.
Fevarin blocks the entry of this mediator into the cell, moreover, serotonin remains in the synaptic cleft longer and interacts with receptors more times.
Systematic intake of fevarin stimulates the synthesis of new serotonin in the neurons of the central nervous system. It takes time to start this process, which explains the delayed effect of the drug.
Thus, this drug increases the concentration of the mediator responsible for good mood, which helps fight depression and other emotional disorders.
In addition, fevarin slightly affects the exchange of two other mood mediators - dopamine and norepinephrine, which causes a number of side effects and contraindications. The drug, unlike many antidepressants, has virtually no effect on the metabolism of acetylcholine, the main mediator of the autonomic nervous system, which makes fevarin a safer medication.
Indications
The use of fevarin is justified in the following cases:
- Recurrent depressive disorder, mild or moderate episode of depression;
- Single episode of depression;
- Bipolar affective disorder, current episode of depression;
- Decreased mood in old age or with diseases of various organs and systems;
- Obsessive thoughts and/or movements;
- Somatoform and functional disorders in complex treatment.
Fevarin has a mild anti-anxiety effect, so it can be prescribed in cases where depressive or obsessive-compulsive syndrome is accompanied by anxiety, fear, and agitation.
Side effects
Fevarin, like any psychotropic drug, has a fairly large number of side effects.
The most common of them include loss of appetite, headache, dizziness, sleep disturbances, both insomnia and drowsiness, nausea, constipation, dry mouth.
These symptoms gradually increase as you take the drug, and then disappear on their own with constant use.
In addition, sometimes when taking fevarin there is a decrease or increase in body weight, development or worsening of endocrine metabolic diseases, and increased sweating. Allergic reactions occur quite often, usually manifested by hives and itchy skin.
Sometimes neurological disorders develop, most often of an extrapyramidal nature; such patients suffer from tremors of the arms and legs, and changes in handwriting and manner of speaking are possible. Neurological symptoms disappear over time on their own with systematic use of the drug.
In rare cases, fevarin can cause productive psychopathological symptoms - hallucinations, delusions, serotonin syndrome, disorders of consciousness.
Cases of pathological bleeding when taking fevarin associated with a decrease in platelet counts have also been described. Particular attention should be paid to this in patients who are prone to thrombocytopenia.
Some patients experience sexual dysfunction - decreased libido, erectile dysfunction, anorgasmia, menstrual irregularities.
Cases of the development of akathisia - the inability to maintain a motionless posture - have been described. Such patients constantly move themselves or make stereotypical movements of their limbs. This syndrome occurs in very rare cases with long-term use of large doses of fevarin and goes away after its discontinuation.
Many side effects are observed when using fevarin with other medications.
For example, when taking different groups of antidepressants together, or mixing with antihypertensive, antiarrhythmic drugs, antibiotics and cytostatics.
You should check with your doctor about the possibility of combination therapy. Another combination that is undesirable in terms of side effects is fevarin and alcohol. You should find out more about this.
Overdose
There are quite a few cases of fevarin overdose. The most often observed symptoms are from the brain - increased drowsiness, unbearable headache, dizziness, cases of coma are known.
In addition, the cardiovascular system suffers, the development of both bradyarrhythmias and tachyarrhythmias is possible, and a sharp drop in blood pressure is observed.
Reflexively, disturbances occur in the digestive system - abdominal pain, diarrhea, nausea, vomiting.
In most cases, an overdose of fevarin is deliberate and can be regarded as an act of suicide. No deaths were observed. The maximum dose of fevarin taken was 12 g, and the patient survived after medical care.
There is no evidence that the cause of suicide is the use of fevarin. Most likely, these actions are associated with the initial condition of the patients and incorrectly selected therapy.
There is no specific antidote for fevarin. If symptoms of overdose appear, you must call an ambulance. Standard detoxification therapy is carried out - gastric lavage, administration of sorbents, infusion therapy of solutions, symptomatic correction of disorders. Such patients are subject to hospitalization in the intensive care unit.
Instructions for use
The treatment regimen for fevarin depends on the pathology for which it was prescribed.
When treating depression, the initial dosage is 50 mg per day; if the drug is well tolerated, it is increased to 100 mg per day after about 4 days. After this, once a week you can increase the dosage until the desired result is achieved. The maximum recommended dose is 300 mg.
To achieve this, the concentration is increased every week by 50 mg per day. After achieving a therapeutic effect, the drug is used in the achieved dosage until all symptoms of depression are completely relieved. After this, they switch to maintenance therapy.
As a rule, it is enough to take 50-100 mg per day for six months.
For the treatment of obsessive-compulsive syndrome, an initial daily dosage of 50 mg is also prescribed, and then 100 mg. These numbers are gradually increased until a maximum of 300 mg is reached.
The difference is that most patients require a lower dose of fevarin and a shorter duration of use to treat compulsions.
As a rule, after 10 weeks of treatment, the drug can be gradually withdrawn, gradually replacing it with psychotherapeutic help.
If the patient takes 50-150 mg of the drug, a single dose is allowed. For example, in the morning during breakfast. If the dose of fevarin is higher, it is better to switch to a two- or three-time dose. For example, take 150 mg of the drug in the morning and evening, or 100 mg in the morning, lunch and evening.
If you abruptly stop taking fevarin, withdrawal syndrome may develop, which you should learn more about.
Analogs
There are a number of drugs whose main active ingredient is fluvoxamine. Such drugs include:
- Avoxin;
- Luvox;
- Faverine;
- Favoxil;
- Fluvoxamine-Sandoz.
All of the drugs listed are produced by different companies, and therefore have different trade names. They differ in excipients, absorption and distribution in the body. It is not recommended to replace one drug with another.
Reviews
Diana M .: “After divorcing my husband, I had terrible depression, obsessive thoughts and generally felt bad. I wasn’t afraid to go to a psychotherapist who prescribed fevarin. I drank it, gradually increasing the dosage.
The first two weeks there were many side effects such as insomnia, nausea, and occasional sweating. Two weeks later everything passed and life began to sparkle with new colors.
Now I am very glad that I started taking the drug, I recommend it to everyone, but only after consulting a doctor.”
Ekaterina P .: “Depression hit me completely unexpectedly. It’s just that at one point life began to deteriorate, everything around became gray. My doctor prescribed Fevarin to me; the drug was quite expensive, but I decided to buy it.
At first everything was fine, there were no side effects, the product helped me. After about a month or a little earlier, I began to notice that my appearance was changing. When I stepped on the scale, I was simply horrified, there was +15 kg to my weight, I don’t know how I didn’t notice it before.
I stopped taking Fevarin and asked to be prescribed another drug, excess weight is a new reason for depression.”
Review from a psychiatrist : “Fevarin is a standard representative of its group of drugs. Selective serotonin reuptake inhibitors are the most commonly used antidepressants.
The advantage of fevarin among representatives of this group is its sedative effect. When prescribing other drugs, it is often necessary to supplement therapy with light tranquilizers; when taking fevarin, you can get by with one tablet.
The drug is well tolerated.”
Source: //antidepressant.ru/fevarin
