3rd generation antidepressants are the most used group of drugs in recent years; they are more purified and therefore less toxic. Fevarin (Fluvoxamine) became one of the first antidepressants of the SSRI group (selective serotonin reuptake inhibitors). It began to be used in clinical practice in 1983 and by 1993, 10 million people had already undergone treatment for depression. Belong to 3rd generation antidepressants.
Pharmacological action of fevarin
The action of the antidepressant is based on selective blocking of the reuptake of the neurotransmitter serotonin by neurons in the brain. At the same time, the drug minimally affects noradrenergic transmission and has a weak ability to bind to m-cholinergic receptors, dopamine, as well as histamine and a- and b-adrenergic receptors. Thus, “Fevarin” has virtually no effect on norepinephrine, which activates the sympathetic nervous system and ensures the readiness of the human body to overcome unexpected extreme situations.
The positive effect of the drug fevarin is observed by the end of the first week of use; optimal effectiveness, however, occurs after 2-3 weeks.
Comparative studies of the effectiveness of various antidepressants have shown that the antidepressant activity of Fevarin is at least equivalent to:
- "gold standard" - amitriptyline
- MAOI drugs
- To fluoxetine, however, the frequency of side effects was observed 2 times less often
- Fevarin effectively stabilizes mood, removes symptoms of depression, melancholy, anxiety, suicidal thoughts, and normalizes sleep
- Fevarin belongs to the group of antidepressants with a balanced effect and, as a rule, does not have a sedative or stimulating effect. Considering the absence of a negative impact on cognitive functions: attention, memory, decision-making, the possibilities of its use for people engaged in mental work are expanding
- Fevarin does not affect the ability to drive a car
- Fevarin can be recommended for children starting from 6 years of age
Indications for use
:
- treatment of depression; mild, severe depression, recurrent depression, resistant depression
- treatment of obsessive-compulsive disorders (OCD)
- panic disorders and panic attacks
- post-traumatic stress disorder
- social phobia
- eating disorder (bulimia)
- obsessive desire to gamble (gambling)
- compulsive buying syndrome
- Hair pulling syndrome (trichotillomania)
- premenstrual dysphoric disorder (PDD)
- prevention of depression
Dosage and method of administration
:
- The drug should be taken in the evening, once a day, and washed down with plenty of water. The initial dosage is 50 mg per day for 7-14 days, depending on the individual response of the patient, the dose can be increased to 200 mg per day. The dosage should be increased gradually. After successful treatment of a depressive episode, it is necessary to take Fevarin for another six months (according to official WHO recommendations).
- The initial prophylactic dose to prevent relapse of depression is 100 mg/day.
- The duration of therapy with Fevarin is carried out until all symptoms disappear completely. When treating depression, the course of taking the drug lasts 6-12 months. In the treatment of generalized anxiety and panic disorder – even longer.
- Plasma caffeine levels may increase while taking Fevarin. Therefore, if you consume large quantities of drinks containing caffeine and if you develop adverse effects of caffeine such as tremor, palpitations, nausea, anxiety, insomnia, it is necessary to reduce your caffeine intake while taking Fevarin.
Side effects
The most commonly observed adverse symptom associated with the use of Fevarin is nausea, sometimes accompanied by vomiting. This side effect usually disappears in the first 2 weeks, so treatment is started with 50 mg at night and the dose is increased after 2 weeks to 100 mg.
From the cardiovascular system
: palpitations, sometimes - ostural hypotension (fainting caused by a change in body position, for example: when suddenly getting out of bed).
From the gastrointestinal tract
: abdominal pain, constipation, diarrhea, dry mouth.
From the side of the central nervous system
: nervousness, anxiety, dizziness, insomnia or drowsiness.
From the skin
: sweating, sometimes - hypersensitivity skin reactions (rash, itching).
From the reproductive system
: sometimes - delayed ejaculation.
Withdrawal of the drug
:
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.
Interaction with other drugs
:
Simultaneous use of Fevarin and tricyclic antidepressants (amitriptyline, imipramine), anticoagulants (warfarin), antipsychotics (clozapine, olanzapine), tacrine, theophylline, methadone, mexiletine, propranolol, carbamazepine, cyclosporine, tramadol, benzodiazepines (triazolam, midazolam, alprazolam, diazepam) not desirable due to the possibility of increasing their concentration in plasma. The dosage of these drugs should be reduced while taking fluvoxamine.
Contraindications
:
- hypersensitivity to fluvoxamine or to one of the excipients included in the drug
- simultaneous use with MAO inhibitors
Carefully
:
- liver and kidney failure
- history of epilepsy
- use during pregnancy and lactation Data from a small number of observations did not reveal any adverse effects of fluvoxamine on pregnancy. Potential risk unknown. Caution should be exercised during pregnancy. Fevarin passes into breast milk in small quantities. In this regard, it cannot be used during breastfeeding.
© Matyash Polina Aleksandrovna Clinical (medical) psychologist psychologist-sexologist, neuropsychologist practicing psychologist-consultant
© Matyash Alexander Afanasyevich Chief psychotherapist of the city, psychotherapist of the highest category psychiatrist, neurologist
© Consultative Internet project on practical psychology and psychotherapy Matyash.info
Category:Experts
Previously Suicide Prevention. Forecast for May 2012
Later Suicide prevention. Forecast for June 2012
Fevarin, 100 mg, film-coated tablets, 30 pcs.
As with the use of other psychotropic drugs, it is not recommended to consume alcohol during treatment with Fevarin®.
Suicide/suicidal ideation or clinical deterioration
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 major 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 are known to be at greater risk of suicidal ideation or suicide attempts before treatment 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.
Children's 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 the lack of clinical experience, the use of fluvoxamine in children for the treatment of depression cannot be recommended. 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.
Additionally, long-term safety data for children and adolescents regarding growth, development, and cognitive development are lacking.
Adults (18 to 24 years old)
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. When prescribing fluvoxamine, the risk of suicide should be weighed against the benefits of its use.
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 greater caution.
Akathisia/psychomotor agitation
The development of akathisia associated with fluvoxamine is characterized by subjectively unpleasant and painful anxiety. 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 liver or kidney failure should begin with low doses and such patients should be under strict medical supervision. In rare cases, treatment with fluvoxamine may lead to an increase in the 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 Fevarin 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, reaching the point of delirium or coma - in such cases, treatment with fluvoxamine should be stopped and appropriate symptomatic treatment should be started.
Metabolic and nutritional disorders
As with the use of other selective serotonin reuptake inhibitors, in rare cases hyponatremia may occur, which reverses after discontinuation of fluvoxamine. Some cases have been caused by antidiuretic hormone deficiency syndrome. 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 Fevarin® 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. and in patients with a history of bleeding or who are prone to bleeding (eg, thrombocytopenia or coagulation disorders).
Cardiac disorders
Increased risk of prolongation of the QT interval/paroxysmal ventricular tachycardia of the "pirouette" type 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)
There is limited clinical experience with the use of fluvoxamine in conjunction with ECT, so such therapy should be carried out with caution.
Withdrawal reactions
If you stop taking fluvoxamine, the syndrome “side effects” may develop.
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.
Impact on the ability to drive vehicles and operate machinery
Fevarin®, administered to healthy volunteers in doses up to 150 mg, had no or negligible effect on the ability to drive a car and control 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.
Scheme for correct withdrawal of fevarin
In order to prevent the development of fevarin withdrawal syndrome, it is necessary to strictly adhere to a specific discontinuation regimen. Its main principle is a gradual reduction in dosage until complete withdrawal of the drug. This allows the cells of the central nervous system to relearn how to function without an additional stimulant, which is fevarin.
First of all, it is worth remembering that after achieving remission in the treatment of any mental illness, it is necessary to continue taking the drug for preventive purposes. To do this, the dose of fevarin is reduced by 50 mg per week until a dosage of 100 mg per day is reached and thus taken for about six months. After this, you can think about stopping the drug.
Stopping taking fevarin does not last long - one to two weeks. The dose is again reduced by 50 mg, taken for a week or two weeks, after which the drug is completely abandoned. If the above-mentioned complaints occur when discontinuing this regimen, you should consult a doctor.
