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Sustanon steroid medication from the group of tetracyclic antidepressants, an antagonist of presynaptic and postsynaptic α 2 receptors in the central nervous system and enhances central noradrenergic and serotonergic. Mirtazapine sedative properties due to its antagonistic activity against H 1 histamine receptors. Mirtazapine generally well tolerated. At therapeutic doses, has practically no anticholinergic action and almost no effect on the cardiovascular system.In clinical conditions also appear anxiolytic and hypnotic properties, therefore mirtazapine is most effective in anxiety depressions of different genesis. The antidepressant effect appears after 1 to 2 weeks of treatment.

Pharmacokinetics
Following oral administration of the drug mirtazapine is rapidly absorbed (bioavailability of about 50%), reaching a maximum concentration in plasma after about 2 hours. About 85% of the mirtazapine is bound to plasma proteins. The average half-life of 20 to 40 hours (of 65 hour rarely). The shorter half-lives observed in young people. The equilibrium concentration is established in 3-5 days. The recommended dose range pharmacokinetic mirtazapine have a linear dependence on the dose administered. Food intake has no effect on the pharmacokinetics of the drug.
Mirtazapine is extensively metabolised and excreted in the urine and faeces within a few days. The main ways of its metabolism in the body are demethylation and oxidation followed by conjugation.Cytochrome R450- dependent enzymes CYP2D6 and CYP1A2 are involved in the formation of 8-hydroxy metabolite of mirtazapine, while as CYP3A4 presumably determines the formation and the N-demethylated metabolites N-oxidized. The clearance of mirtazapine is reduced in patients with renal or hepatic insufficiency.

Indications
Depressive of different etiology.

Contraindications
. Hypersensitivity to mirtazapine or any other components of the preparation
. Simultaneous treatment with monoamine oxidase inhibitors (MAOIs)
Age 18 years (effectiveness and safety have not been established). Precautions:

  • epilepsy and organic brain damage (on the background of therapy with Mirzaten in rare cases may develop convulsions);
  • hepatic or renal failure;
  • heart disease (conduction disturbances, angina or recent myocardial infarction).
  • cerebrovascular disease (including a history of ischemic attack..);
  • hypotension, and conditions that predispose to hypotension (including degidrotatsii and hypovolemia..);
  • patients who abuse drugs, drug addiction, mania, hypomania.
  • impaired urination in t h, prostatic hyperplasia..;
  • Acute angle-closure glaucoma, and increased intraocular pressure;
  • diabetes.

Pregnancy and lactation
The safety of the drug Mirzatena during pregnancy has not been established, so it can be used during pregnancy only when the benefits to the mother outweighs the potential risk to the fetus and under medical supervision.
The use during lactation and breast feeding is not recommended (no data for the withdrawal of the drug in breast milk).

Dosing and Administration
The inside is not liquid, squeezed small amounts of water.
Adults: initial dose – 15 mg per day, 4 days it can be increased up to 30 mg / day, 10 days later, with no effect – up to 45 mg per day.
Elderly patients: the recommended dose is the same as that for adults.
In order to achieve a satisfactory effect and safety, increasing the dose should be under close medical supervision.
In renal and hepatic insufficiency:. daily dose should be reduced by about 1/3 of the
daily dose should preferably be taken at a time at night. It is also possible to receive fractional doses equally spaced throughout the day.
The course of treatment – 4-6 months. Treatment canceled gradually.

Side Effects
From the nervous system: drowsiness, impaired concentration, is more common in the first weeks of treatment (dose reduction generally does not lead to a reduction in sedation, but may reduce the antidepressant effect); in rare cases: psychomotor retardation, anxiety, hyperkinesia, myoclonus, hypokinesia, lethargy, hypersensitivity, tremors, convulsions, fatigue, mania, nightmares / vivid dreams.
From the side of hematopoiesis: rarely oppression blood (graiulotsitopeniya, neutropenia, eosinophilia , agranulocytosis, aplastic anemia and thrombocytopenia); increased activity of transaminases in the blood plasma.
From sustanon steroid the digestive system: nausea, vomiting, constipation, abdominal pain.
From the urogenital system:. dysmenorrhea
Cardio vascular system: seldom possible orthostatic hypotension, decreased blood pressure.
Other: increased appetite and increased body weight, dizziness, headache, edema syndrome; rare: urticaria, back pain, arthralgia, myalgia, dysuria, “cancellation” syndrome, dry mouth, thirst.

Overdose
depression of the central nervous system with disorientation, prolonged sedation, tachycardia, hallucinations, a moderate increase or decrease in blood pressure.
Treatment: gastric lavage, activated charcoal, symptomatic therapy.

Interaction with other medicines
Mirtazapine may potentiate the inhibitory effect of alcohol on the central nervous system. In connection with these patients during treatment to abstain from alcohol.
Mirtazapine should not be used concurrently with MAO inhibitors or within 2 weeks after cessation of use.
Mirtazapine may potentiate the sedative effects of benzodiazepines.
Caution is required in cases where such strong inhibitors of CYP3A4 such as HIV protease inhibitors, azole antifungals, erythromycin and nefazodone, mirtazapine used simultaneously.
mirtazapine dosage may be reduced from the beginning or cimetidine concurrent treatment increased when cimetidine treatment is completed.

special instructions

  • the appointment of antidepressants in patients with schizophrenia or other psychotic disorders, psychotic disorders may potentiate or of aggravated; depressive phase can be replaced by a manic;
  • since there is a risk of suicide, especially at the beginning of treatment, patients should be given only a small amount of pellets;
  • despite the fact that atidepressanty not addictive, abrupt withdrawal of therapy can cause nausea, headache and malaise;
  • elderly patients often more sensitive, especially in relation to adverse events antidepressants.
  • when the signs of jaundice, treatment should be interrupted.
  • suppression of bone marrow function, manifested as granulocytopenia or agranulocytosis is rare and usually occurs after 4-6 weeks of treatment and recovered after discontinuation of treatment. The physician should inform the patient that the appearance of symptoms such as fever, sore throat, stomatitis, and other signs of influenza-like syndrome; it is necessary sustanon steroid to stop treatment, consult a doctor do a blood test.

Effects on ability to drive and use machines
During treatment Mirzatenom should avoid the performance of potentially hazardous activities that require high speed of psychomotor reactions, such as driving a car or operating machinery. steroiden kaufen

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