Антидепрессант, селективный ингибитор обратного захвата серотонина. Обладает бициклической структурой, отличной от структуры других известных антидепрессантов.; Оказывает антидепрессивное и анксиолитическое действие при достаточно выраженном стимулирующем (активизирующем) эффекте.; Антидепрессивное (тимоаналептическое) действие связано со способностью пароксетина избирательно блокировать обратный захват серотонина пресинаптической мембраной, чем обусловлено повышение свободного содержания этого нейромедиатора в синаптической щели и усиление его активности в ЦНС.; Влияние на м-холинорецепторы, - и β-адренорецепторы незначительно, что определяет крайне слабую выраженность соответствующих побочных эффектов.
Показания к применению
Эндогенные, невротические и реактивные депрессии.
Противопоказания
Одновременный прием ингибиторов МАО и период до 14 дней после их отмены, повышенная чувствительность к пароксетину.
Применение при беременности и в период грудного вскармливания
При беременности назначение допустимо только в случае крайней необходимости.; Категория действия на плод по FDA — C.; На время лечения следует прекратить грудное вскармливание (пароксетин проникает в грудное молоко в концентрациях, близких к таковым в сыворотке крови).
Способ применения и дозы
При приеме внутрь начальная доза составляет 10-20 мг/сут. При необходимости, в зависимости от показаний, дозу повышают до 40-60 мг/сут. Увеличение дозы проводят постепенно - на 10 мг с интервалом в 1 неделю. Частота приема - 1 раз/сут. Лечение длительное. Эффективность терапии оценивается через 6-8 недель.; Для пожилых и ослабленных больных, а также при нарушениях функции почек и печени начальная доза - 10 мг/сут; максимальная доза - 40 мг/сут.
Побочное действие
Со стороны ЦНС: редко (при применении в дозах более 20 мг/сут) - сонливость, тремор, астения, бессонница.; Со стороны пищеварительной системы: редко (при применении в дозах более 20 мг/сут) - тошнота, сухость во рту; в отдельных случаях - запоры.; Прочие: редко (при применении в дозах более 20 мг/сут) - усиление потоотделения, нарушения эякуляции.
Передозировка
Симптомы: тошнота, рвота, тремор, мидриаз, сухость во рту, раздражительность, нистагм, ажитация, потливость, сонливость, синусовая тахикардия, судороги, брадикардия, повышение АД, узловой ритм. В очень редких случаях, при одновременном приеме с другими психотропными средствами и/или алкоголем возможны изменения на ЭКГ, кома. При выраженной передозировке - серотониновый синдром, редко - рабдомиолиз.; Лечение: промывание желудка, прием активированного уголя. При необходимости проводят симптоматическую терапию. Специфического антидота нет.
Взаимодействие с другими лекарственными средствами
Одновременный прием антацидных средств не влияет на всасывание и фармакокинетические параметры Пароксетина. Противопоказано одновременное применение Пароксетина с ингибиторами МАО. При одновременном назначении с Пароксетином увеличивается концентрация проциклидина. В связи ингибированием пароксетином цитохрома Р450 возможно усиление эффекта барбитуратов, фенитоина, непрямых антикоагулянтов, трициклических антидепрессантов, фенотиазиновых нейролептиков и антиаритмиков класса 1С, метопролола и повышение риска развития побочных эффектов при одновременном назначении этих лекарственных средств. При одновременном назначении с препаратами, ингибирующими ферменты печени, может потребоваться снижение дозы Пароксетина. Пароксетин увеличивает время кровотечения на фоне одновоременного приема варфарина (при неизмененном протромбиновом времени). При одновременном назначении Пароксетина с атипичными нейролептиками, трициклическими антидепрессантами, препаратами фенотиазинового ряда, НПВС (в т.ч. ацетилсалициловой кислотой) возможно нарушение прооцесса свертывания крови. Одновременное назначение Пароксетина с серотонинергическими препаратами (трамадол, суматриптан) может привести к усилению серотонинергического эффекта. Отмечено взаимное усиление действия триптофана, препаратов лития и пароксетина. При одновременном назначении Пароксетина с фенитоином и другими противосудорожными препаратами возможно увеличение частоты побочных эффектов. Пароксетин намного слабее подавляет антигипертензивные эффекты гуанетидина по сравнению с антидепрессантами, ингибирующими захват норадреналина.
Особые указания
Прекращение применения пароксетина следует проводить, постепенно уменьшая дозу, во избежание синдрома отмены, который проявляется головокружением, тошнотой, рвотой, бессонницей, спутанностью сознания, повышенным потоотделением.; В период лечения пароксетином противопоказано употребление алкоголя.; С осторожностью применять через 14 дней после отмены ингибиторов МАО, постепенно увеличивая дозу. Ингибиторы МАО не следует назначать в течение 2 недель после полной отмены пароксетина.; При одновременном применении с препаратами, ингибирующими метаболизм ферментов печени, пароксетин следует применять в наименьших рекомендуемых дозах. При одновременном применении с препаратами, индуцирующими метаболизм ферментов, не требуется изменения начальных доз пароксетина.; С осторожностью применять пароксетин с препаратами лития (рекомендуется контролировать концентрации лития в плазме крови), пероральными антикоагулянтами.; В экспериментальных исследованиях не установлено канцерогенных и мутагенных свойств пароксетина.; Влияние на способность к вождению автотранспорта и управлению механизмами; С осторожностью применять у пациентов, деятельность которых связана с необходимостью высокой концентрации внимания и быстроты психомоторных реакций.
Влияние на способность управлять автомобилем и движущимися механизмами
Несмотря на то, что пароксетин не ухудшает когнитивные и психомоторные функции, пациенты должны воздерживаться или соблюдать предельную осторожность при управлении автомобилем и занятиях другими потенциально опасными видами деятельности, требующими повышенной концентрации внимания и быстроты психомоторных реакций.
Форма выпуска
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Обладает бициклической структурой, отличной от структуры других известных антидепрессантов.; Оказывает антидепрессивное и анксиолитическое действие при достаточно выраженном стимулирующем (активизирующем) эффекте.; Антидепрессивное (тимоаналептическое) действие связано со способностью пароксетина избирательно блокировать обратный захват серотонина пресинаптической мембраной, чем обусловлено повышение свободного содержания этого нейромедиатора в синаптической щели и усиление его активности в ЦНС.; Влияние на м-холинорецепторы, - и β-адренорецепторы незначительно, что определяет крайне слабую выраженность соответствующих побочных эффектов."}}]},{"id":3,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Эндогенные, невротические и реактивные депрессии."}}]},{"id":4,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Одновременный прием ингибиторов МАО и период до 14 дней после их отмены, повышенная чувствительность к пароксетину."}}]},{"id":5,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"При беременности назначение допустимо только в случае крайней необходимости.; Категория действия на плод по FDA — C.; На время лечения следует прекратить грудное вскармливание (пароксетин проникает в грудное молоко в концентрациях, близких к таковым в сыворотке крови)."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"При приеме внутрь начальная доза составляет 10-20 мг/сут. При необходимости, в зависимости от показаний, дозу повышают до 40-60 мг/сут. Увеличение дозы проводят постепенно - на 10 мг с интервалом в 1 неделю. Частота приема - 1 раз/сут. Лечение длительное. Эффективность терапии оценивается через 6-8 недель.; Для пожилых и ослабленных больных, а также при нарушениях функции почек и печени начальная доза - 10 мг/сут; максимальная доза - 40 мг/сут."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Со стороны ЦНС: редко (при применении в дозах более 20 мг/сут) - сонливость, тремор, астения, бессонница.; Со стороны пищеварительной системы: редко (при применении в дозах более 20 мг/сут) - тошнота, сухость во рту; в отдельных случаях - запоры.; Прочие: редко (при применении в дозах более 20 мг/сут) - усиление потоотделения, нарушения эякуляции."}}]},{"id":8,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Симптомы: тошнота, рвота, тремор, мидриаз, сухость во рту, раздражительность, нистагм, ажитация, потливость, сонливость, синусовая тахикардия, судороги, брадикардия, повышение АД, узловой ритм. В очень редких случаях, при одновременном приеме с другими психотропными средствами и/или алкоголем возможны изменения на ЭКГ, кома. При выраженной передозировке - серотониновый синдром, редко - рабдомиолиз.; Лечение: промывание желудка, прием активированного уголя. При необходимости проводят симптоматическую терапию. Специфического антидота нет."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Одновременный прием антацидных средств не влияет на всасывание и фармакокинетические параметры Пароксетина. Противопоказано одновременное применение Пароксетина с ингибиторами МАО. При одновременном назначении с Пароксетином увеличивается концентрация проциклидина. В связи ингибированием пароксетином цитохрома Р450 возможно усиление эффекта барбитуратов, фенитоина, непрямых антикоагулянтов, трициклических антидепрессантов, фенотиазиновых нейролептиков и антиаритмиков класса 1С, метопролола и повышение риска развития побочных эффектов при одновременном назначении этих лекарственных средств. При одновременном назначении с препаратами, ингибирующими ферменты печени, может потребоваться снижение дозы Пароксетина. Пароксетин увеличивает время кровотечения на фоне одновоременного приема варфарина (при неизмененном протромбиновом времени). При одновременном назначении Пароксетина с атипичными нейролептиками, трициклическими антидепрессантами, препаратами фенотиазинового ряда, НПВС (в т.ч. ацетилсалициловой кислотой) возможно нарушение прооцесса свертывания крови. Одновременное назначение Пароксетина с серотонинергическими препаратами (трамадол, суматриптан) может привести к усилению серотонинергического эффекта. 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Ингибиторы МАО не следует назначать в течение 2 недель после полной отмены пароксетина.; При одновременном применении с препаратами, ингибирующими метаболизм ферментов печени, пароксетин следует применять в наименьших рекомендуемых дозах. 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