Пароксетина гидрохлорида гемигидрат 22.2 мг, что соответствует содержанию пароксетина 20 мг.
Фармакологические свойства
Антидепрессант. Является селективным ингибитором обратного захвата серотонина (5-гидрокситриптамина, 5-НТ) нейронами головного мозга, что определяет его антидепрессивное действие и эффективность при лечении обсессивно-компульсивного (ОКР) и панического расстройства. При метаболизме пароксетина не нарушается обусловленный его действием селективный захват 5-НТ нейронами. Пароксетин обладает низким аффинитетом к м-холинорецепторам. Обладая селективным действием, в отличии от трициклических антидепрессантов, пароксетин показал низкий аффинитет к α1-, α2-, β-адренорецепторам, а также к допаминовым, 5HT1-подобным, 5HT2-подобным и гистаминовым H1-рецепторам. Пароксетин не нарушает психомоторные функции и не потенцирует угнетающие действие на них этанола. По данным исследования поведения и ЭЭГ у пароксетина выявляются слабые активирующие свойства, когда он назначается в дозах выше тех, которые необходимы для ингибирования захвата 5-НТ. У здоровых добровольцев он не вызывает значительного изменения уровня АД, ЧСС и ЭЭГ.
Показания к применению
Депрессия всех типов, включая реактивную, тяжелую эндогенную депрессию и депрессию, сопровождающуюся тревогой
Обсессивно-компульсивное расстройство (ОКР)
Паническое расстройство, в т.ч. со страхом пребывания в толпе (агорафобией)
Одновременный прием ингибиторов МАО и период 14 дней после их отмены
Нестабильная эпилепсия
Беременность и период лактации (грудного вскармливания)
Детский возраст
Повышенная чувствительность к компонентам препарата. С осторожностью: при печеночной недостаточности, почечной недостаточности, закрытоугольной глаукоме, гиперплазии предстательной железы, мании, патологии сердца, эпилепсии, судорожных состояниях, одновременном назначении электроимпульсной терапии, одновременном приеме препаратов, повышающих риск кровотечения, наличии факторов риска повышенной кровоточивости и заболеваниях, повышающих риск кровоточивости, а также пациентам пожилого возраста.
Применение при беременности и в период грудного вскармливания
Препарат противопоказан к применению при беременности и в период лактации.
Способ применения и дозы
Таблетки Адепресс принимать 1 раз/сут, утром, во время еды, не разжевывая, запивая водой. Доза подбирается индивидуально в течение первых 2-3 недель после начала терапии и впоследствии при необходимости корректируется. Эффект в большинстве случаев развивается постепенно. Дозу следует увеличивать на 10 мг каждую неделю до достижения терапевтического эффекта. Максимальная суточная доза не должна превышать 60 мг/сут. При почечной и/или печеночной недостаточности рекомендуемая доза составляет 20 мг/сут. Для пожилых пациентов суточная доза не должна превышать 40 мг. Для предотвращения рецидивов необходимо проводить поддерживающую терапию. После исчезновения симптомов депрессии этот курс может составлять 4-6 мес, а при обсессивных и панических расстройствах - более 4-6 мес. Следует избегать резкой отмены препарата. В целях предупреждения развития синдрома отмены прекращение приема препарата Адепресс следует проводить постепенно.
Побочное действие
Со стороны ЦНС и периферической нервной системы: часто - сонливость или бессонница, тремор, астения, головокружение, тревога; иногда - спутанность сознания, галлюцинации, экстрапирамидные расстройства, парестезии, снижение способности к концентрации внимания; редко - судороги, мании; очень редко - серотониновый синдром (ажитация, гиперрефлексия, диарея), панические расстройства. Со стороны органов чувств: в отдельных случаях - нарушение зрения, мидриаз. Со стороны костно-мышечной системы: редко - миастения, миоклония, артралгия, миалгия. Со стороны мочевыделительной системы: учащенное мочеиспускание; редко - задержка мочи. Со стороны половой системы: расстройства эякуляции, расстройства либидо; редко - гиперпролактинемия/галакторея, аноргазмия. Со стороны пищеварительной системы: снижение аппетита, тошнота, рвота, сухость во рту; иногда - запоры или диарея; в отдельных случаях - гепатит. Со стороны сердечно-сосудистой системы: ортостатическая гипотензия. Аллергические реакции: редко - сыпь, крапивница, экхиматозы, зуд, ангионевротический отек. Прочие: повышенное потоотделение; в единичных случаях - гипонатриемия, нарушение секреции антидиуретического гормона.
Передозировка
Симптомы: тошнота, расширение зрачков, лихорадка, изменения АД, головная боль, непроизвольные мышечные сокращения, ажитация, тревожность, тахикардия. В очень редких случаях, при одновременном приеме с другими психотропными средствами и/или этанолом (алкоголем), возможны изменения на ЭКГ, кома. Лечение: промывание желудка, прием активированного угля. При необходимости проводят симптоматическую терапию. Специфического антидота нет.
Особые указания
Во избежание развития злокачественного нейролептического синдрома с осторожностью следует назначать Адепресс пациентам, принимающим нейролептики. Лечение Адепрессом назначают через 2 недели после отмены ингибиторов МАО. У пациентов пожилого возраста на фоне приема Адепресса возможна гипонатриемия. В некоторых случаях требуется коррекция дозы одновременно применяемых инсулина и/или пероральных гипогликемических препаратов. При развитии судорог лечение Адепрессом прекращают. При первых признаках мании следует отменить терапию Адепрессом. В течение первых нескольких недель терапии Адепрессом следует тщательно наблюдать за состоянием пациента в связи с возможными суицидальными попытками. Во время терапии Адепрессом следует воздерживаться от приема алкоголя в связи с усилением его токсического эффекта. Использование в педиатрииПрименение Адепресса у детей не рекомендуется, поскольку его безопасность и эффективность у этой группы пациентов не установлены. Влияние на способность к вождению автотранспорта и управлению механизмамиНесмотря на то, что пароксетин не ухудшает когнитивные и психомоторные функции, пациенты должны воздерживаться или соблюдать предельную осторожность при управлении автомобилем и при занятиях другими потенциально опасными видами деятельности, требующими повышенной концентрации внимания и быстроты психомоторных реакций.
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