Hypersensitivity to the active substance or auxiliary components (including other non-steroidal anti-inflammatory drugs (NSAIDs)); complete or incomplete combination of bronchial asthma, recurrent polyposis of the nasal mucosa and paranasal sinuses and intolerance to acetylsalicylic acid and other non-steroidal anti-inflammatory drugs (including a history); erosive and ulcerative changes in the mucous membrane of the stomach and duodenum, active gastrointestinal bleeding; ulcerative colitis, Crohn's disease in the acute stage; severe liver failure or active liver disease; severe renal failure (if hemodialysis is not performed, creatinine clearance is less than 30 ml / min, as well as with confirmed hyperkalemia), progressive kidney disease; acute gastrointestinal bleeding, recent cerebrovascular bleeding or an established diagnosis of blood coagulation diseases; severe uncontrolled heart failure; contraindicated in the period after coronary artery bypass grafting; pregnancy; period of breastfeeding; children under 18 years old.
- Anamnestic data on an attack of bronchial obstruction, rhinitis, urticaria after taking acetylsalicylic acid or other NSAIDs (complete or incomplete syndrome of intolerance to acetylsalicylic acid - rhinosinusitis, urticaria, polyps of the nasal mucosa, asthma (bronchial));
- erosive and ulcerative changes in the mucous membrane of the stomach or duodenum, active gastrointestinal bleeding;
- inflammatory bowel disease (ulcerative colitis, Crohn's disease);
- cerebrovascular bleeding or other bleeding;
- in the period after coronary artery bypass grafting;
- decompensated heart failure;
- severe liver failure or active liver disease;
- severe renal failure in patients not undergoing dialysis (creatinine clearance less than 30 ml / min), progressive kidney disease, including confirmed hyperkalemia;
- period of breastfeeding;
- children's age up to 15 years;
- hypersensitivity to any component of the drug.
IHD, cerebrovascular disease, chronic heart failure, dyslipidemia / hyperlipidemia, diabetes mellitus, peripheral arterial disease, smoking, creatinine clearance less than 60 ml / min.
Anamnestic data on the development of gastrointestinal ulceration, the presence of Helicobacter pylori infections, old age, prolonged use of NSAIDs, frequent alcohol consumption, severe somatic diseases, concomitant therapy with the following drugs:
- anticoagulants (e.g. meloxicam cheap online warfarin);
- antiplatelet agents (e.g. acetylsalicylic acid, clopidogrel);
- oral glucocorticosteroids (for example, prednisone);
- selective serotonin reuptake inhibitors (e.g. citalopram, fluoxetine, paroxetine, sertraline).
To reduce the risk of adverse events from the gastrointestinal tract, the minimum effective dose should be used with the minimum possible short course
When using Meloxicam, the following side effects from systems and organs are possible:
- Digestive system: dyspepsia, including vomiting, nausea, flatulence, constipation or diarrhea, abdominal pain; esophagitis, belching, hyperbilirubinemia, stomatitis, bleeding from the gastrointestinal tract (including hidden), gastroduodenal ulcer, transient increase in the activity of hepatic transaminases, gastritis, hepatitis, colitis, perforation of the gastrointestinal tract;
- Respiratory system: bronchospasm;
- Cardiovascular system: peripheral edema, palpitations, increased blood pressure, flushing of the face;
- Urinary system: increased serum urea and / or hypercreatininemia, acute renal failure; connection with the drug has not been established - albuminuria, interstitial nephritis, hematuria;
- Nervous system: headache, dizziness, tinnitus, vertigo, drowsiness, disorientation, confusion, emotional lability;
- Hematopoietic organs: anemia, thrombocytopenia, leukopenia;
- Sense organs: visual impairment, conjunctivitis;
- Integuments: skin rash, itch, urticaria, bullous rashes, photosensitivity, toxic epidermal necrolysis, erythema multiforme;
- Allergic reactions: anaphylactoid / anaphylactic reactions, angioedema.
When administered, the effective dose for adults is 15-45 mg / day, mainly 1 time / day before bedtime. Cheap mirtazapine The dose is gradually increased to 30-45 mg / day. The antidepressant effect develops gradually, usually after 2-3 weeks from the start of treatment, however, administration should be continued for another 4-6 months. If no therapeutic effect is observed within 6-8 weeks of treatment, treatment should be discontinued.
Mirtazapine withdrawal is carried out gradually.
Pharmacodynamics and pharmacokinetics
The main component of the drug is the active central presynaptic α2 receptor antagonist, which can increase the noradrenergic and serotonergic transmission to the nervous system.
Serotonergic transmission is enhanced through 5-HT1 receptors, since mirtazapine can block 5-HT2 and 5-HT3 receptors. Also, the drug is able to block H1 receptors, which determines its sedative effect..
Therapeutic doses of Mirtazapine are not characterized by anticholinergic activity or a negative effect on the cardiovascular system.
After oral administration, the drug is rapidly and fully absorbed, with 50% bioavailability. The maximum concentration in the blood plasma is reached within 2 hours.
About 85% of mirtazapine is bound to plasma proteins. Achieving a stable concentration is observed after 3-4 days, then the accumulation passes.
Pharmacokinetic parameters of the drug have a linear dependence on the dose taken. Eating does not affect the pharmacokinetics of the active substance.
Mirtazapine is characterized by an active metabolism with the formation of several metabolites. Excretion of the drug from the body occurs with urine and feces.
Mirtazapine is contraindicated in case of individual intolerance to the substances included in the tablets, as well as during the treatment of children under the age of 18.
The timely adjustment of the dose and constant medical supervision requires the use of medication in the treatment of patients in whom:
- low blood pressure;
- cerebrovascular disorders;
- impaired functioning of the cardiovascular system in the form of angina pectoris or heart attacks;
- mania, drug dependence;
- epilepsy and organic brain damage (tablets can contribute to the occurrence of convulsive conditions).
Particular care is required when taking tablets with patients with diabetes mellitus, glaucoma (in a closed-angle form), difficulty urinating.
The safety of the use of Mirtazapine tablets during treatment of pregnant and lactating patients has not been established.
A hypotensive effect, respiratory depression, a depressing effect on the nervous system is observed with the joint prescription of medicines that depress the central nervous system: general anesthetics, benzodiazepines, barbiturates, antidepressants and others.
There is a decrease in the effectiveness of alpha-blockers, phenytoin. Fluvoxamine, fluoxetine increase the concentration of the drug in the blood. amitriptyline cheap online The risk of developing epileptic seizures increases, and the central anticholinergic and sedative effects of combined therapy with benzodiazepines, phenothiazines, and anticholinergic drugs increase..
The simultaneous administration of methyldopa, reserpine, betanidine, guanethidine, clonidine reduces the severity of their hypotensive effect. When taking cocaine, arrhythmia develops. Delirium develops when taking acetaldehydrogenase inhibitors, disulfiram.
Amitriptyline enhances the effect on the cardiovascular system of phenylephrine, norepinephrine, epinephrine, isoprenaline. The risk of hyperpyrexia increases with the use of antipsychotics, m-anticholinergics.
- It is not recommended to simultaneously use amitriptyline with monoamine oxidase inhibitors.
- In combination with drugs that depress the central nervous system, a significant increase in their hypotensive effect and respiratory depression is possible.
- In combination with drugs with anticholinergic activity, their effect is enhanced..
- With simultaneous use, the effect of sympathomimetic drugs on the cardiovascular system is enhanced.
- With simultaneous administration with antipsychotics, metabolism is mutually inhibited, a threshold for convulsive readiness decreases.
- In combination with antihypertensive agents, the antihypertensive effect and the risk of orthostatic hypotension may increase.
- In combination with ethanol, its effect is enhanced, especially during the first days of therapy.
Use during pregnancy and lactation
The drug is not recommended during pregnancy, since negative consequences were identified in the development of the fetus after taking the medicine. http://www.healthline.com/health/amitriptyline-oral-tablet Also, the drug is not prescribed during breastfeeding, because the components of Amitriptyline are excreted along with milk and provoke side effects in the baby.