Lepigin 25mg Danapha treatment of chronic schizophrenia (50 tablets)

Dosage form Box of 5 blisters x 10 tablets
Specifications Danapha

Uses

Indications

Lepigin drug 25mg indicated the treatment of chronic schizophrenia features progresses from at least 2 years) in the case of resistance (not clinically and socially relieved despite prescribing at least 2 high -dose neurolysis drugs at least 6 weeks) or intolerance to the classical neurolithic drugs (serious side effects, which can be treated by the nerves. With conventional medications).

Pharmacokinus

Clozapin is a dibenzodiazepin drug, which has a strong mental impact, effective simultaneously on symptoms of emotion and depression.

Clozapin has characteristics that rarely cause extrasic effects and do not significantly increase blood prolactin.

Clozapin causes fast and strong sedation.

Clozapin is different from classical neurolysis: According to surveys on animals, clozapin does not cause evidence to remain in position and do not inhibit the behavior repeating the gesture, words like when treated with apomorphin. In addition to inhibiting the dopaminergic receptor (D1 as well as D2), Clozapin also has an antagonistic effect on the 5-HT2 receptor and has a strong anti-cholinergic effect and canceled noradrenalin.

Dynamic pharmacokinetics

After taking the drug, Clozapin is almost completely absorbed (90-95%), and is not affected by food.

Clozapin's peak plasma concentration is about 1-6 hours after drinking, strongly linked to plasma proteins (95%).

The absolute bioavailability of Clozapin is about 55%. Clozapin is metabolized in the liver, mainly oxidation and reduction of methyl at the position n.

The semi -cancellation time fluctuates, on average about 12 hours after the single dose. 50% of the active ingredient is excreted in the form of urine metabolites and 40% is excreted through one

Pharmacokinetic parameters change for individuals.

Before taking Lepigin 25mg Danapha treatment of chronic schizophrenia (50 tablets)

How to use

Lepigin 25mg oral drugs.

Dosage

Following the instructions of the physician or the average dose:

Initial dose: 25mg on the first day, then increase each step from 25-50mg/ day, to reach the dose of 300 mg/ day on the 14th day to the 21st day.

Average dose: 300 - 450 mg/ day. Divided into several times.

Maximum dose: 600-900 mg/ day

Maintenance dose: 150-300 mg/ day.

Stop treatment: Reduce the dose slowly in 1-2 weeks.

Take the drug again: as the starting dose.

Use the drug on the patient who stopped the drug for more than 2 days: 12.5 mg 1-2 times a day, then increasing the dose may faster than the first use.

Shift from a classic neuron to clozapin: Stop stopping this drug within 1 week, after stopping 24 hours, start taking the drug in the above way.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.What do

do when overdose? However, there are also cases of tolerance with a dose of over 4000 mg.

Symptoms: enhance the anti -cholinergic and sedative effect, convulsions, salivation, pupils, visual disorders, confusion, agitation, delusion, increased reflexes, coma, hypotension, depravity, tachycardia, severe manifestations in the heart (arrhythmia, atrioventricular bloc, suburban collection), respiratory failure.

Treatment: Wash the intestines, then use activated carbon for the first 6 hours after detecting poisoning. Symptomatic treatment in specialized hospitals for at least 5 days (can react slowly). Monitor the signs of life, check the electrolyte and balance the acid. Do not use adrenalin and derivatives in the treatment of hypotension (can cause reverse effects of adrenalin).

In an emergency, call the 115 emergency center immediately or go to the nearest local health station.

What to do when you forget 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double dose to compensate for missed dose.

Side Effects

Unwanted effects (ADR) when using Lepigin 25mg that you may encounter:

Loss of granulocytes, usually appears in the first 18 weeks, can recover from treatment, sometimes death, leukocytosis, eosinophilia.

Hypotension posture (rarely causes vascular collapse with respiratory or cardiac arrest); High blood pressure, transformed on electrocardiograms; Tachycardia, arrhythmia, perinodus and myocarditis (sometimes led to death).

Constipation, vomiting, vomiting, liver disorders, transaminase increases and rarer than increased cholestase.

Ring sphincter disorders or urinary retention, penis pain.

dry mouth, eye regulation disorders, glaucoma.

Magnetic transformation (nose-to-show), reducing the threshold of epilepsy, seizures (rare), expression of the tower including tremor, field, no sitting still and stiff.

Some other effects: increased salivation, drowsiness, weakness, malignant syndrome of neuroleptics, sudden death for unknown reasons, gaining weight.

When experiencing side effects of the drug, patients need to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

contraindicated

Lepigin 25mg contraindicated drug in the following cases:

Hypersensitivity to clozapin.

Be cautious when using

because the drug can cause hematological disorders, it is important to note the following points:

Do not simultaneously use clozapin with measures that can reduce leukocytes (especially classical neurolysis or antidepressants).

Do not be used with slow neurolysis (due to the inability to quickly remove the body in case of granulocytopenia).

Before starting with clozapin treatment, it is necessary to count the white blood cell formula to ensure that only patients with normal leukemia formula can be taken.

After starting treatment, it is necessary to count the white blood cell formula per week for 18 weeks, then at least once a month until the end of the treatment is terminated.

It is necessary to remind patients to immediately notify the doctor at each medical examination if there is an onset infection or high fever.

In case of infection or if leukocytes below 3500/ mm, or a significant decrease compared to the original, immediately check the counting of white blood cells.

If the results of the leukocytes are below 3500/ mm and/ or the neutrophils of neutrophils are between 1500 and 2000/ mm, the number of neutrophils and neutrophils must be checked at least 2 times a week.

If the white blood cell is lower than 3000/ mm and/ or if the neutrophils are neutral below 1500/ mm, the treatment must be stopped immediately and stop permanently.

Despite stopping clozapin, if the white blood cells are absolutely lower than 2000/mm and or neutral leukemia is lower than 1000/mm, the patient must be transferred to a specialized hospital.

Cases of clozapine stops due to leukopenia according to the above standards, not re -used.

Some other points need to be cautious:

In some patients with a history of epilepsy or cardiovascular, kidney or liver disorders, the initial dose must be lower and increased the dose slower.

In case of not severe liver disease, can be treated with clozapin but it is necessary to monitor clinical and subclinical regularly in terms of liver function.

When taking the drug may have posture hypotension, accompanied by fainting or not.

may have temporary fever, usually benign, mainly in the first 3 weeks of treatment. May be accompanied by increased or decreasing leukocytes. Fever may be a sign of a hidden infection or neutrophils. If you have high fever, you can think of malignant syndrome of sedatives.

Elderly: Low initial dose (12.5 mg, taken 1 time in the first day) and increase the dose of 25 mg per day.

Be cautious when used for people who are driving and operating machines because clozapin is at risk of drowsiness, especially during the first treatment.

The ability to drive and operate machinery

Caution when used for driving and operating machinery because Clozapin is at risk of drowsiness, especially during the first treatment.

Women during pregnancy and nursing mothers

during pregnancy: There is no full research on people, so it should not be used for pregnant women.

While breastfeeding: Survey on animals shows that the drug is excreted in breast milk, so it is not advisable to breastfeed during treatment.

Interactive drug

Not used simultaneously with medications causing leukopenia.

Do not coordinate:

Alcohol: Increase sedative effects.

It should be noted when coordinated:

Anti -blood pressure drugs: increase hypotension and can cause posture lowering.

Central nervous systems: Morphin derivatives (pain relief and cough), most antihistamine H1, Barbiturat, Benzodiazepine, Clonidin and drugs with them: Increased central depression, can cause severe consequences, especially drivers and operating machinery.

Be cautious in patients being treated or treated with recent benzodiazepine or other mental drugs due to increased risk of depravity that can cause respiratory arrest or cardiac arrest in some cases.

Move inhibitors: Increases hypotension and can cause posture lowering.

Atropine and drugs have the same effect as atropine (imipramine antidepressants, most H1 antihistamine drugs, anti -vibration anti -vibration drugs, anti -spasms have atropinic effect, disopyramide): Coordinate the alcoholic effects of atropine group that causes urinary truce, constipation, mouth dry.

wafarin and strongly linked drugs with plasma proteins: may change the concentration of plasma of other drugs or clozapin.

cimetidine: Increasing the concentration of clozapin in plasma with increased adverse effects.

Phenytoin and cytochrom P450 induction drugs: Reducing plasma clozapin levels, may cause mental symptoms.

Lithium and other neuroleptic drugs: may increase the risk of malignant syndrome of sedatives.

Adrenalin and derivative: may cause reverse effects on arterial blood pressure (increased risk of hypotension).

Storage

Leave a cool place, avoid light, temperature below 30⁰C.

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