Menelat 30 torrent tablet treat depression (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Mirtazapine

Ingredient

Composition information	Content
Mirtazapine	30mg

Uses

Indications

Dacuel 30 is indicated in the following cases:

Treatment of depression disorders.

The effectiveness of Mirtazapine in maintaining response in patients with depression can mainly up to 40 weeks after 8-12 weeks of treatment (according to a control placebo). When using mirtazapine for a long time, it is necessary to periodically evaluate the long -term effectiveness of the drug for each patient. Pre -clinical research shows that Mirtazapine Cuong Noradrenergic Central and Serotonergic's operation. Mirtazapine is an α2-adrenergic antagonist with central activity, increasing neurotransmitter through Noradrenergic and Central Serotonin. Mirtazapine is a strong receptor antagonist 5-HT2, 5-HT3 but does not have high affinity for 5-HTIA, 5-HTIB receptors.

mirtazapine strong antagonistic histamine receptors (H1), related to the outstanding sedative effect of the drug.

Mirtazapine is opposite to the peripheral peripheral level, which is related to the phenomenon of hypotension when using a combination of drugs.

Mirtazapine is almost non -resistant to cholinergic.

pharmacokinetic

absorption

Mirtazapine absorbs quickly and completely after drinking, the sale time is about 20-40 hours. The peak concentration in plasma is about 2 hours after drinking. Food almost does not affect the rate and level of drug absorption. Bioions about 50%

Distribution

Linking with plasma proteins is about 85%.

Metabolism

Mirtazapine metabolizes strongly after drinking, according to the demethylation path, hydroxylation and connected to glucuronic acid. According to the research of CYP 2D6 and CYP 1A2 enzyme participating in the formation of 8-hydroxyl metabolites, CYP 3A is related to the formation of N-Desmethyl and N-OXID.

Elimination

Elimination mainly through urine (about 75%) and in fertilizer (15%).

Linearly percentage of 15 - 80mg in the concentration range of 0.01 - 10mg/ml.

Before taking Menelat 30 torrent tablet treat depression (3 blisters x 10 tablets)

How to use

Oced 30 -uses. Use according to the guidance of the treating doctor.

Dosage

Initial dose

The initial dose is 15 or 30mg used 1 time/day, best in the evening before going to bed or divided into 2 times/day.

Maintenance dose

usually from 15mg and 45mg per day. The sale time of Mirtazapine 20-40 hours, should not change the dose of about 1-2 weeks, to evaluate the response to treatment with a certain dosage.

Elderly and patients with kidney or liver

Mirtazapine's clearance decreases in the elderly, patients with liver failure, medium and severe renal failure. Therefore, it is necessary to consider and adjust the dose if needed on these objects.

Maintain/expand treatment

To stabilize the depression state of acute phase for several months or longer when treated. Mirtazapine's treatment effect can be maintained for about 40 weeks after about 8-12 weeks of initial treatment of 15 - 45mg/day. Patients should be periodically evaluated to determine the appropriate dose for each patient period.

switch from mirtazapine to imao and vice versa

Start treatment with Mirtazapine tablets for at least 14 days from the date of stopping IMAO and vice versa.

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 to do when overdose?

is limited. The only death when the Mirtazapine dose is combined with Amitriptyline and Chlorprothixene is not based on clinical results. Based on the concentration of plasma Mirtazapine plasma at a dose of 30 - 45mg, the similar concentration of amitriptyline and chlorprothixene is toxic. Signs and overdose symptoms include disorientation, drowsiness, memory impairment and tachycardia. There is no report of abnormal electrocardiogram, coma or seizure when overdose Mirtazapine alone.

Handling overdose

The common measures are used in overdose of antidepressants. Ensure the respiratory tract enough oxygen and ventilation. Monitor heart rate and important signs. Apply general support measures and symptom support. Initially should not cause vomiting, should use activated carbon. No reports on diuretic, dialysis, or blood transfusion in the treatment of Mirtazapine overdose.

Currently, there is no specific antidote due to the overdose of Mirtazapine.

What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.

Side Effects

When using the 30 -year -old medicine, you may experience unwanted effects (ADR).

Common, ADR> 1/100

Neurological: Drowsiness, increase appetite, dizziness.

Digestive: Nausea.

Systemic: gain weight.

Uncommon, 1/1000

Neurology: Drowsiness, increase appetite, dizziness. Overall: weakness, influenza syndrome, back pain.

Digestive: dry mouth, increasing cravings, constipation.

Metabolism and nutrition: weight gain, peripheral edema, edema.

musculoskeletal: muscle pain.

Neurology: Drowsy, dizzy, nightmares, tremor, confusion.

Other: Difficulty breathing, urination. Change ECG.

Instructions on how to handle ADR

When experiencing side effects of medicine, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Warnings

Contraindicated

Hypersensitivity to the ingredients of the drug.

Precautions when using

recommendations

Increase clinical symptoms and risk of suicide: Children treated with antidepressants need to be monitored for changes in clinical symptoms, suicidal behaviors, abnormal signs in behavior, especially in the first few months of treatment, the time to increase or decrease the dose. In the first 4 weeks of the treatment process, it is necessary to monitor the patient's condition through direct contact with patients, family members or caregivers, the next 4 weeks of contact once a week. Up to 12 weeks and then, can contact by phone.

Screening patients with bipolar disorder: Before treating with overlapping drugs, patients should be screened to detect when there is a risk of bipolar disorder such as family mental history, suicide behavior, bipolar disorder and depression. Mirtazapine is not suitable for treating bipolar depression.

Loss of granulocytes: When the patient shows signs of sore throat, fever, stomatitis or signs of infection, low number of white blood cells should stop using mirtazapine and monitor patients closely.

IMAO: The patient is used in combination with antidepressants different from an IMAO or the current patient does not use antidepressants but starts to use imao, which needs to be notified of unwanted effects that can occur such as nausea, vomiting, face, dizziness, tremor, behavior disorders to seizures, mental status changes different from exciting to coma. Although there has been no report on people who interact with Mirtazapine tablets, it is recommended not to combine Mirtazapine with an IMAO or within 14 days from the date of stopping IMAO.

Caution

Must stop the drug slowly to reduce the risk of cessation symptoms.

Sleep: Clinical research shows that 54% of patients treated with Mirtazapine tablets have drowsiness compared to 18% with placebo tablets, 60% with amitriptyline. When stopping in use, 10.4% of patients were treated with mirtazapine had drowsiness, compared to 2.2% in patients who used placebo tablets. The patient is cautious when participating in the work requires alertness before being assessed to cause drowsiness in the patient.

Dizziness: Dizziness appears over 7 % of patients using placebo, compared to 3 % for placebo and 14 % for Amitriptyline. It is unknown whether there is an increase in the use of mirtazapine.

Weight gain/increase appetite: Increase appetite in 17 % of patients using mirtazapine, compared to 2 % for placebo, 6 % with amtenpline, weight gain corresponding to 7 %, 0 % and 5.9 %.

cholesterol/triglycerides (non -diet): Cholesterol increases> 20% of normal limits on 15% of patients using mirtazapine, compared to 7% for placebo and 8% for amitriptyline. Similarly, increased fat> 500mg/dl is 6%, 3%and 3%respectively.

Increased transaminase: ALT (SGPT) has clinical significance (> 3 times the normal limit) in 2.0% of patients using mirtazapine, compared to 0.3% of patients use placebo and 2.0% of patients of amitriptylin. Most have no signs or symptoms associated with damaged liver function. ALT stopped increasing or returning to normal when continuing to be treated with mirtazapine. Mirtazapine should be used carefully in patients with impaired liver function

Stimulating the state of manic/mildly manic: Mirtazapine causes a mild/mild manic with a very low rate, it is necessary to use this drug carefully in patients with a history of manic manic.

Epilepsy: Caution should be used when using the 30th drug for these objects.

Patients with the disease attached: Due to the risk of lowering blood pressure, Mirtazapine should be used carefully in patients with cardiovascular disease or cerebrovascular disease (a history of myocardial infarction, angina, ischemia) and the causes of hypotension (dehydration, reduced blood volume, and treated with hypotension drugs).

Mirtazapine clearance is reduced in patients with average renal impairment [glomerular filtration speed ( Be careful when using mirtazapine for these patients.

affect awareness and motor ability: Mirtazapine reduces the ability to think and exercise due to the outstanding sedative effect. Therefore, it is necessary to be careful to use the drug when doing the work to ask for alertness such as operating machinery and trains.

Medicine coordination: It is necessary to notify the doctor or pharmacist while taking or intending to take other drugs.

Alcohol: Mirtazapine can increase the central neurological inhibition effect of alcohol, to avoid alcoholic beverages when taking the drug.

Pregnancy: Need to notify a doctor or pharmacist if you are pregnant or intend to get pregnant while using the drug.

breastfeeding: Need to notify the doctor or pharmacist while breastfeeding.

The ability to drive and operate machinery

Due to the outstanding sedative effect, need to be careful to use, the drug while operating machinery and train.

Pregnancy

Patients should notify the doctor or pharmacist during pregnancy or plan to get pregnant during treatment with Mirtazapine. Only use drugs for pregnant women when benefits are higher than risk.

Breastfeeding period

Patients should notify physicians or pharmacists when breastfeeding. Only use drugs for breastfeeding women when benefits are higher than risk.

Medicinal interaction

The effect of the liver's metabolism: metabolism or pharmacological effects of Mirtazapine tablets may be affected by the induction or inhibition of drug metabolic enzymes.

Medicines are metabolized by cytochrome P450 enzyme or inhibiting cytochrome p450 enzyme: According to the study of mirtazapine does not affect the pharmacokinetics of risperidone or paroxetine (substrate of CYP2D6), carbamazepanie (CYP 3A4), amitriptyline and cimetidine.

The daily dose of 30 mg causes increased small Inr statistical significance when treated with warfarin. Prothrombin time is required in case of simultaneous use of warfarin and mirtazapine.

alcohol: Due to increasing the central nervous inhibition effect of alcohol, so avoid drinking when taking the drug.

Diazepam: When combining Diazepam and Mirtazapine will reduce the patient's mobility, so Diazepam and similar drugs should be avoided with Mirtazapine.

Storage

Keeping the medicine below 30 ° C, avoiding light and moisture.

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