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    3. Doxepine 25mg 30 capsules — Made in Poland — Free Delivery

    Doxepine 25mg 30 capsules — Made in Poland — Free Delivery


    Brand: TEVA
    Product Code: Doxepine
    Availability: In Stock
    $23.03
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    Indications

    Neurotic disorders with symptoms of depression or anxiety. organic neuroses associated with insomnia. depression and anxiety in alcoholism. depression and anxiety associated with somatic disorders and diseases.
    Depression accompanied by fear and anxiety on the background of psychoses, including involutional depressions and the depressive phase of bipolar disorders.

    Application

    Taken inside. the dose of the preparation is selected individually depending on the severity of the symptoms and the therapeutic effect.
    Doxepin dose is 30–300 mg/day. A dose of up to 100 mg can be used as a single dose or divided. Doses greater than 100 mg should be taken in 3 divided doses. The maximum single dose is 100 mg (taken at bedtime). For moderate or severe symptoms, the usual starting dose is 75 mg/day. In most patients, this dose is effective. In severe forms of the disease, the dose is increased to 300 mg (in 3 divided doses) per day.
    In patients with insomnia, the total dose should be divided so that the higher dose is administered in the evening. In the event that insomnia is reported as an adverse reaction, this regimen may also be used or the dose should be reduced.
    After achieving a satisfactory therapeutic effect, the dose of the preparation should be adjusted to the minimum maintenance dose.
    Reducing the severity of anxiety symptoms when taking Doxepin is achieved earlier than the antidepressant effect. The antidepressant effect appears after 2-3 weeks of treatment.
    Elderly patients with mild symptoms are recommended to take half the usual recommended dose of doxepin hydrochloride (10–50 mg daily). Satisfactory clinical effects were obtained after the use of Doxepin at a dose of 30–50 mg/day. The dose of the preparation should be adjusted individually depending on the clinical response of the patient.
    Doses should be reduced in patients with impaired liver function.

    Contraindications

    Hypersensitivity to the preparation, cross-sensitivity to other dibenzoxepins. manic syndrome; severe liver dysfunction; glaucoma; urinary retention; simultaneous use with MAO inhibitors or their use 2 weeks before the start of treatment with doxepin. hypersensitivity to tricyclic antidepressants. tendency to urinary retention.

    Side effects

    Doxepin is generally well tolerated. most side effects of moderate severity occur at the beginning of treatment and disappear after discontinuation of the preparation or a decrease in its dose. some of the adverse reactions listed below are not specific to doxepin, but the possibility of these reactions should be considered due to the similarity of its pharmacological properties with other tricyclic agents.
    Adverse reactions are distributed according to the frequency of manifestations: very often (1/10), often (1/100, 1/10), infrequently (1/1000, 1/100), rarely (1/10,000, 1/1000), very rare (1/10,000), unknown (frequency cannot be determined according to available information).
    From the nervous system and mental disorders: very often - drowsiness; infrequently - headache, dizziness, insomnia, nightmares, confusion, disorientation, anxiety, numbness or paresthesia, tremor (usually of moderate severity). When using the preparation in high doses (especially in elderly patients), extrapyramidal symptoms may occur, including tardive dyskinesia; rarely - hallucinations, ataxia (in general, if several preparations acting on the central nervous system are used), convulsions (in patients prone to seizures, which may be caused by brain damage or alcohol and substance abuse); unknown - suicidal thoughts and behavior. Cases of suicidal thoughts and behavior have been reported during treatment with doxepin or immediately after its withdrawal.
    Psychiatric manifestations, including mania and paranoid hallucinations, may be exacerbated by treatment with tricyclic antidepressants. Occasionally, tinnitus has been reported.
    On the part of the organ of vision: very rarely - visual impairment (blurring).
    From the vascular system: rarely - orthostatic hypotension, flushing to the face.
    From the side of the heart: very rarely - tachycardia, ECG disorders (expansion of the QRS complex, prolongation of the P-R interval).
    From the immune system: infrequently - allergic reactions, including rash, swelling of the face, increased photosensitivity, itching, urticaria. During treatment with tricyclic antidepressants, an exacerbation of asthma is possible.
    On the part of the skin and subcutaneous tissue: rarely - increased sweating, the above skin allergic reactions; very rarely - alopecia.
    From the blood and lymphatic system: rarely - eosinophilia and bone marrow dysfunction with symptoms such as agranulocytosis, leukopenia, thrombocytopenia, purpura and hemolytic anemia.
    From the digestive system: very often - dryness of the mucous membrane of the mouth and nose, constipation; rarely - nausea, vomiting, dyspepsia, taste disturbance, diarrhea, anorexia, stomatitis.
    From the endocrine system: rarely - a violation of the secretion of antidiuretic hormone, gynecomastia, breast enlargement, galactorrhea in women; isolated cases - a change in libido, swelling of the testicles, an increase or decrease in blood glucose levels.
    From the side of the kidneys and urinary system: rarely - urinary retention (in men with prostatic hypertrophy, complaints may increase).
    From the hepatobiliary system: rarely - jaundice.
    General disorders: very often - fatigue, weakness, weight gain, chills, hyperpyrexia (in patients taking chlorpromazine at the same time).
    Cancellation of doxepin. With the sudden withdrawal of tricyclic antidepressants, withdrawal symptoms may occur, including insomnia, irritability, and excessive sweating. Withdrawal symptoms in newborns whose mothers took tricyclic antidepressants in the third trimester include respiratory depression, convulsions, and hyperreflexia.

    special instructions

    Patients with concomitant diseases or those taking other preparations should use a single dosing regimen. this also applies to patients on anticholinergic preparations.
    Elderly people should also use this dosing regimen and adjust it with caution. These patients are prone to developing adverse reactions such as anxiety, confusion and orthostatic hypotension. Therefore, the initial dose should be administered with caution and under close monitoring of the patient's condition and its response to the preparation. For an appropriate clinical effect, half the dose of doxepin may be sufficient.
    Patients should be warned that drowsiness may occur during treatment and alcohol intake may enhance the effect of the preparation.
    If the symptoms of psychosis or manic episodes worsen during treatment with doxepin, it may be necessary to reduce the dose of the preparation or add tranquilizers (neuroleptics) to the treatment regimen.
    Although the use of doxepin has less effect on the vascular system than other tricyclic antidepressants, it should be used with caution in patients with severe cardiovascular disease (heart block, cardiac arrhythmia and recent myocardial infarction).
    Caution is required when using doxepin in patients with impaired renal function, hepatic impairment, and those with a history of epileptic seizures.
    Suicide/suicidal ideation or clinical deterioration. In patients with severe depression, there is a risk of suicidal thoughts and actions, which may persist until remission is achieved. In the event that improvement does not occur within the first few weeks of treatment or even longer, patients need to be carefully monitored until improvement occurs. It is known from general clinical practice that the risk of suicidal thoughts or actions may increase in the early stages of treatment.
    There is also an increased risk of suicide in other psychiatric conditions for which doxepin is prescribed. Therefore, special precautions must be taken for such patients.
    Careful monitoring is required throughout the treatment of patients with suicidal thoughts or a history of suicide attempts.
    Careful monitoring of patients, especially high-risk groups, should be combined with the use of appropriate preparations, especially in the early stages, followed by a change in dosage if necessary. Patients (and caregivers) should be advised to monitor for any clinical deterioration, suicidal behavior, thoughts, or unusual changes in behavior and seek immediate medical attention if these symptoms occur.
    A meta-analysis of placebo-controlled studies in the use of antidepressants in adult patients with mental disorders showed an increased risk of developing suicidal behavior in patients younger than 25 years of age compared with placebo.
    In patients with moderate prostatic hypertrophy, urinary retention may increase.
    Doxepin contains lactose monohydrate, so patients with rare hereditary forms of galactose intolerance, malabsorption syndrome of glucose and galactose, Lapp lactase deficiency are not recommended to prescribe it.
    Patients with hypersensitivity or intolerance to gluten should not use this preparation, since its excipients include starch.
    Use during pregnancy or lactation. Reproductive studies in animals showed no adverse effects on the fetus; There are no adequate and well-controlled studies in pregnant women. Thus, during pregnancy, the preparation is used only in cases where the expected benefit to the mother outweighs the potential risk to the fetus.
    Doxepin passes into breast milk, so breast-feeding should be discontinued during treatment.
    Children. The safety and efficacy of doxepin in children have not been established.
    The ability to influence the reaction rate when driving vehicles or working with other mechanisms. During treatment with doxepin, it is forbidden to drive vehicles or work with complex mechanisms that require concentration, since the preparation can lead to drowsiness and other negative reactions from the central nervous system.

    Interactions

    With the simultaneous use of ethanol, antidepressants, barbiturates, benzodiazepines and general anesthetics, a significant increase in the inhibitory effect on the central nervous system, respiratory depression and hypotensive effect is possible. doxepin increases the anticholinergic effect of amantadine. phenothiazines, antiparkinsonian preparations, atropine, biperiden, antihistamines increase the risk of side effects from the central nervous system, vision, intestines, bladder. when used simultaneously with antihistamines, clonidine, the inhibitory effect on the central nervous system increases, with atropine, the risk of paralytic ileus increases, with preparations that cause extrapyramidal reactions, body weight and the frequency of extrapyramidal effects increase. with the simultaneous use of doxepin with indirect anticoagulants (coumarin or indadione derivatives), an increase in the anticoagulant activity of the latter is possible. doxepin may exacerbate depression caused by corticosteroids. when combined with anticonvulsants, it is possible to increase the inhibitory effect on the central nervous system, lower the threshold for convulsive readiness (when used in high doses) and reduce the effectiveness of the latter. preparations for the treatment of thyrotoxicosis increase the risk of developing agranulocytosis. doxepin reduces the effectiveness of phenytoin and α-blockers. inhibitors of microsomal oxidation (cimetidine) prolong t½, increase the risk of developing toxic effects of doxepin (a dose reduction of doxepin by 20-30% may be required), inducers of microsomal liver enzymes (barbiturates, carbamazepine, phenytoin, nicotine and oral contraceptives) reduce plasma concentration and efficacy of doxepin. fluoxetine and fluvoxamine increase the concentration of doxepin in blood plasma (a dose reduction of doxepin by 50% may be required). when used simultaneously with anticholinergics, phenothiazines and benzodiazepines - mutual enhancement of sedative and central anticholinergic effects and an increased risk of epileptic seizures (reducing the seizure threshold); phenothiazines, in addition, may increase the risk of neuroleptic malignant syndrome. with the simultaneous use of doxepin with clonidine, guanethidine, betanidine, reserpine and methyldopa, a decrease in the hypotensive effect of the latter; with cocaine - the risk of developing cardiac arrhythmia. estrogen-containing oral contraceptives and estrogens may increase the bioavailability of doxepin; antiarrhythmic preparations (quinidine) increase the risk of developing rhythm disturbances (possibly slowing down the metabolism of doxepin).
    simultaneous use with disulfiram and acetaldehyde genase inhibitors provoke delirium. incompatible with MAO inhibitors (may increase the frequency of periods of hyperpyrexia, severe convulsions, hypertensive crisis and death of the patient). pimozide and probucol can increase cardiac arrhythmia, which is manifested by a prolongation of the q-t interval per ecg. the effect on the cardiovascular system of epinephrine, norepinephrine, isoprenaline, ephedrine and phenylephrine is enhanced (including when these preparations are part of local anesthetics) and the risk of developing heart rhythm disturbances, tachycardia, severe hypertension increases. the simultaneous use of α-adrenergic blockers for intranasal administration or for use in ophthalmology (with significant systemic absorption) may enhance the vasoconstrictive effect of the latter. when combined with thyroid hormones - mutual enhancement of the therapeutic effect and toxic effects (including cardiac arrhythmia and stimulating effect on the central nervous system). m-anticholinergics and antipsychotics increase the risk of developing hyperpyrexia (especially in hot weather).

    Overdose

    Symptoms: drowsiness, anxiety, dry mouth, stupor, blurred vision, arrhythmia. if such symptoms occur, the preparation should be discontinued and the patient examined.
    In severe overdose, a decrease / increase in blood pressure, dilated pupils, tachycardia, urinary retention (bladder atony), ileus, hyperthermia / hypothermia, respiratory depression, increased sweating, convulsions, coma are possible.
    Treatment: discontinuation of the preparation, gastric lavage, artificial ventilation of the lungs, control of the cardiovascular system, the use of hypnotics. If necessary, the introduction of physostigmine salicylate 1-3 mg. Therapy is symptomatic. Hemodialysis and forced diuresis are ineffective.

    Storage conditions

    At a temperature not exceeding 25 ° C in a place protected from light.

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