Precautions: patients with cardiovascular and cerebrovascular disease, or other conditions predisposing to hypotension, inherent increase in the QT interval on the electrocardiogram (ECG), or under the conditions with the potential to cause an increase primobolan enanthate in the interval QT (co-administration of drugs prolonging the interval QT, congestive heart failure , hypokalemia, hypomagnesemia), advanced age, liver failure, epilepsy, seizures in history, pregnancy.
Pregnancy and lactation
The safety and efficacy of quetiapine in pregnant women has not been established. Therefore, quetiapine during pregnancy can only apply if the expected benefit justifies the potential risk. The degree of excretion of quetiapine with mother’s milk is not installed. Women should be advised to avoid breast-feeding while taking quetiapine.
Dosage and administration
. Inside, 2 times a day, regardless of meals Treatment of acute and chronic psychoses, including schizophrenia: A daily dose for the first 4 days is as follows: Day 1 – 50 mg; Day 2 – 200 mg; Day 3 -200 mg and Day 4 – 300 mg. Starting from the fourth day of the daily recommended dose of 300 mg. Depending on the clinical effect and tolerability of the dose may vary individually from 150 mg / day to 750 mg / day. . The maximum daily dose for the treatment of schizophrenia – 750 mg Treatment of manic episodes in bipolar disorder: Quetiapine is recommended as monotherapy or as adjunctive therapy to mood stabilization. The daily dose for the first 4 days is as follows: Day 1 – 100 mg; Day 2 200mg; Day 3 -300 mg and 4 th day – 400 mg. Increasing daily dose may subsequently 200 mg per day and the second day of treatment is 800 mg. Depending on the clinical effect and tolerability of the dose may vary individually from 200 mg / day to 800 mg / day. Typically, the effective primobolan enanthate dose is from 400 to 800 mg / day. . The maximum daily dose for this indication – 800 mg Older age: Because plasma clearance of quetiapine in the elderly is reduced by 30-50%, should be prescribed the drug with caution, especially at the beginning of therapy. . The starting dose – 25 mg / day, with a subsequent increase to 25-50 mg to achieve an effective dose Renal and hepatic insufficiency: In patients with renal and hepatic impairment is recommended to start treatment with the 25 mg / day. Further it is recommended to increase the dose of 25-50 mg daily to achieve an effective dose.
Classification of the incidence of side effects (WHO):
very common> 1/10
often by> 1/100 to <1/10
uncommon from> 1/1000 to <1/100
rarely from> 1/10000 to <1/1000
very rarely from <1/10000, including isolated reports. on the part of the blood and lymphatic system: often – leukopenia; infrequently – eosinophilia; very rarely – neutropenia. Disorders of metabolism and nutrition: often – increased body weight (especially in the first weeks of treatment); very rarely – hyperglycemia or decompensation of diabetes. On the part of the central and peripheral nervous system: very often – dizziness, drowsiness, headache; often – syncope; -trevozhnost infrequently, agitation, insomnia, akathisia, tremor, convulsions, depression, paresthesia; very rare: tardive dyskinesia. On the part of the cardiovascular system: often – tachycardia, orthostatic hypotension, prolongation of the QT interval on the ECG. From the respiratory system: rhinitis, pharyngitis. On the part of the gastrointestinal tract:often – dry mouth, constipation, diarrhea, dyspepsia; rarely – jaundice, nausea, vomiting, abdominal pain; very rarely – hepatitis. Allergic reactions: seldom – skin rash, hypersensitivity reactions; very rarely – angioedema, Stevens-Johnson syndrome. Reproductive system and breast: rarely – priapism (painful erection). Other: often – peripheral edema, asthenia; rarely – back pain, chest pain, low-grade fever, myalgias, dry skin, impaired vision, neuroleptic malignant syndrome (hyperthermia, altered mental status, muscular rigidity, vegetative – vascular disorders, increased creatine phosphokinase concentrations).Laboratory tests: often – increase the level serum transaminases (ACT or ALT); rare – increase in serum GGT levels and triglycerides (not fasting), hypercholesterolemia; decrease in thyroid hormone levels: total T4 and free T4 (in the first 4 weeks), as well as – the total reverse TK and TK (only when taking high doses of quetiapine).
Data on overdose of quetiapine limited. Cases of quetiapine in doses exceeding ’30 In most patients, side effects are not observed in the case of the development of side effects were on their own. Joined case of death when taking 13.6 grams of quetiapine. Very rarely reported cases of quetiapine overdose leads to a lengthening of the QT interval, coma or death. In patients with severe cardiovascular disease in the history of the risk of side effects may increase in overdose. Symptoms: excessive sedation, somnolence, tachycardia, decreased blood pressure. Treatment: symptomatic; activities aimed at the maintenance of respiratory function, cardiovascular system, adequate oxygenation and ventilation. No specific antidote.
Interaction with other drugs
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Quetiapine does not cause induction of enzyme systems of liver involved in the metabolism of phenazone and lithium.
Co-administration of quetiapine with drugs that potentially inhibit hepatic enzymes, such as carbamazepine or phenytoin, as well as with barbiturates, rifampin, may decrease plasma concentrations of quetiapine that may require increased doses of Kventiaksa, depending on the clinical effect. It also must be considered when canceling phenytoin or carbamazepine, inductor or other liver enzyme system or replacement of the drug, non-inducing microsomal liver enzymes (e.g., valproic acid).
The main enzyme responsible for the metabolism of quetiapine cytochrome P450 is CYP3A4. The pharmacokinetics of quetiapine does not change while the application primobolan enanthate like cimetidine (an inhibitor of P450) or fluoxetine (an inhibitor of CYP3A4 and CYP2D6), the antidepressant imipramine (an inhibitor of CYP2D6).
It is recommended to exercise caution while quetiapine and systemic use CYP3A4 inhibitors (antifungals group of azoles and macrolide antibiotics) since quetiapine plasma concentrations may be increased.Therefore, you should use a lower dose of quetiapine. Particular attention should be given to the elderly and immunocompromised patients. The pharmacokinetics of quetiapine were not significantly altered when administered simultaneously with antipsychotic drugs – risperidone or galoperidonom. However, concomitant use of quetiapine with thioridazine led to an increase in the clearance of quetiapine.
Drugs that suppress the central nervous system (CNS), and ethanol increase the risk of side effects. steroiden kaufen
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