After oral administration of paroxetine well absorbed and undergoes first pass metabolism. Due to first-pass testosterone enanthate 250 metabolism, enters into the systemic circulation paroxetine fewer than that which is absorbed from the gastrointestinal tract. As the amount of paroxetine in the body after a single high doses or multiple dose conventional doses a partial saturation of the metabolic pathway of the first passage and decreases the clearance of paroxetine plasma. This leads to a disproportionate increase in the plasma concentrations of paroxetine.
Therefore, its pharmacokinetic parameters are not stable, resulting in a non-linear kinetics. It should be noted, however, that the non-linearity is weak and usually is observed only in those patients in patients receiving low-dose drug in plasma are achieved lower levels of paroxetine. Stable plasma concentrations are reached in 7-14 days after treatment with paroxetine and its pharmacokinetic parameters It will likely not change during long-term therapy.
Distribution. paroxetine widely distributed in tissues, and pharmacokinetic calculations show that the plasma is only 1% of the total amount of paroxetine present in the body. At therapeutic concentrations of about 95% is in the plasma paroxetine associated with proteins. No correlation was found between paroxetine concentrations in plasma and its clinical effect (ie. E. With adverse reactions and efficacy). It is found that paroxetine in small amounts into breast milk of women and in embryos and fetuses Metabolism laboratory animals. The major metabolites of paroxetine are polar and conjugated oxidation and methylation products that are readily eliminated from the body. Given the relative lack of these metabolites of pharmacological activity, it can be argued that they do not affect the therapeutic paroxetine effects. Metabolism does not impair the ability of paroxetine selectively inhibits vat reuptake of serotonin.
The elimination. From the urine as unchanged paroxetine is excreted less than 2% of the dose, whereas the excretion of metabolites reaches 64% of the dose. About 36% of the dose excreted in faeces, probably getting into it with gall; excretion in the feces unchanged paroxetine represents less than 1% of the dose. Thus, paroxetine almost entirely eliminated by metabolism. The excretion of metabolites is biphasic: a first result of first pass metabolism, followed by elimination of paroxetine controlled system. The half-life of paroxetine testosterone enanthate 250 is varied but is usually about 1 day (16-24 hours).
Depression of all types, including reactive and severe depression and depression accompanied by anxiety. In the treatment of depression, paroxetine has approximately the same efficiency as the tricyclic antidepressants. There is some evidence that paroxetine may give good results in patients who have a standard antidepressant therapy was ineffective. Acceptance of paroxetine in the morning does not adversely affect the quality and duration of sleep. Furthermore, as the effect of treatment with paroxetine manifestations sleep can be improved when using a short-acting hypnotic agents in combination with antidepressants additional side effects do not occur. In the first few weeks of paroxetine treatment effectively reduces the symptoms of depression and suicidal thoughts.
Results of studies in which patients were treated with paroxetine for up to one year have shown that the drug effectively prevents the recurrence of depression.
- Obsessive-compulsive disorder
Paroxetine effective in treating obsessive-compulsive disorder (OCD), including as a means of preventive maintenance and therapy.
Further, paroxetine effectively prevented relapses OCD.
- Panic disorder
paroxetine is effective in the treatment of panic disorder with agoraphobia and without it, including as a means of supporting and preventive therapy.
It was found that in the treatment of panic disorder is a combination of paroxetine and cognitive-behavioral therapy was significantly more effective than the isolated use of cognitive-behavioral therapy.Furthermore, testosterone enanthate 250 paroxetine effective in preventing relapse of panic disorder.
- Social phobia
Paroxetine is effective in treating social phobia, including as a long-term maintenance therapy and prevention.
- Generalized Anxiety Disorder
Paroxetine effective in generalized anxiety disorder, including as a long-term maintenance therapy and prevention.
Paroxetine also effectively prevents the recurrence of a given disorder.
- Post-traumatic stress disorder
paroxetine is effective in the treatment of post-traumatic stress disorder.Contraindications
- Hypersensitivity to paroxetine and its components.
The combined use of paroxetine with inhibitors monoaminooksida PS (MAO). Paroxetine should not be used concurrently with MAO ingibito ramie or within 2 weeks of their withdrawal. MAO inhibitors should not be prescribed for 2 weeks after treatment with paroxetine.
- Interactions with thioridazine. Paroxetine should not be used in combination with thioridazine, because, as well as other drugs that suppress the activity of the hepatic enzyme CYP450 2D6, paroxetine can increase thioridazine plasma concentrations, which may lead to a lengthening of the QT interval and related arrhythmias “pirouette” (torsades de pointes ) and sudden death.
- Interactions with pimozide.
- Use in children and adolescents younger than 18 years.Controlled clinical studies of paroxetine in the treatment of depression in children and adolescents has not proved its effectiveness, so the drug is not indicated for treatment of this age group.The safety and efficacy of paroxetine has not been studied in patients with the use of the younger age group (under 7 years).Dosing and Administration
Paroxetine is recommended to take 1 time per day in the morning during the meal. The tablet should be swallowed whole without chewing.
recommended dosage in adults is 20 mg per day. If necessary, depending on the therapeutic effect of the daily dose can be increased weekly by 10 mg per day to a maximum dose of 50 mg per day. As with any treatment with antidepressants, therapy should be evaluated the efficiency and if necessary to adjust the dose of paroxetine after 2-3 weeks of treatment and further depending testosterone enanthate 250 on clinical indications.
For treatment of depressive symptoms and prevent relapses observe adequate duration of acute and maintenance therapy. This period may be several months.
- Obsessive-compulsive disorder
The recommended dose is 40 mg per day. Treatment started with a dose of 20 mg per day, which can increase the weekly 10 mg per day. If necessary, the dose may be increased to 60 mg per day. Observe an adequate duration of treatment (several months and longer).