Mianserin belongs to the piperazino-azepine group of compounds which are not chemically related to tricyclic antidepressants (TCAs). Lerivon enhances noradrenergic transmission in the brain due to the blockade of the receptors and inhibiting the reuptake of norepinephrine. Also it was found the interaction with serotonin receptors in the central nervous system. Drug testosterone suspension gains activity against histamine H 1 ) and antagonism of alpha-adrenoretseporam responsible for its sedative properties, the drug also has anxiolytic effects, which is important in the treatment of patients with anxiety disorders and sleep disorders associated with depressive disorders.
Lerivon well tolerated as the elderly and patients with cardiovascular disease. The therapeutically effective doses of medication is not really Lerivon anticholinergic activity and has practically no effect on the cardiovascular system. Compared with TCA, it causes less cardiotoxic effects in overdose. The drug is not Lerivon sympathomimetic antagonist and antihypertensive agents.
After oral administration, the active substance Lerivon drug mianserin, quickly and well absorbed, reaching maximum plasma levels after 3 hours. Bioavailability is about 20%. Mianserin binding to plasma proteins is approximately 95%. The half-life (21-61 hours) allows to prove a single daily dose of reception. Equilibrium plasma levels are reached within 6 days. Mianserin extensively metabolized and excreted in the urine and feces 7-9 days. The main routes of biotransformation are demethylation and oxidation with subsequent formation of conjugates.
Depression of various etiologies.
- Liver disease with significant dysfunction;
- Hypersensitivity to mianserin or to any component of the drug;
- Lerivon The drug should not be used in children and adolescents under the age of 18 years.Precautions
Hepatic or renal failure, chronic heart failure, angle-closure glaucoma, prostatic hypertrophy, diabetes.Pregnancy and lactation
Although the experiments on animals and limited data on humans indicate that mianserin has no fetal or neonatal injury and that mianserin excreted in breast milk only in very small amounts, for applying Lerivon drug during pregnancy or breast-feeding should be assessed for possible risks to the fetus or newborn.Dosing and Administration
The tablets should be taken orally, drinking water, and swallowed without chewing, if necessary. Adults: Dosage is determined individually. Recommended initial dose of 30 mg per day. This dose can be gradually increased every few days to obtain an optimal clinical response. The effective daily dose is usually 60-90 mg. Elderly: Dosage is determined individually. The initial dose should be 30 mg. This dose can be gradually increased every few days. A lower dose may be required for a satisfactory clinical response than normal for adults. Children: The preparation Lerivon should not be used in children and adolescents under the age of 18 years (see section “Contraindications”, “Cautions”.).
- The daily dose can be divided into several stages or, preferably (in view of the favorable effect on sleep) as a single dose for receiving overnight.
- Treatment of the appropriate dose should lead to a positive response to treatment after 2-4 weeks. In case of inadequate treatment response the dose can be increased. If then after another 2-4 weeks there is no response to treatment, then the treatment with the drug should be discontinued.
- It is recommended that antidepressant treatment for 4-6 months after the onset of clinical improvement.
- Abrupt discontinuation of treatment with Lerivon very rarely causes withdrawal symptoms.Side effects:
In patients with testosterone suspension gains depression, manifest some symptoms directly related to the disease itself (dry mouth, obstipation, accommodation disturbances). Therefore it is sometimes difficult to determine which symptoms are a consequence of the disease, and which are a consequence of treatment with Lerivon.
Symptoms of acute overdose are usually limited to an increase in the duration of sedation. Cardiac arrhythmias, convulsions, severe hypotension and respiratory depression are rare. There is no specific antidote. Treatment consists of gastric lavage combined with symptomatic and supportive care in relation to the vital functions.Interaction with other drugs
- Lerivon may enhance the inhibitory effect of alcohol on the central nervous system, and patients should be advised to abstain from alcohol during treatment.
- Lerivon should not be used concurrently with MAO inhibitors or within the next two weeks after completing the course of treatment of these funds.
- Lerivon interacts with betanidinom, clonidine, methyldopa, guanethidine and propranolol (in combination with hydralazine and without it). Nevertheless, it is recommended to control blood pressure in patients who are treated simultaneously protyvogipertenzivnymi drugs.
- As with other antidepressants, Lerivon drug may disrupt the metabolism of coumarin derivatives, such as warfarin, which requires monitoring.special instructions
- Use in children and adolescents under 18 years of
drug lerivon should not be used in children and adolescents under the age of 18 years. In clinical studies of suicidal behavior (suicide attempts and suicidal thoughts), and hostility (predominantly aggression, suppozitsionnoe behavior and anger) more frequently observed among children and adolescents treated with antidepressants compared to those who received placebo.
If, based on clinical need, yet the decision to conduct the treatment, then the patient should be carefully monitored for appearance of suicidal symptoms. In addition, there are no data on the long-term safety in children and adolescents concerning growth, maturation and cognitive and behavioral development.
- Suicide / suicidal ideation
Depression is associated with an increased risk of suicidal thoughts, self-harm and suicide (suicidal gestures). This risk persists until significant remission offensive. As for the first few weeks of improvement may not occur, patients should remain under the direct control until the improvements.
Patients with suicidal gestures in history, exhibiting a high degree of suicidal imaging before treatment, and young adults are at greater risk of suicidal thoughts or suicide attempts, and they should be carefully monitored during treatment. Patients (and caregivers of patients) should be alerted about the need to control the sudden emergence of suicidal ideation and immediate treatment for medical assistance in the event of such symptoms.
- It was reported that during treatment with Lerivon marked bone marrow depression, which is usually expressed in the form of granulocytopenia or agranulocytosis. These reactions occur most often after 4-6 weeks of treatment and were generally reversible upon termination of treatment; They were observed in all age groups but more common in elderly patients. If the patient appears fever, sore throat, stomatitis or other signs of infection, then the treatment should be discontinued and deployed to check the blood formula.
- Lerivon drug as well as other antidepressants in susceptible subjects suffering from bipolar depressive illness can cause hypomania. In this case, treatment with the drug should be discontinued Lerivon.
- In the period of treatment is recommended Lerivon particularly careful monitoring of the patients with hepatic or renal insufficiency, with heart disease, diabetes.
- Patients with narrow-angle glaucoma, or symptoms of hypertrophy of the prostate should be observed, because of the unpredictability of anticholinergic side effects in the treatment of drug Lerivon.
In the case of treatment of jaundice preparation testosterone suspension gains should be discontinued.
- In the event of the occurrence of seizures, treatment with the drug should be discontinued.Effects on ability to drive and use machines
- The drug Lerivon can affect psychomotor activity during the first few days of treatment. Patients undergoing a course of drug treatment Lerivon should avoid activities that pose a potential hazard, such as driving or using machinery.