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Torin - instructions for use, real counterparts and release form (tablets 50 mg and 100 mg), an antidepressant medication to treat depression, obsessive-compulsive and panic disorders in adults, children and in pregnancy. Composition

Torin - instructions for use, real counterparts and release form (tablets 50 mg and 100 mg), an antidepressant medication to treat depression, obsessive-compulsive and panic disorders in adults, children and in pregnancy. Composition

In this article, you can read the instructions for using the drug Thorin. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors specialists on the use of Thorin in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Thorin in the presence of existing structural analogs. Use for the treatment of depression, obsessive-compulsive and panic disorders in adults, children, as well as in pregnancy and lactation. Composition of the preparation.

 

Thorin antidepressant. Selective serotonin reuptake inhibitor (5-HT) in neurons. The reverse capture of norepinephrine and dopamine affects slightly. In therapeutic doses, sertraline also blocks the seizure of serotonin by human platelets.

 

It does not stimulate, sedative and anticholinergic action. The drug has no affinity for serotonin, dopamine, histamine, benzodiazepine, GABA-, m-cholinergic receptors and adrenoreceptors.

 

The antidepressant effect is noted towards the end of the second week of regular drug intake, the maximum effect is achieved after 6 weeks.

 

Unlike tricyclic antidepressants, when Thorin is prescribed, there is no increase in body weight.

 

The drug does not cause mental or physical drug dependence.

 

Composition

 

Sertraline hydrochloride + excipients.

 

Pharmacokinetics

 

After oral administration, it is slowly absorbed from the digestive tract. Bioavailability with simultaneous intake with food increases by 25%. The binding of sertraline to plasma proteins is 98%. Sertraline excreted in breast milk; It is not known whether sertraline penetrates the placental barrier.It is subjected to intensive biotransformation at the first passage through the liver by N-demethylation. The main metabolite, N-desmethylsertralin, is less active than the parent compound. Metabolites are excreted in urine and feces in equal amounts. About 0.2% sertraline is excreted by the kidneys unchanged. It is not displayed during dialysis.

 

Indications

  • depression of different etiology (treatment and prevention);
  • obsessive-compulsive disorder;
  • panic disorder (with or without agoraphobia);
  • posttraumatic stress disorders.

 

Forms of release

 

Tablets coated with 50 mg and 100 mg.

 

Instructions for use and dosing regimen

 

For adults with depression and obsessive-compulsive disorders, the initial dose of Thorin is 50 mg once a day in the morning or evening. If necessary, the dose can be gradually (once a week) increased to a maximum daily dose of 200 mg.

 

In panic disorders and post-traumatic stress disorders, the initial dose is 25 mg once a day, in the morning or in the evening. In a week, you can increase the dose to 50 mg once a day, and then gradually (1 time per week) increase to a maximum daily dose of 200 mg.

 

A satisfactory therapeutic result is achieved usually after 7 days from the start of treatment.However, in order to achieve the full therapeutic effect, the drug should be taken regularly for 2-4 weeks. In patients with obsessive-compulsive disorders, it may take 8-12 weeks to achieve a therapeutic effect. The minimum dose providing the therapeutic effect is preserved as a supporting one in the future.

 

For children aged 6 to 12 years with obsessive-compulsive disorder, the initial dose of Thorin is 25 mg once a day, in the morning or in the evening. After a week, you can increase the dose to 50 mg once a day.

 

For children aged 12 to 17 years, the initial dose is 50 mg once a day in the morning or evening. If necessary, the dose can be gradually (once a week) increased to a maximum daily dose of 200 mg. With an increase in the dose of more than 50 mg per day, careful monitoring of the children should be ensured and, at the first signs of an overdose, to cancel the drug.

 

In elderly people there is no need for a special dose selection.

 

For violations of liver function, the drug should be administered with caution. In case of severe violations of the liver function, the dose of the drug should be reduced or the intervals between doses should be increased.

 

In patients with impaired renal function, no special correction of the dosing regimen is required.

 

Side effect

  • drowsiness;
  • headache;
  • dizziness;
  • tremor;
  • insomnia;
  • anxiety;
  • mania;
  • violation of gait;
  • weakness;
  • visual impairment;
  • extrapyramidal disorders;
  • dyskinesia;
  • convulsions;
  • dry mouth;
  • decrease in appetite (rarely - increase) up to anorexia;
  • flatulence;
  • nausea, vomiting;
  • diarrhea;
  • abdominal pain;
  • asymptomatic increase in the activity of transaminases in the blood serum (normalized when the drug is withdrawn);
  • ejaculatory disorders;
  • decreased libido;
  • menstrual cycle disorders;
  • hyperprolactinemia;
  • galactorrhea;
  • skin rash;
  • erythema multiforme;
  • increased sweating;
  • decreased body weight;
  • redness of the skin;
  • reversible hyponatremia (more often in the elderly, as well as when taking diuretics or a number of other drugs) associated with the syndrome of inappropriate secretion of ADH.

 

Contraindications

  • simultaneous administration of MAO inhibitors and up to 14 days after their withdrawal;
  • simultaneous use of tryptophan or fenfluramine;
  • unstable epilepsy;
  • children's age till 6 years;
  • pregnancy;
  • lactation (breastfeeding);
  • increased sensitivity to sertraline and other components of the drug.

 

Application in pregnancy and lactation

 

Adequate and strictly controlled clinical studies on the safety of the use of thorin during pregnancy have not been conducted. The administration of the drug is possible only if the intended benefit to the mother exceeds the potential risk to the fetus.

 

Women of childbearing age should be recommended to use effective contraceptives during the use of the drug.

 

If it is necessary to prescribe the drug during lactation, breastfeeding should be discontinued due to a lack of reliable data on the safety of the use of Thorin during this period.

 

Use in children

 

The drug is contraindicated for children under 6 years.

 

For children aged 6 to 12 years with obsessive-compulsive disorder, the initial dose of Thorin is 25 mg once a day, in the morning or in the evening. After a week, you can increase the dose to 50 mg once a day.

 

For children aged 12 to 17 years, the initial dose is 50 mg once a day in the morning or evening.If necessary, the dose can be gradually (once a week) increased to a maximum daily dose of 200 mg. With an increase in the dose of more than 50 mg per day, careful monitoring of the children should be ensured and, at the first signs of an overdose, to cancel the drug.

 

Application in elderly patients

 

In elderly people there is no need for a special dose selection.

 

special instructions

 

Caution should be used in patients with organic brain diseases (including mental retardation), manic conditions, epilepsy, hepatic and / or renal insufficiency, and weight loss.

 

Sertraline is not prescribed together with MAO inhibitors, and also within 14 days after discontinuation of treatment with MAO inhibitors; After the withdrawal of sertraline within 14 days, MAO inhibitors are not prescribed.

 

When prescribing the drug, one should take into account the lack of sufficient experience in the use of sertraline in patients who received electroconvulsive therapy. The possible outcome or risk of such a combined treatment has not been studied.

 

When discontinuing the use of the drug, it is possible (rarely) to develop withdrawal syndrome.There may be paresthesia, hypostases, symptoms of depression, hallucinations, aggressive reactions, psychomotor agitation, anxiety or symptoms of psychosis. These manifestations are difficult to differentiate from the symptoms of the underlying disease, and they can occur with the use of other antidepressants.

 

Patients with depression are at risk for suicide attempts. This danger persists until the development of remission. Therefore, from the beginning of treatment and until the optimal clinical effect is achieved, permanent medical supervision of the patient should be established.

 

The combined use of Thorin and drugs depressing the central nervous system requires close attention, while concomitant use with ethanol (alcohol) and ethanol-containing drugs is contraindicated.

 

Impact on the ability to drive vehicles and manage mechanisms

 

The appointment of sertraline is not accompanied by a violation of psychomotor functions. However, its use simultaneously with other drugs can lead to disruption of attention and coordination of movements. Therefore, during the reception of Thorin is not recommended to perform work that requires increased attention and speed of psychomotor reactions.

 

Drug Interactions

 

With the simultaneous use of Thorin and MAO inhibitors (including selective MAO inhibitors with reversible type of action - selegiline and moclobemide), the development of serotonin syndrome is possible: hyperthermia, rigidity, myoclonus, lability in the autonomic nervous system (rapid fluctuations in respiratory and cardiovascular parameters), changes mental status, including increased irritability, marked agitation, confusion, which in some cases may go into a delirious state or th (this combination is contraindicated).

 

With the joint appointment of thoracic anticoagulants with thorin, there is a significant increase in prothrombin time (control of prothrombin time is required at the beginning of sertraline application and after its withdrawal).

 

Pharmacokinetic interaction

 

When combined, sertraline can interact with other drugs that bind to plasma proteins (diazepam, tolbutamide, and warfarin).

 

Simultaneous use of the drug with cimetidine significantly reduces the clearance of sertraline.

 

Long-term use of sertraline at a dose of 50 mg per day with desipramine (a drug metabolized with the participation of the isoenzyme CYP2D6) is accompanied by an increase in the concentration of desipramine in the blood plasma.

 

In the experiments, it was found that the CYP3A3 / 4 beta-hydroxylation of endogenous cortisol, as well as the metabolism of Carbamazepine and terfenadine, do not change with the long-term administration of sertraline at a dose of 200 mg per day.

 

Concentration in blood plasma tolbutamide, phenytoin and Warfarin for a long-term administration of sertraline at a dose of 200 mg per day does not change, therefore, it can be concluded that sertraline does not inhibit CYP2C9.

 

Sertraline does not affect the concentration of Diazepam in the serum, indicating that there is no inhibition of CYP2C19.

 

According to the research, sertraline has practically no effect or minimally inhibits CYP1A2.

 

The pharmacokinetics of lithium does not change with the concomitant administration of sertraline, however, tremor is observed more often when combined, which suggests the possibility of pharmacodynamic interaction (this combination requires caution).

 

In clinical studies, it has been shown that sertraline causes minimal induction of liver enzymes.Simultaneous administration of sertraline in a dose of 200 mg and antipyrin leads to a significant decrease in the half-life of the antipyrine (this change is detected in only 5% of the observations).

 

With the co-administration of Thorin does not affect the beta-adrenergic blocking effect of atenolol.

 

With the introduction of sertraline in a daily dose of 200 mg drug interaction with glibenclamide and Digoxin is not revealed.

 

Analogues of the drug Thorin

 

Structural analogs for the active substance:

  • Aleval;
  • Asentra;
  • Deprefalt;
  • Zoloft;
  • Serenata;
  • Sirleft;
  • Sertraline hydrochloride;
  • Stimuloton.

 

Analogues for the pharmacological group (antidepressants):

  • Agomelatine;
  • Ademethionine;
  • Adress;
  • Azafen;
  • Alventa;
  • Amizole;
  • Amide;
  • Amitriptyline;
  • Anaphranil;
  • Aurorix;
  • Brintellix;
  • Valdoxane;
  • Velaxin;
  • Venlafaxine;
  • Vokssel;
  • Heptor;
  • Heptral;
  • Depres;
  • Depenone;
  • Deprim;
  • Deprim forte;
  • Duloxetine;
  • St. John's Wort;
  • Ixelles;
  • Kaliksta;
  • Clomipramine;
  • Coaxyl;
  • Lenuksin;
  • Maprotiline;
  • Mirzaten;
  • Mirtazapine;
  • Nerustin;
  • Neuroplant;
  • Oprah;
  • Paxil;
  • Paroxetine;
  • Pirazidol;
  • Plizil;
  • Prozac;
  • Rexetin;
  • Selektra;
  • The Siozam;
  • Triptysole;
  • Trittico;
  • Fluxonil;
  • Flunisan;
  • Fluoxetine;
  • Cipralex;
  • Citalopram;
  • Elivel;
  • Elicia;
  • Escitalopram;
  • Ephevelone;
  • Epevelon retard.

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