Selektra - instructions for use, analogs, reviews and release forms (5 mg, 10 mg, 15 mg and 20 mg tablets) antidepressant medication for the treatment of depression, anxiety, phobias or fears in adults, children and pregnancy. Composition and alcohol

In this article, you can read the instructions for using the drug Selectra. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Selectra 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 Selecters with available structural analogues. Use to treat depression, anxiety, phobias or fears in adults, children, as well as in pregnancy and lactation. Composition and interaction of the drug with alcohol.

Selectra antidepressant. Selectively inhibits the reuptake of serotonin; increases the concentration of the neurotransmitter in the synaptic cleft, enhances and prolongs the action of serotonin on postsynaptic receptors. Escitalopram (the active ingredient of the preparation of Selectra) practically does not bind to serotonin (5-HT), dopamine (D1 and D2) receptors, alpha-adreno, m-cholinergic receptors, and also benzodiazepine and opioid receptors.

The antidepressant effect usually develops in 2-4 weeks after the start of treatment. The maximum therapeutic effect of treatment of panic disorders is reached approximately 3 months after the start of treatment.

Composition

Escitalopram oxalate + excipients.

Pharmacokinetics

Absorption is not dependent on food intake. Bioavailability - 80%. Binding to plasma proteins - 80%. Metabolized in the liver to active demethylated and demodetylated metabolites. After repeated use, the average concentration of demethyl- and didemetilmetabolites is 28-31% and less than 5%, respectively, of the concentration of escitalopram. Metabolism of escitalopram with the formation of a demethylated metabolite occurs mainly with the participation of isoenzymes CYP2C19, CYPZA4 and CYP2D6.In persons with a weak activity of the isoenzyme CYP2C19, the concentration of escitalopram can be 2 times higher than in persons with a high activity of this isoenzyme. Significant changes in the concentration of the drug with a weak activity of the isoenzyme CYP2D6 is not observed. Escitalopram and its major metabolites are excreted by the liver and a large part - by the kidneys, partially excreted in the form of glucuronides.

Indications

• depression;
• recurrent depressive disorder;
• panic disorders (including with agoraphobia);
• generalized anxiety disorder.

Forms of release

Tablets coated with 5 mg, 10 mg, 15 mg and 20 mg.

Instructions for use and dosage

Is taken orally, regardless of food intake. Depending on the indications, a single dose of 10-20 mg per day. The maximum daily dose is 20 mg. Duration of treatment is several months. At the end of treatment, the dose should gradually decrease within 1-2 weeks in order to avoid the occurrence of the "withdrawal" syndrome.

For elderly patients (over 65 years), the recommended dose is 5 mg per day, the maximum daily dose is 10 mg.

If the liver function is disrupted, the recommended initial dose for the first 2 weeks of treatment is 5 mg per day. Depending on the individual reaction, the dose can be increased to 10 mg per day.

For patients with a weak activity of the CYP2C19 isoenzyme, the recommended initial dose for the first 2 weeks of treatment is 5 mg per day. Depending on the individual reaction, the dose can be increased to 10 mg per day.

Side effect

• dizziness;
• weakness;
• fatigue;
• insomnia or drowsiness;
• convulsions;
• tremor;
• motor disorders;
• serotonin syndrome (agitation, tremor, myoclonus, hyperthermia);
• hallucinations;
• mania;
• confusion of consciousness;
• agitation;
• anxiety;
• depersonalization;
• panic attacks;
• increased irritability;
• visual impairment;
• nausea, vomiting;
• dryness of the oral mucosa;
• violation of taste;
• decreased appetite;
• diarrhea, constipation;
• dyspepsia;
• change in liver function;
• orthostatic hypotension;
• decrease in ADH secretion;
• galactorrhea;
• decreased libido;
• impotence;
• violation of ejaculation;
• anorgasmia (in women);
• retention of urine;
• skin rash;
• itching;
• ecchymosis;
• purpura;
• increased sweating;
• angioedema;
• anaphylactic reactions;
• hyponatremia;
• hyperthermia;
• increased sweating;
• arthralgia;
• myalgia;
• sinusitis;
• withdrawal syndrome (dizziness, headaches and nausea).

Contraindications

• simultaneous administration of MAO inhibitors;
• children and adolescence up to 15 years;
• pregnancy;
• lactation period;
• increased sensitivity to escitalopram.

Application in pregnancy and lactation

Selectors contraindicated use during pregnancy and lactation (breast feeding).

Use in children

Contraindicated in children and adolescents under 15 years.

Application in elderly patients

Caution should be used in elderly patients.

special instructions

C caution should be used in patients with renal failure (creatinine clearance less than 30 mL / min), hypomania, mania with pharmacologically uncontrolled epilepsy, depression with suicidal attempts, diabetes, in elderly patients with liver cirrhosis, a tendency to bleeding, simultaneously with the reception of drugs that lower seizure threshold, causing hyponatremia, ethanol (alcohol) with drugs metabolized involving isozymes CYP2C19 system.

Select should be administered only 2 weeks after the cancellation of irreversible MAO inhibitors and 24 hours after discontinuation of therapy with the reversible MAO inhibitor. Non-selective MAO inhibitors can be prescribed no earlier than 7 days after the withdrawal of escitalopram.

In some patients with panic disorder, an increase in anxiety may occur at the onset of treatment with the Selectcept preparation, which usually disappears during the next 2 weeks of treatment. To reduce the likelihood of an alarm, it is recommended to use low initial doses.

It is necessary to abolish Selectra in case of development of epileptic seizures or their increase in pharmacologically uncontrolled epilepsy.

With the development of the manic state of the Selector should be canceled.

The drug Selectra is able to increase the concentration of glucose in the blood in diabetes mellitus, which may require correction of doses of hypoglycemic drugs.

The clinical experience of using escitalopram indicates a possible increase in the risk of suicide attempts in the first weeks of therapy, which is why it is very important to carefully monitor patients during this period.

Hyponatremia, associated with a decrease in ADH secretion, against the background of receiving Selectra occurs rarely and usually disappears when it is withdrawn.

With the development of serotonin syndrome, Selectra should be immediately withdrawn and symptomatic treatment should be prescribed.

Impact on the ability to drive vehicles and manage mechanisms

During the period of treatment, patients should avoid driving motor vehicles and other activities that require a high concentration of attention and speed of psychomotor reactions.

Drug Interactions

When used simultaneously with MAO inhibitors, the risk of developing serotonin syndrome and serious adverse reactions increases.

Joint application with serotonergic drugs (including tramadol, triptans) may lead to the development of serotonin syndrome.

With simultaneous use with drugs that reduce the threshold of convulsive readiness, increases the risk of seizures.

Carbamazepine, inducing microsomal enzymes of the liver, can increase the clearance of escitalopram, which should be borne in mind while simultaneously prescribing these drugs.

There are rare postmarketing reports about the development in patients of weakness, hyperreflexia and poor coordination of movements by using selective inhibitors of serotonin reuptake (SSRI) and sumatriptan. If the use of Sumatriptan and SSRIs (such as fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, escitalopram) clinically substantiated, it is recommended appropriate observation of the patient.

Although escitalopram not potentiate the effects of alcohol (clinical data), as is the case with other psychotropic medications, concurrent use of escitalopram and alcohol is not recommended.

Escitalopram enhances the effects of tryptophan and lithium preparations, increases the toxicity of St. John's wort preparations, the effects of drugs that affect blood clotting (monitoring of blood coagulation indices is necessary).

Drugs metabolized involving CYP2C19 isozyme (including omeprazole), and which are potent inhibitors CYPZA4 and CYP2D6 (including flecainide, propafenone, metoprolol, desipramine, clomipramine, nortriptyline, risperidone, thioridazine, haloperidol), increase concentration of escitalopram in blood plasma.

Escitalopram increases the plasma concentration of desipramine and Metoprolol by a factor of 2.

Analogues of the drug Selectra

Structural analogs for the active substance:

• Lenuksin;
• Miracitol;
• Cipralex;
• Elicia;
• Elicia Ku-tab;
• Escitalopram;
• Escitalopram oxalate.

Analogues for the pharmacological group (antidepressants):

• Agomelatine;
• Ademethionine;
• Adress;
• Azafen;
• Aktaparoxetine;
• Alventa;
• Amizole;
• Amide;
• Amitriptyline;
• Anaphranil;
• Asentra;
• Valdoxane;
• Velaxin;
• Venlafaxine;
• Heparett;
• Heptor;
• Heptral;
• Depres;
• Deprim;
• Deprim forte;
• Duloxetine;
• Zoloft;
• Imipramine;
• Kaliksta;
• Clomipramine;
• Coaxyl;
• Lerivon;
• Maprotiline;
• Mirzaten;
• Mirtazapine (hemihydrate);
• Mirtalan;
• Nerustin;
• Neuroplant;
• Noxibel;
• Newvelong;
• Oprah;
• Paxil;
• Paroxetine;
• Plizil;
• Prozac;
• Rexetin;
• Sirleft;
• Stimuloton;
• Triptysole;
• Trittico;
• Févarine;
• Fluval;
• Flunisan;
• Fluoxetine;
• Cipramyl;
• Citalopram;
• Elivel;
• Ephevelone.

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