Finlepsin - instructions for use, analogs, reviews and release forms (200 mg tablets and 400 mg retard) drugs for the treatment of epilepsy and neuralgia in adults, children and pregnancy. Interaction with alcohol
In this article, you can read the instructions for using the drug Finlepsin. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors specialists on the use of Finlepsin 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 Finlepsin in the presence of existing structural analogues. Use for the treatment of epilepsy and neuralgia in adults, children, as well as during pregnancy and lactation.Interaction of the drug with alcohol.
Finlepsin antiepileptic agent, derivative of tricyclic iminostilbene. It is believed that anticonvulsant action is associated with a decrease in the ability of neurons to maintain a high frequency of development of repeated action potentials through inactivation of sodium channels. In addition, it seems that inhibition of the release of neurotransmitters by blocking the presynaptic sodium channels and the development of action potentials, which in turn reduces the synaptic transmission, is important.
Has a moderate antimanic, antipsychotic effect, as well as analgesic effect with neurogenic pain. The mechanisms of action may involve GABA receptors, which may be associated with calcium channels; Also, apparently, the effect of Carbamazepine (the active ingredient of Finlepsin) on systems of neurotransmitter modulators is important.
The antidiuretic effect of carbamazepine may be associated with a hypothalamic effect on the osmoreceptors, which is mediated through the secretion of ADH, and is also due to direct action on the renal tubules.
Composition
Carbamazepine + excipients.
Pharmacokinetics
When taking the drug inside Finlepsin slowly, but almost completely absorbed from the digestive tract (eating does not significantly affect the speed and degree of absorption). In the spinal fluid and saliva, concentrations are proportional to the amount of the active substance unbound with proteins (20-30%). It penetrates the placental barrier and is excreted in breast milk (the concentration is 25-60% of that in the blood plasma). Metabolised in the liver. Carbamazepine can induce its own metabolism. After a single oral intake of 72% of the dose is excreted in the urine and 28% with feces; while about 2% are excreted in the urine in the form of unchanged carbamazepine, about 1% - in the form of a metabolite.
Indications
- epilepsy: primary generalized seizures (with the exception of absences), partial forms of epilepsy (simple and complex seizures), secondary generalized seizures;
- neuralgia of the trigeminal nerve;
- idiopathic neuropathy of the glossopharyngeal nerve;
- pain in diabetic polyneuropathy;
- epileptiform cramps in multiple sclerosis, spasms of facial muscles with trigeminal neuralgia, tonic convulsions, paroxysmal dysarthria and ataxia,paroxysmal paresthesia and attacks of pain;
- alcohol abstinence syndrome (anxiety, convulsions, hyperexcitability, sleep disturbances);
- psychotic disorders (affective and schizoaffective disorder, psychosis, impaired function of the limbic system).
Forms of release
Tablets 200 mg, 400 mg (retard).
Instructions for use and dosage
Pills
Install individually. When ingested for adults and adolescents 15 years and older, the initial dose is 100-400 mg. If necessary, and taking into account the clinical effect, the dose is increased by no more than 200 mg per day at intervals of 1 week. Frequency of admission is 1-4 times a day. The maintenance dose is usually 600-1200 mg per day in several doses. The duration of treatment depends on the indications, the effectiveness of treatment, the patient's reaction to therapy.
Children under the age of 6 years are administered 10-20 mg / kg per day in 2-3 divided doses; if necessary and taking into account the tolerability dose is increased by no more than 100 mg per day at intervals of 1 week; the maintenance dose is usually 250-350 mg per day and does not exceed 400 mg per day. Children aged 6-12 years - 100 mg twice a day on the first day, then increase the dose by 100 mg per day at intervals of 1 week.until the optimum effect is obtained; the maintenance dose is usually 400-800 mg per day.
Maximum doses: when ingested by adults and adolescents 15 years and older - 1.2 grams per day, children - 1 g per day.
Retard tablets
Tablets are taken orally during or after a meal, with a sufficient amount of liquid. If necessary, the tablet (as well as its half or quarter) can be pre-dissolved in water or in juice (while retaining the ability to prolong the release of the active substance).
The average range of doses is 400-1200 mg per day, the frequency of administration is 1-2 times a day. The maximum daily dose is 1600 mg.
In epilepsy, whenever possible, Finlepsin retard should be given as a monotherapy. Treatment begins with the application of a small daily dose, which is then slowly increased until an optimal effect is achieved.
The admission Finlepsin to the already conducted antiepileptic therapy should be carried out gradually, while the doses of the drugs used do not change or, if necessary, correct.
If you miss a dose of the next dose, take the missed dose immediately, as soon as it is noticed, while you can not take a double dose of the drug.
For adults, the initial dose is 200-400 mg per day, then the dose is slowly increased to achieve the optimal therapeutic effect. The maintenance dose is 800-1200 mg per day (in 1-2 divided doses).
The initial dose for children aged 6 to 15 years is 200 mg per day, then the dose is gradually increased by 100 mg per day until the optimal effect is achieved.
Supportive doses for children aged 6-10 years - 400-600 mg per day (in 2 divided doses), for children aged 11-15 years - 600-1000 mg per day (in 2 divided doses).
The duration of application depends on the indication and the individual reaction of the patient to the drug.
The decision to transfer a patient to the use of the drug Finlepsin retard, the duration of its use or the withdrawal of treatment is made by the doctor individually. The dose of the drug can be reduced or completely canceled no earlier than after a 2-3-year total absence of seizures. Cancellation of the drug is carried out gradually, reducing the dose for 1-2 years, under the control of EEG. In this case, children with a decrease in the daily dose should take into account the increase in body weight with age.
With neuralgia of the trigeminal nerve, idiopathic glossopharyngeal neuralgia, the initial dose is 200-400 mg per day in 2 divided doses.The initial dose is increased until the pain disappears completely, on average to 400-800 mg per day. After that, in a certain part of the patients, therapy can be continued at a lower maintenance dose of 400 mg per day.
With pain in diabetic neuropathy, the drug is prescribed 200 mg in the morning and 400 mg in the evening. In exceptional cases, the drug Finlepsin retard can be prescribed in a dose of 600 mg 2 times a day.
In the treatment of alcohol abstinence in a hospital, the average daily dose is 600 mg (200 mg in the morning and 400 mg in the evening). In severe cases, in the early days, the dose can be increased to 1200 mg per day in 2 divided doses.
If necessary, the preparation Finlepsin retard can be combined with other drugs used to treat alcohol withdrawal, except sedatives and hypnotics. During the treatment, the content of carbamazepine in the blood plasma must be regularly monitored. In connection with the development of adverse reactions from the side of the central nervous system and the autonomic nervous system, patients are carefully monitored in a hospital.
With epileptiform cramps in multiple sclerosis, the average daily dose is 200-400 mg 2 times a day.
For the treatment and prevention of psychosis, the initial dose and maintenance dose is 200-400 mg per day. If necessary, the dose can be increased to 400 mg twice a day.
Side effect
- dizziness;
- ataxia;
- drowsiness;
- headache;
- involuntary movements;
- nystagmus;
- paresthesia;
- muscle weakness;
- hallucinations;
- depression;
- feeling tired;
- aggressive behavior;
- impaired consciousness;
- activation of psychosis;
- violation of taste;
- conjunctivitis;
- noise in ears;
- nausea, vomiting;
- dry mouth;
- diarrhea or constipation;
- decreased appetite;
- stomach ache;
- glossitis;
- stomatitis;
- bradycardia;
- arrhythmias;
- AV-blockade with syncope;
- collapse;
- heart failure;
- manifestations of coronary insufficiency;
- thrombophlebitis;
- thromboembolism
- leukopenia, eosinophilia, thrombocytopenia, leukocytosis, agranulocytosis, aplastic anemia, erythrocyte aplasia, megaloblastic anemia, reticulocytosis, hemolytic anemia;
- fluid retention;
- edema;
- increase in body weight;
- increased cholesterol and triglycerides;
- gynecomastia or galactorrhea;
- thyroid dysfunction;
- impaired renal function;
- interstitial nephritis;
- kidney failure;
- pneumonitis or pneumonia;
- skin rash;
- itching;
- lymphadenopathy;
- fever;
- arthralgia.
Contraindications
- AV blockade;
- previous mielodepression;
- intermittent porphyria in the anamnesis;
- simultaneous administration of MAO inhibitors and lithium preparations;
- increased sensitivity to carbamazepine.
Application in pregnancy and lactation
If necessary, use during pregnancy (especially in the first trimester) and during lactation should carefully weigh the expected benefit of treatment for the mother and the risk to the fetus or child. In this case, Finlepsin is recommended only in the form of monotherapy in the lowest effective doses.
Women of childbearing age during the treatment with carbamazepine are recommended to use non-hormonal contraceptives.
Use in children
The drug is prescribed for children older than 6 years.
special instructions
Finlepsin is not used in atypical or generalized small epileptic seizures, myoclonic or atonic epileptic seizures. Do not use to relieve normal pain; as a preventive agent during long periods of remission of trigeminal neuralgia.
They are used with caution in case of concomitant diseases of the cardiovascular system, expressed violations of the liver and / or kidney function, diabetes mellitus, increased intraocular pressure, with a history of hematological reactions to other drugs, hyponatremia, urinary retention, hypersensitivity to tricyclic antidepressants , with a history of interrupting the course of treatment with carbamazepine, as well as children and elderly patients.
Treatment should be carried out under the supervision of a doctor. With long-term treatment, it is necessary to monitor the blood picture, the functional state of the liver and kidneys, the concentration of electrolytes in the blood plasma, and conduct an ophthalmological examination. It is recommended to periodically determine the level of carbamazepine in the blood plasma to monitor the effectiveness and safety of treatment.
At least 2 weeks before the initiation of therapy with Finlepsin, treatment with MAO inhibitors should be discontinued.
During the treatment period, do not drink alcohol. Finlepsin reduces the tolerance of ethanol (alcohol).
Impact on the ability to drive vehicles and manage mechanisms
During treatment, one should refrain from engaging in potentially dangerous activities that require increased attention, speed of psychomotor reactions.
Drug Interactions
With the simultaneous use of Finlepsin stimulates the metabolism of anticoagulants, folic acid.
With simultaneous application with valproic acid, a decrease in Finlexin concentration and a significant decrease in the concentration of valproic acid in the blood plasma are possible. This increases the concentration of the carbamazepine-epoxide metabolite (probably due to the inhibition of its conversion to carbamazepine-10,11-trans-diol), which also has anticonvulsant activity, so the effects of this interaction can be leveled, but more often there are side reactions - blurred vision, dizziness, vomiting, weakness, nystagmus. With the simultaneous use of valproic acid and carbamazepine, the development of a hepatotoxic effect is possible (apparently due to the formation of a secondary metabolite of valproic acid, which has a hepatotoxic effect).
With the simultaneous use of valpromide reduces the metabolism in the liver of carbamazepine and its metabolite carbamazepine-epoxide due to inhibition of the enzyme epoxide hydrolase. This metabolite has anticonvulsant activity, but with a significant increase in the concentration in the blood plasma can have toxic effects.
With simultaneous use with verapamil, diltiazem, isoniazid, dextropropoxyphene, viloxazine, fluoxetine, fluvoxamine, cimetidine, acetazolamide, danazolum, desipramine, nicotinamide (in adults, only in high doses), erythromycin, troleandomycin, josamycin, clarithromycin; with azoles (including with itraconazole, ketoconazole, fluconazole), terfenadine, loratadine, an increase in the concentration of carbamazepine in the blood plasma is possible with a risk of side effects (dizziness, drowsiness, ataxia, diplopia).
When used simultaneously with hexamidine, the anticonvulsant effect of carbamazepine is weakened; with hydrochlorothiazide, Furosemide - it is possible to reduce the sodium content in the blood; with hormonal contraceptives - it is possible to weaken the effect of contraceptives and to develop acyclic bleeding.
With simultaneous use with thyroid hormones, an increase in the elimination of thyroid hormones is possible; with Clonazepam - it is possible to increase the clearance of clonazepam and decrease the clearance of carbamazepine; with lithium preparations - the mutual enhancement of neurotoxic action is possible.
At simultaneous application with the primidonum reduction of concentration Finplepsina in a blood plasma is possible. There are reports that primidone may increase the concentration in the plasma of the pharmacologically active metabolite - carbamazepine-10,11-epoxide.
With simultaneous application with ritonavir, the side effect of carbamazepine may be increased; with sertraline - may decrease sertraline concentration; with theophylline, rifampicin, cisplatinum, doxorubicin - a decrease in the concentration of carbamazepine in the blood plasma; with Tetracycline - possibly weakening the effects of carbamazepine.
With concomitant use with felbamate, a decrease in Finlexin concentration in the blood plasma is possible, but an increase in the concentration of the active metabolite of carbamazepine-epoxide, with a decrease in the concentration of felbamate in the plasma.
With simultaneous use with phenytoin, phenobarbital, the concentration of carbamazepine in the blood plasma decreases. Possible mutual weakening of anticonvulsant action, and in rare cases - its amplification.
Analogues of the drug Finleshesin
Structural analogs for the active substance:
- Actinerval;
- Apo Carbamazepine;
- Zagreton;
- Zeptol;
- Carbaleptin retard;
- Carbamazepine;
- Carbapine;
- Carbasan retard;
- Mazepine;
- Stasepine;
- Storilate;
- Tegretol;
- Finlepsin retard;
- Epial.
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