Strattera
Strattera (Atomoxetine)Pharmacodynamics
Does not concern psychostimulants and is not to amphetamine derivatives. A withdrawal it does not become perceptible.
Pharmacokinetics
Fast and almost it is completely soaked up after intake. TCmax - 1-2 h. It is well distributed in an organism. Communication with fibers - high (especially with an albumin). It is metabolized in a liver with participation of cytochrome CYP2D6. On pharmacological activity it is equivalent Atomoxetine, but circulates in plasma in much lower concentration. At people with insufficient activity CYP2D6 4-gidroksiatomoksetin it can be formed by means of other isoenzymes of cytochrome P450, but more slowly. T1/2 - 3.6 h at patients with high intensity of a metabolism and 21 h - with lowered. It is deduced, basically, with urine in the form of the 4-4-4-glucuronide. The pharmacokinetics at children and teenagers is similar to pharmacokinetics at adults.
Indications to application
Syndrome of deficiency of concentration of attention with hyperactivity.
Dosage regimen
Inside, irrespective of food intake (or during meal), once a day in the morning or, at occurrence of by-effects - 2 times a day (in the morning and late in the afternoon or early in the evening). Children and teenagers with mass of a body to 70 kg: a recommended initial daily dose - 0.5 mg/kg which raise to 1.2 mg/kg not earlier than in 3 days. In case of absence of improvement of a condition the daily dose can be enlarged to maximum - 1.8 mg/kg (or 120 mg) not earlier than through 2-4 weeks after the beginning of reception of a preparation. A recommended maintenance dose - 1.2 mg/kg/days Children and teenagers with mass of a body more than 70 kg and adults: a recommended initial daily dose - 40 mg which raise to 80 mg not earlier than in 3 days. In case of absence of improvement of a condition the daily dose can be enlarged to maximum - 120 mg not earlier than through 2-4 weeks after the beginning of reception of a preparation. A recommended maintenance dose - 80 mg. At patients with moderate disturbances of function of a liver (a class In on classification Chajld-Pjuga) initial and a maintenance dose reduce on 50 %. At patients with serious disturbances of function of a liver (a class With on classification Chajld-Pjuga) initial and a maintenance dose reduce to 25 % from a usual dose.
Contraindications
Hypersensitivity, angle-closure glaucoma, simultaneous reception of inhibitors MAO, the lactemia period, children's age (till 6 years).
Interaction
Strattera MAO should not be applied during a minimum 2 weeks after cancellation of inhibitors. Treatment by inhibitors MAO should not begin during 2 weeks after cancellation of Strattera (Atomoxetine). Does not cause clinically significant inhibition or an induction of isoenzymes of cytochrome P450, including CYP1A2, CYP3A, CYP2D6 and CYP2C9. At patients with expressed metabolism CYP2D6 inhibitors CYP2D6 raise concentration of Atomoxetinein a blood plasma to the level similar to that at patients with lowered metabolism CYP2D6. Inhibitors of cytochrome P450 at patients with lowered metabolism CYP2D6 do not raise Atomoxetine concentration in plasma gradual rising of its dose, nevertheless, is recommended. Strattera does not influence communication with fibers of warfarin, Phenytoinum and Diazepamum.
Special indicatings
Treatment should be spent under observation of the doctor having an operational experience with patients with a syndrome of deficiency of concentration of attention with hyperactivity. Cancellation of a preparation does not demand a gradual dose decline. At many patients in treatment CARDIAC CONTRACTIONS RATE rising (less 10/mines) and-or BP rising (less than 5 mm hg) became perceptible That in most cases had no clinical value. Cases of development of an orthostatic hypotension have been noted, therefore it is necessary to be careful at preparation appointment at conditions and the diseases leading to a hypotension. In case of occurrence of an icterus or change of the laboratory indicators testifying to disturbance of function of a liver, treatment by Strattera is necessary for cancelling. The rare cases of a hepatotoxic shown by rising of activity of hepatic enzymes, are noted by a hyperbilirubinemia and an icterus. Efficiency and safety at children till 6 years and at elderly patients is not established. Efficiency of treatment throughout more than 1.5 years, and also safety at duration of therapy over 2 years is not studied. At children and teenagers with mass more than 70 kg, and also at adults safety of a unitary dose more than 120 mg and the general daily dose more than 150 mg was not estimated. At children and teenagers with mass of a body to 70 kg safety of the unitary and general daily dose exceeding 1.8 mg/kg is not known. The aggressive behaviour or animosities are often observed at children and teenagers with a syndrome of deficiency of concentration of attention and hyperactivity. Communication of aggressive behaviour or animosities with reception of Strattera is not established. In treatment patients should be observed for the purpose of revealing of signs of aggressive behaviour or animosities. During pregnancy a preparation prescribe only in the event that the potential advantage for mother exceeds potential risk for a foetus. It is not known, whether it is allocated Strattera (Atomoxetine) with thoracal milk. It is necessary to refuse appointment of a preparation in thoracal feeding. Preparation reception can be accompanied by drowsiness. In this connection, in treatment it is necessary to be careful at employment by potentially dangerous kinds of the activity demanding raised concentration of attention and speed of psychomotor reactions (including car driving). With care. An arterial hypertensia, a tachycardia, disturbance of a cerebral circulation, an arterial hypotension and diseases, its causing, pregnancy.
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