Today we will tell you about what is the drug "Symbalta". Instructions for use of this medicine, its composition, side effects and indications will be described below. Also, from the presented article, you will learn about the form in which this medication is issued, how much it costs, whether it has contraindications and how to use it correctly.
Release form
In what form can I buy the drug "Simbalta", whose instructions are enclosed in the package? Currently, this medication is available only in the form of enteric capsules. Moreover, each of them contains pellets that have a white or grayish-white color.
The composition of the drug
What are the components of the drug “Simbalta”? The instructions for the use of capsules states that their main active element is the substance duloxetine. It should also be noted that the composition of the medication under consideration includes additional substances in the form of sucrose, hypromellose, talc, succinate, white dye, hypromellose acetate, titanium dioxide, triethyl citrate, gelatin, sodium lauryl sulfate and yellow iron oxide dye.
Capsules may contain 60 and 30 mg of the drug. They are packaged in blisters for 14 or 7 capsules. In one cardboard pack can be 1, 2 or 6 blisters.
Pharmacological characteristics of the drug
What is an active substance like duloxetine? The instruction for the use of medicinal capsules states that such a drug with the mentioned active element is a very good antidepressant. It is a reuptake inhibitor of norepinephrine and serotonin. It weakly inhibits the uptake of dopamine, and also does not have an affinity for dopamine, histamine, choline and adrenoreceptors.
How does duloxetine work? The instruction contains the following information on this subject: the principle of action of the substance mentioned is to suppress the reuptake of norepinephrine and serotonin. As a result, noradrenergic and serotonergic neurotransmission in the nervous system significantly increases. It should also be noted that duloxetine quickly suppresses pain.
Pharmacokinetics of the drug
Drugs for depression like "Symbalts" are absorbed from the digestive tract, absorption begins a couple of hours after ingestion. In this case, the maximum concentration is reached after 6 hours. Simultaneous eating does not affect the concentration, but increases the time it reaches from 6 to 10 hours. Experts say that this indirectly reduces the degree of absorption (by 11%).
The binding of the drug to plasma proteins is quite high and reaches more than 90%.
The half-life of the drug is 12 hours. At the same time, it comes out with urine in the form of metabolites.
According to studies, there are differences between the pharmacokinetic processes that occur in women and men. Thus, the average clearance of the active component is lower in women. However, there is no need for dose adjustment.
It should also be noted that during the studies, differences were established between the pharmacokinetic processes that occurred in elderly and middle-aged patients. It was found that the half-life of the drug is higher in the elderly than in young people. Dose adjustment is also not required.
In patients with end-stage chronic renal failure who are on hemodialysis, the concentration and AUC of duloxetine increase exactly 2 times. That is why it is recommended to consider the feasibility of lowering the dosage of the drug in patients with severe renal impairment.
In patients with symptoms of liver failure, the metabolism and half-life of duloxetine may slow down.
Indications for use of the drug
When is the medicine "Simbalta" prescribed? Instructions for use include the following list of indications:
- diabetic neuropathy of the pain form;
- depression and depression;
- generalized anxiety disorder;
- chronic pain syndrome of the musculoskeletal system, including those caused by fibromyalgia and osteoarthrosis.
Contraindications
When should you not take the medicine "Simbalta"? Instructions for use include the following list of contraindications:
- the simultaneous use of potent inhibitors of the CYP1A2 isoenzyme (for example, enoxacin, ciprofloxacin or fluvoxamine);
- hypersensitivity of the patient to the components of the drug;
- children under 18 years old;
- simultaneous administration with MAO inhibitors;
- uncontrolled arterial hypertension ;
- closed-angle glaucoma uncompensated;
- severe CRF (with CC less than 30 ml / min);
- deficiency of isomaltase or sucrase, glucose-galactose malabsorption and fructose intolerance;
- liver diseases, which are accompanied by liver failure.
When to use with caution medication
The mentioned drug should be used with extreme caution in case of bipolar disorder and mania, cramps, the risk of developing an attack of angle-closure glaucoma. It is also necessary to be careful with intraocular hypertension, suicidal thoughts, hyponatremia, impaired liver and kidney function.
The drug "Symbalta": instructions for use
The price of this drug is very high. However, its effectiveness is not subject to any doubt.
The medication presented is prescribed only for oral administration. Capsules must be swallowed whole without crushing or chewing them. It should be especially noted that in no case should you add the drug to food or mix it with any liquids, since such an action can easily harm the enteric membrane.
Drugs for depression should be taken at an initial dosage of 60 mg once a day. To achieve a positive result, some patients increase the indicated volume to a maximum dose of 120 mg twice a day.
In patients with a diagnosis of chronic renal failure, which occurs in the terminal stage, the initial dosage of the medication should be 30 mg once a day. If patients have liver dysfunctions, then it is recommended to reduce the indicated amount of the drug or reduce the frequency of administration.
It should also be noted that it is necessary to avoid a sharp withdrawal of the medication. The amount of the drug must be reduced gradually over 1-2 weeks. If pronounced signs of withdrawal syndrome occur against this background, then it is recommended to continue treatment at the prescribed dosage. Subsequently, the doctor may continue to lower the dose, but even more slowly.
Overdose cases
What do experts say about cases of overdose with the drug "Simbalta"? Doctors' reviews contain information that they have such data. To date, there are known cases of overdose when taking the drug inside in an amount of up to 3000 mg, as well as when combined with other drugs. By the way, one death was recorded.
Signs of a combined or isolated overdose include the following conditions: clonic convulsions, drowsiness, vomiting, coma, tachycardia, and serotonin syndrome. As for preclinical studies (animal experiments), the main symptoms of intoxication associated with uncontrolled medication are disorders of the central nervous and digestive systems. Also, patients may experience tremors, ataxia, clonic convulsions, vomiting, and decreased appetite.
What to do in case of overdose? With the development of serotonin syndrome , correctional therapy with cyproheptadine should be immediately carried out, as well as methods to normalize the patient's body temperature should be used.
The patient needs to provide fresh air. You should also monitor the work of his heart and monitor vital signs. All this must be done in conjunction with supportive and symptomatic treatment.
If a little time has passed since taking the drug, then you should rinse your stomach. Also, in order to limit the absorption of the drug, the patient is invited to drink activated charcoal.
Side effect
Can taking the mentioned medication adversely affect human health? Consider the side effects of antidepressant drugs in more detail:
- Very often (in 10% of cases) in clinical trials in patients, the following conditions were noted: dizziness, headaches, dry mouth, sleep disturbance, insomnia, nausea, drowsiness, and constipation.
- Least of all (from 1 to 10% of cases), patients experienced hot flashes, diarrhea, blurred vision, vomiting, sweating, tremors, increased anorgasmia, decreased appetite, decreased libido, weight loss, weakness, erectile dysfunction, as well as delayed or impaired ejaculation.
It can not be said that such a side effect as dizziness (sometimes headaches and nausea) is quite often observed with a sharp cancellation of the medication. By the way, in patients with painful diabetic neuropathy, an increase in fasting blood glucose may be observed.
Reviews about the drug
According to the reviews of specialists and patients, the drug in question completely copes with the task. After taking it, it eliminates anxiety disorder, and also contributes to the disappearance of a depressive state. In addition, this medication well removes pain syndromes in the musculoskeletal system.
Interaction with other means
Is it possible to co-administer other drugs with the Simbalta medication? Reviews of experts say that the mentioned tool directly affects the effectiveness of certain drugs.
So, there is a risk of developing serotonin syndrome if duloxetine is used in combination with MAOI.
Due to the fact that the isoenzyme CYP1A2 takes an active part in the metabolism of the drug “Simbalta”, their simultaneous use can lead to an increase in the concentration of the latter.
It is not recommended to prescribe this medication along with other medicines that affect the central nervous system. Also, during its administration should not drink alcohol.
Sometimes, with the simultaneous use of SSRIs and serotonergic agents, serotonin syndrome is observed in patients. Therefore, extreme caution must be exercised when using this medication with serotonergic antidepressants.
Due to the fact that there is a potentially increased risk of bleeding, do not use duloxetine and anticoagulants (antithrombotic drugs) at the same time .
Breastfeeding and pregnancy
Is it possible to use the drug “Simbalta”, the price of which will be presented later, during pregnancy? Due to the lack of sufficient information on the use of duloxetine during the period of gestation, this medication can be prescribed only if the benefit for the expectant mother significantly exceeds the risk for the baby.
It should also be noted that patients taking this drug should be sure to warn their doctor about the onset or planning of pregnancy.
Studies have shown that taking antidepressants by women in position, especially in the later stages, significantly increases the risk of persistent pulmonary hypertension in newborn babies. At the same time, withdrawal syndrome is also often observed in children in the event of a sudden cessation of the use of duloxetine by a future mother in late pregnancy. Most of the symptoms of this condition were observed during childbirth or in the first days after them.
Due to the fact that duloxetine is able to pass into breast milk, it is extremely undesirable to breast-feed a baby during therapy. Otherwise, the concentration of this substance in the fetus will be in the amount of 0.14% of the concentration in the mother.
Special instructions for the use of the drug
Having prescribed the Simbalta drug to his patient, the doctor is obliged to inform him that the simultaneous administration of this drug with MAO inhibitors is strictly prohibited. Otherwise, this can lead to death, as well as serious complications in the form of hyperthermia, myoclonus and severe excitement with a transition to a coma.
It should also be noted that it is forbidden to take the drug for two weeks after the end of treatment with MAO inhibitors.
According to studies, in patients with manic conditions when using other medications that affect the nervous system, in combination with the Simbalta remedy, the existing disease may worsen.
Due to the fact that there is a chance of suicidal attempts in depressive states, patients at risk should be especially monitored.
Taking this medication can quite easily cause drowsiness. In this regard, patients who take this drug should be especially careful when driving a car and when working with dangerous moving machinery.
Price and analogues of the drug
How much do the enteric capsules of "Simbalta" cost? Their price may be different. It depends on the manufacturer and the margin of pharmacy chains. However, it should be noted that on average this drug costs about 1050 Russian rubles (30 mg, 14 units). If you need to purchase a medicine in a similar amount, but in a dosage of 60 mg, then you will have to give about 1150 rubles.
Now you know how much duloxetine costs. Its price may increase or decrease depending on some factors. Currently, it is not difficult to acquire the named drug. However, you can buy it only by prescription.
But what if you for some reason could not buy the medicinal capsules "Simbalta"? Analogues of this drug are available in almost every pharmacy. Although acquiring them will also require a prescription from a doctor.
What can replace the medicine "Simbalt"? Among its analogues, I want to especially highlight the following drugs:
- "Intriv";
- Asafen (tablets);
- "Duloxetine Canon" (enteric capsules);
- "Venlafaxine Sandoz";
- Alventa;
- Mirtazapin Canon;
- "Befol" (solution for intravenous and intramuscular administration);
- Wellbutrin;
- "Befol" in tablets;
- Valdoxan
- "Neuroplant";
- Velafax
- Calixta
- Venlaxor
- "Wensworth";
- "Dupfix";
- “Venlift OD”;
- "Deprim";
- Efevelon Retard;
- "Doppelherz Nervotonic" in the form of an elixir;
- "Incazan";
- Efevelon;
- Coaxil
- Esprital;
- "Lerivon";
- Trittiko
- "Normazidol";
- Mirzaten;
- Tetrindol;
- Mirtazonal;
- "Remeron";
- Mirtalan;
- Pyrazidolum;
- "Negrustin";
- Newwell;
- "Noxibel."
Storage Method and Shelf Life
What is the shelf life of the drug "Simbalta"? According to the instructions and the date on the package, this product should not be taken after three years. At the same time, it is recommended to store it in a dark place where the air temperature does not exceed 20 degrees.