Selectra
Selektra: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Selectra
ATX code: N06AB10
Active ingredient: escitalopram (escitalopram)
Manufacturer: Actavis Ltd. (Malta)
Description and photo update: 2018-21-11
Prices in pharmacies: from 975 rubles.
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Selectra is an antidepressant.
Release form and composition
Selektra dosage form - film-coated tablets: biconvex, white, round (5 mg) or oval (10, 15 and 20 mg), engraved “E” on one side; on tablets 10, 15 and 20 mg there are lateral risks and risks on the reverse side (10 and 14 pcs. in blisters, in a cardboard box 1, 2 or 3 blisters of 10 tablets or 1, 2 or 4 blisters of 14 tablets; packaging for hospitals - cardboard boxes of 10 blisters).
Composition of 1 tablet Selektra:
- active substance: escitalopram oxalate - 6.39 mg, 12.78 mg, 19.17 mg or 25.56 mg, which corresponds to the content of escitalopram base, respectively 5 mg, 10 mg, 15 mg or 20 mg;
- auxiliary components: sodium croscarmellose, magnesium stearate, talc, salting SMCC®90 / HD90 (silicon dioxide and microcrystalline cellulose);
- the composition of the film coating: opadry white (Opadry 03F28446 White), containing macrogol 6000, titanium dioxide and hypromellose 6cP.
Pharmacological properties
Pharmacodynamics
The active ingredient of Selektra is escitalopram, an antidepressant, selective serotonin reuptake inhibitor (SSRI). Due to the inhibition of serotonin reuptake, the concentration of this neurotransmitter increases in the synaptic cleft, and its effect on postsynaptic receptor sites is enhanced and prolonged.
Escitalopram practically does not bind or only slightly binds to some receptors, including H 1 -histamine, opiate, benzodiazepine, muscarinic cholinergic, dopamine D 1 and D 2, serotonin 5-HT 1A and 5-HT 2, α 1 -, α 2 - and β-adrenergic.
Pharmacokinetics
Food intake does not affect the absorption of escitalopram. The bioavailability of the substance is about 80%. The maximum concentration in blood plasma is observed on average 4 hours after taking Selektra. The apparent volume of distribution is 12–26 l / kg.
The drug is metabolized in the liver to pharmacologically active didemethylated and demethylated metabolites. Escitalopram and its main metabolites bind to blood proteins by about 80%. Partially excreted in the form of glucuronides.
With prolonged use of Selektra, the average concentration of active metabolites is: demethylated - 28–31%, didemethylated - less than 5% of the escitalopram concentration.
In the biotransformation of escitalopram into a demethylated metabolite, cytochrome CYP2C19 is mainly involved. Isoenzymes CYP3A4 and CYP2D6 may also be involved to some extent. In patients with weak activity of CYP2C19, it is possible to increase the concentration of escitalopram by 2 times compared with patients who have a high activity of this enzyme. At the same time, no significant changes in the concentration of escitalopram were found in this case.
The clearance of the drug is about 0.6 l / min. The half-life of escitalopram after repeated administration is about 30 hours, for the main metabolites this period is longer.
The drug is excreted by the liver (metabolic pathway) and kidneys.
Escitalopram is characterized by linear kinetics. When Selektra is taken in a daily dose of 10 mg, the equilibrium concentration is reached in about a week and is 20–125 nmol / l (on average, 50 nmol / l).
In patients over the age of 65, the drug is excreted more slowly than in younger patients. In addition, compared with young healthy volunteers, the elderly have a 50% higher AUC (area under the concentration-time pharmacokinetic curve).
Indications for use
- panic disorder, including agoraphobia;
- depressive disorders of any severity.
Contraindications
Absolute:
- age up to 18 years;
- period of pregnancy and lactation;
- simultaneous use of monoamine oxidase (MAO) inhibitors;
- the presence of hypersensitivity to any component of the drug.
Relative (Selektru should be used with caution):
- depression with suicidal attempts;
- manic disorders;
- hypomania;
- pharmacologically uncontrolled epilepsy;
- bleeding tendency;
- cirrhosis of the liver;
- severe renal failure (creatinine clearance below 30 ml / min);
- diabetes;
- elderly age;
- simultaneous use of ethanol, drugs that lower the seizure threshold or cause hyponatremia, drugs metabolized with the participation of the CYP2C19 system.
Instructions for use of Selektra: method and dosage
Selektra tablets should be taken orally 1 time per day, regardless of meals.
For depressive disorders, 10 mg of the drug is usually prescribed, if necessary, the dose is increased to 20 mg. The therapeutic effect develops within 2-4 weeks, but it is recommended to continue the treatment for at least 6 months after the disappearance of the symptoms of depression, in order to consolidate the effect obtained.
In case of panic disorder, 5 mg is prescribed during the first week, then the daily dose is increased to 10 mg. If necessary, it is possible to increase the daily dose to 20 mg. The therapeutic effect develops within 3 months, the treatment continues for several months.
For elderly patients over the age of 65, the dose of Selektra is usually reduced by 2 times, i.e., the recommended daily dose is 5 mg, the maximum allowable dose is 10 mg.
For patients with impaired liver function and patients with weak activity of the isoenzyme CYP2C19, during the first two weeks, the drug is prescribed in a daily dose of 5 mg, then, if necessary, it is increased to 10 mg.
In order to avoid the development of a withdrawal syndrome at the end of therapy, the dose of Selektra should be reduced gradually, over 1–2 weeks.
Side effects
- from the central nervous system: movement disorders, tremors, convulsions, insomnia or drowsiness, weakness, dizziness, agitation, hallucinations, panic attacks, confusion, increased irritability, anxiety, visual disturbances, depersonalization, manic disorders, serotonin syndrome (tremor, myoclonus, agitation, hyperthermia);
- on the part of the cardiovascular system: orthostatic hypotension;
- from the genitourinary system: urinary retention, anorgasmia (in women), impaired ejaculation, decreased libido, impotence;
- from the endocrine system: galactorrhea, decreased secretion of antidiuretic hormone (ADH);
- from the digestive system: disturbances in taste, dry mouth, diarrhea, constipation, loss of appetite, nausea, vomiting;
- skin and allergic reactions: purpura, itching, skin rash, ecchymosis, angioedema, anaphylactic reactions;
- laboratory parameters: changes in laboratory parameters of liver function, hyponatremia;
- others: arthralgia, myalgia, hyperthermia, excessive sweating, sinusitis; in case of abrupt withdrawal of the drug after prolonged use - withdrawal syndrome (headaches, dizziness, nausea).
Side effects are most often observed at 1-2 weeks of taking Selektra. With continued therapy, the intensity of adverse reactions decreases, they occur less often.
Overdose
Symptoms: drowsiness, dizziness, clouding of consciousness, agitation, seizures, hypokalemia, metabolic acidosis, rhabdomyolysis, vomiting, respiratory depression, tachycardia, arrhythmias, changes in the electrocardiogram (lengthening of the QT interval, widening of the QRS complex, changes in the S-T segment and the wave T); very rarely - acute renal failure.
There is no specific antidote for escitalopram. Gastric lavage, adequate oxygenation and symptomatic therapy are recommended. It is necessary to monitor the respiratory and cardiovascular functions.
special instructions
At the beginning of treatment, anxiety may increase in some patients. This paradoxical reaction usually resolves within 2 weeks. To avoid the development of this effect, it is recommended to start treatment with a minimum dose.
Depression is characterized by the risk of suicide, which persists until significant improvement in the condition, spontaneous or against the background of antidepressant therapy. In this regard, patients on antidepressant treatment should be closely monitored, especially at the initial stage of therapy.
There are isolated cases of increased risk of suicidal manifestations (thoughts and behavior) in young people under the age of 24 who received drugs from the SSRI group.
If seizures develop against the background of escitalopram, the drug is canceled. Selektru is not recommended for patients with uncontrolled epilepsy. Patients with controlled seizures should be closely monitored during treatment. If there is an increase in the frequency of seizures, the drug is discontinued.
Escitalopram should be used with caution in patients with a history of mania / hypomania. In case of development of a manic state, the Selectr is canceled.
The drug can affect the level of glucose in the blood, which is why patients with diabetes mellitus may experience hypoglycemia or hyperglycemia, which will require a dose adjustment of insulin and / or oral hypoglycemic drugs.
Escitalopram can cause the development of subcutaneous hemorrhages (purpura and ecchymosis), so it should be used with caution in patients prone to bleeding and those receiving oral anticoagulants or drugs that affect blood clotting.
While taking escitalopram, in rare cases, hyponatremia occurs, which is probably associated with a violation of ADH secretion and disappears after discontinuation of therapy. Caution should be observed when prescribing Selektra to patients at risk of developing hyponatremia. These include the elderly, patients with cirrhosis of the liver and those taking medications that can cause the development of hyponatremia.
Due to limited experience, escitalopram should be used with caution in conjunction with electroconvulsive therapy.
The occurrence of symptoms such as tremor, hyperthermia, myoclonus and agitation in a patient gives reason to suspect the development of serotonin syndrome. In this case, Selektru is immediately canceled and symptomatic therapy is prescribed.
Influence on the ability to drive vehicles and complex mechanisms
While taking the antidepressant Selectra, patients are advised to refrain from performing potentially hazardous activities that require speed of reactions and increased attention.
Application during pregnancy and lactation
According to the instructions, Selektra is contraindicated during pregnancy and lactation.
Pediatric use
Selektra is not used to treat children and adolescents under the age of 18.
With impaired renal function
With renal failure of mild to moderate severity, there is no need for dose adjustment.
Patients with severe renal impairment (creatinine clearance <30 ml / min) Selectra should be used with caution. It is recommended to start treatment with the minimum therapeutic dose, gradually increasing it depending on the tolerance and severity of the drug effect.
For violations of liver function
For patients with impaired liver function, the dose of Selektra is reduced (the initial daily dose is 5 mg, if necessary, it is increased to 10 mg).
Use in the elderly
For patients over the age of 65, the dose of the drug is usually reduced (the initial recommended daily dose is 5 mg, if necessary, it is increased to 10 mg).
Drug interactions
- MAO inhibitors: there is a high risk of developing serious interaction reactions, including serotonin syndrome. Selecttra can be prescribed no earlier than 14 days after the cancellation of irreversible MOA inhibitors, 1 day after the cancellation of reversible MAO type A inhibitors (for example, moclobemide). Non-selective MAO inhibitors can be prescribed no earlier than 7 days after discontinuation of escitalopram;
- serotonergic drugs (for example, sumatriptan, tramadol, other triptans): the development of serotonin syndrome is possible;
- drugs that lower the seizure threshold, such as antipsychotics (phenothiazines, thioxanthene and butyrophenone derivatives), tricyclic antidepressants, tramadol, mefloquine, other SSRIs: their action may be enhanced;
- tryptophan: its effects are enhanced, including serotonergic;
- St. John's wort: possible increase in the number of side effects;
- lithium: its toxic effects are enhanced;
- anticoagulants and other drugs that affect blood clotting (for example, ticlopidine, dipyridamole, nonsteroidal anti-inflammatory drugs, acetylsalicylic acid, phenothiazines, atypical antipsychotics, most tricyclic antidepressants): bleeding disorders may occur (blood clotting needs to be monitored).
Escitalopram does not enter into pharmacokinetic and pharmacodynamic interactions with ethanol. However, it is not recommended to consume alcoholic beverages while using Selektra, as well as any other psychotropic drugs.
Recommendations needing attention
The concentration of escitalopram in blood plasma can be increased by drugs that inhibit cytochrome CYP2C19 (for example, omeprazole), therefore, when using them simultaneously, caution should be exercised and, if necessary, the dose of Selektra should be reduced.
Patients receiving high doses of escitalopram simultaneously with high doses of strong inhibitors of cytochromes CYP1A2, CYP2D6 and CYP3A4, for example, cimetidine, should be treated with extreme caution.
Caution should be exercised with the simultaneous use of drugs that are metabolized with the participation of the CYP2D6 isoenzyme and have a low therapeutic index, for example, propafenone, flecainide, metoprolol (used for heart failure), are metabolized mainly by CYP2D6 and act on the central nervous system, for example, antidepressants (clomipramine, desipramine, nortriptyline), antipsychotics (thioridazine, risperidone, haloperidol). When prescribing such combinations, it is possible to increase the concentration of escitalopram in the blood plasma, therefore, dose adjustment may be required.
When taken together, escitalopram doubles the concentration of desipramine and metoprolol, which should be taken into account when choosing doses.
It is recommended to be careful when prescribing Selektra in combination with drugs metabolized by CYP2C19, since escitalopram can inhibit this enzyme.
Analogs
Selektra's analogues are: Lenuxin, Miracitol, Sancipam, Tsipralex, Elicea, EISIPI, Escitalopram, Escitalopram Canon, Escitalopram-Teva, Escitalopram Sandoz.
Terms and conditions of storage
Shelf life is 2 years.
Keep out of reach of children at temperatures up to 25 ° C.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Selektr
According to reviews, Selectra is an effective antidepressant drug. Its disadvantages include increased anxiety in the first week of treatment, which is why it is recommended to start treatment with a minimum dose of 5 mg, gradually increasing it. Some patients report the development of side effects, including severe abdominal pain, headaches, deterioration of mood and apathy, due to which they had to stop treatment.
The price of Selectra in pharmacies
Depending on the pharmacy network, the price for Selectra at a dose of 10 mg varies from 700 to 990 rubles for a blister of 28 tablets, 1560–1800 rubles for a blister of 56 tablets.
Selektra: prices in online pharmacies
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Drug name Price Pharmacy |
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Selektra 10 mg film-coated tablets 28 pcs. RUB 975 Buy |
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Selektra tablets p.o. 10mg 28 pcs. 1032 RUB Buy |
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Selektra 10 mg film-coated tablets 56 pcs. RUB 1701 Buy |
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Selektra tablets p.o. 10mg 56 pcs. 1868 RUB Buy |
Maria Kulkes Medical journalist About the author
Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
