Miaser

General characteristics. Structure:

Active agent: миансерин 30 mg.

Pharmacological properties:

Pharmacodynamics. Miaser — antidepressive drug which concerns to group of piperazino-azepinovy connections. In chemical structure of a mianserin (active component of drug) there is no side chain characteristic of tricyclic antidepressants which defines anticholinergic activity of the last. Mianserin raises the central noradrenergichesky neurotransmission by blockade? 2 adrenoceptors and oppressions of the return neyronalny capture of noradrenaline. Drug contacts serotoninovy receptors of TsNS. The antidepressive effect of Miaser is similar to effect of other modern antidepressants. Besides, drug has also expressed anxiolytic effect which is important at treatment of patients with the depression associated with alarm. Miaser sedation connected with his influence on? 1 adrenoceptors and histamine H1 receptors, are the powerful basis for use of drug at sleep disorders against the background of depressions.
Miaser is well had by patients, including advanced age and patients with cardiovascular diseases. At use in therapeutic doses drug practically does not render anticholinergic activity and, respectively, does not excite function of cardiovascular system.
At overdose Miaser causes much less cardiotoxic effects in comparison with tricyclic antidepressants. Drug does not interact with sympathomimetic and anti-hypertensive means which action is caused by influence on? - adrenoceptors (бетанидин) or? - adrenoceptors (a clonidine, Methyldopum).

Pharmacokinetics. At oral administration миансерин it is quickly soaked up. Cmax of active agent in a blood plasma is observed in 3 h after administration of drug. Bioavailability makes 20%. миансерин contacts proteins of a blood plasma approximately for 95%. T1/2 of a mianserin makes from 20 to 60 h therefore to use drug enough 1 once a day. Stable concentration of a mianserin in a blood plasma is reached for 6 days of treatment by drug. Mianserin is metabolized and brought with urine and a stake for 7–9 days. The main ways of biotransformation of a mianserin — demethylation and oxidation with further conjugation of metabolites.

Indications to use:

Depressions of various genesis.

Route of administration and doses:

Pill Miaser is taken inside, swallowing, not chewing, washing down with water.
The dose of drug is defined by the doctor individually for each patient.
For adults the recommended initial dose of Miaser makes 30 mg/days. It is possible to raise a dose of drug gradually each 3–4 days to achievement of optimum clinical effect. As a rule, the effective daily dose of Miaser makes 60–90 mg, maximum — 90 mg.
Treatment of patients of advanced age begin 30 mg/days with a dose. Further Miaser's dose can be raised gradually. The supporting effective daily dose of drug can be slightly lower, than a usual dose for adults.
The daily dose of Miaser can be distributed on several receptions, but it is better to accept drug in one step in the evening, considering its positive influence on a night dream.
Treatment by adequate doses of Miaser usually yields positive result for 2–4 weeks of therapy. If reaction insufficient, the daily dose of drug can be raised. If for further 2–4 weeks the positive effect is not observed, treatment by Miaser needs to be stopped.
After the reached clinical improvement for maintenance of positive effect treatment by Miaser needs to be continued within 4–6 months.
The treatment termination by drug in some cases can become the withdrawal reason.

Features of use:

Like other antidepressants, Miaser can strengthen a hypomaniacal state at persons with bipolar depressive disturbances. In such cases treatment by drug needs to be stopped.
At treatment of patients by Miaser with a diabetes mellitus, patients with cardiovascular pathology, a renal and/or liver failure it is necessary to observe the standard warning measures. The doses of drugs intended for treatment of associated diseases have to be under constant control of the doctor.
Patients with closed-angle glaucoma and/or symptoms which can give the grounds to suspect a prostatauxe have to be under observation of the doctor (though anticholinergic side effects are not characteristic of Miaser).
At emergence of symptoms of jaundice, as well as at development of spasms, treatment needs to be stopped.
In the course of treatment oppression of function of marrow which is shown by a granulocytopenia or an agranulocytosis is possible. These reactions arise after 4–6 weeks of treatment more often and usually have reversible character after the therapy termination. Such side reactions at people of advanced age are observed more often than at patients of other age groups. If the patient has a fever, a pharyngalgia, stomatitis or other symptoms of an infection, it is necessary to stop treatment and to appoint clinical blood test.
Ability to influence speed of response at control of vehicles or work with other mechanisms. Miaser can influence psychomotor reactions in the first days of reception. Therefore patients with a depression throughout a course of treatment with drug need to refrain from control of vehicles or work with other potentially dangerous mechanisms.

Use during pregnancy
Limited clinical data do not contain messages on any undesirable influence of Miaser on fetation and the newborn and demonstrate to what миансерин gets into breast milk only in insignificant quantity. However at Miaser's use during pregnancy and/or feeding by a breast it is necessary to consider a ratio of advantage of use of drug and possible risk for a fruit or the newborn.

Side effects:

In an initiation of treatment drowsiness (sedation) which passes further can be observed. The dose decline, as a rule, does not lead to drowsiness reduction, however can reduce antidepressive efficiency of drug. Therefore for ensuring optimal antidepressive effect Miaser's dose should not be reduced.
In isolated cases it was reported about disturbance of a hemogenesis, an agranulocytosis, spasms, a hypomaniacal state, arterial hypotension, an arthralgia, peripheral hypostases, a gynecomastia, an abnormal liver function, a hyperkinesia, a dieback, and also about possible increase in body weight. In some cases after reception of an initial dose of drug bradycardia was observed.
Frequency and weight of the somatic symptoms caused by a depression (such as dryness in a mouth and a lock), at treatment by Miaser usually do not increase.

Interaction with other medicines:

Miaser is capable to strengthen the oppressing effect of alcohol on TsNS therefore patients need to refrain from its use during treatment by drug.
Miaser it is not necessary to appoint along with MAO inhibitors or for 2 weeks after the termination of a course of treatment these drugs.
Miaser does not influence effect of such medicines as бетанидин, a clonidine, Methyldopum, гуанетидин and propranolol (separately or in a combination with gidralaziny). However at patients who receive anti-hypertensive drugs along with Miaser it is necessary to control the ABP level.
Like other antidepressants, Miaser can influence metabolism of derivatives of coumarin (warfarin, etc.). Therefore patients who accept such drugs need constant observation.
Special instructions at reception.

Contraindications:

Maniacal conditions, heavy disturbances of functions of a liver.

Overdose:

Symptoms of considerable exceeding of the recommended doses of a mianserin are limited to long sedation. Arrhythmias, spasms, the expressed arterial hypotension and respiratory depression develop seldom.
Treatment. There is no specific antidote. The gastric lavage with further symptomatic therapy and maintenance of the main vital signs of an organism is recommended.

Storage conditions:

At a temperature not above 25 °C.

Issue conditions:

According to the recipe

Packaging:

Tablets of 30 mg, No. 10, No. 20.