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Fedorchenko Olga Valeryevna tarafından tıbbi olarak gözden geçirilmiştir, Eczane Son güncelleme: 10.04.2022
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Иксел is indicated for the management of fibromyalgia. Иксел is not approved for use in pediatric patients.
Иксел is given orally with or without food. Taking Иксел with food may improve the tolerability of the drug.
Recommended Dosing
The recommended dose of Иксел is 100 mg/day (50 mg twice daily).
Based on efficacy and tolerability dosing may be titrated according to the following schedule:
Day 1: 12.5 mg once
Days 2-3: 25 mg/day (12.5 mg twice daily)
Days 4-7: 50 mg/day (25 mg twice daily)
After Day 7: 100 mg/day (50 mg twice daily)
Based on individual patient response, the dose may be increased to 200 mg/day (100 mg twice daily).
Doses above 200 mg/day have not been studied.
Иксел should be tapered and not abruptly discontinued after extended use.
Patients With Renal Insufficiency
No dosage adjustment is necessary in patients with mild renal impairment.
Иксел should be used with caution in patients with moderate renal impairment.
For patients with severe renal impairment (indicated by an estimated creatinine clearance of 5-29 mL/min), the maintenance dose should be reduced by 50% to 50 mg/day (25 mg twice daily).
Based on individual patient response, the dose may be increased to 100 mg/day (50 mg twice daily).
Иксел is not recommended for patients with end-stage renal disease.
Patients With Hepatic Insufficiency
No dosage adjustment is necessary for patients with hepatic impairment. As with any drug, caution should be exercised in patients with severe hepatic impairment.
Discontinuing Иксел
Withdrawal symptoms have been observed in clinical trials following discontinuation of milnacipran, as with other serotonin and norepinephrine re-uptake inhibitors (SNRIs) and selective serotonin re-uptake inhibitors (SSRIs). Patients should be monitored for these symptoms when discontinuing treatment. Иксел should be tapered and not abruptly discontinued after extended use.
Switching A Patient To Or From A Monoamine Oxidase Inhibitor (MAOI) Intended To Treat Psychiatric Disorders
At least 14 days should elapse between discontinuation of a MAOI intended to treat psychiatric disorders and initiation of therapy with Иксел. Conversely, at least 5 days should be allowed after stopping Иксел before starting a MAOI intended to treat psychiatric disorders.
Use Of Иксел With Other MAOIs Such As Linezolid Or Methylene Blue
Do not start Иксел in a patient being treated with linezolid or intravenous methylene blue because there is increased risk of serotonin syndrome. In a patient who requires more urgent treatment of a psychiatric condition, other interventions, including hospitalization, should be considered.
In some cases, a patient already receiving Иксел therapy may require urgent treatment with linezolid or intravenous methylene blue. If acceptable alternatives to linezolid or intravenous methylene blue treatment are not available and the potential benefits of linezolid or intravenous methylene blue treatment are judged to outweigh the risks of serotonin syndrome in a particular patient, Иксел should be stopped promptly, and linezolid or intravenous methylene blue can be administered. The patient should be monitored for symptoms of serotonin syndrome for 5 days or until 24 hours after the last dose of linezolid or intravenous methylene blue, whichever comes first. Therapy with Иксел may be resumed 24 hours after the last dose of linezolid or intravenous methylene blue.
The risk of administering methylene blue by non-intravenous routes (such as oral tablets or by local injection) or in intravenous doses much lower than 1 mg/kg with Иксел is unclear. The clinician should nevertheless be aware of the possibility of emergent symptoms of serotonin syndrome with such use.
However, we will provide data for each active ingredient