A drug with an antidepressant effect, belonging to the group of serotonin reuptake inhibitors.
What does Rexetin contain and how does it work?
The active substance is paroxetine, which belongs to the group of serotonin reuptake inhibitors (SSRIs can be found for this group of drugs, derived from the English selective serotonin reuptake inhibitor). Serotonin is one of the neurotransmitters, substances that play an important role in communication between neurons. The junction of two neurons is called a synapse. The information-transmitting cell in front of the synapse releases a so-called mediator into the synaptic cleft, a substance that is captured and recognized by the information-receiving cell behind the synapse. In this case, the mediator is serotonin. Some of the serotonin molecules get caught back by the receptors of the neuron before the synapse, which is called reuptake. Paroxetine acts by inhibiting the serotonin reuptake process, and thus extending the time of serotonin action in the synapse and the time of excitation of the recipient cell. Nerve impulses are sent more frequently. Greater stimulation of serotonin-dependent cells is associated with the antidepressant effect, as well as with conditioning the effectiveness of treatment of obsessive-compulsive disorder, social phobia, generalized anxiety disorder, post-traumatic stress disorder and anxiety disorder with anxiety attacks. Paroxetine has low affinity for muscarinic receptors. Animal studies have shown weak anticholinergic properties. Paroxetine is not central nervous system depressant and has no antihypertensive properties. Taking paroxetine in the morning does not have any harmful effect or on the quality, nor the length of sleep. What’s more, people who respond to paroxetine treatment experience improved sleep.
When should I use Rexetin?
The preparation is indicated in the treatment of:
· severe depressive episode
· obsessive-compulsive disorder
· anxiety disorder with panic attacks with or without agoraphobia
· social phobia
· generalized anxiety disorder
· post-traumatic stress disorder.
When not to use this preparation?
Unfortunately, even if there are indications for the use of the preparation, it cannot always be used. You can not use the preparation if you are allergic (you are hypersensitive) to any of the ingredients.
The use of MAO inhibitors in parallel with paroxetine is contraindicated.
Under special circumstances, linezolid (an antibiotic that is a reversible, non-selective monoamine oxidase inhibitor) may be given together with paroxetine, provided that blood pressure can be monitored and the patient closely monitored for symptoms of serotonin syndrome.
Treatment with paroxetine can be started 14 days after stopping treatment with irreversible MAO inhibitors and the day after stopping treatment with reversible MAO inhibitors. MAO inhibitors can be started 1 week after stopping paroxetine.
Paroxetine should not be used concurrently with thioridazine due to the possible prolongation of the QT interval and the associated severe ventricular torsades de pointes. The preparation should not be used in parallel with pimozide.
When should you take special care with Rexetin?
Certain diseases and other circumstances may constitute a contraindication to the use or an indication to change the dosage of the preparation. Certain check-ups may be necessary in certain situations.
There are limited long-term safety data for the use of paroxetine in children and adolescents up to 18 years of age. There are no long-term safety data on growth, maturation, cognitive development and behavioral development. If the doctor decides that a child should be treated with this preparation, the patient’s development should be monitored, as well as their behavior in terms of suicidal ideation and behavior. If you notice any abnormalities, please contact your pediatrician immediately.
The effects of paroxetine treatment are visible after several weeks of its use, sometimes this time is longer. Especially people prone to suicidal thoughts related to depression should be under close medical supervision during this period, as the use of the drug may be associated with a suicide attempt. Any disturbing behavioral changes noticed should be reported to the physician immediately.
The use of the preparation may lead to akathisia in some people (state of anxiety, inability to refrain from movements), especially in the first weeks of treatment. In this case, your doctor is unlikely to increase your dose.
If you experience symptoms such as:
· muscle stiffness
· muscle clonic convulsions
· Lability of the autonomic system with possible sudden fluctuations in life functions
· changes in mental state (irritability, confusion, extreme psychomotor agitation leading to delirium and coma)
contact your doctor immediately, as their cause may be life-threatening so-called “serotonin syndrome”.
In the following cases, during treatment, the patient should be under close medical supervision:
if he or she suffers from mania (in the case of a manic phase, the doctor will probably stop treatment),
if he or she has renal or hepatic insufficiency,
if he suffers from epilepsy,
if he suffers from work disorders hearts
If you are using oral anticoagulants, drugs that affect the function of platelets or other drugs that may increase the risk of bleeding (e.g. atypical antipsychotics such as clozapine, phenothiazines, most tricyclic antidepressants, acetylsalicylic acid, non-steroidal anti-inflammatory drugs, COX-2), as well as if you have a history of blood coagulation disorders (prolonged or abnormal bleeding may occur during the use of the preparation).
In patients with diabetes, it may be necessary to adjust the dosage of insulin or oral antidiabetic drugs (the decision is made by the doctor).
If a seizure occurs during the use of the preparation, the treatment should be discontinued (the decision is made by the doctor).
There is very little experience of treating paroxetine in people with electroconvulsive therapy. For this reason, caution is advised in this group of people.
Paroxetine, like other drugs in this class, can cause pupil dilation; it should be used with caution in patients with narrow-angle glaucoma or a history of glaucoma.
There have been rare reports of hyponatraemia with paroxetine use, especially in the elderly. This phenomenon usually disappears spontaneously after discontinuation of the preparation.
Treatment should not be stopped abruptly as withdrawal reactions can occur. Common symptoms include dizziness, sensory disturbances (including paraesthesia), sleep disturbances (including insomnia and intense dreams), weakness (asthenia), agitation or anxiety, nausea and / or vomiting, tremors and headaches. If discontinuation of the preparation is required, the dose should be gradually reduced, strictly following the doctor’s instructions.
Does this preparation affect the ability to drive?
The preparation may impair the ability to drive vehicles and operate equipment / machines. Psychoactive drugs can interfere with your ability to make decisions and react in emergencies. Be careful!
Dosage of Rexetin
The preparation is in the form of tablets for oral use. Do not exceed the recommended doses because it will not increase the effectiveness of the drug and may harm your health and life. If you have any doubts about the use of the preparation, consult your doctor.
Severe depressive episode.
Usually 20 mg / day is used; if necessary, your doctor will adjust the dose individually within 3-4 weeks. Depending on the clinical response, your doctor may need to gradually increase the dose in steps of 10 mg to a maximum of 50 mg / day. Treatment should be continued for at least 6 months.
Initially, the dose is 20 mg / day, then your doctor may decide to increase the dose in steps of 10 mg to the recommended dose of 40 mg / day. In case of insufficient clinical response, after a few weeks of using the recommended dose, your doctor may decide to further increase the dose to a maximum of 60 mg / day. Treatment should last several months or more.
Anxiety disorders with anxiety attacks, with or without agoraphobia.
Initially 10 mg / day is used, then your doctor may decide to increase the dose in steps of 10 mg to the recommended dose of 40 mg / day. In case of insufficient clinical response, after a few weeks of using the recommended dose, your doctor may decide to further increase the dose to a maximum of 60 mg / day. Treatment should last for several months or longer.
Social phobia. Generalized anxiety disorder. Post-traumatic stress disorder.
The recommended dose is 20 mg / day. If, after several weeks of using the recommended dose, the observed clinical response is not sufficient, your doctor may decide to gradually increase the dose by 10 mg to a maximum of 50 mg / day. Long-term treatment should be reviewed regularly.
In the elderly, the recommended starting dose does not differ from that recommended for adults, and the maximum dose is 40 mg daily.
In people with hepatic failure and severe renal failure, it is recommended to use the lowest doses of the preparation.
Due to the lack of research, the preparation is not used in children and adolescents under 18 years of age.
Method of administration:
The preparation should be taken once a day in the morning with a meal and a sufficient amount of liquid. The tablets are divisible but should not be chewed, they should be swallowed whole
Can I use Rexetin during pregnancy and breastfeeding?
During pregnancy, do not use any medication without consulting your doctor!
It is very important that before taking any medicine during pregnancy or breastfeeding, consult a doctor and explain beyond any doubt the potential risks and benefits associated with the use of the drug. If you are pregnant or plan to become pregnant, consult your doctor before using the preparation.
It should not be used in women planning pregnancy and during pregnancy, unless the doctor considers that the mother’s condition absolutely requires it (after considering the possibility of using alternative therapy). Abrupt discontinuation of paroxetine treatment during pregnancy should be avoided.
Paroxetine should not be used during breastfeeding unless the doctor decides that the benefit to the mother outweighs the risk to the baby.
Can I use other preparations in parallel?
Tell your doctor about all medications you have recently taken, including those over the counter.
Paroxetine is contraindicated in parallel with MAO inhibitors (risk of serotonin syndrome) and pimozide (possibility of prolongation of the QT interval).
As a strong inhibitor of CYP2D6, paroxetine may decrease the levels of endoxifen, one of the most important active metabolites of tamoxifen. Therefore, the use of paroxetine during tamoxifen treatment should be avoided where possible.
Caution should be exercised when using the preparation in combination:
· with procyclidine, because its concentration in plasma increases significantly and anticholinergic symptoms may occur; the doctor will reduce the dose of procyclidine in this case
With serotonergic drugs (such as L-tryptophan, triptans, tramadol, linezolid, methylthioninium chloride, SSRIs, lithium, pethidine and preparations containing St. John’s wort) due to the possibility of serotonin syndrome
with fentanyl under general anesthesia or in treatment chronic pain
· drugs metabolized by the cytochrome P-450 isoenzyme CYP2D6; Concomitant use of paroxetine and metoprolol in heart failure is not recommended due to its narrow therapeutic index in this indication.
With oral anticoagulants, as well as with drugs that affect the function of platelets or other drugs that may increase the risk of bleeding (e.g. atypical antipsychotics such as clozapine, phenothiazines, most tricyclic antidepressants, acetylsalicylic acid, non-steroidal anti-inflammatory drugs, COX-2 inhibitors), as their effect may be altered (for example increased bleeding)
with St. John’s wort preparations, as the risk of side effects of paroxetine increases.
You should not drink alcohol during treatment.
What side effects may occur?
Like all drugs, Rexetin can also cause side effects, although they will not occur in all patients using this preparation. Remember that the expected benefits of using the drug are usually greater than the harm resulting from the occurrence of side effects.
Very common may occur: nausea, sexual dysfunction.
Common may occur: increased cholesterol, decreased appetite, somnolence, insomnia, agitation, abnormal dreams (including nightmares), dizziness, tremor, headache, impaired concentration, blurred vision, constipation, diarrhea, vomiting, dry mouth mouth, sweating, weakness, weight gain.
Uncommon bleeding may occur, mostly of the skin and mucous membranes – most often petechiae, confusion, hallucinations, extrapyramidal symptoms, mydriasis, sinus tachycardia, transient increase or decrease in blood pressure, orthostatic hypotension, rash, itching, urinary retention, incontinence urine.
Rarely, the following may occur: hyponatraemia, manic reactions, anxiety, depersonalisation, panic attacks, akathisia, convulsions, restless legs syndrome, bradycardia, increased liver enzymes, hyperprolactinaemia / galactorrhoea, arthralgia, muscle pain.
Very rarely, the following may occur: thrombocytopenia, allergic reactions (including urticaria and angioedema), syndrome of inappropriate antidiuretic hormone secretion, serotonin syndrome (symptoms: agitation, confusion, sweating, hallucinations, hyperreflexia, myoclonus, chills, tachycardia and tremors), acute glaucoma, gastrointestinal bleeding, liver dysfunction such as hepatitis, sometimes associated with jaundice and / or liver failure, severe skin reactions (including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis), photosensitivity, priapism (prolonged painful erection without sexual stimulation), peripheral edema.
In addition, with an unknown frequency the following may occur: suicidal thoughts, suicidal behavior, tinnitus.
Cases of suicidal ideation and suicidal behavior have been reported during treatment with paroxetine or soon after treatment discontinuation.
Epidemiological studies have shown an increased risk of bone fractures in patients taking this class of medicines, the mechanism of this effect is unknown.