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Risperidone od: Risperidone Uses,Images & Side effects

Risperidone Uses,Images & Side effects

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Risperdal 0. 25 mg

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Risperdal 1 mg

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Risperdal 2 mg

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Risperidone 0.25 mg-MYL

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Risperidone 3 mg-TEV

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Risperidone 4 mg-TEV

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Delayed Respiratory Depression After Risperidone Overdose : Anesthesia & Analgesia

Antipsychotic drugs, also called major tranquilizers and neuroleptics, are used to treat schizophrenia and other types of psychoses. Toxicity of these drugs may result from suicidal overdose or from adverse reactions after therapeutic administration. Risperidone overdose is rare but life-threatening. All antipsychotics produce extrapyramidal side effects (EPS), such as acute dystonic reactions, which can cause respiratory difficulty by pharyngeal and laryngeal muscle spasm. The introduction of drugs that produce minimal EPS and of atypical antipsychotics (e.g., risperidone) has allowed separation of antipsychotic from neuroleptic effects and prevents the interchange of terms. The serotonin-dopamine antagonist concept contends that antipsychotics that are more potent at 5-hydroxytryptamine 2A receptors than at D2 receptors (e.g., risperidone) have a low EPS liability (1).

Case Report

A 26-yr-old woman who had been treated with risperidone for 3 mo was found unconscious on the street. The patient was admitted to a state hospital where it was determined that she had ingested 30 mg of risperidone (a suicide attempt after an argument with her husband) rather than her usual amount of 6 mg/d. Her medical history included long-term schizophrenia.

On Day 3 (after 52 h), respiratory distress developed, and the patient was transferred to our university hospital. On admission, she was hypotensive, with an arterial blood pressure (BP) of 80/50 mm Hg, and she had a Glasgow Coma Scale (GCS) score of 8 of 15. A chest radiograph showed no abnormality. Serum electrolytes and her electrocardiogram were normal (heart rate, 50 bpm). The slow heart rate and BP responded initially to treatment that included IV fluids and a single dose of 0.5 mg of atropine.

Two hours after arrival in the intensive care unit (ICU), the patient’s respiratory drive began failing, and she started gasping. The blood gas analysis at this time, under O2 6 L/min with face mask, showed a pH value of 7.39, Po2 of 51 mm Hg, Pco3 of 24.3 mmol/L, with a respiratory rate of 5 breaths/min. After 10 min, the patient had a respiratory arrest and was endotracheally intubated and ventilated. Sedation was maintained by propofol infusion. A computed tomography scan of the head was performed and showed no abnormalities. There were no other causes of respiratory depression, and she was not receiving any other respiratory depressant drugs. The patient remained hemodynamically stable, and laboratory tests were normal.

The patient started to make respiratory efforts on Day 5. Her reported GCS was 13. After 6 h, she managed to breathe spontaneously with a continuous positive airway pressure mode. She was tracheally extubated on Day 6 and discharged from the ICU on Day 8.

Discussion

Toxicity of antipsychotic drugs results from unintentional or intentional overdose or from adverse reactions after therapeutic administration. EPS are a result of basal ganglia dopamine D2 receptor blockade and consist of four main drug-induced syndromes. These can be divided into reversible syndromes, which occur within days to weeks of the onset of antipsychotic therapy (acute dystonia, parkinsonism, and akathisia) and a potentially irreversible syndrome that occurs after months to years of therapy (tardive dyskinesia).

Acute dystonic reactions (dyskinesias) consist of intermittent spasmodic or sustained involuntary contractions of muscles in the face, neck, trunk, and occasionally the extremities. Resulting clinical manifestations include trismus, tongue protrusion, torticollis, opisthotonos, and respiratory difficulty. Pharyngeal and laryngeal muscle spasm may produce respiratory distress and asphyxia (2,3).

Reported side effects of risperidone are lethargy, dystonia, hypotension, tachycardia, dysrhythmia, impaired concentration, and abnormal temperature regulation (4–7). The recommended dose is 2 mg on Day 1, 4 mg on Day 2, and 6 mg on Day 3; however, in the elderly (or in patients with hepatic or renal failure), the dose is 0.5 mg up to 2 mg on Day 3. This patient was under treatment with risperidone for three months, and her usual medication was 6 mg/d.

Delayed respiratory failure has not been a prominent feature in overdose cases. Rassam and Srinivasa (8) reported a 72-year-old patient with respiratory depression after accidental risperidone overdose, and Acri and Henretig (9) reported cases of impaired respiration when risperidone was given concomitantly with other respiratory depressant drugs resulting in no additive side effects.

In this case, we evaluated whether acute dystonic reaction contributed to the clinical course of our patient, who demonstrated lethargy, tongue protrusion, and pharyngeal-laryngeal muscle spasm, all of which were related to respiratory dysfunction.

Experience with risperidone overdose is limited and the clinical presentation difficult to predict after an overdose. Therefore, patients who are being treated for risperidone overdose should be monitored for hypotension, sedation, and respiratory depression. It should be noted that respiratory depression may be seen as late as the third day after risperidone overdose.

References


1. Huttunen M. The evolution of the serotonin-dopamine antagonist concept. J Clin Psychopharmacol 1995;15:4–8.

2. Rupniak NMJ, Jenner P, Marsden CD. Acute dystonia induced by neuroleptic drugs. Psychopharmacology (Berl) 1986;88:403–5.

3. Sweet C. Drug-induced dystonia. Am J Psychiatry 1975;132:532–7.

4. Himstreet JE, Daya M. Hypotension and orthostasis following a risperidone overdose. Ann Pharmacother (United States) 1998;32:267–70.

5. Brown K, Levy H, Brenner C, et al. Overdose of risperidone. Ann Emerg Med 1993;22:1908–10.

6. Vecchio FL, Hamilton RJ, Hoffman RJ. Risperidone overdose. Am J Emerg Med 1996;14:95–6.

7. British Medical Association and the Royal Pharmaceutical Society of Great Britain. Risperidone. British National Formulary 2001;41:182–9.

8. Rassam S, Srinivasa R. Respiratory depression after accidental risperidone overdose. Am J Emerg Med 2002;20:570–4.

9. Acri AA, Henretig FM. Effects of risperidone in overdose. Am J Emerg Med 1998;16:498–501.

What you need to know about Risperdal (risperidone)!

What is Risperdal?

Risperdal is a medication known as an atypical antipsychotic that is used to treat symptoms of schizophrenia in teenagers and adults. The medication is also sometimes used to treat symptoms of bipolar disorder.

When did the U.S. Food and Drug Administration (FDA) approve the medication?

Risperdal was first approved by the FDA in 1993.

Is there a generic version of Risperdal?

Yes, risperidone is the generic version of Risperdal and is available in the United States.

Are there any major differences between Risperdal and other antipsychotics used to treat Risperdal?

Risperdal belongs to the class of medications known as atypical antipsychotics or second generation psychotics. The drug is also used to treat symptoms of bipolar disorder and irritability associated with autistic disorder in children. The medication comes in tablet, oral solution, and orally disintegrating tablet forms. Talk to your doctor about what might work best for you and the costs and benefits of taking the medication. Some people may need to try several different antipsychotics before they find the most effective with the fewest side effects.

Can children take Risperdal?

Risperdal has been approved for treatment of schizophrenia for children ages 13-17 years, for Bipolar I disorder in children ages 10-17 years, and for irritability associated with autistic disorder for children ages 5-16 years.

Are there potential interaction issues for people taking Risperdal and any other drugs?

There are hundreds of other drugs which are known to interact with Risperdal in major, moderate, or mild ways. Some of these include antidepressants, carbamazepine, cimetidine, clozapine, dopamine agonists, anxiety medication, high blood pressure medication, seizure medication, paroxetine, phenobarbital, phenytoin, quinidine, ranitidine, rifampin, sedatives, sleep medications, tranquilizers, and valproic acid. Let your doctor know what other prescription and nonprescription medications you are taking before you begin taking the medication.

Are there any other medical conditions that would make someone ineligible for Risperdal therapy?

Talk to your doctor about other medical conditions before you take Risperdal, such as diabetes, dementia, seizures, low white blood cell count, Parkinson’s disease, high cholesterol, high or low blood pressure, a history of heart attack or stroke, breast cancer, heart disease, kidney, disease, or liver disease. Also, talk to your doctor if you have a history of substance abuse or any other mental health issues.

What is the typical starting dose that would be prescribed to someone taking Risperdal?

The FDA recommends a starting dosage of 2mg a day for the treatment of schizophrenia in adults. Safety and efficacy have not been established beyond a dosage of 16mg a day. Dosage may differ when treating other conditions.

What do I do if I miss a dose?

Take the dose of Risperdal when you remember, but skip the missed dose if it’s almost time for your next dose. You should never take extra doses of the medication to make up for missed doses.

Can Risperdal cause side effects?

Common side effects of Risperdal can include:

  • Weight gain
  • Restlessness
  • Agitation
  • Dry mouth
  • Increased saliva
  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • Trouble urinating
  • Stomach pain
  • Vision problems
  • Muscle or joint paint
  • Heartburn
  • Increased appetite
  • Anxiety
  • Trouble sleeping
  • Breast enlargement
  • Late or missed menstrual periods
  • Decreased sexual ability
  • Dry or discolored skin.

Doctors recommend that you not drink alcohol while on the medication. It also is recommended that you wait to drive or operate machinery until you know how the medication affects you. Report major side effects to your doctor immediately, which can include faintness, unusual body movements, sweating, fever, stiff muscles, fever, seizures, hives, itching, shuffling walk, difficulty breathing or swallowing, and long-lasting and pain erection. You can also report side effects to the FDA at 1-800-FDA-1088 or online.

What are the potential long-term effects of taking Risperdal?

Your doctor should monitor for progression of potential long-term side effects of Risperdal, which can include changes in heart rhythm, weight gain, high blood sugar, and tardive dyskinesia.

Is it safe for a woman who is pregnant, about to become pregnant, or nursing to take Risperdal?

There have been no controlled human pregnancy studies on the effects of Risperdal. The drug can be transferred via human breast milk, and patients are advised not to breastfeed while taking the medication. Before you take Risperdal, talk to your doctor if you are pregnant, planning to become pregnant, or are nursing.

Can symptoms occur if Risperdal is discontinued?

It’s important not to discontinue use of the drug if you feel better. Withdrawal symptoms may include dizziness, nausea, sleepiness, and the return of symptoms of schizophrenia. Maintain contact with your doctor and seek medical attention if necessary when discontinuing the drug, and talk to your doctor about how to mitigate potential withdrawal symptoms.

What should I do if I overdose on Risperdal?

Seek immediate help or call the Poison Help Line at 1-800-222-1222 if you overdose, as it can be fatal. Symptoms may include fainting, blurred vision, drowsiness, fast or irregular heartbeat, dizziness, and seizures.

Is Risperdal habit-forming?
Risperdal has no habit-forming potential, but it is not recommended that you discontinue use of the drug before talking with your doctor, as withdrawal symptoms can occur.

How much does Risperdal cost?

According to goodrx.com, 30 tablets of 1mg Risperdal cost approximately $300. 30 tablets of 1mg generic risperidone cost approximately $14.

Are there any disadvantages to Risperdal?

The biggest disadvantages of Risperdal are the potential long-term side effects, which can include tardive dyskinesia, increased blood sugar, high triglycerides, and weight gain.

 

DISCLAIMER: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider.  This article mentions drugs that were FDA-approved and available at the time of publication and may not include all possible drug interactions or all FDA warnings or alerts. The author of this page explicitly does not endorse this drug or any specific treatment method. If you have health questions or concerns about interactions, please check with your physician or go to the FDA site for a comprehensive list of warnings.

 

 

 

Article Sources

Last Updated: Feb 21, 2018

Risperidone toxicity • LITFL • Toxicology Library Toxicants

Risperidone is an atypical antipsychotic agent associated with tachycardia and acute dystonic reactions.

Toxic Mechanism:

Risperidone antagonises the mesolimbic dopamine (D2), serotonin and alpha 1 + 2 receptors. Compared with other antipsychotics it has a low affinity for histamine the muscarninic receptors, meaning less CNS depression and anticholinergic features.

Toxicokinetics: 

  • Rapidly absorbed
  • Moderate volume of distribution 1.5 L/kg
  • Highly protein bound
  • Metabolised in the liver and excreted in the urine

Resuscitation:

Risk Assessment

  • Dose related risk assessment is poorly defined
  • Children: >1 mg is associated with clinical features. Acute dystonic reactions are more common in children.
  • Clinical features should manifest within 4 hours and resolve by 24 hours
    • Sinus tachycardia 50%
    • Acute dystonia 10%
    • Mild sedation
    • QT prolongation but no reports of Torsades de pointes
    • CNS depression is rare

Supportive Care

Investigations

  • Screening: 12 lead ECG, BSL, Paracetamol level
  • Specific:
    • ECG at presentation and 4 hours (if normal no further ECGs required)
    • Sinus tachycardia is common
    • Reports of minor QT prolongation but no Torsades de pointes.

Decontamination:

Enhanced Elimination

Antidote

  • Benztropine for acute dystonic reactions.
    • Over 3 yrs 0.02 mg/kg IM or IV.
    • Adults 1mg.
    • May repeat in 15 minutes.

Disposition

  • Children who are symptomatic all need review
  • Patients who are well with a normal baseline ECG can be medically cleared at 4 hours post ingestions
  • Symptomatic patients need supportive care until toxicity resolves
  • Patients should be warned that extrapyramidal movements may occur up to 3 days later.
References:

Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Burnaby Hospital in Vancouver. Loves the misery of alpine climbing and working in austere environments. Supporter of FOAMed, toxicology, tropical medicine, sim and ultrasound

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    Risperidone overdose – wikidoc

    Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

    Overdosage topics

    Human experience

    Management of overdosage


    Human experience

    Pre-marketing experience

    Premarketing experience included eight reports of acute Risperidone overdosage with estimated doses ranging from 20 to 300 mg and no fatalities. In general, reported signs and symptoms were those resulting from an exaggeration of the drug’s known pharmacological effects, i.e., drowsiness and sedation, tachycardia and hypotension, and extrapyramidal symptoms. One case, involving an estimated overdose of 240 mg, was associated with hyponatremia, hypokalemia, prolonged QT, and widened QRS. Another case, involving an estimated overdose of 36 mg, was associated with a seizure. Return to top

    Post-marketing experience

    Postmarketing experience includes reports of acute Risperidone overdosage, with estimated doses of up to 360 mg. In general, the most frequently reported signs and symptoms are those resulting from an exaggeration of the drug’s known pharmacological effects, i.e., drowsiness, sedation, tachycardia, hypotension, and extrapyramidal symptoms. Other adverse events reported since market introduction which were temporally (but not necessarily causally) related to Risperidone overdose, include torsade de pointes, prolonged QT interval, convulsions, cardiopulmonary arrest, and rare fatality associated with multiple drug overdose. Return to top

    Management of overdosage

    In case of acute overdosage, establish and maintain an airway and ensure adequate oxygenation and ventilation. Gastric lavage (after intubation, if patient is unconscious) and administration of activated charcoal together with a laxative should be considered. Because of the rapid disintegration of Risperdal® M-TAB®Orally Disintegrating Tablets, pill fragments may not appear in gastric contents obtained with lavage.

    The possibility of obtundation, seizures, or dystonic reaction of the head and neck following overdose may create a risk of aspiration with induced emesis. Cardiovascular monitoring should commence immediately and should include continuous electrocardiographic monitoring to detect possible arrhythmias. If antiarrhythmic therapy is administered, disopyramide, procainamide, and quinidine carry a theoretical hazard of QT-prolonging effects that might be additive to those of risperidone. Similarly, it is reasonable to expect that the alpha-blocking properties of bretylium might be additive to those of risperidone, resulting in problematic hypotension.

    There is no specific antidote to Risperidone. Therefore, appropriate supportive measures should be instituted. The possibility of multiple drug involvement should be considered. Hypotension and circulatory collapse should be treated with appropriate measures, such as intravenous fluids and/or sympathomimetic agents (epinephrine and dopamine should not be used, since beta stimulation may worsen hypotension in the setting of risperidone-induced alpha blockade). In cases of severe extrapyramidal symptoms, anticholinergic medication should be administered. Close medical supervision and monitoring should continue until the patient recovers. Return to top


    Adapted from the FDA Package Insert.

    Tricyclic antidepressants and tetracyclic antidepressants

    Tricyclic antidepressants and tetracyclic antidepressants

    Tricyclic and tetracyclic antidepressants affect brain chemicals to ease depression symptoms. Explore their possible side effects and whether one of these antidepressants may be a good option for you.

    By Mayo Clinic Staff

    Tricyclic and tetracyclic antidepressants, also called cyclic antidepressants, are among the earliest antidepressants developed. They’re effective, but they’ve generally been replaced by antidepressants that cause fewer side effects. However, cyclic antidepressants may be a good option for some people. In certain cases, they relieve depression when other treatments have failed.

    Cyclic antidepressants are designated as tricyclic or tetracyclic, depending on the number of rings in their chemical structure — three (tri) or four (tetra).

    How cyclic antidepressants work

    Cyclic antidepressants ease depression by affecting chemical messengers (neurotransmitters) used to communicate between brain cells. Like most antidepressants, cyclic antidepressants work by ultimately effecting changes in brain chemistry and communication in brain nerve cell circuitry known to regulate mood, to help relieve depression.

    Cyclic antidepressants block the reabsorption (reuptake) of the neurotransmitters serotonin (ser-o-TOE-nin) and norepinephrine (nor-ep-ih-NEF-rin), increasing the levels of these two neurotransmitters in the brain. Cyclic antidepressants also affect other chemical messengers, which can lead to a number of side effects.

    Cyclic antidepressants approved to treat depression

    The Food and Drug Administration (FDA) approved these tricyclic antidepressants to treat depression:

    • Amitriptyline
    • Amoxapine
    • Desipramine (Norpramin)
    • Doxepin
    • Imipramine (Tofranil)
    • Nortriptyline (Pamelor)
    • Protriptyline
    • Trimipramine

    The FDA approved the tetracycline antidepressant maprotiline to treat depression.

    Sometimes cyclic antidepressants are used to treat conditions other than depression, such as obsessive-compulsive disorder, anxiety disorders or nerve-related (neuropathic) pain.

    Possible side effects and cautions

    Because of the different ways cyclic antidepressants work, side effects vary somewhat from medication to medication. Some side effects may go away after a time, while others may lead you and your doctor to try a different medication. Side effects may also be dependent on the dose, with higher doses often causing more side effects.

    Some common possible side effects include:

    • Drowsiness
    • Blurred vision
    • Constipation
    • Dry mouth
    • Drop in blood pressure when moving from sitting to standing, which can cause lightheadedness
    • Urine retention

    Other possible side effects include:

    • Weight loss
    • Increased appetite leading to weight gain
    • Excessive sweating
    • Tremor
    • Sexual problems, such as difficulty achieving an erection, delayed orgasm or low sex drive

    Generally speaking:

    • Amitriptyline, doxepin, imipramine and trimipramine are more likely to make you sleepy than other tricyclic antidepressants are. Taking these medications at bedtime may help.
    • Amitriptyline, doxepin, imipramine and trimipramine are more likely to cause weight gain than other tricyclic antidepressants are.
    • Nortriptyline and desipramine appear to have better tolerated side effects than other tricyclic antidepressants do.

    For antidepressants that cause sleepiness, be careful about doing activities that require you to be alert, such as driving a car, until you know how the medication will affect you.

    Which antidepressant is best for you depends on a number of issues, such as your symptoms and any other health conditions you may have. Ask your doctor and pharmacist about the most common possible side effects for your specific antidepressant and read the patient medication guide that comes with the prescription.

    Safety issues

    Some tricyclic antidepressants are more likely to cause side effects that affect safety, such as:

    • Disorientation or confusion, particularly in older people when the dosage is too high
    • Increased or irregular heart rate
    • More-frequent seizures in people who have seizures

    Other issues to discuss with your doctor before you take a cyclic antidepressant:

    • Antidepressants and pregnancy. Talk to your doctor about the risks and benefits of using specific antidepressants. Some antidepressants may harm your baby if you take them during pregnancy or while you’re breast-feeding. If you’re taking an antidepressant and you’re considering getting pregnant, talk to your doctor or mental health professional about the possible risks. Don’t stop taking your medication without contacting your doctor first, as stopping might pose risks for you.
    • Drug interactions. When taking an antidepressant, tell your doctor about any other prescription or over-the-counter medications, herbs or other supplements you’re taking. Some antidepressants can cause dangerous reactions when combined with certain medications or herbal supplements.
    • Serotonin syndrome. Rarely, an antidepressant can cause high levels of serotonin to accumulate in your body. Serotonin syndrome most often occurs when two medications that raise the level of serotonin are combined. These include other antidepressants, certain pain or headache medications, and the herbal supplement St. John’s wort.
      • Signs and symptoms of serotonin syndrome include anxiety, agitation, high fever, sweating, confusion, tremors, restlessness, lack of coordination, major changes in blood pressure and a rapid heart rate.
      • Seek immediate medical attention if you have any of these signs and symptoms.
    • Safety and blood tests. Your doctor may recommend blood levels to determine the most effective dose. Some side effects and benefits of cyclic antidepressants depend on the dose. Overdose of cyclic antidepressants can be dangerous.
    • Chronic health conditions. Cyclic antidepressants can cause problems in people with certain health conditions. For example, if you have glaucoma, an enlarged prostate, heart problems, diabetes, liver disease or a history of seizures, talk to your doctor about whether a cyclic antidepressant is a safe choice for you.

    Suicide risk and antidepressants

    Most antidepressants are generally safe, but the FDA requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.

    Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

    Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.

    Stopping treatment with cyclic antidepressants

    Cyclic antidepressants aren’t considered addictive. However, stopping antidepressant treatment abruptly or missing several doses can cause withdrawal-like symptoms. Symptoms may vary depending on how the drug works. This is sometimes called discontinuation syndrome. Work with your doctor to gradually and safely decrease your dose.

    Withdrawal-like symptoms can include:

    • Agitation, irritability or anxiety
    • Nausea
    • Sweating
    • Flu-like symptoms, such as chills and muscle aches
    • Insomnia
    • Lethargy
    • Headache

    Finding the right antidepressant

    People may react differently to the same antidepressant. For example, a particular drug may work better — or not as well — for you than for another person. Or you may have more, or fewer, side effects from taking a specific antidepressant than someone else does.

    Inherited traits may play a role in how antidepressants affect you. In some cases, where available, results of special blood tests may offer clues about how your body may respond to a specific antidepressant. However, other variables besides genetics can affect your response to medication.

    When choosing an antidepressant, your doctor takes into account your symptoms, any health problems, other medications you take, and what’s worked for you in the past.

    Typically, it may take several weeks or longer before an antidepressant is fully effective and for initial side effects to ease up. Your doctor may recommend dose adjustments or different antidepressants, but with patience, you and your doctor can find a medication that works well for you.

     

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    Show references

    1. Depression: FDA-approved medications may help. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/depression-fda-approved-medications-may-help. Accessed Aug. 13, 2019.
    2. Depression basics. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/depression/index.shtml. Accessed Aug. 13, 2019.
    3. Revisions to product labeling. U.S. Food and Drug Administration. https://www.fda.gov/media/77404/download. Accessed Aug. 13, 2019.
    4. Mental health medications. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml#part_149856. Accessed Aug. 13, 2019.
    5. Gabriel M, et al. Antidepressant discontinuation syndrome. Canadian Medical Association Journal. 2017; doi:10.1503/cmaj.160991.
    6. What is pharmacogenomics? Genetics Home Reference. https://ghr.nlm.nih.gov/primer/genomicresearch/pharmacogenomics. Accessed Aug. 13, 2019.
    7. Hirsch M, et al. Tricyclic and tetracyclic drugs: Pharmacology, administration, and side effects. https://www.uptodate.com/contents/search. Accessed Aug. 19, 2019.
    8. Tricyclic antidepressants. Facts& Comparisons eAnswers. http://www.wolterskluwercdi.com/facts-comparisons-online/. Accessed Aug. 19, 2019.
    9. Tetracyclic antidepressants. Facts& Comparisons eAnswers. http://www.wolterskluwercdi.com/facts-comparisons-online/. Accessed Aug. 19, 2019.
    10. Ritter J, et al. Antidepressant drugs. In: Rang and Dale’s Pharmacology. 9th ed. Elsevier; 2020.
    11. Amitriptyline (prescribing information). Accord Healthcare Inc.; 2018. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1e6d2c80-fbc8-444e-bdd3-6a91fe1b95bd. Accessed Aug. 19, 2019.
    12. Amoxapine (prescribing information). Actavis Pharma Inc.; 2015. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a16297df-3158-48db-85e5-5cd506885556. Accessed Aug. 19, 2019.
    13. Norpramin (prescribing information). Validus Pharmaceuticals LLC; 2018. https://dailymed.nlm.nih.gov/dailymed/drugInfo. cfm?setid=70b562ea-9f21-4e4a-b3ed-0590b2892f6a. Accessed Sept. 12, 2019.
    14. Doxepin (prescribing information). Amneal Pharmaceuticals NY LLC; 2017. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=20bfb8af-7933-4e5c-a2b5-010659d9125b. Accessed Aug. 19, 2019.
    15. Tofranil (prescribing information). SpecGx LLC; 2017. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1827a5aa-733a-49d9-89d9-48ea0367b230. Accessed Sept.12, 2019.
    16. Pamelor (prescribing information). Mallinckrodt Inc.; 2019. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e17dc299-f52d-414d-ab6e-e809bd6f8acb. Accessed Aug. 19, 2019.
    17. Protriptyline (prescribing information). West-Ward Pharmaceuticals Corp.; 2016. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=700abc58-9362-4ef5-9d7a-dd3c4d364d0a. Accessed Aug. 26, 2019.
    18. Trimipramine (prescribing information). Breckenridge Pharmaceutical, Inc.; 2019. https://dailymed.nlm.nih.gov/dailymed/drugInfo. cfm?setid=4f31df66-7dc2-1f04-e054-00144ff88e88. Accessed Aug. 20, 2019.
    19. Maprotiline (prescribing information). Mylan Pharmaceuticals Inc.; 2014. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c3ca69e6-1ea0-4c2c-abcb-7264b2e79a87. Accessed Sept. 12, 2019.
    20. Krieger CA (expert opinion). Mayo Clinic. Sept. 11, 2019.

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    .

    Long-acting risperidone for schizophrenia

    Review question

    Risperidone is a new antipsychotic drug that was first available as a depot injection. The review analyzes the clinical effects of depot-risperidone in the treatment of patients with schizophrenia.

    Relevance

    People with schizophrenia often hear voices, see different things (visual hallucinations) and have strange beliefs (delusional beliefs, delusions). Patients can also become withdrawn, socially isolated, tired, and apathetic. The main treatment for these symptoms of schizophrenia is the use of antipsychotic medications (neuroleptics). However, these drugs can cause serious side effects such as weight gain, uncontrolled shaking of the whole body, tremors, cramping, and fatigue (tiredness). A common consequence of these side effects is that patients stop taking their medication (non-compliance), which can lead to an exacerbation of the disease.

    Research characteristics

    The review was updated in 2015 to include 12 studies involving 5723 people who received depot-risperidone along with other treatments (placebo, conventional oral antipsychotics, oral risperidone, oral quetiapine, oral aripiprazole, oral olanzapine, non-standard / new depot neuroleptics , earlier depot antipsychotics).

    Highlights

    Based on the review, it is difficult to conclude that depot-risperidone is more effective in treating the symptoms of schizophrenia than placebo or other treatments. In the case of patients who prefer oral administration of drugs, depot-risperidone has shown approximately the same results as oral risperidone. Patients taking oral risperidone can continue with depot-risperidone without the need for pills. However, in high doses, depot-risperidone can cause serious side effects, especially movement disorders, uncontrolled shaking, spasms and tremors. Depo-risperidone can be used in patients who stop taking oral risperidone, which may reduce the risk of an exacerbation with a small risk of increased side effects.

    Quality of evidence

    The quality of the evidence presented is generally low or moderate at best. There is a need for a large, long-term and well-documented study of the efficacy of depot-risperidone treatment of schizophrenia. Depot injections are often used to treat refusals. Such individuals are difficult to include in research.

    Written by a consumer (Ben Gray, Senior Research Fellow, McPean Foundation). http://mcpin.org

    VED List

    Vital and Essential Medicines (VED; until 2011 – Vital and Essential Medicines) is a list of medicinal products approved by the Government of the Russian Federation for the purpose of state regulation of prices for medicines. The task of state regulation of prices for medicines is to increase the availability of medicines for the population and medical institutions.

    The VED List contains a list of medicines under international nonproprietary names and covers almost all types of medical care provided to citizens of the Russian Federation under state guarantees, in particular, emergency medical care, inpatient care, specialized outpatient and inpatient care, and also includes includes a significant amount of medicines sold in the commercial sector.In addition, the List of Vital and Essential Drugs serves as the basis for the development of regional lists of constituent entities of the Russian Federation and formulary lists of drugs of inpatient medical organizations.

    It is formed using the international Anatomical Therapeutic Chemical Classification System (ATC).

    1. Means for anesthesia

    Dinitrogen oxide /

    Halothane

    Ketamine

    Gamma hydroxybutyric acid

    Sodium thiopental

    Diethyl ether

    Propofol

    Sevoflurane

    2.Sleeping pills

    Flunitrazepam

    Nitrazepam

    Zopiclone

    Zolpidem

    3. Anticonvulsants

    Benzobarbital

    Carbamazepine

    Valproic acid

    Clonazepam

    Lamotrigine

    Topiramate

    Ethosuximide

    Phenobarbital

    4. Antipsychotics

    Haloperidol

    Droperidol

    Sulpirides

    Thioridazine

    Chlorpromazine

    Amisulpride

    Zuclopenthixol

    Quetiapine

    Clozapine

    Levomepromazine

    Olanzapine

    Peritsiazine

    Risperidone

    Sertindole

    Trifluoperazine

    Flupentixol

    Fluphenazine

    Chlorprothixene

    Alimemazin

    5. Tranquilizers

    Medazepam

    Diazepam

    Bromodihydrochlorophenylbenzodiazepine

    Oxazepam

    Chlordiazepoxide

    Tofisopam

    Morpholinoethylthioethoxybenzimidazole

    Hydroxyzine

    Diazepam + Cyclobarbital

    Alprazolam

    6. Sedatives

    Valerian

    Sodium bromide

    Peppermint oil + phenobarbital + ethyl bromisovalerianate

    Oregano oil + peppermint oil + phenobarbital + ethyl bromisovalerianate

    An alcoholic infusion of leaves and flowers of motherwort ordinary

    7.Psychostimulants

    Caffeine

    8. Antidepressants

    Amitriptyline hydrochloride

    Fluoxetine

    Amitriptyline + Chlordiazepoxide

    Venlafaxine

    Imipramine

    Clomipramine

    Lithium carbonate

    Maprotiline

    Mianserin

    Milnacipran

    Paroxetine

    Pipofezin

    Pirlindol

    Trazodone

    Fluvoxamine

    Citalopram

    Escitalopram

    Sertraline

    Agomelatine

    nine. Opiate antagonists

    Naloxone

    Naltrexone

    10. Nootropics

    Nicotinoyl-gamma-aminobutyric acid

    Piracetam

    Cerebrolysin

    Cattle brain hydrolyzate

    Nicergoline

    Meldonium

    Glycine

    Noopept

    Betahistine

    Piracetam + Vinpocetine

    Piracetam + Cinnarizine

    Sulbutiamine

    Phenylpiracetam

    Livestock cerebral cortex polypeptides

    Ipidacrine

    Citicoline

    Hopantenic acid

    eleven.Analeptics

    Dopamine

    Niketamide

    12. Antiparkinsonian drugs

    Trihexyphenidil

    Galantamine

    Memantine

    Piribedil

    Pramipexole

    13. Narcotic analgesics

    Morphine hydrochloride

    Trimeperidine

    Fentanyl

    Morphine + Codeine + Narcotine + Papaverine + Thebaine

    Fentanyl

    fourteen. Non-narcotic analgesics and NSAIDs

    Acetaminophen

    Acetylsalicylic acid

    Acetylsalicylic acid + Magnesium hydroxide

    Diclofenac sodium

    Ibuprofen

    Indomethacin

    Tenoxicam

    Ketorolac

    Ketoprofen

    Lornoxicam

    Metamizole sodium

    Tramadol hydrochloride

    Nimesulide

    Metamizole sodium + Triacetonamine-4-toluenesulfonate

    Salicylic acid

    Metamizole sodium + Pitofenone + Fenpiverinium bromide

    Butorphanol

    Nalbuphin

    Meloxicam

    Choline salicylate

    Choline Salicylate + Cetalkonium Chloride

    Sumatriptan

    15.Local irritants

    Levomenthol solution in menthil isovalerate

    Ammonia

    Camphor

    16. Holinotropic drugs

    Azamethonium bromide

    Articaine + Epinephrine

    Atropine

    Galantamine

    Neostigmine methyl sulfate

    Dystigmine bromide

    Pilocarpine

    Pyridostigmine bromide

    Platyphyllin

    Methocinia iodide

    17. Muscle relaxants

    Pipecuronium bromide

    Suxamethonium iodide

    Tolperisone

    Atracuria besilat

    Tizanidine

    Baclofen

    Flupirtine

    Rocuronium bromide

    18. Adrenomimetics

    Naphazoline

    Oxymetazoline

    Norepinephrine

    Phenylephrine

    Epinephrine

    Ephedrine

    Dobutamine

    19.Adrenergic blockers

    Timolol

    Butylaminohydroxypropoxyphenoxymethyl methyloxadiazole

    Terazosin

    Doxazosin

    Tamsulosin

    20. Antiallergic drugs

    Diphenhydramine

    Chloropyramine

    Mebhydrolin

    Loratadin

    Fexofenadine

    Ketotifen

    Dimethindene

    Ebastin

    Cromoglycic acid

    21.Local anesthetics

    Lidocaine

    Procaine

    Tetracaine

    Bupivacaine hydrochloride

    Chlorhexidine + lidocaine

    Ropivacaine

    22. Expectorants and antitussives

    Acetylcysteine

    Bromhexine

    Thermopsis lancent herb + sodium bicarbonate

    Codeine + terpine hydrate + sodium bicarbonate

    Ambroxol

    Butamirat

    Bromhexine + Guaifenesin + Salbutamol

    23.Bronchodilators

    Ipratropium bromide

    Tiotropium bromide

    Salbutamol

    Salmeterol

    Salmeterol + fluticasone

    Formoterol + Budesonide

    Fenoterol hydrobromide

    Fenoterol hydrobromide + ipratropium bromide

    Theophylline

    24. Cardiac glycosides

    Digoxin

    Strofantin K

    Lily of the valley leaf glycoside

    25.Antiarrhythmic drugs

    Amiodarone

    Procainamide

    Propranolol

    Quinidine

    Sotalol

    Propafenone

    26. Antianginal drugs

    Atenolol

    Metoprolol

    Metoprolol succinate

    Nebivolol

    Bisoprolol

    Betaxolol

    Verapamil hydrochloride

    Molsidomin

    Diltiazem

    Isosorbide dinitrate

    Isosorbide mononitrate

    Nitroglycerine

    Ivabradin

    27. Means that improve cerebral circulation

    Vinpocetine

    Nimodipine

    Choline alfoscerate

    Ethylmethylhydroxypyridine succinate

    Livestock cerebral cortex polypeptides

    28. Antispasmodics

    Bendazole

    Papaverine hydrochloride

    Pinaveria bromide

    Drotaverin

    Aminophylline

    Theophylline

    Cistenal

    Spasmotsistenal

    Bencyclan

    Drotaverine + nicotinic acid

    Mebeverin

    29.Antihypertensive drugs

    Amlodipine

    Nifedipine

    Clonidine

    Rilmenidine

    Captopril

    Enalapril

    Enalapril + Hydrochlorothiazide

    Ramipril

    Lisinopril

    Lisinopril + Hydrochlorothiazide

    Perindopril

    Fosinopril

    Telmisartan

    Felodip

    Amlodipine + perindopril

    Indapamide + Perindopril

    Enalapril + indapamide

    Losartan

    Irbesartan

    Candesartan cilexetil

    Valsartan

    Aliskiren

    Moxonidine

    thirty. Diuretics

    Acetazolamide

    Hydrochlorothiazide

    Indapamide

    Mannitol

    Spironolactone

    Furosemide

    Triamterene + hydrochlorothiazide

    Torasemid

    Eplerenone

    31. Uricosuric funds

    Allopurinol

    32. Antiulcer drugs

    Aluminum hydroxide

    Algeldrate + Magnesium hydroxide

    Omeprazole

    Ranitidine

    Famotidine

    Sucralfate

    Bismuth tripotassium dicitrate (Colloidal bismuth subcitrate)

    Pantoprazole

    Esomeprazole

    Plantain leaf extract

    Fennel ordinary fruit

    33.Drugs affecting gastrointestinal motility

    Loperamide

    Simethicone

    Microlax

    34. Emetics and antiemetics

    Metoclopramide

    Domperidone

    Ondansetron

    Itoprid

    35. Laxatives

    Bisacodyl

    Castor oil

    Sennoside A + B

    Fortrans

    36. Hepatotropic drugs

    Milk thistle fruit extract

    Ursodeoxycholic acid

    Essential phospholipids

    Bile + Pancreas Powder + Small Intestine Mucosa Powder

    Lactulose

    Ornithine

    Ademetionine

    Ropren

    Glycyrrhizic acid + phospholipids

    Field artichoke leaf extract

    37.Enzymes and antienzyme drugs

    Aprotinin

    Pancreatin

    Trypsin

    Chymotrypsin

    Trypsin + Chymotrypsin

    Fibrinolysin

    Somatostatin

    Octreotide

    38. Uterine funds

    Oxytocin

    Fenoterol

    Hexoprenaline

    Dihydrogesterone

    39. Drugs affecting hematopoiesis

    Folic acid

    Calcium folinate

    Epoetin alfa

    Epoetin beta

    Filgrastim

    Iron sulfate

    Iron (III) hydroxide sucrose complex

    Iron (III) hydroxide polymaltose

    Iron (II) chloride

    40. Drugs affecting hemostasis

    Heparin sodium

    Enoxaparin sodium

    Nadroparin calcium

    Dalteparin sodium

    Fenindion

    Warfarin

    Dipyridamole

    Pentoxifylline

    Aminocaproic acid

    Etamsilat

    Tranexamic acid

    Sulodexide

    Clopidogrel

    Clotting factor IX

    Clotting factor VIII

    Eptacog alpha (activated)

    Alprostadil

    Streptokinase

    Alteplaza

    Tenekteplaza

    Rivaroxaban

    Fondaparinux sodium

    Prourokinase

    Urokinase

    Dabigatran etexilate

    41.Hormones, their analogues and antihormonal agents

    Beclomethasone

    Budesonide

    Dexamethasone

    Hydrocortisone

    Prednisone

    Mazipredon

    Methylprednisolone aceponate

    Betamethasone

    Methylprednisolone

    Mometasone

    Triamcinolone

    Fluticasone

    Fluticasone furoate

    Flumethasone

    Fludrocortisone

    Bromocriptine

    Chorionic gonadotropin

    Nandrolone

    Norethisterone

    Progesterone

    Sinestrol

    Testosterone

    Estron

    Ethinylestradiol

    Calcitonin

    Proktoven

    Dexamethasone + framycetin + gramicidin C

    Cinacalcet

    42. Thyroid-stimulating agents

    Dihydrotachysterol

    Levothyroxine

    Thiamazole

    Potassium iodide

    Triiodothyronine

    Levothyroxine sodium + liothyronine + potassium iodide

    Levothyroxine sodium + liothyronine

    43. Biogenic stimulants

    Dioxomethyltetrahydropyrimidine

    Hyaluronidase

    Prostate extract

    Chondroitin sulfate

    44.Means for the treatment of sugar

    diabetes and diabetes insipidus

    Desmopressin

    Glibenclamide

    Gliclazide

    Insulin – isophane

    Insulin detemir

    Insulin lispro

    Insulin aspartate biphasic

    Insulin glargine

    Biphasic insulin

    Insulin soluble

    Insulin aspart

    Metformin

    Glickvidone

    Glimepiride

    Acarbose

    Repaglinide

    Glibenclamide + Metformin

    Adiurecrin

    Exenatid

    Glucagon

    Vildagliptin

    Vildagliptin + Metformin

    45. Vaccines, serums and other biological products

    Vaccines

    Immunoglobulins

    Gangrenous antitoxin

    Anti-snake specific serum

    Diphtheria antitoxin

    Tetanus toxoid

    Bifidobacterium bifidum

    Lactobacillus acidophilus

    Lactobacillus acidophilus + Kefir fungi

    Coli

    Linex

    Bactisubtil

    Coliprotein bacteriophage

    Staphylococcal bacteriophage

    Enterol

    46.Vitamins and their analogues

    Ascorbic acid

    Thioctic acid

    Nicotinic acid

    Nicotinamide

    Menadione sodium bisulfite

    Pyridoxine

    Riboflavin

    Thiamine

    Tocopherol acetate

    Cyanocobalamin

    Pyridoxine + Thiamine + Cyanocobalamin + Lidocaine

    Calcium carbonate + colecalciferol

    Alfacalcidol

    47 – 48.Preparations for the correction of water-salt

    and acid-base balance

    Potassium and magnesium asparaginate

    Calcium carbonate

    Potassium chloride

    Calcium chloride

    Magnesium sulfate

    Sodium bicarbonate

    Sodium chloride

    Sodium acetate + Sodium chloride

    Potassium chloride + Sodium acetate + Sodium chloride

    Potassium chloride + Calcium chloride + Magnesium chloride + Sodium lactate + Sodium chloride

    Sodium chloride solution complex

    Amino acids for parenteral nutrition + other drugs

    Human albumin

    Dextran

    Dextrose + Sodium Hydrocitrate

    Gelatin

    Hydroxyethyl starch

    49. Preparations for parenteral and enteral nutrition

    Amino acids for parenteral nutrition + other preparations

    Dipeptive

    Nutrizone

    Enpit

    Nutricomp

    Nutriflex

    Berlamin modular

    Ketosteril

    Lipofundin

    Lipovenosis

    Diazon

    Glucose

    Sorbitol

    Amino acids for parenteral nutrition

    Osmolite

    Oxepa

    50.Statins and various medicines,

    stimulating metabolic processes

    Actovegin

    Solcoseryl

    Atorvastatin

    Atorvastatin + amlodipine

    Rosuvastatin

    Simvastatin

    Ezetimibe

    Trimetazidine

    Taurine

    Troxerutin

    Adenosine + Nicotinamide + Cytochrome C

    Methylethylpyridinol

    Hesperidin + Diosmin

    Dioxomethyltetrahydropyrimidine + sea buckthorn buckthorn oil + sulfaetidol

    Olazol

    Zinc sulfate

    Dexrazoxane

    Inosine + nicotinamide + riboflavin + succinic acid

    51. Immunotropic drugs

    Azathioprine

    Tyrosyl-D-alanyl-glycyl-phenylalanyl-leucyl-arginine diacetate

    Human interleukin-2, recombinant

    Interferon alpha

    Human immunoglobulin normal

    Azoximer bromide

    Meglumine Acridone Acetate

    Iodophenazone

    Arginyl-alpha-aspartyl-lysyl-valyl-tyrosyl-arginine

    Penicillamine

    Leflunomide

    Crocus splendid alkaloid

    Tiloron

    Cyclosporine

    Mycophenolic acid

    Mitoxantrone

    52.Antibacterial medicines

    Pipemidic acid

    Nitroxoline

    Nitrofurantoin

    Nifuroxazide

    Furazolidone

    Intetrix

    Bacterial lysate mixture

    Fosfomycin

    Furazidine

    53. Antibiotics

    Ampicillin

    Ampicillin + sulbactam

    Amoxicillin

    Amoxicillin + sulbactam

    Amoxicillin + clavulanic acid

    Benzylpenicillin

    Benzathine benzylpenicillin

    Daptomycin

    Linezolid

    Oxacillin

    Cefazolin

    Cefuroxime

    Cefotaxime

    Ceftriaxone

    Ceftazidime

    Cefoperazone

    Cefoperazone + sulbactam

    Cefepim

    Cefixime

    Imipenem + cilastatin

    Meropenem

    Ertapenem

    Vancomycin

    Amikacin

    Fosfomycin

    Gentamicin

    Azithromycin

    Clarithromycin

    Erythromycin

    Clindamycin

    Doxycycline

    Tetracycline

    Lincomycin

    Ciprofloxacin

    Norfloxacin

    Pefloxacin

    Ofloxacin

    Levofloxacin

    Moxifloxacin

    Tigecycline

    Piperacillin + tazobactam

    Chloramphenicol

    Rifaximin

    Netilmicin

    54. Sulfanilamide medicines

    Co-trimoxazole

    Sulfasalazine

    Mesalazine

    Sulfacetamide

    55. Antiviral medicines

    Acyclovir

    Famciclovir

    Dioxotetrahydroxytetra hydronaphthalene

    Lamivudine

    Zanamivir

    Oseltamivir

    Idoxuridine

    Ganciclovir

    Valacyclovir

    56.Antiprotozoal drugs

    Metronidazole

    Chloroquine

    Ornidazole

    57. Antifungal medicines

    Amphotericin B

    Voriconazole

    Posaconazole

    Caspofungin

    Fluconazole

    Ketoconazole

    Nystatin

    Clotrimazole

    Nitrofungin

    58. Anthelmintic drugs

    Praziquantel

    Mebendazole

    Pirantel

    59.Disinfectants and antiseptics

    Ahdez

    Dimethyl sulfoxide

    Methenamine

    Methylthionine chloride

    Brilliant green

    Hydroxymethylquinoxylindoxide

    Potassium permanganate

    Lysoformin

    Hydrogen peroxide

    Formic acid

    Ethanol

    Septocide

    Furacilin

    Boric acid

    Xeroform

    Iodine

    Combined drug

    Chlorhexidine bigluconate

    Chlorine antiseptics

    Silver preparation

    Diamond

    Wapusan 2000R

    Samarovka

    Laina

    Liquid soap

    Silver nitrate, colloidal silver

    Disinfectants

    Formaldehyde

    Povidone iodine

    Miramistin

    Polyhexanide

    Medilok

    Hexetidine

    60. Insecticides

    Permethrin

    Benzyl benzoate

    61. Antidotes and chelators

    Methionine

    Sodium thiosulfate

    Protamine sulfate

    Activated carbon

    Unitiol

    Cytochrome C

    Hemosorbent

    Deferoxamine

    Enterosorbent

    Enterodesis

    Acetylcysteine

    Dioctahedral smectin

    Hydrolytic lignin

    Sugammadex

    62.Diagnostic tools

    Barium sulfate

    Yogeksol

    Sodium amidotrizoate

    Indigocarmine

    Yoversol

    63. Anti-tuberculosis drugs

    Rifampicin

    Isoniazid

    Kanamycin

    Capreomycin

    Moxifloxacin

    Ofloxacin

    Aminosalicylic acid

    Pyrazinamide

    Prothionamide

    Cycloserine

    Ethambutol

    Ethionamide

    Streptomycin

    64. Cytostatics

    Anastrozole

    Buserelin

    Cyproterone

    Bicalutamide

    Zoledronic acid

    Pamidronic acid

    Treosulfan

    Vinorelbin

    Asparginase

    Bleomycin

    Busulfan

    Vinblastine

    Vincristine

    Hydroxycarbamide

    Dakarbazine

    Daunorubicin

    Doxorubicin

    Imatinib

    Colchicine

    Lomustin

    Melphalan

    Mercaptopurine

    Calcium folinate

    Gemcitabine

    Carboplatin

    Capecitabine

    Carmustin

    Hydrazine sulfate

    Temozolomide

    Triptorelin

    Oxaliplatin

    Topotecan

    Paclitaxel

    Tegafur

    Tamoxifen

    Tacrolimus

    Goserelin

    Letrozole

    Ibandronic acid

    Exemestane

    Methotrexate

    Procarbazine

    Epirubicin

    Fluorouracil

    Chlorambucin

    Cyclophosphamide

    Cytarabine

    Etoposide

    Fludarabine

    Mycophenolate mofetil

    Mitoxantrone

    Cisplatin

    Tretinoin

    Thioguanine

    Ifosfamide

    Rituximab

    Mesna

    65. Other medicines

    Sterilization controls

    Vaseline medical

    Water for injections

    Gypsum

    Glycerol

    Medical gelatin

    Talc

    Copper sulfate

    Zinc oxide

    Sulfur besieged

    Hydrochloric acid

    Citral

    Trilon-B

    Desicont

    Talc + starch

    Silver 7.8%

    Dexpanthenol

    Sea buckthorn oil

    66.Medical products

    Subclavian catheters

    Peripheral intravenous catheters

    Urinary catheters

    Gauze bandages

    Gauze

    Biopsy needle

    Spinal needle

    Epidural needle

    Cotton wool

    Adhesive plasters

    Collagen hemostatic sponge

    Infusion systems

    Irrigoscopy system

    Gloves

    Condom

    Rubber finger cot

    Eye bath

    Eye pipette

    Syringe

    Esmarch’s irrigator

    Bed vessel

    Warmer

    Ice bubble

    Kalopriyemnik

    Urine collection

    Oilcloth

    Probes

    Esmarch’s harness

    Silicone tube

    Container Gemakon 500/300/300

    Wooden crutches

    Esmarch Mug Tips

    Cover glass, specimen

    Thermometers

    Endotracheal tube, tracheostomy

    Syringe

    Needle

    Elastic bandage

    Garbage bags

    Medical mask

    Remedies

    Device for active drainage of wounds, dressings with specified healing properties (Hartmann)

    Diapers, milk nipple, pacifier, sterile napkins

    67. Reagents, culture media, diagnostics

    and other consumables

    Reagents for CDL

    Reagents for PJSC

    Reagents for KIL

    Reagents and media for the tank. Laboratories

    Reagents for OLD

    Consumables for OFD

    Pharmacy reagents

    Consumables for hemodialysis

    68. Means for prevention

    Rh-conflict between mother and fetus

    Resonative

    CAMROW

    PKB number 5 – Schizophrenia

    Schizophrenia is a chronic mental illness, which is characterized by a violation of the unity of thinking processes, with a relatively preserved intellect, which is combined with significant emotional impoverishment and a decrease in will.Hallucinatory and delusional disorders often join.

    The term “schizophrenia” itself is made up of two Greek words – “schizo” – I split and “freni” – reason – reason.

    This term was first used by the Swiss psychiatrist Eigen Bleuler in 1908. Schizophrenia, of course, existed before, but only by the beginning of the 20th century the idea of ​​it as a special kind of psychoses matured.

    In the mass consciousness, there is an unreasonable identification of schizophrenia with a “split personality” – that is, in fact, with a very rare mental disorder, in which different “I” are alternately activated in one person.

    Schizophrenia, unfortunately, is quite common. Its prevalence among the population of Russia is 35 per 10,000 people, with no significant difference between the sexes. Thus, in Russia there are at least half a million patients with this serious pathology.

    Schizophrenia refers to endogenous mental illness, which means that it is an internal mental breakdown. It cannot be caused by any factors acting on the brain from the outside (trauma, intoxication, severe stress).Of course, these factors can affect the rate of development of schizophrenia, but not on its occurrence. Nevertheless, the mechanism for the development of the schizophrenic process has not yet been established with any certainty. There are several hypotheses on this score. Thus, there is evidence of a connection between schizophrenia and impaired distribution of dopamine in the central nervous system.

    The role of heredity is very important. So, if one of the twins fell ill with schizophrenia, then the risk of getting sick for the other twin is 17% in the opposite pair and 48% in the identical one.However, it is believed that in half of cases, schizophrenia arises from an accidental mutation, that is, on the basis of genetic changes that were absent in the parents and appeared after conception.

    Symptoms can develop at any age (possibly even in utero), but usually its onset is timed to the third pubertal crisis, that is, by the age of 12-18 years or for the next several years (approximately up to 30 years).

    Most often, the disease begins with negative symptoms associated with the loss of normal functioning – a person for no apparent reason changes in character, becomes withdrawn, fenced off, loses social contacts, emotional warmth in relation to loved ones disappears. Previous interests disappear, academic performance at school or university is sharply reduced, or official duties are not fulfilled. Thus, from the very beginning of clinical manifestations, there is a very high risk of disability. In the most unfavorable variant, which is designated as simple schizophrenia, the patient can lie for days, look at the ceiling and, with clear consciousness and normal physical strength, is not able to serve himself elementarily. Even with more favorable options, thinking disorders increase, which are expressed in the influx of thoughts or in the feeling that there are no thoughts at all.Reasoning becomes unproductive, unfocused, an ambivalence is formed towards life phenomena (ambivalence). Speech is notable for its ornateness, sometimes with neologisms that the patient himself comes up with. During a conversation, there are distractions from his topic (slippage), and not on specific details and circumstances, but on the “bad” attitude of certain characters towards the patient, or on global philosophical topics. People with schizophrenia tend to be somewhat cynical about many aspects of their environment.

    Patients have a painful feeling that everything around is somehow changed, devoid of naturalness, harmony (- derealization), the same sensations can arise in relation to their personality (- depersonalization). With depersonalization, the consciousness (but not the personality!) Seems to split in two: one part of it looks at what is happening from the side, and the other feels horror at the realization of the loss of control over itself.

    Own thoughts and ideas begin to be perceived as alien. According to modern views, this is why verbal hallucinations (“voices”) occur in schizophrenia, and it is not surprising that the sound of “voices” inside the head is typical for this disease.For the same reason, it seems to the patient that someone controls him from the outside, up to the control of movements and the work of internal organs. Visions are less common.

    Such a growing wave of unusual sensations is very painful. In many cases, internal tension is somewhat relieved due to the formation of delusional ideas (quickly – like insight – delirium crystallizes). The patient suddenly becomes “clear” that what is happening to him is, for example, the “intrigues” of some “organization”, which, with the help of modern equipment, exerts an “influence” on him from the outside (delirium of persecution, influence).There is also delirium of jealousy, damage. It is clear that the storyline of experiences is influenced by the level of development of society, including the plots of popular works of literature and cinema.

    This entire clinical picture often develops acutely, in the form of an attack that lasts from several days to several months, and then may be repeated. Paroxysmal forms of schizophrenia are more favorable, in prognostic terms, than continuous ones. The intervals between attacks are very long (sometimes tens of years), and between them a person looks almost as before, before the illness.But this is rather an exception. Much more often, exacerbations of symptoms are repeated annually or several times a year, and after each new attack comes out, it turns out that the will has become even weaker and the emotions have faded even more. Gradually, over the years, hallucinatory experiences become less relevant. At the same time, but also very slowly, delirium is falling apart as a system of pseudo-logical inferences, – separate scraps of delirium remain. As a result, a defect condition develops that resembles simple schizophrenia.

    Patients either do not recognize themselves as sick, or have conflicting thoughts on this score. As a rule, they negatively meet the persuasion of their relatives about the need to see a psychiatrist. There are attempts to alleviate their condition with alcohol and drugs, which only complicates the clinical picture and leads to further social maladjustment.

    Under the influence of command “voices” and against the background of delusional experiences, the risk of socially dangerous actions of patients increases. For example, there are known cases of attacks on alleged “persecutors”.But much more often patients with endogenous mental pathology commit OOD by other mechanisms, including when alcohol or drug intoxication influences their behavior, which is superimposed on negative symptoms.

    Schizophrenia is the most frequent illness among patients in the Moscow City Clinical Hospital No. 5.

    A common diagnosis: “Paranoid schizophrenia, episodic course with a growing defect, incomplete remission.” The clinical picture with this diagnosis includes delusions and hallucinations (usually – delusions of persecution and verbal hallucinations – “voices”).

    Treatment of schizophrenia includes antipsychotics, antidepressants, nootropics. The leading role belongs to antipsychotics, whose action is aimed primarily at combating delusions and hallucinations. Against the background of treatment, at first, as a rule, the patient’s affective reaction to his own experiences is dulled – he becomes calmer, psychomotor agitation passes. Then the hallucinations decrease in intensity or completely disappear. All these positive changes become noticeable already in the first days of the use of antipsychotics.But the plot (that is, the plot) of delirium can linger for a long time, although in the picture of internal experiences it fades significantly in relevance. After the relief of acute symptoms, the task comes to the fore: how to reduce negative symptoms and eliminate psychopathic (that is, as with psychopathies) behavioral disorders. This is helped by the latest generation of antipsychotics, such as olanzapine, paliperidone, risperidone. Already at this stage, it is worth thinking about the patient’s rehabilitation. Contrary to the earlier opinion, psychotherapy is indicated for these patients, and it helps to strengthen remission and resocialization.A good prognostic sign is the patient’s participation in physical labor, which, in itself, brings a significant therapeutic effect.

    Although schizophrenia is a very formidable disease, it is not a death sentence. Due to the partial preservation of certain abilities (especially intellectual) and non-standard thinking, many of these patients have significant creative potential, which is evident, among other things, from the works presented at the “Ariadne’s Thread” festival of arts.

    Risperdal OD – instructions for use, dosage, composition, analogs, side effects / Pillintrip

    Inside. Food intake has no effect on drug absorption.

    Patients who have persistent drowsiness while taking Risperidone Organica are advised to divide the daily dose into two doses.

    Cancellation of the drug Risperidone Organica is recommended to be carried out gradually. Very rarely, after abrupt cessation of high doses of antipsychotic drugs, a withdrawal syndrome occurs, including nausea, vomiting, hyperhidrosis, and insomnia.

    Schizophrenia

    Adults. Risperidone Organic can be administered 1 or 2 times a day. The initial dose is 2 mg / day. On the second day, the dose can be increased to 4 mg / day. From this point on, the dose can either be kept at the same level, or individually adjusted (if necessary). Usually the optimal dose is 4-6 mg / day. In some cases, a slower dose increase and a lower initial and maintenance dose may be justified. Doses above 10 mg / day have not been shown to be more effective than lower doses and may cause extrapyramidal symptoms.Due to the fact that the safety of doses above 16 mg / day has not been studied, doses above this level cannot be used.

    Elderly patients. Risperidone at a different dosage (0.5–1 mg) is recommended for starting therapy. The dosage can be individually increased by 1 mg / day. Tablets of the drug Risperidone Organica 2 mg can be prescribed to elderly patients when, as a result of titration, the maximum recommended daily dose is reached – 4 mg in 2 divided doses.

    Children from 13 years old. Risperidone at a different dosage (0.5 mg) is recommended for starting therapy. If necessary, the dose can be increased no earlier than 24 hours by 0.5–1 mg / day. Tablets of the drug Risperidone Organica 2 mg can be prescribed when the daily dose reaches 2 mg as a result of titration with good tolerance. Despite the effectiveness demonstrated in the treatment of schizophrenia in adolescents with doses of risperidone 1–6 mg / day, with the appointment of doses of more than 3 mg / day, no increase in effectiveness was observed, and side effects developed more often.The use of doses above 6 mg / day has not been studied.

    Manic episodes associated with bipolar disorder

    Adults. The recommended initial dose of the drug is 2 mg / day in 1 dose. If necessary, this dose can be increased no earlier than 24 hours by 1 mg per day. For most patients, the optimal dose is 1–6 mg / day. The use of doses above 6 mg / day in patients with manic episodes has not been studied.

    As with any other symptomatic therapy, the advisability of continuing treatment with Risperidone Organica should be regularly evaluated and confirmed.

    Elderly patients. Risperidone at a different dosage (0.5–1 mg) is recommended for starting therapy. The dosage can be individually increased by 1 mg / day. Tablets Risperidone Organika 2 mg can be prescribed to elderly patients when the titration reaches the maximum recommended daily dose of 4 mg in 2 divided doses. Care must be taken due to the limited experience of use in elderly patients.

    Children from 10 years old. Risperidone at a different dosage (0.5 mg) is recommended for starting therapy.If necessary, the dosage can be increased at least 24 hours later by 0.5–1 mg per day until a dose of 1–2.5 mg / day is reached with good tolerance. Risperidone Organic 2 mg tablets can be prescribed to children under 10 years of age when the titration reaches a daily dose of 2 mg. Despite the effectiveness demonstrated in the treatment of manic episodes associated with bipolar disorder in children, doses of 0.5–6 mg / day, when doses of more than 2.5 mg / day were prescribed, there was no increase in effectiveness, and side effects developed more often.The use of doses above 6 mg / day has not been studied.

    Persistent aggression in patients with Alzheimer’s dementia

    A different dosage of risperidone (less than 2 mg) is recommended. For persistent aggression in patients with Alzheimer’s dementia, risperidone should not be used for more than 6 weeks. During treatment, the condition of patients and the need for continuation of therapy should be regularly assessed.

    Incessant aggression in the structure of behavior disorder

    Children from 5 to 18 years old. For patients weighing 50 kg or more, the appointment of risperidone with a different dosage (less than 2 mg) is recommended.

    For patients weighing less than 50 kg, a different dosage of risperidone (less than 1 mg) is recommended.

    As with any other symptomatic therapy, the advisability of continuing treatment with risperidone should be regularly assessed and confirmed.

    Use in children under 5 years of age is not recommended due to the lack of data on efficacy and safety.

    Diseases of the liver and kidneys

    In patients with kidney diseases, the ability to excrete the active antipsychotic fraction is reduced in comparison with other patients. In patients with liver disease, an increased concentration of the free fraction of risperidone in the blood plasma is observed. The initial and maintenance doses, in accordance with the indications, should be reduced by 2 times, the increase in the dose in patients with liver and kidney diseases should be carried out more slowly.Risperidone should be used with caution in this category of patients.

    Int.

    Schizophrenia. Adults and children over 15 years old: 1 or 2 times a day. The initial dose is 2 mg / day, on the second day the dose should be increased to 4 mg / day. From this point on, the dose can either be kept at the same level or individually adjusted if necessary. Usually the optimal dose is 4-6 mg / day. In some cases, a slower dose increase and lower initial and maintenance doses may be justified.Doses above 10 mg / day have not been shown to be more effective than lower doses and may cause extrapyramidal symptoms. Due to the fact that the safety of doses above 16 mg / day has not been studied, doses above this level cannot be used. There is no data on use for the treatment of schizophrenia in children under 15 years of age.

    Elderly patients and with diseases of the liver and kidneys: the initial dose is 0.5 mg per dose 2 times a day. The dosage can be individually increased to 1-2 mg 2 times a day.

    Drug abuse or drug dependence: the recommended daily dose is 2–4 mg.

    Behavioral disorders in patients with dementia: initial dose – 0.25 mg per dose 2 times a day. The dosage, if necessary, can be individually increased by 0.25 mg 2 times a day, not more often than every other day. For most patients, the optimal dose is 0.5 mg 2 times a day. However, some patients are shown taking 1 mg 2 times a day. When the optimal dose is reached, taking the drug once a day may be recommended.

    Mania for bipolar disorder: The recommended starting dose is 2 mg per day in 1 dose. If necessary, this dose can be increased by 2 mg per day, not more often than every other day. For most patients, the optimal dose is 2–6 mg / day.

    Behavioral disorders in patients with mental retardation. Patients weighing 50 kg or more: the recommended initial dose is 0.5 mg once a day. If necessary, this dose can be increased by 0.5 mg per day, not more often than every other day.For most patients, the optimal dose is 1 mg per day. However, some patients prefer 0.5 mg per day, while others require an increase in dose to 1.5 mg per day.

    Patients weighing less than 50 kg: the recommended initial dose is 0.25 mg once a day. If necessary, this dose can be increased by 0.25 mg per day, not more often than every other day. For most patients, the optimal dose is 0.5 mg per day. However, some patients prefer 0.25 mg per day, while some require an increase in dose to 0.75 mg per day.

    Long-term use of Risperdal OD in adolescents should be carried out under constant medical supervision.

    Not recommended for use in children under 15 years of age.

    Int.

    Rispolept ® Quiclet tablets can be taken without water or with water or other liquid, but if taken with meals, there should be no food in the mouth when the patient puts the tablet on the tongue. Rispolept ® Queklet tablets begin to disintegrate in the mouth within a few seconds and can be swallowed immediately.

    Schizophrenia

    Adults and children over 15 years old. Rispolept ® Kviklet can be administered 1 or 2 times a day. The initial dose of the drug Rispolept ® Kviklet – 2 mg / day. On the second day, the dose should be increased to 4 mg / day. From this point on, the dose can either be kept at the same level or individually adjusted if necessary. Usually the optimal dose is 4-6 mg / day. In some cases, a slower dose increase and lower initial and maintenance doses may be justified.

    Doses above 10 mg / day do not show higher efficacy compared to lower doses and may cause extrapyramidal symptoms. Due to the fact that the safety of doses above 16 mg / day has not been studied, doses above this level cannot be used.

    Benzodiazepines can be added to therapy with Rispolept ® if additional sedation is required.

    Elderly patients. An initial dose of 0.5 mg twice a day is recommended.The dose can be individually increased by 0.5 mg 2 times a day to 1-2 mg 2 times a day.

    If it is necessary to use a dose of 0.5 mg, it is recommended to prescribe the drug Rispolept ® , oral solution.

    Adolescents over 13 years of age. An initial dose of 0.5 mg is recommended once a day in the morning or in the evening. If necessary, the dose can be increased at least 24 hours later by 0.5–1 mg per day to the recommended dose of 3 mg / day with good tolerance. The safety of doses above 6 mg / day has not been studied.

    Patients who experience persistent drowsiness are advised to take half the daily dose 2 times a day.

    If it is necessary to use a dose of 0.5 mg, it is recommended to prescribe the drug Rispolept ® , oral solution.

    There is no information on the use of the drug for the treatment of schizophrenia in children under 13 years of age.

    Behavioral disorders in patients with dementia

    An initial dose of 0.25 mg per dose 2 times a day is recommended.The dose, if necessary, can be individually increased by 0.25 mg 2 times a day, not more often than every other day. For most patients, the optimal dose is 0.5 mg 2 times a day. However, some patients are shown taking 1 mg 2 times a day.

    Upon reaching the optimal dose, it may be recommended to take the drug once a day.

    If it is necessary to use doses of 0.25 or 0.5 mg, it is recommended to prescribe the drug Rispolept ® , oral solution.

    Bipolar disorders in mania

    Adults. The recommended initial dose of the drug is 2 or 3 mg / day at a time. If necessary, this dose can be increased at least 24 hours by 1 mg / day. For most patients, the optimal dose is 1–6 mg / day.

    Adolescents and children over 10 years old. An initial dose of 0.5 mg is recommended once a day in the morning or in the evening. If necessary, the dose can be increased at least 24 hours later by 0.5–1 mg / day to the recommended dose of 2.5 mg / day with good tolerance.For most patients, the optimal dose is 0.5–6 mg / day.

    If it is necessary to use a dose of 0.5 mg, it is recommended to prescribe the drug Rispolept ® , oral solution.

    The safety of doses above 6 mg / day has not been studied.

    Patients who experience persistent drowsiness are advised to take half the daily dose 2 times a day.

    There is no information on the use of the drug for the treatment of bipolar disorders in children under 10 years of age.

    Behavioral disorders

    Patients weighing 50 kg or more. The recommended initial dose of the drug is 0.5 mg once a day. If necessary, this dose can be increased by 0.5 mg / day no more often than every other day. For most patients, the optimal dose is 1 mg / day. However, for some patients, a dose of 0.5 mg / day is preferable, while some require an increase in the dose to 1.5 mg / day.

    If it is necessary to use a dose of 0.5 mg, it is recommended to prescribe the drug Rispolept ® , oral solution.

    Patients weighing less than 50 kg. The recommended initial dose of the drug is 0.25 mg once a day. If necessary, this dose can be increased by 0.25 mg / day no more often than every other day. For most patients, the optimal dose is 0.5 mg / day. However, for some patients, a dose of 0.25 mg / day is preferable, while some require an increase in dose to 0.75 mg / day.

    If it is necessary to use doses of 0.25 or 0.5 mg, it is recommended to prescribe the drug Rispolept ® , oral solution.

    Long-term use of the drug Rispolept ® Kviklet in adolescents should be carried out under the constant supervision of a physician.

    Use in children under 5 years of age has not been studied.

    Autism in children and adolescents

    The dose of Rispolept ® Kviklet should be selected individually. The recommended initial dose of the drug is 0.25 mg / day for patients weighing less than 20 kg and 0.5 mg / day for patients weighing 20 kg or more.On the 4th day of admission, the dose may be increased by 0.25 mg / day for patients weighing less than 20 kg and by 0.5 mg / day per day for patients weighing 20 kg or more.

    This dose should be applied until about the 14th day of treatment when an assessment of efficacy is required. A further increase in the dose is carried out only in the absence of efficacy. The dose can be increased at intervals of 2 weeks or more by 0.25 mg / day for patients weighing less than 20 kg and by 0.5 mg / day for patients weighing 20 kg or more.

    In clinical studies, the maximum daily dose did not exceed 1.5 mg / day for patients weighing less than 20 kg and 2.5 mg / day for patients weighing 20 kg or more, and 3.5 mg / day for patients with a body weight of more than 45 kg.

    Table

    Doses of the drug Rispolept ® in the treatment of autism in children (per day)

    Body weight, kg Days 1–3, mg Days 4–14 +, mg Increase in dose ( if necessary) Recommended dose, mg
    Less than 20 0.25 0.5 +0.25 mg after 2 weeks or more 0.5–1.5
    20 or more 0.5 1 +0.5 mg after 2 weeks or more 1–2.5 *

    * For patients weighing more than 45 kg, higher doses may be required, the maximum studied dose is 3.5 mg / day.

    If it is necessary to use doses of 0.25 or 0.5 mg, it is recommended to prescribe the drug Rispolept ® , oral solution.

    Rispolept ® Quiclet can be administered 1 or 2 times a day.

    Patients who experience persistent drowsiness are advised to take a daily dose 1 time before bedtime or 2 times a day.

    If consistent efficacy is observed, a decision may be made to gradually reduce the dose to achieve an optimal balance of efficacy and safety.

    Use in children under 5 years of age has not been studied.

    Other patient groups

    Patients with liver and kidney diseases. Patients with kidney disease have a reduced ability to excrete the active antipsychotic fraction compared to other patients. In patients with liver disease, an increased concentration of the free fraction of risperidone in the blood plasma is observed.

    The initial and maintenance dose in accordance with the indications should be reduced by 2 times, the dose increase in patients with liver and kidney disease should be carried out more slowly.

    If it is necessary to use doses of 0.25 or 0.5 mg, it is recommended to prescribe the drug Rispolept ® , oral solution.

    Rispolept ® Kviklet should be prescribed with caution in this category of patients.

    V / m , once every 2 weeks, deep into the gluteus muscle, using the sterile needle attached to the syringe. Injections should be given alternately in the right and left buttocks. The drug should not be administered intravenously.

    In patients who have not previously received risperidone, it is recommended to determine the tolerance of oral dosage forms of risperidone before starting treatment with Risperdal OD ® .

    Adults. The recommended dose is 25 mg every 2 weeks. Some patients require higher doses of 37.5 or 50 mg. In clinical studies, no increase in efficacy was observed with the use of 75 mg. The maximum dose should not exceed 50 mg once every 2 weeks.

    Within 3 weeks after the first administration of Risperdal OD ® , the patient should be taking an effective antipsychotic agent.

    The dose of the drug can be increased no more than once every 4 weeks.The effect of such an increase in dose should be expected no earlier than 3 weeks after the first injection of the increased dose.

    Elderly patients. The recommended dose is 25 mg every 2 weeks. Within 3 weeks after the first injection of Risperdal OD ® , the patient should be taking an effective antipsychotic agent.

    Patients with impaired liver or kidney function. There is currently no data on the use of the drug Risperdal OD ® in patients with impaired liver or kidney function.

    If it is necessary to treat patients with impaired liver or kidney function with Risperdal OD ® in the first week, it is recommended to take 0.5 mg orally 2 times a day, an oral dosage form of risperidone. During the second week, the patient can take 1 mg 2 times a day or 2 mg 1 time a day. If the patient tolerates an oral dose of at least 2 mg well, then he can be administered IM 25 mg of the drug Risperdal OD ® 1 time in 2 weeks.

    Directions for use

    The use of Risperdal OD ® requires strict adherence to the instructions for preparing the suspension in order to ensure accurate administration of the drug and avoid possible errors.

    To prepare a suspension from the Risperdal OD ® extended-release microgranules in the vial, only the solvent in the pre-filled syringe can be used. The finished suspension is injected intramuscularly only into the gluteal region. The components in the package must not be replaced with any other product. To ensure that the full dose of risperidone is used, the entire contents of the vial must be injected. The introduction of part of the contents of the vial cannot ensure that the patient receives the required dose of the drug.The drug should be administered immediately after preparation of the suspension.

    First, remove the package of Risperdal OD ® from the refrigerator and allow the suspension to warm to room temperature for 30 minutes before preparing the suspension.

    The contents of the package are shown in the figure below:

    1. Remove the colored plastic cap from the bottle. Do not remove the gray rubber plug. Wipe unopened bottle with an alcohol wipe and allow to dry.

    2. Open the blister pack and remove the Alaris Smart Site ® Needleless Device by holding it between the white Luer cap and the skirt. Never touch the sharp tip of the .

    3. It is very important that the Smart Site ® Needleless Device is correctly installed on the vial, otherwise the solvent may leak when it enters the vial. Place the bottle on a hard surface. Hold the base of the bottle. Aim the Smart Site ® Needleless Device vertically at the vial with the sharp tip in the center of the vial rubber stopper.

    Correct

    Incorrect

    Pushing from top to bottom, push the sharp tip of the Smart Site ® Needleless Device through the center of the vial rubber stopper until the device is securely attached to the top of the vial.

    4. Before attaching the syringe to the Smart Site ® Needleless Device, hold the base of the bottle, wipe the syringe attachment point (blue circle) with an alcohol wipe and allow to dry.

    5.The pre-filled syringe has a white tip with two parts: a white collar and a glossy white cap. To open the syringe, hold the syringe by the white collar and break off the glossy white cap (the white cap cannot be twisted or cut off) . Then remove the white cap together with the rubber tip inside it.

    At all stages of assembly, hold the syringe only by the white collar located on the tip of the syringe.Fixing the white collar will help keep the collar from separating and ensure a good connection to the syringe. Care must be taken not to twist the components during assembly, as in this case, parts of the syringe may come off from it.

    6. Holding the syringe by the white collar, insert the syringe into the blue circle of the needleless device, push and turn clockwise so that the syringe is firmly connected to the needleless device (avoid twisting).To prevent the needleless device from rotating while connecting to the syringe, hold the skirt firmly. The syringe and needleless device must be in line.

    7. Introduce the entire contents of the solvent syringe into the vial.

    8. Holding the syringe plunger with your thumb, shake vigorously the contents of the vial for at least 10 seconds until a homogeneous suspension is formed. After proper mixing, the suspension becomes homogeneous, thick, milky in color. Microgranules may be visible in the liquid, but there should be no dry microgranules not wetted with solvent. Do not store the vial after preparation of the suspension, as the suspension may separate.

    9. Turn the bottle upside down and slowly draw the entire contents of the bottle into the syringe. Separate part of the label from the bottle along the perforation line and stick it to the syringe (for identification).

    10. Holding the syringe by the white collar, disconnect the syringe from the needleless device. Dispose of the vial and needleless device in accordance with local regulations for the disposal of this type of waste.

    11. Open the blister pack of the Needle-Pro ® needle. Do not touch the part of the needle that connects to the syringe. Take the needle out of the package, holding it by the transparent case.

    12. To prevent the entry of germs, do not touch the luer tip of the orange needle guard Needle-Pro ® . Holding the syringe by the white collar, attach the orange needle guard Needle-Pro ® Luer-lock cannula to the syringe with a slight clockwise twist.

    13. While still holding the syringe by the white collar, clamp the transparent needle sheath and secure the needle tightly to the Needle-Pro ® guard by pressing and turning clockwise. Securing the needle can ensure a safe connection between the needle and the Needle-Pro ® Needle Guard during the following steps.

    14. Immediately before administration, the preparation Risperdal OD ® must be resuspended, since after preparation of the suspension in the vial, some of the microgranules may settle.Shake the syringe vigorously to resuspend the microbeads.

    15. Holding the syringe by the white collar, remove the transparent case from the needle. Do not bend the case as in this case, the connection of the luer lock can be violated.

    16. Tap the syringe lightly with your finger so that the air bubbles in it rise up. Slightly pushing the plunger upward, remove air bubbles from the syringe and needle, holding the syringe so that the needle is pointing straight up. Inject the entire contents of the syringe into the upper outer quadrant of the gluteal region.

    The suspension must not be administered intravenously!

    Caution: to avoid injury to medical personnel by the used needle:

    – do not touch the Needle-Pro ® needle guard with your free hand when pressing it to a flat surface;

    – do not disassemble the Needle-Pro ® needle guard;

    – do not try to straighten the needle or touch the Needle-Pro ® needle guard if the needle is bent or damaged;

    – Use the Needle-Pro ® needle guard only for its intended purpose, otherwise the needle may protrude from the protective cap.

    17. After injection, insert the needle into the orange Needle-Pro ® needle guard with one hand. To do this, gently press the orange Needle-Pro ® needle guard against a flat surface.

    18. Once the orange Needle-Pro ® needle guard is depressed, the needle should fit snugly into the Needle-Pro ® needle guard. Before discarding the needle, make sure the needle is firmly seated in the orange Needle-Pro ® needle guard.Dispose of in accordance with local regulations for the disposal of this type of waste.

    Do not reuse: This device is for single use only. Any attempt at subsequent reuse may adversely affect the integrity of the device itself or result in degradation of its performance.

    Sublingual. The lozenges are fragile and should not be squeezed through the foil of the packaging, becausebecause they can break. Open the package by gently pulling on the edge of the blister foil marked with a dot, remove the tablet and immediately put it on the tongue. The tablet begins to dissolve in the mouth within a few seconds and can be swallowed without water; you should also not mix the drug in the mouth with food, bite or chew.

    Schizophrenia (acute and chronic) and other psychotic conditions with productive and / or negative symptoms. For adults and children over 15 years of age, the drug is prescribed 1 or 2 times a day.The initial dose is 2 mg / day. On the second day, the dose should be increased to 4 mg / day. From this point on, the dose can either be kept at the same level or individually adjusted if necessary. Usually the optimal dose is 4-6 mg / day. In some cases, a slower dose increase and lower initial and maintenance doses may be justified.

    Doses above 10 mg / day do not show higher efficacy compared to lower doses and may cause extrapyramidal symptoms.Due to the fact that the safety of doses above 16 mg / day has not been studied, doses above this level should not be used.

    Behavioral disorders in patients with dementia with symptoms of aggressiveness (outbursts of anger, physical violence). Mental disorders (agitation, delusions) or psychotic symptoms. The recommended initial dose is 0.25 mg 2 times a day (an adequate dosage form should be used). The dosage, if necessary, can be individually increased by 0.25 mg 2 times a day, not more often than every other day.For most patients, the optimal dose is 0.5 mg 2 times a day. However, some patients are shown taking 1 mg 2 times a day. Upon reaching the optimal dose, it may be recommended to take the drug once a day.

    Mania in bipolar disorder. The recommended starting dose is 2 mg once a day. If necessary, this dose can be increased by 2 mg / day no more often than every other day. For most patients, the optimal dose is 2–6 mg / day.

    Behavioral disorders in adolescents from 15 years of age and adult patients with reduced intellectual level or mental retardation. Patients weighing 50 kg or more. The recommended starting dose is 0.5 mg once a day. If necessary, this dose can be increased by 0.5 mg / day, not more often than every other day. For most patients, the optimal dose is 1 mg / day. However, for some patients, a dose of 0.5 mg / day is preferable, while some require an increase in the dose to 1.5 mg / day.

    Special patient groups

    Elderly patients. Initial dose of 0.5 mg 2 times a day.The dosage can be individually increased by 0.5 mg 2 times a day to 1-2 mg 2 times a day.

    Children. The use of the drug Torendo ® Ku-tab in children under 15 years of age is contraindicated.

    Long-term use of the drug Torendo ® Ku-tab in adolescents over 15 years old requires constant medical supervision.

    Renal and / or liver dysfunction. Therapy with Torendo ® Q-tab is recommended to start with 0.5 mg 2 times a day.The dose can be gradually increased by 0.5 mg of risperidone 2 times a day to 1-2 mg / day. In this group of patients, the drug Torendo ® Ku-tab should be used with caution until more complete information is obtained.

    Drug abuse or drug dependence. The recommended daily dose of the drug is 2–4 mg.

    Patients weighing less than 50 kg. The recommended initial dose of the drug is 0.25 mg once a day. If necessary, this dose can be increased by 0.25 mg / day, not more often than every other day.For most patients, the optimal dose is 0.5 mg / day. However, for some patients, a dose of 0.25 mg / day is preferable, while others require an increase in dose to 0.75 mg / day.

    Inside, regardless of food intake.

    Schizophrenia

    Adults. Risperdal OD ® can be administered 1 or 2 times a day. The initial dose of Risperdal OD ® is 2 mg / day. On the second day, the dose should be increased to 4 mg / day.From this point on, the dose can either be kept at the same level or individually adjusted if necessary. Usually the optimal dose is 4-6 mg / day. In some cases, a slower dose increase and lower initial and maintenance doses may be justified.

    Doses above 10 mg / day do not show higher efficacy compared to lower doses and may cause extrapyramidal symptoms. Due to the fact that the safety of doses above 16 mg / day has not been studied, doses above this level cannot be used.

    Benzodiazepines can be added to therapy with Risperdal OD ® if additional sedation is required.

    Elderly patients. An initial dose of 0.5 mg twice a day is recommended. The dose can be individually increased by 0.5 mg 2 times a day to 1-2 mg 2 times a day.

    Adolescents over 13 years of age. An initial dose of 0.5 mg is recommended once a day in the morning or in the evening. If necessary, the dose can be increased at least 24 hours later by 0.5–1 mg per day to the recommended dose of 3 mg / day with good tolerance.The safety of doses above 6 mg / day has not been studied.

    Patients who experience persistent drowsiness are advised to take half the daily dose 2 times a day.

    There is no information on the use of the drug for the treatment of schizophrenia in children under 13 years of age.

    Behavioral disorders in patients with dementia

    An initial dose of 0.25 mg per dose 2 times a day is recommended. The dose, if necessary, can be individually increased by 0.25 mg 2 times a day, not more often than every other day.For most patients, the optimal dose is 0.5 mg 2 times a day. However, some patients are shown taking 1 mg 2 times a day.

    Upon reaching the optimal dose, it may be recommended to take the drug once a day.

    Bipolar disorders in mania

    Adults. The recommended initial dose of the drug is 2 or 3 mg / day at a time. If necessary, this dose can be increased at least 24 hours by 1 mg / day. For most patients, the optimal dose is 1–6 mg / day.

    Adolescents and children over 10 years old. An initial dose of 0.5 mg is recommended once a day in the morning or in the evening. If necessary, the dose can be increased at least 24 hours later by 0.5–1 mg / day to the recommended dose of 2.5 mg / day with good tolerance. For most patients, the optimal dose is 0.5–6 mg / day.

    The safety of doses above 6 mg / day has not been studied.

    Patients who experience persistent drowsiness are advised to take half the daily dose 2 times a day.

    There is no information on the use of the drug for the treatment of bipolar disorders in children under 10 years of age.

    Behavioral disorders

    Patients weighing 50 kg or more. The recommended initial dose of the drug is 0.5 mg once a day. If necessary, this dose can be increased by 0.5 mg / day no more often than every other day. For most patients, the optimal dose is 1 mg / day. However, for some patients, a dose of 0.5 mg / day is preferable, while some require an increase in the dose to 1.5 mg / day.

    Patients weighing less than 50 kg. The recommended initial dose of the drug is 0.25 mg once a day. If necessary, this dose can be increased by 0.25 mg / day no more often than every other day. For most patients, the optimal dose is 0.5 mg / day. However, for some patients, a dose of 0.25 mg / day is preferable, while some require an increase in dose to 0.75 mg / day.

    Long-term use of Risperdal OD ® in adolescents should be carried out under constant medical supervision.

    Use in children under 5 years of age has not been studied.

    Autism in children and adolescents

    The dose of Risperdal OD ® should be selected individually. The recommended initial dose of the drug is 0.25 mg / day for patients weighing less than 20 kg and 0.5 mg / day for patients weighing 20 kg or more. On the 4th day of admission, the dose may be increased by 0.25 mg / day for patients weighing less than 20 kg and by 0.5 mg / day per day for patients weighing 20 kg or more.

    This dose should be applied until about the 14th day of treatment when an assessment of efficacy is required. A further increase in the dose is carried out only in the absence of efficacy. The dose can be increased at intervals of 2 weeks or more by 0.25 mg / day for patients weighing less than 20 kg and by 0.5 mg / day for patients weighing 20 kg or more.

    In clinical studies, the maximum daily dose did not exceed 1.5 mg / day for patients weighing less than 20 kg and 2.5 mg / day for patients weighing 20 kg or more, and 3.5 mg / day for patients with a body weight of more than 45 kg.

    Table

    Doses of Risperdal OD ® in the treatment of autism in children (per day)

    Body weight, kg Days 1–3, mg Days 4–14 +, mg Dose increase (if necessary) Recommended dose, mg
    Less than 20 0.25 0.5 +0.25 mg after 2 weeks or more 0.5–1.5
    20 or more 0.5 1 +0.5 mg after 2 weeks or more 1–2.5 *

    * Patients weighing more than 45 kg may require higher doses , the maximum studied dose is 3.5 mg / day.

    Risperdal OD ® can be administered 1 or 2 times a day.

    Patients who experience persistent drowsiness are advised to take a daily dose 1 time before bedtime or 2 times a day.

    If consistent efficacy is observed, a decision may be made to gradually reduce the dose to achieve an optimal balance of efficacy and safety.

    Use in children under 5 years of age has not been studied.

    Other patient groups

    Patients with liver and kidney diseases. Patients with kidney disease have a reduced ability to excrete the active antipsychotic fraction compared to other patients. In patients with liver disease, an increased concentration of the free fraction of risperidone in the blood plasma is observed.

    The initial and maintenance dose in accordance with the indications should be reduced by 2 times, the dose increase in patients with liver and kidney disease should be carried out more slowly.

    Risperdal OD ® should be prescribed with caution in this category of patients.

    Trade names of medicinal products, the prescriptions for which must remain in the pharmacy and be stored for 3 months

    ADAPTOL ADEPRESS AZAPHEN
    AZAFEN MV AKTAPAROXETIN ALVENTA
    ALEVAL ALEMBIK PIPZOL AMDOAL
    AMINAZINE AMITRIPTILINE AMITRIPTILINE NIKOMED
    AMITRIPTILINE-AKOS AMITRIPTILIN-GRINDEX AMITRIPTILIN-ZENTIVA
    AMITRIPTILINE-LENS AMITRIPTILINE-FEREINE ANAFRANIL
    ANAFRANIL SR ANVIFEN ANDANTE
    APO-PAROXETIN APO-FLUOXETIN ARIPIPRAZOL OD-TEVA
    ARIPIPRAZOL-TEVA ARIPRISOL ASENTRA
    ATARAX BRINTELLIX BELLATAMINAL
    BETAMAX VELAXIN VALOCORDIN-DOXYLAMINE
    VALDOXAN VELAFAX MV VELAFAX
    VELAFAX VENLAFAXIN ORGANIKA VENLAXOR
    VENLAFAXIN VOKSEMEL VERO-AMITRIPTILINE
    VICTOEL GALOPERIDOL-ACRI HALOPERIDOL
    GALOPERIDOL DECANOAT GALOPERIDOL-FEREINE GALOPERIDOL-RATIOPHARM
    GALOPERIDOL-RICHTER DEKSDOR HYDROXISIN CANON
    GRANDAXIN DULOXENTA DEPREFOLT
    DIAMIDAZEPAM ZALASTA KU-TAB DULOXETIN CANON
    ROOM ZIPRASIDON ZELDOX
    ZILAXERA ZIPSILA ZIPREXA
    ZIPREKSA ZIDIS INVEGA ZOLOFT
    IKSEL QUENTIAX SR KALIKSTA
    QUENTIAX QUETIAPIN CANON PROLONG QUETIAPIN
    QUETIAPIN CANON QUETIAPIN-VIAL QUETIAPIN SAN
    QUETIAPIN STADA KETILEPT KVETIAPIN-NW
    QUETITEX KLOPIXOL DEPOT CLOMIPRAMINE
    CLOPIXOL CONDILIN KLOPIXOL-AKUFAZ
    CLOFRANEL XEPLION HORSE CHESTNUT EXTRACT LIQUID
    KUTIPIN LAQUEL KUMENTAL
    LEVOMYCETIN ALCOHOL SOLUTION FOR EXTERNAL APPLICATION 1%, 3%, 5% (YFF) LEPTINORM LATUDA
    LENUKSIN LYUDIOMIL LERIVON
    LIMIPRANIL MELIPRAMIN MEBIKAR
    MEBIX MIRTAZAPIN CANON MIRZATEN
    MIRZATEN KU-TAB. NANTARID MIRTAZONAL
    MODITEN DEPOT UNULEPTED NANTARID
    NEUROPHAZOL NOOPHEN NOVO-TRIPTIN
    NOXIBEL NEWELONG NORMAZIDOL
    NORMITON OLANZAPIN-VIAL OLANZAPIN
    OLANZAPIN CANON OLANZAPIN-TL OLANZAPIN-NW
    OLANZAPIN-TEVA PARNASAN RIM
    PAXIL PIRAZIDOL PAROXETIN
    PERICIASINE PRAM PLYSIL
    PLYSIL N PROPAZINE PRODEP
    PROZAK CUT PROSULPINE
    PROFLUZAK RIDONEX RECSETIN
    REMERON RISDONAL RILEPT
    RILEPTIDE RISPERIDON RISPAXOL
    RISPEN RISPERIDON ORGANIKA RISPERIDON ZENTIVA
    RISPERIDON CANON RISPOLEPT RISPERIDON-SZ
    RISPERIDON-TL RISPOLUX RISPOLEPT KVIKLET
    RISPOLEPT CONSTA SAROTHEN RETARD RISSET
    RISSET QUITAB SELANK SAFRIS
    SEDALITE SERVER SELECTRA
    SENORM SERLIFT SERDOLEKT
    SERENATA SIZODON-SAN SEROQUEL
    SEROQUEL PROLONG SIRESTILL SIMBALTA
    SYOZAM SPERIDAN SOLIAN
    SONAPAX STRESAM SPITOMIN
    STIMULOTON TIAPRID SULPIRIDE
    SULPIRIDE BELUPO THIORYL TIAPRIDAL
    THIODAZINE TORENDO KU-TAB TISON
    TORENDO TREVIKTA TORIN
    TRANQUESIPAM TRIFTHAZIN-DARNITSA TRITTICO
    TRIFTHAZINE FEVARIN TRUKSAL
    UMORAP FENZITATE FESANEF
    PHENAZEPAM PHENORELAXAN FLUWAL
    FLUNISAN FLUOXETIN FLUOXETIN LANNACHER
    FLUOXETIN-OBL FLUOXETIN-ACRY FLUOXETIN-CANON
    FLUFENAZINE FLUANKSOL FRAMEX
    CHLOROPHILLIPT CHLORPROTIXEN CHLORPROTIXEN ZENTIVA
    CYCLODINONE CYPRALEX TSIPRAMIL
    CIRCADIN CITALIFT CITALON
    CITALOPRAM CITOL EGLEK
    EGLONIL EGOLANZA ACEEPY
    ELZEPAM ELIVEL ELICEE
    ESPRITAL ESCITALOPRAM ETHAPERAZINE
    EPHEVELON EPHEVELON RETARD

    Problems of general anesthesia while taking psychopharmacotherapy (Part II)

    3

    Most water-soluble injectable TAPs

    (for example, haloperidol, chlorpromazine, trifluopera-

    zina, etc.)) T1 / 2 and the retention time on the D2 receptor also

    allows them to be used once a day (although in the case of ost-

    ry states or in the process of increasing doses, as indicated above, the introduction several times a day can be

    forest-like). An exception is the droperidol used in

    mainly in anesthesiological practice,

    T1 / 2 of which, when injected into a vein, does not exceed 2 hours,

    and the main effect falls on the first 30-45

    minutes, and when injected into the muscle it lengthens up to 6 hours [Fisc-

    hler M et al., 1986].

    Oil solutions of prolonged forms of esters

    TAP have different T1 / 2 depending both on the specific

    TAP and on its dose and on which etheric

    residue the particular TAP is connected to. So, for zuclopenthic-

    acetate salt (clopixol-akufase) the duration of

    action is up to 3 days, for decanoates of haloperidol, flupen-

    thixol, zuclopenthixol, perphenazine, fluorophenazine and

    for palmitate 9000 depending on the dose varies from 1–2 weeks (with a minimum

    dose of the depot preparation) to 4–6 weeks (with a maximum

    permissible dose).In accordance with this, the schedule of

    repeated administrations is also different for different de-

    in the form of TAP and at different dosages.

    Main side effects. It is known that many

    typical antipsychotics are capable of causing extra-

    ramid side effects, such as: acute dystonia,

    akathisia, parkinsonism and tardive dyskinesia, prolongation of the

    QT interval leading to sudden death [Attri2 JP et al

    ., 2012; Huyse FJ et al., 2007].

    The withdrawal syndrome of typical antipsychotics

    Abrupt withdrawal of TAP leads to the development of a syndrome of

    mena, which can have manifold manifestations: who had psychotic

    manifestations, and received TAP for other indications,

    , withdrawal dyskinesia, withdrawal akathisia [Becker RA,

    Bykov YV, 2016 (a)], insomnia, anxiety, tremor.

    With a sharp abolition of TAP, which have a pronounced m-x –

    linoleic effect, so-called. “Holi-

    nergic rebound”, manifested by nausea, an-

    rexia, sometimes vomiting, diarrhea, painful spasms,

    mi of the gastrointestinal tract. With a sharp abolition of TAP with a pronounced alpha-ad-

    renoblocking effect, against the background of cancellation,

    arterial hypertension is possible.

    Atypical antipsychotics

    Atypical antipsychotic drugs (AAP)

    are called AP, which, unlike TAP, have less ability to cause extrapyramidal syndrome

    (EPS), cause less depression5 and less ability to 9000 secondary, AP-induced, negative or deficient symptoms (

    NIDS – neuroleptic-induced deficiency syndrome) [Uçok A,

    Gaebel W, 2008].Today, the AAP group includes

    risperidone, paliperidone, iloperidone, clozapine, queti-

    pin, clotiapine, olanzapine, asenapine, aripiprazole, ser-

    tindol, ziprasidone, amisulpride and siprasidone. The group of

    is constantly updated with new drugs.

    The general property of the AAP group to cause less EPS and

    secondary negative symptoms is based on the fact that they have a shorter retention time on the D2 receptor

    (more quickly “release” the receptor), have a higher

    selectivity to D2- receptors of the mesolimbic and me-

    zocortical systems than to the D2 receptors of the nigrostri-

    ary system and the prefrontal cortex (their binding to the

    D2 receptor depends on the “microenvironment” of the receptor),

    as well as the fact that many of these,

    5-HT2A and 5-HT2C receptors are more strongly blocked than D2 receptors, which, with

    , leads to a reciprocal increase in the level of dopamine in the

    nigrostriatal system and in the prefrontal cortex and co-

    EPS and secondary negative

    phenomena [Seeman P, 2002].

    Aripiprazole stands alone. Its reduced

    ability to induce EPS and secondary negative

    phenomena is associated with its special mechanism of action: unlike most AAPs, it is not an antagonist of

    D2 receptors, but their weak partial agonist, and,

    thus, its action is reduced to imitation of the effect of dopamine in those areas of the brain where its concentration is reduced

    , and to blockade of the effect of dopamine in those

    areas of the brain where its concentration is high [de Bartolo-

    meis A et al., 2015]. In addition, aripiprazole is also a

    partial agonist of 5-HT1A receptors, like beads

    pyrone, and this is associated with both its antidepressant and

    anxiolytic properties, as well as its ability to indirectly

    but increase the dopamine system in the nigrostriatal system. and pre-

    frontal cortex, which again leads to a decreased ability to cause EPS and secondary negative

    symptoms [de Bartolomeis A et al., 2015].

    In the lesser ability of AAP to induce EPS, compared to

    as compared to TAP, their effect on M-cholinergic receptors

    (especially in clozapine and olanzapine), h2-hista

    min receptors, a1- adrenergic receptors and others. a1-Antago-

    NISM is considered the main mechanism for decreasing EPS in

    of the newest AAP iloperidone [Stahl SM, 2013 (b)].

    Brief pharmacokinetics and pharmacodynamics

    [Bykov Y., et al., 2013].The half-lives of dilutions of

    personal AAP vary from 6-7 hours for quetiapine and zipras-

    don, up to 72 hours for sertindole and almost 96 hours for aripipraz-

    la. Therefore, some AADs (for example, quetiapine or zi-

    prasidone) must be taken

    2 times a day, while some others, for example,

    risperidone or aripiprazole, can be taken once-

    times a day (for aripiprazole, a regimen of

    administrations every other day has even been developed, which allows its large T1 / 2).It is important to note

    that even despite a significant T1 / 2 in some

    representatives of the AAP class, their retention time at the

    D2 receptor is short and much shorter than that of TAP. Therefore, with even a slight decrease in the concentration of AAP

    in the blood, the deterioration of the mental state in patients with

    psychoses can occur very quickly, much faster –

    faster than in the case of TAP (often the next day

    after discontinuation or dose reduction) [Stahl SM, 2013 (a)].

    Main side effects. For many AAPs,

    is characterized by the ability to cause weight gain, me-

    tabolic disorders (hypercholesterolemia, hyperlipidemia

    , hyperglycemia), the development of type 2 diabetes

    , obesity and metabolic syndrome. This

    is associated with their strong 5-HT2C-blocking and h2-hy-

    staminoblocking properties, which leads to

    increased appetite, drowsiness and weight gain and

    metabolic disorders [UHok A, Gaebel W, 2008 ; Attri

    JP et al.