Finlepsin retard, 400 mg, extended-release tablets, 50 pcs.

Pharmacodynamics and pharmacokinetics

This antiepileptic drug, which is a derivative of dibenzazepine , is also characterized by antidepressant, antipsychotic, antidiuretic and analgesic effects. The action of the drug is related to the blockade of voltage-gated sodium channels , which helps stabilize the membranes of overexcited neurons, reduce the synaptic conduction of impulses and inhibit the serial discharges of neurons. The release of the neurotransmitter amino acid glutamate , which has an stimulating effect, is reduced, which helps reduce the convulsive threshold of the nervous system, and, consequently, the likelihood of an epileptic attack.

The effectiveness of the drug is manifested in simple or complex epileptic seizures, which may be accompanied by secondary generalization and so on. At the same time, a decrease in symptoms of anxiety, depression, irritability and aggressiveness was noted.

This drug is characterized by slow but complete absorption , independent of food intake. The concentration of the substance in the body is achieved within 12 hours with a single use of Finlepsin retard 400 mg, maintaining therapeutic effectiveness for 4–5 hours. In this case, equilibrium concentrations of the active substance in the plasma are achieved after a therapeutic course of 1–2 weeks. However, this may depend on the patient’s metabolic characteristics: autoinduction of enzyme systems in the liver, heteroinduction by other drugs taken simultaneously, the patient’s condition, dosage and duration of treatment. It has been established that carbamazepine passes into breast milk and through the placental barrier.

Metabolism of the drug occurs in the liver with the formation of the main metabolites: carbamazepine-10,11-epoxide - active action and inactive conjugate with glucuronic acid . As a result of the metabolic process, a less active metabolite, 9-hydroxy-methyl-10-carbamoylacridan, is formed, which is capable of inducing its own metabolism. The drug is excreted primarily in urine, some in feces.

Pharmacological properties of the drug Finlepsin retard

Pharmacodynamics . Anticonvulsant, derivative of tricyclic iminostilbene. It has a moderate antidepressant and normothymic effect. The therapeutic effect is primarily due to the inhibition of synaptic transmission of excitation, and thereby reducing the spread of convulsive attacks. At higher concentrations, carbamazepine causes a decrease in post-tetanic potentiation. Reduces pain in trigeminal neuralgia. This effect is due to inhibition of synaptic transmission of stimulation in the spinal nucleus of the trigeminal nerve. Pharmacokinetics. After oral administration, carbamazepine is absorbed slowly and almost completely. The half-life is 8.5 hours and has a wide range (approximately 1.72–12 hours). After a single dose, the maximum concentration of carbamazepine in the blood plasma in adults is achieved after 4-16 hours (very rarely - after 35 hours), in children - after approximately 4-6 hours. The concentration of carbamazepine in the blood plasma is not linearly dependent on the dose and at When used in higher doses, the plasma concentration curve has the appearance of a plateau. When using extended-release tablets, a lower concentration of carbamazepine in the blood plasma is achieved than when using regular tablets. Equilibrium concentration is achieved after 2–8 days. There is no close correlation between the dose of carbamazepine and steady-state plasma concentrations. Regarding the therapeutic and toxic concentrations of carbamazepine in the blood plasma, it is indicated that attacks may disappear when its level in the blood plasma is 4–12 μg/ml. Concentrations of the drug in blood plasma exceeding 20 mcg/ml worsen the picture of the disease. The drug, with a concentration of the active substance in the blood plasma of 5–18 mcg/ml, eliminates pain in trigeminal neuralgia. 70–80% of carbamazepine is bound to plasma proteins. The portion of carbamazepine not bound to proteins remains constant at a concentration of 50 μg/ml. 48–53% of the pharmacologically active metabolite carbamazepine-10, 11-epoxide is bound to plasma proteins. The concentration of carbamazepine in the cerebrospinal fluid is 33% of the concentration in the blood plasma. Carbamazepine crosses the placental barrier and is excreted into breast milk. After taking a single dose, carbamazepine is eliminated from the blood plasma with a half-life of 36 hours. With prolonged treatment, the half-life is reduced by 50% due to the induction of microsomal liver enzymes. In healthy people, the total plasma clearance is approximately 19.8 ml/h/kg body weight, in patients with monotherapy - approximately 54.6 ml/h/kg, in patients with combination treatment - approximately 113.3 ml/h/kg . After a single oral dose of carbamazepine, 72% of the dose in the form of metabolites is excreted from the body by the kidneys. The remaining 28% is excreted along with feces, partially unchanged. Only 2–3% of the substance excreted in the urine is unchanged carbamazepine.

Indications for use of Finlepsin

Main indications for use of Finlepsin:

• various forms of epilepsy;
• neuralgia;
• pain due to nervous disorders in patients with diabetes mellitus;
• different types of convulsive conditions - spasms, seizures, and so on;
• alcohol withdrawal syndrome;
• psychotic disorders.

Contraindications for use

Finlepsin is not prescribed for:

• hypersensitivity to its components or tricyclic antidepressants;
• disorders of bone marrow hematopoiesis;
• acute intermittent porphyria ;
• AV block;
• while taking lithium drugs or MAO inhibitors.

It is recommended to be careful when treating patients with decompensated chronic heart failure, dilution hyponatremia, liver and kidney disorders, elderly age, active alcoholism, suppression of bone marrow hematopoiesis, while taking certain medications, prostatic hyperplasia, increased intraocular pressure, and so on.

Side effects of Finlepsin

As a rule, side effects during treatment with this drug can develop due to excess dosage or significant fluctuations in the concentration of the active substance in the body. In most cases, abnormalities in the functioning of the nervous system occur: dizziness , ataxia, drowsiness, general weakness, headache, and so on. It is also possible to experience allergic reactions , such as urticaria, erythroderma , skin rashes and other symptoms.

The hematopoietic and blood system may respond with the occurrence of: leukopenia, thrombocytopenia, eosinophilia, leukocytosis, lymphadenopathy . There is still a possibility of developing abnormalities in the gastrointestinal tract: nausea, vomiting, dry mouth, increased activity of gamma-glutamyltransferase, activity of liver transaminases, diarrhea or constipation .

In addition, disturbances associated with the functioning of the endocrine system and metabolism may appear: swelling, fluid retention, weight gain, vomiting, hyponatremia , etc. The development of abnormalities in the functions of the cardiovascular and genitourinary systems, musculoskeletal system and sensory organs should not be excluded.

Side effects of the drug Finlepsin retard

The side effects that were observed occurred more frequently with combination treatment than with monotherapy. Depending on the dose and mainly at the beginning of treatment, certain side effects may occur. In general, they disappear on their own after 8–14 days or after a temporary dose reduction. From the central nervous system and psyche Confusion, drowsiness, dizziness, fatigue, impaired coordination of movements (cerebellar ataxia) and headache may often occur. Elderly patients may experience confusion and restlessness. In isolated cases, depressive mood, aggressive behavior, slowness of thinking, decreased motivation, as well as perception disorders (hallucinations) and tinnitus are noted. When treated with Finlepsin retard, latent psychoses may become more active. Rarely, involuntary movements such as large-scale tremors, muscle contractions, or nystagmus occur. In addition, in elderly patients with brain damage, involuntary movements in the maxillofacial area may occur in the form of grimacing (maxillofacial dyskinesia), rotational movements (choreoathetosis), neuroleptic malignant syndrome, and polyneuropathy. Isolated cases of speech impairment, false sensations, muscle weakness, neuritis (peripheral neuritis), as well as paralysis of the lower limbs (paresis) and taste disturbances have been reported. On the part of the organ of vision In some cases, inflammation of the mucous membrane of the eye (conjunctivitis) occurs, sometimes developing into visual disturbances (impaired accommodation, double vision, blurred images), increased intraocular pressure. There have been reports of cases of lens opacity. Retinotoxicity was detected in 2 patients after prolonged therapy with carbamazepine. After stopping carbamazepine, the severity of these phenomena decreased significantly. From the organ of hearing: Decreased hearing, increased auditory perception, impaired perception of pitch. From the musculoskeletal system In isolated cases, arthralgia, myalgia, and muscle spasms were noted. These phenomena disappeared after stopping the drug. On the skin There have been reports of cases of allergic reactions from the skin with or without fever, for example, urticaria, pruritus, sometimes large lamellar or scaly inflammation of the skin (exfoliative dermatitis, erythroderma), Lyell's syndrome, photosensitivity, exudative erythema multiforme, erythema nodosum, Stevens syndrome - Johnson), petechial hemorrhages in the skin and disseminated lupus erythematosus). In isolated cases, hair loss (alopecia) and sweating (diaphoresis), changes in skin pigmentation, acne, hirsutism and vasculitis were noted. From the circulatory and lymphatic system When treated with Finlepsin retard, hemogram disorders may occur: leukocytosis, eosinophilia or leukopenia, thrombocytopenia. According to the literature, the most common form of leukopenia occurs benign (transient in approximately 10% of cases, and permanent in 2% of cases). There are isolated cases of blood diseases, sometimes life-threatening, such as agranulocytosis, aplastic anemia along with other forms of anemia (hemolytic, megaloblastic), reticulocytosis, pancytopenia, erythrocyte aplasia, as well as enlargement of the spleen and lymph nodes. As a rule, this occurs in the first 4 months of treatment. From the gastrointestinal tract Sometimes - loss of appetite, dry mouth, nausea and vomiting, rarely diarrhea or constipation. Isolated cases of abdominal pain and inflammation of the mucous membrane of the nasopharynx (stomatitis, gingivitis, glossitis) are known. There are indications in the literature that carbamazepine can sometimes cause pancreatitis. From the liver and gallbladder Sometimes changes in liver function test parameters are noted, in some cases jaundice occurs, in isolated cases - various forms of hepatitis (cholestatic, hepatocellular, granulomatous, mixed). In isolated cases, acute hepatitis with liver failure developed in the first few months against the background of allergic manifestations. Hormonal and water-salt metabolism Individual cases of enlarged mammary glands in men (gynecomastia) and spontaneous leakage of milk from the mammary glands in women (galactorrhea) have been reported. Finlepsin retard can affect indicators of thyroid function (triiodothyronine, thyroxine, thyroid-stimulating hormone and free thyroxine), especially when combined with other antiepileptic drugs. The most common side effect was hyponatremia, sometimes accompanied by fluid retention, weight gain, and decreased plasma osmotic concentration. In very rare cases, this has resulted in water intoxication with vomiting, headache, confusion, drowsiness and other neurological disorders. Individual cases of edema and weight gain have been observed. Finlepsin retard may reduce serum calcium levels. In isolated cases, this leads to softening of the bones (osteomalacia). In extremely rare cases, cholesterol levels may increase, including HDL cholesterol and TG, as well as free cortisol in the blood serum. Carbamazepine may reduce serum folate levels. A decrease in serum vitamin B12 levels and an increase in homocysteine ​​levels have also been reported under the influence of carbamazepine. In two cases, acute intermittent porphyria occurred. On the part of the respiratory system, isolated disorders have been described, which were accompanied by fever, shortness of breath (dyspnea), inflammation and the development of pulmonary fibrosis. From the genitourinary system Rarely, renal dysfunction occurs, which is manifested by proteinuria, hematuria, oliguria, interstitial nephritis, in isolated cases they develop into renal failure. Perhaps these disorders are due to the drug's own antidiuretic effect. Sometimes dysuria, polakiuria and urinary retention occur. In addition, there are known cases of sexual disorders, such as impotence, decreased libido, and impaired spermatogenesis. From the cardiovascular system Very rarely, mainly in elderly people or in patients with impaired heart function, bradycardia, cardiac arrhythmias, congestive heart failure, circulatory collapse, as well as worsening of coronary heart disease may occur. Disturbances in the conduction of excitation in the myocardium (AV blockade) are rarely observed, which is occasionally accompanied by fainting conditions. In addition, in some cases, significant fluctuations in blood pressure are detected. A drop in blood pressure mainly occurs when the drug is used in high doses. Vasculitis, thrombophlebitis and thromboembolism were also observed. Hypersensitivity reactions Rarely, delayed-type hypersensitivity reactions to the drug develop, accompanied by fever, skin rash, swollen lymph nodes, joint pain, leukocytosis, enlarged liver and spleen, changes in liver function tests, with involvement of other organs, such as the lungs, kidneys, pancreas and myocardium. In isolated cases, an acute generalized reaction and aseptic meningitis with manifestations of myoclonus, eosinophilia, anaphylactic reactions and angioedema were observed.

Finlepsin tablets, instructions for use (Method and dosage)

This medicine is intended to be taken orally, regardless of food intake.

In the treatment of epilepsy, tablets are prescribed as monotherapy. If Finlepsin is added to antiepileptic therapy, then this is done gradually, strictly controlling the dosage. In cases where a pill is missed, it should be taken as soon as the omission occurs, but the missed dose should not be made up for with a double dose.

According to the instructions for use of Finlepsin retard , adult patients are prescribed a daily dose of 200–400 mg at the beginning of treatment. Then a gradual increase in dosage is possible to achieve optimal effectiveness. The maintenance daily dose is 800-1200 mg, with this amount divided into 1-3 doses. The maximum permissible daily dose should not exceed 1.6–2 g.

For children, the dose of the drug depends on age. In addition, when it is difficult for a child to take a whole tablet, it can be chewed, crushed and dissolved in a small volume of liquid.

Children 1-5 years old are prescribed 100–200 mg, gradually increasing the daily dosage to achieve optimal effect.

Children 6-10 years old are recommended to start treatment with a daily dosage of Finlepsin retard 200 mg, then the dose is also gradually increased.

The initial daily dosage for children 11-15 years old is 100-300 mg. After which it is gradually increased by 100 mg until the optimal effect appears.

Average maintenance daily doses: for young patients 1–5 years old – 200–400 mg, 6–10 years old within 400–600 mg, 11–15 years old – 600–1000 mg, divided into several doses.

The duration of treatment is directly dependent on the indication and individual characteristics of the patient. In any case, all decisions related to therapy remain within the competence of the doctor. Typically, the issue of reducing the dose or discontinuing the drug is discussed when the patient has been seizure-free for 2-3 years.

Discontinuation of treatment involves a gradual reduction in dose, lasting 1-2 years, under regular EEG monitoring. In children, increasing weight and age must be taken into account.

During the treatment of other disorders according to indications, the dosage and duration of administration are determined by the doctor, taking into account the complexity of the disease and the characteristics of the individual patient.

Overdose

With an overdose of Finlepsin, various symptoms may develop, indicating disruption of the nervous, cardiovascular and respiratory systems, sensory organs and general abnormalities.

This is manifested by: depression of central nervous system functions, disorientation, drowsiness, agitation, hallucinations, coma, blurred vision, tachycardia , low blood pressure, fainting, breathing problems, pulmonary edema, nausea, vomiting, urinary retention, and so on.

It has been established that there is no antidote for the treatment of overdose, so supportive treatment is carried out depending on the symptoms that appear, in difficult cases - in a hospital setting.

Overdose of the drug Finlepsin retard, symptoms and treatment

An overdose of the drug requires urgent medical intervention. The picture of an overdose of the drug Finlepsin retard is characterized by an increase in side effects such as trembling (tremor), convulsive seizures that occur when the brain is excited (tonic-clonic seizures), agitation, as well as impaired breathing and function of the cardiovascular system with often reduced (sometimes also elevated) blood pressure, tachycardia and conduction dysfunction (AV block, ECG changes), cardiac arrest, accompanied by loss of consciousness and respiratory depression. The following may occur: dizziness, ataxia, drowsiness, stupor, nausea, vomiting, agitation, confusion, involuntary movements, dilated pupils, nystagmus, flushing, urinary retention, cyanosis, opisthotonus, abnormal reflexes (weakening or strengthening of reflexes). In isolated cases, leukocytosis, leukopenia, neutropenia, glucosuria or acetonuria were observed. When assessing intoxication, it is necessary to take into account the possibility of multiple intoxication with other pharmacological drugs that could be used for suicidal purposes. Intoxication with carbamazepine occurs mainly when taken in very high doses from 4 to 10 g. The level of the drug in the blood plasma is more than 20 mcg/ml. People have survived after intentionally or accidentally taking high doses of carbamazepine that produced plasma concentrations of 38 mcg/mL. There is no specific antidote for the treatment of acute poisoning with Finlepsin retard. Treatment for overdose with Finlepsin retard is usually carried out depending on the severity of poisoning in a hospital setting. In case of overdose, treatment is symptomatic: if possible, quickly remove the toxic substance from the stomach by inducing vomiting and/or gastric lavage, as well as using activated charcoal and laxatives. For convulsive attacks, anticonvulsants may be used. It is not recommended to prescribe barbiturates due to respiratory depression, especially in children. Due to the high binding of carbamazepine to blood proteins, forced diuresis, as well as hemodialysis or peritoneal dialysis are ineffective

Interaction

The combination of this drug with CYP3A4 inhibitors causes an increase in the concentration of carbamazepine in the blood plasma and the development of adverse reactions. Combination with CYP3A4 inducers often accelerates the metabolism of carbamazepine , reducing its concentrations and therapeutic effect.

Concomitant use of verapamil, diltiazem, felodipine, dextropropoxyphene, viloxazine, fluoxetine, fluvoxamine, cimetidine, acetazolamide, danazol , desipramine, nicotinamide, as well as macrolides - erythromycin, josamycin, clarithromycin, troleandomycin, some azoles - itraconazole , ketoconazole and fluconazole can significantly increase the concentration carbamazepine a . The same effect is characteristic of terfenadine, loratadine, isoniazid, propoxyphene , grapefruit juice, and viral protease inhibitors. In this case, it is necessary to adjust the dosage and control the concentration of the substance in the plasma.

of felbamate and can lead to a mutual decrease or increase in concentration .

following can also reduce the concentration of carbamazepine phenobarbital, primidone, methsuximide, phenytoin, fensuximide, theophylline, cisplatin, doxorubicin, rifampicin, clonazepam , valproic acid, valpromide, oxcarbazepine and a number of herbal preparations that contain St. John's wort.

Carbamazepine reduces the plasma concentrations of drugs such as: clobazam, clonazepam, ethosuximide, primidone, digoxin, valproic acid, alprazolam, cyclosporine, tetracycline, haloperidol, oral drugs containing estrogen and progesterone , and so on.

It has been established that tetracyclines weaken the therapeutic effect of carbamazepine . Use with paracetamol increases the risk of liver toxicity, reducing therapeutic effectiveness. Combination with phenothiazines, pimozide, molindone, clozapine, haloperidol, thioxanthenes, maprotiline and tricyclic antidepressants enhances the inhibitory effect on the nervous system, weakening the anticonvulsant effect of the drug.

Therefore, when patients are prescribed Finlepsin, they must immediately inform the doctor about what other medications they are taking.

Finlepsin® (Finlepsin®)

Monotherapy for epilepsy begins with a low initial dose, gradually increasing it until the desired therapeutic effect is achieved.

When selecting the optimal dose, it is advisable to determine the concentration of carbamazepine in the blood plasma, especially during combination therapy. In some cases, the optimal dose may deviate significantly from the recommended initial and maintenance dose, for example, due to the induction of microsomal liver enzymes or due to interactions during combination therapy.

Finlepsin® should not be combined with sedative-hypnotics. If necessary, it can be combined with other substances used to treat alcohol withdrawal. During treatment, it is necessary to regularly monitor the content of carbamazepine in the blood plasma. Due to the development of side effects from the central and autonomic nervous system, patients are closely monitored in a hospital setting. When transferring a patient to carbamazepine, the dose of the previously prescribed antiepileptic drug should be gradually reduced until it is completely discontinued. Sudden cessation of carbamazepine may trigger epileptic seizures. If it is necessary to abruptly interrupt treatment, the patient should be transferred to another antiepileptic drug under the cover of the drug indicated in such cases (for example, diazepam administered intravenously or rectally, or phenytoin administered intravenously).

Several cases of vomiting, diarrhea and/or decreased nutrition, convulsions and/or respiratory depression have been described in newborns whose mothers took carbamazepine concomitantly with other anticonvulsants (these reactions may represent neonatal withdrawal syndrome). Before prescribing carbamazepine and during treatment, liver function testing is necessary, especially in patients with a history of liver disease, as well as in elderly patients. If existing liver dysfunction worsens or active liver disease develops, the drug should be discontinued immediately. Before starting treatment, it is necessary to conduct a study of the blood picture (including counting platelets, reticulocytes), iron level in the blood serum, general urine analysis, urea level in the blood, electroencephalogram, determination of the concentration of electrolytes in the blood serum (and periodically during treatment, because hyponatremia may develop). Subsequently, these indicators should be monitored weekly during the first month of treatment and then monthly.

In most cases, a transient or persistent decrease in the number of platelets and/or leukocytes is not a precursor to the onset of aplastic anemia or agranulocytosis. However, before starting treatment, and periodically during treatment, clinical blood tests should be performed, including platelet counts and possibly reticulocyte counts, and serum iron levels should be determined. Non-progressive asymptomatic leukopenia does not require discontinuation, however, treatment should be discontinued if progressive leukopenia or leukopenia accompanied by clinical symptoms of an infectious disease occurs. Carbamazepine should be discontinued immediately if hypersensitivity reactions or symptoms suggestive of Stevens-Johnson syndrome or Lyell's syndrome occur. Mild skin reactions (isolated macular or maculopapular exanthema) usually disappear within a few days or weeks, even with continued treatment or after reducing the dose of the drug (the patient should be under close medical supervision at this time).

The possibility of activation of latent psychoses should be taken into account, and in elderly patients, the possibility of developing disorientation or psychomotor agitation.

In some cases, treatment with antiepileptic drugs was accompanied by the occurrence of suicide attempts/suicidal intentions. This was also confirmed in a meta-analysis of randomized clinical trials using antiepileptic drugs. Since the mechanism of suicide attempts when using antiepileptic drugs is not known, their occurrence cannot be ruled out when treating patients with Finlepsin®. Patients and staff should be warned to monitor for suicidal thoughts/behavior and to seek immediate medical attention if symptoms occur.

Male fertility and/or spermatogenesis disorders are possible, but the relationship between these disorders and carbamazepine has not yet been established.

Intermenstrual bleeding may occur with simultaneous use of oral contraceptives. Carbamazepine may adversely affect the reliability of oral contraceptives, so women of reproductive age should use alternative methods of birth control during treatment.

Carbamazepine should only be used under medical supervision. Patients should be informed of early signs of toxicity, as well as skin and liver symptoms. The patient is informed of the need to immediately consult a doctor in case of adverse reactions such as fever, sore throat, rash, ulceration of the oral mucosa, causeless bruising, hemorrhages in the form of petechiae or purpura.

Before starting treatment, it is recommended to conduct an ophthalmological examination, including fundus examination and measurement of intraocular pressure. If the drug is prescribed to patients with increased intraocular pressure, constant monitoring of this indicator is required.

Patients with severe cardiovascular diseases, liver and kidney damage, as well as elderly people are prescribed lower doses of the drug. Although the relationship between the dose of carbamazepine, its concentration and clinical efficacy or tolerability is very small, regular determination of carbamazepine levels may be useful in the following situations: with a sharp increase in the frequency of attacks; to check whether the patient is taking the drug properly; during pregnancy; when treating children or adolescents; if there is a suspicion of impaired absorption of the drug; if toxic reactions are suspected if the patient is taking several medications.

During treatment with Finlepsin® it is recommended to refrain from drinking alcohol.

Reviews about Finlepsin

In most cases, users leave reviews about Finlepsin retard , which they or their loved ones have been taking for several years. Some patients suffering from epilepsy note that taking this drug has an undesirable effect on their intellectual activity, leading to the development of apathy and impaired social communication. However, despite these symptoms, patients confirm the high effectiveness of the medicine, allowing them to forget about the attacks.

There are reviews when Finlepsin was used in the treatment of panic attacks associated with the fear of open or, conversely, closed spaces. As a result of treatment, in most cases, panic goes away, but some continue to be bothered by unsteadiness in gait.

Thus, Finlepsin is one of the most common anticonvulsant and antiepileptic drugs, which is successfully used in clinical practice. According to experts, treatment with this particular remedy allows you to achieve incredible results. The main thing is to strictly follow all doctor’s prescriptions regarding dosing of the drug and lifestyle changes, to know exactly what Finlepsin tablets are for and take them only as indicated.

Interactions of the drug Finlepsin retard

Cytochrome P450 ZA4 (CYP ZA4) is the main enzyme that catalyzes the formation of the active metabolite carbamazepine-10, 11-epoxide. The simultaneous use of CYP3A4 inhibitors may cause an increase in the concentration of carbamazepine in the blood plasma, which in turn can lead to the development of adverse reactions. Concomitant use of CYP3A4 inducers may increase the metabolism of carbamazepine, leading to a potential decrease in carbamazepine serum concentrations and its therapeutic effect. Similarly, discontinuation of the CYP3A4 inducer may decrease the rate of carbamazepine metabolism, resulting in increased plasma levels of carbamazepine. Carbamazepine is a powerful inducer of CYP3A4, and therefore can reduce the concentration of other drugs in the blood plasma, which are predominantly metabolized by inducing their metabolism. Drugs that increase the level of carbamazepine in the blood plasma. Since an increase in the level of carbamazenin in the blood plasma can lead to adverse reactions, the dosage of the drug must be adjusted and/or monitored its level in the blood plasma when used simultaneously with the following drugs:

• macrolide antibiotics: erythromycin, troleandomycin, yosamycin, clarithromycin;
• anti-tuberculosis drugs: isoniazid;
• affecting the cardiovascular system: verapamil, diltiazem; - carbonic anhydrase inhibitors: acetazolamide;
• antidepressants: viloxazine, fluoxetine, nefazodone, desipramine and fluvoxamine, trazodone;
• antifungals: itraconazole, ketoconazole, fluconazole;
• antihistamines: terfenadine, loratadine;
• drugs for the treatment of gastrointestinal diseases: cimetidine;
• antiviral drugs: ritonavir.

Other substances: nicotinamide (in adults and only in high doses). Elevated levels of carbamazepine-10, 11-epoxide in blood plasma can cause dizziness, fatigue, unsteadiness of gait, and diplopia. The dosage of carbamazepine in the event of these symptoms should be adjusted accordingly and/or the level of the drug in the blood plasma should be monitored if Finlepsin retard is taken simultaneously with the following drugs: loxapine, quetiapine, primedone, progabide, valproic acid, valpromide. Effect of the drug Finlepsin retard on plasma levels when used in combination with other drugs Carbamazepine can reduce the levels of certain drugs in the blood plasma and reduce or neutralize their effects. Therefore, their dose must be adjusted according to clinical need. This applies to the following drugs:

• other anticonvulsants: for example, clonazepam, ethosuximide, felbamate, primidom, lamotrigine, oxcarbazepine, tiagabine, topiramate, valproic acid. Under the influence of carbamazepine, the concentration of phenytoin in the blood plasma may increase or decrease. In exceptional cases, this can cause confusion and even coma;
• benzodiazepines: alprazolam, clobazam;
• typical antipsychotics: (haloperidol, bromperidol) and atypical antipsychotics (clozapine, olanzapine, risperidone, quetiapine);
• tricyclic antidepressants: for example imipramine, amitriptyline, nortriptyline, clomipramine;
• tetracyclic drugs: for example doxycycline;
• azole-type antifungals: for example, voriconazole, itraconazole, since antifungals may cause ineffective treatment;
• anthelmintic drugs: praziquantel;
• antiviral drugs: indinavir;
• analgesics, anti-inflammatory drugs: methadone, paracetamol, tramadol;
• antibiotics: doxycycline;
• anxiolytics: midazolam, alprazolam;
• GCS (for example, prednisolone, dexamethasone), cyclosporines, tacrolimus;
• anticoagulants (eg warfarin, phenprocoumon, dicumarol);
• hormonal contraceptives.

In patients taking hormonal contraceptives, the effectiveness of contraception may decrease and intermenstrual bleeding may suddenly begin. Therefore, it is necessary to take oral contraceptives containing more than 50 mg of estrogen, or the use of other, non-hormonal methods of contraception can be recommended. Drugs that reduce the level of carbamazepine in the blood plasma. It may be necessary to adjust the dose of the drug when used in combination with the following drugs: - other anticonvulsants: phenobarbital, phenytoin, primidone, felbamate, methsuximide; - anti-tuberculosis drugs: rifampicin; - bronchodilators or anti-asthma drugs: theophylline, aminophylline; — antitumor drugs: doxorubicin, cisplatin; - other: preparations containing St. John's wort (Hypericum perforatum). Combinations of drugs that require separate consideration The combined use of lithium with carbamazepine may enhance the neurotoxic effect of both drugs. Therefore, it is necessary to carefully monitor serum levels of both substances. Patients should not take concomitant antipsychotics during the 8-week run-in period before prescribing carbamazepine, nor during treatment with carbamazepine. The following symptoms of neurotoxicity should be observed: unsteadiness of gait, ataxia, horizontal nystagmus, increased muscle proprioceptive reflexes, muscle twitching (muscle fasciculation). Information has been published in the literature that in patients taking carbamazepine in combination with antipsychotics, the risk of neuroleptic malignant syndrome and erythema maligna was increased. The combined use of Finlepsin retard with most diuretics (hydrochlorothiazide, furosemide) can cause symptomatic hyponatremia. Under the influence of Finlepsin retard, the effectiveness of muscle relaxants (for example, pancuronium bromide) may decrease. Therefore, patients taking muscle relaxants should be monitored and, if necessary, the dose of these drugs should be increased. In cases where Finlepsin retard is taken in combination with isotretinoin (an anti-acne drug), it is necessary to monitor the level of carbamazepine in the blood plasma. Carbamazepine may increase the excretion of thyroid hormone, resulting in an increased need for this hormone in patients with hypothyroidism. Therefore, at the beginning and at the end of treatment with Finlepsin retard, it is necessary to determine indicators of thyroid function in patients receiving hormone replacement therapy. If necessary, adjust the dose of the thyroid hormone drug. Thyroid function may change, especially when carbamazepine is combined with other anticonvulsants (in particular phenobarbital). Carbamazepine appears to accelerate the metabolism of zotepine.

Finlepsin price, where to buy

The price of Finlepsin tablets in different regions of Russia differs slightly. At the same time, you can buy Finlepsin 200 mg, 50 pieces each, for 215-270 rubles. The price of Finlepsin retard (400 mg, etc.) varies between 260-330 rubles.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

ZdravCity

• Finlepsin tablets 200 mg 50 pcs. Teva Operations Poland Sp.z.
  o.o. 162 rub. order

Pharmacy Dialogue

• Finlepsin tablets 200 mg No. 50Teva

  RUB 174 order

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Pharmacy24

• Finlepsin retard 200 mg No. 50 tablets TOV Teva Operations Poland, Poland
  416 UAH. order
• Finlepsin 200 mg No. 50 tablets TOV Teva Operations Poland, Poland

  370 UAH. order

• Finlepsin 400 mg N50 tablets TOV Teva Operations Poland, Poland

  528 UAH order

PaniPharmacy

• Finlepsin retard tablets Finlepsin retard tablets 200 mg No. 50 Poland, Pliva Krakow

  363 UAH. order

• Finlepsin tablets Finlepsin tablets 200 mg No. 50 Poland, Teva Operations Poland

  270 UAH. order

  Read also:  Recommendations for using a pregnancy test

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