Fevarin: instructions for use, analogues and reviews, prices in Russian pharmacies. Fevarin: reviews, analogues, instructions, where to buy Fevarin synonyms

Tablets - 1 tab.:

• active substance: fluvoxamine maleate 100 mg;
• excipients: mannitol 303.0 mg, corn starch 80.0 mg, pregelatinized starch 12.0 mg, sodium stearyl fumarate 3.5 mg, colloidal silicon dioxide 1.5 mg;
• shell: hypromellose 5.6 mg, macrogol 6000 2.0 mg, talc 0.4 mg, titanium dioxide (E171) 2.1 mg.

15 or 20 tablets in PVC / PVDC / Al blister.

1, 2, 3 or 4 blisters in a cardboard box along with instructions for use.

Description of the dosage form

Film-coated tablets, oval, biconvex, white, scored on one side, engraved with 313 on both sides of the score.

pharmachologic effect

Antidepressant.

Pharmacokinetics

Suction

After oral administration, fluvoxamine is completely absorbed from the gastrointestinal tract. The maximum concentration of the drug in the blood plasma is observed 3-8 hours after administration. Absolute bioavailability is 53% after primary metabolism in the liver. Simultaneous administration of fluvoxamine with food does not affect the pharmacokinetics.

Distribution

Plasma protein binding of fluvoxamine is 80% (in vitro). Distribution volume - 25 l/kg.

Metabolism

The metabolism of fluvoxamine occurs mainly in the liver. Although the 2D6 isoenzyme of cytochrome P450 is the main one in the metabolism of fluvoxamine, the concentration of the drug in blood plasma in individuals with a reduced function of this isoenzyme is not much higher than in individuals with a normal metabolism.

The average plasma half-life of 13-15 hours for a single dose increases slightly with multiple doses (17-22 hours), and the equilibrium plasma concentration is usually reached within 10-14 days.

Fluvoxamine is biotransformed in the liver (mainly by oxidative demethylation) to at least nine metabolites, which are excreted via the kidneys. The two major metabolites have little pharmacological activity. Other metabolites are probably pharmacologically inactive.

Fluvoxamine significantly inhibits cytochrome P450 1A2 and P450 2C19, moderately inhibits cytochromes P450 2C9, P450 2D6 and P450 ZA4.

The pharmacokinetics of a single dose of fluvoxamine is linear. The equilibrium concentration of fluvoxamine is higher than that of a single dose, and this disproportion is more pronounced at higher daily doses.

Special patient groups

The pharmacokinetics of fluvoxamine is the same in healthy people, the elderly and patients with renal insufficiency.

The metabolism of fluvoxamine is reduced in patients with liver disease.

The equilibrium concentration of fluvoxamine in plasma is twice as high in children (aged 6-11 years) than in adolescents (aged 12-17 years). Plasma concentrations in adolescents are similar to those in adults.

Pharmacodynamics

Receptor binding studies have shown that fluvoxamine is a potent serotonin reuptake inhibitor both in vitro and in vivo with minimal serotonin receptor affinity. Its ability to bind to α- and β-adrenergic receptors, histamine, m-choline or dopamine receptors is negligible.

Fluvoxamine has a high affinity for ϭ1 receptors, acting as their agonist.

Indications for use Fevarin

Depression of various origins; obsessive-compulsive disorders.

Contraindications to the use of Fevarin

Simultaneous reception with tizanidine and monoamine oxidase inhibitors (MAO inhibitors).

Treatment with fluvoxamine can be initiated:

• 2 weeks after stopping an irreversible MAO inhibitor;
• the day after you stop taking a reversible MAO inhibitor (eg, moclobemide, linezolid).

The time interval between stopping fluvoxamine and starting therapy with any MAO inhibitor should be at least 1 week.

Co-administration with ramelteon.

Hypersensitivity to the active substance or to any of the components of the drug.

Carefully:

Hepatic and renal insufficiency, history of convulsions, epilepsy, old age, patients with a tendency to bleeding (thrombocytopenia), pregnancy, lactation.

Fevarin Use during pregnancy and children

Pregnancy

Epidemiological data suggest that the use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy, especially in the last months of pregnancy, may increase the risk of persistent pulmonary hypertension (PLH) in newborns. The available data show that PLH occurs in about 5 per 1000 births (as opposed to 1-2 per 1000 births if the mother did not use SSRIs in the last stages of pregnancy).

Isolated cases of neonatal withdrawal syndrome have been described following the use of fluvoxamine at the end of pregnancy.

Feeding and/or breathing difficulties, convulsive disorders, unstable body temperature, hypoglycemia, tremors, muscle tone disturbances, neuroreflex hyperexcitability syndrome, cyanosis, irritability, lethargy, drowsiness, nausea, difficulty falling asleep and continuous crying, which may require a longer hospital stay.

lactation period

Fluvoxamine passes into breast milk in small amounts. In this regard, the drug should not be used during lactation.

Fertility

Reproductive toxicity studies in animals have shown that fluvoxamine affects the reproductive function of males and females, increases the risk of fetal death and reduces fetal body weight at doses exceeding the maximum recommended human dose by approximately 4 times. In addition, there has been an increase in perinatal mortality in puppies in pre- and postnatal studies. The relevance of these data to humans is unknown.

Fluvoxamine should not be administered to patients who are planning a pregnancy, unless the clinical condition of the patient warrants the administration of fluvoxamine.

Fevarin side effects

The most commonly observed symptom associated with the use of Fevarin is nausea, sometimes accompanied by vomiting. This side effect usually disappears in the first 2 weeks of treatment.

Some side effects observed during clinical trials were often associated with symptoms of depression, and not with ongoing treatment with Fevarin®.

General: often (1-10%) - asthenia, headache, malaise.

From the side of the cardiovascular system: often (1-10%) - palpitations, tachycardia; sometimes (less than 1%) - postural hypotension.

From the gastrointestinal tract: often (1-10%) - abdominal pain, anorexia, constipation, diarrhea, dry mouth, dyspepsia; rarely (less than 0.1%) - impaired liver function (increased levels of hepatic transaminases).

From the side of the central nervous system: often (1-10%) - nervousness, anxiety, agitation, dizziness, insomnia or drowsiness, tremor; sometimes (less than 1%) - ataxia, confusion, extrapyramidal disorders, hallucinations; rarely (less than 0.1%) - convulsions, manic syndrome.

From the skin: often (1-10%) - sweating; sometimes (less than 1%) - skin hypersensitivity reactions (rash, itching, angioedema); rarely (less than 0.1%) - photosensitivity.

From the musculoskeletal system: sometimes (less than 1%) - arthralgia, myalgia.

From the reproductive system: sometimes (less than 1%) - delayed ejaculation; rarely (less than 0.1%) - galactorrhea.

Others: rarely (less than 0.1%) - a change in body weight; serotonergic syndrome, a condition similar to neuroleptic malignant syndrome, hyponatremia and syndrome of insufficient secretion of antidiuretic hormone; very rarely - paresthesia, anorgasmia and taste perversion.

When you stop taking fluvoxamine, withdrawal symptoms may develop - dizziness, paresthesia, headache, nausea, anxiety (most symptoms are mild and stop on their own). When the drug is discontinued, a gradual dose reduction is recommended.

Hemorrhagic manifestations - ecchymosis, purpura, gastrointestinal bleeding.

drug interaction

MAO inhibitors

Fluvoxamine should not be used in combination with MAO inhibitors, including linezolid, due to the risk of serotonin syndrome.

Effect of fluvoxamine on the oxidative process of other drugs

Fluvoxamine can inhibit the metabolism of drugs that are metabolized by certain cytochrome P450 isoenzymes. In vitro and in vivo studies have shown a strong inhibitory effect of fluvoxamine on cytochrome P450 1A2 and P450 2C19 isoenzymes and, to a lesser extent, on cytochrome P450 2C9, P450 2D6 and P450 3A4 isoenzymes. Drugs that are extensively metabolized by these isoenzymes are more slowly eliminated and may have higher plasma concentrations when co-administered with fluvoxamine. Such drugs should be prescribed at a minimum dose or reduced to a minimum dose when used simultaneously with fluvoxamine. Careful monitoring of plasma concentrations, effects or side effects is required, as well as dose adjustment of these drugs, if necessary. This is especially significant for drugs that have a narrow therapeutic window.

ramelteon

When taking the drug Fevarin® twice a day at 100 mg for 3 days before the simultaneous use of the drug ramelteon at a dose of 16 mg, the AUC value (area under the concentration-time curve) for ramelteon increased approximately 190 times, and the Cmax value ( maximum concentration) increased by approximately 70 times compared with these parameters when ramelteon alone was administered.

Drugs with a narrow therapeutic window

Patients concomitantly receiving fluvoxamine and drugs with a narrow therapeutic range, metabolized exclusively or by a combination of cytochrome isoenzymes that inhibit fluvoxamine (such as tacrine, theophylline, methadone, mexiletine, phenytoin, carbamazepine and cyclosporine) should be carefully monitored. If necessary, dose adjustment of these drugs is recommended.

Tricyclic antidepressants and neuroleptics

With the simultaneous use of fluvoxamine, an increase in the concentration of tricyclic antidepressants (for example, clomipramine, imipramine, amitriptyline) and neuroleptics (for example, clozapine, olanzapine, quetiapine) was observed, which are largely metabolized by the cytochrome P450 1A2 isoenzyme. Therefore, if treatment with fluvoxamine is initiated, dose reduction of these drugs should be considered.

Benzodiazepines

With the simultaneous use of benzodiazepines undergoing oxidative metabolism, such as triazolam, midazolam, alprazolam and diazepam, with fluvoxamine, their plasma concentrations may increase. The dose of these benzodiazepines should be reduced while taking fluvoxamine.

Cases of increased plasma concentration

With the simultaneous use of fluvoxamine and ropinirole, plasma concentrations of ropinirole may increase, thus increasing the risk of overdose. In such cases, it is recommended to control, or, if necessary, reduce the dose or cancel ropinirole for the duration of treatment with fluvoxamine.

When fluvoxamine interacted with propranolol, an increase in plasma propranolol concentrations was noted. In this regard, it can be recommended to reduce the dose of propranolol in the case of simultaneous use with fluvoxamine.

When fluvoxamine was used in combination with warfarin, a significant increase in warfarin plasma concentrations and prolongation of prothrombin time were observed.

Increasing incidence of side effects

Isolated cases of cardiotoxicity have been reported with the simultaneous use of fluvoxamine and thioridazine.

Plasma concentrations of caffeine may increase while taking fluvoxamine. Thus, patients who consume large amounts of caffeinated beverages should reduce their intake while taking fluvoxamine and when adverse effects of caffeine such as tremors, palpitations, nausea, restlessness, and insomnia are observed.

Cytochrome P450 isoenzyme 3A4

Gerfenadine, astemizole, cisapride, sildenafil: in combination therapy with fluvoxamine, plasma concentrations of terfenadine, astemizole or cisapride may increase, increasing the risk of QT prolongation/paroxysmal ventricular tachycardia of the torsades de pointes. Therefore, fluvoxamine should not be administered with these drugs.

Glucuronidation

Fluvoxamine does not affect the plasma concentration of digoxin.

renal excretion

Fluvoxamine does not affect the plasma concentration of atenolol.

Pharmacodynamic Interactions

In the case of simultaneous use of fluvoxamine with serotonergic drugs (such as triptans, tramadol, selective serotonin reuptake inhibitors and St. John's wort preparations), the serotonergic effects of fluvoxamine may increase.

Fluvoxamine has been used in combination with lithium to treat critically ill patients with poor response to pharmacotherapy. It should be noted that lithium (and possibly also tryptophan) enhances the serotonergic effects of the drug, and therefore this kind of combined pharmacotherapy should be used with caution.

With the simultaneous use of indirect anticoagulants and fluvoxamine, the risk of developing hemorrhages may increase. Such patients should be under medical supervision.

Dosage Fevarin

Fluvoxamine tablets should be taken orally, without chewing, with water. The tablet can be divided into two equal parts.

The effective daily dose, which is usually 100 mg, is selected individually depending on the patient's response to treatment. The daily dose can reach 300 mg. Daily doses over 150 mg should be divided into several doses.

Due to the lack of clinical experience, Fevarin® is not recommended for the treatment of depression in children under 18 years of age.

Obsessive Compulsive Disorders (OCD)

adults

The recommended starting dose for adults is 50 mg of Fevarin per day for 3-4 days. An effective daily dose is usually 100 to 300 mg. Doses should be increased gradually until an effective daily dose is reached, which should not exceed 300 mg in adults. Doses up to 150 mg can be taken once a day, preferably in the evening. Daily doses over 150 mg are recommended to be divided into 2 or 3 doses.

Children over 8 and teenagers

The initial dose is 25 mg / day at one time. Maintenance dose 50 - 200 mg / day. In the treatment of OCD in children aged 8 to 18 years, the daily dose should not exceed 200 mg. Daily doses over 100 mg are recommended to be divided into 2 or 3 doses.

With a good therapeutic response to the drug, treatment can be continued with an individually selected daily dose. If improvement is not achieved after 10 weeks, fluvoxamine treatment should be reconsidered. So far, no systematic studies have been organized that could answer the question of how long fluvoxamine treatment can last, however, obsessive-compulsive disorders are chronic, and therefore it may be considered appropriate to extend fluvoxamine treatment beyond 10 weeks in patients who respond well for this drug.

The selection of the minimum effective maintenance dose should be carried out with caution on an individual basis. The need for treatment needs to be reassessed periodically. Some clinicians recommend concomitant psychotherapy in patients who respond well to pharmacotherapy.

"Withdrawal" syndrome after discontinuation of fluvoxamine

Abrupt discontinuation of the drug should be avoided. When fluvoxamine treatment is stopped, the dose should be gradually reduced over a period of at least 1-2 weeks to reduce the risk of "withdrawal" syndrome (see section "Side Effects" and "Special Instructions"). consider resuming treatment at the previously recommended dose. Later, the doctor may again begin to reduce the dose, but more gradually.

Treatment of patients with hepatic or renal insufficiency should begin with low doses under strict medical supervision.

Overdose

Symptoms

The most characteristic symptoms include gastrointestinal disturbances (nausea, vomiting and diarrhea), drowsiness and dizziness. In addition, there are reports of cardiac disorders (tachycardia, bradycardia, arterial hypotension), abnormal liver function, convulsions and coma.

Fluvoxamine has a large therapeutic dose latitude with respect to overdose safety. Since market launch, deaths attributed to fluvoxamine-only overdose have been extremely rare. The highest reported dose of fluvoxamine taken by one patient was 12 g. This patient was completely cured. More serious complications have been observed in cases of deliberate overdose of fluvoxamine in combination with other drugs.

There is no specific antidote for fluvoxamine. In case of overdose, gastric lavage is recommended, which should be carried out as soon as possible after taking the drug, as well as symptomatic treatment. In addition, repeated intake of activated charcoal is recommended, if necessary, the appointment of osmotic laxatives. Forced diuresis or dialysis is not effective.

Precautionary measures

As with the use of other psychotropic drugs, it is not recommended to consume alcohol during treatment with Fevarin®.

Suicide/suicidal ideation or clinical deterioration

Depression is associated with an increased risk of suicidal thoughts, self-harm, and suicide attempts (suicidal behavior). This risk remains until a significant improvement in the condition. Since improvement may not occur during the first few weeks of treatment or longer, patients should be closely monitored until such improvement occurs.

It is common in clinical practice to increase the risk of suicide in the early stages of recovery.

Other psychiatric disorders treated with fluvoxamine may also be associated with an increased risk of suicidal behavior. In addition, these conditions may be accompanied by deep depression. Therefore, patients with other psychiatric disorders should be closely monitored.

Patients with a history of suicidal behavior or who exhibit significant suicidal ideation are known to be at greater risk of suicidal thoughts or suicide attempts before starting treatment and should be closely monitored during treatment.

Careful monitoring of patients, especially those at high risk, should accompany drug therapy, especially in its early stages and after dose changes.

Patients (and their caregivers) should be warned to watch for any clinical deterioration, suicidal behavior or suicidal thoughts, unusual changes in behavior, and seek immediate specialist advice if such symptoms occur.

Child population

Fluvoxamine should not be used in children and adolescents under 18 years of age, except in patients with obsessive-compulsive disorder. Due to the lack of clinical experience with fluvoxamine in children for the treatment of depression, it cannot be recommended. In clinical studies conducted among children and adolescents, suicidal behavior (suicidal attempts and thoughts) and hostility (mainly aggression, oppositional behavior and anger) were observed more frequently in patients treated with an antidepressant compared to those receiving placebo. If a treatment decision is made based on clinical need, the patient should be closely monitored for the occurrence of suicidal symptoms.

In addition, long-term safety data for children and adolescents regarding the growth, development and establishment of cognitive behavior are not available.

Adults (18 to 24 years old)

A meta-analysis of placebo-controlled clinical trials of antidepressants in adult patients with psychiatric disorders found an increased risk of suicidal behavior with antidepressants compared with placebo in patients younger than 25 years of age. When prescribing fluvoxamine, the risk of suicide should be weighed against the benefits of its use.

Elderly patients

Data obtained in the treatment of elderly patients and younger patients indicate that there are no clinically significant differences between their usual daily doses. However, dose escalation in elderly patients should always be done more slowly and with more caution.

Akathisia/psychomotor agitation

The development of fluvoxamine-associated akathisia is characterized by subjectively unpleasant and distressing anxiety. The need to move was often accompanied by an inability to sit or stand still. This condition is most likely to develop during the first few weeks of treatment. Increasing the dose of the drug in patients with such symptoms may worsen their condition.

Treatment of patients suffering from hepatic or renal insufficiency should begin with low doses and such patients should be under strict medical supervision. In rare cases, treatment with fluvoxamine can lead to an increase in liver enzymes, most often accompanied by corresponding clinical symptoms, and in such cases, Fevarin® should be canceled.

Disorders of the nervous system

Care must be taken when prescribing the drug to patients with a history of seizures. Fluvoxamine should be avoided in patients with unstable epilepsy, and patients with stable epilepsy should be closely monitored. Treatment with Fevarin® should be discontinued if epileptic seizures occur or their frequency increases.

Rare cases of the development of serotonin syndrome or a condition similar to neuroleptic malignant syndrome have been described, which may be associated with the use of fluvoxamine, especially in combination with other serotonergic and / or neuroleptic drugs. Since these syndromes can lead to potentially life-threatening conditions manifested by hyperthermia, muscle rigidity, myoclonus, autonomic nervous system lability with possible rapid changes in vital parameters (pulse, respiration, blood pressure, etc.), changes in mental status, including confusion, irritability, extreme agitation, reaching delirium or coma - in such cases, treatment with fluvoxamine should be discontinued and appropriate symptomatic treatment should be started.

Metabolic and nutritional disorders

As with other selective serotonin reuptake inhibitors, in rare cases, hyponatremia may occur, which is reversed after fluvoxamine is discontinued. Some cases have been caused by antidiuretic hormone deficiency syndrome. Most of these cases were observed in elderly patients.

Blood glucose control (i.e. hyperglycemia, hypoglycemia, impaired glucose tolerance) may be impaired, especially in the early stages of treatment. In the case of the appointment of fluvoxamine in patients with a history of diabetes mellitus, dose adjustment of antidiabetic drugs may be required.

The most commonly observed symptom associated with the use of Fevarin® is nausea, sometimes accompanied by vomiting. This side effect usually disappears within the first two weeks of treatment.

Violation of the organ of vision

Mydriasis has been reported with SSRIs such as fluvoxamine. Therefore, patients with elevated intraocular pressure or patients at increased risk of acute angle-closure glaucoma should be given fluvoxamine with caution.

Hematological disorders

There are reports of intradermal hemorrhages such as ecchymosis and purpura, as well as other hemorrhagic manifestations (eg, gastrointestinal bleeding or gynecological bleeding) observed with the use of selective serotonin reuptake inhibitors. Caution should be exercised when prescribing these drugs in elderly patients and in patients receiving concomitant drugs that act on platelet function (for example, atypical antipsychotics and phenothiazines, many tricyclic antidepressants, acetylsalicylic acid, non-steroidal anti-inflammatory drugs) or drugs that increase the risk of bleeding, as well as in patients with a history of bleeding or prone to bleeding (for example, with thrombocytopenia or coagulation disorders).

Cardiac disorders

An increase in the risk of prolongation of the QT interval / paroxysmal ventricular tachycardia of the "pirouette" type with combination therapy of fluvoxamine with terfenadine or astemizole or cisapride, due to an increase in the concentration of the latter in the blood plasma. Therefore, fluvoxamine should not be administered with these drugs.

Fluvoxamine may cause a slight decrease in heart rate (by 2-6 beats per minute).

Electroconvulsive therapy (ECT)

Clinical experience with fluvoxamine during ECT is limited and should therefore be used with caution.

Withdrawal reactions

Discontinuation of fluvoxamine may lead to a "withdrawal" syndrome, although available preclinical and clinical data have not shown dependence on fluvoxamine treatment. The most common symptoms noted in case of discontinuation of the drug are: dizziness, sensory disturbances (including paresthesias, visual disturbance and electric shock), sleep disturbances (including insomnia and vivid dreams), agitation, irritability, confusion, emotional lability, headache, nausea and / or vomiting, diarrhea, sweating, palpitations, tremors and anxiety (see section "Side Effects").

Most of these symptoms are mild to moderate and self-limiting, but in some patients they may be severe and/or prolonged. These symptoms usually occur within the first few days after stopping treatment. For this reason, it is recommended to gradually reduce the dose of fluvoxamine before complete withdrawal, according to the patient's condition.

Mania/hypomania

Fluvoxamine should be used with caution in patients with a history of mania/hypomania. If a patient develops a manic phase, fluvoxamine should be discontinued.

Influence on the ability to drive vehicles and control mechanisms

Fevarin®, administered to healthy volunteers at doses up to 150 mg, did not affect or had a negligible effect on the ability to drive a car and control machines. At the same time, there are reports of drowsiness observed during treatment with fluvoxamine. In this regard, it is recommended to exercise caution until the final determination of the individual response to the drug.

One tablet of Fevarin contains: fluvoxamine maleate - 100 or 50 mg.

Excipients: corn starch - 80 or 40 mg; - 303 or 152 mg; pregelatinized starch - 12 or 6 mg; sodium stearyl fumarate - 3.5 or 1.8 mg; colloidal silica - 1.5 or 0.8 mg.

Shell composition: macrogol 6000 - 2 or 1.5 mg; hypromellose - 5.6 or 4.1 mg; talc - 0.4 or 0.3 mg; titanium dioxide - 2.1 or 1.5 mg.

The drug does not contain lactose And sugar .

Release form

Tablets, regardless of dosage, are available in blisters of 15 and 20 pieces, in a cardboard bundle 4, 3, 2 or 1 such blister.

pharmachologic effect

The drug has antidepressant action .

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

The drug selectively inhibits reuptake by brain cells and has minimal effect on noradrenergic transmission. Possesses poor ability to interact with histaminergic, cholinergic, alpha And beta-adrenergic, m-dopaminergic And serotonergic receptors .

Pharmacokinetics

When taken orally, it is completely adsorbed from the intestine. The maximum concentration is observed 4-8 hours after administration, the equilibrium concentration is reached after two weeks. Bioavailability - 53% after initial metabolism in the liver. Food does not affect the pharmacodynamics of Fevarin.

Approximately 80% of the molecules of the active substance bind to blood proteins.

The elimination half-life from the blood for a single dose is 13-15 hours, with multiple doses - 17-22 hours.

The metabolism of Fevarin is localized in the liver. The drug undergoes biotransformation by oxidative demethylation . Metabolites are excreted by the kidneys. Only 2 out of 9 metabolites have pharmacological activity.

Pharmacokinetics is the same regardless of age and the presence of renal insufficiency. Metabolism may be inhibited in individuals with liver disease.

Indications for use Fevarin

Indications for the use of Fevarin are reduced to the need for prevention and therapy, treatment obsessive-compulsive symptoms.

Contraindications

It is forbidden to prescribe Fevarin simultaneously with MAO inhibitors, or ramelteon . Treatment with the drug can be started only 14 days after the abolition of irreversible MAO inhibitors , and the next day after stopping the intake of reverse inhibitors MAO .

Therapy MAO inhibitors start 1 week after the abolition of Fevarin.

The drug is contraindicated in persons with fluvoxamine maleate or to any of the other components of the medicinal product, with severe liver disease and children under eight years of age.

Side effects

• From the hematopoietic system: (gastrointestinal, gynecological, ecchymosis ).
• From the endocrine system: an imbalance in the production of,.
• From the side of nutrition and metabolism:, hyponatremia , change in body weight.
• From the side of the psyche: hallucinations, mania, suicidal thoughts and behavior.
• From the nervous system: agitation, anxiety, nervousness, drowsiness, headache, ataxia , convulsions , serotonin syndrome , .
• From the point of view: mydriasis , .
• From the side of the cardiovascular system: hypotension .
• From the digestive system: abdominal pain, nausea, impaired liver function.
• From the skin: sweating, rash, itching, photosensitivity.
• From the musculoskeletal system: muscle and joint pain, fractures.
• From the genitourinary system: a variety of urination disorders (urinary retention, incontinence, enuresis, and others), late ejaculation , Galactorrhea, anorgasmia, menstrual disorders.
• General violations: asthenia, general weakness, withdrawal syndrome.

Termination of treatment often causes the development of a withdrawal syndrome. Cancellation of the drug is recommended to be done gradually.

Instructions for use Fevarin

According to the instructions for use of Fevarin, the dosing regimen is set individually in each individual case. Initially, the daily dose of the drug is 50-100 mg (1 or 2 tablets, depending on the dosage). The drug is recommended to be taken at night. If necessary, the daily dose is increased to 150-200 mg. The maximum daily dose is 300 mg. If the daily dose is more than 100 mg, then it should be taken in two or three doses.

Overdose

Overdose symptoms.

• From the digestive system: nausea , impaired hepatic function.
• From the nervous system: convulsions , drowsiness , dizziness .
• Heart problems have also been reported: bradycardia, tachycardia, hypotension .

Fatalities due to overdose fluvoxamine occur extremely rarely. The highest recorded dose for overdose is 12 grams. The person who took this dose made a full recovery.

Treatment. There is no specific antidote. In case of an overdose, it is necessary to wash the stomach and prescribe symptomatic treatment. Recommended use. or forced diuresis ineffective.

Interaction

• When taken together with MAO inhibitors there is a possibility of serotonin syndrome .
• When used together with , the concentration of these drugs in the blood increases, and their negative effects intensify.
• When taken concomitantly with , carbamazepine, trimipramine, theophylline their content in blood plasma increases.
• When used together, c reduces its effectiveness; With valproic acid - its effects are activated; c - its concentration and the risk of bleeding increase; c - its negative effects are enhanced; c - increases the content of lithium in the blood.
• The use of the drug together with increases the risk of extrapyramidal disorders.
• When used together with quinidine its metabolism is inhibited and clearance is reduced.

Terms of sale

The drug is released only by prescription.

Storage conditions

Keep away from children. Store in a dry, dark place at temperatures below 20 degrees.

Best before date

Three years.

special instructions

Patients with and other conditions need to be under the constant supervision of the attending physician until the condition improves.

In persons with hypofunction of the liver or kidneys, treatment should be started with small doses under the supervision of the attending physician.

Should be administered with caution fluvoxamine persons with convulsive syndrome in history. If the patient develops or becomes more frequent convulsions therapy should be discontinued.

Rarely when used fluvoxamine (and other selective serotonin reuptake blockers) may occur hyponatremia which disappears after discontinuation of the drug. The vast majority of episodes hyponatremia observed in elderly patients.

The most common adverse effect of treatment fluvoxamine is nausea and vomiting, but they disappear after the first two weeks of therapy.

Possible withdrawal syndrome when treatment is stopped fluvoxamine . Most common symptoms after withdrawal fluvoxamine : sensory disturbance, dizziness, sleep disturbances, irritability, agitation, confusion, headache, emotional instability, nausea, vomiting, sweating, anxiety. As a rule, these phenomena are mild and disappear on their own. They are observed in the first days after cessation of therapy. In this regard, it is advised to slowly reduce the dose of the consumed fluvoxamine .

Fevarin in a daily dose of 150 mg does not affect the ability to drive a car. However, drowsiness may develop during the treatment period, so care must be taken until the individual response to the drug is investigated.

Fevarin's analogs

Coincidence in the ATX code of the 4th level:

The most common are such analogues of Fevarin, containing fluvoxamine , How Deprivox And Fluvoxamine Sandoz .

children

The antidepressant Fevarin is contraindicated in children under 8 years of age.

During pregnancy and lactation

The use of drugs based on fluvoxamine , especially in the later stages, can increase the possibility of developing persistent pulmonary hypertension of the newborn . Therefore, Fevarin should not be used during pregnancy unless the patient's condition requires therapy with this drug.

The drug in a small amount can penetrate into breast milk, so the use of the drug in women during lactation is contraindicated.

Stress, difficult life problems, experiences, loss of loved ones and loved ones significantly affect the human nervous system. Sometimes external problems can drive you into a severe depressive state, from which it is very difficult to find a way out.

Many people, unable to get out of the shackles of anxiety and sadness, see only one way - suicide. However, doctors have found a way to combat depression. Antidepressants can help the patient bring back the joy of life. Fevarin is one of those saviors of the human soul that can be found on pharmacy shelves.

But for many, it is out of reach in terms of acquisition - the price for a package of an antidepressant is more than high. Fortunately, a wide range of pharmaceutical preparations allows you to find more affordable analogues of Fevarin, which have a similar method of influencing the human nervous system, while having an attractive cost.

Fevarin: basic information about the drug

The American-made drug belongs to the group of antidepressants listed on the B list (strong drugs dispensed from pharmacies strictly according to a doctor's prescription).

Let's pay attention to the brief instructions for the use of Fevarin and prices in pharmacies.

Compound

The basis of the antidepressant is the substance fluvoxamine. Also, each tablet contains excipients - silicon dioxide, mannitol, sodium and starch.

Indications

An antidepressant is prescribed for severe forms of disorders of the psycho-emotional state of a person:

• depressive syndrome;
• feeling of anxiety, nervousness;
• sleep disturbance (up to insomnia) against the background of stress;
• compulsive disorder;
• apathy, loss of interest in everything around.

It is used not only directly during the period of a nervous disorder, but also as a preventive measure to prevent relapse after the treatment.

Contraindications

An antidepressant has a serious effect on a person's well-being, therefore in some cases, it is strictly prohibited to use it. The list of contraindications includes:

• kidney failure;
• disruption of the liver;
• epileptic seizures;
• tendency to thrombocytopenia;
• convulsive state;
• intolerance to the substance that is the basis of the drug.

During pregnancy and during breastfeeding, the drug may be prescribed in extreme cases, and treatment should be accompanied by the close attention of a physician.

Side effects

Antidepressant can cause a deterioration in the psycho-emotional state of a patient with suicidal tendencies. In this case, the attending physician may refrain from prescribing this drug to the patient or prescribe it in the minimum dosage.

In addition, taking Fevarin can cause a number of side effects:

As you can see from the impressive list of side effects, an antidepressant should not be taken as an easy and safe panacea for a bad mood. Even with strict adherence to all recommendations for use, the medication can have an extremely negative effect on human health.

Price

Fevarin is available in the form of tablets. The cost depends on the content of the main active ingredient in the tablet:

1. a package of tablets, each containing 50 milligrams of fluvoxamine, costs around 700 rubles (for 15 tablets);
2. a package of tablets, each containing 100 milligrams of the main active ingredient, can be purchased for an average of 910 rubles (for 15 tablets).

The antidepressant has a powerful effect not only on the human nervous system, but also on his financial condition. It must also be taken into account that treatment requires a full course, only in this case, you can count on a positive result. Since one package contains only 15 tablets, you will have to pay an impressive amount for the treatment of depression.

Cheap analogues

In order not to once again disturb your nervous system, shrouded in depression and anxiety, it is recommended to refrain from acquiring such an expensive drug.

And there is a weighty circumstance for this - in the vast stocks of any pharmacy you can find a number of drugs that are not inferior to Fevarin in terms of efficiency, but at the same time paying a much smaller amount of money for them.

Deprivox

A German-made antidepressant that belongs to list B and is sold in pharmacies strictly on prescription.

Compound. The main active ingredient of the antidepressant is fluvoxamine.

Indications. It is prescribed for depressive syndrome and obsessive-compulsive states. Effective in dealing with panic attacks, anxiety and unreasonable fears.

Contraindications. The main contraindication is individual intolerance to the active ingredient that is part of the drug. Also, Deprivox should not be combined with other psychotropic drugs.

Price. The antidepressant comes in tablet form. For a package of the drug containing 20 tablets (100 milligrams of the active substance each), you will have to pay in the range of 500 rubles.

Comparison with the original. The two drugs have the same active substance in the composition - fluvoxamine. Also, the indications for use are absolutely identical. The analog has much less contraindications, as well as a much more attractive cost (500 rubles for 20 tablets containing 100 milligrams of fluvoxamine, versus 910 rubles for 15 tablets of Fevarin).

Fluvoxin (Fluvoxamine)

An Indian-made antidepressant, it belongs to list B (strong drugs that are dispensed from pharmacies by prescription).

Compound. The basis of the drug is the substance fluvoxamine.

Indications. It is prescribed for mental disorders:

• depressive syndrome;
• anxiety state;
• panic attacks;
• stress;
• phobias.

Contraindications. Taking the drug is contraindicated in:

• diabetes mellitus;
• epileptic seizures;
• renal failure;
• liver diseases;
• hypersensitivity or absolute intolerance to the main active substance;
• pregnancy;
• breastfeeding;
• children up to eight years of age.

Price. You can buy an antidepressant for an average of 400 rubles (10 tablets, each containing 100 milligrams of the active substance).

Comparison with the original. The two drugs are based on the substance fluvoxamine. In indications and contraindications, the two antidepressants are also very similar. The main difference is that the analogue is much cheaper.

fluoxetine

One of the most effective Russian antidepressants with a very long history of existence. Refers to drugs from list B (strong drugs dispensed from pharmacies by prescription only).

Compound. The composition is based on the active substance of the same name - fluoxetine.

Indications. The antidepressant is aimed at combating such pathologies of the central nervous system as:

• depression (including severe form);
• neurosis;
• bulimia (excessively active appetite in a nervous state, stress);
• stress;
• insomnia.

Contraindications. An antidepressant should not be taken when:

• diseases of the liver and kidneys;
• violation of the genitourinary system;
• glaucoma;
• oncological pathologies;
• epilepsy;
• pregnancy;
• breastfeeding;
• convulsions;
• concomitant use with other psychotropic drugs;
• individual intolerance to the components of the drug.

Price. You can buy Fluoxetine for an average of 60 rubles (20 capsules, each containing 20 milligrams of the main active ingredient). Of course, finding an analogue cheaper will not be easy!

Comparison with the original. Despite the different substances in the basis of the drugs, both antidepressants have a similar focus. Significant difference in price. Despite the low cost, Fluoxetine is recognized as one of the most powerful antidepressants in the history of pharmacology.

If you have overcome severe depression, you should not give up and lose the colors of life. It is necessary to contact an experienced neurologist or psychotherapist who will select an effective drug and draw up a course of treatment.

It is important to remember that psychotropic drugs and drugs used to normalize the functioning of the nervous system should not be prescribed by yourself! Having arbitrarily diagnosed yourself with depression and illegally, without a doctor's prescription, having bought an antidepressant, you can significantly harm your health!

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Fevarin is an antidepressant. The mechanism of action is associated with selective inhibition of serotonin reuptake by brain neurons and is characterized by a minimal effect on noradrenergic transmission.

Fevarin has a weak ability to bind to alpha and beta-adrenergic receptors, histamine, m-cholinergic receptors, dopamine and serotonin receptors.

When taken orally, it is completely absorbed from the gastrointestinal tract. Cmax is achieved after 3-8 hours, the equilibrium concentration - after 10-14 days. Absolute bioavailability is 53% after primary metabolism in the liver.

Simultaneous administration of Fevarin with food does not affect the pharmacokinetics. Plasma protein binding is approximately 80%.

Pharmacokinetics is the same in healthy people, the elderly and patients with renal insufficiency. Metabolism is reduced in patients with liver disease.

Steady-state plasma concentrations in children aged 6–11 years are twice as high as in adolescents (12–17 years). Plasma concentrations of Fevarin in adolescents are similar to those in adults.

Indications for use

What helps Fevarin? The drug is prescribed for depression of various origins and obsessive-compulsive disorders.

The drug is used for depression of a different nature:

• social depression, with or without agitation,
• depression with anxiety
• neuropsychiatric conditions and disorders that are strongly associated with depression,
• somatic and psychosomatic disorders, accompanied by a depressive component.

As part of complex treatment for alcoholism, drug addiction, chronic pain syndromes.

Instructions for use Fevarin and dosage

In the treatment of depression, the recommended initial dose is 50 mg or 100 mg 1 time / day, in the evening. Increasing the dose should be carried out gradually. An effective dose, usually 100 mg/day, is selected individually depending on the patient's response to treatment. The daily dose can reach 300 mg.

Doses greater than 150 mg/day should be divided into several doses.

To prevent recurrence of depression, 100 mg of Fevarin is prescribed once a day.

When used in children and adolescents aged 8-18 years, the recommended daily dose, depending on the age and severity of clinical manifestations, is 25-100 mg, the maximum is 150-200 mg.

With a good therapeutic response to treatment, Fevarin therapy can be continued within the framework of an individually selected daily dose. If there is no improvement after 10 weeks, it is necessary to reconsider the feasibility of treatment.

Side effects

Some side effects observed in clinical studies were often related to the disease, and not to the treatment being given. When prescribing Fevarin, the following side effects may occur:

• Bleeding (eg, gastrointestinal bleeding, gynecological bleeding, ecchymosis, purpura),
• Hyperprolactinemia, syndrome of inadequate ADH production,
• Anorexia,
• Anxiety, irritability, restlessness,
• Insomnia, drowsiness, tremor, headache, dizziness,
• Extrapyramidal disorders,
• Glaucoma, mydriasis,
• Palpitations, tachycardia,
• Abdominal pain, constipation, diarrhea, dry mouth, dyspepsia, nausea,
• increased sweating,
• Hypersensitivity skin reactions (including rash, pruritus, angioedema,
• Arthralgia,
• Urinary disorders (including urinary retention, urinary incontinence, pollakiuria, nocturia and enuresis),
• Violation (delay) of ejaculation, anorgasmia, menstrual disorders (such as amenorrhea, hypomenorrhea, metrorrhagia, menorrhagia).
• Asthenia,
• Drug withdrawal syndrome, including withdrawal syndrome in newborns whose mothers took fluvoxamine in late pregnancy.

Discontinuation of use often leads to the development of a withdrawal syndrome. For this reason, if therapy is no longer required, it is recommended to gradually reduce the dose until the drug is completely discontinued.

Contraindications

The appointment of Fevarin is contraindicated in the following cases:

• hypersensitivity to fluvoxamine maleate or to one of the excipients that make up the drug;
• simultaneous reception of tizanidine and MAO inhibitors.

Use with caution when:

• liver and kidney failure;
• history of seizures, epilepsy;
• elderly age;
• patients with a tendency to bleed (thrombocytopenia);
• pregnancy.

special instructions

In depression, there is a high likelihood of suicide attempt, which may persist until sufficient remission is achieved.

Use Fevarin with caution in a history of convulsions. With the development of an epileptic seizure, treatment with fluvoxamine should be discontinued.

In case of hepatic or renal insufficiency at the beginning of treatment, fluvoxamine should be prescribed in low doses under the strict supervision of a physician. Fluvoxamine should be discontinued if symptoms associated with elevated liver enzymes appear.

In elderly patients, the dose of Fevarin should always be increased more slowly and with more caution.

During the treatment period, alcohol is not allowed.

Treatment with MAO inhibitors should be discontinued 2 weeks before the start of the drug.

Overdose

An overdose of Fevarin manifests itself as nausea, vomiting, impaired stool, fainting, lethargy and drowsiness. There are reports of symptoms from the cardiovascular system: tachycardia, hypotension, bradycardia. Violations in the work of the liver, convulsions are possible. In severe cases, coma may develop.

If you deliberately exceed the dosage of the drug, more serious consequences are possible.

The drug has no specific antidote. In case of overdose, gastric lavage is done as soon as possible and treated symptomatically. Activated charcoal is recommended.

Analogues Fevarin, list of drugs

If necessary, you can replace Fevarin with similar analogues, the list of drugs:

1. Deprivox,
2. Actaparoxetine,
3. Please,
4. Fluxen

When choosing analogues, it is important to understand that the instructions for using Fevarin, the price and reviews of drugs of similar action do not apply. It is important to consult a doctor and not to make an independent replacement of the drug.

The average cost of Fevarin tablets in pharmacies: 781-893 rubles.

The shelf life of the tablets is 3 years from the date of manufacture. Store in the original original packaging, in a dark, dry place out of the reach of children at an air temperature not exceeding +25°C.

Content

The drug Fevarin, which has an antidepressant effect, is produced by the Dutch company Abbott Laboratories. Fevarin is a remedy that contains fluvoxamine, which depresses the excitement of the psyche and helps restore psychological balance. To understand how the drug works, it is important to understand its composition, indications, adverse reactions and methods of administration. Fevarin's instructions will help you with this.

Composition and form of release

Fevarin is available only in the form of film-coated tablets. Check out their description and composition:

Pharmacodynamics and pharmacokinetics

An antidepressant drug selectively inhibits the reuptake of serotonin by brain neurons in order to increase the amount of this substance in the body. The active component of Fevarin fluvoxamine weakly binds to alpha and beta adrenoreceptors, histamine, m-cholinergic receptors, dopamine and serotonin types, therefore it does not affect the release of hormone molecules.

After using the tablets, fluvoxamine is rapidly absorbed from the stomach and reaches the maximum concentration in the blood after 3-8 hours. The substance has a 53% bioavailability. The drug binds to proteins by 80%, is metabolized in the liver. During oxidative demethylation, up to 9 metabolites are formed, their half-life from the blood is 13-15 hours. The drug is excreted from the body in the urine.

Indications for use Fevarin

The instructions say that the drug is intended for the treatment and prevention of obsessive-compulsive disorders, depression of various origins. Fevarin can be used by adults and children over eight years old. For each item of indications there is a scheme for the use of the drug.

Method of application and dosage

Tablets are taken orally without chewing and crushing, washed down with water. You can divide the dose into two parts. According to the instructions, the recommended starting dose for the treatment of depression is 50-100 mg once a day, in the evening. Gradually, the dosage is increased to the maximum effective level (100 mg). The daily dose can reach 300 mg, but then it is divided into several doses. Antidepressant treatment continues for at least six months after remission. To prevent recurrence of depression, Fevarin is prescribed at a dose of 100 mg once a day.

According to the instructions, the use of the drug for obsessive-compulsive disorders for adults begins with taking 50 mg per day for 3-4 days. Then the dose is increased to 100-300 mg. Dosage up to 150 mg is taken once a day in the evening, the amount of more than 150 mg is divided into 2-3 doses. After reaching the desired therapeutic effect, treatment is continued without changing the dosage. If there is no improvement after 10 weeks of use, therapy is reviewed.

special instructions

The state of depression in patients is associated with an increased risk of suicidal thoughts and self-harm. During the first weeks of taking the medication, such reactions may not occur, so the doctor should closely monitor the well-being of patients until their mood improves. Among the special instructions in Fevarin's instructions are and others recommendations:

• Against the background of taking pills, akathisia may develop - the need to move often. At the same time, patients cannot sit or stand still, they experience excruciating anxiety.
• The drug should be used with caution if there is a history of seizures. Doctors do not recommend giving the drug to patients with unstable epilepsy.
• While taking the tablets, it is possible to develop hyponatremia (lack of sodium), which disappears after discontinuation of treatment. In the early stages of therapy, blood glucose levels often rise or fall.
• Against the background of the use of fluvoxamine, cases of mydriasis (dilated pupils) have been reported, therefore, with increased intraocular pressure or acute angle-closure glaucoma, the drug is prescribed with caution.
• When prescribing Fevarin to patients prone to gastrointestinal or gynecological bleeding, with metabolic disorders, the presence of thrombocytopenia, care should be taken. The same applies to people with a history of coagulation changes, mania or hypomania, patients taking atypical antipsychotics, phenothiazines.
• With the termination of therapy, the development of a withdrawal syndrome is possible. It manifests itself in the form of dizziness, impaired sensitivity, falling asleep, excessive excitement, nausea or vomiting, diarrhea, sweating, anxiety.

During pregnancy

The use of selective serotonin reuptake inhibitors in the last trimester of pregnancy can lead to the development of persistent pulmonary hypertension in newborns (0.5%), so the use of tablets during childbearing is prohibited. The danger for an infant born to a mother taking Fevarin is that he may experience convulsions, hypoglycemia, tremors, respiratory and sucking disorders, cyanosis, nausea, lethargy.

It is forbidden to use Fevarin during lactation, because it is found in breast milk. The drug is not prescribed to patients planning pregnancy. According to animal studies, fluvoxamine affects reproductive function, increases the risk of fetal death inside the womb. The weight of the fetus decreases if the expectant mother consumes doses of Fevarin that are four times the recommended ones.

In childhood

For the treatment of obsessive-compulsive disorder in children older than 8 years, the initial dose is 25 mg per day in one dose. The maintenance dosage is 50-200 mg per day, and the maximum daily dose is 200 mg. Doses over 100 mg are recommended to be divided into 2-3 doses. According to the directions in the manual, children under eight years of age are not allowed to use Fevarin.

drug interaction

It is forbidden to combine fluvoxamine with monoamine oxidase inhibitors, Linezolid, because. at the same time, serotonin syndrome develops. The medication instructions say And about features others drug interactions:

• The combination of the drug with Terfenadine, Astemizol, Cisapride, Diazepam leads to the risk of ventricular tachycardia. These combinations are prohibited.
• In the minimum dose, Fevarin can be combined with Ramelteon, Tacrine, Theophylline, Methadone, Carbamazepine, Cyclosporine, Phenytoin.
• Fluvoxamine increases the concentration of tricyclic antidepressants, neuroleptics, benzodiazepines, Ropinirole, Propranolol, Warfarin, caffeine, Metoclopramide, Clozapine, Imipramine.
• The combination of the drug with Thioridazine can lead to cardiotoxicity.
• Triptans, Galantamine, Bromazepam, Tramadol, Alprazolam, St. John's wort or lithium preparations, selective serotonin reuptake blockers can enhance the effect of the medication.
• The combination of the drug with indirect anticoagulants increases the risk of developing hemorrhages (hemorrhages).

Fevarin and alcohol

In combination with alcohol, Fevarin can aggravate the patient's current state of health, increase the frequency of suicidal thoughts. During therapy with this drug, it is recommended to refrain from taking ethanol and drinks or medicines based on it. The danger of drinking alcohol during treatment is also to increase the load on the liver.

Side effects of Fevarin

The instructions highlight a number of side effects that occur during the use of Fevarin. These include:

• bleeding, ecchymosis (bleeding under the skin);
• hyperprolactinemia;
• constipation, dyspepsia;
• hypotension;
• anorexia, hyponatremia, weight gain or decrease;
• hallucinations, confusion;
• anxiety, irritability, excitability, paresthesia (impaired sensitivity), anxiety, akathisia, insomnia;
• serotonin syndrome, drowsiness, convulsions, tremor, headache, dizziness, nervousness, convulsions;
• glaucoma, dilated pupils, blurred vision;
• cardiopalmus;
• ataxia - impaired coordination of movements;
• violation of the functions of the liver and kidneys, digestion;
• increased sweating, photosensitivity, skin hypersensitivity, rash, angioedema, itching, urticaria;
• urinary disorders, problems with urination, enuresis;
• bone fractures;
• delayed ejaculation, impaired hormone production, hypofunction of the gonads, anorgasmia;
• menstrual pathologies: menorrhagia, metrorrhagia, hypomenorrhea, amenorrhea;
• asthenia.

Overdose

Symptoms of an overdose of Fevarin are nausea, diarrhea, vomiting and dizziness. May occur: tachycardia, bradycardia, muscle cramps, coma. A lethal outcome was observed in very rare cases, even a dose of 12 g was well tolerated by patients. Overdose treatment consists of gastric lavage, repeated administration of activated charcoal and osmotic laxatives. There is no specific antidote, dialysis and forced diuresis are ineffective.

Contraindications

According to the instructions, the use of the drug is carried out with caution in case of renal, hepatic insufficiency, metabolic disorders, history of convulsions, epilepsy, with a tendency to intestinal bleeding, during pregnancy, in old age. Contraindications for taking Fevarin are:

• lactation;
• combination with Tizanidine or MAO inhibitors (the interval between their intake should be two weeks), Ramelteon;
• hypersensitivity to the components of the composition, lactose;
• age up to 8 years.

Terms of sale and storage

The drug is dispensed by prescription, stored at temperatures up to 25 degrees for three years from the date of manufacture.

Fevarin's analogs

Only some medicines can replace this drug. There are only two analogues of Fevarin, which have the same effect:

• Deprivox - tablets based on fluvoxamine maleate with antidepressant properties;
• Fluvoxamine Sandoz is a complete analogue of Fevarin, its generic (contains the same active ingredient, but is cheaper). Produced by another company - Salyutas Pharma GmbH (Germany).

Fevarin price

You can buy a medicine via the Internet or at a pharmacy at prices depending on the concentration of the active substance in the tablets and the volume of the package. The approximate cost of Fevarin in Moscow is:

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