The scourge of the 21st century is stress. His faithful companions: anxiety, excitement, neuroses, panic attacks, somatic manifestations (urticaria, skin itching, allergic dermatitis, eczema), sleep disturbances. It would seem that there’s nothing wrong with it, just rest and everything will pass. But if it does not go away, gets worse and disrupts the usual rhythm of life, then you need to consult a doctor. During drug treatment, doctors often prescribe a prescription for the anxiolytic (tranquilizer) Atarax, which is allowed even for children over one year of age.
Stress is a very common problem
pharmachologic effect
A derivative of diphenylmethane, it has moderate anxiolytic activity;
It also has a sedative, antiemetic, antihistamine and m-anticholinergic effect. Blocks central m-cholinergic receptors and histamine H1 receptors and inhibits the activity of certain subcortical zones. Does not cause mental dependence or addiction. The clinical effect occurs 15-30 minutes after taking the drug orally. Has a positive effect on cognitive abilities, improves memory and attention. Relaxes skeletal and smooth muscles, has bronchodilator and analgesic effects, and a moderate inhibitory effect on gastric secretion. Hydroxyzine significantly reduces itching in patients with urticaria, eczema and dermatitis. With long-term use, there was no withdrawal syndrome or deterioration of cognitive functions. Polysomnography in patients with insomnia and anxiety clearly demonstrates an increase in sleep duration and a decrease in the frequency of night awakenings after a single or repeated dose of hydroxyzine at a dose of 50 mg. A decrease in muscle tension in patients with anxiety was noted when taking the drug at a dose of 50 mg 3 times a day.
Composition of the medicine
The main active component - hydroxyzine - has a calming, anti-allergenic, analgesic, antispasmodic effect, and also increases concentration, improves attention and cognitive functions. If anxiety is pronounced, and chronic insomnia is also associated with it, then Atarax, or rather hydroxyzine, relieves anxiety, normalizes sleep, strengthening and increasing its duration, and reduces the frequency of awakenings at night. The drug is able to relax skeletal muscles, as well as smooth muscles. All this is due to the effect of the drug Atarax on certain areas of the subcortical zones of the brain.
The drug is absorbed into the gastrointestinal tract, after which it quickly enters the systemic circulation. That is why the effect of taking Atarax is noticeable within 15-30 minutes.
If you take Atarax for a long time, then addiction or dependence on the drug will not develop. This means that he does not have “withdrawal syndrome”.
Pharmacokinetics
Suction
Hydroxyzine is highly absorbed from the gastrointestinal tract. Cmax is observed 2 hours after taking the drug.
After a single dose of the drug in a single dose of 25 mg or 50 mg in adults, the plasma concentration is 30 ng/ml and 70 ng/ml, respectively.
Bioavailability when taken orally and intramuscularly is 80%.
Distribution
Hydroxyzine is more concentrated in tissues (particularly skin) than in plasma. The distribution coefficient is 7-16 l/kg.
Hydroxyzine penetrates the BBB and the placental barrier, concentrating more in the fetal tissues than in the mother's body. Metabolites are found in breast milk.
Metabolism and excretion
Hydroxyzine is metabolized in the liver. The main metabolite (45%) is cetirizine, which is a histamine H1 receptor blocker. The total clearance of hydroxyzine is 13 ml/min/kg. T1/2 in adults is 14 hours. Only 0.8% of hydroxyzine is excreted unchanged in the urine.
Pharmacokinetics in special clinical situations
In children, the total clearance is 4 times less than in adults, T1/2 in children aged 14 years is 11 hours, in children aged 1 year - 4 hours.
In elderly patients, T1/2 is 29 hours, the distribution coefficient is 22.5 l/kg.
In patients with impaired liver function, T1/2 increases to 37 hours, the concentration of metabolites in the blood serum is higher than in young patients with normal liver function. The antihistamine effect can last for 96 hours.
About anxiolytic therapy with hydroxyzine (Atarax)
Practicing doctors of various specialties have long and widely used psychotropic drugs of different classes in the combined treatment of mental disorders of a non-psychotic level, giving constant preference to benzodiazepine tranquilizers from different groups of drugs in this series. As a rule, the choice is made in favor of the most well-known of them, and this choice is mainly justified by empirical ideas about the effectiveness and relative safety of psychopharmacological drugs, the administration of which leads to a fairly rapid, although not always complete and persistent anxiolytic effect. The use of tranquilizers in order to achieve a hypnotic and anti-anxiety effect has become so firmly established in everyday practice [2,13] that drugs of this series have not only long been in the arsenal of therapeutic agents for doctors working with different groups of patients, but are also constantly on everyone’s lips. . At the same time, even doctors with insufficient clinical and therapeutic experience do not bother themselves with doubts or reasoned justification for this or that remedy and do not prescribe the drug by clarifying its properties and nuances of indications or contraindications for this type of therapy. As a recent special study showed [12], 38% of doctors trust only their own experience in using medications, although, as a rule, they do not conduct a serious analysis of the results of their prescriptions. Very rarely (8%) prescriptions or changes in treatment are based on the recommendations of experts (consultants) or the opinions of colleagues (5%), and the published results of studies, both domestic and foreign, judging by the results of a special survey, have practically no significance in the choice therapy. As the experience of joint cooperation between internists and psychiatrists shows, the greatest alertness and rigor in justifying prescriptions is demonstrated by doctors providing assistance in urgent situations, despite the fact that in these cases we are not talking about long courses. On the contrary, in the routine practice of doctors in a polyclinic and general somatic hospital, the ease of prescribing, in particular, benzodiazepine tranquilizers is not overcome by any administrative or resource restrictions, often of a temporary nature. With a general understanding of the complexities of changes in medical ideas, tolerance for the traditional inertia of clinical thinking, and the established views of medical practitioners, such a conservative idea does not meet all the attempts being made to reverse the style of passive perception of old models and views on the treatment of mental disorders of a non-psychotic level [10], especially taking into account development and emergence of new non-benzodiazepine tranquilizers and hypnotics. In recent years, a systematic scientific analysis of the use of benzodiazepine tranquilizers for anxiolytic therapy has been repeatedly undertaken [2,7]. Data on the consumption of benzodiazepines (BD) indicate that they remain the most frequently prescribed psychotropic drugs, although there is also a tendency to lose their leading role in the treatment of neurotic disorders with anxiety and other manifestations [15]. Still, at present, the proportion of patients receiving BD ranges from 52 to 76%, and most often these drugs are prescribed for the correction of dyssomnia disorders and somewhat less often as an anxiolytic agent. From 10 to 15% of the total population in different countries receive a prescription for one or another tranquilizer once a year. Anxiety conditions account for 19.2% of all benzodiazepine tranquilizer prescriptions, and are significantly more common in outpatient therapy than in inpatient settings [2]. According to the results of another study [8], tranquilizers account for 36.3% of all prescriptions in outpatient practice to patients with a depressive disorder identified during a population survey and thus not diagnosed by the attending physician. The fairly rapid achievement of anti-anxiety, primarily sedative, effect, the absence of adverse effects on a number of functional systems of the body and interaction with somatotropic drugs [7] justify the known expectations of doctors and patients, at least at the beginning of treatment. The psychotropic properties of anxiolytics are associated with their effect on the GABAergic neurotransmitter system. Due to the fact that the neurons of this system are morphologically homogeneous in different parts of the central nervous system, tranquilizers can affect most of the functional formations of the brain. In this case, anxiolytics act on areas of the brain with maximum arousal and stimulate the suppression of the activity of most neurons. This explains the relief of anxiety and somatotropic effects (in particular, reduction of vegetative symptoms). Undoubtedly, the positive experience of the widespread use of benzodiazepine tranquilizers is accompanied by the identification of a number of problems associated with the peculiarities of their pharmacological action and the development of known side effects of therapy [6]. The main ones include: – phenomena of hypersedation (daytime sleepiness, decreased level of wakefulness, impaired concentration, complaints of forgetfulness). These manifestations occur in 10% of cases and have a dose-dependent effect; – muscle relaxation (general weakness, muscle weakness) occurs in 1–2% of elderly people, much more often and often leads to falls; – so-called “behavioral toxicity” (mild impairment of cognitive functions and coordination); – “paradoxical reactions” (increased agitation); – mental and physical non-toxicomaniac dependence (can occur with long-term use and be accompanied by phenomena similar to neurotic anxiety when withdrawing from BD). For these reasons, there has been a tendency towards the loss of the dominant position of BD in the treatment of neurotic disorders; the desire to avoid side effects by shortening courses of BD therapy inevitably minimized the therapeutic effect [15]. In connection with the achievements of neuroscience, increasing knowledge about neurochemical processes in the central nervous system and modern trends in the development of drugs that increasingly selectively affect certain neurotransmitter systems, the range of anxiolytic drugs with a narrower spectrum of undesirable effects and more targeted psychotropic activity is expanding [1] . Overcoming the dichotomy of psychiatry and psychosomatic medicine in the last decades of the last century took shape in an intensively developing independent scientific direction, most systematically and comprehensively represented in the achievements of a team that unites researchers from the Department of Borderline Mental Pathology and Psychosomatics of the National Center for Mental Health of the Russian Academy of Medical Sciences and the Department of Psychiatry and Psychosomatics of the Faculty of Physiopathology and Psychosomatics of the Russian Academy of Medical Sciences. THEM. Sechenov under the leadership of Academician of the Russian Academy of Medical Sciences A.B. Smulevich. In accordance with the developed concepts [16,17], the phenomenology of psychosomatic pathology includes: © constitutional anomalies (neuropathic constitution) and mental pathology realized in the somatic sphere; © mental (organo-neurotic) somatized (somatoform) disorders that develop on pathologically altered (somatic) grounds; © mental (psychogenic) disorders provoked by somatic diseases - nosogenic reactions and personality development; © somatic pathology provoked by mental disorders (psychosomatic diseases). The clinical parameters of disorders characteristic of psychosomatic medicine in general are reflected in the most general form by psychocardiology. To date, the scientific and practical results of the joint 15-year collaboration of psychiatrists and cardiologists, recently published in the monograph by Acad. RAMS, prof. A.B. Smulevich and prof. A.L. Syrkin “Psychocardiology” [17]. Psychosomatic relationships in a cardiology clinic, according to the concept of researchers, form a continuum, at one pole of which predominantly mental disorders prevail, and at the other - cardiovascular disorders. The possibility of interpreting neurotic disorders within a wide range is proved, allowing the coexistence of cardioneurosis as an organo-neurotic disorder, on the one hand, with manifestations of other mental disorders, and on the other, with signs of undoubted somatic pathology. This approach is considered as the most promising, allowing to take into account the complexity of pathogenetic relationships, including (along with psychogenic factors) not only mental, but also somatic pathology, which is of independent importance when developing strategies and tactics of therapeutic intervention. Cardioneurotic disorders lead in frequency and account for slightly less than half of all forms of organ neuroses. In the entire sample of patients in general somatic institutions, patients with these manifestations account for 4.7%, while in the hospital - 1.8%, and in the clinic - 15.6%, that is, with a multiple increase in the frequency of cardioneurosis among the outpatient population of patients. The largest proportion of such patients are in therapeutic and cardiology departments (26 and 39%, respectively). Cardioneurotic disorders in a variety of manifestations are much more common in women (66%). The diagnostic criteria for cardioneurosis, developed jointly by cardiologists and psychiatrists, include the following signs: 1) persistent or recurrent symptoms for at least 3 months (unpleasant sensations in the heart area or cardialgia, palpitations, tendency to tachycardia, extrasystole); 2) the connection between the occurrence of symptoms and psychogenic influences or periods of hormonal changes; 3) signs of autonomic dysfunction, lability of heart rate and blood pressure; 4) nonspecific and variable ECG indicators [17]. Among the mental disorders in patients with cardioneurosis, the leading symptoms are anxiety symptoms within the framework of an anxiety-neurotic disorder or anxious depression. The most common are anxiety-phobic disorders, panic attacks and hypochondriacal phobias (65.2, 61.6, 58.0%, respectively). Symptoms of cardioneurosis may be a manifestation of a depressive state within the framework of cyclothymia, the dynamics of a personality disorder or dysthymia. Concomitant somatic pathology is detected in half of patients with cardioneurosis [17]. Among comorbid somatic pathologies, diseases of the cardiovascular system predominate in frequency, usually in the initial stages and with subclinical manifestations. Anxiety states often develop spontaneously, while attacks of angina are provoked, as a rule, by physical activity. A combination of these forms of pathology is possible, as a result of which the clinical symptoms of exacerbation of coronary artery disease appear to be inappropriately more severe in comparison with objectively detected signs of ischemia. Nosogenic reactions in cardiac patients are considered as an independent form of psychopathological disorder. The formation of nosogenies of the hyper- and hyponosognosic type involves: information about the diagnosis, clinical features of somatic disease and comorbid mental pathology, personal and constitutional characteristics, age, gender and social factors. The frequency of nosogenic reactions in inpatients with coronary artery disease is 28.2%, ranking first among other forms of comorbid mental pathology identified in this group of patients. Non-psychotic disorders in patients who have undergone CABG surgery are considered as very special forms of reactions and personality development [14]. The prevalence and severity of anxiety disorders in patients of general somatic, and especially cardiological practice, determines the need for anxiolytic therapy. Special studies have examined the need for the prescription of psychopharmacological agents and indications for this type of treatment in patients in general somatic institutions. In determining the relevant indicators, two calculation methods were used - according to the actual prescription and according to expert assessment of the indications for the use of certain psychotropic drugs [7,8,17]. It was found that they are prescribed to almost half of the patients (49.3%), while in 37.5% they are tranquilizers. On average in a hospital, the prescription of psychotropic drugs is 0.8 drugs per 1 patient (in general therapeutic departments - 1.3, in cardiology departments - 1.2, and in cardiac intensive care departments this figure is even higher). Psychotropic drugs are prescribed by cardiologists in 82% of cases and only in 14% by consultation with a psychiatrist. Among the medications consumed, tranquilizers predominate (62.3%). Expert assessment indicates that more than two thirds of cardiac patients (67.2%) require psychotropic medications. Anxiolytic therapy with tranquilizers is carried out for somatoform disorders, organ neuroses (cardio- and angioneuroses, etc.), psychogenic reactions and the development of nosogenies, with a predominance in the clinical picture of somatized anxiety, phobias, algia, hysteriform and vegetative manifestations and other manifestations of neurotic hypochondria [14, 17]. In combination with antidepressants, tranquilizers are indicated for depressed patients to quickly reduce symptoms of anxiety and sleep disorders. In combined therapy of comorbid somatic and mental pathology of a non-psychotic level, the somatotropic, including cardiotropic, effect of anxiolytics is used [7]. As a result, the proportion of respondents increases significantly (up to 54%). Although benzodiazepine tranquilizers retain their position among the most frequently prescribed drugs in anxiolytic therapy, recently non-benzodiazepine anxiolytics, which lack a number of properties that cause the undesirable effects of tranquilizer therapy, have attracted increasing attention from researchers and doctors. In addition, the search for new medications for the treatment of anxiety disorders remains relevant due to the clinical and pathogenetic diversity of these conditions and the constant need for the development of differentiated therapy with drugs that have the most selective effect on anxiety symptoms. These drugs include hydroxyzine (Atarax). Hydroxyzine is not a benzodiazepine or phenothiazine. In the 60s of the 20th century, a number of clinical studies when prescribing the drug in doses from 100 mg to 400 mg revealed its anxiolytic properties, but only 30 years later the effectiveness of Atarax in generalized anxiety disorder was proven [19,20]. It was found that in terms of the speed of onset of the anti-anxiety effect, hydroxyzine is not inferior to benzodiazepines, increases the duration of the REM sleep phase and eliminates dissomnia disorders, reduces the manifestations of tension and stress, and anxiety symptoms. At the same time, good tolerance of cognitive functions to its action was found, the absence of an amnestic effect and dependence on its use. Thus, the administration of hydroxyzine represents a therapeutic alternative to benzodiazepine tranquilizers in the treatment of anxiety disorders of various origins. Hydroxyzine in its chemical structure is a derivative of diphenylmethane. The pharmacokinetic properties of the drug ensure its rapid absorption from the gastrointestinal tract. The maximum concentration in blood plasma is achieved after 2 hours, in tissues - at a higher level. The drug penetrates the blood-brain barrier and the placenta, accumulating more in fetal tissues than in maternal tissues. Hydroxyzine is metabolized in the liver. Its main metabolite is an H1 blocker. The antihistamine effect occurs within an hour after ingestion. Less than 1% of the drug is excreted unchanged by the kidneys. The half-life depends on the age of the patients (from 7 hours in children to 20 hours in adults and 29 hours in the elderly and elderly). In case of overdose, the biotransformation of hydroxyzine occurs in a different way. In patients with liver disease, the half-life is extended to 37 hours, and the antihistamine effect is extended to 96 hours. The onset of the psychotropic effect of hydroxyzine is detected 5–10 minutes after intramuscular administration and 30–40 minutes after oral administration. The drug also has antispasmodic, sympathicolytic, bronchodilator and antiemetic effects, significantly reduces itching in patients with urticaria, eczema, and dermatitis. Hydroxyzine prevents the development of the pressor effect of adrenaline, the anticonvulsant activity of phenytoin and anticholinesterase drugs, but does not change the effect of atropine, belladonna alkaloids, digitalis, antihypertensive drugs, H2-antihistamines, and weakens the gastrointestinal side effects of theophylline and H2-agonists. Inhibitors of liver enzymes are potentially capable of increasing the concentration of hydroxyzine in the blood. In connection with the indicated properties, the drug is not prescribed simultaneously with MAO inhibitors, and when an overdose for lifting pressure, only norepinephrine is used, but not adrenaline. Hydroxine in ordinary dosages does not cause clinically significant respiratory depression (as opposed to the possibility of such an effect in benzodiazepines). Atarax is produced in three drug forms: in 25 mg tablets, in a solution for injection (only intramuscular!) - in ampoules of 2 ml (in 1 ml of 50 mg), as well as in the form of syrup (0.02%) in the bottles 20 ml with a content of 2 mg of the drug in 1 ml. Thus, the possibility of alternative oral methods of introducing atarax is given [3.16.17]. In psychiatric practice, Atarax is prescribed in doses from 50 mg to 100 mg per day, divided into two or three doses. Sometimes it is possible to increase the dose up to 300 mg per day. The maximum single dose is 200 mg, the maximum daily dose is 300 mg. An elderly patients are prescribed a half dose of the drug. For children, the dose of atarax is calculated by body weight (1-2 mg per kg of weight in several receptions per day). Domestic researchers have studied the effectiveness of anxiolytic therapy with hydroxyzine both in psychiatric and in general social practice. Based on the material of 50 patients (the average age of 42 years) according to the results of 4 -heat treatment with hydroxyzine in various alarming and neurotic disorders, significant reduction of the symptoms of anxiety was noted [4]. In 66% of observations, the results are regarded as excellent and good, unsatisfactory result was obtained only in 10%. The most pronounced decrease in the severity of anxiety (along two alarm scales - Hamilton and Fard) is registered with a generalized alarming disorder, and less distinct - with maladaptation reactions. However, by the end of the therapeutic course, leveling of differences in the level of anxiety between groups of patients with different genesis of anxious symptoms was noted. Significant changes in the state were noted after two weeks of treatment with the initial detection of the sedative effect and the rapid attachment of an anxiolytic effect itself. At the end of the relatively short -term course, the therapeutic effect was preserved. As the most important feature, the absence of phenomena of psychological and physical dependence on the use of hydroxyzine was noted. In somatic practice, the psychotropic activity of hydroxyzine was studied in patients with cardio -European disorders underwent examination and treatment in a cardiological hospital and in a general -power clinic [9]. The routine purpose of thymoanaleptics and tranquilizers was ineffective and was limited to contraindications from the cardiovascular system and age -related restrictions (the average age of patients of 59 years). In a group of 39 patients, by the 14th day of therapy, hydroxyzine turned out to be 36% of responders, and 67% of responders by the 28th day. The response to therapy was higher with the predominance of somatized anxiety in the structure of cardiourosis. Gidoxin discovered compliance with the requirements for anxiolytics during the treatment of anxiety disorders, comorbid cardiovascular diseases. A positive effect on functional disorders by the cardiovascular system (tachycardia, cardialgia, a sensation of heartbeat, and pulsation of blood vessels) was noted. There were no manifestations of the "behavioral toxicity" characteristic of benzodiazepine tranquilizers, and the abolition syndrome. Hydroxine was well tolerated by patients with coronary heart disease, conditions after acute myocardial infarction and did not find negative interaction with the basic therapy of cardiovascular disease. The most important feature of the psychotropic activity of hydroxyzine, in contrast to benzodiazepine tranquilizers, is the absence of a negative effect on cognitive functions [5,19,20]. In a special study [5], the state of cognitive functioning was studied in patients who received hydroxyzine. The dynamic assessment of cognitive functions was carried out using tests of memorization of 10 words, the dough of the numbers, the test of repertoire grilles, the attention test (“flickering”) and iconograms. The results of the study showed that hydroxyzine does not cause inhibition and weakening of memory. On the contrary, test results demonstrated improvement, pace of thinking, improving short -term memory and normalizing important aspects of perception and assessment of reality. It was revealed that the therapeutic activity of hydroxyzine is manifested unequally depending on the characteristics of the cognitive style in the patents, which is associated with the selectivity of the anxiolytic effect of hydroxyzine. The prospects of the use of hydroxyzine are considered in order to prevent chronicity of neurotic conditions with anxious symptoms, as well as an agent with preventive, contributive properties. Hydoxizine finds its application in psychiatry and in a number of other indications, but using its anxiolytic properties. The drug is prescribed as a drug that improves sleep [3]. A comparative study of the effectiveness of modern antidepressants and hydroxyzine in the treatment of anxious and depressive disorders on the material of patients of the general somatic clinic [18] confirmed the anxiolytic properties of the drug, but showed only partial relief of depressive symptoms in hydraulic monotoxizine monotherapy. It is noted that the improvement in the mental state, achieved at the intake of the drug, was also preserved at the end of treatment with hydroxyzine in 25% of patients. The feasibility of the use of hydroxyzine as a means of premedication during electricity therapy (EST) has been proved. Due to the often experienced fear of the procedure, such patients were previously prescribed tranquilizers or neuroleptics in combination with cholinolytics. Meanwhile, it is known that benzodiazepines lower the convulsive readiness of the brain, can cause respiratory holding, which has a negative effect in this type of therapy of mental disorders resistant to psychopharmacotherapy. An hour before the EST intramuscularly 20 patients were administered hydroxyzine at a dose of 100 mg. After 15 minutes, a sedative and transcoving effect came, a feeling of fear, anxiety and a sense of tension disappeared. The premedication of hydroxyzine did not affect the conduct of anesthesia and the nature of the caused convulsive syndrome. There were no complications due to the use of hydroxyzine. The drug is considered as a useful alternative to benzodiazepines for stopping anxiety in anticipation of EST session [11]. The unique features of the anxiolytic action of the atarax, the rapid onset of the therapeutic effect, the lack of muscle relaxation, pronounced sedation and “behavioral toxicity” along with the lack of negative effects on cognitive functions make it possible to recommend the drug to use in the widest circle of anxious disorders in various clinical situations. The ability to avoid side effects of benzodiazepine tranquilizers justifies the prescription of atarax as a drug of choice in cardiourotic disorders of various genesis and other organic neurosis (in particular, in the skin clinic, taking into account the powerful antipruritic effect of the drug). The use of the somatotropic effect of hydroxyzine in relation to the functional disorders of the cardiovascular system substantiates its use in difficult conditions of comorbid somatic pathology. Cautions relate to the simultaneous purpose of antiarrhythmics. Due to the features of pharmacokinetics, the drug is contraindicated in porphyria and is not recommended for use during pregnancy, in childbirth, and breastfeeding. Knowing all the features of psychotropic and somatotropic activity of hydroxyzine (Atarax) along with the accumulation of their own clinical experience and regular familiarization with the results of research are the necessary basis for the rational application of this effective and safe anxiolytic in the practice of psychiatrists and internists. The community of professional goals of clinicians of various specialties in relation to patients whose condition includes comorbid somatic and mental pathology that does not imply an alternative separation as in terms of diagnosis. and in the aspect of therapy, contributes to progress in the understanding of the pathogenesis of somatopsychic and psychosomatic relationships in their natural unity.
Literature 1. Avedisova A.S., Borodin V.I. Adverse events in pharmacotherapy of borderline mental disorders. Psychiatry and Psychopharmacotherapy, 2003, vol. 5, no. 3, pp. 96–100. 2. Avedisova A.S., Yastrebov D.V., Kostycheva E.A. et al. Ibid., 2005, volume 7, no. 2, pp. 63–68. 3. Arana J., Rosenbaum J. Pharmacotherapy of mental disorders. Moscow. Publishing house Binom, 2004, p. 309. 4. Bobrov A.E., Belyanchikova M.A., Gladyshev O.A. et al. The drug atarax in the outpatient treatment of anxiety. Journal neuropathol. and psychiatrist. them. S.S. Korsakova, 1998, volume 98, issue. 2, pp. 31–33. 5. Bobrov A.E., Kulygina M.A., Belyanchikova M.A. et al. The effect of the drug atarax on cognitive functions in the treatment of anxiety disorders. Psychiatry and psychopharmacotherapy, 2000, volume 2, no. 1, pp. 23–28. 6. Borodin V.I. Side effects of tranquilizers and their role in borderline psychiatry. Ibid., 2000, volume 2, no. 3, pp. 72–74. 7. Drobizhev M.Yu. Psychopharmacotherapy in the general somatic network (somatotropic effects, compatibility with somatotropic drugs). Ibid., 2000, volume 2, no. 2, pp. 49 – 52. 8. Drobizhev M.Yu. The practice of using antidepressants in the treatment of depression in psychiatry and the general medical network (review of the results of pharmacoepidemiological studies). Ibid., 2004, volume 6, no. 5, pp. 221–223. 9. Drobizhev M.Yu., Ivanov S.V., Lebedeva O.I. et al. Therapy of cardioneurotic disorders in the general medical network (experience of using atarax). In the book: Anxiety and obsessions. M., 1998, pp. 286–295. 10. Kornetov N.A. Comorbidity of somatic diseases and depressive disorders: overcoming psychosomatic dualism. In the book: X11 Russian National Congress “Man and Medicine”. Current issues in cardiology, neurology and psychiatry. M., 2005, pp. 226–244. 11. Kostitsyn N.V., Ilyin S.A., Tsukarze E.E. et al. About the experience of using hydroxyzine (atarax) as a premedication during ECT. In the book: Materials of the XIth Congress of Psychiatrists of Russia. November 15 – 18, 2005 M., 2005, pp. 273–274. 12. Mosolov S.N. Controversial and little-studied issues of the practical use of antipsychotic pharmacotherapy in patients with schizophrenia (analysis of the results of an interactive survey of doctors). Journal Psychiatry, 2006, No. 3, in press. 13. Pogosova G.V., Romasenko L.V. Diagnosis and treatment of depression in patients with cardiovascular diseases (results of a multicenter prospective study COORDINATE). Psychiatry and psychopharmacotherapy, 2006, volume 8, no. 1, pp. 47–50. 14. Samushiya M.A. Approaches to pharmacotherapy of pathological dynamics of personality disorders at the stage of outpatient rehabilitation after coronary artery bypass surgery. Journal Psychiatry, 2005, no. 2, pp. 20–26. 15. Sergeev I.I. Psychiatry and psychopharmacotherapy, 2003, volume 5, no. 6, pp. 230–235. 16. Smulevich A.B. Depression in somatic and mental illnesses. MIA. Moscow, 2003, pp. 238–240. 17. Smulevich A.B., Syrkin A.L. Psychocardiology. MIA. Moscow, 2005, 778 pp. 18. Chernetsov M.Yu. Comparative effectiveness of treatment of anxiety and depressive disorders with modern antidepressants and the atypical tranquilizer hydroxyzine in patients of the psychotherapeutic office of a city clinic. In the book: Mater. X! At the Congress of Russian Psychiatrists. November 15–18, 2005 M., 2005, pp. 293–294. 19., Recent clinical trials of hydroxyzine in generalized anxiety disorder. Acta psychiat. scand., 1998, 98, Suppl. 393, pp. 102–108/ 20. Hantouche E.–G., Ferreri M. Efficacy of hydroxyzine in generalized anxiety. Psychiatry and Psychopharmacotherapy, 2000, volume 2, 3;, pp. 124–125.
Indications
- adults: for the relief of anxiety, psychomotor agitation, feelings of internal tension, increased irritability in neurological, mental (including generalized anxiety, adaptation disorders) and somatic diseases, chronic alcoholism; withdrawal syndrome in chronic alcoholism, accompanied by psychomotor agitation;
- as a sedative during premedication;
- skin itching (as symptomatic therapy).
Atarax for neuroses and panic attacks
Neuroses are a fairly common diagnosis. This is a reversible neuropsychic disorder, which is provoked by constant stress, chronic fatigue, tension and anxiety. Neuroses are often accompanied by panic attacks. A panic attack is a state of sudden and extremely intense attack of fear or anxiety. Refers to neurotic diseases.
For such conditions, the doctor may prescribe Atarax. The main purpose of this tranquilizer is to calm and relieve anxiety. The product must be used strictly as prescribed by the doctor in the prescribed dosage and regularity. Atarax suppresses the activity of certain areas of the brain, relieving tension and panic attacks.
Contraindications
- porphyria;
- pregnancy;
- period of labor;
- lactation period (breastfeeding);
- hypersensitivity to the components of the drug;
- hypersensitivity to cetirizine and other piperazine derivatives, aminophylline or ethylenediamine.
It is not recommended to prescribe Atarax tablets to patients with hereditary galactose intolerance, as well as impaired absorption of glucose and galactose, because The tablets contain lactose.
The drug should be prescribed with caution for myasthenia gravis, prostatic hyperplasia with clinical manifestations, difficulty urinating, constipation, increased intraocular pressure, dementia, and a tendency to seizures; with a predisposition to the development of arrhythmia; with simultaneous use of drugs that have arrhythmogenic effects; simultaneously with other CNS depressants or anticholinergics (dose reduction required). A reduction in the dose of the drug is required in patients with severe and moderate renal failure, with liver failure, and in elderly patients with decreased glomerular filtration.
Dosage
The drug is taken orally.
For the symptomatic treatment of itching in children aged 12 months to 6 years, the drug is prescribed in a daily dose of 1-2.5 mg/kg body weight in several doses; children over 6 years of age - at a dose of 1-2 mg/kg/day in several doses.
For premedication in children, the drug is prescribed at a dose of 1 mg/kg body weight 1 hour before surgery, and additionally the night before surgery.
For the symptomatic treatment of anxiety, adults are prescribed a dose of 25-100 mg/day in several doses during the day or at night. The average dose is 50 mg/day (12.5 mg in the morning, 12.5 mg in the afternoon and 25 mg at night). If necessary, the dose can be increased to 300 mg/day.
For the symptomatic treatment of itching, the initial dose is 25 mg; if necessary, the dose can be increased 4 times (25 mg 4 times a day).
The maximum single dose should not exceed 200 mg, the maximum daily dose is no more than 300 mg.
In elderly patients, the initial dose should be reduced by 2 times.
Patients with moderate to severe renal insufficiency, as well as hepatic insufficiency, require a dose reduction.
Side effects
Side effects associated with anticholinergic effects: rarely (mainly in elderly patients) - dry mouth, urinary retention, constipation, impaired accommodation.
From the central nervous system: drowsiness, general weakness (especially at the beginning of treatment), headache, dizziness. If weakness and drowsiness do not disappear after a few days from the start of therapy, the dose of the drug must be reduced. Very rarely (with significant overdose) - tremors, convulsions, disorientation.
From the cardiovascular system: arterial hypotension, tachycardia.
From the digestive system: nausea, changes in liver function tests.
Other: increased sweating, allergic reactions, fever, bronchospasm.
When using the drug in recommended doses, no clinically significant respiratory depression was observed. Involuntary motor activity (including very rare cases of tremors and convulsions), disorientation were observed with significant overdose.
Side effects observed when taking Atarax are usually mild, transient and disappear within a few days of starting treatment or after reducing the dose.
Atarax and alcohol
Drinking alcohol is prohibited while taking Atarax medication
During therapy with the drug, drinking alcohol is prohibited, as alcohol enhances the effect of the drug and provokes adverse reactions. That is, the central nervous system is depressed, the state of intoxication increases, blood pressure decreases, and allergic reactions appear. With all this, there is a high risk of severe intoxication of the body, which can lead to death.
Overdose
Symptoms: increased anticholinergic effects, depression or paradoxical stimulation of the central nervous system, nausea, vomiting, involuntary motor activity, hallucinations, impaired consciousness, arrhythmia, arterial hypotension; rarely - tremors, convulsions, disorientation, which occur with a significant overdose.
Treatment: if spontaneous vomiting is absent, it is necessary to induce it artificially or perform gastric lavage. Carry out general measures aimed at maintaining the vital functions of the body, and monitor the patient until the symptoms of intoxication disappear in the next 24 hours.
If it is necessary to obtain a vasopressor effect, norepinephrine or metaramenol is prescribed. Epinephrine should not be used. There is no specific antidote. The use of hemodialysis is ineffective.
Drug interactions
Atarax potentiates the effect of drugs that depress the central nervous system, such as opioid analgesics, barbiturates, tranquilizers, hypnotics, ethanol (combinations require individual selection of drug doses).
Atarax, when used simultaneously, interferes with the pressor effect of epinephrine (adrenaline) and the anticonvulsant activity of phenytoin, and also interferes with the action of betahistine and cholinesterase blockers.
With simultaneous use, Atarax does not affect the activity of atropine, belladonna alkaloids, cardiac glycosides, antihypertensive drugs, histamine H2 receptor blockers.
Co-administration of Atarax with MAO inhibitors and anticholinergics should be avoided.
Hydroxyzine is an inhibitor of the CYP2D6 isoenzyme and, when used in high doses, may cause interactions with CYP2D6 substrates. Since hydroxyzine is metabolized in the liver, an increase in its concentration in the blood can be expected when co-administered with liver enzyme inhibitors.
Analogs of the drug Atarax
In the pharmacy you can find the following analogues of the drug: Hydroxyzine, Phenazepam, Grandaxin, Anvifen.
Analogs of the drug Atarax
Remember that the prescription of an analogue or replacement of one drug with another is made exclusively by the attending physician, who can correlate the nature of the disease, the desired effect of taking the drug, contraindications, adverse reactions and dosage.
Atarax is sometimes compared to Phenibut. But this is not entirely true.
Atarax or Phenibut?
Phenibut is a nootropic drug that improves cognitive abilities and has a mild tranquilizing effect. This drug effectively relieves anxiety, psycho-emotional stress, and improves sleep. But Atarax is a tranquilizer, most often used to relieve itching, reduce anxiety and psychomotor agitation.
special instructions
If allergy tests are necessary, Atarax should be discontinued 5 days before the test.
Patients taking Atarax should avoid drinking alcohol.
Impact on the ability to drive vehicles and operate machinery
Patients taking Atarax, if necessary to drive a car or operate machinery, should be warned that the drug may affect concentration and the speed of psychomotor reactions.
