Aleval, 50 mg, film-coated tablets, 28 pcs.

Aleval, 50 mg, film-coated tablets, 28 pcs.

Sertraline should not be co-administered with an MAOI, or within 14 days of stopping treatment with an MAOI. Similarly, after discontinuation of sertraline, no MAOIs are prescribed for 14 days.

Serotonin syndrome and neuroleptic malignant syndrome

When using selective serotonin reuptake inhibitors (SSRIs), cases of the development of serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) have been described, the risk of which increases when combining SSRIs with other serotonergic drugs (including triptans), as well as drugs that affect metabolism serotonin (including monoamine oxidase inhibitors), antipsychotics and other dopamine receptor antagonists. Manifestations of SS may include changes in mental status (in particular, agitation, hallucinations, coma), autonomic instability (tachycardia, blood pressure fluctuations, hyperthermia), changes in neuromuscular transmission (hyperreflexia, incoordination) and/or gastrointestinal disorders (nausea, vomiting and diarrhea). Some manifestations of SS, including hyperthermia, muscle rigidity, autonomic instability with the possibility of rapid fluctuations in vital signs, and changes in mental status, may resemble symptoms that develop in NMS.

Other serotonergic drugs - Caution should be exercised when sertraline is co-administered with other drugs that enhance serotonergic neurotransmission, such as tryptophan, fenfluramine or 5-HT agonists. Such co-administration should be avoided whenever possible, given the potential for pharmacodynamic interactions.

Switching from other selective serotonin reuptake inhibitors (SSRIs), antidepressants, or medications used for OCD.

The experience of clinical studies aimed at determining the optimal time required to transfer patients from taking other antidepressants and drugs used for OCD to sertraline is limited. Caution must be used when switching, especially from long-acting drugs such as fluoxetine. The required interval between stopping one selective serotonin reuptake inhibitor and starting another similar drug has not been established.

It should be noted that there is no sufficient experience with the use of sertraline in patients undergoing electroconvulsive therapy. The possible success or risk of this combination treatment has not been studied.

There is no experience with the use of sertraline in patients with seizure disorders, so its use should be avoided in patients with unstable epilepsy, and patients with controlled epilepsy should be carefully monitored during treatment. If seizures occur, the drug should be discontinued.

Patients with depression are at risk for suicide attempts. This danger persists until remission develops. Therefore, from the start of treatment until the optimal clinical effect is achieved, patients should be under constant medical supervision.

Activation of manic disorders. During clinical studies prior to the marketing of sertraline, manic episodes were observed in approximately 0.4% of patients taking sertraline. Cases of activation of manic disorders have also been described in a small proportion of patients with manic-depressive psychosis who received other antidepressants or drugs used for OCD.

Use for liver failure. Sertraline is actively biotransformed in the liver. According to a pharmacokinetic study, with repeated administration of sertraline in patients with stable mild liver cirrhosis, an increase in the half-life of the drug and an almost threefold increase in AUC (area under the concentration-time curve) and maximum concentration of the drug were observed compared with those in healthy people. There were no significant differences in plasma protein binding between the two groups. Sertraline should be used with caution in patients with liver disease. When prescribing the drug to a patient with impaired liver function, it is necessary to discuss the advisability of reducing the dose or increasing the interval between taking the drug.

Use for renal failure. Sertraline undergoes active biotransformation, so it is excreted unchanged in the urine in small quantities. In patients with mild to moderate renal failure (creatinine clearance 30–60 ml/min) and patients with moderate or severe renal failure (creatinine clearance 10–29 ml/min or less), pharmacokinetic parameters (AUC0-24 and Cmax) of sertraline with repeated administration did not differ significantly from the control group. In all groups, the half-life of the drug was the same, and there were no differences in plasma protein binding. The results of this study suggest that, as expected given the low renal excretion of sertraline, no dosage adjustment is required based on the severity of renal impairment.

Pathological bleeding/hemorrhage. It is recommended to exercise caution when prescribing selective serotonin reuptake inhibitors in combination with drugs that have an established ability to alter platelet function, as well as in patients with a history of hemorrhagic diseases.

Hyponatremia. Transient hyponatremia may occur during treatment with sertraline. This develops more often in older patients, as well as when taking diuretics or a number of other drugs. This side effect is associated with the syndrome of inappropriate secretion of antidiuretic hormone. If symptomatic hyponatremia develops, sertraline should be discontinued and adequate therapy aimed at correcting the concentration of sodium in the blood should be prescribed. Signs and symptoms of hyponatremia include headache, difficulty concentrating, memory problems, weakness and unsteadiness, which can lead to falls. In more severe cases, hallucinations, fainting, seizures, coma, respiratory arrest, and death may occur.

Use in children. In children, adolescents and young adults (under 24 years of age) with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and suicidal behavior. Therefore, when prescribing Aleval or any other antidepressants in children, adolescents and young adults (under 24 years of age), the risk of suicide should be weighed against the benefits of their use. In short-term studies, the risk of suicide did not increase in people over 24 years of age, but it decreased slightly in people over 65 years of age. Any depressive disorder itself increases the risk of suicide. Therefore, during treatment with antidepressants, all patients should be monitored for early detection of disturbances or changes in behavior, as well as suicidality.

Impact on the ability to drive vehicles and operate machinery

During treatment with sertraline, driving vehicles, special equipment or engaging in activities associated with increased risk is not recommended.

Differences between biorevitalization and mesotherapy -

Mesotherapy and biorevitalization of the face and neck are very similar procedures and are performed by the same specialists - mesotherapists. So how are they different? When it comes to intensive rejuvenation of the face and neck (using high concentrations of active ingredients), the term “biorevitalization” is used. Mesotherapy uses lower concentrations of active components, and this procedure can be performed not only on the face, but also on the body.

Thus, when it comes to the correction of cellulite or local fat deposits on the body, or procedures are carried out to improve the condition of the hair and scalp, or to improve the condition of the skin of the face and neck (but with low dosages of active substances) - this is called the term “ mesotherapy". If intensive rejuvenation and lifting of the skin of the face/neck is required, then drugs with high concentrations of active substances are used, and in this case the terms “biorevitalization” or “bioreparation” are used.

For example, the concentration of hyaluronic acid (HA) in mesopreparations is usually only from 0.3-0.5%, which corresponds to 3-5 mg/ml, and in biorevitalization products it is usually from 1.5 to 2.0% (= 15-20 mg/ml). Accordingly, in the second case, the saturation of the dermis with moisture will be much more intense, and this will lead to a more noticeable lifting effect. It is also worth noting that low molecular weight HA (with a molecular weight of about 800 kDa) is usually used in mesotherapy, and high molecular weight HA (from 1800 to 3000 kDa) is used in biorevitalization procedures.

An important point is that mesopreparations are made on a water or sol basis (sol is a liquid gel), and biorevitalizants are produced in the form of viscous gels. This greatly affects the time of drug deposition in tissues. Those. if in the first case, the drugs quickly spread in the tissues and are quickly eliminated from them, then in the second case, a drug depot is created in the tissues (at the site of each injection) for a period of approximately 2-3 weeks. That is why it is customary to inject mesopreparations once a week, and biorevitalizants - usually once every 2-3 weeks. Such differences between mesopreparations and biorevitalizants affect not only the frequency, but also the required number of procedures.

Non-injection biorevitalization: reviews

The administration of medicinal substances can also be carried out using a non-injection method - by pulsed iontophoresis. The fact is that the permeability of the skin for molecules of large molecular weight (hyaluronic acid, amino acids, vitamins) is minimal, and in order to somehow increase it, pulsed discharges of weak electric current are used. A biorevitalizant solution is first applied to the skin. The procedure lasts about 45 minutes. The course consists of 6-8 procedures over 2 weeks. A repeat course is carried out after half a year.

Reviews for non-injection biorevitalization are mostly negative, which is due to the low efficiency of the method and the inability to introduce therapeutically effective concentrations of active substances into the skin. On the other hand, this technique reduces the risk of developing an infection and also eliminates the possibility of scars appearing at the site of skin punctures with a needle, which happens in patients with a tendency to ankylosis.

Before the first procedure, a microdermabrasion session must be performed, or one of the special enzyme masks must be applied. This will remove superficial dead skin cells and increase skin permeability to medicinal components. We hope that our article on the topic: Biorevitalization of the face before and after, effect, reviews – turned out to be useful to you!

Sources:

1. Add. professional

, 2. Personal experience of clinical application, 3. National Library of Medicine (USA), 4. The National Center for Biotechnology Information (USA), 5. “Aesthetic mesotherapy” (Tochinova N.A.).

Biorevitalization technique –

There are several injection techniques - nappage, papules, tubercles, as well as the linear-retrograde technique.
If all of them are used in mesotherapy, then when carrying out biorevitalization - everything except the “nappage” technique, which is associated with the inability of this technique to achieve deposition of the drug in the dermis. Before the biorevitalization procedure, superficial anesthesia of the skin is required using gels and creams containing from 5 to 12% of the anesthetic lidocaine. The cream is applied to the face for 15-20 minutes (under the film).

Papules (superficial or medium) –

This technique involves injections into the dermal layer of the skin, in such a way that at the site of each injection a “papule” will form, which looks like an elevation above the surface of the skin (Fig. 5). The size of the papules will depend on the volume of drug removed at each injection point. Papules can be small (micropapules), having a diameter of 1-2 mm, in which case injections are performed into the upper layers of the dermis. Each injection produces a volume of the drug of about 0.01-0.02 ml, the distance between papules is about 0.3 to 0.5 cm. Micropapules are usually made in areas with thin skin, for example, in the periorbital zone.

In areas with dense skin, papules are made of medium size - 3-4 mm in diameter, injecting 0.03-0.04 ml of the drug with each injection. The needle will penetrate into slightly deeper layers of the dermis, and the distance between papules should be about 1.5 cm. It should be noted that the larger the papules, the slower they will resolve. Usually papules disappear within 3 days, and in rare cases – up to 5-7 days. But if the doctor made medium-sized papules using a drug with partially stabilized hyaluronic acid (doctor’s mistake), then we can sympathize with you, because they will dissolve in about 3 weeks.

Superficial papules: video

Technique “tubercles” –

This technique has a big advantage, because... after it, the skin at the injection sites is practically invisible, and only traces of needle injections are visible. If with the “papules” technique injections are made with a needle placed at an angle of 15 degrees to the surface of the skin, and thus a drug depot is created in the upper or middle layers of the dermis, then with the “tubercles” technique - injections are made with a 4 mm needle at 45 degrees in the skin surface . Thus, the drug depot is created in the deeper layers of the dermis (at a depth of about 3 mm).

The distance between injections is 1.0 on the face, on the neck it is usually 1.5 cm. The disadvantage of this technique is that it is more difficult to control the volume of drug removal at each point.

Linear-retrograde technique –

This technique came from contouring, and most mesotherapists do not like it, because... technically it is the most difficult. However, it is also the most effective, and the same technique is also used for bioreinforcement of the face. If for previous techniques 4 mm needles are used, here they are 12-13 mm long. After injection, the needle is given a horizontal position, and it advances in the middle layers of the dermis parallel to the surface of the skin for its entire length. The drug is administered by retrograde movement of the needle backwards.

This technique is successfully used in the middle and lower thirds of the face - in the area of ​​the cheekbones, cheeks, chin, corners of the mouth, facial contours (strictly along massage lines), in the neck area, and also around the eyes. It allows you to reduce the number of needle injections several times, thereby reducing the rehabilitation period. Advancing the needle 13 mm into the dermis leads to more pronounced subdermal damage (than when using 4 mm needles), which means tissue regeneration will be more active. This means that collagen synthesis will increase not only due to the introduction of active substances, but also in response to damage.

Linear-retrograde technique: video

Important: the biorevitalization procedure itself will take about 15-20 minutes. After the procedure, the skin is treated with a chlorhexidine solution. However, the indicated time does not take into account the lymphatic drainage vascular injection of the face and collar area, as well as the 15-20 minutes required to apply a special mask to the face, which will help minimize the visibility of needle injection marks and relieve redness.

Facial biorevitalization: before and after photos, effect

You will have great difficulty finding real photos before and after biorevitalization, because... Cosmetology clinics post only cases of the most successful procedures, or simply take photographs of patients after hardware rejuvenation techniques, passing them off as biorevitalization procedures. The following 2 photos are from an independent clinical study. Each patient was administered 2.0 ml of Restylane Vital during 1 procedure. The course of treatment consisted of three procedures done with an interval of 4 weeks.

Biorevitalization: before and after photos (course with HA mono-drug)

As you can see: the effect of therapy with a mono-drug of hyaluronic acid in patients aged 35 and 46 years is either minimal or not noticeable at all. As we said above, patients over 30 years old need other drugs containing vitamins, amino acids, microminerals, antioxidants, and 40-45+ also nucleotides, peptides and growth factors. What do you think: will patient reviews for such facial biorevitalization be positive? It is unlikely that cosmetology clinics will post such photographs.

Example No. 2 –

The following photos were taken by cosmetologist Victoria Petrovskaya. The patient underwent a course of 4 procedures, once every 2 weeks. At the beginning of each procedure, lymphatic drainage vascular injection was first performed with the drug “GAG Complex DVL Capyl formula”, then “Hydro Line P-Anti-wrinkles formula” - for the periorbital area, and “Hydro Line Peptide formula” - for all other areas of the face. Photos were taken after the second procedure. Those. Each procedure used the same 3-drug regimen.

Example No. 3 –

The following photos were taken by cosmetologist A.Yu. Voropaeva. The patient underwent a course of 4 procedures, once every 10-14 days. At the beginning of each procedure, lymphatic drainage vascular injection was first performed with the drug “GAG Complex DVL Capyl formula”. Then, different biorevitalizants were used in each procedure -

1. 
   "Nucleospire Revitalizing Complex A"

2. "Nucleospire DNA-RNA 2%",
3. "Nucleospire Revitalizing Complex A"
4. "Nucleospire DNA-RNA 2%".

Example No. 4 –

The following photos were taken by cosmetologist Irina Pyagai. The patient underwent a course of 8 procedures, once every 10 days. At the beginning of each procedure, lymphatic drainage vascular injection was first performed with the drug “GAG Complex DVL Capyl formula”. Different biorevitalizants were used in different procedures -

1. 
   "Nucleospire Revitalizing Complex A"

2. "Nucleospire Revitalizing Complex B formula",
3. "Nucleospire DNA-RNA 2%",
4. "Nucleospire Revitalizing Complex B formula",
5. "Nucleospire DNA-RNA 2%",
6. 7. 8. procedures – “Nucleospire DNA-RNA 1% DM Peptide formula”.

Biorevitalization: price for 1 procedure

How much biorevitalization of the face and neck costs will depend on the cost of the chosen drug, as well as the amount of the clinic’s markup. In most clinics the markup is +150-200% of the cost of the drug. Private cosmetologists usually have a markup of +100%. For the biorevitalization technique, the cost of 1 procedure in mid-price clinics will be (for 2022) –

The purchase price for cosmetology clinics for Restylane Vital and Vital Light is about 5,000 rubles (for 1.0 ml), for Juvederm Hydrate – 4,000 rubles (for 1.0 ml), for Aquashine – about 3,500 rubles (for 2.0 ml) etc. But you must understand that the cost of the service includes anesthesia, consumables, and the cost of a special regenerating mask, which must be applied to the face after the procedure. Don’t forget about office rent, employee salaries, taxes, reimbursement of specialist training costs, etc.

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