Paroxetine pills 20mg 30pcs

Composition

Active ingredient:

paroxetine hydrochloride hemihydrate – 22.77 mg, in terms of paroxetine-20.00 mg.

Excipients: calcium hydrophosphate dihydrate-209.73 mg; microcrystalline cellulose-60.00 mg; sodium carboxymethyl starch-3.00 mg; colloidal silicon dioxide-1.50 mg; magnesium stearate-3.00 mg.

Shell composition: hypromellose-4.54 mg; macrogol-4000-1.06 mg; titanium dioxide-2.40 mg

Pharmacological action

Pharmacotherapeutic group: antidepressant. ATX Code: N06AB05 PHARMACOLOGICAL PROPERTIESPHARMACODYNAMICMECHANISM of action Paroxetine is a potent and selective 5-hydroxytryptamine (5-HT, serotonin) reuptake inhibitor. It is generally believed that its antidepressant activity and effectiveness in the treatment of obsessive-compulsive (OCD) and panic disorder is due to a specific inhibition of serotonin reuptake in brain neurons. Paroxetine differs in its chemical structure from tricyclic, tetracyclic and other known antidepressants. Paroxetine has a weak affinity for muscarinic cholinergic receptors, and animal studies have shown that it has only weak anticholinergic properties. In accordance with the selective action of paroxetine, in vitro studies have shown that it, unlike tricyclic antidepressants, has a weak affinity for α1 -, α2 – and β-adrenergic receptors, as well as for dopamine (D2),5-HT1-like,5 HT2 – and histamine (H1) receptors. This lack of interaction with postsynaptic receptors in vitro is confirmed by the results of in vivo studies that demonstrated the lack of paroxetine’s ability to depress the central nervous system (CNS) and cause arterial hypotension. Pharmacodynamic effects

Paroxetine does not interfere with psychomotor functions and does not enhance the depressing effect of ethanol on the central nervous system. Like other selective serotonin reuptake inhibitors, paroxetine causes symptoms of over-stimulation of 5-HT receptors when administered to animals that have previously received monoamine oxidase (MAO) inhibitors or tryptophan. Studies of EEG behavior and changes have shown that paroxetine produces weak activating effects at doses higher than those required to inhibit serotonin reuptake. By its nature, its activating properties are not “amphetamine-like”.

Animal studies have shown that paroxetine does not affect the cardiovascular system. In healthy individuals, paroxetine does not cause clinically significant changes in blood pressure, heart rate, or ECG.

Studies have shown that, unlike antidepressants that inhibit norepinephrine reuptake, paroxetine has much less ability to inhibit the antihypertensive effects of guanethidine.

Pharmacokinetics

Absorption rate

After oral use, paroxetine is well absorbed and undergoes a “first pass” metabolism. Due to first-pass metabolism, less paroxetine enters the systemic circulation than is absorbed from the gastrointestinal tract. As the amount of paroxetine in the body increases with a single large dose or with repeated use of conventional doses, partial saturation of the “first pass” metabolic pathway occurs and the clearance of paroxetine from plasma decreases. This leads to a disproportionate increase in plasma concentrations of paroxetine. Therefore, its pharmacokinetic parameters are not stable, which results in nonlinear kinetics. It should be noted, however, that non-linearity is usually poorly expressed and is observed only in those patients who have low plasma levels of paroxetine against the background of taking low doses of the drug. Stable plasma concentrations are achieved 7-14 days after the start of treatment with paroxetine, its pharmacokinetic parameters are most likely not changed during long-term therapy. Distribution Paroxetine is widely distributed in tissues, and pharmacokinetic calculations show that only 1% of the total amount of paroxetine present in the body remains in plasma. At therapeutic concentrations, approximately 95% of plasma paroxetine is bound to proteins. No correlation was found between plasma concentrations of paroxetine and its clinical effect (i. e., with adverse reactions and efficacy). It was found that paroxetine in small amounts penetrates into the breast milk of women, as well as into the embryos and fetuses of laboratory animals. Metabolism The main metabolites of paroxetine are polar and conjugated oxidation and methylation products that are easily eliminated from the body. Given the relative lack of pharmacological activity of these metabolites, it can be argued that they do not affect the therapeutic effects of paroxetine. Metabolism does not impair the ability of paroxetine to selectively inhibit serotonin reuptake. Elimination in the urine as unchanged paroxetine, less than 2% of the dose is excreted, while the excretion of metabolites reaches 64% of the dose. About 36% of the dose is excreted in the faeces, probably entering it with bile; fecal excretion of unchanged paroxetine is less than 1% of the dose. Thus, paroxetine is eliminated almost entirely through metabolism. The excretion of metabolites is biphasic: first it is the result of first-pass metabolism, then it is controlled by systemic elimination of paroxetine. The elimination half-life of paroxetine varies, but is usually about 1 day (16-24 hours).

Indications

Depression

Depression of all types, including reactive and severe depression, as well as depression accompanied by anxiety.

In the treatment of depressive disorders, paroxetine has about the same effectiveness as tricyclic antidepressants. There is evidence that paroxetine may provide good results in patients in whom standard antidepressant therapy has been ineffective.

Taking paroxetine in the morning does not adversely affect the quality and duration of sleep. In addition, as the effect of paroxetine treatment becomes apparent, sleep may improve.

When using short-acting sleeping pills in combination with antidepressants, no additional side effects occurred. In the first few weeks of therapy, paroxetine effectively reduces symptoms of depression and suicidal thoughts.

The results of studies in which patients took paroxetine for up to 1 year showed that the drug effectively prevents relapses of depression.

Obsessive-compulsive disorder

Paroxetine is effective in the treatment of obsessive-compulsive disorder (OCD), including as a means of maintenance and preventive therapy. In addition, paroxetine effectively prevented relapses of OCD.

Panic disorder

Paroxetine is effective in the treatment of panic disorder with and without agoraphobia, including as a means of maintenance and preventive therapy.

It was found that in the treatment of panic disorder, the combination of paroxetine and cognitive behavioral therapy is significantly more effective than the isolated use of cognitive behavioral therapy.

In addition, paroxetine effectively prevented relapses of panic disorder.

Social phobia

Paroxetine is an effective treatment for social phobia, including long-term maintenance and preventive therapy.

Generalized anxiety disorder

Paroxetine is effective for generalized anxiety disorder, including as a long-term maintenance and preventive therapy. Paroxetine is also effective in preventing relapses in this disorder.

Post-traumatic stress disorder.

Paroxetine is effective in the treatment of post-traumatic stress disorder.

Use during pregnancy and lactation

fertility According to animal studies, paroxetine may affect the quality characteristics of sperm. Data from in vitro studies of human material may indicate some effect on the quality characteristics of semen, but reports of human use of certain SSRI inhibitor drugs (including paroxetine) have shown that the effect on the quality characteristics of sperm has been reversible. To date, no effect on human fertility has been observed.

Pregnancy studies in animals did not reveal teratogenic or selective embryotoxic activity in paroxetine. Epidemiological studies of pregnancy outcomes when taking antidepressants in the first trimester revealed an increased risk of congenital anomalies, in particular, of the cardiovascular system (for example, defects in the interventricular and atrial septum) associated with paroxetine use. According to available data, the incidence of cardiovascular defects with paroxetine during pregnancy is approximately 1/50, while the expected occurrence of such defects in the general population is approximately 1/100 of newborns. When prescribing paroxetine, it is necessary to consider the possibility of alternative treatment for pregnant women and women planning pregnancy.

Paroxetine should only be prescribed if its potential benefit outweighs the potential risk.If a decision is made to discontinue treatment with paroxetine during pregnancy, the doctor should follow the recommendations of the sections “Dosage and use” — “Withdrawal of paroxetine” and “Special instructions” — “Symptoms that may occur when stopping treatment with paroxetine in adults”. There have been reports of preterm labor in women who received paroxetine or other SSRI medications during pregnancy, but a causal relationship between these medications and preterm labor has not been established. It is necessary to monitor the health status of those newborns whose mothers took paroxetine in late pregnancy, since there are reports of complications in newborns exposed to paroxetine or other SSRI drugs in the third trimester of pregnancy. However, the causal relationship between these complications and this drug therapy has not been confirmed. The clinical complications described included: respiratory distress syndrome, cyanosis, apnea, convulsive seizures, temperature instability, difficulty feeding, vomiting, hypoglycemia, hypertension, hypotension, hyperreflexia, tremor, increased neuro-reflex excitability syndrome, irritability, lethargy, constant crying and drowsiness. In some reports, the symptoms were described as neonatal manifestations of withdrawal syndrome. In most cases, the described complications occurred immediately after delivery or shortly after it ( According to epidemiological studies, taking SSRIs (including paroxetine) during pregnancy, especially in the late stages, is associated with an increased risk of developing persistent pulmonary hypertension in newborns.

The increased risk is observed in children born to mothers who took SSRI drugs in late pregnancy, and is 4-5 times higher than that observed in the general population (1-2 per 1000 pregnancies). The results of animal studies showed reproductive toxicity of the drug, but no direct adverse effects on pregnancy, embryo and fetus development, childbirth or postnatal development were shown.

During breast-feeding, small amounts of paroxetine enter breast milk. In published studies in breastfed infants, paroxetine concentrations were undetectable (<2 ng / ml) or very low (In children, no signs of exposure to the drug were detected. However, paroxetine should not be taken during breastfeeding unless its benefits to the mother outweigh the potential risks to the baby.

Contraindications

• hypersensitivity to paroxetine and any other component of the drug;
• paroxetine is contraindicated in combination with monoamine oxidase inhibitors (MAOIs). In exceptional cases, linezolid (an antibiotic that is a reversible non-selective MAOI) can be combined with paroxetine, provided that acceptable alternatives to treatment with linezolid are not available, and the potential benefits of linezolid use outweigh the risks of serotonin syndrome or neuroleptic malignant syndrome, as a reaction in a particular patient.

Equipment for close monitoring of serotonin syndrome symptoms and blood pressure monitoring should be available. Treatment with paroxetine is allowed:

– 2 weeks after discontinuation of treatment with an irreversible MAOI or

through, at least 24 hours after cessation of treatment reversible MAOI (e. g.

moclobemide, linezolid, methylthionine chloride (methylene blue)),

– must pass at least 1 week between discontinuation of paroxetine and starting therapy

with any MAOI;

combined use with thioridazine. Paroxetine should not be used in combination with thioridazine because, as with other drugs that inhibit the activity of the hepatic isoenzyme CYP2D6, paroxetine may increase the concentration of thioridazine plasma, which can lead to prolongation of the QTc interval and associated ventricular arrhythmias type “pirouette”, a potentially life-threatening, and sudden death;

concomitant use of pimozide;

use in children and adolescents under 18 years of age. Controlled clinical trials of paroxetine in the treatment of depression in children and adolescents have not proven its effectiveness, so the drug is not indicated for the treatment of this age group. The safety and efficacy of paroxetine have not been studied in younger patients (under 7 years of age).

Side effects

The frequency and intensity of some of the following adverse reactions to paroxetine may decrease with continued treatment, and such reactions usually do not require discontinuation of the drug. The adverse reactions listed below are listed according to the lesion of organs and organ systems and frequency of occurrence.

The frequency of occurrence is defined as follows: very common (≥1/10), common (≥1/100, ≥1/10), uncommon (≥1/1000, ≥1/100), rare (≥1/10000, ≥1/1000), very rare (≥1/10000), including isolated cases, and the frequency is unknown. The incidence of frequent and infrequent adverse reactions was determined based on generalized data on the safety of the drug in more than 8000 patients who participated in clinical trials, it was calculated by the difference between the frequency of adverse reactions in the paroxetine group and in the placebo group. The occurrence of rare and very rare adverse reactions was determined based on post-marketing data, and it concerns the frequency of reports of such reactions rather than the true frequency of the reactions themselves.

From the hematopoietic system: infrequently-abnormal bleeding, mainly hemorrhage in the skin and mucous membranes (most often – bruising); very rarely – thrombocytopenia.

Immune system disorders: very rare – allergic reactions (including anaphylactoid reactions and angioedema).

From the endocrine system: very rarely – syndrome of impaired secretion of antidiuretic hormone. Metabolic and nutritional disorders: often-decreased appetite, increased cholesterol concentration; rarely-hyponatremia. Hyponatremia occurs mainly in elderly patients and may be caused by a syndrome of impaired secretion of antidiuretic hormone.

Psychiatric disorders: often-drowsiness, insomnia, restlessness, unusual dreams (including nightmares); infrequently-confusion, hallucinations; rarely-manic reactions, anxiety, depersonalization, panic attacks, akathisia; frequency unknown – suicidal thoughts, suicidal behavior.

Cases of suicidal thoughts and suicidal behavior have been reported during treatment with paroxetine or early after discontinuation of treatment. These symptoms may also be caused by the disease itself.

From the nervous system: often – dizziness, tremor, headache, impaired concentration; infrequently-extrapyramidal disorders; rarely-convulsions, restless legs syndrome; very rarely-serotonin syndrome (symptoms may include agitation, confusion, increased sweating, hallucinations, hyperreflexia, myoclonus, tachycardia with tremors and tremor). Extrapyramidal symptoms, including orofacial dystonia, have been reported infrequently in patients with motor impairment or who have been treated with antipsychotics.

From the side of the organ of vision: often-blurred vision; infrequently-mydriasis; very rarely-acute glaucoma.

Hearing and balance disorders: frequency unknown-tinnitus.

From the cardiovascular system: infrequently-sinus tachycardia, postural hypotension, short-term increase and decrease in blood pressure. Short-term increases and decreases in blood pressure have been reported after paroxetine treatment, usually in patients with prior hypertension or anxiety; rarely, bradycardia.

From the respiratory system: often – yawning.

From the gastrointestinal tract: very often-nausea; often-constipation, diarrhea, vomiting, dry mouth; very rarely-gastrointestinal bleeding.

From the liver and biliary tract: rarely-increased activity of liver enzymes; very rarely-hepatitis, sometimes accompanied by jaundice and / or liver failure.

Post-marketing reports of adverse liver reactions (such as hepatitis, sometimes accompanied by jaundice and / or liver failure) are very rare. The question of whether to discontinue treatment with paroxetine should be addressed in cases where there is a long-term increase in liver function tests.

From the skin and subcutaneous tissues: often-increased sweating; infrequently-skin rashes, pruritus; very rarely-photosensitivity reactions, severe skin reactions (including erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis), urticaria.

From the urinary system: infrequently-urinary retention, urinary incontinence.

From the reproductive system and mammary glands: very often – sexual dysfunction; rarely-hyperprolactinemia, galactorrhea, menstrual disorders (including menorrhagia, metrorrhagia and amenorrhea); very rarely – priapism.

From the musculoskeletal system: rarely-artalgia, myalgia. Epidemiological studies, mainly conducted in patients aged 50 years and older, have shown an increased risk of bone fractures in patients receiving SSRIs and tricyclic antidepressants. The mechanism leading to this risk is unknown.

Other: often-asthenia, weight gain; very rarely-peripheral edema.

Symptoms that occur when paroxetine treatment is discontinued: often – dizziness, sensory disturbances, sleep disturbances, anxiety, headache; infrequently-agitation, nausea, tremor, confusion, increased sweating, diarrhea, irritability.

Abrupt discontinuation of the drug causes withdrawal symptoms. As with the withdrawal of many psychotropic medications, discontinuation of paroxetine treatment (especially abrupt) can cause symptoms such as dizziness, sensory disturbances (including paresthesia, electric shock and tinnitus), sleep disturbances (including vivid dreams), agitation or anxiety, nausea, headache, tremor, confusion, diarrhea, increased sweating, palpitation, emotional lability, irritability, visual disturbances. In most patients, these symptoms are mild to moderate and resolve spontaneously. No group of patients is known to be at an increased risk of such symptoms; therefore, if treatment with paroxetine is no longer necessary, the dose should be reduced slowly until the drug is completely discontinued.

Interaction

Serotonergic drugs

The use of paroxetine, as well as other SSRI drugs, simultaneously with serotonergic drugs (including L-tryptophan, triptans, tramadol, SSRI drugs, fentanyl, lithium and herbal products containing St. John’s wort) may cause effects associated with 5-HT (serotonin syndrome), caution should be exercised and careful clinical monitoring should be carried out.

Concomitant use of paroxetine with MAO inhibitors (including linezolid, an antibiotic that transforms into a non-selective MAO inhibitor, and methylthioninium chloride (methylene blue)) contraindicated.

Pimozide

In a study of the possibility of co-use of paroxetine and pimozide in a single low dose (2 mg), an increase in pimozide levels was recorded. This fact is explained by the well-known property of paroxetine to inhibit the CYP2D6 system. Due to the narrow therapeutic index of pimozide and its known ability to prolong the QT interval, the simultaneous use of pimozide and paroxetine is contraindicated.

Enzymes involved in drug metabolism

The metabolism and pharmacokinetics of paroxetine may change under the influence of induction or inhibition of enzymes that are involved in drug metabolism.

When using paroxetine concomitantly with inhibitors of enzymes involved in drug metabolism, the feasibility of using a paroxetine dose that is in the lower part of the therapeutic dose range should be evaluated. The initial dose of paroxetine does not need to be adjusted if it is used simultaneously with a drug that is a known inducer of enzymes involved in drug metabolism (for example, carbamazepine, rifampicin, phenobarbital, phenytoin). Any subsequent dose adjustment of paroxetine should be determined by its clinical effects (tolerability and efficacy).

Fosamprenavir/ritonavir

Concomitant use of fosamprenavir / ritonavir with paroxetine resulted in a significant decrease in paroxetine plasma concentrations. Plasma concentrations of fosamprenavir/ritonavir when co-administered with paroxetine were similar to control values from other studies, which indicates that there is no significant effect of paroxetine on the metabolism of fosamprenavir/ritonavir. There are no data on the effect of long-term co-use of paroxetine with fosamprenavir/ritonavir. Any subsequent dose adjustment of paroxetine should be determined by its clinical effect (tolerability and efficacy).

Procyclidine

Daily intake of paroxetine significantly increases the concentration of procyclidine in the blood plasma. If anticholinergic effects occur, the dose of procyclidine should be reduced.

Anticonvulsant medications

Concomitant use of paroxetine and anticonvulsants (carbamazepine, phenytoin, sodium valproate) does not affect their pharmacokinetic and pharmacodynamic profiles in patients with epilepsy.

Neuromuscular blockers

SSRI drugs can reduce the activity of plasma cholinesterase, which leads to an increase in the duration of the neuromuscular blocking action of mivacurium and suxamethonium.

Ability of paroxetine to inhibit the CYP2D6 isoenzyme

Like other antidepressants, including other SSRIs, paroxetine inhibits the liver enzyme CYP2D6, which belongs to the cytochrome P450 system. Inhibition of the CYP2D6 enzyme can lead to an increase in plasma concentrations of concomitantly used drugs that are metabolized by this enzyme. These drugs include certain tricyclic antidepressants (such as amitriptyline, nortriptyline, imipramine, and desipramine), phenothiazine-type neuroleptics (perphenazine and thioridazine), risperidone, atomoxetine, certain Class 1 C antiarrhythmic drugs (such as propafenone and flecainide), and metoprolol. It is not recommended to use paroxetine in combination with metoprolol in heart failure, due to the narrow therapeutic index of metoprolol with this indication for use.

Irreversible inhibition of the CYP2D6 system by paroxetine can lead to a decrease in the concentration of its active metabolite, endoxifen, in blood plasma, and as a result, reduce the effectiveness of tamoxifen.

The ability of paroxetine to inhibit the CYP3A4 isoenzyme.

An in vivo interaction study with concomitant use of paroxetine and terfenadine, which is a substrate of the CYP3A4 isoenzyme, showed that paroxetine does not affect the pharmacokinetics of terfenadine. A similar in vivo interaction study found no effect of paroxetine on the pharmacokinetics of alprazolam, and vice versa. Concomitant use of paroxetine with terfenadine, alprazolam and other drugs that serve as a substrate for the CYP3A4 isoenzyme is unlikely to cause harm to the patient.

Clinical studies have shown that the absorption and pharmacokinetics of paroxetine are independent or practically independent (i. e., the existing dependence does not require a dose change) from food, antacids, digoxin, propranolol, alcohol (paroxetine does not increase the negative effect of ethanol on psychomotor functions, however, it is not recommended to take paroxetine and alcohol at the same time).

Oral anticoagulants

There may be a pharmacodynamic interaction between paroxetine and oral anticoagulants. Concomitant use of paroxetine and oral anticoagulants may increase the activity of anticoagulants and increase the risk of bleeding. Therefore, paroxetine should be used with caution in the treatment of patients receiving oral anticoagulants.

NSAIDs, acetylsalicylic acid, and other antiplatelet medications

There may be a pharmacodynamic interaction between paroxetine and NSAIDs/acetylsalicylic acid. Concomitant use of paroxetine and NSAIDs/acetylsalicylic acid may increase the risk of bleeding.

Caution should be exercised when treating patients receiving SSRIs concomitantly with oral anticoagulants, with drugs that affect platelet function or increase the risk of bleeding (for example, atypical antipsychotics such as clozapine, phenothiazines, most tricyclic antidepressants, acetylsalicylic acid, NSAIDs, COX-2 inhibitors), as well as in the treatment of patients with a history of blood clotting disorders or conditions that may cause bleeding. predisposition to bleeding.

How to take, course of use and dosage

Paroxetine is recommended to be taken once a day in the morning with meals. The tablet should be swallowed whole, without chewing. Depression The recommended dose for adults is 20 mg per day. If necessary, depending on the therapeutic effect, the daily dose can be increased weekly by 10 mg per day to a maximum dose of 50 mg per day.

As with any antidepressant treatment, the effectiveness of therapy should be evaluated and, if necessary, the dose of paroxetine should be adjusted 2-3 weeks after the start of treatment and further depending on the clinical indications. To stop depressive symptoms and prevent relapses, it is necessary to observe an adequate duration of relief and maintenance therapy. This period can be several months.

Obsessive-compulsive disorder

The recommended dose is 40 mg per day. Treatment begins with a dose of 20 mg per day, which can be increased weekly by 10 mg per day. If necessary, the dose can be increased to 60 mg per day. It is necessary to observe an adequate duration of therapy (several months or longer).

Panic disorder

The recommended dose is 40 mg per day. Treatment of patients should begin with a dose of 10 mg per day and weekly increase the dose by 10 mg per day, focusing on the clinical effect. If necessary, the dose can be increased to 60 mg per day. A low initial dose is recommended to minimize the possible increase in symptoms of panic disorder that may occur at the beginning of treatment with any antidepressants. It is necessary to observe adequate terms of therapy (several months or longer).

Social phobia

The recommended dose is 20 mg per day. If necessary, the dose can be increased weekly by 10 mg per day, depending on the clinical effect, up to 50 mg per day. Generalized anxiety disorder The recommended dose is 20 mg per day. If necessary, the dose can be increased weekly by 10 mg per day, depending on the clinical effect, up to 50 mg per day.

Post-traumatic stress disorder

The recommended dose is 20 mg per day. If necessary, the dose can be increased weekly by 10 mg per day, depending on the clinical effect, up to 50 mg per day.

Overdose

Objective and subjective symptoms

The available information about paroxetine overdose indicates its wide range of safety. In case of an overdose of paroxetine, in addition to the symptoms described in the section “Side effects”, fever, changes in blood pressure, involuntary muscle contractions, anxiety and tachycardia are observed.

Patients ‘ condition usually returned to normal without serious consequences, even with a single dose of up to 2000 mg. A number of reports described symptoms such as coma and ECG changes, and deaths were very rare, usually in situations where patients were taking paroxetine together with other psychotropic drugs or with alcohol.

There is no treatment-specific antidote to paroxetine. Treatment should consist of general measures used for overdose of any antidepressants. Maintenance therapy and frequent monitoring of the main physiological parameters are indicated. Treatment of the patient should be carried out in accordance with the clinical picture or in accordance with the recommendations of the national toxicology center.

Form of production

Film-coated tablets 20 mg and 30 mg. 7,10,14,20,25 or 30 tablets in a contour cell package made of polyvinyl chloride film and aluminum foil printed varnished.

10,20,30,40,50 or 100 tablets in cans made of polyethylene terephthalate for medicines, sealed with screw-on lids with control of the first opening or the “push-turn” system made of polypropylene or polyethylene, or polypropylene cans for medicines, sealed with stretch lids with control of the first opening made of polyethylene, or polypropylene cans for medicines, sealed with stretch lids with control of the first opening made of high-pressure polyethylene.

One jar or 1,2,3,4,5,6,7,8,9 or 10 contour cell packages together with the instructions for use are placed in a cardboard package (pack) made of cardboard.

Storage conditions

In a dark place at a temperature not exceeding 25 °C. Keep out of reach of children.

Shelf

life is 3 years. Do not use after the expiration date

Active ingredient

Paroxetine

Conditions of release from pharmacies

By prescription

Dosage form

Tablets