Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. [52] Continuous treatment with sub-therapeutic doses of sertraline (25 mg vs. usual 50–100 mg) is also effective. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: Side effects have been reported to be generally mild and transient. Then order kamagra tablets online. Following discontinuation of the drug and administration of intravenous normal saline solution, the patient's serum sodium and serum and urine osmolality returned to normal levels. All that Glitters Ani’t Gold – Test Spirits My Story about the need to Test Spirits. Gold Standard 100% Plant protein was made for active adults who care about where their nutrients come from and how good their protein tastes. [37], Cognitive behavioral therapy alone was superior to sertraline in both adults and children; however, the best results were achieved using a combination of these treatments. Active in the Michiana community, Jerry served on the Board of the Berrien County Easter Seals Society and as President of Berrien Springs/Eau Claire Rotary Club. [45] While imprecise, comparison of the results of trials of sertraline with separate trials of other anti-panic agents (clomipramine, imipramine, clonazepam, alprazolam, and fluvoxamine) indicates approximate equivalence of these medications. [40][41] Sertraline is equally effective for men and women,[41] and for patients with or without agoraphobia. Sertraline, sold under the brand name Zoloft among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. [58] Another meta-analysis relegated sertraline to the second line, proposing trauma focused psychotherapy as a first-line intervention. Cases of QT interval prolongation and ventricular arrhythmias reported in postmarketing experience were predominantly in females, with hypokalemia, or with pre-existing QT interval prolongation or other cardiac diseases. [Ref], Very common (10% or more): Insomnia (up to 14%), Common (1% to 10%): Abnormal dreams, agitation, anxiety, nervousness, restlessness, Uncommon (0.1% to 1%): Abnormal thinking, aggravated depression, aggression/aggressive reaction, aggravated restlessness, alcohol problem, apathy, bruxism, confusion, confusional state, depersonalization, depression, emotional lability, excitability, feeling unreal, forgetfulness, visual/auditory hallucination, hypomania, irritability, jitteriness, obsessive-compulsive disorder, panic attack/reaction, paranoia/paroniria, sleep disorder, suicide attempt, tics, Frequency not reported: Mania, suicidal ideation/behavior, Postmarketing reports: Acute psychosis, anger, completed suicide, delirium, delusion, disorientation, non-accidental overdose, mood swings, nightmare, psychotic disorder, withdrawal syndrome[Ref]. [114], The major metabolite of sertraline, desmethylsertraline, is about 50 times weaker as a serotonin transporter inhibitor than sertraline and its clinical effect is negligible. Bad news: another loss. This result compares favorably with placebo, where, according to the literature, 3–6% of patients gained more than 7% of their initial weight. [17][27] Sertraline is equivalent to imipramine for the treatment of depression with co-morbid panic disorder, but it is better tolerated. [31] With depression in dementia, there is no benefit of sertraline treatment compared to either placebo or mirtazapine. By combining organic pea, brown rice and sacha inchi proteins, there’s a complete profile of essential amino acids to support muscle recovery. They generally do not lead to treatment cessation. um hydrochlorothiazide 3566 um hydrochlorothiazide 3566 um hydrochlorothiazide 3566 um hydrochlorothiazide 3566 zoloft ulotka zoloft ulotka . [77][78] Sertraline appears to be associated with microscopic colitis, a rare condition of unknown etiology. The episodes occurred several times a day lasting for several minutes and would resolve spontaneously. [61], A 2019 systematic review suggested that sertraline may be a good way to control anger, irritability and hostility in depressed patients and patients with other comorbidities. Convulsions (including grand mal convulsions) have been reported with racemic citalopram. What is the difference between Celexa and Lexapro? [16], Nausea, ejaculation failure, insomnia, diarrhea, dry mouth, somnolence, dizziness, tremor, and decreased libido are the common adverse effects associated with sertraline with the greatest difference from placebo. [20] Comparative clinical trials demonstrated that sertraline is similar in efficacy against depression to moclobemide,[21] nefazodone,[22] escitalopram, bupropion,[23] citalopram, fluvoxamine, paroxetine,[20] venlafaxine[24] and mirtazapine. I am here to tell you that this is not a hereditary issue, as our recent living style and environ are related with andropause. Sertraline is not approved for use in children except for those with OCD. [129], "Lustral" redirects here. [11], Abrupt interruption of sertraline treatment may result in withdrawal or discontinuation syndrome. [17], In several double-blind studies, sertraline was consistently more effective than placebo for dysthymia, a more chronic variety of depression, and comparable to imipramine in that respect. (Presentation at Psychopharmacologic Drugs Advisory Committee; December 13, 2006)", "Clinical review: relationship between antidepressant drugs and suicidality in adults", "Statistical Evaluation of Suicidality in Adults Treated with Antidepressants", "Memorandum from Pfizer Global Pharmaceuticals Re: DOCKET: 2006N-0414 –"Suicidality data from adult antidepressant trials" Background package for December 13 Advisory Committee", "Report of the CSM expert working group on the safety of selective serotonin reuptake inhibitor antidepressants", "Selective serotonin reuptake inhibitors (SSRIs) and suicide in adults: meta-analysis of drug company data from placebo controlled, randomised controlled trials submitted to the MHRA's safety review", "Suicidal antidepressant overdoses: a comparative analysis by antidepressant type", "Effect of proton pump inhibitors on the serum concentrations of the selective serotonin reuptake inhibitors citalopram, escitalopram, and sertraline", "The affinity and selectivity of α-adrenoceptor antagonists, antidepressants, and antipsychotics for the human α1A, α1B, and α1D-adrenoceptors", "Effect of Polymorphisms on the Pharmacokinetics, Pharmacodynamics and Safety of Sertraline in Healthy Volunteers", "Impact of CYP2C19 genotype on sertraline exposure in 1200 Scandinavian patients", "Minutes of the 33rd Meeting of Psychopharmacological Drugs Advisory Committee on November 19, 1990", "Safety review of antidepressants used by children completed", "Overview of regulatory status and CSM advice relating to major depressive disorder (MDD) in children and adolescents", "FDA Proposes New Warnings About Suicidal Thinking, Behavior in Young Adults Who Take Antidepressant Medications", "Zoloft in Short Supply as Prescriptions Soar During Pandemic", https://en.wikipedia.org/w/index.php?title=Sertraline&oldid=1016337253, Short description is different from Wikidata, Wikipedia indefinitely move-protected pages, Drugboxes which contain changes to watched fields, Wikipedia medicine articles ready to translate, Creative Commons Attribution-ShareAlike License, This page was last edited on 6 April 2021, at 16:58. This warning is based on statistical analyses conducted by two independent groups of FDA experts that found a 100% increase of suicidal thoughts and behavior in children and adolescents, and a 50% increase - in the 18 – 24 age group. The proposed mechanism for the development of hyponatremia involves SIADH via release of antidiuretic hormone. While nefazodone and bupropion do not have negative effects on sexual functioning, 67% of men on sertraline experienced ejaculation difficulties versus 18% before the treatment. Some authors believe that the most lateral aspect of reaching advanced age even in those who fail nonoperative therapy, surgery may be all that is turned off and decreases the load increases, the medial aspect annular ligament ad he dorsal tubercle of the knee are innervated by … Life-threatening suspected cyanide toxicity or carbon diox- the presence of antibodies to double-stranded dna, glomerulo- matoid arthritis and may differentiate into striated muscle, cartilage, or fat. [66][67] In spite of lower subjective rating, that is, feeling that they performed worse, no clinically relevant differences were observed in the objective cognitive performance in a group of people treated for depression with sertraline for 1.5 years as compared to healthy controls. [90][91], Sertraline is a moderate inhibitor of CYP2D6 and CYP2B6 in vitro. [51][28][35], Sertraline is effective in alleviating the symptoms of premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome. Medically reviewed by Drugs.com. In the bottom of the 6th, Cody Bellingerhit a solo shot to make the score 5-2. During the discussion, Paul Leber, the director of the FDA Division of Neuropharmacological Drug Products, noted that granting approval was a "tough decision", since the treatment effect on outpatients with depression had been "modest to minimal". Weissman and Koe recalled that the group did not set up to produce an antidepressant of the SSRI type—in that sense their inquiry was not "very goal driven", and the discovery of the sertraline molecule was serendipitous. For other uses, see, ClC1=CC=C([C@H]2C3=C([C@H](CC2)NC)C=CC=C3)C=C1Cl, InChI=1S/C17H17Cl2N/c1-20-17-9-7-12(13-4-2-3-5-14(13)17)11-6-8-15(18)16(19)10-11/h2-6,8,10,12,17,20H,7,9H2,1H3/t12-,17-/m0/s1. [36] The onset of action is also slower for OCD than for depression. We present a 60 day full money back guarantee. Considered separately, sertraline use in adults decreased the odds of suicidal behavior with a marginal statistical significance by 37%[85] or 50%[84] depending on the statistical technique used. [7] According to in vitro studies, sertraline is metabolized by multiple cytochrome 450 isoforms;[9][113] however, it appears that in the human body CYP2C19 plays the most important role, followed by CYP2B6. Adult and pediatric patients receiving antidepressants for MDD, as well as for psychiatric and nonpsychiatric indications, have reported symptoms that may be precursors to emerging suicidality, including anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania. The estimates of the incidence of untoward sexual experience and performance may underestimate their actual incidence, partly because patients and physicians may be reluctant to discuss this issue. [43] However, the response rate was lower for the patients with more severe panic. See below for a comprehensive list of adverse effects. Divided attention was improved and verbal memory under interference conditions decreased marginally. Data sources include IBM Watson Micromedex (updated 1 Apr 2021), Cerner Multum™ (updated 5 Apr 2021), ASHP (updated 6 Apr 2021) and others. Following discontinuation of escitalopram serum sodium levels returned to normal values over a period of 5 days. The authors noted that Pfizer had declined to submit the results of a negative trial for the inclusion into the meta-analysis making the results unreliable. [99], CYP2C19 inhibitor esomeprazole increased sertraline concentrations in blood plasma by approximately 40%. Sertraline is effective for panic disorder and obsessive–compulsive disorder; however, for the latter disorder cognitive behavioral therapy, particularly in combination with sertraline, is a better treatment. June 9, 2019 at 5:26 pm . Stay tuned! [9], The history of sertraline dates back to the early 1970s, when Pfizer chemist Reinhard Sarges invented a novel series of psychoactive compounds, including lometraline, based on the structures of the neuroleptics thiothixene and pinoxepin. [26], There are differences between sertraline and some other antidepressants in their efficacy in the treatment of different subtypes of depression and in their adverse effects. These side effects may go away during treatment as your body adjusts to the medicine. Sleepy Time Tea nourishes and soothes the nervous system, slowly melting away the stress of the day. [70][71], Sertraline has a low level of exposure of an infant through the breast milk and is recommended as the preferred option for the antidepressant therapy of breast-feeding mothers. Les vidéos du site Abondance : moteurs de recherche, référencement naturel, et SEO ! You may report them to the FDA. [10] In 2016, sertraline was the most commonly prescribed psychiatric medication in the United States[13] and in 2018, it was the fourteenth most commonly prescribed medication in the United States, with over 38 million prescriptions. Cerner Multum, Inc. "UK Summary of Product Characteristics." Hyponatremia tends to develop within the first few weeks of treatment (range 3 to 120 days) and typically resolves within 2 weeks (range 48 hours to 6 weeks) after therapy has been discontinued with some patients requiring treatment. The authors suggest that the risk of hyponatremia is highest during the initial weeks of treatment and is higher in women than in men, in patients 65 years of age or older, and in patients receiving multiple drugs that may also cause hyponatremia. [124][125] However, sertraline can still be used in the UK for the treatment of OCD in children and adolescents. [96], Sertraline had a slight inhibitory effect on the metabolism of diazepam, tolbutamide and warfarin, which are CYP2C9 or CYP2C19 substrates; this effect was not considered to be clinically relevant. Postural hypotension has been reported with other SSRIs. In the blood, it is 98.5% bound to plasma proteins. [108][109][112] However, sertraline affinity for its main target (SERT) is much greater than its affinity for σ1 receptor and DAT. Cipralex and Seroplex are the names used for the same drug in the rest of the world. [1], In May 2020, the FDA placed Zoloft on the list of drugs currently facing a shortage. In contrast, poor CYP2B6 metabolizers have 1.6-fold higher levels of sertraline and intermediate metabolizers - 1.2-fold higher levels. Those that most often resulted in interruption of the treatment are nausea, diarrhea and insomnia. [17], Sertraline provides no benefit to children and adolescents with depression. [62], Sertraline is contraindicated in individuals taking monoamine oxidase inhibitors or the antipsychotic pimozide. Over … After that, the dose can be raised to the maximal recommended in the cases of unsatisfactory response. [30] On the other hand, in a 2003 trial the effect size was modest, and there was no improvement in quality of life as compared to placebo. trazodone, sertraline, escitalopram, alprazolam, duloxetine, Lexapro, Xanax, citalopram, Zoloft, venlafaxine. [14][15], Sertraline has been approved for major depressive disorder (MDD), obsessive–compulsive disorder (OCD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), panic disorder, and social anxiety disorder (SAD). Naval Academy. A calming bedtime retreat. They are most common during the first 2 weeks of treatment and decrease in intensity and frequency with continued treatment. Antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. [7][95] In a placebo-controlled study, the concomitant administration of sertraline and methadone caused a 40% increase in blood levels of the latter, which is primarily metabolized by CYP2B6. The group had to overcome initial bureaucratic reluctance to pursue sertraline development, as Pfizer was considering licensing an antidepressant candidate from another company. Sertraline, sold under the brand name Zoloft among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. Potentially life-threatening serotonin syndrome has been reported with SSRIs and SNRIs as monotherapy, but particularly with concomitant use of other serotonergic drugs and drugs that impair the metabolism of serotonin. Escitalopram oxalate is not approved for use in pediatric patients less than 12 years of age. Sertraline shares the common side effects and contra-indications of other SSRIs, with high rates of nausea, diarrhea, insomnia, and sexual side effects; but it appears not to lead to much weight gain, and its effects on cognitive performance are mild. Here is the post. Alphabetical list of pharmaceutical drugs trade names, medications, cosmetics, nutritions, supplements, veterinary drugs, pet meds and health care products from Drugs-about.com database, page 192 Applies to escitalopram: oral solution, oral tablet. Why? zyban 50 mg. proventil online kaufen coupons … Check with your doctor immediately if any of the following side effects occur while taking escitalopram: Some side effects of escitalopram may occur that usually do not need medical attention. An increased risk of suicidal thinking and behavior in children, adolescents, and young adults (aged 18 to 24 years) with major depressive disorder (MDD) and other psychiatric disorders has been reported with short-term use of antidepressant drugs. Available for Android and iOS devices. [48] The improvement is greater among the patients with later, adult onset of the disorder. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Welch then prepared stereoisomers of this compound, which were tested in vivo by animal behavioral scientist Albert Weissman. In the top of the 7th, Descalso hit a two run shot off Tony Cingranito make the score 7-2. [127], The US patent for Zoloft expired in 2006,[128] and sertraline is available in generic form and is marketed under many brand names worldwide. [11][12], Sertraline was invented and developed by scientists at Pfizer and approved for medical use in the United States in 1991. The improvement began during the first week of treatment, and in addition to mood, irritability, and anxiety, improvement was reflected in better family functioning, social activity and general quality of life. It is available as a generic medication. The authors of the study argued that the improvement achieved with sertraline is different and of a better quality than the improvement achieved with placebo. Snovitra kaufen kamagra gold tabletten green 100mg viagra kaufen in der apotheke aldactone zastosowanie allopurinol 500 um nolvadex gegen gyno cytotec colombia . [10] The efficacy of sertraline for depression is similar to that of other antidepressants, and the differences are mostly confined to side effects. June 12, 2019 at 8:23 pm. So, Do you also want to try this medicine? In addition to decreasing the frequency of panic attacks by about 80% (vs. 45% for placebo) and decreasing general anxiety, sertraline resulted in improvement of quality of life on most parameters. and the PDF articles and their links follow… Serotonin syndrome has been reported with racemic citalopram. [16] The response rate was independent of the dose. The paroxysmal movement disorders were characterized by cervical and oral contracture with sustained and painful laterocollis and twisting tongue movements. [57] There are both negative and positive clinical trial results for sertraline, which may be explained by the types of psychological traumas, symptoms, and comorbidities included in the various studies. N Engl J Med 356 (2007): 94-5. [64] Similarly, a 30-month-long treatment with sertraline for OCD resulted in a mean weight gain of 1.5% (1 kg). Forest Pharmaceuticals, St. Louis, MO. In 2007, labeling was again changed to add a warning regarding suicidal behavior in young adults ages 18 to 24. Fav-store specialize in supplying special featured herbal medecines, developed to improve your life and makes better your health. Similarly to other antidepressants, the use of sertraline for depression may be associated with a higher rate of suicidal thoughts and behavior in people under the age of 25. kamagra gold tabletten green 100mg. [83][84][85], Suicidal ideation and behavior in clinical trials are rare. Covyeou JA, Jackson CW "Hyponatremia associated with escitalopram." Commonly reported side effects of escitalopram include: diarrhea, drowsiness, ejaculatory disorder, headache, insomnia, nausea, and delayed ejaculation. [75] The withdrawal symptoms for sertraline are less severe and frequent than for paroxetine, and more frequent than for fluoxetine. Certain embodiments are related to inventive systems and methods in which tissue patches can be made quickly and robustly without the use of complicated fabrication or sterilization equipment. By binding serotonin transporter (SERT) it inhibits neuronal reuptake of serotonin and potentiates serotonergic activity in the central nervous system. For example, in some embodiments, tissue patches are made by applying a compressive force to a liquid medium … Lexapro (escitalopram)." The score was 5-1. Other side effects include: anorgasmia, constipation, dizziness, dyspepsia, fatigue, decreased libido, diaphoresis, and xerostomia. The most potent and selective (+)-isomer was taken into further development and eventually named sertraline. Due to the slower elimination of sertraline in these groups, their exposure to sertraline may be as high as three times the average exposure for the same dose. Yesterday, I posted this article about how to test Spirits you (or those around you) are operating under. The Kaleka family donated its funds to the temple to purchase and install gold domes atop the gurudwara — something Satwant Kaleka had always dreamed of, they said. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Those who follow this blog will probably have noticed a long time ago, that Vikings are one of my favourite subjects to photograph (I am Gudrun from Danhostel Ribe – the hostel in Ribe, Denmark).. Viking child exploring the big world [57][28] When necessary, long-term pharmacotherapy can be beneficial. Dizziness, insomnia, anxiety, agitation, and irritability are its common symptoms. escitalopram oxalate manufacturer/supplier, China escitalopram oxalate manufacturer & factory list, find qualified Chinese escitalopram oxalate manufacturers, suppliers, factories, exporters & wholesalers quickly on Made-in-China.com. Welch generated a number of potent norepinephrine and triple reuptake inhibitors, but to the surprise of the scientists, one representative of the generally inactive cis-analogs was a serotonin reuptake inhibitor. We believe the best partner is … Buy toplexil online egydoc.com :: online Toplexil syrup - Dr. Hala Sabry - Egydoc.com. Plasma, serum or blood concentrations of sertraline and norsertraline, its major active metabolite, may be measured to confirm a diagnosis of poisoning in hospitalized patients or to aid in the medicolegal investigation of fatalities. Sertraline taken during pregnancy is associated with significant increase in congenital heart defects in the newborns. Closely monitor all antidepressant-treated patients for clinical worsening and emergence of suicidal thoughts and behaviors. Benefits of Shilajit Gold Capsules: Shilajit gold brings to the body, a power packed nutritional supplement consisting of over 80 vital minerals and vitamins, including Vitamin E which is essential in maintaining healthy skin tone and repairing damaged skin. According to Welch, they worked outside the mainstream at Pfizer, and even "did not have a formal project team". Collagen contains high amounts of glycine, an amino acid that has been correlated with better sleep regulation and quality. [72][73] There is 29-42% increase in congenital heart defects among children whose mothers were prescribed sertraline during pregnancy,[11][12] with sertraline use in the first trimester associated with 2.7-fold increase in septal heart defects. What line of work are you in? The efficacy of sertraline for depression is similar to that of other antidepressants, and the differences are mostly confined to side effects. For the above analysis, the FDA combined the results of 295 trials of 11 antidepressants for psychiatric indications in order to obtain statistically significant results. Numerous cases of hyponatremia have been reported following treatment with an SSRI. Sertraline is better tolerated than the older tricyclic antidepressants, and it may work better than fluoxetine for some subtypes of depression. [82], The FDA requires all antidepressants, including sertraline, to carry a boxed warning stating that antidepressants increase the risk of suicide in persons younger than 25 years. If it results in a cut incharges, â Iâ d say, â bravo.â â Excelentné, 17.11.2020 15:26. [16], Sertraline also shows relatively high activity as an inhibitor of the dopamine transporter (DAT)[102][110][111] and antagonist of the sigma σ1 receptor (but not the σ2 receptor). [103] Sertraline can be deaminated in vitro by monoamine oxidases; however, this metabolic pathway has never been studied in vivo. Some side effects may not be reported. Along with its needed effects, escitalopram may cause some unwanted effects. [74][75] In most cases symptoms are mild, short-lived, and resolve without treatment. The New Titleist AVX golf ball utilizes breakthrough core, cover and aerodynamic technology. [53][54] Taking sertraline only during the luteal phase, that is, the 12–14 days before menses, was shown to work as well as continuous treatment. [Ref], Frequency not reported: Inappropriate antidiuretic hormone secretion (SIADH), Postmarketing reports: Hyperprolactinemia[Ref], Uncommon (0.1% to 1%): Anemia, hypochromic anemia, leucopenia, Postmarketing reports: Agranulocytosis, aplastic anemia, decreased prothrombin, hemolytic anemia, idiopathic thrombocytopenia purpura, increased INR[Ref], Uncommon (0.1% to 1%): Bilirubinemia, hepatic enzymes increased, Postmarketing reports: Abnormal liver function tests, fulminant hepatitis, hepatic failure, hepatic necrosis, hepatitis, increased bilirubin[Ref], Uncommon (0.1% to 1%): Aggravated allergy, allergic reactions, Rare (less than 0.1%): Anaphylaxis/anaphylactic reaction, Postmarketing reports: Hypersensitivity not otherwise specified, photosensitivity reaction[Ref], Common (1% to 10%): Influenza-like symptoms, Uncommon (0.1% to 1%): Bacterial infection, herpes simplex, herpes zoster, infection, moniliasis, parasitic infection, tuberculosis[Ref], Common (1% to 10%): Arthralgia, back pain, myalgia, neck/shoulder pain, Uncommon (0.1% to 1%): Arthritis, arthropathy, arthrosis, bursitis, costochondritis, fibromyalgia, ischial neuralgia, jaw stiffness, leg pain, limb pain, leg cramps, lumbar disc lesion, muscle contractions, muscle cramp, muscle spasms, muscle stiffness, muscle tightness, muscle weakness, myopathy, osteoporosis, plantar fasciitis, tendinitis, tenosynovitis, tetany, twitching, Postmarketing reports: Rhabdomyolysis[Ref], Epidemiological studies, primarily in patients aged 50 years or older, have shown an increased risk of bone fractures in patients receiving SSRIs or TCAs. He asked another Pfizer chemist, Willard Welch, to synthesize some previously unexplored tametraline derivatives. Book your place at Sivan’s Weekend Retreat Intensive FRI, SAT, SUN – All Three Nights $975.00 USDFRI, SAT – Two Nights $775.00 USDSKYPE ONLY – All Three Nights […] [7], Sertraline is a selective serotonin reuptake inhibitor (SSRI). [117][119][120], Sertraline was approved by the US Food and Drug Administration (FDA) in 1991 based on the recommendation of the Psychopharmacological Drugs Advisory Committee; it had already become available in the United Kingdom the previous year. Results of a Systematic Review", "A comparative review of escitalopram, paroxetine, and sertraline: Are they all alike? In those rare cases, HighPoint will manage the situation swiftly, compassionately, and effectively. [102], Sertraline is absorbed slowly when taken orally, achieving its maximal concentration in the plasma 4 to 6 hours after ingestion.