2010/06/06

TRIGAN-D

Pharmacological action


Incoming in the drug paracetamol has analgesic, antipyretic and anti-inflammatory effects negligible. The mechanism of action is associated with a moderate inhibition of cyclooxygenase-1 and to a lesser extent COX-2 in peripheral tissues and central nervous system, resulting in the inhibition of prostaglandin biosynthesis modulators of pain sensitivity, thermoregulation and inflammation.

The second component ditsikloverina tertiary amine hydrochloride, which has a relatively weak non-selective M-anticholinergic and direct miotropnym antispasmodic effect on smooth muscles of internal organs. At therapeutic doses, is effective relaxation of smooth muscles, which is not accompanied by side effects typical of atropine.

The combined effect of two components Trigano-D provides a relaxation spasm of smooth muscles of internal organs and reducing pain.


Pharmacokinetics


The drug is well absorbed in the gastrointestinal tract. C max plasma levels achieved after 60-90 min. V d - 3.65 L / kg. Paracetamol is metabolized in the liver with the formation of several metabolites, one of which is N-acetyl-benzohinomin under certain conditions (an overdose of medication, lack of glutathione in the liver) could have a damaging effect on the liver and kidneys. About 80% of the drug excreted in the urine and in small numbers in the faeces.


Indications for use of the drug Trigano-D


- Spasm of smooth muscles of internal organs;

L - intestinal, hepatic and renal colic;

- Algomenorrhea;

- Headache, toothache, migraine headache;

- Neuralgia;

- Myalgia;

- Infectious and inflammatory diseases accompanied by fever.




Dosage regimen


Used inside adults and children over 15 years: 1 tablet 2-3 The maximum single dose for adults is 2 tablets, 4 tablets daily. The duration of intake without consulting a physician not more than 5 days when administered as an analgesic and 3 days - as a febrifuge. Prolonged use of the drug is necessary to monitor patterns of peripheral blood and functional state of the liver.

Do not exceed the daily dose, increasing it or more prolonged treatment is possible only under medical supervision, because overdose of the drug can cause liver failure.


Side effect


On the part of the gastrointestinal tract: dry mouth, loss of taste, loss of appetite, epigastric pain, constipation, increased liver enzymes, usually without the development of jaundice, gepatonekroz (dose-dependent effect).

Allergic reactions: skin rash, itching, urticaria, Quincke's edema, erythema multiforme exudative (including Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell's syndrome).

Quired for central nervous system (usually develops when taking high doses): drowsiness, dizziness, psychomotor agitation, and disorientation.

From the Endocrine: hypoglycemia, up to hypoglycemic coma.

From the side of blood: anemia, methemoglobinemia (cyanosis, shortness of breath, pain in the heart), hemolytic anemia (especially for patients with deficiency of gluco-6-phosphate dehydrogenase).

On the part of the genitourinary system: Piura, urinary retention, interstitial nephritis, papillary necrosis.

From the side of view: mydriasis, blurred vision, cycloplegia, increased vnetriglaznogo Dahlen.

- Reduction of potency.


Contraindications to the use of the drug Trigano-D


- Hypersensitivity to paracetamol and ditsikloverinu;

- Obstructive bowel disease;

- Peptic ulcer and 12 duodenal ulcer (acute phase);

- Reflux esophagitis;

- Hypovolemic shock;

- Myasthenia gravis;

- Pregnancy

- Lactation;

- Children age (up to 15 years).

Precautions should be used in patients with severe disorders of the liver or kidneys, if the genetic absence of glucose-6-phosphate dehydrogenase, blood diseases, glaucoma, benign hyperbilirubinemia (including Gilbert's syndrome), viral hepatitis, alcoholic liver damage, alcoholism, old age .


Use of the drug Trigano-D during pregnancy and breastfeeding


The drug is contraindicated during pregnancy and lactation.


Application for violations of liver function


Precautions should be used in patients with severe disturbances of liver function.

An overdose of the drug can cause liver failure.


Application for violations of renal function


Precautions should be used in patients with severe impaired renal function.


Cautions


With caution and under medical supervision should priment drug in patients with impaired liver function or kidney disease, in conjunction with other anti-inflammatory and painkiller, as well as anticoagulants and drugs affecting the central nervous system. When you receive metoclopramide, domperidone, or kolestiramina also need to consult with your doctor.

Paracetamol distorts performance laboratory for the quantitative determination of the content of uric acid and glucose in plasma.

To prevent toxic liver damage paracetamol should not be combined with the reception of alcoholic beverages, and to take individuals who are prone to chronic alcohol consumption. The risk of liver damage increases in patients with alcoholic hepatosis.

Effects on ability to drive vehicles and management mechanisms:

In applying the drug should avoid potentially hazardous activities, tebuyuschih increased concentration and speed of psychomotor reactions (management of vehicles, etc.)

During prolonged treatment is necessary to monitor patterns of peripheral blood and liver functional state.


Overdose


Symptoms: tachycardia, tachypnea, fever, agitation, convulsions, epigastric pain, decreased appetite, anemia, thrombocytopenia, hemolytic anemia, aplastic anemia, methemoglobinemia, pancytopenia, nephrotoxicity (papillary necrosis), gepatonekroz.

Treatment: stop taking the drug, do gastric lavage, appoint adsorbents introduce tools that increase the formation of glutathione (acetylcysteine intravenously) and strengthening the conjugation reaction (methionine inside).


Drug Interactions


The action intensifies ditsikloverina amantadine, antiarrhythmic drugs I-Class, antipsychotic means, benzodiazepines, MAO inhibitors, narcotic analgesics, nitrates and nitrites, sympathomimetic drugs, tricyclic antidepressants.

Ditsikloverin increases the concentration of dioxin in the blood (due to slow gastric emptying).

Stimulants microsomal oxidation in the liver (fenitoin. ethanol, barbiturates, rifampicin, fenilbutazon, tricyclic antidepressants) increase the production of hydroxylated active metabolites, which leads to the possibility of severe intoxication with small overdoses of paracetamol. Adrenostimulyatorov, as well as other preparatys anticholinergic effect of increasing the risk of side effects. Mikerosomalnogo oxidation inhibitors (cimetidine) decrease the risk of hepatotoxic action.

Reduces the effectiveness of urikoziricheskih drugs.

Paracetamol increases the effectiveness of indirect anticoagulants.


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The drug is approved for use as a non-prescription medicines.


Terms and Conditions of storage


List B. In dry place, protected from light and away from children at or above 25 ° C.

Shelf life 3 years. Do not use after the time specified on the package.