VIROLEX powder pro infusionibus

Pharmacological properties: acyclovir - antiviral drug active against herpes simplex virus type 1 and type-2 virus, and herpes zoster. Has virostaticheskoe action. Inhibit the synthesis of viral DNA, not impacting on the physiological processes in the cell.

The half-life in patients with normal renal function is 2.9 h after i / v infusion. Acyclovir penetrates well into tissues, organs and parts of the body: the brain, kidneys, lungs, liver, muscle, spleen, uterus, vaginal mucosa, vaginal secretions, CSF, and the contents of herpetic vesicles. Since plasma proteins binds 15,4% acyclovir. In healthy individuals acyclovir derived mainly from the urine in unchanged form. Pharmacokinetics in children aged over 1 year is similar to that in adults.

Indications: infections caused by the virus Herpes simplex: a primary genital herpes, recurrent genital herpes, herpes encephalitis and generalized infection, herpes of the skin and mucous membranes in patients with immunodeficiency, neonatal herpes and other infections (herpes eczema, hepatitis, proctitis, esophagitis, pneumonia).

Prevention of infections caused by the virus Herpes simplex: after transplantation of bone marrow or kidneys, with aplasia of the bone marrow after treatment with cytotoxic drugs, recurrent genital herpes (with a frequency of 6 times a year and more), frequent recurrent infections in patients with normal immune status, infection patients with immunodeficiencies.

Infections caused by the virus Varicella zoster: varicella in immunocompromised patients, severe or prolonged forms of varicella in patients with normal immune status, complications of varicella caused by the direct action of virus, Varicella zoster; zoster in immunocompromised patients, complications of shingles caused by the direct action of the virus Varicella zoster; eye and ear shape zoster, herpes zoster in individuals aged over 50 years.

APPLICATION: treatment with acyclovir should be started as early as possible, immediately after the first signs of the disease.

The drug is introduced into / in slowly for 1 h.
Infection

Dosage for adults and children over 12 years

Dosage for children aged 3 months to 12 years

Duration of treatment


Herpes simplex

5 mg / kg every 8 h

250 mg / m 2 every 8 h

5 days


Herpes encephalitis

10 mg / kg every 8 h

500 mg / m 2 every 8 h

10 days


Varicella in patients with normal immune status

5 mg / kg every 8 h

250 mg / m 2 every 8 h

7 days


Varicella in immunocompromised patients

10 mg / kg every 8 h

500 mg / m 2 every 8 h

from 7 to 10 days


Preventing infections

250 mg / m 2 every 8 h




Doses for infants: 10 mg / kg every 8 hours dosing regimens for patients with impaired renal function is shown below:
Creatinine clearance

Dosage regimen


25-50 ml / min (0,41-0,83 ml / s)

The usual dose every 12 hours


10-25 ml / min (0,16-0,41 ml / s)

The usual dose every 24 hours


0-10 ml / min (0-0,16 ml / s)

Half the usual dose every 24 hours and immediately after dialysis




Before using the contents of 1 vial should be dissolved in 10 ml water for injection or isotonic p-ra sodium chloride; entered by infusion pump. To prepare the infusion of p-ra contents of two vials of ex tempore dissolved in 100 ml isotonic p-ra sodium chloride or lactate Ringer p-ra, if necessary, dose exceeding 500 mg, add an adequate amount of solvent.

Preparation of infusion p-ra for children who need doses of 10 mg and below, are performed in two stages: first the contents of the vial dissolved in 10 ml water for injection or isotonic p-ra sodium chloride, and then add the appropriate dose for infusion of p-py at a ratio of 1:5 (such as 4 ml in 20 ml).

The product contains no preservatives. Ready rr stable for 12 hours at a temperature from 15 to 25 ° C. Do not use the p-p, which appeared blurred or formed crystals. To prepare the infusion of p-ditch can use isotonic rr sodium chloride or p-p Ringer.

Water for injection should not contain preservatives (benzyl alcohol or parabens).

CONTRAINDICATIONS: Hypersensitivity to the drug.

SIDE EFFECTS: at too fast a / in the introduction of acyclovir and dehydration may be a transitory increase in the level of urea and creatinine in serum, so the injection should be done slowly and ensure adequate hydration of the body. Acute renal failure in the application of the drug occurs very rarely. With the development of renal failure during treatment with acyclovir should appoint adequate hydration, reduce the dose or stop treatment.

Rarely observed neurological symptoms (only in the treatment of complicated forms of the disease), which had a reversible character: convulsions, confusion, hallucinations, tremors, drowsiness, psychosis, coma. There may also be observed nausea, vomiting, skin rashes, increased liver enzymes, anemia, neutropenia, thrombocytopenia.

Cautions: The drug should be used with caution in renal failure, elderly patients, as well as the appointment in high doses, especially in patients with dehydration. Dosage should be corrected in the light of creatinine clearance.

Purpose of the drug during pregnancy can only be life-threatening infections, where the expected benefit to the mother outweighs the potential risk to the fetus. Acyclovir penetrates into the breast milk, so at the time of treatment the drug should be stopped breastfeeding.

Avoid contact with p-pa drug in the eye.

INTERACTIONS: Probenecid, while the application increases the concentration of acyclovir in plasma and lengthens the period of its half-life. The simultaneous use of acyclovir and mycophenolate mofetil leads to increased concentrations of both ingredients in the blood plasma. With simultaneous application of acyclovir and nephrotoxic or neurotoxic drugs should be careful.

OVERDOSE: It is recommended to monitor renal function. It is important to maintain sufficient urine output to prevent crystalluria. Must be active hydration body. Acyclovir is excreted in hemodialysis, peritoneal dialysis is less efficient.

STORAGE CONDITIONS: Powder in vials should be stored at temperatures not above 25 ° C; ready infusion of p-p is stable for 12 hours at a temperature not exceeding 25 ° C; p-p should not be stored in the refrigerator.

Bismuthate tripotassium dicitrate

International name:
Bismuth tripotassium ditsitrat (Bismuthate tripotassium dicitrate)

Group Affiliation:
Intestinal antiseptic and astringent

Description of the active substance (INN):
Bismuth tripotassium ditsitrat

Dosage form:
tablets, coated tablets

Mode of action:
Antiulcer vehicle with bactericidal activity against Helicobacter pylori, also possesses anti-inflammatory and astringent properties. At pH 4 and below (gastric juice), the insoluble precipitate of bismuth oxychloride and citrate, chelate compounds are formed with the protein substrate (insoluble protective coating at the site of ulcer). By increasing the synthesis PgE, which increases mucus and bicarbonate secretion, stimulates the activity of cytoprotective mechanisms. Leads to accumulation of epidermal growth factor in the area of the defect. Reduces the activity of pepsin and pepsinogen. Improves the protective properties of the mucous membrane of the digestive tract. Increasing production of mucus, mucosal resistance to the effects of pepsin, HCl and enzymes.

Indications:
Peptic ulcer and 12 duodenal ulcer (in acute), chronic gastritis (including associated with Helicobacter pylori); dyspepsia not associated with organic diseases of the digestive tract.

Contraindications:
Hypersensitivity, chronic renal failure, pregnancy, lactation.

Side effects:
Nausea, vomiting, diarrhea, allergic reactions. With prolonged use at high doses - encephalopathy associated with the accumulation of Bi in TsNS.Peredozirovka. Symptoms: the development of renal dysfunction. Treatment: gastric lavage, the appointment of activated charcoal and saline laxatives drugs, symptomatic therapy, dialysis.

Dosage and administration:
Inside, adults - 120 mg 4 times a day (3 times for 30 minutes before eating and 2 hours after last meal) for children older than 12 years - 2 times a day to 240 mg on an empty stomach (30 minutes before eating), children under 12 years - 120 mg 2 times daily, with a small amount of water (not milk) within 28-56 days, after which it is necessary to make a break for 8 weeks. For the effect on Helicobacter pylori combined with oral metronidazole - 250 mg 4 times daily and amoxicillin 250 mg 4 times a day (with hypersensitivity to amoxicillin tetracycline use - 500 mg 3 times daily) for 10 days.

Cautions:
In the treatment of fecal staining is observed in the black.

Interaction:
For 30 minutes before and after appointment should refrain from eating, antacid drugs and liquids. During the therapy should not eat ethanol. Reduces the absorption of tetracycline. Or combined with other Bi-containing drugs increases the risk of side effects (increase in Bi concentration in plasma). Antacids drugs with local action reduces the effect of bismuth tripotassium ditsitrata.

Salbutamol

International name:
Salbutamol (Salbutamol)

Group Affiliation:
Beta2-selective adrenoagonists

Description of the active substance (INN):
Salbutamol

Dosage form:
aerosol for inhalation dose capsules with the powder for inhalation, powder for inhalation dose, solution for inhalation

Mode of action:
Bronchodilator, in therapeutic doses has a marked stimulating action on beta 2-adrenergic receptors of the bronchi, blood vessels and myometrium. Virtually no effect on beta1-adrenergic receptors of the heart. Ingibiruet release from mast cells of histamine, leukotrienes, PgD2 etc. biologically active substances for a long time. Inhibits early and late bronchial reactivity. A pronounced effect of bronchodilators, warning or kupiruya bronchospasm, reduces the resistance in the airways, increases the VC. Increases mucociliary clearance (in case of chronic bronchitis and 36%), stimulates mucus secretion, activates the function of ciliated epithelium. Hinders release of inflammatory mediators from mast cells and basophils, in particular anti-IgE-induced release of histamine, prevents suppression of antigen mucocilliary transport and separation factor of chemotaxis neutrophils. Prevents the development of allergen-induced bronchospasm. Can lead to a decrease in the number of beta-adrenergic receptors, including on lymphocytes. It has a number of metabolic effects: reduces the concentration of K + in the plasma affects glycogenolysis and insulin release, has hyperglycemic (especially in patients with bronchial asthma) and the lipolytic effect, increases the risk of acidosis. In recommended therapeutic doses has no negative impact on the CAS does not cause blood pressure increase. To a lesser degree, compared with drugs of this group has a positive chrono-and inotropic effect. It was the expansion of the coronary arteries. After the inhaled form of the action develops quickly, the beginning of the effect - after 5 minutes, maximum - after 30-90 minutes (75% of the maximum effect is achieved within 5 min), duration - 3-6 hours

Indications:
Bronhospastichesky syndrome, bronchial asthma (including nocturnal - Extended form) - prevention and cupping, COPD (including chronic bronchitis, emphysema).

Contraindications:
Hypersensitivity, children's age (under 2 years - for a solution for oral administration and syrup, under 4 years - for the powder for inhalation and aerosol metered without a spacer). C care. Tachyarrhythmias, severe CHF, hypertension, hyperthyroidism, pheochromocytoma, pregnancy, lactation.

Side effects:
Often - palpitations, headache, tremor, anxiety, less often - cough, respiratory tract irritation, dizziness, dry mouth and throat, changes in taste sensations, seldom - bronchospasm (paradoxical or cause hypersensitivity to the drug), dermatitis, allergic reactions (in including angioedema, skin rash), facial flushing, discomfort or chest pain, drowsiness, fatigue, hypokalemia, arrhythmias, muscle cramps, nausea, rvota.Peredozirovka. Symptoms of acute poisoning by inhalation use: more frequent - hyperglycemia, hypokalemia, reduced blood pressure, lactic acidosis, tachycardia, muscle tremors, vomiting less frequent - excitement, hypercalcaemia, hypophosphataemia, leukocytosis, respiratory alkalosis, the rare - hallucinations, paranoia, seizures, tachyarrhythmias. Symptoms of chronic intoxication by inhalation use: more frequent - lowering blood pressure, tachycardia, tremor, vomiting less frequent - excitement, rare - convulsions, tachyarrhythmia. Treatment: symptomatic, with tachycardia enter cardioselective beta-blockers (with caution because of the risk of bronchospasm ).

Dosage and administration:
Inhalation: prevention: adults - to 0.1-0.2 mg (1-2 inhalations) 4 times during the day, children - up to 0.1-0.2 mg 4 times a day. Cupping - 0.1-0.2 mg for children and adults. Prevention of an asthma attack, or physical stress associated with exposure to allergen: 0.2 mg for 15-30 minutes before exposure to a provoking factor. May not be receiving more than 12 inhalations per day. Powder for inhalation: the input mode disk inhaler (tsiklohalera). To treat an attack - once, for the prevention of bronchospasm - 3-4 times a day. Single dose - 200-400 mg. Daily dose - 0.8-1 mg, if necessary the dose may be increased to 1.2-1.6 mg. For the prevention of bronchospasm induced by physical activity - 400 mcg. The kids, for removal of an attack of bronchospasm: a single dose - 200 micrograms; prevention - 200 mcg / d, the multiplicity of the introduction - 3-4. For prevention of bronchospasm induced by physical stress - 200 micrograms before anticipated exercise. If you experience unpleasant sensations in the mouth and back of the throat after inhalation should rinse your mouth with water. In a severe attack, the introduction of inhalation solution with the use of nebulizers of different designs within 5-15 min: initial dose - 2.5-5 mg 4 times a day. In asthmatic status dose may be increased to 40 mg / day.

Cautions:
Frequent use of salbutamol may exacerbate bronchospasm, a sudden death, in connection with which between-meal regular doses of the drug must take breaks in a few hours (6 h). Reduction of these intervals can only occur in exceptional cases. When using dosed aerosols must be clear that the following instructions: Shake spray cans before each use, precise synchronization of breath and proceeds of the drug, the most profound, intense and long enough breath, breath holding after inhalation of the drug 10 seconds. Patients (including young children) who find it difficult to perform correct breathing maneuver should be used for inhalation drug special device (spacer), which increases tidal volume and smoothing inaccuracies asynchronous breaths. If necessary, the appointment during lactation should cease to be careful (unknown, penetrates whether salbutamol in breast milk). strictly controlled clinical studies on the teratogenicity of salbutamol is not carried out. In separate studies revealed polydactyly in children at the background of reception mothers during pregnancy, salbutamol (an unambiguous causal link its occurrence to the drug intake is not installed). In experimental studies revealed the presence of teratogenic effects from salbutamol: in mice after sc administration (doses of 11.5-115 times the maximum recommended in humans for inhalation) noted the development of cleft palate, in rabbits at oral assignment (the dose of 2315 times exceeding the maximum for inhalation) - nezaraschenie skull. adrenergic bronchodilators may be used during pregnancy because the potential risk of placental hypoxemia the fetus against the background of uncontrolled asthma is much greater than the risk associated with their use. However, their use during pregnancy should be careful because it may cause tachycardia and hyperglycemia in the mother (especially if you have diabetes) and the fetus, and cause delay in the mother in labor, reduction of blood pressure, acute pulmonary edema, and NC.

Interaction:
Enhances the action of the central nervous system stimulants, tachycardia in patients with thyrotoxicosis, the likelihood of beats in the background taking cardiac glycosides. Theophylline and other xanthine, while the application increases the risk of tachyarrhythmias; means for inhalation anesthesia, levodopa - severe ventricular arrhythmias. MAO inhibitors and tricyclic antidepressants amplifying effect of salbutamol, may lead to a sharp decrease in BP. Incompatible (pharmacological antagonism) with non-selective beta-blockers (which must also be taken into account in applying eye forms of beta-adorenoblokatorov). Simultaneous with the appointment of anticholinergic drugs (including inhalants) can contribute to increased intraocular pressure. Diuretics and SCS reinforce gipokaliemicheskoe effect of salbutamol.

VARILRIX

INDICATIONS: Healthy persons

The vaccine is indicated for active immunization against varicella of healthy individuals (ranging from 9 months of age). People in close contact with patients at high risk of disease should be vaccinated to reduce the risk of transmission of the agent in such patients. These include the parents and close relatives of patients at high risk, medical (including nursing) staff and other persons in close contact with patients, patients with varicella or with patients with high risk of disease.

Patients with high risk of disease chickenpox

Patients with leukemia receiving immunosuppressive therapy (including therapy GCS), patients with malignant tumors or severe chronic diseases (chronic renal failure, autoimmune diseases, collagen, BA), as well as those who planned organ transplantation are at high risk of disease and tend to a severe course of varicella. Such patients show vaccination to reduce the risk of chicken pox. Given the limited clinical trials for the vaccine Varilriks, immunization of patients at risk should be prescribed with the following caveats:

- When vaccinated patients in the acute phase of leukemia maintenance chemotherapy should be abolished for 1 week before and during 1 week after immunization. Patients receiving a radiation therapy is not recommended to vaccinate throughout the entire period of treatment.

It is desirable that the number of lymphocytes in the peripheral blood was at least 1200/mm 3, and no other manifestations of immunodeficiency.

APPLICATION: 0,5 ml dose of vaccine (after reconstitution) contains a single immunizing dose.

For children from 9 months of age and under 12 years of age inclusive appoint 1 dose of vaccine (0.5 ml), children under the age of 13 years and older - 2 doses with an interval between them at least 6 weeks. For the vaccination of patients at risk may require the introduction of additional doses of vaccine.

The vaccine is designed to Varilriks sc injection. The recommended injection site - the shoulder in place of the projection of the deltoid muscle.

Due to minor variations in pH color ready for the introduction of the vaccine may have a tinge of pink to red. Before injection of the solvent and the vaccine must be carefully visually assess for the presence of any impurities and / or rejection of physical characteristics. In case of deviations of the solvent or the vaccine do not apply.

Varilriks dissolved, adding to the vial containing a dry lyophilized powder, attached solvent. After adding the solvent to the powder mixture should be shaken until complete dissolution of the powder. When processing the injection site should await the complete drying alcohol or other antiseptic on the skin surface before the introduction of the vaccine because they may result in partial inactivation of the virus. The vaccine should be administered immediately after reconstitution.

Contraindicated intradermal and intravascular injection Varilriksa.

CONTRAINDICATIONS: vaccination Varilriksom contraindicated in individuals who have the total number of lymphocytes in the peripheral blood of less than 1200/mm 3 or if other manifestations of immune deficiency, persons with known systemic hypersensitivity to neomycin (a history of contact dermatitis due to the action of neomycin is not a contraindication to vaccination); during pregnancy. Moreover, it should avoid pregnancy for 3 months after vaccination.

SIDE EFFECTS: Healthy persons

More than 7900 people participated in clinical studies on reactogenicity of the vaccine.

Children (ages 9 months to 12 years)

The most frequent side effects were injection site reactions (moderate pain, hyperemia, edema).

Also notes the following side effects: general reactions may be in the form of fever - body temperature of 37,5 ° C (under the arms) / 38 ° C (rectal) to 39 ° C (under the arms) / 39,5 ° C (rectal) . There have been reports of cases of papules, vesicular rash (like a rash varicella). In double-blind, placebo-controlled study with a 4-week monitoring period, which included 513 children aged 12-30 months, there was no statistically significant differences in the nature or frequency of clinical symptoms in patients who received the vaccine or placebo.

Adolescents (≥ 13 years and adults). The most frequent side effects are reactions at the site of reference (moderate pain, hyperemia, edema). It was also reported such side-effects: Common reactions may occur in the form of fever with body temperature of 37,5 ° C (under the arms) / 38 ° C (rectal) to 39 ° C (under the arms) / 39,5 ° C (rectal ). There have been reports of cases of papules, vesicular rash (like a rash varicella) in about 5% of persons within 6 weeks after vaccination. In general, the reactogenicity after the second dose was not higher than after the introduction of the first.

In double-blind, placebo-controlled study involving 513 children aged 12-30 months found no statistically significant differences in the nature or frequency of occurrence of fever and skin rash in children who received vaccine or placebo. There were no differences between reactogenicity in initially seropositive and seronegative reacting reacting individuals.

Patients with high risk

For this group of patients, systematic clinical trial data are limited. Yet the reaction associated with the use of vaccines (mostly papules, vesicular rash and fever), tended to be moderate. As in healthy individuals, congestion, swelling and pain at the injection site were inconspicuous and quickly passing (from several days to several weeks). The symptoms are often observed in patients with leukemia receiving immunosuppressive therapy, are at the maintenance phase of chemotherapy. The appearance of the rash does not affect the clinical status of patients. IQ that immunization can adversely affect the course of the disease, no.

Cautions: Like other vaccines, immunization Varilriksom should be delayed in people with acute illnesses that occur with a fever. However, the existence of minor manifestations of infection is not a contraindication for vaccination.

Like all other injectable vaccines, immunization must be conducted under the supervision of medical staff. It should take the necessary measures in case of rare anaphylactic reaction observed after vaccine administration.

As with other vaccines for the prevention of varicella, chickenpox cases have identified and the patients who were previously immunized Varilriksom. These cases are rare and the fever and other clinical symptoms were less pronounced than that of unvaccinated patients.

It was shown that the transmission of the virus (Oka strain) vaccine in seronegative contacts of vaccinees responding with individuals is very rare.

Moderately pronounced rash in healthy contact persons indicates that the virus is weakened (attenuated) after transmission through people - carriers of the virus.

During pregnancy and lactation appointment Varilriksa contraindicated, since the effect on fetal development are unknown. In addition, you should avoid pregnancy for 3 months after vaccination. Data on the use of vaccine in breast-feeding are not available.

In carrying out immunization in Ukraine on immunization, contraindications and interactions with other drugs, should be guided by existing orders MH of Ukraine.

INTERACTION: in patients treated with immunoglobulins, or who made blood transfusion, vaccination should be postponed for at least 3 months in connection with the passive acquisition of antibodies to varicella zoster virus.

For 6 weeks after vaccination against chickenpox should avoid use of salicylates, as reported on the development of Reye syndrome, occurring after the use of salicylates during spontaneous infection caused by the varicella zoster virus.

Healthy persons

Varilriks can be assigned in conjunction with any other vaccine. Different injectable vaccines should always be installed in different areas. The vaccine can enter at any time against the introduction of this vaccine. If a vaccine containing measles virus is not introduced concurrently with Varilriksom are encouraged to observe an interval of at least 1 month, because they believe that measles vaccination can cause a short depression of cellular component of the immune response.

Patients with high risk

Varilriks should not be given simultaneously with other live attenuated vaccines. The vaccine may be used at any time against the introduction of this vaccine. Different injection vaccine must always be installed in different places.

Varilriks not be mixed with other vaccines in one syringe.

STORAGE CONDITIONS: shelf life of freeze-dried vaccine Varilriks in the refrigerator at +2 +8 ° C is 24 months. Date of expiry vaccine is indicated on the label and packaging. At the lyophilized vaccine does not affect freezing. Diluent should be stored in the refrigerator or at room temperature (not above 25 ° C). The vaccine should be administered immediately after dissolution. For transportation of vaccines, especially in hot climates, you should use refrigerators.

DESCRIPTION: mechanism of action of vaccine Varilriks is that in susceptible individuals the vaccine causes a weakening of clinically asymptomatic form of varicella. Some level of protection can be achieved by immunization for up to 72 hours after contact with sick chicken pox.

Healthy persons

In children aged 9 months to 12 years the overall level of seroconversion within 6 weeks after vaccination was more than 98%. Children immunized at the age of 12-15 months, antibodies persisted for at least 7 years after vaccination.

Persons aged 13 and over rate of seroconversion was 100% after 6 weeks after the second dose. One year after vaccination, all persons remained seropositive.

In the study of the effectiveness in children under the age of 10 to 30 months of protective efficacy was 100% compared with conventional clinical cases of varicella (≥ 30 vesicles). In comparison with mild cases of varicella (a mild form, at least with the presence of a vesicle or papule) protective efficacy was 88%. However, the cases were mild (the average number of vesicles - 1; reports of fever was not).

Patients with high risk of disease chickenpox

Patients at high risk of disease chickenpox overall seroconversion rates exceeded 80%. In these patients, it is desirable to periodically examine the level of antibodies to varicella zoster virus in order to determine the persons to whom it is expedient to revaccination.

Vaccine hepatitis B

Trade name:
Hepatitis B Vaccine

International name:
The vaccine for the prevention of hepatitis B (Vaccine hepatitis B)

Group Affiliation:
MIBP vaccine

Description of the active substance (INN):
A vaccine to prevent hepatitis B

Mode of action:
A vaccine to prevent hepatitis B. Forms specific immunity to the virus of hepatitis B. The immunization in 98% creates a specific immunity to the virus of hepatitis B. The mean values of antibody titers were consistent with standard WHO. Antiviral antibodies in the protective titres persist for at least 5 years.

Indications:
Hepatitis B (specific immunoprophylaxis infection caused by all known subtypes of the virus).

Contraindications:
Hypersensitivity (including to the yeast). C care. Pregnancy, lactation (due to risk of infection with hepatitis B), multiple sclerosis.

Side effects:
Rarely - fever, headache, dizziness, weakness, malaise, myalgia, arthritis, nausea, vomiting, transient increase in activity of "liver" enzymes, skin rashes, and very rarely (without an unambiguous connection with vaccination) - polyneuropathy, optic neuritis , facial nerve palsy, exacerbation of multiple sclerosis, Guillain-Barré syndrome, allergic reactions of immediate type. Local reactions: pain, congestion, swelling, compaction.

Dosage and administration:
In / m (adults and older children are introduced in the deltoid region, children under 2 years - in the anterior-lateral surface of the thigh), adults and children from the age of 16 - 1 ml (20 mg surface antigen of hepatitis B), newborn and child 15 years - 0.5 ml (10 mg surface antigen of hepatitis B virus). It is recommended that the following immunization scheme: 1 dose - in the selected date, 2 dose - after 1 month and 3 dose - 6 months after administration of 1 dose. Revaccination - 1 dose every 5 years. For high-risk groups (newborns whose mothers are infected with hepatitis B; patients, those who visit the regions with a high incidence of hepatitis B): 1 dose - for the current day, 2 and 3 doses - 1 month and 2 months after administration of 1 dose. Revaccination - within 1 year after 3 doses of primary immunization. Before the introduction of a drug should be good stir, since the storage can be formed small quantity of sediment (white with a clear colorless supernate).

Cautions:
In diseases accompanied by fever, vaccinations should be postponed until he recovers. When immunodeficiency and hemodialysis may require the introduction of additional doses of vaccine, because these patients after primary immunization protective antibody titers (> 10 IU / L) could not be induced. Immunization may be ineffective and even harmful in people who are in a latent or progressive stage of hepatitis B. In the conduct of vaccination must be kept in the presence of drugs needed for emergency assistance in the event of an anaphylactic reaction.

Interaction:
The product is compatible with other vaccines. The effect of reducing immunosuppressive therapy.

Bromhexine

International name:
Bromhexine (Bromhexine)

Group Affiliation:
Mucolytic tool

Description of the active substance (INN):
Bromhexine

Dosage form:
pills, drops for oral administration, injection, solution for oral, syrup, syrup [for children], tablets, pills [for children]

Mode of action:
Mucolytic (sekretoliticheskoe) tool, has expectorant and antitussive effect of the weak. Reduces the viscosity of sputum (depolymerized mukoproteinovye and mukopolisaharidnye fiber increases serous component of bronchial secretions) activates the ciliated epithelium, increases the volume and improves the expectoration of sputum. Promotes endogenous surfactant, providing the stability of alveolar cells in the process of respiration. The effect is manifested after 2-5 days of starting treatment.

Indications:
Diseases of the respiratory tract, accompanied by the difficulty of separation of viscous sputum: tracheobronchitis, bronchitis of various etiologies (including complicated by bronchiectasis), bronchial asthma, pulmonary tuberculosis, pneumonia (acute and chronic), cystic fibrosis. Remediation bronchial tree in the preoperative period and during treatment and diagnostic intrabronchial manipulation, prevention of accumulation in the bronchi of the thick viscous sputum after the operation.

Contraindications:
Hypersensitivity, peptic ulcer, pregnancy (I term), lactation, infancy (up to 6 years - for the tablet form). C care. Renal and / or hepatic insufficiency, bronchial diseases, accompanied by excessive accumulation of secretions in history - gastric bleeding.

Side effects:
Allergic reactions, nausea, vomiting, dyspepsia, aggravation of gastric ulcer and 12 duodenal ulcer, dizziness, headache, increased activity of "liver" transaminase (extremely rare). Overdosage. Symptoms: nausea, vomiting, diarrhea, dyspepsia. Treatment: artificial vomiting, gastric lavage (in the first 1-2 h after admission).

Dosage and administration:
Inside (syrup, tablets and pills - for children over 6 years, drops, solution for oral use), adults and children over 14 years - 8-16 mg 3-4 times a day. Children under 2 years - 2 mg 3 times daily, 2-6 years - 4 mg 3 times daily, 6-14 years - 8 mg 3 times a day. If necessary, the dose may be increased for adults up to 16 mg 4 times a day. By inhalation (solution for inhalation) for adults - to 8 mg for children older than 10 years - 4 mg, 2-10 years - 2 mg. Inhalation spend 2 times a day. The solution is diluted 1:1 with distilled water and heated to body temperature to prevent coughing. If bronchial obstruction before the inhalation is necessary to appoint a bronchodilator drugs. Bromhexine 8-drop: inside, adults and adolescents over 14 years - 23-47 cap 3 times a day for children 6-14 years of age and patients with body weight below 50 kg - to 23 cap 3 times a day, up to 6 years - 12 cap 3 times a day. The therapeutic effect may occur at 4-6 days of treatment. Parenteral (IM, n / k / v slowly over 2-3 minutes) - 2-4 mg 2-3 times a day. Solution for i / v injection should be diluted with Ringer's solution or sterile water for injection. Patients with renal insufficiency prescribe smaller doses or increase the interval between infusions.

Cautions:
In the treatment should take plenty of fluids, which increases the expectorant action of bromhexine. In children, treatment should be combined with postural drainage and vibration massage of the thorax, facilitates the removal of bronchial secretions. Note that in the Bromhexine 8-drop is ethanol (41 vol. %).

Interaction:
Not appointed concurrently with drugs that suppress the cough center (including codeine), because this makes it difficult expectoration attenuated sputum (accumulation of bronchial secretions in the airways). Incompatible with alkaline solutions. Bromhexine facilitated the penetration of antibiotics (amoxicillin, erythromycin, cephalexin, oxytetracycline ), sulfanilamide drugs in the bronchial secretion in the first 4-5 days of antimicrobial therapy.

Bismuthate tripotassium dicitrate

International name:
Bismuth tripotassium ditsitrat (Bismuthate tripotassium dicitrate)

Group Affiliation:
Intestinal antiseptic and astringent

Description of the active substance (INN):
Bismuth tripotassium ditsitrat

Dosage form:
tablets, coated tablets

Mode of action:
Antiulcer vehicle with bactericidal activity against Helicobacter pylori, also possesses anti-inflammatory and astringent properties. At pH 4 and below (gastric juice), the insoluble precipitate of bismuth oxychloride and citrate, chelate compounds are formed with the protein substrate (insoluble protective coating at the site of ulcer). By increasing the synthesis PgE, which increases mucus and bicarbonate secretion, stimulates the activity of cytoprotective mechanisms. Leads to accumulation of epidermal growth factor in the area of the defect. Reduces the activity of pepsin and pepsinogen. Improves the protective properties of the mucous membrane of the digestive tract. Increasing production of mucus, mucosal resistance to the effects of pepsin, HCl and enzymes.

Indications:
Peptic ulcer and 12 duodenal ulcer (in acute), chronic gastritis (including associated with Helicobacter pylori); dyspepsia not associated with organic diseases of the digestive tract.

Contraindications:
Hypersensitivity, chronic renal failure, pregnancy, lactation.

Side effects:
Nausea, vomiting, diarrhea, allergic reactions. With prolonged use at high doses - encephalopathy associated with the accumulation of Bi in TsNS.Peredozirovka. Symptoms: the development of renal dysfunction. Treatment: gastric lavage, the appointment of activated charcoal and saline laxatives drugs, symptomatic therapy, dialysis.

Dosage and administration:
Inside, adults - 120 mg 4 times a day (3 times for 30 minutes before eating and 2 hours after last meal) for children older than 12 years - 2 times a day to 240 mg on an empty stomach (30 minutes before eating), children under 12 years - 120 mg 2 times daily, with a small amount of water (not milk) within 28-56 days, after which it is necessary to make a break for 8 weeks. For the effect on Helicobacter pylori combined with oral metronidazole - 250 mg 4 times daily and amoxicillin 250 mg 4 times a day (with hypersensitivity to amoxicillin tetracycline use - 500 mg 3 times daily) for 10 days.

Cautions:
In the treatment of fecal staining is observed in the black.

Interaction:
For 30 minutes before and after appointment should refrain from eating, antacid drugs and liquids. During the therapy should not eat ethanol. Reduces the absorption of tetracycline. Or combined with other Bi-containing drugs increases the risk of side effects (increase in Bi concentration in plasma). Antacids drugs with local action reduces the effect of bismuth tripotassium ditsitrata.

Insulin biphasic [human semisynthetic]

International name:
Insulin biphasic [human semisynthetic] (Insulin biphasic [human semisynthetic])

Group Affiliation:
Hypoglycemic tool - a combination of insulin and the short average duration of

Description of the active substance (INN):
Insulin biphasic [human semisynthetic]

Dosage form:
Suspension for subcutaneous injection

Mode of action:
Insulin average duration of action. Interacting with specific receptor outer cell membrane, forming insulinretseptorny complex. By increasing the synthesis of cAMP (in the fat cells and liver cells) or directly penetrate the cell (muscle), insulinretseptorny complex stimulates intracellular processes, including synthesis of several key enzymes (hexokinase, pyruvate kinase, glikogensintetaza, etc.). Reduction of blood glucose due to an increase of intracellular transport, increased absorption and assimilation tissue, stimulation of lipogenesis, glikogenogeneza, protein synthesis, reduced speed hepatic glucose production (reduction of the collapse of glycogen), etc. After sc injection effect occurs after 30-45 minutes . The maximum effect - in between 1-8.5 h duration - from 10 to 20 hours (depending on the composition of insulin), dose-dependent and reflects the considerable inter-and vnutripersonalnye deviation.

Indications:
Diabetes mellitus type 1. Diabetes mellitus type 2, stage of resistance to oral hypoglycemic, in part resistance to oral hypoglycemic drugs (combination therapy), intercurrent diseases, surgical interventions (mono or combination therapy), diabetes against a background of pregnancy (in ineffectiveness diet ).

Contraindications:
Hypersensitivity, Hypoglycemia, insulinoma.

Side effects:
Allergic reactions (urticaria, angioedema - fever, shortness of breath, blood pressure reduction), including Local (hyperemia, swelling, itching of the skin at the injection site); lipodystrophy at injection of the drug; hypoglycemia (pale skin, sweating, perspiration, palpitations, tremor, hunger, excitement, anxiety, paresthesia in the mouth, headache, drowsiness , insomnia, fear, depressed mood, irritability, unusual behavior, lack of movement, speech and vision), hypoglycemic coma. At the beginning of treatment - swelling and a violation of refraction (of a temporary nature and are continuing with treatment.) overdose. Symptoms: perspiration, palpitations, tremor, hunger, anxiety, paresthesia in the mouth, pallor, headache, drowsiness, insomnia, fear, depressed mood, irritability, unusual behavior, lack of movement, speech and vision, hypoglycemic coma, convulsions. Treatment: if the patient is conscious, appoint dextrose inside; n / a, i / m or i / v injected glucagon or in / in hypertonic dextrose. With the development of hypoglycemic coma in / jet injected 20-40 ml (100 ml) 40% dextrose until until the patient is out of a coma.

Dosage and administration:
P / K, 1-2 times a day for 30-45 minutes before breakfast (the place of injections should be changed every time). In special cases, the doctor may prescribe a / m injection. In / in insulin average duration of the forbidden! Doses are selected individually and depend on the concentration of glucose in the blood and urine, the characteristics of the disease. Typically, doses are 8-24 IU 1 time per day. In adults and children with a high sensitivity to insulin may be sufficient dose of less than 8 IU / day, patients with low sensitivity - exceeding 24 IU / day. With a daily dose exceeding 0.6 IU / kg - in the form of two injections in different places. Patients receiving 100 IU per day or more, the replacement of insulin appropriate to be hospitalized. Translation from one drug to others should be under the control of blood glucose concentration.

Cautions:
Possible immunological cross-reaction with human insulin. If hypersensitivity to animal insulin should test the tolerance of insulin with skin tests (in / for the introduction). If / to test confirms expressed hypersensitivity to insulin (an allergic reaction of immediate type - Arthus phenomenon) further treatment should be conducted only under clinical control. Ability to transfer a patient in the event of increased insulin sensitivity of animals to human insulin is often hampered by cross-immunological reaction between human and animal insulin. Before taking insulin from a vial to check the transparency of the solution. When a foreign body, turbidity or precipitation of the substance on the glass bottle solution of the drug can not be used. Temperature of insulin must correspond to room temperature. Insulin dose must be adjusted in cases of infectious diseases, thyroid, Addison's disease, hypopituitarism, chronic renal failure and diabetes diabetes in individuals over 65 years. The causes of hypoglycemia can be: an overdose of insulin replacement medication, skipping meals, vomiting and diarrhea, physical stress, disease, reducing the need for insulin (very advanced kidney and liver, and hypofunction of adrenal, pituitary or thyroid gland), change the injection site (such as the skin on the abdomen, shoulder, hip), as well as interaction with other drugs. May decrease the concentration of glucose in the blood during transfer of a patient with insulin animals to human insulin. Transfer the patient to human insulin should always be medically justified and undertaken only under medical supervision. The tendency to develop hypoglycemia can impair the ability of patients to actively participate in traffic, as well as maintenance of machinery. Diabetics can cut short by themselves felt by a slight hypoglycemia by taking sugar or foods with high carbohydrate content (recommended to always carry with them no less than 20 grams of sugar). The transfer of hypoglycemia should inform the attending physician to decide on the need for correction of treatment. During pregnancy should take into account the reduction of (I trimester) or increase (II-III trimesters) in insulin requirements. During childbirth and immediately after their need for insulin can dramatically decrease. During the period of lactation should be monitored daily for several months (up to stabilize insulin requirements).

Interaction:
Pharmaceutical incompatible with solutions of other drugs. Hypoglycemic action of sulfonamides increase (including oral hypoglycemic drugs, sulfonamides), MAO inhibitors (including furazolidone, procarbazine, selegiline), carbonic anhydrase inhibitors, ACE inhibitors, NSAIDs (in m . salicylates hours), anabolic steroids (including stanozolol, oxandrolone, methandrostenolone), androgens, bromocriptine, tetracyclines, clofibrate, ketoconazole, mebendazole, theophylline, cyclophosphamide, fenfluramin, preparations Li +, pyridoxine, quinidine, quinine, hlorohinin, ethanol. hypoglycemic effect of weakening glucagon, somatropin, GCS, oral contraceptives, estrogens, thiazide and loop diuretics, BCCI, thyroid hormones, heparin, sulfinpirazon, sympathomimetic, danazol, tricyclic antidepressants, clonidine, calcium antagonists, diazoxide, morphine, marijuana, nicotine, phenytoin, epinephrine, blockers of H1-histamine receptors. Beta-blockers, reserpine, octreotide, pentamidine can both strengthen and weaken the hypoglycemic effect of insulin.

Paracetamol

Description of the active substance (INN):
Paracetamol

Dosage form:
capsule, effervescent powder for solution for oral use [for children], solution for infusion, Solution for oral use [for children], syrup, rectal suppositories, rectal suppositories [children], a suspension for oral, suspension

Mode of action:
Non-opioid analgesics, blocks and TSOG1 TSOG2 predominantly in the CNS, acting on pain centers and thermoregulation. In inflamed tissue the cellular peroxidase neutralize the influence of paracetamol on COX, which explains the almost complete absence of anti-inflammatory effect. The absence of a blocking effect on the synthesis of Pg in peripheral tissues determines that it has no negative effect on water-salt metabolism (delay of Na + and water) and gastrointestinal mucosa.

Indications:
Feverish syndrome on a background of infectious diseases, pain (mild to moderate severity): arthralgia, myalgia, neuralgia, migraine, toothache and headache, algomenorrhea.

Contraindications:
Hypersensitivity, the neonatal period (up to 1 month). C care. Renal and hepatic failure, benign hyperbilirubinemia (including Gilbert's syndrome), viral hepatitis, alcoholic liver disease, alcoholism, pregnancy, lactation, old age, early infancy (up to 3 months), lack of glucose-6-phosphate dehydrogenase; diabetes mellitus (for syrup).

Side effects:
On the part of the skin: itching, skin rash and mucous membranes (usually erythematous, rash), angioedema, erythema multiforme exudative (including Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell's syndrome). On the part of the CNS (usually develops when taking high doses): dizziness, psychomotor agitation, and disorientation. On the part of the digestive system: nausea, epigastric pain, increased activity of "liver" enzymes, usually without the development of jaundice, gepatonekroz (dose-dependent effect). From the Endocrine: hypoglycemia, up to hypoglycemic coma. From the side of blood: anemia, sulfgemoglobinemiya and methemoglobinemia (cyanosis, shortness of breath, pain in the heart), hemolytic anemia (especially for patients with deficiency of glucose-6-phosphate dehydrogenase). With prolonged use at high doses - aplastic anemia, pancytopenia, agranulocytosis, neutropenia, leukopenia, thrombocytopenia. On the part of the urinary system: (in large doses) - nephrotoxicity (renal colic, interstitial nephritis, papillary necrosis). Overdosage. Symptoms (acute overdose develops within 6-14 h after administration of paracetamol, chronic - within 2-4 days after exceeding the dose) acute overdose: dysfunction of the gastrointestinal tract (diarrhea, decreased appetite, nausea and vomiting, abdominal discomfort and / or pain in the abdominal), increased sweating. Symptoms of chronic overdose: development hepatotoxic effect, characterized by common symptoms (pain, fatigue, weakness, increased sweating), and specific, characterizing liver lesions. As a result, may develop gepatonekroz. Hepatotoxic effect of paracetamol may be complicated by the development of hepatic encephalopathy (disturbances of thinking, CNS depression, stupor), convulsions, respiratory depression, coma, cerebral edema, hypocoagulation, the development of DIC-syndrome, hypoglycemia, metabolic acidosis, arrhythmia, collapse. Rarely abnormal liver function developed at lightning speed and can be complicated by kidney failure (renal tubular necrosis). Treatment: An Introduction donators of SH-groups and precursors of glutathione synthesis - through methionine 8-9 h after the overdose, and N-acetylcysteine - 12 pm The need for additional therapeutic interventions (further introduction of methionine, in / in the introduction of N-acetylcysteine) is determined depending on the concentration of paracetamol in the blood, as well as the time elapsed after the reception.

Dosage and administration:
Inside, with plenty of fluid after 1-2 hours after meals (reception immediately after a meal leads to delay the onset of action). Adults and adolescents older than 12 years (body weight 40 kg) single dose - 500 mg and the maximum one-time dose - 1 of Multiplicity purpose - to 4 times a day. The maximum daily dose - 4 g and the maximum duration of treatment - 5-7 days. In patients with disorders of the liver or kidneys, with Gilbert syndrome, in elderly patients with daily dose should be reduced and increase the interval between doses. Children: The maximum daily dose for children up to 6 months (up to 7 kg) - 350 mg, up to 1 year ( to 10 kg) - 500 mg, up to 3 years (15 kg) - 750 mg, up to 6 years (up to 22 kg) - 1 g, up to 9 years (30 kg) - 1.5 g, up to 12 years (up to 40 kg) - 2 years in the form of a suspension: Children 6-12 years - 10-20 ml (5 ml - 120 mg), 1-6 years - 5-10 mL, 3-12 months - 2.5-5 ml. The dose for children aged 1 to 3 months is determined individually. Multiplicity pattern - 4 times a day interval between each reception - at least 4 h. The maximum duration of treatment without consulting a doctor - 3 days (for admission as an antipyretic drug) and 5 days (as an analgesic). Rectally. Adults - 500 mg 1-4 times a day and a maximum single dose - 1 g, the maximum daily dose - 4 PM Children 12-15 years - 250-300 mg 3-4 times a day, and 8-12 years - 250 -300 mg three times daily, 6-8 years - 250-300 mg 2-3 times a day, 4-6 years - 150 mg 3-4 times a day, 2-4 years - 150 mg 2 - 3 times a day, 1-2 years - 80 mg 3-4 times a day, from 6 months to 1 year - 80 mg 2-3 times a day from 3 months to 6 months - 80 mg 2 times day.

Cautions:
With the continued feverish syndrome during treatment with paracetamol for more than 3 days, and pain for more than 5 days is required doctor's consultation. The risk of liver damage increases in patients with alcoholic hepatosis. Distorts the performance of laboratory research in quantitative determination of glucose and uric acid in plasma. During the long treatment is necessary to monitor patterns of peripheral blood and functional state of the liver. syrup contains 0.06 XE sucrose 5 ml, which should be considered when treating patients with diabetes mellitus.

Interaction:
Urikozuricheskih reduces the effectiveness of drugs. Concomitant use of paracetamol at high doses increases the effect of anticoagulant drugs (reduced synthesis prokoagulyantnyh factors in the liver). Inductors microsomal oxidation in the liver (phenytoin, ethanol, barbiturates, rifampicin, fenilbutazon, tricyclic antidepressants), ethanol, and hepatotoxic drugs increase the production hydroxylated active metabolites, leading to the possibility of severe intoxication, even with a small overdose. Prolonged use barbiturates reduce the effectiveness of paracetamol. Ethanol contributes to the development of acute pancreatitis. microsomal oxidation inhibitors (including cimetidine) can reduce the risk of hepatotoxic action. Long-term joint use of paracetamol, etc . NSAIDs increases the risk of "analgesic" nephropathy and renal papillary necrosis, onset of end-stage renal failure. Simultaneous long-term assignment in high doses of paracetamol and salicylates increases the risk of kidney cancer or bladder. Diflunisal increases the plasma concentration of paracetamol by 50% - the risk of hepatotoxicity . myelotoxic drugs increase the expression gematotoksichnosti drug.

RESERPINE+ DIHYDRALAZINE+ HYDROCHLOROTHIAZIDE

International name:
Reserpine + Hydrochlorothiazide + Digidralazin (Reserpine + Dihydralazine + Hydrochlorothiazide)

Group Affiliation:
Hypotensive combined tool

Description of the active substance (INN):
+ Reserpine + Hydrochlorothiazide Digidralazin

Dosage form:
Tablets

Mode of action:
Combined medication. Reserpine - sympatholytic, penetrating into the presynaptic end postganglionic fibers releases norepinephrine from vesicles with a simultaneous violation of its reverse neuronal capture and amplification process of inactivation of MAO. Cause depletion of the neurotransmitter and sustained reduction in blood pressure. Helps reduce the concentration in the neurons of dopamine, serotonin and other neurotransmitters, exerting antipsychotic action. Weakens the influence of sympathetic innervation in the SCA, reduces heart rate and TPVR; remains active parasympathetic nervous system deepens and strengthens the physiological sleep, inhibits interoretseptivnye reflexes. Increases peristalsis of the digestive tract, increases the production of stomach HCl; slows metabolic processes in the body, slows and deepens breathing movements, causes miosis, hypothermia, reduces the intensity of metabolism. Has a positive effect on the lipid and protein metabolism in patients with arterial hypertension, and coronary atherosclerosis, increases renal blood flow, increases the glomerular filtration. Digidralazin - arterial vasodilator, lowers resistance in the vessels of the heart, brain, kidney (to a lesser extent - the skin and skeletal muscle) are not effect on renal blood flow; hypotensive effect is not accompanied by orthostatic hypotension. Hydrochlorothiazide - thiazide diuretics, acting at the cortical segment of the loop of Henle, increases the excretion of Na +, K +, Mg2 +, Cl-and water, increases the reabsorption of Ca2 +; maximum diuretic effect - after 6 h, duration of - 12 h. The drug does not cause reflex tachycardia, typical digidralazina and hydrochlorothiazide (leveled reserpine), and fluid retention characteristic of reserpine and digidralazina (eliminated hydrochlorothiazide).

Indications:
Hypertension.

Contraindications:
Hypersensitivity, depression (including history), Parkinson's disease, epilepsy, electroconvulsive therapy, pheochromocytoma, concomitant or recent medication MAO inhibitors, peptic ulcer and 12 duodenal ulcer (exacerbation), ulcerative colitis, SLE, recent myocardial infarction, marked tachycardia, CH, coupled with a high cardiac output (including with thyrotoxicosis) or due to mechanical obstruction (aortic, mitral stenosis, constrictive pericarditis), isolated right ventricular failure due to pulmonary hypertension (pulmonary, heart); anuria, severe chronic renal failure (CC less than 30 ml / min), hepatic failure, refractory hypokalemia, hyponatremia, hypercalcemia, hyperuricemia with clinical manifestations, pregnancy, lactation, age 18 let.C caution. CHF, bradycardia, slowing AV and intraventricular conduction, recent myocardial infarction, cerebral and coronary atherosclerosis, diabetes mellitus, peptic ulcer and 12 duodenal ulcer (in history), erosive gastritis, calculous cholecystitis.

Side effects:
On the part of the digestive system: diarrhea, dry mouth, hypersecretion of gastric juice, hyperptyalism, nausea, vomiting, bulimia, gastrointestinal bleeding, jaundice, increased activity of "liver" enzymes, hepatitis. On the part of the SSA: lowering blood pressure, arrhythmia, angina "tides" of blood to the skin of the face, cerebrovascular accident. On the part of the nervous system: dizziness, depression, irritability, nightmares, dreams, fatigue, extrapyramidal disorders (including Parkinson's), headache, anxiety, reduced ability to concentrate, stupor, disorientation, very rarely - swelling of the brain. the respiratory system: swelling of nasal mucosa, dyspnoea, epistaxis. On the part of the urogenital system: reduced potency and / or libido, ejaculation disorder, dysuria, glomerulonephritis . On the part of the endocrine system: weight gain, hyperprolactinemia, galactorrhea, gynecomastia. From the senses: blurred vision, conjunctival hyperemia, lacrimation, hearing loss. Allergies: eczema, skin rash, itching, volchanochnopodobny syndrome, photosensitization, fever, purpura. From the side of blood: anemia, leukopenia, thrombocytopenia. Laboratory indicators: hypokalaemia, hyperlipidemia, hyponatremia, gipomagniemiya, hyperuricemia, hypercalcemia, hyperglycemia, Glycosuria, increased metabolic abnormalities in diabetes mellitus, gipohloremichesky alkalosis. Other: edema dairy zhelez.Peredozirovka. Symptoms: orthostatic hypotension, headache, dizziness, drowsiness, confusion, coma, extrapyramidal disorders, convulsions, paresthesia, miosis, vomiting, diarrhea, tachycardia, bradycardia, myocardial ischemia, angina, arrhythmias, depression of the respiratory center, water-electrolyte disturbances, myasthenia gravis, cramps in the calf muscles, oliguria. Treatment: gastric lavage, inside - activated charcoal, while lowering blood pressure - plazmozameschayuschie solutions, correction of electrolyte disturbances, vasoconstrictors, diarrhea - anticholinergic drugs, epilepsy and convulsions - antiepileptic drugs, with respiratory depression - AV.

Dosage and administration:
Ext. Initial dose - 1 tablet per day, with gradual increase to 3 tablets, maximum daily dose - 3 tablets; maintenance therapy - the minimum effective dose. In the liver, renal failure (CC 30 ml / min or a serum creatinine 2.5 mg/100 ml = 221 micromol / l) increase the interval between doses or reduce the dose.

Cautions:
7 days before the start of electroconvulsive therapy, elective surgery should be abolished drug, in case of emergency operations - preliminary enter atropine. Elderly patients and patients suffering from chronic diseases and cirrhosis of the liver should regularly monitor the concentration of blood electrolytes, in patients with hyperlipidemia - concentration of lipids in blood serum. If you suspect depression, arthralgia drug immediately overturned. MAO inhibitors should be lifted no later than 2 weeks before the start of drug treatment. In the appointment of diabetics receiving insulin or other hypoglycemic drugs, may require correction of dosing regimen these drugs. Be careful when using eye drops, nose drops and other drugs, which include alpha-adrenostimulyatorov. During the period of treatment must be careful when driving and occupation of other potentially hazardous activities that require increased attention and concentration quickness of psychomotor reactions.

Interaction:
Enhances Neurotoxicity salicylates, reduces the effect of oral hypoglycemic drugs, norepinephrine, epinephrine, antiepileptic drugs, and levodopa, holinoblokatorov, drugs that reduce the concentration of uric acid reduces the analgesic effect of morphine, enhances the effects (including spin), cardiac glycosides, cardiotoxic and neurotoxic effects of drugs Li +, the efficiency nondepolarizing muscle relaxants, reduces excretion of quinidine; enhances the central action of barbiturates, ethanol, drugs for inhalation anesthetics, antihistamine drugs, tricyclic antidepressants. increases the risk of allergic reactions to allopurinol, amantadine, reduces the kidney excretion of cytotoxic drugs, increasing their mielodepressivnoe action. Methyldopa increases the risk of depression, tricyclic antidepressants impair hypotensive effect; MAO inhibitors increase the risk of hyperactivity, hypertension, SCS, ACTH, amphotericin, karbenoksolon, laxatives, drugs - hypokalemia; NSAIDs weaken the diuretic and antihypertensive effects; kolestiramin reduces absorption. Guanetidin, methyldopa, beta-blockers , vasodilators, BCCI, ACE inhibitors enhance the hypotensive effect. Vitamin D, drugs Ca2 + increase the risk of hypercalcemia, cyclosporine - hyperuricemia, gout.

Albumin

International name:
Albumin (Albumin)

Group Affiliation:
Plazmozameschayuschee tool

Description of the active substance (INN):
Albumin

Dosage form:
solution [for diagnostic purposes], solution for infusion

Mode of action:
Plazmozameschayuschee funds received by fractionating human plasma. Replenishes deficit albumin plasma colloid osmotic supports (oncotic) pressure of the blood, rapidly improves blood pressure and BCC, and enhances the transition contributes to the retention of tissue fluid in the bloodstream increases the reserves of protein nutrition of tissues and organs.

Indications:
Shock (traumatic, operational and toxic); burns, accompanied by dehydration and condensation of "blood, hypoproteinemia, hypoalbuminemia, gastrointestinal lesions in violation of the digestive system (peptic ulcer and 12 duodenal ulcer, tumor, breach of patency of the gastrointestinal anastomosis).

Contraindications:
Hypersensitivity, severe anemia, CHF II-III century., Hypervolemia, edema legkih.C caution. Arterial hypertension, renal failure, thrombosis, continued internal bleeding, and CHF.

Side effects:
Allergic reactions, urticaria, pyrexia, pain in the lumbar region.

Dosage and administration:
V / a drip, 5, 10 and 20% solution injected at a speed of 50-60 drops / min, single dose - 200 ml. Dose was set individually depending on the indications and the clinical picture, usually 1-2 ml / kg 10% solution every day or two before reaching effect.

Cautions:
Introduction dehydration is possible only after preliminary ensure sufficient revenue fluid (oral, parenteral).

Aloes arborescens folia

International name:
Aloe arborescens leaves (Aloes arborescens folia)

Group Affiliation:
Herbal remedy

Description of the active substance (INN):
Aloe arborescens leaves

Dosage form:
injection, solution for subcutaneous injection, syrup, juice, coated tablets, Extract Oral [liquid]

Mode of action:
Nutrient stimulant. Has adaptogenic, tonic, laxative, antiseptic and choleretic effect. Improves cellular metabolism, trophic and regeneration of tissues, improves overall nonspecific body resistance and stability of the mucous membranes to the action of damaging agents, accelerates regeneration. Laxative effect due to the irritating effect on the intestinal mucosa and increased peristalsis. Time of onset of effect - 8-10 h after administration. It has some antimicrobial activity against streptococci, staphylococci, typhoid and dysentery bacilli, Proteus. It stimulates the protective functions of granulocytes, stimulates the appetite. Increases energy reserves in spermatozoa and enhances their mobility.

Indications:
Constipation, stomach ulcer and 12 duodenal ulcer, loss of appetite, gastritis, gastro, enterocolitis, cholecystitis, neuralgia, headache, asthma, tuberculosis, pneumonia, blepharitis, conjunctivitis, keratitis, vitreous opacity, myopic chorioretinitis, iritis, pigment retinitis, the inflammation of blood vessels eye, optic nerve atrophy, progressive myopia, trachoma, scar tissue changes, trophic ulcer, scleroderma, infertility (including men), radiation sickness, hearing loss and smell.

Contraindications:
Hypersensitivity, pregnancy, chronic renal failure, CHF, hypertension, metrorrhagia, haemorrhoids, cystitis, acute inflammatory diseases of the digestive tract, hemoptysis, cholelithiasis.

Side effects:
Allergic reactions, increased blood pressure, hyperthermia, diarrhea.

Dosage and administration:
N / a, inside. Sc daily for 1 ml (maximum daily dose - 3.4 ml), children under 5 years - 0.2-0.3 ml over 5 years - 0.5 ml. The course of treatment - 30-50 injections, repeated after 2-3 months. When tuberculous lesions of the respiratory tract initial dose of 0.2 ml with a gradual increase. In bronchial asthma - 1-1.5 ml for 10-15 days every day, and later - 1 time in 2 days. In the course of treatment - 30-35 injections. Inside: adults - 0.05 g (1 tablet) 3-4 times a day for 15-20 minutes before eating. The course of treatment - 1 month, if necessary, repeat in 3-6 months. Constipation - 0.05-0.2 g at bedtime. Liquid extract - 5 ml 2-3 times a day for 20-30 minutes before eating. The treatment course - 15-30 days, with infertility - 30-45 days. When diseases of the digestive tract, anorexia - 5-10 ml of juice for 30 minutes before meals 2-3 times a day.

TRICOR

Pharmacological action


Lipid-lowering drugs from the group of derivatives fibroevoy acid. Fenofibrate has the ability to modify the content of lipids in the human organism due to activation of receptor PPAR-α (alpha-activated receptors proliferatorom peroxisomes).

Fenofibrate increases lipolysis and elimination from the plasma of atherogenic lipoproteins with high triglyceride levels through activation of receptor PPAR-α, lipoprotein lipase and reducing the synthesis of apo C-III (apo C-III). The above effects lead to a decrease in content of fractions of LDL and VLDL, which include apo B (apo B), and increased content of HDL fraction, which include apo A-I (apo A-I) and apo A-II (apo A-II) . In addition, due to the correction of synthesis and catabolism of VLDL, fenofibrate increases LDL clearance and reduces the content of small and dense LDL particles (increase of LDL observed in patients with atherogenic lipid phenotype is accompanied by a high risk of CHD).

In clinical trials it was noted that the use of fenofibrate lowers total cholesterol by 20-25% and triglycerides by 40-55% with an increase in the level of CS-HDL by 10-30%. In patients with hypercholesterolemia, in which the level of CS-cholesterol decreased by 20-35% the use of fenofibrate resulted in a decline in the ratio: total cholesterol / HDL-XC, Hs-LPNP/Hs-LPVP, and apo B / apo A-I, which are markers of atherogenic risk.

Given the impact of fenofibrate on the level of CS-LDL and triglycerides, the use of the drug effective in patients with hypercholesterolemia as an attendant, and is not accompanied by hypertriglyceridemia, including secondary hyperlipoproteinemia, such as diabetes mellitus type 2. During treatment with fenofibrate treatment can significantly decrease or even disappear entirely extravascular deposits Xc (tendon and tuberous xanthoma). Patients with elevated levels of fibrinogen who receive treatment fenofibrate treatment, showed a significant decline in this indicator, as well as in patients with elevated levels of lipoproteins. In the treatment of fenofibrate treatment decrease the concentration of C-reactive protein and other markers of inflammation.

For patients with dyslipidemia and hyperuricemia additional advantage is that fenofibrate has urikozurichesky effect, which leads to a decrease in the concentration of uric acid by approximately 25%.

During clinical studies and animal experiments have shown that fenofibrate reduces platelet aggregation caused adrenalininduced, arachidonic acid and epinephrine.


Pharmacokinetics


Absorption

Once inside Traykora 145 mg C max achieved after 2-4 h. C max in blood plasma and the total effect of micronised fenofibrate in the form of nanoparticles (Traykor 145 mg) does not depend on the simultaneous ingestion (and therefore the drug can be taken at any time, regardless of meal).

Distribution

Fenofibroevaya acid durable and more than 99% bound to albumin plasma. T 1 / 2 - about 20 hours after the drug is not cumulative single dose and prolonged use.

Metabolism

After oral fenofibrate is rapidly hydrolyzed esterases. The plasma is found only major active metabolite of fenofibrate - fenofibroevaya acid. Prolonged use of concentration fenofibroevoy acid in the plasma remains stable, regardless of the individual patient. Fenofibrate is not a substrate for CYP3A4, is not involved in the microsomal metabolism.

Withdrawal

Derive mainly from the urine in the form fenofibroevoy acid and glucuronide conjugate. Within 6 days fenofibrate displayed almost completely.

Pharmacokinetics in special clinical situations

In elderly patients the overall clearance fenofibroevoy acid does not change.

When hemodialysis is not displayed.


Indications for use of the drug TRAYKOR


- Hypercholesterolemia and hypertriglyceridemia isolated or mixed (dyslipidemia type IIa, IIb, IV) with non-drug therapies failure (hypolipidaemic diet, weight loss, increased physical activity), especially when associated with dyslipidemia risk factors such as hypertension and smoking;

- Secondary hyperlipoproteinaemia, in cases where hyperlipoproteinaemia persists despite effective treatment of underlying disease (eg, dyslipidemia in diabetes mellitus).




Dosage regimen


Adults appoint 1 tablet 1 time /

Patients receiving 1 capsule. fenofibrate 200 mg can go to receive 1 tablet 145 mg Traykora no additional dose adjustment. Patients taking one tablet of fenofibrate 160 mg / Can go to receive 1 tablet Traykora 145 mg dose without additional adjustments.

Elderly patients are encouraged to nominate a standard dose for adults.

The use of the drug in patients with liver disease is not known.

Traykor drug 145 mg taken at any time of day, regardless of the meal, the tablet should be swallowed whole without chewing, with a glass of water.

The drug should take a long time, while continuing to diet, the patient adhered to the treatment Traykorom.


Side effect


On the part of the digestive system: (> 1 / 100, <1> 1 / 1000, <1 / 100) - pancreatitis , the formation of gallstones; (<1 / 10 000) - hepatitis. If you have symptoms of hepatitis (jaundice, pruritus) should conduct laboratory tests and, if confirmation of the diagnosis, remove the drug.

On the part of the musculoskeletal system: (> 1 / 10 000, <1 / 1000) - diffuse myalgia, myositis, muscle cramps, muscle weakness (<1 / 10 000) - rhabdomyolysis, increased CPK activity.

Since the cardiovascular system: (> 1 / 1000, <1 / 100) - deep vein thrombosis, pulmonary embolism.

On the part of the hemopoietic system: (> 1 / 10 000, <1 / 1000) - elevated levels of hemoglobin, increasing the number of leukocytes.

From the central nervous system and peripheral nervous system: (> 1 / 10 000, <1 / 1000) - sexual dysfunction, headache.

On the part of the respiratory system: (<1 / 10 000) - Interstitial pneumopathy.

From the laboratory data: (> 1 / 1000, <1 / 100) - increase the level of creatinine and urea in the blood serum.

Allergic reactions: (> 1 / 1000, <1 / 100) - skin rash, hives, itching.

Dermatological reactions: (1 / 10 000.1 / 1000) - alopecia; (<1 / 10 000) - photosensitivity, accompanied by erythema, formation of blisters or nodules on the skin areas exposed to sunlight or artificial ultraviolet light, for example, quartz lamps (these effects can occur even after months of use without any complications).


Contraindications to the use of the drug TRAYKOR


- Hepatic impairment (including cirrhosis);

- Renal failure, severe (CC <20 ml / min);

- Gallbladder disease;

- Congenital galactosemia, lactase deficiency, malabsorption of glucose and galactose (product contains lactose);

- Congenital fruktozemiya, lack sucrose-izomaltazy (product contains sucrose);

- A history of allergic reaction to peanuts, peanut butter, soy lecithin or related products (in relation to the risk of hypersensitivity reactions);

- Childhood and adolescence to 18 years;

- Lactation (breastfeeding);

- A history of photosensitivity or phototoxicity in the treatment of fibrates or ketoprofenom;

- Hypersensitivity to the drug's components.

Precautions designate patients with impaired renal function, in hypothyroidism, patients who abuse alcohol, elderly patients, with indications of a history on the hereditary muscle diseases, while taking oral anticoagulants, inhibitors of HMG-CoA reductase.


Use of the drug TRAYKOR during pregnancy and breastfeeding


Data on the use of fenofibrate in pregnancy are scarce. The potential risk for humans is unknown. Use of the drug during pregnancy is possible only when the intended benefits to the mother outweighs the potential risk to the fetus.

Due to the lack of safety data, use during lactation (breastfeeding) is contraindicated.

In experimental animal studies, teratogenic effect of fenofibrate was not found. Embryotoxicity in giving doses toxic to the maternal organism.


Application for violations of liver function


Contraindicated in hepatic failure (including cirrhosis);


Application for violations of renal function


Contraindicated in renal failure, severe (CC <20 ml / min); carefully prescribed to patients with impaired renal function


Cautions


Before you start therapy Traykorom, there should be an appropriate treatment to eliminate the cause of secondary hypercholesterolemia, for example, in diseases such as uncontrolled type 2 diabetes mellitus, hypothyroidism, nephrotic syndrome, dysproteinemia, obstructive liver disease, the effects of drug therapy, alcoholism.

The effectiveness of therapy should be evaluated on the content of lipids (CH, LDL, triglycerides) in blood serum. If there is no therapeutic effect after several months of therapy (usually after 3 months) should consider whether the use of concomitant or alternative therapies.

Patients with hyperlipidemia receiving estrogens or hormonal contraceptives containing estrogen, should determine whether hyperlipidemia primary or secondary nature. In such cases, increasing lipid levels may be caused by estrogen

When you receive Traykora and other drugs that reduce the concentration of lipids, some patients described increased activity of hepatic transaminases. In most cases, this increase was temporary, minor and asymptomatic. During the first 12 months of treatment is recommended to control the level of hepatic transaminases (ALT, ACT) every 3 months. Patients who during the treatment increased the concentration of enzymes, require attention and, if elevated concentrations of alanine aminotransferase and the ACT more than 3 times compared with FHG stop taking the drug.

Have been described cases of pancreatitis during the treatment Traykorom. Possible causes of pancreatitis in these cases were: lack of efficacy in patients with severe hypertriglyceridemia, a direct effect the drug, as well as secondary effects associated with the presence of stones or the formation of sludge in the gallbladder accompanied by obstruction of the common bile duct.

When receiving Traykora and other drugs that reduce the concentration of lipids, described cases of toxic effects on muscle tissue, including the very rare cases of rhabdomyolysis. The frequency of such violations increased in the case of hypoalbuminemia and renal failure in history. The possibility of this complication increases in cases of hypoalbuminemia and renal failure.

The toxic effect on muscle tissue can be suspected based on the patient's complaints of weakness, diffuse myalgia, myositis, muscle spasms and cramps, and / or a pronounced increase in the activity of CK (more than 5 times compared to FHG). In these cases, treatment Traykorom should cease.

The risk of rhabdomyolysis may be increased in patients with a predisposition to myopathy and / or rhabdomyolysis, including age older than 70 years, weighed down by history of hereditary muscle diseases, renal failure, hypothyroidism, alcohol abuse. Such patients should be prescribed the drug only if the expected benefit exceeds the potential risk of rhabdomyolysis.

At the same time taking with inhibitors HMG-CoA reductase inhibitors or other fibrates increases the risk of serious toxic effects on muscle fibers especially if the patient prior to treatment suffered muscle diseases. In this regard, a joint appointment Traykora and statin is permissible only if the patient has severe mixed dyslipidemia and high cardiovascular risk, in the absence of a history of muscle diseases and in conditions of close monitoring to detect signs of toxic effects on muscle tissue.

In the case of increasing the concentration of creatinine by more than 50% above FHG treatment should be suspended. In the first 3 months of treatment is recommended to determine the concentration of creatinine.

Effects on ability to drive vehicles and management mechanisms

When the drug effect on the ability to drive a car and management mechanisms have been discovered.




Cases of overdose have not been described.

Treatment: the holding of symptomatic and, if necessary, supportive therapy. The specific antidote is known. Hemodialysis is ineffective.


Drug Interactions


Fenofibrate enhances the effect of oral anticoagulants and may increase the risk of bleeding, which is associated with the displacement of anticoagulant from the binding sites of plasma proteins. In the early treatment of fenofibrate treatment is recommended to reduce the dose of anticoagulants approximately one third, followed by gradual selection of the dose. Selection of the dose recommended for control of the level of MHO.

We describe a few severe cases of reversible decline of renal function during the simultaneous treatment of fenofibrate treatment and cyclosporine. It is therefore necessary to monitor the status of renal function in these patients and cancel fenofibrate in the case of a serious change in laboratory parameters.

When receiving fenofibrate together with inhibitors HMG-CoA reductase inhibitors or other fibrates increases the risk of serious toxic effects on the muscle fibers.

Studies of human liver microsomes in vitro demonstrated that fenofibrate and fenofibroevaya acid are not inhibitors isozymes CYP3A4, CYP2D6, CYP2E1 or CYP1A2. At therapeutic concentrations, these compounds are weak inhibitors of CYP2C19 and CYP2A6 isozymes, and weak or moderate inhibitors of CYP2C9.

NEOFILIN

Pharmacological properties: theophylline (1,3-theobromine) - a natural compound, an alkaloid. Its mechanism of action is mainly due to the blocking of adenosine receptors, inhibition of phosphodiesterases, increases the content of intracellular cAMP and decrease intracellular calcium ion concentration. Consequently, the relaxation of bronchial smooth muscle, gastrointestinal tract, biliary tract cancer, coronary, cerebral and pulmonary blood vessels, dilates coronary arteries, decreases peripheral vascular resistance. The drug increases the tone of respiratory muscles (intercostal muscles and diaphragm) reduces pulmonary vascular resistance and improves oxygenation of the blood, activates the respiratory center of the medulla oblongata, increases its sensitivity to carbon dioxide, improves alveolar ventilation, which reduces the severity and reduce the frequency of episodes of apnea. Theophylline eliminates angiospasm, increases collateral blood flow and blood oxygen saturation, and a general decrease perifocal edema, cerebrospinal fluid and thus reduces intracranial pressure. It improves the rheological properties of blood, reduces blood clots, inhibits platelet aggregation (factor inhibiting platelet activation and prostaglandin F2-α), normalizes microcirculation. Has antiallergic effect by inhibiting degranulation of mast cells and reducing the level of allergy mediators (serotonin, histamine, leukotrienes). Promotes renal blood flow, has a diuretic effect due to a decrease in the reabsorption of tubular, increases the excretion of water, chloride ions, sodium, etc. The effect of drug is fully developed after 3-4 days of starting treatment.

When administered theophylline completely absorbed in the gastrointestinal tract, bioavailability is about 90%. When receiving theophylline in the form of tablets with prolonged action the maximum concentration achieved after 6 h. The binding to plasma proteins is in healthy adults - about 60% of patients with liver cirrhosis - 35%. Penetrates histohematogenous barriers, dividing in the tissues. About 90% of theophylline is metabolized in the liver with involvement of several isozymes of cytochrome P450 to inactive metabolites - 1,3-dimetilmochevoy acid, 1-metilmochevoy acid and 3-methylxanthine. Excreted mainly by the kidneys as metabolites; unchanged output in adults up to 13% in children - up to 50% of the drug. Partially allocated to breast milk. The half-life of theophylline depends on the age and the presence of concomitant diseases and of adult patients with asthma - 6-12 h in children older than 6 months - 3-4 hours, with tobacco smoking - 4-5 h, y the elderly and in heart failure, abnormal liver function, pulmonary edema, COPD and bronchitis - more than 24 h, which requires appropriate correction of the interval between doses of the drug. Therapeutic concentrations of theophylline in blood in order to achieve a bronchodilator effect - 10-20 mg / ml for the stimulative effect on the respiratory center - 5-10 ug / ml. Toxic concentration - above 20 ug / ml.

Indications: asthma, including asthma status, chronic obstructive bronchitis and pulmonary disease with symptoms of bronchial obstruction, pulmonary hypertension, sleep apnea syndrome.

APPLICATION: dose is selected individually depending on the severity of disease, body weight, age, metabolism in smokers.

In adults the initial dose is usually 0.3 1 g once a day. After 3 days in the absence of serious side effects, the dose can be increased to maintenance - 0,6 g (0,3 g, 2 times a day), in the case of predominantly nocturnal and early morning attacks - 0.6 g once in the evening. In smoking patients the initial dose is 0.3 g 1 per day, which with good endurance gradually increase every 2 days at 0,3 g to maintenance - 0,9-1,2 g (0,6 g in the evening, 0,3 -0.6 g in the morning).

For persons weighing less than 60 kg daily dose is 0.3 grams (1 time per day or 0.2 g in the evening and the morning of 0,1 g) birth weight less than 40 kg initial dose is 0.2 g 1 times day, keeping - 0,4 g (0,2 g, 2 times a day).

For children aged 12-16 years with body weight 40-60 kg initial dose is 0.3 g 1 per day. After 3 days, with good tolerance dose can be increased to maintenance - 0,6 g (0,3 g, 2 times a day).

For children aged 6-12 years weighing 20-40 kg initial dose is 0.2 g 1 per day. After 3 days, with good tolerability the dose can be increased to maintenance - 0,4 g (0,2 g, 2 times a day). The initial dose for children aged 3-6 years weighing up to 20 kg of 0.1 1 g once a day. 3 days later with good tolerability the dose can be increased to maintenance - 0,2 g (0,1 g, 2 times a day).

CONTRAINDICATIONS: Hypersensitivity to the drug's components, and xanthine derivatives (caffeine, pentoxifylline), epilepsy, peptic ulcer or duodenal ulcer, glaucoma, simultaneous reception Oleandomycin or erythromycin, hemorrhagic stroke, bleeding in the retina of the eye, acute myocardial infarction, marked coronary atherosclerosis, forerunner of internal bleeding, pregnancy and lactation, age 3 years, severe hypertension, tachyarrhythmia, hypertrophic obstructive cardiomyopathy, hyperthyroidism.

SIDE EFFECTS: headache, dizziness, agitation, tremor, anxiety, insomnia, convulsions, tachycardia, arrhythmia, lower blood pressure, discomfort and pain in the epigastric region, vomiting, heartburn, aggravation of cholecystitis, cholestatic hepatitis, increased activity of ALT, AST in serum ; allergic reactions - skin rash, itching, flu-like syndrome, difficulty in nasal breathing.

Cautions: severe disease of the cardiovascular system, liver, virus infections, the elderly, drug dose should be reduced and applied with caution. Smokers of efficacy may be reduced.

Engagement: when used with drugs theophylline and sympathomimetics with diuretic drugs is mutual reinforcement of their actions, with-adrenoceptor blockers in the therapy of lithium and their effects are mutually reduced. Pharmacological effects of theophylline may be reduced (due to increase its clearance through the induction of microsomal liver enzymes), while the use of xanthine, carbamazepine, phenytoin, rifampicin, isoniazid, terbutaline. Allopurinol, cimetidine, isoprenaline, cyclosporine A, macrolide antibiotics (erythromycin, Oleandomycin), lincomycin, oral contraceptives (estrogens) and antiserum to increase the risk of side effects of theophylline (due to the reduction of its clearance), which necessitates the correction of the dose. The risk for side effects of GCS mineralokortikoidov, means for anesthesia (increased risk of ventricular arrhythmias), xanthine and means that excite the central nervous system (increased neurotoxicity), ephedrine and efedrinsoderzhaschih drugs, in-sympathomimetics.

OVERDOSE:

Symptoms in adults: convulsions, increased body temperature, cardiac abnormalities (tachycardia, ventricular arrhythmias, hypotension).

Symptoms in children: irritability, mental disturbances, fever, nausea, cramps, tachycardia, hypotension, dyspnea.

Treatment: the cessation of drug administration, gastric lavage, irrigation, bowel combination of polyethylene glycol and salt, activated charcoal method, stimulation of excretion of theophylline from the body (forced diuresis, hemosorbtion, plasmasorption, hemodialysis, peritoneal dialysis) and of symptomatic means: when expressed nausea and vomiting - metoclopramide or ondansetron, in convulsions - diazepam.

Storage: Store in original container at 25 ° C.

ORNISTAT

Pharmacological properties: an integrated drug for treatment of chronic gastritis, peptic ulcer and duodenal ulcer associated with Нelicobacter pylori. Rabeprazole - antisecretory drug group substituted benzimidazoles, blocks the secretion of hydrochloric acid in the stomach by specific inhibition of the enzyme H + / K +-ATPase at the secretory surface parietal cells (ie, a proton pump inhibitor).

The mechanism of action Ornidazole associated with DNA damage was sensitive to it microorganisms. Ornidazole active against Trichomonas vaginalis, Entamoeba histolytica, Giardia lamblia (Giardia intestinalis), Helicobacter pylori, as well as some anaerobic bacteria such as Bacteroides and Clostridium spp., Fusobacterium spp. And anaerobic cocci.

Clarithromycin has an antibacterial effect by inhibition of protein synthesis by binding to the 50S-ribosomal subunit.

After receiving rabeprazole inside antisecretory effect develops within 1 h and reaches a maximum after 2-4 hours Inhibition of basal and stimulated gastric secretion observed after 23 h after the first dose of rabeprazole. Stable inhibition of gastric secretion is achieved after 3 days of receiving rabeprazole. Thanks to a special dosage form of rabeprazole absorption occurs in the intestines. The drug is rapidly absorbed from the intestine, its maximum plasma concentration achieved after 3.5 h after oral administration at a dose of 20 mg.

Once inside absorbed 90% Ornidazole. Maximum plasma concentration achieved after 3 h. The binding Ornidazole with blood plasma proteins is approximately 13%. Depending on the dosage regimen the concentration of active substance in the blood serum of 6-36 mg / liter. Ornidazole well into the CSF, other body fluids and tissues. The half-life is about 13 hours After a single dose of 85% of drug output during the first 5 days, 63% - in the urine, 22% - with the feces. Approximately 4% of applied dose excreted in the urine in unchanged form. The coefficient of cumulation after repeated taking the drug at a dose of 500 or 1000 mg of healthy volunteers every 12 hours is 1,5-2,5.

The concentration of clarithromycin in plasma 2 h after oral administration at a dose of 500 mg of 1,97 mg / ml. The half-life of the drug dozozavisim. Clarithromycin is metabolized in the liver. Active against H. pylori (IPC 90 = 0,03 mg / l), which makes it possible to use the drug in the schemes for eradication of H. pylori.

INDICATIONS: eradication of H. pylori in chronic gastritis, peptic ulcer of stomach and duodenum.

APPLICATION: Each blister Ornistata contains 2 tablets of rabeprazole (20 mg), 2 tablets Ornidazole (500 mg) and 2 tablets of clarithromycin (500 mg). A blister is calculated at 1 day treatment. Take 1 tablet of rabeprazole, 1 tablet Ornidazole and 1 tablet of clarithromycin in the morning and evening. The recommended duration of treatment - 7 days.

CONTRAINDICATIONS: Hypersensitivity to rabeprazole, clarithromycin and ornidazole, during pregnancy.

SIDE EFFECTS: Dry mouth, in a few cases - dyspepsia, prolonged use at high doses are rarely - Hepatotoxic effects, expressed mild and quickly passing drowsiness, headache, fatigue, in some cases - excitement, very rarely - tremor, muscular rigidity , violations of coordination, convulsions, confusion, angioedema, rash, itching, hives.

Cautions: The components of the drug are excreted with breast milk, so it is recommended to stop breast-feeding during treatment.

Clarithromycin is allocated by the liver and kidneys, so the dose in patients with hepatic and renal insufficiency should be adjusted. The dose of rabeprazole should be reduced in hepatic failure. Ornidazole used with caution in liver disease and chronic alcoholism.

In appointing Ornistata patients with diseases of the CNS (eg epilepsy, multiple sclerosis, in the case of exceeding the recommended dose) increases the risk of side effects.

INTERACTION: Appointment of rabeprazole in combination with antacids does not cause clinically significant change in the concentration of rabeprazole in plasma. Ornidazole may interact with indirect anticoagulants, as well as to prolong the effect of vecuronium bromide. Clarithromycin should not be given concurrently with ergotamine or its derivatives in connection with the possibility of a spasm of the arteries, which may lead to ischemia. Clarithromycin alters the pharmacokinetics of carbamazepine and interacts with warfarin, ranitidine and magnesium or aluminum containing antacids. Appointment of clarithromycin to patients who are simultaneously taking drugs metabolized by cytochrome P450 may increase their level in blood serum, which requires the monitoring of concentration.

OVERDOSE: describes reception of rabeprazole 80 mg. Overdosing was not accompanied by any clinical symptoms. A large overdose can occur Ornidazole disorientation, nausea and vomiting, clarithromycin overdose - nausea, vomiting, diarrhea, abdominal pain. Carry out gastric lavage, appoint symptomatically.

Storage: Store in dark place at a temperature of 15-25 ° C.

LIMZER

Pharmacological properties: combined drug effect is due to the components in its composition. Omeprazole belongs to the antiulcer Drugs that inhibit the basal and stimulated secretion of hydrochloric acid in gastric parietal cells due to the specific blocking H + / K +-ATPase (proton pump). Antisecretory effect of omeprazole develops during the first hour after administration and lasts for days. Omeprazole due to its high lipophilicity easily penetrates the parietal cells of the stomach, is concentrated in them, and provides Cytoprotective effect. Inhibitory effect increases in the first 4 days of admission. Omeprazole does not affect the motility of the gastrointestinal tract.

Domperidone blocks peripheral dopamine receptors, eliminates the inhibitory effect of dopamine on the motor function of the gastrointestinal tract, in particular, stimulates motor-evacuatory activity of the stomach. Eliminates the nausea and hiccups, has the action of antiemetics. Poorly crosses the BBB, has virtually no effect on dopamine receptors in the brain.

INDICATIONS: Peptic ulcer of the stomach and duodenum in the absence of H. pylori, slow evacuation of stomach contents, Gastroparesis, reflux esophagitis, functional dyspepsia.

APPLICATION: capsules taken by mouth in whole, without disclosing and not liquid. The recommended dose and duration of treatment depends on the disease and set individually. The average recommended dose for adults - 1 capsule 1 time a day for 10-15 minutes before a meal (drink a glass of water).

Elderly patients and patients with renal insufficiency requires an individual approach in the selection of doses, but in many cases, dose adjustment is required.

CONTRAINDICATIONS: Hypersensitivity to the drug's components, gastrointestinal bleeding, mechanical intestinal obstruction, perforation of the stomach or intestine, prolaktinoma, during pregnancy and lactation, age 12 years.

SIDE EFFECTS: Most patients tolerate the drug well. Prolonged use may experience skin reactions (rash, pruritus, urticaria, polymorphous erythema), dryness of the mouth, diarrhea, constipation, intestinal colic, headache, photosensitivity, alopecia, Quincke's edema, dizziness, parastezii, drowsiness, insomnia, blurred vision, change in taste, agitation, depression, leukopenia, thrombocytopenia, pancytopenia, agranulocytosis, myalgia, arthralgia, bronchospasm, interstitial nephritis, very rarely - galactorrhea, gynecomastia. Domperidone may lead to development of extrapyramidal disorders, particularly in elderly patients.

SPECIAL PRECAUTIONS: before and after omeprazole therapy is necessary to endoscopy to exclude undiagnosed cases of malignant process, as treatment omeprazole can mask symptoms and delay the correct diagnosis.

Patients with chronic liver diseases should always (at least 1 time in 2 weeks) to conduct laboratory testing of blood for determining the activity of liver enzymes. In case of change of these indices taking the drug should be discontinued.

During the period of drug treatment need to be careful while driving or operating machinery.

INTERACTIONS: Antacids drugs slow down and reduce the absorption Limzera, so they should be applied no earlier than 2 hours after his admission.

Because the metabolism of omeprazole by the liver via the cytochrome P450, should carefully take it along with diazepam, phenytoin, warfarin, propranolol, prednisolone, theophylline (with omeprazole may reduce their elimination, which requires lower doses of these drugs). With simultaneous application of omeprazole and clarithromycin concentration in plasma increases.

Cimetidine and sodium bicarbonate reduces the bioavailability of domperidone.

Antiholinergicheskie drugs neutralize the action of domperidone.

OVERDOSAGE: Symptoms: drowsiness, disorientation, vomiting, tachycardia, extrapyramidal disorders.

Treatment: gastric lavage, the use of activated charcoal, symptomatic therapy.

Storage: Store in a dry place protected from light at 25 ° C.

ORNISTAT

Pharmacological properties: an integrated drug for treatment of chronic gastritis, peptic ulcer and duodenal ulcer associated with Нelicobacter pylori. Rabeprazole - antisecretory drug group substituted benzimidazoles, blocks the secretion of hydrochloric acid in the stomach by specific inhibition of the enzyme H + / K +-ATPase at the secretory surface parietal cells (ie, a proton pump inhibitor).

The mechanism of action Ornidazole associated with DNA damage was sensitive to it microorganisms. Ornidazole active against Trichomonas vaginalis, Entamoeba histolytica, Giardia lamblia (Giardia intestinalis), Helicobacter pylori, as well as some anaerobic bacteria such as Bacteroides and Clostridium spp., Fusobacterium spp. And anaerobic cocci.

Clarithromycin has an antibacterial effect by inhibition of protein synthesis by binding to the 50S-ribosomal subunit.

After receiving rabeprazole inside antisecretory effect develops within 1 h and reaches a maximum after 2-4 hours Inhibition of basal and stimulated gastric secretion observed after 23 h after the first dose of rabeprazole. Stable inhibition of gastric secretion is achieved after 3 days of receiving rabeprazole. Thanks to a special dosage form of rabeprazole absorption occurs in the intestines. The drug is rapidly absorbed from the intestine, its maximum plasma concentration achieved after 3.5 h after oral administration at a dose of 20 mg.

Once inside absorbed 90% Ornidazole. Maximum plasma concentration achieved after 3 h. The binding Ornidazole with blood plasma proteins is approximately 13%. Depending on the dosage regimen the concentration of active substance in the blood serum of 6-36 mg / liter. Ornidazole well into the CSF, other body fluids and tissues. The half-life is about 13 hours After a single dose of 85% of drug output during the first 5 days, 63% - in the urine, 22% - with the feces. Approximately 4% of applied dose excreted in the urine in unchanged form. The coefficient of cumulation after repeated taking the drug at a dose of 500 or 1000 mg of healthy volunteers every 12 hours is 1,5-2,5.

The concentration of clarithromycin in plasma 2 h after oral administration at a dose of 500 mg of 1,97 mg / ml. The half-life of the drug dozozavisim. Clarithromycin is metabolized in the liver. Active against H. pylori (IPC 90 = 0,03 mg / l), which makes it possible to use the drug in the schemes for eradication of H. pylori.

INDICATIONS: eradication of H. pylori in chronic gastritis, peptic ulcer of stomach and duodenum.

APPLICATION: Each blister Ornistata contains 2 tablets of rabeprazole (20 mg), 2 tablets Ornidazole (500 mg) and 2 tablets of clarithromycin (500 mg). A blister is calculated at 1 day treatment. Take 1 tablet of rabeprazole, 1 tablet Ornidazole and 1 tablet of clarithromycin in the morning and evening. The recommended duration of treatment - 7 days.

CONTRAINDICATIONS: Hypersensitivity to rabeprazole, clarithromycin and ornidazole, during pregnancy.

SIDE EFFECTS: Dry mouth, in a few cases - dyspepsia, prolonged use at high doses are rarely - Hepatotoxic effects, expressed mild and quickly passing drowsiness, headache, fatigue, in some cases - excitement, very rarely - tremor, muscular rigidity , violations of coordination, convulsions, confusion, angioedema, rash, itching, hives.

Cautions: The components of the drug are excreted with breast milk, so it is recommended to stop breast-feeding during treatment.

Clarithromycin is allocated by the liver and kidneys, so the dose in patients with hepatic and renal insufficiency should be adjusted. The dose of rabeprazole should be reduced in hepatic failure. Ornidazole used with caution in liver disease and chronic alcoholism.

In appointing Ornistata patients with diseases of the CNS (eg epilepsy, multiple sclerosis, in the case of exceeding the recommended dose) increases the risk of side effects.

INTERACTION: Appointment of rabeprazole in combination with antacids does not cause clinically significant change in the concentration of rabeprazole in plasma. Ornidazole may interact with indirect anticoagulants, as well as to prolong the effect of vecuronium bromide. Clarithromycin should not be given concurrently with ergotamine or its derivatives in connection with the possibility of a spasm of the arteries, which may lead to ischemia. Clarithromycin alters the pharmacokinetics of carbamazepine and interacts with warfarin, ranitidine and magnesium or aluminum containing antacids. Appointment of clarithromycin to patients who are simultaneously taking drugs metabolized by cytochrome P450 may increase their level in blood serum, which requires the monitoring of concentration.

OVERDOSE: describes reception of rabeprazole 80 mg. Overdosing was not accompanied by any clinical symptoms. A large overdose can occur Ornidazole disorientation, nausea and vomiting, clarithromycin overdose - nausea, vomiting, diarrhea, abdominal pain. Carry out gastric lavage, appoint symptomatically.

Storage: Store in dark place at a temperature of 15-25 ° C.