2010/06/24

Azithrus

Composition, structure and packing

Gelatine capsules, yellow; content caps - white granules or nearly white.

A capsule. azithromycin (in the form of dihydrate) 250 mg.

Excipients: povidone (polyvinylpyrrolidone), calcium stearate, microcrystalline cellulose.

The composition of gelatin capsules: titanium dioxide, metilgidroksibenzoat, propilgidroksibenzoat, acetic acid, gelatin. Powder for suspension for oral use white or nearly white, with orange odor; preparation of the suspension - a homogeneous, white with a yellowish tinge.

Clinico-pharmacological group: Antibiotic macrolide - azalid.

Pharmacological action

Broad-spectrum antibiotic of macrolides, azalid.

Valid bacteriostatic. Communicating with the 50S-subunit of ribosomes, inhibits protein synthesis and slows the growth and multiplication of bacteria. In high concentrations, has a bactericidal effect. Operates on extra-and intracellular pathogens.

It is active against Gram-positive microorganisms: Streptococcus spp. (Groups C, F and G, except for resistance to erythromycin), Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus viridans, Staphylococcus epidermidis, Staphylococcus aureus; Gram-negative bacteria: Haemophilus influenzae, Moraxella catarrhalis, Bordetella pertussis, Bordetella parapertussis, Legionella pneumophila, Haemophilus ducreyi, Campylobacter jejuni, Neisseria gonorrhoeae and Gardnerella vaginalis; some anaerobic microorganisms: Bacteroides bivius, Clostridium perfringens, Peptostreptococcus spp., as well as intracellular pathogens: Chlamydia trachomatis, Chlamydia pneumoniae, Mycoplasma pneumoniae, Mycobacterium avium complex, Ureaplasma urealyticum, Treponema pallidum, Borrelia burgdoferi.

Azithromycin is not active against gram-positive bacteria resistant to erythromycin.

Pharmacokinetics

Absorption

After taking the drug inside azithromycin is rapidly absorbed from the gastrointestinal tract, due to its stability in acidic medium and lipophilicity. After receiving the oral dose of 500 mg Cmax in the plasma is achieved through 2.5-2.9 h and is 0.4 mg / liter. Bioavailability - 37.5%.

Distribution

Azithromycin is quickly distributed throughout the body, while in the tissues reached high concentrations of antibiotic. Well into the respiratory tract, organs and tissues of the urogenital tract (in particular, in the prostate gland), in skin and soft tissue. The high concentration in tissues (10-50 times higher than in blood plasma) and a long T1 / 2 due to low binding of azithromycin from plasma proteins, as well as its ability to penetrate into eukaryotic cells and concentrate in an environment with low pH, environmental lysosomes. This, in turn, defines a large apparent Vd (31.1 L / kg) and high plasma clearance. The ability of azithromycin to accumulate mainly in lysosomes is particularly important for elimination of intracellular pathogens. Shown that phagocytes deliver azithromycin to the localization of infection sites, where it is released during phagocytosis. The concentration of azithromycin in the foci of infection was significantly higher than in healthy tissues (on average 24-34%) and correlated with the degree of inflammatory edema. Despite the high concentration in phagocytes, azithromycin did not significantly affect their function. Azithromycin remains in bactericidal concentrations of inflammation within 5-7 days after receiving the last dose, which allowed the development of short (3-day and 5-day) courses of treatment.

Metabolism

Azithromycin is metabolized in the liver by demethylation with the formation of inactive metabolites.

Withdrawal

Withdrawal of azithromycin from plasma takes place in two stages: T1 / 2 was 14-20 h in the range of 8 to 24 h after drug administration and 41 h - in the range of 24 to 72 hours, which allows to use a drug once a day. Derive mainly from the bile in unchanged form, a small part is displayed by the kidneys.

Statement

Infectious and inflammatory diseases caused by organisms sensitive to the drug:
infections of the upper respiratory tract and ENT-organs (including tonsillitis, sinusitis, tonsillitis, pharyngitis, otitis media);
Infection of lower respiratory tract (including bacterial and atypical pneumonia, bronchitis);
infections of skin and soft tissue (including erysipelas, impetigo, secondarily infected dermatitis);
urinary tract infection (gonorrheal urethritis and negonoreyny);
infections of the reproductive system (including cervicitis);
scarlet fever;
Lyme disease (Lyme disease) in the early stages (erythema migrans);
gastric and duodenal ulcers, associated to Helicobacter pylori (in the combined therapy).

Dosage regimen

Drugs are taken by mouth 1 time / day for 1 hour before or 2 hours after meals.

Adults

When infections of the upper and lower respiratory tract appoint 500 mg / day for 3 days (course dose - 1.5 g).

With infections of the skin and soft tissue appoint 1 g / day in 1 day, then 500 mg daily from 2 to 5-day (course dose - 3 g).

In uncomplicated urethritis and / or cervicitis appoint a single city

When Lyme disease (borrelia) for the treatment of early stages (erythema migrans) appoint 1 g in 1-day and 500 mg daily, from 2 to 5 days (course dose - 3 g).

For gastric ulcers and duodenal ulcers associated with Helicobacter pylori, appoint 1 g / day for 3 days in a combination therapy of H. pylori.

Children

The drug in capsule form prescribed for children over 3 years and / or body weight over 25 kg in infections of the upper and lower respiratory tract, skin and soft tissue at the rate of 10 mg / kg 1 time / day for 3 days (course dose - 30 mg / kg), or 1 day - 10 mg / kg, then 4 days - at 5-10 mg / kg / day.

In the treatment of early stages (erythema migrans) Lyme disease (borreliosis), a drug administered in a dose of 20 mg / kg / day 1, followed by 10 mg / kg from 2 to 5 day.

The drug in the form of a suspension for oral designate children older than 6 months with infections of the upper and lower respiratory tract, skin and soft tissue at the rate of 10 mg / kg 1 time / day for 3 days (course dose - 30 mg / kg) or within 5 days: 1 day - 10 mg / kg, then for 4 days - by 5-10 mg / kg / day.

In the treatment of early stages (erythema migrans) Lyme disease (borreliosis), a drug administered in a dose of 20 mg / kg / day 1, followed by 10 mg / kg from 2 to 5 th day.

Terms of preparing a suspension for oral

Single-dose packet. In a clean glass pour a small amount of boiled and cooled water, then pour the contents of one packet and mix until a homogeneous suspension. When you receive the glass should be rinsed with water, dried and stored in a dry and clean place.

Side effect
On the part of the digestive system: - diarrhea (5%), nausea (3%), abdominal pain (3%); ≤ 1% - flatulence, vomiting, melena, cholestatic jaundice, increase in liver transaminases; children - constipation loss of appetite, gastritis, candidiasis of the oral mucosa, changes in taste (≤ 1%).
Since the cardiovascular system: heart, chest pain (≤ 1%).
From the side of the central nervous system: dizziness, headache, drowsiness; in children - a headache (in the treatment of otitis media), hyperkinesia, anxiety, neurosis, sleep disturbances (≤ 1%).
From the urinary system: Jade (≤ 1%).
On the part of the reproductive system: vaginal candidiasis.
Allergic reactions: rash, urticaria, pruritus, angioedema; children - conjunctivitis, pruritus, urticaria.
Other: asthenia, photosensitivity.

Contraindications
renal failure;
hepatic impairment;
lactation (breastfeeding);
Children younger than 6 months (for suspension);
Children aged 3 years and / or body weight less than 25 kg (for capsules);
Hypersensitivity to the drug's components.

With care prescribers to patients with cardiac arrhythmias (ventricular arrhythmias are possible, lengthening the interval QT), children with severe disorders of the kidneys or liver, when pregnant.

Pregnancy and lactation

Use of the drug during pregnancy is possible only when the intended benefits to the mother outweighs the potential risk to the fetus. When necessary use during lactation should resolve the issue of termination of breastfeeding.

Application for violations of liver function

The drug is contraindicated in severe liver problems.

Application for violations of renal function

The drug is contraindicated for use with severely impaired renal function.

Cautions

The drug is not taken during the meal. In the case of missing acceptance, should take the missed dose as soon as possible, and follow - with an interval of 24 hours is necessary to observe a break of at least 2 hours between taking the drug AzitRus and antacid drugs. After discontinuation of the drug hypersensitivity reactions in some patients may persist in such cases it is recommended the appointment of a specific therapy under medical supervision.

Overdose

Symptoms: nausea, temporary hearing loss, vomiting, diarrhea.

Treatment: gastric lavage, the holding of symptomatic therapy.

Drug Interactions

With simultaneous use of antacids (aluminum and magnesium), ethanol and food slow down and reduce the absorption of azithromycin.

When the joint application AzitRus at therapeutic doses with warfarin prothrombin time change is not mentioned, but considering that the interaction of macrolides with warfarin may be increased anticoagulation effect when assigning patients to this combination requires careful monitoring prothrombin time.

With the simultaneous application of increasing concentrations of digoxin in the blood plasma.

With simultaneous application of enhanced toxicity (vasospasm, dysesthesia), ergotamine and dihydroergotamine.

With simultaneous application of decreasing clearance and increasing the pharmacological effect triazolama. Azithromycin inhibits microsomal oxidation in hepatocytes, which leads to slower excretion and increase of plasma concentrations and toxicity of cycloserine, indirect anticoagulants, methylprednisolone, felodipina, as well as preparations exposed to microsomal oxidation (carbamazepine, terfenadin, cyclosporine, geksobarbital, ergot alkaloids, valproic acid, dizopiramid, bromocriptine, phenytoin, oral hypoglycemic means, xanthine derivatives, including theophylline). Linkozaminy reduce the effectiveness of azithromycin. Tetracycline and chloramphenicol enhance the effectiveness of azithromycin.

Terms and Conditions of storage

List B. The drug should be stored out of reach of children, dry, dark place at a temperature of 15 ° to 25 ° C. Shelf life - 2 years.

Azithrox

Composition, structure and packing

Capsules are white capsules contents - powder white or white with a yellowish tint.

A capsule. azithromycin (in the form of dihydrate) 250 mg.

Excipients: mannitol (mannitol), corn starch, magnesium stearate, sodium lauryl sulfate.

The composition of the shell and operculum capsules: titanium dioxide (E171), gelatin medicine.

Hard gelatin capsules, with the body white and yellow cap, the contents of capsules - powder white or white with a yellowish tint.

A capsule. azithromycin (in the form of dihydrate) 500 mg.

Excipients: mannitol (mannitol), corn starch, magnesium stearate and sodium lauryl sulphate.

The composition of the capsule shell: titanium dioxide (E171), quinoline yellow (E104), sunset yellow dye (E110), gelatin medicine.

Clinico-pharmacological group: Antibiotic macrolide - azalid.

Pharmacological action

Broad-spectrum antibiotic, a representative subgroup of macrolide antibiotics - azalidov. Communicating with the 50S subunit of ribosomes, inhibits peptidtranslokazu at the stage of translation, inhibits protein synthesis and slows the growth and multiplication of bacteria. Valid bacteriostatic, in high concentrations has a bactericidal effect. Operates on extra-and intracellular pathogens.

It is active against Gram-positive cocci: Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, streptococci of groups C, F and G, Staphylococcus aureus, Streptococcus viridans; Gram-negative bacteria: Haemophilus influenzae, Moraxella catarrhalis, Bordetella pertussis, Bordetella parapertussis, Legionella pneumophila, Haemophilus ducreyi, Campylobacter jejuni, Neisseria gonorrhoeae and Gardnerella vaginalis; some anaerobic microorganisms: Bacteroides bivius, Clostridium perfringens, Peptostreptococcus spp., as well as Chlamydia trachomatis, Mycoplasma pneumoniae, Ureaplasma urealyticum, Treponema pallidum, Borrelia burgdoferi.

Azithromycin is not active against gram-positive bacteria resistant to erythromycin.

Pharmacokinetics

Absorption

After taking the drug inside azithromycin is rapidly absorbed from the gastrointestinal tract, due to its stability in acidic medium and lipophilicity. After oral administration of 500 mg of azithromycin Cmax in plasma is achieved through 2.5-3 h and is 0.4 mg / liter.

Bioavailability - 37%. Acceptance of the drug along with diet slows down and reduces the absorption of azithromycin.

Distribution

Azithromycin well into the respiratory tract, organs and tissues of the urogenital tract (in particular, in the prostate gland), in skin and soft tissue. The high concentration in tissues (10-50 times higher than in blood plasma) and a long T1 / 2 due to low binding of azithromycin from plasma proteins, as well as its ability to penetrate into eukaryotic cells and concentrate in an environment with low pH, environmental lysosomes. This, in turn, defines a large apparent Vd (31.1 L / kg) and high plasma clearance. The ability of azithromycin to accumulate mainly in lysosomes is particularly important for elimination of intracellular pathogens. Shown that phagocytes deliver azithromycin to the localization of infection sites, where it is released during phagocytosis. The concentration of azithromycin in the foci of infection was significantly higher than in healthy tissues (on average 24-34%) and correlated with the degree of inflammatory edema. Despite the high concentration in phagocytes, azithromycin did not significantly affect their function.

Azithromycin remains in bactericidal concentrations of inflammation within 5-7 days after receiving the last dose, which allowed the development of short (3-day and 5-day) courses of treatment.

Metabolism

In the liver azithromycin demethylates formed metabolites are inactive.

Withdrawal

Withdrawal of azithromycin from plasma takes place in 2 stages: T1 / 2 is 14-20 hours in the range of 8 to 24 hours after taking the drug and 41 hours - in the range of 24 to 72 hours to allow the use a drug once a day.

Statement

Infectious and inflammatory diseases caused by organisms sensitive to the drug:
infections of the upper respiratory tract and ENT-organs (including tonsillitis, sinusitis, tonsillitis, otitis media);
scarlet fever;
Infection of lower respiratory tract (including bacterial and atypical pneumonia, bronchitis);
infections of skin and soft tissue (including erysipelas, impetigo, secondarily infected dermatitis);
urogenital tract infections (including urethritis and / or cervicitis);
Lyme disease (Lyme disease) in the early stages (erythema migrans);
gastric and duodenal ulcers, associated to Helicobacter pylori (in the combined therapy).

Dosage regimen

Azitroks ingest 1 time / day for 1 hour before or 2 hours after meals.

Adults with infections of the upper and lower respiratory tract appoint 500 mg / day for 3 days (course dose - 1.5 g).

With infections of the skin and soft tissue administered in a dose of 1 g / day for 1 admission on the first day, then - 500 mg / day every day from 2 to 5 days. Heading dose - 3 PM

In uncomplicated urethritis and / or cervicitis designate single 1 in a complicated, protracted urethritis / cervicitis caused by Chlamydia trachomatis, and 1 g 3 times with an interval of 7 days (taking the drug in the treatment of the day 07/01/1914). Heading dose of 3 g.

When Lyme disease (borrelia) for the treatment of stage I (erythema migrans) appoint 1 g in 1-day and 500 mg daily from 2 to 5 th day. Heading dose - 3 PM

For gastric ulcers and duodenal ulcers associated with Helicobacter pylori, appoint 1 g / day for 3 days in a combination therapy of H. pylori.

For children weighing over 45 kg with infections of the upper and lower respiratory tract, skin and soft tissue, scarlet fever medication prescribed at 500 mg (1 capsule). 1 reception for 3 days.

Children over 12 years of drug (kaps. 250 mg) designate a rate of 10 mg / kg 1 time / day for 3 days or the first day - 10 mg / kg followed by 4 days - on 5-10 mg / kg / day 3 days. Heading dose - 30 mg / kg.

In the treatment of erythema migrans in children dose of the drug (Table 500 mg) is 1 g at 1 day and 500 mg daily from 2 to 5 th day. Heading dose - 3 years Apply Azitroks in the form of tablets of 250 mg should dose - 20 mg / kg in 1 day and 10 mg / kg from 2 to 5 th day.

Side effect
On the part of the digestive system: diarrhea (5%), nausea (3%), abdominal pain (3%), 1% or less - dyspepsia, flatulence, vomiting, melena, cholestatic jaundice, increase in liver transaminases; children - constipation , anorexia, gastritis. Chance kandidomikoz oral mucosa.
Since the cardiovascular system: a feeling of palpitations, chest pain (≤ 1%).
From the side of the central nervous system: dizziness, headache, drowsiness; children - headaches (for the treatment of otitis media), hyperkinesia, anxiety, neurosis, sleep disturbances (≤ 1%).
On the part of the reproductive system: ≤ 1% - vaginal candidiasis.
From the urinary system: ≤ 1% - jade. Dermatological reactions: in some cases, rash, photosensitivity.

Allergic reactions: rash, itching, Quincke's edema, urticaria, conjunctivitis.

Other: fatigue.

Contraindications
hepatic impairment;
renal failure;
children weighing less than 45 kg (for capsules 500 mg);
Children under 12 years
Hypersensitivity to macrolide antibiotics.

With care use in patients with arrhythmias (ventricular arrhythmias may be, the elongation range QT), in children with severe disorders of the liver or kidneys.

Pregnancy and lactation

Use of the drug during pregnancy is possible only when the intended benefits to the mother outweighs the potential risk to the fetus. When necessary use during lactation should resolve the issue of termination of breastfeeding.

Application for violations of liver function

The drug is contraindicated in severe liver problems.

Application for violations of renal function

The drug is contraindicated in severe renal dysfunction.

Cautions

Azitroks should not be taken with food. In the case of missing next meal missed dose should be taken as quickly as possible, and follow - with an interval of 24 h.

Must comply with a break of at least 2 hours between doses Azitroksa and antacid drugs. After discontinuation of treatment hypersensitivity reactions in some patients may persist, which requires specific therapy under medical supervision.

Overdose

Symptoms: when using the drug in high doses may be increased side effects - severe nausea, temporary hearing loss, vomiting, diarrhea. Treatment: gastric lavage, the appointment of activated carbon, conducting symptomatic therapy.

Drug Interactions

Antacids (aluminum and magnesium), ethanol and food slow down and reduce the absorption of azithromycin. With simultaneous use of azithromycin with digoxin observed an increased concentration of the latter. In case of simultaneous appointment of warfarin and azithromycin (at normal doses) changes prothrombin time is not revealed, but given that the interaction of macrolides and warfarin may be increased anticoagulation effect, patients need careful monitoring prothrombin time. With the simultaneous use of azithromycin with ergotamine and dihydroergotamine increasing their toxicity (vasospasm, dysesthesia).

With simultaneous use of azithromycin with triazolamom decreases clearance and increases the pharmacological effect triazolama.

Azithromycin inhibits microsomal oxidation in hepatocytes and therefore slows the excretion and increases plasma concentration and toxicity of cycloserine, indirect anticoagulants, methylprednisolone, felodipina, as well as preparations exposed to microsomal oxidation (carbamazepine, terfenadin, cyclosporine, geksobarbital, ergot alkaloids, valproic acid, dizopiramid, bromocriptine, phenytoin, oral hypoglycemic funds, xanthine derivatives, including theophylline). Linkozaminy reduce the effectiveness of azithromycin. Tetracycline and chloramphenicol enhance the effectiveness of azithromycin.

Pharmaceutical incompatibilities

Azithromycin pharmaceutically incompatible with heparin.

Terms and Conditions of storage

List B. The drug should be stored out of reach of children, dry, dark place at a temperature of 15 ° to 25 ° C. Shelf life - 2 years.

Azitral

Composition, structure and packing

Hard gelatin capsules, with the body and lid in white; content caps - white powder.

A capsule. azithromycin dihydrate (in terms of azithromycin) 250 mg.

Excipients: anhydrous lactose, corn starch, sodium lauryl sulfate, magnesium stearate, titanium dioxide, purified water, methylparaben, propylparaben, gelatin.

Hard gelatin capsules, with the body and lid in white; content caps - white powder.

A capsule. azithromycin dihydrate (in terms of azithromycin) 500 mg.

Excipients: anhydrous lactose, corn starch, sodium lauryl sulphate, magnesium stearate, titanium dioxide, purified water, methylparaben, propylparaben, gelatin.

Clinico-pharmacological group: Antibiotic macrolide - azalid.

Pharmacological action

Broad-spectrum antibiotic from the macrolide, a derivative azalida. When you create inflammation in high concentrations has a bactericidal effect.

It is active against Gram-positive cocci: Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, streptococci of groups C, F and G, Staphylococcus viridans, Staphylococcus aureus; Gram-bacteria: Haemophilus influenzae, Moraxella catarrhalis, Bordetella pertussis, Bordetella parapertussis, Legionella pneumophila, Haemophilus ducreyi, Campylobacter jejuni, Helicobacter pylori, Neisseria gonorrhoeae, Gardnerella vaginalis; some anaerobic microorganisms: Bacteroides bivius, Clostridium perfringens, Peptostreptococcus spp.; also active against other microorganisms: Chlamydia trachomatis, Mycoplasma pneumoniae, Ureaplasma urealyticum, Treponema pallidum, Borrelia burgdoferi. Azithromycin is inactive against Gram-positive bacteria resistant to erythromycin.

Pharmacokinetics

Absorption

Azithromycin is rapidly absorbed from the gastrointestinal tract, due to its stability in acidic medium and lipophilicity. After receiving Azitrala oral dose of 500 mg Cmax of azithromycin in plasma achieved after 2.5-2.96 h and is 0.4 mg / liter. Bioavailability is 37%.

Distribution

Azithromycin well into the respiratory tract, organs and tissues of the urogenital tract (particularly in the prostate gland), in skin and soft tissue. The high concentration in tissues (10-50 times higher than in blood plasma) and a long T1 / 2 due to low binding of azithromycin from plasma proteins, as well as its ability to penetrate into eukaryotic cells and concentrate in an environment with low pH, environmental lysosomes. That, in turn, determines a large Vd = 31.1 L / kg and higher Plasma clearance.

The ability of azithromycin to accumulate mainly in lysosomes is particularly important for elimination of intracellular pathogens. Shown that phagocytes deliver azithromycin to the localization of infection sites, where it is released during phagocytosis. The concentration of azithromycin in the foci of infection was significantly higher than in healthy tissues (on average 24-34%) and correlated with severity of inflammatory edema. Despite the high concentration in phagocytes, azithromycin did not significantly affect their function. Azithromycin remains in bactericidal concentrations of inflammation within 5-7 days after receiving the last dose, which allowed the development of short (3-day and 5-day) courses of treatment.

Metabolism

The liver demethylates with the formation of inactive metabolites.

Withdrawal

Derivation of azithromycin from plasma occurs in 2 stages: T1 / 2 is 14-20 h in the range from 8 hours to 24 hours after drug administration and 41 h - in the range from 24 h to 72 h, which allows you to use a drug once a day .

Statement

Infectious and inflammatory diseases caused by organisms sensitive to the drug:
infections of the upper respiratory tract and ENT-organs (tonsillitis, sinusitis, tonsillitis, pharyngitis, otitis media);
Infection of lower respiratory tract (bacterial and atypical pneumonia, bronchitis);
scarlet fever;
infections of skin and soft tissues (erysipelas, impetigo, secondarily infected dermatitis);
urogenital tract infection (gonorrheal urethritis and / or cervicitis);
Lyme disease (borreliosis) - for treatment of early stage (erythema migrans);
gastric and duodenal ulcers associated with Helicobacter pylori (in a combination therapy).

Dosage regimen

Drugs are taken 1 time / day for 1 hour before meals or 2 hours after meals.
With infections of the upper and lower respiratory tract adult appoint 500 mg / day in 1 reception for 3 days; course dose of 1.5 PM
When infections of skin and soft tissues of adult appoint 1 g in 1 day to 1 admission; further - 500 mg in 1 receive daily from 2 to 5 th day; course dose is 3 g.
In uncomplicated urethritis and / or cervicitis designate single 1 g in 1 reception.
When Lyme disease (borrelia) for the treatment of early stages (erythema migrans) appoint 1 g in 1-day and 500 mg in 1 reception daily from 2 to 5 th day (course dose - 3 g).
In gastric ulcer and duodenal ulcer associated with Helicobacter pylori, a drug prescribed to 1 g / day for 3 days in a combination therapy of H. pylori.

Children of drug prescribed rate of 10 mg / kg 1 time / day for 3 days or 1 day - 10 mg / kg followed in 3 days - at 5-10 mg / kg / day (course dose is determined rate of 30 mg / kg).

In the treatment of erythema migrans dose is 20 mg / kg in 1-day and 10 mg / kg from 2 to 5 th day.

Side effect

On the part of the digestive system: nausea (3%), diarrhea (5%), abdominal pain (3%), indigestion, vomiting, flatulence, melena, cholestatic jaundice, increase in liver transaminases (1% or less). The children - constipation, anorexia, gastritis.

Since the cardiovascular system: heart, chest pain (1% or less).

From the side of the central nervous system: headache, dizziness, drowsiness; in children - a headache (for the treatment of otitis media), hyperkinesia, Anxiety, neurosis, sleep disorder (1% or less).

On the part of the urogenital system: jade, vaginal candidiasis (1% or less).

Allergic reactions: rash, photosensitivity, edema Quincke.

Other: fatigue, kandidomikoz oral cavity in children - conjunctivitis, pruritus, urticaria.

Contraindications
renal failure;
hepatic impairment;
Lactation (breastfeeding);
Children age 12 months;
Hypersensitivity to azithromycin and other macrolide antibiotics.

With caution is prescribed for arrhythmias (ventricular fibrillation and possible prolongation of the interval QT), pregnancy, and in children with severe disorders of the liver or kidneys.

Pregnancy and lactation

During pregnancy Azitral can be applied, when the intended use of such therapy substantially outweigh the risks existing in the application of drugs during pregnancy. In the appointment during lactation breastfeeding should be suspended at the time of treatment.

Application for violations of liver function

The drug is contraindicated in hepatic failure.

Application for violations of renal function

The drug is contraindicated in renal impairment.

Cautions

In the case of missed the missed dose should be taken as early as possible, and follow - with an interval of 24 h. Note that after the withdrawal of the drug allergic reactions in some patients may persist, requiring appropriate treatment and medical supervision. Among the methods Azitrala and antacid drugs should be observed by a break of at least 2 hours

Overdose

Symptoms: severe nausea, temporary hearing loss, vomiting, diarrhea.

Treatment: the holding of symptomatic therapy.

Drug Interactions

Antacids (aluminum and magnesium), ethanol, food slow and reduce the absorption of azithromycin.

When combined warfarin and Azitrala changes in recommended doses prothrombin time is not revealed, however, given that the interaction of macrolides and warfarin may be increased anticoagulant effect requires monitoring prothrombin time.

When the joint application of azithromycin increases the concentration of digoxin.

With simultaneous application of azithromycin increases the toxic effect of ergotamine and dihydroergotamine (vasospasm and dysesthesia).

When the joint application of azithromycin slows excretion and enhances the pharmacological effects triazolama.

With the combined application of azithromycin slows excretion, increases the concentration in blood plasma and increases the toxicity of cycloserine, indirect anticoagulants, methylprednisolone, felodipina. Azithromycin, inhibition of microsomal oxidation in rat hepatocytes, slow elimination, increases the concentration in the serum and enhances the toxicity of carbamazepine, terfenadina, cyclosporine, geksobarbitala, ergot alkaloids, valproic acid, phenytoin, dizopiramid, bromocriptine, theophylline (and other xanthine derivatives), oral hypoglycemic tools .

When the joint application linkozaminy weaken the effectiveness of azithromycin and tetracycline and chloramphenicol increase.

Terms and Conditions of storage

List B. The drug should be stored out of reach of children, dry place at temperatures not above 25 ° C.

Shelf life - 3 years.

Azilect

Composition, structure and packing

Tablets are white or nearly white, round, ploskotsilindricheskie, with beveled and etched "GIL 1" on one side.

1 tab. razagilina mesilate 1.56 mg, which corresponds to the content razagilina 1 mg.

Excipients: mannitol, colloidal silicon dioxide, corn starch, corn starch pregelatinized, stearic acid, talc.

Clinico-pharmacological group: antiparkinsonian drug - a selective MAO inhibitors of type B.

Pharmacological action

Antiparkinsonian medication. Selective irreversible MAO type B enzyme, 80% is determined by the activity of MAO in the brain and metabolism of dopamine. Razagilin in 30-80 times more active on MAO type B compared with MAO type A.

As a result of the inhibiting action of the drug on the type of MAO B in the central nervous system increases dopamine levels, decreases the formation of toxic free radicals, excessive formation of which occurs in Parkinson's disease. Razagilin also has a neuroprotective effect.

Unlike the nonselective MAO inhibitors, the drug at therapeutic doses does not block the metabolism of incoming dietary biogenic amines (eg tyramine), and therefore is not due to tyramine-hypertensive syndrome ("cheese effect").

Pharmacokinetics

Absorption

Razagilin rapidly absorbed after oral administration, Cmax plasma levels achieved after 0.5 h. The absolute bioavailability after a single administration is about 36%. Food does not affect the time to achieve Cmax razagilina in blood, however, when fat intake reduces Cmax and AUC of 60% and 20% respectively.

Distribution

Pharmacokinetics is linear within the dose range 0.5-2 mg. Relationship to plasma proteins ranges from 60% to 70%.

Metabolism

Razagilin almost completely metabolized in the liver. Biotransformation is carried out by N-dealkylation and / or hydroxylation with the formation of basic biological metabolite fallow period - 1-aminoindana, as well as two other metabolites - 3-hydroxy-N-propargyl-1-aminoindana and 3-hydroxy-1-aminoindana. The metabolism of the drug carried out with the participation of isoenzyme 1A2 of cytochrome P450.

Withdrawal

Razagilin derived primarily by the kidneys (60%) and to a lesser extent through the intestine (20%). Less than 1% of the administered dose of the drug is released in unchanged form. T1 / 2 was 0.6-2 h.

Pharmacokinetics in special clinical situations

Pharmacokinetic Parameters razagilina virtually unchanged in patients with renal insufficiency with mild and moderate.

When liver failure may occur mild increase in the parameters AUC and Cmax by 80% and 38%, while patients with moderate hepatic impairment, these parameters reach more than 500% and 80% respectively.

Statement
treatment of Parkinson's disease (as monotherapy or combination therapy with levodopa).

Dosage regimen

Assign 1 mg 1 time / day as monotherapy, and during treatment with levodopa, long time. The tablets are inside, regardless of the meal.

Side effect

These side effects occurred with a frequency of more than 1 / 100, side effects encountered with a frequency of 1 / 100 - 1 / 1000 are listed as rare.

Monotherapy razagilinom:
From the CNS: headaches, depression, dizziness, anorexia, convulsions, rarely - and cerebral blood flow.
On the part of the digestive system: loss of appetite, dyspeptic phenomena.
From the Musculoskeletal System: arthralgia, arthritis, pain around the neck. Dermatological reactions: vezikulobulleznaya rashes, contact dermatitis, rarely - carcinoma of the skin.
Since the cardiovascular system: angina pectoris; rarely - myocardial infarction.
Other: flu-like syndrome, fever, leukopenia, rhinitis, weakness, conjunctivitis, dysuria, allergic reactions.

In the application, together with levodopa:
From the central nervous system and peripheral nervous system: dyskinesia, muscle dystonia, anorexia, unusual dreams, ataxia, rarely - and cerebral blood flow.
On the part of the digestive system: constipation, vomiting, abdominal pain, dry mouth.
From the Musculoskeletal System: arthralgia, pain in the neck, peritendinitis.
Dermatological reactions: rash, rarely - melanoma of the skin.
Since the cardiovascular system: postural hypotension; rarely - angina.

Other: accidental falls, weight loss, allergic reactions.

Contraindications
concomitant therapy pethidine or other MAO inhibitors (a break between the lifting razagilina and the beginning of therapy these medicines should not be less than 14 days);
moderate or severe hepatic impairment (class B and C on the scale of Child-Pugh);
co-therapy with sympathomimetics (ephedrine, pseudoephedrine), other decongestants, dextromethorphan, and with drugs containing them;
pheochromocytoma;
childhood and adolescence to 18 years;
Pregnancy
Lactation (milk production risk of oppression against the background of inhibition of Education prolactin);
Hypersensitivity to razagilinu or to any of the components of the drug.

With care prescribers in mild hepatic insufficiency, with a joint reception with selective serotonin reuptake inhibitors (fluoxetine and fluvoxamine), tricyclic and tetracyclic antidepressants, active inhibitors of cytochrome P450 1A2 isoform.

Pregnancy and lactation

The drug is contraindicated during pregnancy and lactation.

Application for violations of liver function

Contraindicated in moderate or severe hepatic insufficiency (Class B and C on the scale of Child-Pugh).

Application for violations of renal function

Pharmacokinetic Parameters razagilina virtually unchanged in patients with renal insufficiency with mild and moderate.

Cautions

Application

Azilekta at the recommended therapeutic dose does not cause "tiraminovogo syndrome" ("cheese effect") that allows patients to use without any restrictions in food products containing significant amount of tyramine (cheese, chocolate).

Effects on ability to drive vehicles and management mechanisms

The influence of razagilina on driving and managing other mechanisms was conducted.

Overdose

Symptoms of overdosing Azilekt similar to those of an overdose of non-selective MAO inhibitors (including hypertension, postural hypotension).

Treatment: gastric lavage, activated charcoal method, symptomatic therapy. No specific antidote.

Drug Interactions

Due to the fact that the mechanism of action razagilina associated with inhibition of MAO, it should not be prescribed concomitantly with other inhibitors of this enzyme because of the risk of hypertensive crisis.

With simultaneous application of razagilina with serotonin reuptake inhibitors (fluoxetine, fluvoxamine), tricyclic and tetracyclic antidepressants may develop "serotonin syndrome" when in confusion, hypomanic, restlessness, shivering, tremor, diarrhea. If possible, avoid combined use razagilina with similar drugs, and if necessary their simultaneous use should provide increased precautions.

Due to the fact that the isoform of the enzyme cytochrome P450 1A2 (CYP1A2) participates in the metabolism of razagilina, active inhibitors of this enzyme (eg, ciprofloxacin) can increase the concentration of drug in plasma that determines caution when combining these drugs with razagilinom. Patients with Parkinson's disease use of levodopa does not affect the clearance razagilina.

Terms and Conditions of storage

The drug should be stored out of reach of children at or above 25 ° C.

Shelf life - 3 years.

Aziwok

Composition, structure and packing

Hard gelatin capsules, yellowish-white with markings "AZIWOK" and "WOCKHARDT" black; content caps - white or near white powder;

A capsule. azithromycin 250 mg.

Excipients: lactose, corn starch, magnesium stearate, sodium lauryl sulfate.

Clinico-pharmacological group: Antibiotic macrolide - azalid.

Pharmacological action

Macrolide antibiotic, a derivative azalida. It has a wide spectrum of antimicrobial action. When you create inflammation in high concentrations has a bactericidal effect.

The drug is active against gram-positive cocci: Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, streptococci of CF and G, Streptococcus viridans, Staphylococcus aureus; Gram-negative bacteria: Haemophilus influenzae, Moraxella catarrhalis, Bordetella pertussis, Bordetella parapertussis, Legionella pneumophila, Haemophilus ducreyi, Campylobacter jejuni, Neisseria gonorrhoeae, Gardnerella vaginalis; some anaerobic microorganisms: Bacteroides bivius, Clostridium perfringens, Peptostreptococcus spp.; against other microorganisms: Chlamydia trachomatis, Mycoplasma pneumoniae, Ureaplasma urealyticum, Treponema pallidum, Borrelia burgdoferi.

Azivok inactive against Gram-positive bacteria resistant to erythromycin.

Pharmacokinetics

Absorption

Azithromycin is rapidly absorbed from the gastrointestinal tract, due to its stability in acidic medium and lipophilicity. After receiving Azivoka oral dose of 500 mg of azithromycin Cmax plasma levels achieved after 2.5-2.96 h and is 0.4 mg / liter. Bioavailability is 37%.

Distribution

Azithromycin well into the respiratory tract, organs and tissues of the urogenital tract (particularly in the prostate gland), in skin and soft tissue. The high concentration in tissues (10-50 times higher than in blood plasma) and a long T1 / 2 due to low binding of azithromycin from plasma proteins, as well as its ability to penetrate into eukaryotic cells and concentrate in an environment with low pH, environmental lysosomes. This, in turn, determines a large Vd and high plasma clearance. The ability of azithromycin to accumulate mainly in lysosomes is particularly important for elimination of intracellular pathogens.

Shown that phagocytes deliver azithromycin to the localization of infection sites, where it is released during phagocytosis. The concentration of azithromycin in the foci of infection was significantly higher than in healthy tissues (on average 24-34%) and correlated with severity of inflammatory edema. Despite the high concentration in phagocytes, azithromycin did not significantly affect their function. Azithromycin remains in bactericidal concentrations of inflammation within 5-7 days after receiving the last dose, which allowed the development of short (3-day and 5-day) courses of treatment.

Withdrawal

Derivation of azithromycin from plasma occurs in 2 stages: T1 / 2 is 14-20 h in the range from 8 hours to 24 hours after drug administration and 41 h - in the range from 24 h to 72 h, which allows you to use a drug once a day .

Statement

Infectious and inflammatory diseases caused by organisms sensitive to the drug:
infections of the upper respiratory tract and ENT-organs (tonsillitis, sinusitis, tonsillitis, otitis media);
Infection of lower respiratory tract (bacterial and atypical pneumonia, bronchitis);
scarlet fever;
infections of skin and soft tissues (erysipelas, impetigo, secondarily infected dermatitis);
Uncomplicated urethritis and / or cervicitis;
Lyme disease (borreliosis) - for treatment of early stage (erythema migrans);
gastric and duodenal ulcers associated with Helicobacter pylori.

Dosage regimen

Drugs are taken 1 time per day is strictly for 1 hour before meals or 2 hours after meals.

With infections of the upper and lower respiratory tract infections, skin and soft tissue prescribe 500 mg / day for 3 days; course dose of 1.5 PM

In uncomplicated urethritis and / or cervicitis designate single 1 g (4 capsules. 250 mg).

When Lyme disease (borrelia) for the treatment of early stages (erythema migrans) appoint 1 g (4 capsules. 250 mg) in 1-day and 500 mg daily, from 2 to 5 Days (course dose - 3 g).

In gastric and duodenal ulcers associated with Helicobacter pylori, a drug prescribed for 1 g (4 capsules. 250 mg) daily for 3 days in a combination therapy. In the case of a missed dose missed dose should be taken as soon as possible, and follow-up - with a break in 24 hours

Side effect
From the digestive system: nausea, diarrhea, abdominal pain, rarely - vomiting, flatulence, transient increase in liver enzymes.
Dermatological reactions: in some cases - a rash.

Contraindications
severe renal dysfunction;
severe liver problems;
Pregnancy
Lactation (breastfeeding);
Children under 12 years
Hypersensitivity to azithromycin and other macrolide antibiotics.

Pregnancy and lactation

Azivok contraindicated in pregnancy. When you need to use during lactation breastfeeding should be interrupted for the duration of treatment.

Application for violations of liver function

Contraindicated in severe liver problems.

Application for violations of renal function

Contraindicated in severe renal dysfunction.

Cautions

Among the methods Azivoka and antacid drugs should be observed by a break of at least 2 hours

Overdose

Data on drug overdose Azivok not available.

Drug Interactions

Azivok intensifies the effect of ergot alkaloids, dihydroergotamine, tetracycline and chloramphenicol - Synergy effects; Lincosamides reduce the effectiveness of azithromycin. Antacids, ethanol, food slow down and reduce the absorption of azithromycin. Cycloserine, indirect anticoagulants, methylprednisolone, felodipin - slow excretion, increased concentration in the serum and increased toxicity of these drugs, while the use of azithromycin.

Inhibiting microsomal oxidation in hepatocytes, azithromycin increases T1 / 2, slow excretion, improves concentration and toxicity of medicines undergoing microsomal oxidation (including carbamazepine, ergot alkaloids, valproic acid, geksobarbital, phenytoin, dizopiramid, bromocriptine, theophylline and other xanthine derivatives, oral hypoglycemic agents).

Pharmaceutical incompatible with heparin.

Terms and Conditions of storage

The drug should be stored in a dark place at temperatures not above 30 ° C.

Shelf life - 2 years.

Azaphen MR

Composition, structure and packing

Enteric coating is yellowish-green, round, biconvex; exception of marbling.

1 tab. pipofezin 150 mg.

Excipients: gipromelloza (metotsel K4M Premium), kollidon 25 (povidone), microcrystalline cellulose, colloidal silicon dioxide (aerosil), talc (magnesium hydrosilicate), magnesium stearate.

Clinico-pharmacological group: antidepressant.

Pharmacological action

Tricyclic antidepressant of the group of indiscriminate capture of inhibitors of neuronal monoamines. Has timoanalepticheskoe and sedative effect. By blocking reverse neuronal capture of monoamine presynaptic membranes, increasing their content in the synaptic cleft, which leads to rapid relief of symptoms of depression, along with the inherent central pipofezinu antiserotoninovaya activity, determining its sedative effect. In contrast to other tricyclic antidepressants have anticholinergic properties. It has no effect on the activity of MAO.

Pharmacokinetics

Absorption

After oral administration quickly and almost completely absorbed from the gastrointestinal tract. Tmax in plasma is 1.2 hours

Metabolism

To a large extent Biotransformation in the liver with the formation of inactive metabolites.

Withdrawal

T1 / 2 - 9 am to derive mainly from urine.

Statement
depressive disorders of mild to moderate severity (including depression with chronic somatic diseases).

Dosage regimen

The drug taken by mouth. After determining the optimal daily dose in the application Azafena tablets 25 mg, appoint Azafen MB to 150 mg 1 time per day (morning), or 2 times a day (morning and evening) with a view of the effectiveness and tolerability.

Side effect
From the CNS: headache, dizziness.
On the part of the digestive system: nausea, vomiting.
Other: allergic reactions.

Contraindications
marked disturbances of liver function;
pronounced renal dysfunction;
CHD
state after acute ischemic;
serious infectious diseases;
diabetes;
Pregnancy
Lactation (breastfeeding);
childhood;
Hypersensitivity to the drug's components.

Pregnancy and lactation

The drug is contraindicated during pregnancy and lactation (breastfeeding).

Application for violations of liver function

The drug is contraindicated for use in violation of liver function.

Application for violations of renal function

The drug is contraindicated for use in violation of renal function.

Cautions

In the period of treatment required periodic monitoring of liver function and kidney. It is recommended to limit the prescription of a person whose work requires quick physical and mental reactions, such as driving. During the period of treatment prohibited intake of alcohol.

There should be appointed with antidepressants MAO inhibitors or before 1-2 weeks after their withdrawal.

Overdose

Symptoms: increased side effects.

Treatment: the holding of symptomatic therapy.

Drug Interactions

Potentiates the effects of alcohol and other central depressant drug, antihistamine drugs and anticoagulants. Reduces the effectiveness of anticonvulsant therapy.

Terms and Conditions of storage

List of B. The product should be stored out of reach of children, dry, dark place at temperatures not above 25 ° C. Shelf life - 3 years.

Azaphen

Composition, structure and packing

The tablets are yellowish-greenish color, ploskotsilindricheskie, with beveled; exception of marbling.

1 tab. pipofezin (in form of hydrochloride), 25 mg.

Excipients: potato starch, colloidal silicon dioxide (Aerosil), microcrystalline cellulose, lactose, povidone (polyvinylpyrrolidone low molecular medicine), magnesium stearate.

Clinico-pharmacological group: Antidepressants.

Pharmacological action

Tricyclic antidepressant of the group of indiscriminate capture of inhibitors of neuronal monoamines. Has timoanalepticheskoe and sedative effect.

The mechanism of antidepressant action linked to the indiscriminate inhibition of reverse neuronal capture of serotonin and norepinephrine, which leads to an increase in their concentration in the CNS. Almost does not have the m-anticholinergic activity and no effect on the activity of MAO. It has no cardiotoxic action.

Pharmacokinetics

Absorption

Quickly and completely absorbed from the gastrointestinal tract. Bioavailability - 80%. Time to reach C max - 2 hours

Distribution and Metabolism

Binding to plasma proteins - 90%. Metabolised in the liver to form inactive metabolites.

Withdrawal

T1 / 2 - 16 hours excreted mainly by the kidneys.

Statement
depressive disorders of mild to moderate severity (including depression with chronic somatic diseases).

Dosage regimen

The initial dose for adults is 25-50 mg in 2 divided doses (morning and lunch). With good endurance gradually increase the dose to 150-200 mg / day (3-4 reception, the last reception before going to sleep), in some cases - up to 400 mg / day. The optimum daily dosage - 150-200 mg, the maximum daily dose - 400-500 mg.

Upon reaching the desired effect of switching to maintenance doses - 25-75 mg / day.

The course of treatment - up to 1 year (at least 1-1.5 months).

Side effect
From the CNS: headache, dizziness.
On the part of the digestive system: nausea, vomiting.

Other: allergic reactions.

Contraindications
severe hepatic and / or renal failure;
simultaneous reception of MAO inhibitors;
Pregnancy
Lactation (breastfeeding);
Hypersensitivity to the drug.

Precautions should be prescribed the drug for chronic heart failure, myocardial infarction, ischemic heart disease, conditions after a stroke, infectious diseases, diabetes mellitus, children.

Pregnancy and lactation

The drug is contraindicated during pregnancy and lactation.

Application for violations of liver function

The drug is contraindicated in severe renal failure.

Application for violations of renal function

The drug is contraindicated in severe renal insufficiency.

Cautions

In the period of treatment prohibited use of alcohol.

Effects on ability to drive vehicles and management mechanisms

During the reception Azafena patients is not recommended to perform work that requires quick reaction (to drive vehicles and to perform other potentially dangerous activities).

Overdose

In case of overdose may gain side effects.

Treatment: perform symptomatically.

Drug Interactions

With simultaneous application Azafen enhances the effects of anticoagulants, ethanol, antihistamines and other drugs that depress the central nervous system. With simultaneous application Azafen reduces the effectiveness of anti-epileptic drugs.

Terms and Conditions of storage

List B. The drug should be stored in dry, light, reach of children, at a temperature not above 25 ° C. Period of validity - 5 years.

Azaran

Composition, structure and packing

Powder for solution for injection from white to yellowish-white color.

1 vial. ceftriaxone (in the form of ceftriaxone disodium triseskvigidrata) 1 PM

Clinico-pharmacological group: cephalosporins III generation.

Pharmacological action

Cephalosporin antibiotic III generation of broad-spectrum parenteral administration. Effective bactericidal, inhibiting the synthesis of the bacterial cell wall. Acetylating transpeptidase of membranes, thereby violating the cross-stitching peptidoglikanov necessary to ensure the strength and rigidity of the cell wall. Resistant against β-lactamase produced by most gram-positive and Gram-negative bacteria.

Active on the Gram positive aerobic bacteria: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus viridans, Streptococcus bovis; aerobic gram-negative bacteria: Aeromonas spp., Alcaligenes spp., Branhamella catarrhalis (including strains forming β-lactamase), Citrobacter spp., Enterobacter spp., (some strains are resistant), Escherichia coli, Haemophilus ducreyi, Haemophilus influenzae (including strains, penicillinase-producing), Haemophilus parainfluenzae, Klebsiella spp. (Including Klebsiella pneumoniae), Moraxella spp., Morganella morganii, Neisseria gonorrhoeae (including strains that are penicillinase-producing), Neisseria meningitidis, Plesiomonas shigelloides, Proteus mirabilis, Proteus vulgaris, Providencia spp., Salmonella spp. (Including Salmonella typhi), Serratia spp. (Including the Serratia marsescens), Shigella spp., Vibrio spp. (Including Vibrio cholerae), Yersinia spp. (Including Yersinia enterocolitica), Pseudomonas aeruginosa (some strains), Gram-negative anaerobic bacteria: Bacteroides spp. (Including some strains of Bacteroides fragilis), Clostridium spp. (Except for Clostridium difficile), Fusobacterium spp. (Except for Fusobacterium mortiferum and Fusobacterium varium), Peptococcus spp., Peptostreptococcus spp.

To the drug resistant methicillin-resistant strains Staphylococcus spp., Strains of Enterococcus spp. (Enterococcus faecalis), Clostridium difficile, many strains of Bacteroides spp. (Producing β-lactamases).

Not hydrolyzed R-plasmid β-lactamases and a majority hromosomooposredovannyh penicillinases and tsefalosporinaz can act on multidrug strains tolerant to penicillins and cephalosporins of the first generations and aminoglycosides. The acquired resistance of some strains due to production β-lactamase, which inactivates ceftriaxone (tseftriaksonazy).

Pharmacokinetics

Absorption and distribution

After a / m ceftriaxone administration is rapidly and completely absorbed into the systemic circulation. Well into the tissues and body fluids: the respiratory tract, bones, joints, urinary tract, skin, subcutaneous tissue and abdominal cavity. When inflammation of meningeal membranes well into the spinal fluid. Bioavailability of ceftriaxone in the i / m administration of 100%. After i / m administration Cmax achieved within 2-3 h, with a / in the introduction - in the end of infusion.

When i / m administration of ceftriaxone at a dose of 500 mg and 1 g of Cmax in plasma was 38 pg / ml and 76 pg / ml, respectively, with a / in a dose of 500 mg, 1 g and 2 g - 82 mg / ml 151 ug / ml and 257 ug / ml, respectively. In adults over 2-24 hours after administration of the drug in a dose of 50 mg / kg concentration in the cerebrospinal fluid is many times greater than the IPC for the most common meningitis pathogens. The equilibrium state is established within 4 days of drug administration.

The reversible binding to plasma proteins (albumin) is 83-95%. Vd is 5.78-13.5 L (0.12-0.14 L / kg) in children - 0.3 l / kg.

Withdrawal

T1 / 2 of 6-9 h. Plasma clearance - 0.58-1.45 l / h, renal clearance - 0.32-0.73 l / h. The In adult patients within 48 h 50-60% of the drug appears kidneys unchanged, 40-50% is excreted in the bile in the intestine, where biotransformiruetsya in an inactive metabolite.

Pharmacokinetics in special clinical situations

In neonates, the kidneys excreted 70% of the drug. In infants and elderly patients (aged 75 years), as well as in patients with impaired renal function and liver T1 / 2 significantly increased.

Patients who are on hemodialysis with QC 0-5 ml / min, T1 / 2 was 14.7 h and QA 5-15 ml / min - 15.7 h and QA 16-30 ml / min - 11.4 h and CC 31 - 60 ml / min - 12.4 hours

In children with meningitis T1 / 2 after i / v administration in a dose of 50-75 mg / kg is 4.3-4.6 h.

Statement

Treatment of infectious-inflammatory diseases caused by susceptible microorganisms:
infections of the upper and lower respiratory tract (including pneumonia, lung abscess, empyema);
infections of skin and soft tissues;
infections of bones and joints;
urinary tract infections (including pyelonephritis);
inflammatory disease of the gastrointestinal tract and biliary tract (including cholangitis, empyema gall bladder);
pelvic infection;
peritonitis;
bacterial meningitis;
bacterial endocarditis;
sepsis
acute and complicated gonorrhea;
Lyme disease;
shigellosis;
salmonellosis.

Prevention and treatment of infectious postoperative complications.

Dosage regimen

The drug is introduced into the / m or / in.

For adults and children over 12 years, the average daily intake is 1-2 g 1 time / day. The maximum daily dose for adults - 4 PM

For infants under 14 days, the dose is 20-50 mg / kg / day. Maximum daily dose of 50 mg / kg.

For children aged 15 days and up to 12 years of daily dose is 20-80 mg / kg. The daily dose of more than 50 mg / kg of body weight should be prescribed in the form of in / infusion.

Duration is typically less than 10 days. The introduction of the drug should continue for 2-3 days after normalization of body temperature and the disappearance of symptoms.

To prevent infections in the postoperative period the drug injected once per 30-90 minutes prior to surgery at a dose of 1-2 g (depending on the degree of risk of infection). Through an operation on the colon and rectum recommend additional injection of the drug from the group of 5-nitroimidazole.

With bacterial meningitis daily dose is 100 mg / kg. The maximum dose - 4 g 1 time / day. Duration of therapy depends on the type of pathogen and can vary from 4 days in meningitis caused by Neisseria meningitidis, to 10-14 days for meningitis caused by susceptible strains of Enterobacteriaceae.

Children with infections of the skin and soft tissue preparation prescribe a daily dose of 50-75 mg / kg of body weight one time per day or 25-37.5 mg / kg every 12 h, but not more than 2 g / day. In severe infections at other sites - at a dose of 25-37.5 mg / kg every 12 h, but not more than 2 g / day. In otitis media introducing drug / m at a dose of 50 mg / kg of body weight, but not more than 1 g. When gonorrhea introducing drug / m once at a dose of 250 mg.

Patients with impaired renal function dosage adjustment is required only for severe renal insufficiency (CC <10 ml / min), in which case the daily dose of ceftriaxone should not exceed 2 years

Terms preparation and administration solution for injection

To prepare the solution for i / m injection of 1 g of the drug is dissolved in 3.5 ml of 1% lidocaine chloride. Enter deeply into a large muscle mass. Do not enter more than 1 g in a single muscle. It should be remembered that lidocaine chloride can not enter into / in.

To prepare the solution for i / v dose of 1 g dissolved in 9.6 ml of sterile water for injection. The solution is injected slowly over 2-4 min.

To prepare the solution for i / v infusion of 2 g of the drug dissolved in 40 ml of a solution containing no Ca (0.9% sodium chloride solution, 0.45% sodium chloride solution and 2.5% dextrose in 5% dextrose, 10% dextrose 6% solution of dextran and 5% solution of dextrose, 6-10% solution of starch). Running in / infusion - at least 30 minutes.

Freshly ceftriaxone solutions are stable for 6 h at ambient temperature and within 24 hours when stored in a refrigerator at a temperature of 2 ° to 8 ° C.

Side effect
From the CNS: headache, dizziness.
From the urinary system: oliguria, Glycosuria, hematuria, hypercreatininemia, elevated levels of urea.
On the part of the digestive system: nausea, vomiting, breach of taste, flatulence, stomatitis, glossitis, diarrhea, pseudomembranous enterocolitis, psevdoholelitiaz (sludge-syndrome), dysbacteriosis, abdominal pain, increase in liver transaminases and of alkaline phosphatase, hyperbilirubinemia.
On the part of the hemopoietic system: anemia, leukopenia, leukocytosis, lymphopenia, neutropenia, granulocytopenia, and thrombocytopenia, thrombocytosis, basophilia, hemolytic anemia.
From the blood coagulation system: nosebleeds, an increase (decrease) in prothrombin time.

Allergic reactions: urticaria, rash, itching, erythema exudative multiforme, fever, edema, eosinophilia, anaphylactic shock, serum sickness, bronchospasm.

Other: superinfection (including candidiasis).

Local reactions: with a / in the introduction - phlebitis, pain along the vein, with a / m introduction - soreness at the injection site.

Contraindications
hypersensitivity to ceftriaxone and other cephalosporins, penicillins and carbapenems.

With care prescribers in violation of the liver and / or kidneys (the probability of cumulation requires monitoring drug concentration in serum), and preterm newborns with hyperbilirubinemia (there is likely to strengthen the side effects) with ulcerative colitis, as well as enteritis or colitis associated with the use of antibacterial drugs.

Pregnancy and lactation

Application Azarana during pregnancy is possible only in cases where the intended benefits to the mother outweighs the potential risk to the fetus (ceftriaxone penetrates through the placenta).

If necessary, use Azarana during lactation should decide on the termination of breastfeeding (ceftriaxone is excreted in breast milk).

Application for violations of liver function

In patients with hepatic impairment T1 / 2 significantly increased.

Application for violations of renal function

Patients with impaired renal function dosage adjustment is required only for severe renal insufficiency (CC <10 ml / min), in which case the daily dose of ceftriaxone should not exceed 2 years

Cautions

The drug is used only in a hospital. At the same time severe renal and hepatic failure in patients on hemodialysis, should regularly determine the concentration of ceftriaxone in blood plasma.

Prolonged treatment is necessary to regularly monitor the picture of peripheral blood parameters of the functional state of the liver and kidneys.

In rare cases, ultrasonography of the gallbladder observed darkening that disappear after discontinuation of the drug (even if this phenomenon is accompanied by pain in the right hypochondrium, continue to recommend the appointment of an antibiotic and symptomatic treatment).

When applying the drug can not use ethanol, because may develop disulfiramopodobnyh effects (flushing, abdominal cramping and in the stomach, nausea, vomiting, headache, lower blood pressure, tachycardia, dyspnea).

Against the background of Azarana elderly and debilitated patients may require vitamin K.

Overdose

Currently, cases of overdosing Azaran not reported. For removing the drug from the body hemodialysis are not effective.

Drug Interactions

Ceftriaxone and aminoglycosides have synergistic against many gram-negative bacteria. When combined with the use of NSAIDs and other antiagregantami increases the likelihood of bleeding.

When applied simultaneously with the "loop" diuretics and other nephrotoxic drugs increases risk of nephrotoxicity.

Pharmaceutical interactions

Pharmaceutical incompatible with solutions containing other antibiotics.

Terms and Conditions of storage

List B. The drug should be stored out of reach of children, dry, dark place at a temperature of 15 ° to 25 ° C. Shelf life - 3 years.

Adrianol

Composition, structure and packing

Nasal drops (for children).

1 ml of phenylephrine hydrochloride 500 mg trimazolina hydrochloride 500 mg.

Auxiliary substances: ammonia, glycerol, citric acid monohydrate, methylcellulose M.N.V. 10000, sodium hydrogen phosphate dihydrate, phenyl-mercury (II) borate, ethanol 96%, purified water.

Nasal drops 1 ml of phenylephrine hydrochloride 1 mg trimazolina hydrochloride 1.5 mg.

Other ingredients: methylcellulose M.N.V. 10000, phenyl-mercury (II) borate, ethanol 96%, glycerol, ammonia, citric acid monohydrate, sodium hydrogen phosphate dihydrate, purified water.

Clinico-pharmacological group: vasoconstrictor drug for local use in ENT-practice

Adiupressinum

Dosage form, composition and packaging

Nasal Drops - 0,1 mg / ml vial. 2,5 ml. Dezmopressin - 0,1 mg / ml.

Other ingredients: benzalkonium chloride, water for injection.

Pharmacological action

Dezmoprescin - a synthetic polypeptide analog vazoprescina - posterior pituitary hormone. Possesses strong antidiuretic effect, but the impact dezmopressina blood vessels and smooth muscle compared with vasopressin significantly weaker. Acts on blood clotting: enhances fibrinolysis by increasing the activity of factor VIII and the level of plasminogen activator in plasma, but the fibrinolytic properties dezmopressina clinically, as a rule, do not appear.

Dezmopressin, as a polypeptide, cleaved under the action of enzymes of the digestive tract, so it is introduced intranasally, and the impossibility of this route of administration (nasal tamponade, damage to mucous membranes) - sublingually. Dezmopressin well tolerated.

Statement

Diagnosis and treatment diabetes insipidus, temporary polyuria and polydipsia after surgery in the pituitary, the auxiliary treatment of enuresis, conduct tests on the concentration ability of the kidneys.

Dosage regimen

Dose was set individually. Usually they bury 1-4 drops of 0.01% p-ra in the nose or under the tongue every 12 hours in severe cases can be applied every 8 hours when enuresis appoint 1 drop at bedtime. When conducting tests on the concentration ability of the kidneys is introduced to children on a drop, and adults - to 2 drops.

Contraindications

Hypersensitivity to dezmopressinu, anury, edema of any etiology, heart failure, decreased osmotic pressure of blood plasma.

Side effect

Are rare and usually disappear after dose reduction. Possible severe headache, nausea, rhinitis, swelling of the mucous membrane of the nasal cavity, moderate increase in blood pressure, stomach pain, spastic nature, increased pain during menses.

Cautions

Administration of these drugs requires special monitoring for the following groups of patients: children and adolescents, the elderly, patients with disorders of water and electrolyte balance, a risk of increasing intracranial pressure. With caution is prescribed for violations of renal function and / or cardio-vascular diseases, fibrosis of the bladder.

Application for the study of concentration ability of the kidneys in children under 1 year should be carried out only in a hospital. With caution used during pregnancy. The drug is excreted in breast milk in quantities that do not affect the diuresis and hemostasis in children.

Drug Interactions

Antidiuretic effect of clofibrate increased dezmopressina, hlorpropamidom and indomethacin, attenuated gliburidom and carbamazepine. Dezmopressin may potentiate the action of other drugs that increase blood pressure.

Cases of lower osmotic pressure of blood plasma with the development of overhydration and anasarca. Treatment is symptomatic.

Storage conditions and expiry dates

In a dry, dark place at a temperature of 8-25 ° C.

Adepress

Composition, structure and packing

Tablets, coated in white or almost white, round, biconvex.

1 tab. paroxetine (in the form gemigidrata hydrochloride) 20 mg.

Excipients: calcium hydrophosphate (calcium disodium phosphate), corn starch, sodium karboksimetilkrahmal (primogel), magnesium stearate.

The composition of the shell: Opadry II (gipromelloza, lactose monohydrate, macrogol / polyethylene glycol 3350, polyethylene 4000 /, titanium dioxide).

Clinico-pharmacological group: Antidepressants.

Pharmacological action

Antidepressant. Is a selective serotonin reuptake inhibitors (5-hydroxytryptamine, 5-HT) neurons of the brain that determines its antidepressant action and effectiveness in treating obsessive-compulsive (OCD) and panic disorder.

Paroxetine has low affinity to m-cholinergic receptors (has a weak anticholinergic effect), α1-, α2-and β-adrenoceptors, as well as dopamine (D2), 5HT1-like, 5HT2-like and histamine H1-receptors. Paroxetine does not affect psychomotor function and potentiates the inhibitory effect of ethanol on them.

According to the study of behavior and EEG paroxetine the weak activating properties when it is administered in doses higher than those required for inhibition of serotonin. In healthy volunteers it causes no significant change in levels of blood pressure, heart rate and EEG.

Pharmacokinetics

Absorption

After oral administration of paroxetine is well absorbed from the gastrointestinal tract. Simultaneous food intake does not affect the absorption and pharmacokinetics of paroxetine.

Distribution

The equilibrium state is reached in 7-14 days after initiation of therapy, further pharmacokinetics during prolonged treatment does not change.

Clinical effects of paroxetine (side-effects and efficacy) did not correlate with its concentration in plasma.

Since the effect of paroxetine being the "first pass" through the liver, its amount, as determined in systemic circulation is less than that which is absorbed from the gastrointestinal tract. With increasing doses of paroxetine or when multiple dosing has been partially reduced the effect of "first pass" through the liver and reduced plasma clearance of paroxetine. As a result, may increase the concentration of paroxetine in plasma and variations of pharmacokinetic parameters that can be observed only in those patients in whom the drug in low doses achieved low levels of paroxetine in plasma.

Paroxetine is extensively distributed in tissues, and pharmacokinetic calculations indicate that only 1% of it is present in plasma, with therapeutic concentrations of 95% associated with plasma proteins.

Metabolism

The main metabolites of paroxetine are polar and conjugated products of oxidation and the methylation, which are rapidly cleared from the body, have weak pharmacological activity and do not affect its therapeutic effect. Withdrawal from the body of metabolites of paroxetine biphasic, initially as a result of "first pass" through the liver, then it is controlled by systemic elimination.

Withdrawal

T1 / 2 of paroxetine is in the range of 6 to 71 h, but the average is 24 hours about 64% of paroxetine is excreted in the urine (2% - unchanged, 64% - in the form of metabolites), approximately 36% is excreted in the bile through intestine, mainly in the form of metabolites, less than 1% - unchanged.

Pharmacokinetics in special clinical situations

The concentration of paroxetine in plasma increases with abnormal liver function and kidney, as well as in the elderly, with a range of plasma concentrations of nearly coincides with the range of concentrations in healthy adult volunteers.

Statement
depression of all types, including reactive, severe endogenous depression and depression accompanied by anxiety;
obsessive-compulsive disorder (OCD);
panic disorder, including fear stay in the crowd (agoraphobia);
social anxiety disorder / social phobia;
generalized anxiety disorder;
PTSD.

Dosage regimen

Tablets should be taken 1 time per day in the morning, while eating, not chewing, drinking water. The dose is individually during the first 2-3 weeks after starting therapy and subsequently, if necessary, corrected. The effect in most cases develops gradually. For depression the recommended dose is 20 mg 1 time / day. If necessary, gradually increase the dose to 10 mg at intervals of 1 week to achieve a therapeutic effect, the maximum daily dose should not exceed 50 mg / day.

In obsessive-compulsive disorders initial therapeutic dose is 20 mg / day, followed by a weekly increase of 10 mg to achieve a therapeutic response. Recommended mean therapeutic dose - 40 mg / day, if necessary, the dose may be increased to 60 mg / day. When panic disorders initial dose - 10 mg / day (to reduce the possible risk of worsening of panic symptoms) followed by a weekly increase of 10 mg. The average therapeutic dose - 40 mg / day. The maximum daily dose should not exceed 60 mg / day.

When social anxiety disorder / social phobia initial dose is 20 mg / day, with no effect for at least 2 weeks may increase the dose to a maximum of 50 mg / day. The dose should be increased to 10 mg at intervals of not less than a week in accordance with the clinical effect.

Post-traumatic stress disorder for most patients starting and therapeutic doses are 20 mg / day. In some cases, we recommend an increase in the maximum dose to 50 mg / day. The dose should be increased to 10 mg per week according to the clinical effect.

When generalized anxiety disorder and the initial therapeutic dose is 20 mg / day.

In renal and / or hepatic insufficiency the recommended dose is 20 mg / day. For elderly patients daily dose should not exceed 40 mg. To prevent recurrence should be carried out by maintenance therapy. With the disappearance of the symptoms of depression, this course can be 4-6 months, and for obsessive and panic disorders - more than 4-6 months. Should avoid abrupt withdrawal of the drug. In order to prevent the development of withdrawal symptoms discontinuing treatment should be gradual.

Side effect
From the CNS and the peripheral nervous system: Frequently - drowsiness or insomnia, tremor, asthenia, dizziness, anxiety, and sometimes - confusion, hallucinations, extrapyramidal disorder, paresthesia, reduced capacity to concentrate; rarely - seizures, mania, and very rarely - serotonin syndrome (agitation, hyperreflexia, diarrhea), panic disorder.
On the part of the organ of vision: in some cases - blurred vision, mydriasis.
On the part of the musculoskeletal system: rarely - myasthenia gravis, myoclonia, arthralgia, myalgia.
From the urinary system: frequent urination; rarely - urinary retention.
On the part of the reproductive system: disorders of ejaculation, libido disorders, seldom - hyperprolactinaemia / galactorrhoea, anorgasmia.
On the part of the digestive system: loss of appetite, nausea, vomiting, dry mouth, and sometimes - constipation or diarrhea, and in some cases - hepatitis.
Since the cardiovascular system: orthostatic hypotension.
Allergic reactions: seldom - rash, urticaria, ekhimatozy, pruritus, angioedema.
Other: increased sweating, in rare cases - hyponatremia, violation of secretion of antidiuretic hormone.

Contraindications
simultaneous reception of MAO inhibitors and the period of 14 days after their removal;
unstable epilepsy;
Pregnancy
Lactation (breastfeeding);
Hypersensitivity to the drug's components.

Precautions should be prescribed the drug for hepatic failure, renal insufficiency, angle-closure glaucoma, prostatic hyperplasia, mania, heart disease, epilepsy, convulsive states, while the appointment of electro therapy, simultaneous intake of drugs that increase risk of bleeding, the presence of risk factors for bleeding disorders and diseases, increase the risk of bleeding, as well as elderly patients.

Pregnancy and lactation

The drug is contraindicated during pregnancy and lactation.

Application for violations of liver function

Precautions should be prescribed the drug for hepatic failure. In liver failure the recommended dose is 20 mg / day.

Application for violations of renal function

Precautions should be prescribed the drug in renal failure. In renal insufficiency the recommended dose is 20 mg / day.

Cautions

In order to avoid the development of neuroleptic malignant syndrome should be prescribed with caution Adepress patients taking neuroleptics.

Treatment Adepressom appoint 2 weeks after discontinuation of MAO inhibitors. Elderly patients on a background of reception Adepressa possible hyponatremia. In some cases a dose correction applied simultaneously insulin and / or oral hypoglycemic agents.

With the development of seizures treatment Adepressom stop.

When the first signs of mania should be abolished Adepressom therapy. During the first few weeks of therapy Adepressom should carefully monitor the condition of the patient in connection with possible suicide attempts. During therapy Adepressom should refrain from taking alcohol in relation to increasing its toxic effect.

Use in Pediatrics

Application Adepressa in children is not recommended because of its safety and efficacy in this group of patients is not installed.

Effects on ability to drive vehicles and management mechanisms

In spite of the fact that paroxetine did not affect cognitive and psychomotor function, patients should avoid or exercise extreme caution when driving and when engaging in other potentially hazardous activities that require high concentration and quickness of psychomotor reactions.

Overdose

Symptoms: nausea, dilated pupils, fever, changes in blood pressure, headache, involuntary muscle contractions, agitation, anxiety, tachycardia. In very rare cases, while taking other psychotropic drugs and / or ethanol (alcohol), there are ECG changes, coma.

Treatment: gastric lavage, activated charcoal method. If necessary, a symptomatic therapy. No specific antidote.

Drug Interactions

Simultaneous reception antacid did not affect the absorption and pharmacokinetic parameters Adepressa. Because inhibition of cytochrome P450 paroxetine may strengthen the effect of barbiturates, phenytoin, indirect anticoagulants, tricyclic antidepressants, neuroleptics and fenotiazinovogo class 1C antiarrhythmic drugs, metoprolol, and increased risk of side effects, while the appointment of these medicines.

In case of simultaneous appointment with drugs that inhibit liver enzymes may require dose reduction Adepressa.

Between paroxetine and warfarin expected pharmacodynamic interaction (with unaltered prothrombin time was an increase in bleeding). At the same time appointing Adepressa with atypical neuroleptics, tricyclic antidepressants, drugs phenothiazine series, acetylsalicylic acid, NSAIDs may be in breach of the process of blood clotting.

Simultaneous with the appointment Adepressa serotoninergic drugs (tramadol, sumatriptan) may lead to increased serotoninergic effect.

It is marked synergism tryptophan, drugs lithium and paroxetine.

At the same time appointing Adepressa with phenytoin and other anticonvulsant drugs may reduce the concentration of paroxetine in plasma and increased frequency of side effects.

Paroxetine is much weaker than inhibits the antihypertensive effect guanetidina compared with antidepressants, which inhibit the capture of norepinephrine.

Terms and Conditions of storage

List B. The drug should be kept dry, out of reach of children, at a temperature not above 25 ° C.

Shelf life - 2 years.

Adelphane-esidrex

Composition, structure and packing

Tablets 1 tab. Reserpine 100 mcg digidralazina sulphate (hydrated) 10 mg hydrochlorothiazide 10 mg.

Excipients: mannitol, corn starch, magnesium stearate, talc, disodium edetate.

Clinico-pharmacological group: antihypertensive drugs.

Pharmacological action

Adelfan-Ezidreks is a combination of three antihypertensive components having different points of application of their actions and mutually complementary antihypertensive effects of each other.

Reserpine causes depletion of the depot of catecholamines in postganglionic sympathetic nerve endings and in the CNS. Consequently, the ability to deposit catecholamines disturbed for quite a long period of time.

Catecholamine depletion leads to disruption of impulse transmission in the sympathetic nerve endings, which in turn leads to a decrease in tone of the sympathetic nervous system (the parasympathetic nervous system activity does not change). Thus, reserpine lowers high blood pressure and heart rate. In addition, reserpine causes sedation. Reserpine depletes reserves and other neurotransmitters, including serotonin, dopamine, adrenaline and neuropeptides in the central and peripheral neurons. The effects of reserpine may play a role in the implementation of its pharmacological effects and antihypertensive action. After receiving reserpine into its antihypertensive effect develops slowly, to a maximum of action is achieved only after 2-3 weeks and maintained for a long time.

Digidralazina sulfate - arterial vasodilator, lowers the tone of the smooth muscle of arterial vessels (mostly arterioles) and reduces TPVR. The mechanism of this action at the cellular level remains unclear. To a greater degree of vascular resistance decreased in the vessels of the heart, brain, kidneys and other internal organs, and to a lesser extent - in the vessels of the skin and skeletal muscles. If the blood pressure reduction is not pronounced, blood flow in the enlarged bloodstream as a whole increases. Preferential expansion of arterioles and venules are not, reduces the severity of orthostatic hypotension and improves cardiac output. Expansion vessels, leading to a decrease in blood pressure (diastolic more than systolic), accompanied by a reflex increase in heart rate, stroke volume and cardiac output.

The reflex increase in heart rate and cardiac output can be offset by the expense of combining digidralazina with reserpine, which inhibits the sympathetic nervous system.

Hydrochlorothiazide - thiazide diuretics - is acting in the cortical segment of the loop of Henle and distal renal tubules. Hinders reabsorption of sodium and chloride ions (due to an antagonistic interaction with the transport enzyme Na + Cl-) and increases the reabsorption of calcium ions (mechanism unknown). Increasing the amount and / or rate of supply of sodium ions and water in the cortical segment of collecting tubules leads to increased secretion and excretion of potassium ions and hydrogen.

In patients with normal renal function, increased urine output observed after a single use of hydrochlorothiazide in a dose of 12.5 mg. Increased urinary excretion of sodium and chlorine, and somewhat less pronounced increase kaliyureza depend on the dose of hydrochlorothiazide. After taking the drug inside the diuretic and natriuretic effects begin within 1-2 h, reaching a maximum after 4-6 h and continued for 10-12 h. Diuresis caused by thiazide, first leads to a decrease in the volume of circulating plasma cardiac output and systemic blood pressure. Possibility of activation of the renin-angiotensin-aldosterone system.

With prolonged use of hydrochlorothiazide maintain the hypotensive effect is provided, probably due to a decrease TPVR. Cardiac output returned to baseline values, remains a slight decrease in plasma volume and an increase in plasma renin.

Pharmacokinetics

Absorption

Reserpine is rapidly absorbed after oral administration. Systemic bioavailability is 50%. Digidralazin rapidly absorbed after oral administration. In blood plasma digidralazin located mainly in the form of unchanged digidralazina and gidrazonovyh substances formed by the metabolism of the basic substance. Approximately 10% digidralazina is in the blood plasma in the form of hydralazine. Hydrochlorothiazide is absorbed after oral administration of 60-80%. Tmax in plasma - 1.5-3 h. Changes in absorption under the influence of food intake have no clinical significance. In the range of therapeutic doses of systemic bioavailability of hydrochlorothiazide is approximately proportional to size of the dose. When taken regularly digidralazina its pharmacokinetics is not altered.

Distribution

Relative Vd reserpine on average 9.1 l / kg (range, 6.4 to 11.8 l / kg). Linking to plasma proteins is more than 96% (albumin and lipoproteins). Hydrochlorothiazide accumulates in erythrocytes. In the phase of elimination, its concentration in red blood cells 3-9 times higher than in plasma. Linking to plasma proteins - 40-70%. Vd in the terminal phase of elimination is 3-6 L / kg (equivalent to 210-420 hp in body weight 70 kg).

Metabolism

Reserpine is metabolized in the intestine and liver. The main metabolites are metilrezerpat and trimetoksibenzoynaya acid. Digidralazin metabolized significantly by oxidation (the formation of hydrazones), and acetylation. Hydrochlorothiazide is metabolized in a very small extent. His only found in trace amounts of metabolite is 2-amino-4-chloro-N-benzendisulfonamid.

Withdrawal

Derivation of reserpine and its metabolites from blood plasma occurs in two phases: T1 / 2 in the α-phase is 4.5 hours; T1 / 2 in β-phase - 271 h. The average value of T1 / 2 of the unmodified substance is 33 hours total clearance of reserpine an average of 245 ml / min. During the first 96 h after ingestion of 8% dose was excreted by the kidneys, mainly in the form of metabolites, and 62% - through the intestine, mainly in unchanged form. T1 / 2 of the unmodified digidralazina averages 4 hours total clearance averaged 1450 ml / min. Once inside, about 46% of applied dose was excreted within 24 hours, mostly in the form of metabolites, mainly through the intestine. About 0.5% of applied dose found in urine as unchanged substance.

Derivation of hydrochlorothiazide from plasma-phase: T1 / 2 in α-phase is 2 h, T1 / 2 in β-phase - about 10 hours in patients with normal renal function, excretion is carried out almost exclusively by the kidneys. In general, 50-75% of applied inside the dose was excreted in the urine unchanged.

Pharmacokinetics in special clinical situations

In elderly patients and patients with renal clearance of hydrochlorothiazide is considerably reduced, which leads to a significant increase of its concentration in blood plasma. Reduced clearance, were observed in elderly patients, appears to be associated with reduced kidney function. In patients with cirrhosis of the liver changes in the pharmacokinetics of hydrochlorothiazide is not marked. In elderly patients and patients with impaired renal function, the average therapeutic dose Adelfan-Ezidreks may be lower than in younger patients with normal renal function.

In patients with impaired renal function and / or liver may occur cumulation digidralazina. In patients with renal insufficiency observed slow excretion reserpine, which, however, offset by an increase in its excretion through the intestine. In these cases, to avoid the cumulation of reserpine in the body requires correction of a single dose Adelfan-Ezidreks or increased intervals between doses, taking into account the dynamics of blood pressure and tolerability.

Statement
hypertension.

Dosage regimen

Drug is taken with food and drank water. Dose should be selected individually.

Treatment begins with a minimal dose, which can be gradually (not more than every 2-3 weeks) increase, depending on patient response to treatment. The daily dose is usually 1-3 pi. The maximum daily dose - 3 Tab. Multiplicity taking the drug - 2-3 times / day.

If adequate blood pressure control could not be reached, treatment should be reviewed and possibly go to a drug other pharmacological groups (beta-blocker, calcium channel blocker of the slow, ACE inhibitor).

In elderly patients, as well as in patients with hepatic impairment a single dose of the drug or the interval between his appointment should be set with caution, taking into account the desired clinical response to treatment and tolerability.

Side effect

Components Adelfan-Ezidreks present it in lower doses, compared with the same doses of drugs prescribed for the treatment of hypertension separately. Nevertheless, may experience the following adverse events, which are characteristic of the individual components.

We used the following criteria for assessing the incidence of adverse events: the concept of "often" use if adverse events observed in more than 10% of patients, the concept of "sometimes" - from 1-10%, the term "rare" - a 0.001-1% the concept of "occasionally" - less than 0.001% of patients.

Reserpine
On the part of the gastrointestinal tract: sometimes - diarrhea, dry mouth, increased secretion of gastric juice, increased salivation, rarely - nausea, vomiting, increase appetite, ulceration, and in some cases - gastro-intestinal bleeding.
Since the cardiovascular system: Sometimes - sinus bradycardia, edema, rare - arrhythmia, pain behind the sternum, suggesting angina pectoris, orthostatic hypotension, flushing of the face, and in some cases - syncope, heart failure, ischemic.
On the part of the respiratory system: sometimes - swelling of the mucous membrane of the nose, shortness of breath, and in some cases - nosebleeds.
From the side of the central nervous system: sometimes - dizziness, depression, irritability, nightmares, fatigue, seldom - extrapyramidal disorders (including Parkinson's), headache, anxiety, impaired concentration, stupor, disorientation, and in some cases - swelling of the brain.
On the part of the urogenital system: rarely - a violation of potency and ejaculation, in some cases - dysuria, glomerulonephritis.
On the part of the endocrine system and metabolism: sometimes - an increase of body weight; rarely - increased secretion of prolactin, galactorrhea, gynecomastia, in some cases - swelling of the mammary glands.
From the senses: sometimes - blurred vision, conjunctival hyperemia, lacrimation, and in some cases - hearing impairment.
Other: rarely - eczema, itching, decreased libido, and in some cases - purpura, anemia, and thrombocytopenia.

Digidralazina sulfate
Since the cardiovascular system: often - tachycardia, palpitations, and sometimes - a rush of blood to his face, marked reduction of blood pressure, angina, rarely - edema, heart failure.
On the part of the gastrointestinal tract: sometimes - dyspepsia, nausea, vomiting, diarrhea.
From the Liver: rare - the jaundice, abnormal liver function, hepatitis.
From the side of the central nervous system and peripheral nervous systems: common - headache, and sometimes - dizziness rare - excitement, anorexia, irritability, anxiety state, anxiety, peripheral neuritis, paresthesia (these side effects are eliminated in the appointment of pyridoxine), and in certain cases - depressed mood .
From the hemopoietic system: rarely - anemia, leukopenia, thrombocytopenia.
Allergic and immunological reactions: seldom - volchanochnopodobny syndrome.
Other: sometimes - arthralgia; rarely - weight loss, fever, weakness, skin rash, itching.

Hydrochlorothiazide
From the water-electrolyte balance and metabolism: often - mainly when used in high doses - hypokalaemia, increased blood lipids, and sometimes - hyponatremia, gipomagniemiya, hyperuricemia, seldom - hypercalcemia, hyperglycemia, Glycosuria, increased metabolic abnormalities in diabetes mellitus; in some cases - gipohloremichesky alkalosis.
Dermatological reactions: occasionally - urticaria, other skin rashes, rarely - photosensitivity, in some cases - necrotizing vasculitis, toxic epidermal necrolysis, cutaneous manifestations volchanochnopodobnogo syndrome, exacerbation of cutaneous manifestations of lupus erythematosus.
On the part of the gastrointestinal tract, liver and pancreas: sometimes - loss of appetite, moderate nausea and vomiting; rarely - discomfort, constipation, diarrhea, intrahepatic cholestasis, jaundice, and in some cases - pancreatitis.
Since the cardiovascular system: sometimes - orthostatic hypotension (which may worsen while alcohol and while the application of anesthetics and sedatives), rarely - arrhythmias.
From the side of the central nervous system and sensory organs: rarely - headache, dizziness, sleep disorders, depression, paresthesia, visual disturbances (especially in the first weeks of treatment).
On the part of the hemopoietic system: rarely - thrombocytopenia, sometimes with purpura, in some cases - leukopenia, agranulocytosis, bone marrow suppression of hematopoiesis, hemolytic anemia.
Other: Sometimes - impotence, in some instances - hypersensitivity reactions, disorders of respiratory organs, including pneumonia and lung edema.

Contraindications
depression (current or in history);
Parkinson's disease;
epilepsy;
electroconvulsive therapy;
stomach ulcer and duodenal ulcer exacerbation;
ulcerative colitis
pheochromocytoma;
concomitant or recent treatment of MAO inhibitors;
systemic lupus erythematosus (idiopathic);
marked tachycardia and heart failure coupled with a high cardiac output (including with thyrotoxicosis);
heart failure due to mechanical constraints (including the presence of aortic or mitral stenosis or constrictive pericarditis);
isolated right ventricular failure due to pulmonary hypertension (pulmonary, heart);
anuria, marked renal impairment (creatinine clearance less than 30 ml / min);
hepatic impairment;
refractory hypokalemia, hyponatremia, hypercalcemia;
hyperuricemia with clinical manifestations;
Pregnancy
sensitivity to reserpine and related compounds, or other digidralazinu gidrazinoftalazinam, hydrochlorothiazide or other sulfonamide derivatives.

You should not use the drug in patients under 18 years of age (efficacy and safety have not been established).

Pregnancy and lactation

Adelfan-Ezidreks contraindicated in pregnancy for the following reasons. Reserpine, in the case of his appointment before the birth, the newborn may cause pronounced sleepiness, swelling of the nasal mucosa and anorexia. The impact of thiazide diuretics, including hydrochlorothiazide, resulted in the emergence of the fetus and newborn thrombocytopenia. Because thiazide diuretics do not prevent the appearance and does not affect the severity of signs of toxicity during pregnancy (edema, proteinuria, arterial hypertension), they should not be given for this indication. Reserpine, hydrochlorothiazide and digidralazin penetrate into breast milk. Newborn infants reserpine may cause the above reaction. Hydrochlorothiazide may suppress lactation. Apply Adelfan-Ezidreks during lactation is not recommended. No studies on the effect of Adelfan-Ezidreks the reproductive animals.

Application for violations of liver function

In patients with impaired liver function single dose of a drug or the interval between his appointment should be set with caution, taking into account the desired clinical response to treatment and tolerability. Need to systematically monitor the status of patients with impaired liver function, given the possibility of a part of the liver of rare but serious side effects digidralazina. It should also be borne in mind that even minor violations of water-electrolyte balance caused by thiazide diuretics may provoke a hepatic coma, especially in patients with cirrhosis.

Application for violations of renal function

In patients with renal clearance of hydrochlorothiazide is considerably reduced, which leads to a significant increase of its concentration in blood plasma. Reduced clearance, were observed in elderly patients, appears to be associated with reduced kidney function.

In elderly patients and patients with impaired renal function, the average therapeutic dose Adelfan-Ezidreks may be lower than in younger patients with normal renal function. In patients with impaired renal function may be a cumulative digidralazina. In patients with renal insufficiency observed slow excretion reserpine, which, however, offset by an increase in its excretion through the intestine. In these cases, to avoid the cumulation of reserpine in the body require correction of a single dose Adelfan-Ezidreks or increased intervals between doses, taking into account the dynamics of blood pressure and tolerability.

Cautions

Patients after myocardial infarction, should not appoint digidralazin until until all the stabilization period after myocardial infarction. As in the case of the appointment of any antihypertensive drugs with a marked hypotensive effect, should be very careful in the appointment of the drug Adelfan-Ezidreks patients with coronary and cerebral atherosclerosis. In these cases, to avoid sharp decline in blood pressure, because this may lead to a reduction of blood flow. The following precautions apply not only to each component separately, but also to the drug-Adelfan Ezidreks in general.

Since reserpine increases motility and secretion in the gastrointestinal tract, caution should be exercised in its application in patients with gastric ulcer and duodenal ulcer in the anamnesis, as well as in patients with erosive gastritis and cholelithiasis. Also, caution should be exercised in patients with heart failure, sinus bradycardia, conduction disturbances, as well as in patients with recent myocardial infarction.

Caution must be exercised in patients with suspected coronary heart disease. Invoked digidralazinom tachycardia can cause an attack of angina and ECG changes, indicating myocardial ischemia. In some cases, did not prevent communication of myocardial infarction receiving digidralazina.

Avoid use of the drug-Adelfan Ezidreks (especially when used in conjunction with preparations of potassium or potassium-sparing diuretics), patients receiving ACE inhibitors. As with the application of other thiazide diuretics, caution should be exercised in patients with diabetes and gout. If you suspect depression, medication should be lifted immediately, because there is a risk of suicidal actions. Depression provoked by reserpine (especially in cases of drug-Adelfan Ezidreks in high doses), may be heavy enough to trigger suicidal action. It may persist for several months following drug discontinuation.

Application digidralazina can lead to sodium and water retention in the body and, consequently, to the development of edema and reduced urine output.

Need to systematically monitor the status of patients with impaired liver function, given the possibility of a part of the liver of rare but serious side effects digidralazina. It should also be borne in mind that even minor violations of water-electrolyte balance caused by thiazide diuretics may provoke a hepatic coma, especially in patients with cirrhosis. Currently, there are few reported cases of volchanochnopodobnogo syndrome associated with receiving digidralazina. Mild forms of this syndrome manifested arthralgias, sometimes accompanied by fever and skin rashes, to remove the drug, these symptoms disappear on their own. In more severe cases, the clinical picture is similar to the manifestations of systemic lupus erythematosus; complete disappearance of symptoms can be achieved only with long-term treatment of GCS. The frequency of occurrence of this syndrome is directly dependent on the dose and duration of treatment. In connection with this for a long maintenance therapy is recommended to use the minimum effective dose.

During treatment digidralazinom seems appropriate to determine the antinuclear factor in the blood plasma every 6 months. In case of antinuclear factor should be systematically identified his credits. When developing clinical volchanochnopodobnogo Syndrome, the drug should be lifted immediately. Reserpine should cancel at least 7 days prior to electroconvulsive therapy.

Cancel reserpine before surgery is no guarantee that during the operation will not have hemodynamic instability. It is important to warn the anesthesiologist that the patient takes reserpine, and reflect this in the management of the patient. Cases are known to reduce blood pressure in patients receiving Rauwolfia preparations. During the surgical intervention in patients receiving digidralazin, there may be a pronounced decrease blood pressure.

Against the background of hydrochlorothiazide hypokalemia develops. Hypokalaemia may increase the sensitivity of the myocardium or enhance response of the heart to the toxic effects of digitalis drugs. The risk of hypokalemia increased in cirrhosis, rapidly developing increase in diuresis, insufficient intake of potassium from food, concomitant therapy of GCS, β2-adrenoceptor stimulants, or ACTH. In order to timely detect possible violations of the electrolyte balance is necessary to determine the content of electrolytes in the plasma at the beginning of treatment and at regular intervals during treatment. Nonspecific manifestations of disorders of electrolyte balance observed in some cases, have been dry mouth, thirst, weakness, drowsiness, restlessness, muscle pains and cramps, muscle weakness, reduced blood pressure, oliguria, tachycardia, nausea.

Thiazide diuretics, causing a reduction in calcium excretion. In a few patients receiving long-term thiazide diuretics, were found pathological changes in the parathyroid gland, accompanied by hypercalcaemia and hypophosphataemia. In case of hypercalcemia required to conduct additional surveys to refine the diagnosis. There were no complications, which are usually associated with hyperparathyroidism, such as the formation of kidney stones, bone resorption, peptic ulcer. Thiazide diuretics cause a rise in urinary excretion of magnesium, which may lead to gipomagniemii. When used in high doses, thiazide diuretics may cause a decrease in glucose tolerance and lead to increased concentrations of plasma cholesterol, triglycerides and uric acid.

The use of reserpine influences the results of determination of urinary 17-ketosteroids and 17-gidroksikortikosteroidov colorimetric method, leading to an underestimation of these results.

Effects on ability to drive vehicles and management mechanisms

Adelfan-Ezidreks may violate the patient's ability to make quick reactions, especially in the beginning of treatment. As with the appointment of other antihypertensive drugs, patients, managers of vehicles and machinery should be warned about the possibility of reducing the speed of psychomotor reactions, and be careful.

Overdose

Symptoms: There may be headache, dizziness, drowsiness, confusion, coma, extrapyramidal disorders, convulsions, paresthesia, persistent miosis. There may be nausea, vomiting, diarrhea. Also reported the appearance of tachycardia, marked reduction in blood pressure, collapse, and sometimes - on myocardial ischemia with such manifestations as angina and arrhythmias. There may be respiratory depression, disruption of water-electrolyte balance, muscle weakness, muscle cramps (especially calf), oliguria.

Treatment: if the patient is conscious, should induce vomiting or gastric lavage, give activated charcoal. In marked decrease in blood pressure patient should be put with raised legs and shows the introduction of plasma substitutes and correction of electrolyte disturbances, if necessary, with caution you can enter vasoactive funds. In the case of diarrhea introduced anticholinergic. In the case of seizures demonstrates the use of anticonvulsants (slow in / diazepam). In the case of pronounced respiratory depression shows an IVL. The duration of observation of the patient is not less than 72 hours since reserpine has prolonged action.

Drug Interactions

The hypotensive effect Adelfan-Ezidreks increases while receiving other antihypertensive drugs: guanetidina, alpha-methyldopa, beta-blockers, vasodilators, calcium channel blockers slow, ACE inhibitors.

It is also possible number of interactions of individual components of the drug.

Reserpine

You must undo the MAO inhibitors for at least 14 days before the start of therapy reserpine. If necessary, the appointment of MAO inhibitors, patients receiving reserpine, MAO inhibitors should be administered no less than 14 days after discontinuation of reserpine. At simultaneous application of reserpine and MAO inhibitors may be hyperactive, hypertensive crises. Reserpine enhances the depressant effects of alcohol on the central nervous system, funds for general anesthesia, some antihistamines, barbiturates and tricyclic antidepressants. Reserpine reduces the effect of levodopa. The simultaneous use of reserpine and tricyclic antidepressants can diminish hypotensive effect of reserpine.

Reserpine should be lifted for a few days before the planned operation to avoid excessive reduction of blood pressure during the general anesthetic. Appointment of reserpine in combination with antiarrhythmic drugs or medications of digitalis may cause sinus bradycardia. Reserpine may intensify the effects of epinephrine (adrenaline) or other sympathomimetic agents (be careful with the simultaneous use of bechic, nasal drops, eye drops).

Digidralazina sulfate

The simultaneous use of tricyclic antidepressants, neuroleptics, as well as etanolsoderzhaschih drugs may increase the hypotensive effect digidralazina. Appointment digidralazina just before or shortly after the appointment of diazoxide may cause a marked reduction of blood pressure.

Hydrochlorothiazide

With the simultaneous use of hydrochlorothiazide and preparations of lithium may increase the concentration of lithium in the blood, so in this case requires a systematic monitoring of the level of lithium in the blood. In cases where drugs lithium cause polyuria, hydrochlorothiazide may cause a paradoxical antidiuretic effect. Hydrochlorothiazide may increase the effects of nondepolarizing muscle relaxants. Gipokaliemichesky effect induced by diuretics may increase when used with the SCS, ACTH, amphotericin, karbenoksolona. Hypokalemia and gipomagniemiya (undesirable effects of thiazide diuretics) can contribute to the development of cardiac arrhythmias in patients receiving cardiac glycosides. In the application of hydrochlorothiazide in patients with diabetes may require adjustment of insulin doses and oral hypoglycemic agents.

Simultaneous appointment of NSAID (including indomethacin) can reduce the diuretic, natriuretic, and antihypertensive effects of hydrochlorothiazide. There are isolated reports of worsening renal function in susceptible patients.

Absorption of hydrochlorothiazide is violated in the presence of anion exchange resins. Absorption of hydrochlorothiazide from the gastrointestinal tract, while a single application kolestiramina and colestipol decreased by 85% and 43% respectively due to binding of these compounds.

The simultaneous use of thiazide diuretics (including hydrochlorothiazide) may increase the risk of hypersensitivity reactions to allopurinol, increasing the risk of side effects of amantadine and enhance the hyperglycemic effect of diazoxide, reduce renal excretion of cytotoxic drugs (including cyclophosphamide, methotrexate is) and strengthen their mielosupressivnoe action.

Anticholinergic drugs (including atropine, biperiden) may increase the bioavailability of hydrochlorothiazide, which is connected with decrease gastrointestinal motor activity and rate of gastric emptying. Simultaneous reception of hydrochlorothiazide with vitamin D or calcium supplementation may lead to increased levels of calcium in the blood.

With simultaneous use of hydrochlorothiazide and cyclosporine increases the risk of developing hyperuricemia and gout. There are reports on the development of hemolytic anemia while receiving hydrochlorothiazide drugs and dopegyt.

Terms and Conditions of storage

List B. The drug should be protected from light and moisture. Keep out of reach of children at or above 30 ° C.

Shelf life - 4 years. The drug should not be used after the expiration date.