Bagothyrox

Release form, composition and packing Bagothyrox 
Pill yellow, rectangular, with three notches on each side, on each of four equal parts tablets impression "T4" on both sides. 1 tab. levothyroxine sodium 50 mg. Inactive ingredients: microcrystalline cellulose, powdered cellulose, lactose monohydrate, magnesium stearate, sodium croscarmellose, Quinoline yellow dye.

Tablets white, rectangular, with three notches on each side, on each of four equal parts tablets impression "T4" on both sides. 1 tab. levothyroxine sodium 100 mcg. Inactive ingredients: microcrystalline cellulose, powdered cellulose, lactose monohydrate, magnesium stearate, sodium croscarmellose.

Pill blue, rectangular, with three notches on each side, on each of four equal parts tablets impression "T4" on both sides. 1 tab. levothyroxine sodium 150 mcg. Inactive ingredients: microcrystalline cellulose, powdered cellulose, lactose monohydrate, magnesium stearate, sodium croscarmellose, brilliant blue dye.

Clinico-pharmacological group: preparation of thyroid hormones.

Pharmacological action

The preparation of thyroid hormones, synthetic levogyrate isomer of thyroxine. After partial conversion to triiodothyronine (in the liver and kidneys) and the transition to the body's cells, influences the growth and development of tissue metabolism.

When used in low doses has anabolic effects on protein and fat metabolism.

When used in moderate doses stimulate the growth and development of the organism, increases in oxygen demand of tissues, stimulates the metabolism of proteins, fats and carbohydrates, increases the functional activity of the cardiovascular system and central nervous system. When used in high doses inhibits the production of thyrotropin-releasing hormone, hypothalamus and pituitary thyroid stimulating hormone. Therapeutic effect observed after 7-12 days, during the same time preserves the action after the drug. Clinical effect of hypothyroidism is manifested in 3-5 days. Basedow's disease is reduced or disappears within 3-6 months.

Statement
hypothyroidism;
euthyroid goiter;
as replacement therapy for prevention of recurrence of goiter after thyroid gland resection;
thyroid cancer (after surgery);
toxic goiter after reaching the euthyroid state thyreostatics (as a combination therapy or monotherapy);
as a diagnostic tool during the test thyroid suppression.

Dosing regimen

The daily dose is determined individually depending on the evidence. Bagotiroks take 1 time per day in the morning on an empty stomach, at least 30 minutes before meals. Wash down the pill a little liquid (half a cup of water) and do not chew.

During replacement therapy of hypothyroidism in patients under the age of 55 years in the absence of cardiovascular disease drug is prescribed a daily dose of 1.6-1.8 mg / kg body weight in patients older than 55 years or concomitant cardiovascular diseases - 0.9 mg / kg body. With significant obesity dose calculation should be done on an "ideal weight".

Babies Bagotiroksa daily dose given in 1 reception for 30 minutes before the first feeding. Tablet dissolved in water to a fine mist just before taking this medication. In severe, long-existing hypothyroidism, treatment should be started with caution at low doses - 12.5 mg / day. Increase the dose to maintenance at longer intervals - 12.5 mg / day every 2 weeks - and often determine the level of TSH.

Hypothyroid Bagotiroks usually take in a lifetime. When thyrotoxicosis take medication in the treatment of thyreostatics after reaching the euthyroid state. In all cases, the duration of drug treatment is determined individually.

Side effect

Using the drug in recommended doses and under the supervision of a doctor side effects are not observed. Hypersensitivity to the drug may experience allergic reactions.

Contraindications
untreated hyperthyroidism;
Acute myocardial infarction;
acute myocarditis;
untreated adrenal insufficiency;
increased individual sensitivity to the drug.

Precautions should be prescribed the drug for coronary heart disease (including atherosclerosis, angina pectoris, history of myocardial infarction), hypertension, arrhythmia, diabetes, severe long-existing hypothyroidism, malabsorption syndrome (may require dose adjustment).

Pregnancy and lactation

During pregnancy and lactation (breastfeeding) should continue therapy with drugs prescribed at the hypothyroidism.

During pregnancy require increased doses of the drug because of elevated levels of thyroxine-binding globulin. Number of thyroid hormone secreted in breast milk during lactation (even during treatment with high-dose) is insufficient to cause any disturbances in the child.

Use of the drug during pregnancy in combination with thyreostatics contraindicated because receiving levothyroxine may require increased doses thyreostatics. Since thyreostatics, unlike levothyroxine, can cross the placenta, the fetus may develop hypothyroidism.

During breastfeeding the drug should be taken with caution, under medical supervision, is strictly at the recommended doses.

Cautions

In hypothyroidism, caused the defeat of the pituitary gland, it is necessary to determine whether there is a simultaneous failure of the adrenal cortex. In this case, substitution therapy, corticosteroids should begin before the treatment of hypothyroidism with thyroid hormone in order to avoid the development of acute adrenal insufficiency.

Overdose

Symptoms associated with hyperthyroidism: palpitations, cardiac arrhythmias, heart pain, anxiety, tremor, sleep disturbance, increased sweating, decreased appetite, weight loss, diarrhea.

Treatment: Depending on the severity of symptoms showed reduction of daily dose, treatment interruption for several days, the appointment of beta-blockers. After the disappearance of side effects of treatment should be started cautiously with lower doses.

Drug Interactions

Together, levothyroxine sodium enhances the effect of indirect anticoagulants, which may require reduction of their dose. The use of tricyclic antidepressants with levothyroxine sodium may lead to increased action of antidepressants. Thyroid hormones may increase the need for insulin and oral hypoglycemic agents (when using this combination is recommended more frequent monitoring of blood glucose, especially in the early appointment of levothyroxine sodium, as well as its dose).

Together, levothyroxine sodium reduces the effect of cardiac glycosides. While the application kolestiramin, colestipol, and aluminum hydroxide, reducing the concentration of levothyroxine sodium in the blood plasma due to inhibition of its absorption from the gastrointestinal tract.

With the simultaneous application of levothyroxine sodium with anabolic steroids, asparaginase, tamoxifen might pharmacokinetic interaction at the level of binding protein.

In an application with phenytoin, salicylates, clofibrate, furosemide in high doses increases the content of unbound to plasma proteins of levothyroxine sodium and T4.

Receiving estrogenosoderzhaschih drugs increases the content of thyroxine-binding globulin (may increase the need for levothyroxine sodium in some patients).

Growth hormone, while the application of levothyroxine sodium may speed up the closure of the epiphyseal growth zones. Acceptance of phenobarbital, carbamazepine and rifampin may increase the clearance of levothyroxine sodium (which will require increased doses).

Conditions and terms of

List B. The drug should be kept in the dark and inaccessible to children at or above 25 ° C. Shelf life - 2 years.

Bagopril

Release form, composition and packing Bagopril. 

Pill white, round, biconvex, with the inscription "GLI 2.5" on one side and company logo - on the other.

1 tab.

Enalapril Maleate 2.5 mg.

Pill white, round, biconvex, with the inscription "GLI" and the numeral "5" under it on one side and company logo - on the other.

1 tab.

Enalapril Maleate 5 mg.

Pill white, round, biconvex, scored with a cross on one side, a segment of a circle notation "G", "L", "I" and "10", on the other side - the corporate logo.

1 tab.

enalapril 10 mg.

Pill white, round, biconvex, scored with a cross on one side, a segment of a circle notation "G", "L", "I" and "20", on the other side - the corporate logo.

1 tab.

enalapril 20 mg.

Excipients: sodium starch glycolate, povidone, microcrystalline cellulose, magnesium stearate, lactose monohydrate.

Pharmacological action

Bagopril - an antihypertensive drug, its mechanism of action is associated with a decrease in formation of angiotensin I angiotensin II, decrease of which leads to a direct reduction of aldosterone release. At the same time decreases the total peripheral vascular resistance, systolic and diastolic blood pressure, fasting and preload on the myocardium.

Expands the artery to a greater extent than the vein, with a reflex increase in heart rate is not marked.

Reduces the degradation of bradykinin, increases prostaglandin synthesis.

Hypotensive effect was more pronounced at high levels of plasma renin blood than normal or reduced its level.

Blood pressure reduction in the therapeutic range has no effect on cerebral blood flow, blood flow in the vessels of the brain is maintained at a sufficient level on the background of reduced pressure.

Strengthens the coronary and renal blood flow.

With prolonged use decreases left ventricular hypertrophy and myocardial muscle cells of the arteries resistant type, prevents the progression of heart failure and slowing the development of dilatation of the left ventricle.

Improves blood flow to ischemic myocardium.

Reduces platelet aggregation.

Has some diuretic effect. Enalapril is a "prodrug": as a result of its hydrolysis formed enalaprilat, which inhibits ACE.

Time of onset of hypotensive effect when taken orally - 1 hour, reaches a maximum after 4-6 h and persists up to 24 hours. In some patients, achieving optimal blood pressure level is required therapy for several weeks.

Heart failure significant clinical effect observed with prolonged use - 6 months or more.

Pharmacokinetics

After oral administration, absorbed 60% of the drug. Food intake did not affect the absorption of enalapril. Enalapril and 50% bound to plasma proteins. Enalapril is rapidly metabolized in the liver with the formation of the active metabolite enalaprilat, which is more active ACE inhibitor than enalapril. Bioavailability 40%. The maximum concentration of enalapril in plasma is reached after 1 hour, enalaprilat - 3-4 hours. Enalaprilat easily passes through gistogematicheskie barriers, except the blood-brain, small amounts cross the placenta and breast milk. Half-life of enalaprilat about 11 hours. Enalapril is derived primarily (60%) through the kidneys (20% as enalapril and 40% as enalaprilat), through the intestines - 33% (6% as enalapril and 27% as enalaprilat). Removed during dialysis (rate 62 ml / min) and peritoneal dialysis.

Statement
Bagopril prescribed for various forms of hypertension, including renovascular hypertension.
The drug is also effective in chronic heart failure (as part of combination therapy).

Dosing regimen

Bagopril appointed interior, regardless of meal times.

In monotherapy of hypertension the initial dose - 5 mg once a day.

In the absence of clinical effect in 1-2 weeks increase the dose of 5 mg.

After receiving the initial dose, patients should be under medical supervision for 2 hours and an additional 1 hour, until it stabilizes blood pressure.

If necessary, and reasonably good tolerability, the dose may be increased to 40 mg / day for 1-2 reception. After 2-3 weeks go to the maintenance dose equal to 10 - 40 mg per day, divided into 1 -2 reception.

With moderate hypertension average daily dose is about 10 mg.

The maximum daily dose - 40 mg.

In fact, if you want to assign Bagopril patients who take diuretics, treatment with diuretics should be discontinued 2-3 days prior to the start of Bagoprila. If it is not possible, the initial dose Bagoprila should be 2.5 mg / day.

Patients with hyponatremia (sodium ion concentration in the serum of less than 130mmol / L) or with increasing concentrations of serum creatinine over 0.14 mmol / L designate Bagopril in an initial dose of 2.5 mg 1 time per day.

When renovascular hypertension the initial dose - 2,5 - 5 mg / day.

The maximum daily dose is 20 mg.

In chronic heart failure the initial dose Bagoprila - 2.5 mg dose, then increase the dose of 2,5 - 5 mg every 3-4 days according to clinical response up to maximum tolerable doses, depending on the values of blood pressure, but not exceeding 40 mg single dose or in 2 divided doses.

In patients with low systolic blood pressure (less than 110 mm Hg), therapy should begin with a dose of 1.25 mg / day.

Titration should be carried out for 2-4 weeks or when necessary and possible in the shortest possible time.

The average maintenance dose - 5 - 20 mg / day for 1 -2 reception.

Older people more often, a more pronounced hypotensive effect and prolonged time of action of enalapril, which is associated with a decrease in clearance rate of the drug, so the recommended initial dose for elderly patients - 1,25 mg / day.

In chronic renal failure, accumulation of enalapril comes with a decrease in filtering of less than 10 ml / min.

When creatinine clearance (CC) 80-30 ml / min dose of enalapril should be 5-10 mg / day, while reducing spacecraft to 10.30 ml / min - 2,5 - 5 mg / day, with CC <10>

Bagomet

Release form, composition and packing Bagomet 

Tablets, coated white, round, biconvex, with two cross-positioned risks on one side and a logo - on the other, on a break - the rough surface of white. 1 tab. metformin hydrochloride 500 mg.

Inactive ingredients: croscarmellose sodium, povidone, stearic acid, corn starch, lactose monohydrate, purified water. The composition of the shell: Opadry White YS-30-18056 (ready mix for the shell, consisting of lactose, hypromellose, titanium dioxide and triacetin in a ratio of 40:40:10:10), Opadry clear YS 1-7006 (ready mix for the shell, consisting of hypromellose and polyethylene glycol in a ratio of 90:10), purified water, sodium saccharin.

Extended release tablets, coated in blue, Valium, with Valium on one side and a logo - on the other, on a break - the rough surface of white. 1 tab. metformin hydrochloride 850 mg. Inactive ingredients: hypromellose, povidone, magnesium stearate, alcohol, lactose monohydrate, methylene chloride. The composition of the shell: Opadry White YS-30-18056 (ready mix for the shell, consisting of lactose, hypromellose, titanium dioxide and triacetin in a ratio of 40:40:10:10), Opadry clear YS 1-7006 (ready mix for the shell, consisting of hypromellose and polyethylene glycol in a ratio of 90:10), purified water, sodium saccharin, vanilla, food coloring Brilliant Blue.

Clinico-pharmacological group: oral hypoglycemic agents.

Pharmacological action

Hypoglycemic drug from biguanide group. Inhibits hepatic gluconeogenesis, decreases absorption of glucose from the intestine, enhances peripheral glucose utilization and increases tissue insulin sensitivity. In this case, has no effect on the secretion of insulin β-cells in the pancreas. Bagomet lowers triglyceride and LDL cholesterol in the blood.

Mildly anorectics effect that helps patients to diet, stabilize or reduce body weight. Improves fibrinolytic properties of blood due to suppression of plasminogen activator inhibitor type of tissue.

Pharmacokinetics

Absorption and distribution

After oral administration, metformin is absorbed from the gastrointestinal tract. Bioavailability after administration of standard dose is 50-60%. Cmax in plasma achieved 2 h after ingestion. Practically does not bind to plasma proteins. Accumulates in the salivary glands, liver and kidneys.

Breeding

Stands unchanged by the kidneys. T1 / 2 is approximately 6.5 hours

Pharmacokinetics in special clinical situations

If the kidney function is possible cumulative effect of the drug.

Statement
Type 2 diabetes patients without the propensity to ketoacidosis with the ineffectiveness of diet (especially in obese).

Dosing regimen

Set individually depending on the level of glucose in the blood. The initial dose is 0.5-1 g / day. 10-15 days may further gradual increase in the dose depending on the level of glucose in the blood. Maintenance dose is usually 1.5-2 g / day. The maximum dose - 3 g / day. To reduce the side effects on the digestive system of the daily dose should be divided into 2-3 doses.

Elderly patients recommended daily dose should not exceed 1 g.

In severe metabolic disturbances dose

Bagometa be reduced (due to an increased risk of lactic acidosis). The tablets should be taken entirely Bagometa during or immediately after the meal with a small amount of liquid (water glass).

Side effect
From the digestive system: nausea, vomiting, metallic taste, anorexia, diarrhea, flatulence, abdominal pain.
From the hemopoietic system: in some cases - megaloblastic anemia.
From the Endocrine: hypoglycemia (when used in inadequate doses) and in rare cases, lactic acidosis (requires treatment).

Allergic reactions: skin rash.

Other: long-term use - Hypovitaminosis B12 (due to malabsorption).

Contraindications
diabetic ketoacidosis;
diabetic precoma;
coma;
marked impairment of renal function;
liver function;
cardiac and respiratory failure;
acute phase of myocardial infarction;
acute cerebrovascular accident;
dehydration;
lactic acidosis (including history);
chronic alcoholism, and other conditions that might promote lactic acidosis;
major surgery and trauma (when shown an insulin);
acute alcohol poisoning;
application for at least 2 days before and within 2 days after the application of radioisotope iodine-containing drugs or X-ray;
adherence to a strict diet (less than 1000 kcal / day).
pregnancy;
Lactation (breastfeeding);
hypersensitivity to the drug.

Not recommended to prescribe the drug to people over 60 years of performing heavy physical load (due to an increased risk of lactic acidosis).

Pregnancy and lactation

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

Use in hepatic dysfunction

Contraindicated in marked hepatic dysfunction.

Use in renal impairment

Contraindicated in marked renal impairment.

Cautions

During the period of treatment needed to control renal function. Need to monitor lactate levels were at least 2 times a year, as well as the appearance of myalgia.

Bagometa possible to use in combination with sulfonylureas. In this case, requires particularly careful monitoring of blood glucose.

At the use of ethanol during treatment

Bagometa may develop lactic acidosis.

Overdose

Symptoms: may develop lactic acidosis with fatal consequences (for reasons of development may also include the cumulation of the drug due to renal dysfunction). The early symptoms include nausea, vomiting, diarrhea, drop in body temperature, abdominal pain in muscles and in the future possibly shortness of breath, dizziness, impaired consciousness and the development of coma.

Treatment: medication to terminate immediately, the patient should be hospitalized immediately and determine the concentration of lactate. The most effective hemodialysis. If necessary, symptomatic treatment.

Combination therapy with sulfonylureas Bagometa possible hypoglycemia.

Drug Interactions

In an application with sulfonylureas, acarbose, insulin, NSAIDs, MAO inhibitors, oxytetracycline, ACE inhibitors, derivatives of clofibrate, cyclophosphamide, beta-blockers may increase hypoglycemic action of metformin.

In an application with corticosteroids, oral contraceptives, epinephrine, sympathomimetics, glucagon, thyroid hormone drugs, thiazide and loop "diuretics, phenothiazine derivatives, derivatives of nicotinic acid may decrease hypoglycemic effect of metformin.

With the simultaneous application of cimetidine slows the excretion of metformin, which increases the risk of developing lactic acidosis. With the simultaneous application of metformin may reduce the action of anticoagulants (coumarin derivatives).

Conditions and terms of

List B. The drug should be stored in a dry place, protected from light and away from children, at up to 25 ° C. Shelf life - 2 years.