Pharmacological action
Base antirheumatic drug. Has antiproliferative, immunomodulatory (immunosuppressive) and anti-inflammatory effect. The active metabolite of leflunomide A771726 inhibits the enzyme degidroorotat dehydrogenase and has an antiproliferative effect. A771726 inhibits in vitro cell proliferation caused by mitogens and DNA synthesis of T-lymphocytes. Antiproliferative activity A771726 seen, apparently at the level of pyrimidine biosynthesis, since the addition of cell culture eliminates the inhibitory effect of uridine metabolite A771726. With the use of radioisotope ligand shown that A771726 selectively binds to the enzyme degidroorotat dehydrogenase, which explains its properties this enzyme and inhibit proliferation of lymphocytes at the stage of G1. Simultaneously A771726 inhibits the expression of receptors for interleukin-2 and core antigen Ki-67 and PCNA, associated with the cell cycle.
Therapeutic effect of leflunomide has been shown in several experimental models of autoimmune diseases, including rheumatoid arthritis.
Pharmacokinetics
The absorption and distribution
After oral administration, absorbed 82-95% of the drug. Eating does not affect the absorption leflunamida. Leflunomide is rapidly metabolized with the formation of the active metabolite A771726. Cmax metabolite A771726 determined within 1-24 h after a single dose of the dose. In plasma A771726 rapidly binds to albumin. Untie A771726 fraction is 0.62%. Binding A771726 more variable and somewhat reduced in patients with rheumatoid arthritis or chronic renal insufficiency.
Due to the long T1 / 2 A771726 was used a loading dose of 100 mg for 3 days. Pharmacokinetic parameters A771726 have a linear dependence at doses from 5 mg to 25 mg. In these studies, the clinical effect is closely related to plasma concentration of A771726 and a daily dose of leflunomide. At a dose of 20 mg / day, mean plasma concentration of A771726 at steady-state was 35 micrograms / ml.
Metabolism
Leflunomide is rapidly metabolized in the intestinal wall and liver to one of the main (A771726) metabolite and several secondary metabolites, including 4-trifluorometilalanin. Biotransformation of leflunomide to A771726 and A771726 of the subsequent metabolism are controlled by several enzymes and occur in microsomal and other cell fractions.
Withdrawal
In plasma, urine and feces determined by the trace amounts of leflunomide. Removing A771726 slow and characterized by clearance of 31 mL / h. T1 / 2 – about 2 weeks.
Pharmacokinetics in special clinical cases
Patients on hemodialysis, elimination of the drug quickly and T1 / 2 is shorter.
Data on the pharmacokinetics in patients with liver failure are absent.
Pharmacokinetics in patients younger than 18 years has not been studied.
Elderly patients (65 years and older) pharmacokinetic data correspond approximately to the middle age group.
Indications
- As the reference drug for the treatment of active rheumatoid arthritis to reduce symptoms and delay the development of structural damage of joints.
Dosage regimen
Treatment is initiated with the appointment of a shock dose of 100 mg daily for 3 days. As a maintenance dose prescribed dose of 10 mg to 20 mg 1 time per day.
The therapeutic effect is evident after 4-6 weeks of admission and may grow within 4-6 months.
Tablets should be swallowed whole, drinking plenty of fluids.
Not require dose adjustment for patients older than 65 years.
There are currently no recommendations for dosing regime for patients with mild renal insufficiency.
Side effects
Classification of the alleged frequency of side effects: typical – 1-10%, atypical – 0.1-1%, rare – 0.01-0.1%, very rare – 0.01% or less.
Since the cardiovascular system: typical – increase blood pressure.
From the digestive system: typical – diarrhea, nausea, vomiting, anorexia, lesions of the oral mucosa (thrush, mouth ulceration), abdominal pain, increased hepatic transaminases (particularly ALT, rarely – GGT, alkaline phosphatase, bilirubin); rarely – hepatitis, jaundice, cholestasis, very rarely – liver failure, acute liver necrosis.
On the part of the musculoskeletal system: typical – abscess, atypical – the gap ligaments.
Dermatological reactions: typical – hair loss, eczema, dry skin, atypical – Stevens-Johnson syndrome, Lyell syndrome, erythema multiforme.
The part of the hemopoietic system: typical – leukopenia (white blood cells more 2000/mkl); atypical – anemia, thrombocytopenia (platelets less than 100 000/mkl); rarely – eosinophilia, leukopenia (leukocytes less 2000/mkl), pancytopenia, very rarely – agranulocytosis. The risk of hematologic disorders increases with the recent, concomitant and subsequent application of myelotoxic drugs.
Allergic reactions: typical – rash (including makulo-papular), pruritus; atypical – urticaria; very rare – anaphylactic reactions.
On the part of the exchange processes: hyperlipidemia, hypophosphatemia, reduced levels of uric acid. Laboratory data (not clinically confirmed) showed a modest increase lactate dehydrogenase, creatine phosphokinase.
Other: very rarely – the development of severe infection and sepsis may develop rhinitis, bronchitis and pneumonia. In the application of immunosuppressive drugs increases the risk of cancer and some lymphoproliferative processes.
We can not exclude the possibility of a reversible reduction of sperm concentration, total sperm count and motility.
Contraindications
- Human liver;
- Severe immunodeficiency (including AIDS);
- Pronounced disorders of bone marrow hematopoiesis or anemia, leukopenia, thrombocytopenia due to other causes (other than rheumatoid arthritis);
- Infection heavy flow;
- Moderate or severe renal insufficiency (because of the small experience of clinical observations);
- Severe hypoproteinemia (including with nephrotic syndrome);
- Pregnancy;
- Lactation (breastfeeding);
- Childhood and adolescence to 18 years;
- Hypersensitivity to the ingredients.
The drug is contraindicated in women of childbearing age who do not use adequate contraception.
Pregnancy and lactation
The drug should not be administered during pregnancy and women of childbearing age who are not using reliable contraception. You must verify the absence of pregnancy before starting treatment.
In experimental studies have found that the drug may have fetotoksicheskoe and teratogenic effect.
Patients should be informed that suspected pregnancy should seek medical advice immediately and do a pregnancy test. If the test is positive, the physician should inform the patient about the possible risk to the fetus.
Women who take leflunomide and want to become pregnant (or already in the ensuing pregnancy) procedure is recommended to launch the drug, which will rapidly reduce the concentration of leflunomide and its metabolite in blood plasma (after cessation of treatment prescribed leflunomide kolestiramin in a dose of 8 g 3 times / day within 11 days or 50 g of activated charcoal, crushed into powder, 4 times / day for 11 days).
Next, you need to determine the concentration of metabolite A771726 2 times with an interval of 14 days. From the moment when the concentration of the drug will be fixed below 20 mg / l until fertilization should take 1.5 months.
Note that without the procedure of removing the drug, reduced metabolite concentrations below 20 ug / l occurs in 2 years.
Kolestiramin and activated carbon can affect the absorption of estrogen and progesterone in such a way that reliable oral contraceptives do not guarantee the necessary contraception during launch preparation. It is recommended to use alternative methods of contraception.
Studies in animals have shown that leflunomide or its metabolites are excreted in breast milk milk. Therefore, the need to designate a lactation should resolve the issue of termination of breastfeeding.
There is currently no information confirming the link between taking the drug Arava men and fetotoksicheskim action of the drug. Experimental studies in this direction were made. However, men receiving leflunomide therapy, should be warned of the possible effect of fetotoksicheskom and the need to use adequate contraception. To minimize risk when planning pregnancy should stop taking leflunomide and use kolestiramin to 8 mg 3 times daily for 11 days or 50 grams of powdered activated charcoal 4 times daily for 11 days.
Cautions
Note that the drug Arava may be imposed only after a medical examination (including before starting treatment and during treatment should monitor blood pressure).
Before treatment drug Arava should be mindful of possible increase in the number of side effects in patients previously treated with other basic tools for the treatment of rheumatoid arthritis, which have hepato-and gematotoksicheskim action.
The active metabolite of leflunomide A771726 characterized by long T1 / 2. Therefore, side effects can occur even after cessation of therapy. If you have any similar cases of toxicity or when moving to another base receiving the drug after treatment with leflunomide should be the procedure of removing the drug (after the cessation of leflunomide treatment prescribed kolestiramin in a dose of 8 g 3 times daily for 11 days or 50 g of activated carbon, crushed to powder, 4 times / day for 11 days).
Note that during the development of severe dermatologic adverse reactions, severe infections receiving the drug Arava should stop and immediately initiate the removal of the drug.
Need to monitor patients with tuberculin reactivity due to the risk of activating tuberculosis.
Given the long-term elimination of Arava is not recommended to vaccinate live vaccines against a background of leflunomide treatment.
Overdose
No data on overdose of leflunomide. Admission leflunomide 100 mg daily for 14 days was observed in 10 healthy volunteers. Two of them were removed after a week because of the increased level of transaminases in the blood plasma.
In case of overdose or toxicity is recommended to use kolestiramina or powdered activated carbon. Kolestiramin, take 3 healthy volunteers administered orally to 8 mg 3 times / day during the day, reduced levels of A771726 in plasma by approximately 40% after 24 h and 49-65% after 48 h.
Shown that introduction of activated charcoal orally or via oral gavage (50 mg every 6 hours during the day) reduced the concentration of the active metabolite A771726 in plasma by 37% after 24 h and 48% after 48 h.
Perhaps repetition procedures are preparation for clinical indications.
Drug Interactions
Increased adverse reactions may occur in the case of recent or concomitant use of hepatotoxic drugs or hematotoxicity or when receiving these drugs after starting leflunomide treatment procedure without removing the drug.
Not observed pharmacokinetic interaction between leflunomide (10-20 mg / day) and methotrexate (10-25 mg / week).
Unknown clinically significant interactions with concomitant use of leflunomide and triphasic oral contraceptives, NSAIDs, cimetidine, rifampicin.
Studies in vitro showed that the metabolite of leflunomide A771726 inhibits the activity of cytochrome P450 2C9. Therefore, caution should be prescribed the drug Arava with drugs metabolized by this enzyme system (phenytoin, warfarin, tolbutamide).
Conditions and terms of storage
The product should be stored at temperatures not above 25 ° C. Shelf life – 3 years.
Conditions of supply of pharmacies
The drug is released with a prescription.

Arava

Pharmacological action

Base antirheumatic drug. Has antiproliferative, immunomodulatory (immunosuppressive) and anti-inflammatory effect. The active metabolite of leflunomide A771726 inhibits the enzyme degidroorotat dehydrogenase and has an antiproliferative effect. A771726 inhibits in vitro cell proliferation caused by mitogens and DNA synthesis of T-lymphocytes. Antiproliferative activity A771726 seen, apparently at the level of pyrimidine biosynthesis, since the addition of cell culture eliminates the inhibitory effect of uridine metabolite A771726. With the use of radioisotope ligand shown that A771726 selectively binds to the enzyme degidroorotat dehydrogenase, which explains its properties this enzyme and inhibit proliferation of lymphocytes at the stage of G1. Simultaneously A771726 inhibits the expression of receptors for interleukin-2 and core antigen Ki-67 and PCNA, associated with the cell cycle.

Therapeutic effect of leflunomide has been shown in several experimental models of autoimmune diseases, including rheumatoid arthritis.

Pharmacokinetics

The absorption and distribution

After oral administration, absorbed 82-95% of the drug. Eating does not affect the absorption leflunamida. Leflunomide is rapidly metabolized with the formation of the active metabolite A771726. Cmax metabolite A771726 determined within 1-24 h after a single dose of the dose. In plasma A771726 rapidly binds to albumin. Untie A771726 fraction is 0.62%. Binding A771726 more variable and somewhat reduced in patients with rheumatoid arthritis or chronic renal insufficiency.

Due to the long T1 / 2 A771726 was used a loading dose of 100 mg for 3 days. Pharmacokinetic parameters A771726 have a linear dependence at doses from 5 mg to 25 mg. In these studies, the clinical effect is closely related to plasma concentration of A771726 and a daily dose of leflunomide. At a dose of 20 mg / day, mean plasma concentration of A771726 at steady-state was 35 micrograms / ml.

Metabolism

Leflunomide is rapidly metabolized in the intestinal wall and liver to one of the main (A771726) metabolite and several secondary metabolites, including 4-trifluorometilalanin. Biotransformation of leflunomide to A771726 and A771726 of the subsequent metabolism are controlled by several enzymes and occur in microsomal and other cell fractions.

Withdrawal

In plasma, urine and feces determined by the trace amounts of leflunomide. Removing A771726 slow and characterized by clearance of 31 mL / h. T1 / 2 – about 2 weeks.

Pharmacokinetics in special clinical cases

Patients on hemodialysis, elimination of the drug quickly and T1 / 2 is shorter.

Data on the pharmacokinetics in patients with liver failure are absent.

Pharmacokinetics in patients younger than 18 years has not been studied.

Elderly patients (65 years and older) pharmacokinetic data correspond approximately to the middle age group.

Indications

- As the reference drug for the treatment of active rheumatoid arthritis to reduce symptoms and delay the development of structural damage of joints.

Dosage regimen

Treatment is initiated with the appointment of a shock dose of 100 mg daily for 3 days. As a maintenance dose prescribed dose of 10 mg to 20 mg 1 time per day.

The therapeutic effect is evident after 4-6 weeks of admission and may grow within 4-6 months.

Tablets should be swallowed whole, drinking plenty of fluids.

Not require dose adjustment for patients older than 65 years.

There are currently no recommendations for dosing regime for patients with mild renal insufficiency.

Side effects

Classification of the alleged frequency of side effects: typical – 1-10%, atypical – 0.1-1%, rare – 0.01-0.1%, very rare – 0.01% or less.

Since the cardiovascular system: typical – increase blood pressure.

From the digestive system: typical – diarrhea, nausea, vomiting, anorexia, lesions of the oral mucosa (thrush, mouth ulceration), abdominal pain, increased hepatic transaminases (particularly ALT, rarely – GGT, alkaline phosphatase, bilirubin); rarely – hepatitis, jaundice, cholestasis, very rarely – liver failure, acute liver necrosis.

On the part of the musculoskeletal system: typical – abscess, atypical – the gap ligaments.

Dermatological reactions: typical – hair loss, eczema, dry skin, atypical – Stevens-Johnson syndrome, Lyell syndrome, erythema multiforme.

The part of the hemopoietic system: typical – leukopenia (white blood cells more 2000/mkl); atypical – anemia, thrombocytopenia (platelets less than 100 000/mkl); rarely – eosinophilia, leukopenia (leukocytes less 2000/mkl), pancytopenia, very rarely – agranulocytosis. The risk of hematologic disorders increases with the recent, concomitant and subsequent application of myelotoxic drugs.

Allergic reactions: typical – rash (including makulo-papular), pruritus; atypical – urticaria; very rare – anaphylactic reactions.

On the part of the exchange processes: hyperlipidemia, hypophosphatemia, reduced levels of uric acid. Laboratory data (not clinically confirmed) showed a modest increase lactate dehydrogenase, creatine phosphokinase.

Other: very rarely – the development of severe infection and sepsis may develop rhinitis, bronchitis and pneumonia. In the application of immunosuppressive drugs increases the risk of cancer and some lymphoproliferative processes.

We can not exclude the possibility of a reversible reduction of sperm concentration, total sperm count and motility.

Contraindications

- Human liver;

- Severe immunodeficiency (including AIDS);

- Pronounced disorders of bone marrow hematopoiesis or anemia, leukopenia, thrombocytopenia due to other causes (other than rheumatoid arthritis);

- Infection heavy flow;

- Moderate or severe renal insufficiency (because of the small experience of clinical observations);

- Severe hypoproteinemia (including with nephrotic syndrome);

- Pregnancy;

- Lactation (breastfeeding);

- Childhood and adolescence to 18 years;

- Hypersensitivity to the ingredients.

The drug is contraindicated in women of childbearing age who do not use adequate contraception.

Pregnancy and lactation

The drug should not be administered during pregnancy and women of childbearing age who are not using reliable contraception. You must verify the absence of pregnancy before starting treatment.

In experimental studies have found that the drug may have fetotoksicheskoe and teratogenic effect.

Patients should be informed that suspected pregnancy should seek medical advice immediately and do a pregnancy test. If the test is positive, the physician should inform the patient about the possible risk to the fetus.

Women who take leflunomide and want to become pregnant (or already in the ensuing pregnancy) procedure is recommended to launch the drug, which will rapidly reduce the concentration of leflunomide and its metabolite in blood plasma (after cessation of treatment prescribed leflunomide kolestiramin in a dose of 8 g 3 times / day within 11 days or 50 g of activated charcoal, crushed into powder, 4 times / day for 11 days).

Next, you need to determine the concentration of metabolite A771726 2 times with an interval of 14 days. From the moment when the concentration of the drug will be fixed below 20 mg / l until fertilization should take 1.5 months.

Note that without the procedure of removing the drug, reduced metabolite concentrations below 20 ug / l occurs in 2 years.

Kolestiramin and activated carbon can affect the absorption of estrogen and progesterone in such a way that reliable oral contraceptives do not guarantee the necessary contraception during launch preparation. It is recommended to use alternative methods of contraception.

Studies in animals have shown that leflunomide or its metabolites are excreted in breast milk milk. Therefore, the need to designate a lactation should resolve the issue of termination of breastfeeding.

There is currently no information confirming the link between taking the drug Arava men and fetotoksicheskim action of the drug. Experimental studies in this direction were made. However, men receiving leflunomide therapy, should be warned of the possible effect of fetotoksicheskom and the need to use adequate contraception. To minimize risk when planning pregnancy should stop taking leflunomide and use kolestiramin to 8 mg 3 times daily for 11 days or 50 grams of powdered activated charcoal 4 times daily for 11 days.

Cautions

Note that the drug Arava may be imposed only after a medical examination (including before starting treatment and during treatment should monitor blood pressure).

Before treatment drug Arava should be mindful of possible increase in the number of side effects in patients previously treated with other basic tools for the treatment of rheumatoid arthritis, which have hepato-and gematotoksicheskim action.

The active metabolite of leflunomide A771726 characterized by long T1 / 2. Therefore, side effects can occur even after cessation of therapy. If you have any similar cases of toxicity or when moving to another base receiving the drug after treatment with leflunomide should be the procedure of removing the drug (after the cessation of leflunomide treatment prescribed kolestiramin in a dose of 8 g 3 times daily for 11 days or 50 g of activated carbon, crushed to powder, 4 times / day for 11 days).

Note that during the development of severe dermatologic adverse reactions, severe infections receiving the drug Arava should stop and immediately initiate the removal of the drug.

Need to monitor patients with tuberculin reactivity due to the risk of activating tuberculosis.

Given the long-term elimination of Arava is not recommended to vaccinate live vaccines against a background of leflunomide treatment.

Overdose

No data on overdose of leflunomide. Admission leflunomide 100 mg daily for 14 days was observed in 10 healthy volunteers. Two of them were removed after a week because of the increased level of transaminases in the blood plasma.

In case of overdose or toxicity is recommended to use kolestiramina or powdered activated carbon. Kolestiramin, take 3 healthy volunteers administered orally to 8 mg 3 times / day during the day, reduced levels of A771726 in plasma by approximately 40% after 24 h and 49-65% after 48 h.

Shown that introduction of activated charcoal orally or via oral gavage (50 mg every 6 hours during the day) reduced the concentration of the active metabolite A771726 in plasma by 37% after 24 h and 48% after 48 h.

Perhaps repetition procedures are preparation for clinical indications.

Drug Interactions

Increased adverse reactions may occur in the case of recent or concomitant use of hepatotoxic drugs or hematotoxicity or when receiving these drugs after starting leflunomide treatment procedure without removing the drug.

Not observed pharmacokinetic interaction between leflunomide (10-20 mg / day) and methotrexate (10-25 mg / week).

Unknown clinically significant interactions with concomitant use of leflunomide and triphasic oral contraceptives, NSAIDs, cimetidine, rifampicin.

Studies in vitro showed that the metabolite of leflunomide A771726 inhibits the activity of cytochrome P450 2C9. Therefore, caution should be prescribed the drug Arava with drugs metabolized by this enzyme system (phenytoin, warfarin, tolbutamide).


Conditions and terms of storage

The product should be stored at temperatures not above 25 ° C. Shelf life – 3 years.

Conditions of supply of pharmacies

The drug is released with a prescription.

BUY ARAVA cheap

Latin name
Cozaar ®
ATC:
>> C09CA01 Losartan
Pharmacological Group
>> Receptor antagonists of angiotensin II (AT1-subtype)
Nosological classification (ICD-10)
>> I10-I15 Diseases characterized by high blood pressure
>> I50 Heart failure
The composition and the form
1 tablet contains losartan potassium 12.5 or 50 mg in the contour of cellular packing 21 or 14 pieces., In box 2 and 1 pack respectively.
Pharmacological action
Mode of action – hypotensive. Blocks angiotensin II (type AT1) reduces OPSS, reduces afterload, reduces systemic blood pressure and the pressure in the lesser circulation.
Pharmacokinetics
Well absorbed. Be distributed relatively evenly. Metabolized to form the active derivative.
Pharmacodynamics
Maximum antihypertensive effect is achieved within 3-6 weeks of treatment.
Indications
Arterial hypertension, heart failure (including when treatment with ACE inhibitors is no longer appropriate for the patient.
Contraindications
Hypersensitivity, children’s age.
Application of pregnancy and breastfeeding
When the reception immediately terminate pregnancy (may cause developmental defects or fetal death, especially in the II-III trimester). Nursing mothers should stop breastfeeding.
Side effects
Dizziness, hypotension (dose-related), hyperkalemia (1.5% of patients).
Interaction
Compatible with other antihypertensive agents. Against the background of diuretics (high doses) increases the risk of excessive hypotension in patients with dehydration.
Overdose
The most likely manifestation – hypotension and tachycardia (possible vagal bradycardia). Treatment of symptomatic – no Kozaar nor its active metabolite are not displayed hemodialysis.
Dosing and Administration
Inside, regardless of the meal, once. Usually – 50 mg / day. In some cases, to achieve greater effect, increase the dose to 100 mg. Patients with dehydration may make an initial dose of 25 mg / day. For patients with heart failure the initial dose may reach 12.5 mg 1 time per day.
Precautions
Patients with a history of liver disease should be prescribed lower doses (plasma concentration significantly increased for violations of its functions, especially with cirrhosis).
Expiration
3 years
Storage
List B.: In the dark place at a temperature not above 25 ° C.
Date update
2001-07-31

Latin name

Cozaar ®

ATC:

>> C09CA01 Losartan

Pharmacological Group

>> Receptor antagonists of angiotensin II (AT1-subtype)

Nosological classification (ICD-10)

>> I10-I15 Diseases characterized by high blood pressure

>> I50 Heart failure

The composition and the form

1 tablet contains losartan potassium 12.5 or 50 mg in the contour of cellular packing 21 or 14 pieces., In box 2 and 1 pack respectively.

Pharmacological action

Mode of action – hypotensive. Blocks angiotensin II (type AT1) reduces OPSS, reduces afterload, reduces systemic blood pressure and the pressure in the lesser circulation.

Pharmacokinetics

Well absorbed. Be distributed relatively evenly. Metabolized to form the active derivative.

Pharmacodynamics

Maximum antihypertensive effect is achieved within 3-6 weeks of treatment.

Indications

Arterial hypertension, heart failure (including when treatment with ACE inhibitors is no longer appropriate for the patient.

Contraindications

Hypersensitivity, children’s age.

Application of pregnancy and breastfeeding

When the reception immediately terminate pregnancy (may cause developmental defects or fetal death, especially in the II-III trimester). Nursing mothers should stop breastfeeding.

Side effects

Dizziness, hypotension (dose-related), hyperkalemia (1.5% of patients).

Interaction

Compatible with other antihypertensive agents. Against the background of diuretics (high doses) increases the risk of excessive hypotension in patients with dehydration.

Overdose

The most likely manifestation – hypotension and tachycardia (possible vagal bradycardia). Treatment of symptomatic – no Kozaar nor its active metabolite are not displayed hemodialysis.

Dosing and Administration

Inside, regardless of the meal, once. Usually – 50 mg / day. In some cases, to achieve greater effect, increase the dose to 100 mg. Patients with dehydration may make an initial dose of 25 mg / day. For patients with heart failure the initial dose may reach 12.5 mg 1 time per day.

Precautions

Patients with a history of liver disease should be prescribed lower doses (plasma concentration significantly increased for violations of its functions, especially with cirrhosis).

Expiration

3 years

Storage

List B.: In the dark place at a temperature not above 25 ° C.

Date update

2001-07-31

BUY Cozaar

Coumadin – Warfarin
Coumadin should be taken strictly in accordance with a medical prescription.
If you are over 60 years, then as a rule, you should take a lower dose than is usually assigned to reduce the risk of bleeding
Taken once a day, preferably at the same time
After three months of the reception, your doctor should reassess the need to continue taking Coumadin.
In the case of misuse, Coumadin can cause serious side effects: haemorrhage, bleeding, bruises, red spots on the body, irritation and skin damage.
Precautions – protection against shock, falls, cuts – even insect bites can lead to hemorrhage.
Fractures, traumatic injuries, blows to the stomach – can lead to massive bleeding, blood loss and death, and therefore should take action and nemedlennopoluchit immediate medical attention!
During the reception Coumadin, your doctor should monitor your condition through regular blood PT / INR (Pi.Ti.) and change in dosage if necessary, to ensure maximum efficiency of treatment.
Coumadin interacts with virtually all drugs. Its anticoagulant effect is very difficult to control, if the period of his admission begins or ceases to use or change the dose of another drug. Another drug can amplify or weaken the effect of Coumadin.
During the reception Coumadin should not take any other medicines, including OTC drugs (eg aspirin, cold remedies, antacid, laxative), or change the dose, which you are currently taking, without first talking to your doctor.
Note the interaction with Coumadin Paracetamol (Akamol-Deksamol) – the risk of bleeding increases tenfold!
Talk to your doctor, how to behave in case of need anesthesia.
Analysis – PT / INR as balancing performance and prescribed by the doctor once every 3 months: hemoglobin, platelet count, liver function tests, albumin, liver enzymes, kidney parameters, bleeding time, tests of functional activity of platelets
Take Coumadin dose should agree with the doctor, depending on the result of the analysis of PT / INR.
Do not take the responsibility for the appointment dose lekarstva.Tolko doctor can and knows how to take and will give you a diagram.
It is important to draw attention to the fact that interaction coumadin vegetables green.
Since Coumadin interacts with vitamin K, while taking Coumadin prohibited use food white cabbage (even fermented), red, color, Brussels sprouts, broccoli, cilantro, parsley, celery, fennel (green), lettuce, green onions, green peas, green beans, avocado

Coumadin – Warfarin

Coumadin should be taken strictly in accordance with a medical prescription.


If you are over 60 years, then as a rule, you should take a lower dose than is usually assigned to reduce the risk of bleeding


Taken once a day, preferably at the same time


After three months of the reception, your doctor should reassess the need to continue taking Coumadin.


In the case of misuse, Coumadin can cause serious side effects: haemorrhage, bleeding, bruises, red spots on the body, irritation and skin damage.


Precautions – protection against shock, falls, cuts – even insect bites can lead to hemorrhage.

Fractures, traumatic injuries, blows to the stomach – can lead to massive bleeding, blood loss and death, and therefore should take action and nemedlennopoluchit immediate medical attention!


During the reception Coumadin, your doctor should monitor your condition through regular blood PT / INR (Pi.Ti.) and change in dosage if necessary, to ensure maximum efficiency of treatment.


Coumadin interacts with virtually all drugs. Its anticoagulant effect is very difficult to control, if the period of his admission begins or ceases to use or change the dose of another drug. Another drug can amplify or weaken the effect of Coumadin.


During the reception Coumadin should not take any other medicines, including OTC drugs (eg aspirin, cold remedies, antacid, laxative), or change the dose, which you are currently taking, without first talking to your doctor.

Note the interaction with Coumadin Paracetamol (Akamol-Deksamol) – the risk of bleeding increases tenfold!


Talk to your doctor, how to behave in case of need anesthesia.


Analysis – PT / INR as balancing performance and prescribed by the doctor once every 3 months: hemoglobin, platelet count, liver function tests, albumin, liver enzymes, kidney parameters, bleeding time, tests of functional activity of platelets


Take Coumadin dose should agree with the doctor, depending on the result of the analysis of PT / INR.

Do not take the responsibility for the appointment dose lekarstva.Tolko doctor can and knows how to take and will give you a diagram.


It is important to draw attention to the fact that interaction coumadin vegetables green.


Since Coumadin interacts with vitamin K, while taking Coumadin prohibited use food white cabbage (even fermented), red, color, Brussels sprouts, broccoli, cilantro, parsley, celery, fennel (green), lettuce, green onions, green peas, green beans, avocado.

buy Coumadin

Name: Amara (Amaryl)
Pharmacological Effects:
Amari – preparation sulfonylureas, oral hypoglycemic agent. Has primary prolonged effect. The mechanism of action is to stimulate the secretion and release of insulin from beta cells of the pancreas (pancreatic effect). Also increases the sensitivity of fat and muscle tissue to insulin (ekstrapankreatichesky effect). It acts by blocking the cytoplasmic ATP-dependent potassium channel beta-cells of the pancreas. This is accompanied by the opening of calcium channel beta-cell membranes and increase the infiltration of calcium (depolarization).
Active ingredient amara – glimepiride – quick disconnects and connects with the beta-cell proteins, which has a molecular mass of 65 kDa / SURX and is associated with adenosine triphosphoric-dependent potassium channels. From other sulfonylurea derivatives differs in that there is no interaction with the protein beta-cells with a molecular mass of 140 kD/SUR1. This leads to the exocytosis of insulin, and the content of released insulin is much less than the influence of other traditional medicines. Slight amara stimulating effect on the secretion of beta-cells, insulin leads to a lower risk of hypoglycemia.
Amara Ekstrapankreatichesky effect leads to a decrease in insulin resistance, a negligible impact on the cardiovascular system. Has antiagregantnym, antiatherogenic and antioxidant effects.
Increased glucose utilization of fat and muscle tissue is carried out due to the presence in cell membranes of specific transport proteins. With the penetration of glucose-insulin-dependent diabetes in these tissues is restricted at the stage of disposal. Amari rapidly increases the activity of transport proteins, through which glucose is absorbed better. There is also an increase in the number of transport proteins on the background of Amarah. Virtually no blocking effects on ATP-dependent potassium channels of cardiac myocytes. Saved on the possibility of metabolic adaptation of cardiomyocytes to ischemic conditions. Increases the activity of specific glikozil-phosphatidylinositol-phospholipase C, which accounts for observed correlated with the admission amara glikogenez and lipogenesis.
Amari blocking hepatic production of glucose by increasing the content in hepatocytes of fructose-2 ,6-bisfosfata (the latter also inhibits gluconeogenesis).
Against the background of the drug observed blocking secretion of COX and a decrease in the transformation of arachidonic acid to thromboxane A2, thereby decreasing platelet aggregation (antithrombotic effect). Influenced amara observed increase in the concentration of alpha-tocopherol, which is produced endogenously. Also there is increased activity of superoxide dismutase, catalase and glyutationperoksidazy that manifested reduced severity of oxidative reactions in diabetes mellitus.
Indications:
Insulin-dependent diabetes mellitus (type 2) – as monotherapy or in combination with insulin (or metformin).
Dosing:
Amari are inside. Tablets do not chew,? High water about 150 ml. It is important not to forget to eat after dosing.
Starting and maintenance dosage is established physician individually depending on the level of glucose in the blood serum and its excretion in the urine.
First, apply the medication to 1 mg / day, if necessary, you can gradually increase the daily dose of 6 mg. Dose escalation is carried out at intervals of 1-2 weeks according to the scheme: 1 mg/sutki-2 mg/sutki-3 mg/sutki-4 mg/sutki-6 mg / day Amarah. Not exceed the recommended dose amara more than 6 mg / day. Multiplicity and time consumption of the drug is determined by the individual physician, depending on the lifestyle of the patient. Typically, the daily dose prescribed amara 1 time per day during or before the first plentiful meal (breakfast). If the morning dose was not adopted – that during or before the second meal. Prolonged therapy.
Using a combination of Amar metformin. Those patients who are taking metformin, and they have observed the lack of decrease of glucose in the blood serum, you can start receiving additional Amarah. If the daily dosage of metformin does not change, then the therapy Amarillo begin with a dose of 1 mg / day. Subsequently amara dose can be increased to achieve the desired reduction of glucose in the blood serum up to 6 mg / day.
Using a combination of Amar insulin. To stabilize the glucose in the blood serum in cases where the use of monotherapy or combination Amar metformin inefficiently used a combination of insulin with Amarillo. This dose amara left unchanged, but insulin therapy starting with small doses. In the future, may increase insulin. Therapy should be accompanied by monitoring the concentration of glucose in the blood serum. The treatment is performed under the supervision of the treating physician. Scheme insulin-Amari can reduce the need for insulin by about 40%.
Replacing another antidiabetes therapies Amara. Launch treated with 1 mg / day Amarah, in not depending on the dose of previous medication (even if it was maximal). Depending on the therapeutic effect amara can increase the dose of the above rules. In some instances, removal of Amari because of the risk of hypoglycemia (especially if the Amari to use the drug with a high value of the half-life – hlorpropramid). Therapy is stopped for a few days (because of the probable additive effect).
Replacement of insulin in Amarah. In cases where patients with type 2 diabetes insulin is prescribed, but they remained intact insulinsekretiruyuschaya function of beta cells of the pancreas, can be translated to the patient an appointment with amara except insulin. In this case, therapy Amarillo begin with a dose of 1 mg / day.
Side effects:
Metabolism: The Rise of hypoglycemic reactions shortly after receiving Amari (such reactions are very difficult to correct).
Nervous system: headache, sleep disturbances, drowsiness, fatigue, aggressiveness, anxiety, changes in concentration and velocity of the psycho-motor responses, visual and speech disturbances, dizziness, confusion, depression, sensory disturbances, aphasia, disturbances of coordination, paresis, helpless condition, cerebral convulsions, loss of self-control, tremor, loss or confusion, delirium, coma, restlessness, cold, clammy sweat.
Gastrointestinal tract: vomiting, epigastric discomfort, hunger, abdominal pain, diarrhea, jaundice, cholestasis, elevation of liver transaminases, hepatitis, liver failure, nausea.
Cardiovascular system: tachycardia, cardiac arrhythmia, hypertension, bradycardia, angina pectoris.
Organ of: transient visual disturbances due to changes in blood glucose (especially in the beginning of therapy).
The respiratory system: shallow breathing.
Hematopoietic system: leucopenia, thrombocytopenia (moderate or severe), erythropenia, aplastic or hemolytic anemia, granulocytopenia, pancytopenia, agranulocytosis.
Hypersensitivity reactions: urticaria, itching, skin rashes, allergic vasculitis. Allergic reactions are usually slightly expressed, but it is sometimes possible progression up to anaphylactic shock. Perhaps cross-reaction to sulfonylureas, as well as sulfanilamidami.
Other: hyponatremia, photosensitivity.
Contraindications:
• genesis of diabetic ketoacidosis, diabetic coma and prekoma,
• insulin-dependent diabetes mellitus (type 1),
• Expression of renal dysfunction (including patients on hemodialysis),
• severe hepatic impairment,
• Individual hypersensitivity to Amarillo (Glimepiride) or other components of the drug, other means sulfonylureas, sulfonamides.
Pregnancy:
Amari should not be administered to pregnant women and women breast-feeding. If the patient is planning a pregnancy, it must be translated into the introduction of insulin with the exception of Amarah. If the patient is breastfeeding, she continued to insulin or breast-feeding stopped (because Amari passes into breast milk).
Interaction with other drugs:
In combination with insulin, other medication for the treatment of hypoglycemia, allopurinol, inhibitors of angiotensin-converting factor, male sex hormones, anabolic steroids, coumarin derivatives, chloramphenicol, fenfluramine, fluoxetine, fibrates, feniramidolom, MAO inhibitors, guanetidinom, pentoxifylline (with the introduction parenterally in large doses ), miconazole, azapropazonom, phenylbutazone, quinolones, probenecid, oksifenbutazonom, salicylates, sulfinpirazonom, tetracyclines, sulfonamides of prolonged action, tritokvalinom, Tropics, cyclo-, and ifosfamide may increase hypoglycemic effect of Amarah.
In combination with adrenaline (epinephrine) and sympathomimetics, acetazolamide, glucocorticosteroid, glucagon, diazoksidom, barbiturates, saluretics laxatives (prolonged use), thiazide diuretics, nicotinic acid in large doses, phenytoin, phenothiazines, rifampin, progestogens and estrogens, chlorpromazine , thyroid hormone, lithium salts may decrease hypoglycemic effect of Amarah.
In combination with amara reserpine, clonidine and blocking histamine H2-receptors may decrease as well as increased hypoglycemic effect.
May decrease or weakening of the effects of coumarin and its derivatives in conjunction with Amarillo. Prolonged or single use entanolsoderzhaschih drugs and drinks can both weaken and strengthen the hypoglycemic effect of Amarah.
Overdose:
In case of overdose amara possible hypoglycemia within 12-72 hours of admission amara in the high dose. Perhaps the re-development of hypoglycemia after the restoration of glucose in the blood. Hypoglycemia manifested by the following symptoms: high blood pressure, increased sweating, nausea, vomiting, arrhythmia, pain in the heart, anxiety, rapid increase of appetite, lethargy, dizziness, drowsiness, headache, anxiety, palpitations, aggression, violation of concentration, tremor , confusion, paresis, depression, breach of sensitivity, tachycardia, seizures of central origin. In some cases, hypoglycemia is manifested symptoms of stroke. There is a risk of coma. Treatment of hypoglycemia should begin with taking a piece of sugar, sweet tea or juice. The patient was warned that he always had with him approximately 20 g of glucose (in the form of 4 pieces of sugar, for example). In the treatment ineffective are the various sweeteners. In severe cases require hospitalization. By induction of vomiting, the patient spend dehydration (water with activated charcoal inside a laxative). Parenteral dextrose injected (intravenous bolus 40% solution 50 ml). In the future, use diluted dextrose (10% solution). Treatment was escorted to the constant control of glucose in the blood serum. Other indications cropped symptomatic treatment.
In case of accidental admission amara people without diabetes (children) need to avoid the development of hyperglycemia. A dose of dextrose carefully selected on the background monitoring of glucose in the blood serum.
Product:
Amari – tablets are dividing strip, elongated shape. Glimepiride Tablets 1 ml have a pink color. Amari, 2 ml – tablets green. Amari and 3 mg – Tablets light yellow color. Amari to 4 mg – green. In package 2 blisters, each with 15 tablets.
Storage:
Amari is stored at a temperature not exceeding 25 ° C. Shelf life – 3 years.
Ingredients:
Active ingredient: Glimepiride.
Inactive components: lactose monohydrate, polyvidone 25 000, sodium starch glycolate, microcrystalline cellulose, magnesium stearate, dyes (for amara 1 mg – iron oxide red (E172), for amara 2 mg – iron oxide yellow (E172) and indigo (E132) for amara 3 mg – iron oxide yellow (E172), for amara 4 mg – indigo (E132).
Extras:
In the treatment of Amarillo need to remember the states that require the transfer of the patient on parenteral administration of insulin (polytrauma, surgery, illness with fever, extensive burns, modified food absorption from the gastrointestinal tract in diseases – intestinal obstruction, intestinal paresis, etc.) .
In combination Amar metformin should be borne in mind that taking high doses of metformin and glimepiride sovrovozhdaetsya marked improvement in metabolism in patients with uncontrolled diabetes type. In the case of high doses of metformin and Amara, if the control still inadequate, it is possible to transfer the patient to a combination of Amar insulin.
Factors that encourage the development of hypoglycemia: low komplaentnost patient, inadequate, irregular meals, habitual diet changes, omissions, eating, drinking, fasting, changing the balance between carbohydrate intake and physical activity, severe dysfunction of the liver and kidneys; related uncompensated endocrine diseases , an overdose of Amara, thyroid gland, adrenal insufficiency, pituitary insufficiency, the combination with other drugs.
Signs of hypoglycemia are offset in the elderly, patients with neurocirculatory dystonia, patients who take beta-blockers, reserpine, clonidine, guanetidin, simpatolitiki.
Dose is adjusted individually depending on the content of glucose in the blood. If another dose is missed, absolutely not supposed to accept the next higher dose. Patient should inform your doctor about receiving too high doses of Amarah. In the case of compensation of diabetes may begin to improve sensitivity to insulin, thus possibly reducing the dose Amari (or even cancellation of the drug). Need to adjust the dose amara the appearance of various factors that may provoke hypoglycemia or hyperglycemia, as well as in the case of change of lifestyle. It must be remembered that the right diet, correction of physical activity, weight loss are of great importance for the treatment of diabetes while taking Amarah.
Should inform the patient that he immediately informed the doctor all the side effects that develop on a background therapy of Amarillo. It is also necessary to inform him about the factors that cause both hyper-and hypoglycemia and the symptoms of these conditions.
Therapy of Amarillo should be accompanied by regular monitoring of glucose in the blood serum, urine, determination of glycated hemoglobin concentration. Regular monitoring of these laboratory parameters in time helps to identify possible resistance to the drug of primary or secondary nature.
In the laboratory control includes the determination of liver function, complete blood count. Against the background of drug therapy may decrease the rate of psycho-motor reactions, and therefore work with the precise mechanisms and driving contraindicated. Especially concerns the initial stages of treatment Amarillo.
Warning
Before using the product Amari, you should consult your doctor. This instruction is given a free transfer and is intended solely for review. For more information, please contact the manufacturer annotations.

Name: Amara (Amaryl)

Pharmacological Effects:

Amari – preparation sulfonylureas, oral hypoglycemic agent. Has primary prolonged effect. The mechanism of action is to stimulate the secretion and release of insulin from beta cells of the pancreas (pancreatic effect). Also increases the sensitivity of fat and muscle tissue to insulin (ekstrapankreatichesky effect). It acts by blocking the cytoplasmic ATP-dependent potassium channel beta-cells of the pancreas. This is accompanied by the opening of calcium channel beta-cell membranes and increase the infiltration of calcium (depolarization).

Active ingredient amara – glimepiride – quick disconnects and connects with the beta-cell proteins, which has a molecular mass of 65 kDa / SURX and is associated with adenosine triphosphoric-dependent potassium channels. From other sulfonylurea derivatives differs in that there is no interaction with the protein beta-cells with a molecular mass of 140 kD/SUR1. This leads to the exocytosis of insulin, and the content of released insulin is much less than the influence of other traditional medicines. Slight amara stimulating effect on the secretion of beta-cells, insulin leads to a lower risk of hypoglycemia.

Amara Ekstrapankreatichesky effect leads to a decrease in insulin resistance, a negligible impact on the cardiovascular system. Has antiagregantnym, antiatherogenic and antioxidant effects.

Increased glucose utilization of fat and muscle tissue is carried out due to the presence in cell membranes of specific transport proteins. With the penetration of glucose-insulin-dependent diabetes in these tissues is restricted at the stage of disposal. Amari rapidly increases the activity of transport proteins, through which glucose is absorbed better. There is also an increase in the number of transport proteins on the background of Amarah. Virtually no blocking effects on ATP-dependent potassium channels of cardiac myocytes. Saved on the possibility of metabolic adaptation of cardiomyocytes to ischemic conditions. Increases the activity of specific glikozil-phosphatidylinositol-phospholipase C, which accounts for observed correlated with the admission amara glikogenez and lipogenesis.

Amari blocking hepatic production of glucose by increasing the content in hepatocytes of fructose-2 ,6-bisfosfata (the latter also inhibits gluconeogenesis).

Against the background of the drug observed blocking secretion of COX and a decrease in the transformation of arachidonic acid to thromboxane A2, thereby decreasing platelet aggregation (antithrombotic effect). Influenced amara observed increase in the concentration of alpha-tocopherol, which is produced endogenously. Also there is increased activity of superoxide dismutase, catalase and glyutationperoksidazy that manifested reduced severity of oxidative reactions in diabetes mellitus.

Indications:

Insulin-dependent diabetes mellitus (type 2) – as monotherapy or in combination with insulin (or metformin).

Dosing:

Amari are inside. Tablets do not chew,? High water about 150 ml. It is important not to forget to eat after dosing.

Starting and maintenance dosage is established physician individually depending on the level of glucose in the blood serum and its excretion in the urine.

First, apply the medication to 1 mg / day, if necessary, you can gradually increase the daily dose of 6 mg. Dose escalation is carried out at intervals of 1-2 weeks according to the scheme: 1 mg/sutki-2 mg/sutki-3 mg/sutki-4 mg/sutki-6 mg / day Amarah. Not exceed the recommended dose amara more than 6 mg / day. Multiplicity and time consumption of the drug is determined by the individual physician, depending on the lifestyle of the patient. Typically, the daily dose prescribed amara 1 time per day during or before the first plentiful meal (breakfast). If the morning dose was not adopted – that during or before the second meal. Prolonged therapy.

Using a combination of Amar metformin. Those patients who are taking metformin, and they have observed the lack of decrease of glucose in the blood serum, you can start receiving additional Amarah. If the daily dosage of metformin does not change, then the therapy Amarillo begin with a dose of 1 mg / day. Subsequently amara dose can be increased to achieve the desired reduction of glucose in the blood serum up to 6 mg / day.

Using a combination of Amar insulin. To stabilize the glucose in the blood serum in cases where the use of monotherapy or combination Amar metformin inefficiently used a combination of insulin with Amarillo. This dose amara left unchanged, but insulin therapy starting with small doses. In the future, may increase insulin. Therapy should be accompanied by monitoring the concentration of glucose in the blood serum. The treatment is performed under the supervision of the treating physician. Scheme insulin-Amari can reduce the need for insulin by about 40%.

Replacing another antidiabetes therapies Amara. Launch treated with 1 mg / day Amarah, in not depending on the dose of previous medication (even if it was maximal). Depending on the therapeutic effect amara can increase the dose of the above rules. In some instances, removal of Amari because of the risk of hypoglycemia (especially if the Amari to use the drug with a high value of the half-life – hlorpropramid). Therapy is stopped for a few days (because of the probable additive effect).

Replacement of insulin in Amarah. In cases where patients with type 2 diabetes insulin is prescribed, but they remained intact insulinsekretiruyuschaya function of beta cells of the pancreas, can be translated to the patient an appointment with amara except insulin. In this case, therapy Amarillo begin with a dose of 1 mg / day.

Side effects:

Metabolism: The Rise of hypoglycemic reactions shortly after receiving Amari (such reactions are very difficult to correct).

Nervous system: headache, sleep disturbances, drowsiness, fatigue, aggressiveness, anxiety, changes in concentration and velocity of the psycho-motor responses, visual and speech disturbances, dizziness, confusion, depression, sensory disturbances, aphasia, disturbances of coordination, paresis, helpless condition, cerebral convulsions, loss of self-control, tremor, loss or confusion, delirium, coma, restlessness, cold, clammy sweat.

Gastrointestinal tract: vomiting, epigastric discomfort, hunger, abdominal pain, diarrhea, jaundice, cholestasis, elevation of liver transaminases, hepatitis, liver failure, nausea.

Cardiovascular system: tachycardia, cardiac arrhythmia, hypertension, bradycardia, angina pectoris.

Organ of: transient visual disturbances due to changes in blood glucose (especially in the beginning of therapy).

The respiratory system: shallow breathing.

Hematopoietic system: leucopenia, thrombocytopenia (moderate or severe), erythropenia, aplastic or hemolytic anemia, granulocytopenia, pancytopenia, agranulocytosis.

Hypersensitivity reactions: urticaria, itching, skin rashes, allergic vasculitis. Allergic reactions are usually slightly expressed, but it is sometimes possible progression up to anaphylactic shock. Perhaps cross-reaction to sulfonylureas, as well as sulfanilamidami.

Other: hyponatremia, photosensitivity.

Contraindications:

• genesis of diabetic ketoacidosis, diabetic coma and prekoma,

• insulin-dependent diabetes mellitus (type 1),

• Expression of renal dysfunction (including patients on hemodialysis),

• severe hepatic impairment,

• Individual hypersensitivity to Amarillo (Glimepiride) or other components of the drug, other means sulfonylureas, sulfonamides.

Pregnancy:

Amari should not be administered to pregnant women and women breast-feeding. If the patient is planning a pregnancy, it must be translated into the introduction of insulin with the exception of Amarah. If the patient is breastfeeding, she continued to insulin or breast-feeding stopped (because Amari passes into breast milk).

Interaction with other drugs:

In combination with insulin, other medication for the treatment of hypoglycemia, allopurinol, inhibitors of angiotensin-converting factor, male sex hormones, anabolic steroids, coumarin derivatives, chloramphenicol, fenfluramine, fluoxetine, fibrates, feniramidolom, MAO inhibitors, guanetidinom, pentoxifylline (with the introduction parenterally in large doses ), miconazole, azapropazonom, phenylbutazone, quinolones, probenecid, oksifenbutazonom, salicylates, sulfinpirazonom, tetracyclines, sulfonamides of prolonged action, tritokvalinom, Tropics, cyclo-, and ifosfamide may increase hypoglycemic effect of Amarah.

In combination with adrenaline (epinephrine) and sympathomimetics, acetazolamide, glucocorticosteroid, glucagon, diazoksidom, barbiturates, saluretics laxatives (prolonged use), thiazide diuretics, nicotinic acid in large doses, phenytoin, phenothiazines, rifampin, progestogens and estrogens, chlorpromazine , thyroid hormone, lithium salts may decrease hypoglycemic effect of Amarah.

In combination with amara reserpine, clonidine and blocking histamine H2-receptors may decrease as well as increased hypoglycemic effect.

May decrease or weakening of the effects of coumarin and its derivatives in conjunction with Amarillo. Prolonged or single use entanolsoderzhaschih drugs and drinks can both weaken and strengthen the hypoglycemic effect of Amarah.

Overdose:

In case of overdose amara possible hypoglycemia within 12-72 hours of admission amara in the high dose. Perhaps the re-development of hypoglycemia after the restoration of glucose in the blood. Hypoglycemia manifested by the following symptoms: high blood pressure, increased sweating, nausea, vomiting, arrhythmia, pain in the heart, anxiety, rapid increase of appetite, lethargy, dizziness, drowsiness, headache, anxiety, palpitations, aggression, violation of concentration, tremor , confusion, paresis, depression, breach of sensitivity, tachycardia, seizures of central origin. In some cases, hypoglycemia is manifested symptoms of stroke. There is a risk of coma. Treatment of hypoglycemia should begin with taking a piece of sugar, sweet tea or juice. The patient was warned that he always had with him approximately 20 g of glucose (in the form of 4 pieces of sugar, for example). In the treatment ineffective are the various sweeteners. In severe cases require hospitalization. By induction of vomiting, the patient spend dehydration (water with activated charcoal inside a laxative). Parenteral dextrose injected (intravenous bolus 40% solution 50 ml). In the future, use diluted dextrose (10% solution). Treatment was escorted to the constant control of glucose in the blood serum. Other indications cropped symptomatic treatment.

In case of accidental admission amara people without diabetes (children) need to avoid the development of hyperglycemia. A dose of dextrose carefully selected on the background monitoring of glucose in the blood serum.

Product:

Amari – tablets are dividing strip, elongated shape. Glimepiride Tablets 1 ml have a pink color. Amari, 2 ml – tablets green. Amari and 3 mg – Tablets light yellow color. Amari to 4 mg – green. In package 2 blisters, each with 15 tablets.

Storage:

Amari is stored at a temperature not exceeding 25 ° C. Shelf life – 3 years.

Ingredients:

Active ingredient: Glimepiride.

Inactive components: lactose monohydrate, polyvidone 25 000, sodium starch glycolate, microcrystalline cellulose, magnesium stearate, dyes (for amara 1 mg – iron oxide red (E172), for amara 2 mg – iron oxide yellow (E172) and indigo (E132) for amara 3 mg – iron oxide yellow (E172), for amara 4 mg – indigo (E132).

Extras:

In the treatment of Amarillo need to remember the states that require the transfer of the patient on parenteral administration of insulin (polytrauma, surgery, illness with fever, extensive burns, modified food absorption from the gastrointestinal tract in diseases – intestinal obstruction, intestinal paresis, etc.) .

In combination Amar metformin should be borne in mind that taking high doses of metformin and glimepiride sovrovozhdaetsya marked improvement in metabolism in patients with uncontrolled diabetes type. In the case of high doses of metformin and Amara, if the control still inadequate, it is possible to transfer the patient to a combination of Amar insulin.

Factors that encourage the development of hypoglycemia: low komplaentnost patient, inadequate, irregular meals, habitual diet changes, omissions, eating, drinking, fasting, changing the balance between carbohydrate intake and physical activity, severe dysfunction of the liver and kidneys; related uncompensated endocrine diseases , an overdose of Amara, thyroid gland, adrenal insufficiency, pituitary insufficiency, the combination with other drugs.

Signs of hypoglycemia are offset in the elderly, patients with neurocirculatory dystonia, patients who take beta-blockers, reserpine, clonidine, guanetidin, simpatolitiki.

Dose is adjusted individually depending on the content of glucose in the blood. If another dose is missed, absolutely not supposed to accept the next higher dose. Patient should inform your doctor about receiving too high doses of Amarah. In the case of compensation of diabetes may begin to improve sensitivity to insulin, thus possibly reducing the dose Amari (or even cancellation of the drug). Need to adjust the dose amara the appearance of various factors that may provoke hypoglycemia or hyperglycemia, as well as in the case of change of lifestyle. It must be remembered that the right diet, correction of physical activity, weight loss are of great importance for the treatment of diabetes while taking Amarah.

Should inform the patient that he immediately informed the doctor all the side effects that develop on a background therapy of Amarillo. It is also necessary to inform him about the factors that cause both hyper-and hypoglycemia and the symptoms of these conditions.

Therapy of Amarillo should be accompanied by regular monitoring of glucose in the blood serum, urine, determination of glycated hemoglobin concentration. Regular monitoring of these laboratory parameters in time helps to identify possible resistance to the drug of primary or secondary nature.

In the laboratory control includes the determination of liver function, complete blood count. Against the background of drug therapy may decrease the rate of psycho-motor reactions, and therefore work with the precise mechanisms and driving contraindicated. Especially concerns the initial stages of treatment Amarillo.

Amaryl. Best price. OFFERS

Warning

Before using the product Amari, you should consult your doctor. This instruction is given a free transfer and is intended solely for review. For more information, please contact the manufacturer annotations.

Latin name
Adalat ®
ATC:
>> C08CA05 Nifedipine
Pharmacological Group
>> Calcium channel blockers
The composition and the form
Solution for infusion 1 fl. (50 ml)
Nifedipine 5 mg
Excipients: ethanol 96%, macrogol 400, sodium hydroxide, 0,1 N.; water for injection
in dark glass vials of 50 ml (complete with a syringe, tube PE) in the stack of cardboard 1 set.
Pharmacological action
Mode of action – antianginalnoe, hypotensive.
Dosing and Administration
In / in, infusion, within approximately 4-8 h (at a rate 6,3-12,5 ml / h, which corresponds to 0,63-1,25 mg / h nifedipine).
Maximum dose, administered within 24 hours should not exceed 150-300 ml (equivalent to 15-30 mg / day nifedipine).
In patients with renal impairment dose adjustment is required.
Infusion therapy may be performed continuously for 3 days. Then recommended the transition to oral therapy nifedipine.
Instructions for the introduction of the solution for infusion Adalat ®
Ready-to-use infusion solution Adalat ® should be administered only through a special syringe and vascular system marks perfusors ® or Inzhektomat ®, annexed to the solution. Subject to the use of prescribed infusion supplies loss nifedipine through conducting system can not be afraid.
Nifedipine (active substance infusion solution Adalat ®) is sensitive to light, so it is necessary to protect the solution from this impact.
Equipped with the protective plastic shell vial must be removed from packaging only immediately before use.
When the hybrid infusion must also provide protection solution Adalat ® from exposure to light, so it has to be entered directly into the infusion tube, which has already received a different solution, with the introduction of the system should be implemented as close as possible to the site of vein puncture. It is strictly forbidden to mix the solution Adalat ® in a vial with other solutions.
If the solution was kept in the refrigerator, before the introduction of its temperature must be brought to room temperature.

Latin name

Adalat ®

ATC:

>> C08CA05 Nifedipine

Pharmacological Group

>> Calcium channel blockers

The composition and the form

Solution for infusion 1 fl. (50 ml)

Nifedipine 5 mg

Excipients: ethanol 96%, macrogol 400, sodium hydroxide, 0,1 N.; water for injection

in dark glass vials of 50 ml (complete with a syringe, tube PE) in the stack of cardboard 1 set.

Pharmacological action

Mode of action – antianginalnoe, hypotensive.

Dosing and Administration

In / in, infusion, within approximately 4-8 h (at a rate 6,3-12,5 ml / h, which corresponds to 0,63-1,25 mg / h nifedipine).

Maximum dose, administered within 24 hours should not exceed 150-300 ml (equivalent to 15-30 mg / day nifedipine).

In patients with renal impairment dose adjustment is required.

Infusion therapy may be performed continuously for 3 days. Then recommended the transition to oral therapy nifedipine.

Instructions for the introduction of the solution for infusion Adalat ®

Ready-to-use infusion solution Adalat ® should be administered only through a special syringe and vascular system marks perfusors ® or Inzhektomat ®, annexed to the solution. Subject to the use of prescribed infusion supplies loss nifedipine through conducting system can not be afraid.

Nifedipine (active substance infusion solution Adalat ®) is sensitive to light, so it is necessary to protect the solution from this impact.

Equipped with the protective plastic shell vial must be removed from packaging only immediately before use.

When the hybrid infusion must also provide protection solution Adalat ® from exposure to light, so it has to be entered directly into the infusion tube, which has already received a different solution, with the introduction of the system should be implemented as close as possible to the site of vein puncture. It is strictly forbidden to mix the solution Adalat ® in a vial with other solutions.

If the solution was kept in the refrigerator, before the introduction of its temperature must be brought to room temperature.

Adalat cheap

Company GlaxoSmithKline announced that the application (New Drug Application) for beta-blocker Coreg CR ™ (Carvedilol phosphate controlled-release capsules) taken in the FDA. On the 55 th annual scientific meeting of the American College of Cardiology (11-14 March 2006 Atlanta, USA) presented the results of a multicenter randomized double-blind, placebo-controlled clinical study of drugs used in doses of 20, 40 and 80 mg once daily for 6 weeks patients with arterial hypertension. Coreg CR ™ effectively reduce rates of blood pressure in these patients!

COREG BUY online CHEAP

Carvedilol (Carvedilol) in the form of tablets and tablet controlled release (Coreg, Coreg CR): FDA warns of risk of severe hypersensitivity reactions
According to data from FDA, patients receiving carvedilol therapy, occasionally observed hypersensitivity reactions (anaphylactic reaction, angioedema, urticaria).
Application of carvedilol is contraindicated in patients with severe hypersensitivity reactions (eg Stevens-Johnson syndrome, anaphylactic reaction, angioedema) to carvedilol in history.
FDA notes that patients receiving beta-blockers with severe anaphylactic reactions to various allergens in history may have more severe episodes of anaphylaxis upon repeated contact with the allergen. Such patients may be insensitive to the usual doses of epinephrine.
Carvedilol – antihypertensive means of a group of alpha-and beta-blockers without intrinsic sympathomimetic activity. Blocks α1-, β1-and β2-adrenergic receptors. As a result of the blockade β1-adrenoceptor moderately reduces the conductivity, strength and heart rate, without causing severe bradycardia. As a result of α1-adrenoceptor blockade causes expansion of peripheral vessels. Carvedilol is used to treat hypertension, angina, congestive heart failure (as part of combination therapy).

Carvedilol (Carvedilol) in the form of tablets and tablet controlled release (Coreg, Coreg CR): FDA warns of risk of severe hypersensitivity reactions

According to data from FDA, patients receiving carvedilol therapy, occasionally observed hypersensitivity reactions (anaphylactic reaction, angioedema, urticaria).

Application of carvedilol is contraindicated in patients with severe hypersensitivity reactions (eg Stevens-Johnson syndrome, anaphylactic reaction, angioedema) to carvedilol in history.

FDA notes that patients receiving beta-blockers with severe anaphylactic reactions to various allergens in history may have more severe episodes of anaphylaxis upon repeated contact with the allergen. Such patients may be insensitive to the usual doses of epinephrine.

Carvedilol – antihypertensive means of a group of alpha-and beta-blockers without intrinsic sympathomimetic activity. Blocks α1-, β1-and β2-adrenergic receptors. As a result of the blockade β1-adrenoceptor moderately reduces the conductivity, strength and heart rate, without causing severe bradycardia. As a result of α1-adrenoceptor blockade causes expansion of peripheral vessels. Carvedilol is used to treat hypertension, angina, congestive heart failure (as part of combination therapy).

The main producer (the owner of the trademark):

Schering-Plough (USA)

Indications:

Claritin is indicated for the elimination of symptoms of seasonal and perennial allergic rhinitis (such as: sneezing, itching and rhinorrhea), allergic conjunctivitis, as well as to relieve the symptoms of acute and chronic urticaria, angioedema, and other skin diseases of allergic nature, allergic reactions to insect bites and stings . It is used in complex treatment of itching dermatoses (contact allergodermatitov, chronic eczema, etc.).

Contraindications / side effects:

Contraindicated with hypersensitivity to any of the components, as well as during lactation.

Side effect. When you receive Claritin may cause adverse reactions. Adults: headache, fatigue, dry mouth, drowsiness, nausea, gastritis, allergic reactions (hives), anaphylaxis, alopecia, abnormal liver function. In children: headache, increased nervous irritability, sedation.

Additional Information:

Pharmacological properties. Claritin is a specific blocker of H1-histamine receptors. Quickly, after 30 minutes, ensures the removal of allergic symptoms. Valid for 24 hours. Not addictive. Half-life of 24 hours. Excreted in urine in unchanged form. Do not penetrate the blood-brain barrier, and therefore has no effect on the central nervous system. Not have a sedative action. Not have holinoblokiruyuschim action. There is an incompatibility with food, do not potentiate the effect of alcohol.

Features of the application. During pregnancy Claritin used with caution under medical supervision. The drug is used in children older than 2 years.

Precautions Claritin appointed with liver failure.

The main producer (the owner of the trademark):
Schering-Plough (USA)
Indications:
Claritin is indicated for the elimination of symptoms of seasonal and perennial allergic rhinitis (such as: sneezing, itching and rhinorrhea), allergic conjunctivitis, as well as to relieve the symptoms of acute and chronic urticaria, angioedema, and other skin diseases of allergic nature, allergic reactions to insect bites and stings . It is used in complex treatment of itching dermatoses (contact allergodermatitov, chronic eczema, etc.).
Contraindications / side effects:
Contraindicated with hypersensitivity to any of the components, as well as during lactation.
Side effect. When you receive Claritin may cause adverse reactions. Adults: headache, fatigue, dry mouth, drowsiness, nausea, gastritis, allergic reactions (hives), anaphylaxis, alopecia, abnormal liver function. In children: headache, increased nervous irritability, sedation.
Additional Information:
Pharmacological properties. Claritin is a specific blocker of H1-histamine receptors. Quickly, after 30 minutes, ensures the removal of allergic symptoms. Valid for 24 hours. Not addictive. Half-life of 24 hours. Excreted in urine in unchanged form. Do not penetrate the blood-brain barrier, and therefore has no effect on the central nervous system. Not have a sedative action. Not have holinoblokiruyuschim action. There is an incompatibility with food, do not potentiate the effect of alcohol.
Features of the application. During pregnancy Claritin used with caution under medical supervision. The drug is used in children older than 2 years.
Precautions Claritin appointed with liver failure.

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Form of production, composition and packaging

Tablets, film-coated orange, pentagonal, with the inscription “GSK” on one side and “4″ – on the other side.
1 tab.
* rosiglitazone (as maleate) 4 mg

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

Composition of membrane shell: hydroxypropyl methylcellulose, titanium dioxide, polyethylene glycol, purified talc, lactose, triatsetin, iron oxide red, iron oxide yellow.

7 – blisters (1) – packs cardboard.
14 – blisters (2) – packs cardboard.
14 – Valium (4) – packs cardboard.
14 – Crohn’s & Colitis (8) – packs cardboard.

Tablets, film-coated red-brown, pentagonal, with the inscription “GSK” on one side and “8″ – on the other side.
1 tab.
* rosiglitazone (as maleate) 8 mg

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

Composition of membrane shell: hydroxypropyl methylcellulose, titanium dioxide, polyethylene glycol, lactose, triatsetin, iron oxide red.

7 – blisters (1) – packs cardboard.
14 – blisters (2) – packs cardboard.
14 – Valium (4) – packs cardboard.
14 – Crohn’s & Colitis (8) – packs cardboard.

* International nonproprietary name, as recommended by WHO – rosiglitazone.

Clinico-pharmacological group: Oral hypoglycemic drug. Pharmacological action

Oral hypoglycemic agent from the group of thiazolidinediones. Is a selective agonist of nuclear receptor PPARγ (peroxisomal proliferator activated gamma). Rosiglitazone lowers blood glucose by increasing insulin sensitivity in adipose tissue, skeletal muscle and liver tissue, improves the course of metabolic processes, reduces the levels of glucose, insulin and free fatty acids in the blood.

The product retains the function of β-cells, as evidenced by the mass of islets of Langerhans of the pancreas and insulin, and prevents the development of severe hyperglycemia. It was also established that the drug significantly slows the development of renal dysfunction and systolic hypertension. Not stimulates the secretion of insulin in the pancreas and does not cause hypoglycemia.

In accordance with the mechanism of action of rosiglitazone improved glycemic control accompanied by a clinically significant reduction in insulin levels in the serum. Also reduced production of precursors of insulin, which are considered risk factors for developing cardiovascular system.

A key feature of drug therapy Avandia is a significant reduction in free fatty acids in the blood.

Due to different but complementary mechanisms of action, combined therapy of rosiglitazone, metformin and sulfonylurea derivatives provided by the synergistic effect and improves control of blood glucose in diabetes mellitus type 2.

Pharmacokinetics

Suction

After taking the drug orally at a dose of 4 mg or 8 mg of rosiglitazone absolute bioavailability is about 99%. After taking the drug inside rosiglitazone Cmax plasma levels achieved within 1 h.

In the range of therapeutic doses plasma concentrations are approximately proportional to dose.

Receiving medication with food causes a small reduction in Cmax (approximately 20-28%) and increase the time to achieve it to 1.75 h compared with fasted. These small changes are not clinically significant, so there is no need for any coordination with the receiving rosiglitazone meal times. Absorption of rosiglitazone is not violated with increasing pH of gastric secretion.

Distribution

Cvyazyvanie with blood proteins is high (about 99.8%) and does not depend on the concentration of rosiglitazone in plasma or age of the patient.

Vd rosiglitazone in healthy volunteers is approximately 14 liters.

After taking the drug rosiglitazone 1.2 not cumulative.

Cumulation of metabolites in the blood serum is expected after repeated dosing. To a greater degree of accumulated major metabolite (paragidroksisulfat), for which we can expect 5-fold increase in concentration.

Metabolism

Rosiglitazone subjected to intensive metabolism mainly through N-demethylation and hydroxylation with subsequent conjugation with sulphate and glucuronic acid. Metabolites of rosiglitazone did not have clinically significant activity.

In in vitro studies showed that rosiglitazone is metabolized primarily with the participation of isoenzyme CYP2C8 and to a small extent – with the involvement of CYP2C9.

Since the use of rosiglitazone is no significant inhibition of in vitro isozymes CYP1A2, 2A6, 2C19, 2D6, 2E1, 3A or 4A, it is unlikely interaction with drugs whose metabolism is carried out with the participation of these isoenzymes.

In vitro rosiglitazone moderately inhibits the isoenzyme CYP2C8 (inhibiting kontsentratsiya18 mmol), and to a lesser degree – CYP2C9 (inhibitory concentration 50 mmol). In in vivo studies with warfarin has been shown that rosiglitazone does not interact with substrates of CYP2C9.

Withdrawal

T1 / 2 rosiglitazone is approximately 3-4 h. The total plasma clearance – about 3 liters / h.

Excreted as metabolites, mostly kidneys – approximately 2 / 3 of the dose in feces – about 25%.

Final T1 / 2 is about 130 h, indicating a very slow breeding metabolites.

Pharmacokinetics in special clinical cases

No differences were observed in the pharmacokinetics of the drug depending on sex, as well as in adult patients and patients of advanced age.

In patients with moderate to severe hepatic impairment Smax drug in plasma and AUC were raised by 2-3 times, respectively, which was due to lower degree of binding to plasma proteins and reduced clearance rosiglitazone.

Clinically significant differences pharmacokinetics in patients with kidney disease or kidney failure in the terminal stage, in hemodialysis, are absent.

Indications for use drugs Avandia

Diabetes mellitus type 2:

- As monotherapy in case of insufficient effectiveness of diet therapy and exercise;

- In combination with derivatives of sulfonylurea, metformin to improve glycemic control;

- In combination with derivatives of sulfonylurea and metformin (triple combination therapy) to improve glycemic control.
Dosage regimen

The drug is taken orally. Dose and treatment regimen set individually.

The daily dose taken every 1-2 hours, regardless of the meal.

For adults the recommended starting dose is 4 mg / For lack of efficacy after 6-8 weeks of treatment the dose can be increased to 8 mg /

For older patients, correction of the dose is not required.


Side effects

The frequency of adverse reactions is presented in accordance with the following gradation: very common (≥ 1 / 10), common (≥ 1 / 100, <1 / 10), sometimes (≥ 1 / 1000, <1 / 100), rare (≥ 1 /10 000, <1 / 1000), very rare (<1 / 10 000).

Categories frequency determined in comparison with the frequency of unwanted reactions in the treatment of placebo or drug comparison, and not the absolute values for those side effects that may be associated with rosiglitazone. For dose-dependent adverse reactions the frequency category reflects the maximum dose of rosiglitazone. Categories frequency does not account for other factors, including differences in the duration of studies, pre-existing conditions and baseline characteristics of patients. Categories of frequency of adverse reactions are defined on the basis of clinical studies and may not reflect the frequency of adverse reactions in routine clinical practice.

Data from clinical trials

R – rosiglitazone, M – metformin, N – sulfonylurea
Side effects R R + M P + P + C + M
The part of the hemopoietic system
Anemia often often often often
Leukopenia often
Thrombocytopenia often
Granulocytopenia often
Anemia is mild to moderate severity, is often dose-dependently
From metabolism
Cholesterol often often often often
Giperglitseridemiya often often
Hyperlipidemia often often often often
Weight gain often often often often
Increased appetite is often occasionally
Hypoglycemia is often very often very often
When hypercholesterolemia total cholesterol increased simultaneously with an increase in HDL and LDL, the ratio of cholesterol / HDL remained unchanged.
Increased body weight is dose-dependent and possibly related to fluid retention and accumulation of fatty deposits.
Hypoglycemia weak or moderate degree, is largely a dose-dependently.
From CNS
Dizziness often often
Headache often
Since the cardiovascular system
Heart failure / pulmonary edema often often
Myocardial ischemia often often often often
Increased number of cases of heart failure was observed in accession to rosiglitazone therapy, based on sulfonylureas or insulin. The number of observations does not allow an unambiguous conclusion about the connection with the dose, but the incidence is higher for daily dose of rosiglitazone 8 mg, compared with a daily dose of 4 mg. Symptoms of myocardial ischemia more frequently observed in the appointment of rosiglitazone in patients who are on insulin therapy. Data on the ability of rosiglitazone to increase the risk of myocardial ischemia insufficient. Retrospective analysis of mostly short-clinical studies with placebo, but not with the comparator, said the relationship between taking rosiglitazone and the risk of myocardial ischemia. These data are not confirmed by long-term clinical studies with drugs of comparison (metformin and / or sulfonylurea), and the relationship between rosiglitazone and the risk of ischemia is not installed. Increased risk of ischemic myocardial lesions observed in patients who were in clinical research on basic therapy with nitrates. Rosiglitazone is not recommended in patients receiving concomitant therapy with nitrates.
From the digestive system
Constipation (mild or moderate) often often often often
On the part of the musculoskeletal system
Fractures often
Myalgia often
Most reports related to fractures of the forearm, hand and foot women
On the part of the organism as a whole
Edema often often often often
Edema from mild to moderate severity, often dose-dependent manner.

In post-marketing period reported the following adverse reactions

Allergic reactions: very rare – anaphylactic reactions.

Since the cardiovascular system: rarely – chronic heart failure / pulmonary edema.

Reports on the development of these adverse reactions were obtained for rosiglitazone, used as monotherapy and in combination with other hypoglycaemic agents. It is known that the risk of heart failure significantly increased in patients with diabetes compared with patients without diabetes.

From the digestive system: rarely seen reports of liver damage, accompanied by increasing concentrations of liver enzymes, but the causal link between treatment of rosiglitazone and liver dysfunction is not established.

Allergic reactions: seldom – angioedema, hives, rashes, itchy skin.

The part of the organ of vision: a very rare – macular edema.

Contraindications to the drug Avandia

- Diabetes mellitus type 1 (in the absence of insulin rociglitazon ineffective);

- Heart failure (I-IV functional classes in the classification NYHA);

- Moderate or severe hepatic impairment;

- Pregnancy;

- Lactation (breastfeeding);

- Childhood and adolescence to 18 years (effectiveness and safety of the drug not established);

- Combined use with insulin;

- Hypersensitivity to rosiglitazone and other components of the drug.

Precautions should be used drug in renal failure and severe.

Avandia use of the drug during pregnancy and breastfeeding

Contraindicated drug use Avandiya during pregnancy and lactation.

Data on the use of the drug Avandiya during pregnancy and lactation is not enough.

Patients with type 2 diabetes in pregnancy is recommended holding of insulin therapy.

If necessary, the drug Avandiya during lactation should stop breastfeeding.

Application for violations of liver function

The drug is contraindicated in moderate or severe hepatic impairment.


Use in Renal Impairment

Sostorozhnostyu should use the drug for renal insufficiency.

Cautions

Increased total cholesterol was associated with an increase in both LDL and HDL, while the ratio of total cholesterol to HDL cholesterol did not change. These effects are usually mild or moderate expressed and do not require discontinuation of treatment.

The frequency of anemia was higher with the combined use of the drug with metformin. In general, this effect was weak or moderate, generally did not require discontinuation of treatment.

Thiazolidinediones can cause or worsen during chronic heart failure. After the start of rosiglitazone therapy and during dose titration, careful medical monitoring of the patient in respect of the following signs and symptoms of heart failure: a rapid and excessive weight gain, shortness of breath and / or swelling. In the development of symptoms of heart failure should discontinue treatment and to designate rosiglitazone therapy in accordance with current standards of treatment of heart failure.

The drug is contraindicated in patients with heart failure, including history, I-IV functional class classification NYHA.

Patients with acute coronary syndrome (ACS) is not included in clinical studies. Appointment of rosiglitazone, as well as other oral hypoglycemic drugs are not recommended for acute coronary syndrome, especially taking into account the increased risk of heart failure in acute coronary syndrome. During acute phase to cancel the reception rosiglitazone. Data on the possibility of rosiglitazone increase the risk of myocardial ischemia insufficient. A retrospective analysis of short-term clinical studies showed an increased risk of ischemic events with rosiglitazone treatment compared with control groups as a whole (placebo plus active drugs). In the same analysis comparing rosiglitazone with other oral hypoglycemic drugs differences in the incidence of ischemic events were observed. Elevated risk of myocardial ischemia associated with rosiglitazone, was not confirmed in further long-term randomized controlled clinical trials comparing rosiglitazone with metformin and sulfonylureas. Relationship between taking rosiglitazone and the risk of ischemia is not installed. Increased risk of ischemic myocardial lesions observed in patients receiving treatment with nitrates initially or during the clinical study concerning the introduction of coronary heart disease. Rosiglitazone is not recommended in patients receiving concomitant therapy with nitrates.

Patients with mild hepatic impairment (Class A / 6 points or less / by Child-Pugh) correction of the dose is not required. In connection with the few data on the use of the drug in patients with moderate or severe hepatic impairment and identified changes pharmacokinetic profile, the drug is contraindicated in this category of patients (class B or C / more than 6 points / by Child-Pugh).

In renal insufficiency mild to moderate correction dosing regime is not required. In the application of the drug in patients with severe renal insufficiency insufficient data, so the drug should be prescribed with caution.

In the long term study of monotherapy of diabetes mellitus type 2 patients previously treated with oral hypoglycemic agents, there was an increase incidence of fractures among women in the rosiglitazone group (9.3%, 2.7 cases per 100 patient-years) compared with metformin group (5.1%, 1.5 cases per 100 patient-years) and glyburide / glibenclamide (3.5%, 1.3 cases per 100 patient-years). Most of the cases registered in the rosiglitazone group concerned the fracture of the forearm, hand and foot. Possible increased risk of fractures should take into account in the appointment of rosiglitazone, especially women. Requires monitoring of bone tissue and the maintenance of bone health in accordance with accepted standards of therapy.

When using rosiglitazone in premenopausal women observed hormonal instability but serious side effects associated with the violation of the menstrual cycle were observed. In the case of such violations is necessary to evaluate the potential risks and potential benefits with continued therapy.

Because sensitivity to insulin in patients with insulin resistance and anovulatory cycles in premenopausal (eg, polycystic ovary syndrome), rosiglitazone may lead to the resumption of ovulation and pregnancy.

Effects on ability to drive vehicles and management mechanisms

Avandia not cause drowsiness and has no sedative effect. The drug has no effect on the ability to drive vehicles or other mechanisms.

Overdose

Data on overdose is limited. In clinical trials with human volunteers observed well tolerated in a single dose to 20 mg.

Treatment: In case of overdose spend symptomatic therapy. Rosiglitazone is highly bound to blood proteins and therefore does not appear in hemodialysis.

Drug Interactions

Neither was there a clinically significant drug interactions Avandiya with other drugs.

Avandia in therapeutic doses does not cause clinically significant changes in pharmacokinetics and pharmacodynamics of other oral hypoglycemic drugs, including metformin, glibenclamide and acarbose.

With simultaneous use of rosiglitazone with metformin or sulfonylurea derivatives as a result of various complementary mechanisms of action observed synergy hypoglycemic action in patients with diabetes mellitus type 2.

Rosiglitazone does not affect the pharmacokinetics of digoxin, and does not affect the anticoagulant activity of warfarin.

Clinically significant pharmacokinetic drug interactions Avandiya with S (-)-warfarin (substrate for CYP2C9) is not observed.

Rosiglitazone does not affect the pharmacokinetics of nifedipine and oral contraceptives containing ethinyl estradiol and norethindrone, which indicates a low probability of drug interaction Avandiya with drugs, is metabolized with the participation of isoenzyme CYP3A4.

Gemfibrozil (an inhibitor of CYP2C8) in a dose of 600 mg 2 Css rosiglitazone increased in 2 times. This increase in concentration of rosiglitazone is associated with the risk of dose-dependent side effects, so when the combined use of Avandia with inhibitors of CYP2C8 may require lower doses of rosiglitazone.

Other CYP2C8 inhibitor caused a slight increase in systemic concentrations of rosiglitazone.

Rifampin (inductor CYP2C8) in a dose of 600 mg reduced the concentration of rosiglitazone by 65%. Therefore, patients who receive both rosiglitazone and inducers of enzyme CYP2C8, should conduct a careful control of blood glucose and change if necessary dose of rosiglitazone.

Moderate alcohol consumption in the treatment Avandia no effect on blood glucose control.

Conditions of supply of pharmacies

The drug is released with a prescription.

Conditions and terms of storage

List B. The drug should be stored in a place inaccessible to children at or above 25 ° C. Shelf life – 2 years.

Avandia (buy cheap online)

International title

Lovastatin (Lovastatin)

Trade name

Mevacor

Country of Assembly

Netherlands

Manufacturing Company

Merck Sharp & Dohme (recorded by: Merck Sharp & Dohme BV)

Number of registered drug

P № 013709/01-2002

Method of production

tablets 20, 40 mg (blister)

Pharmacological Group

lipid-lowering means

Pharmacological Group APC

C10AA02 Lovastatin (Lovastatin)

Pharmacological action

hypolipidemic

hypocholesterolemic

reduces the synthesis of cholesterol

Date of registration, re -

11/02/2002

ingredientstext from the main table

lovastatin 10 mg, excipients (butilgidroksianizol, starch pregelatinized, lacquered aluminum, lactose, magnesium ctearat, microcrystalline cellulose) – tablets, lovastatin 20 mg, excipients (butilgidroksianizol, starch pregelatinized, lacquered aluminum, lactose, magnesium ctearat, microcrystalline cellulose) — tablets, lovastatin 40 mg, excipients (butilgidroksianizol, starch pregelatinized, lacquered aluminum, lactose, magnesium ctearat, microcrystalline cellulose) – tablets

Dosage form

Tablets

Product

Blister

Section base

Medicines

Indications for ICD

Hyperlipidemia unspecified

Giperhilomikronemiya

Metabolic lipoproteins and other lipidemia

Metabolic lipoprotein unspecified

Mixed hyperlipidemia

Other hyperlipidaemia

Other metabolic lipoprotein

Net giperglitseridemiya

Pure hypercholesterolemia

The composition of the components

butilgidroksianizol

Aluminum lacquer

lactose

pre-gelled starch

lovastatin

magnesium stearate

microcrystalline cellulose

Pharmacodynamics

Violates the biosynthesis of cholesterol in the early stages due to specific inhibition of 3-hydroxy-3-methylglutaryl-coenzyme A-reductase, reducing total cholesterol, very low density lipoprotein (VLDL), low-density lipoprotein (LDL) cholesterol and triglycerides, a moderate increase in high-density lipoprotein ( HDL). Inactive lactone form of the corresponding gidrokisloty with a strong inhibitory effect on the endogenous synthesis of cholesterol.Pronounced therapeutic effect is evident within 2 weeks, and the maximum – in 4-6 weeks from the start of treatment.

Pharmacokinetics

It is well absorbed by ingestion. Subjected to intensive metabolism in the first passage through the liver and the subsequent release of bile

Indications

Primary hypercholesterolemia (nekorregiruemaya), combined hypercholesterolemia and hypertriglyceridemia, correction of lipid profile in patients with uncomplicated diabetes mellitus type I-II. Hyperlipoproteinemia without modifying the special diet and physical exercise.

Dosage regimen

Initial dose – 10-20 mg 1 time per day during the evening meal. If necessary, increase the dose of 1 every 4 weeks. The maximum daily dose – 80 mg, in 1 or 2 hours (during lunch and dinner).In the case of lower plasma concentrations of total cholesterol to 140 mg/100 ml (3.6 mmol / L) or LDL-cholesterol to 75 mg/100 ml (1.94 mmol / L) dose should be reduced. In simultaneous appointment mevakora and drugs that suppress immunity, mevakora daily dose should not exceed 20 mg.

Side effects

The drug is usually well tolerated. Possible nausea, diarrhea, constipation, flatulence, dry mouth, taste disorders, anorexia, increased hepatic transaminases in the blood, transient elevation of creatine phosphokinase (CPK) in the blood, dizziness, headache, insomnia, seizures, paresthesia. Seldom – myalgia, myopathy, hepatitis. There are reports of occurrence of cholestatic jaundice, mental disorders, urticaria, angioedema, toxic epidermal necrolysis, hemolytic anemia, leukopenia, thrombocytopenia. In patients receiving both cyclosporine, gemfibrozil or nicotinic acid, there have been cases of rhabdomyolysis, which led to the emergence of acute renal failure.

Contraindications

Acute liver disease, a permanent increase in the concentration of hepatic transaminases in the serum of unknown etiology, pregnancy or its possibility, lactation, severe general condition of the patient, hypersensitivity, childhood.

Interaction

Gently combine with immunosuppressants, fibrates, nicotinic acid (may develop myopathy).Enhances the anticoagulant effect of coumarins.

Cautions

With care prescribe medication for patients with a history of liver disease, as well as patients who abuse alcohol. In the case of a persistent increase in blood content of liver transaminases and / or CPK shown abolition of the drug. Mevakorom therapy should be interrupted for a long time, or discontinued with an overall poor condition of the patient due to an illness.

Buy Mevacor CHEAP

Synonyms: Glibenese, Glucotrol, Glydiazinamide, Melizid, Menodiab, Mindiab, Minibetic, Minidiab, Minodiab, Minidiab
Group: Means of regulating the metabolic processes, hormones, their analogues and antihormones; insulins, saharoponizhayuschie synthetic drugs and other antidiabetics
Diseases: Infertility, Diabetes diabetes, diabetic xanthomatosis

Glipizide (Glipizide). 1-cyclohexyl-3-[[pair-2-(5-metilpirazinkarboksamid) ethyl] phenyl] sulfonyl] urea.

Synonyms: Minidiab, Glibenese, Glucotrol, Glydiazinamide, Melizid, Menodiab, Mindiab, Minibetic, Minidiab, Minodiab.

On the chemical structure and action is very close to glibenclamide.

Well absorbed. The maximum concentration in the blood through a 1 – 2 h after administration.Very low half-life (3 – 4 h at 5 – 7 h with glibenclamide and 30 – 40 h with chlorpropamide).Rapidly excreted from the body, and therefore reduced risk of cumulation.

Indications for use are the same as for other derivatives of sulfonylurea antidiabetic (type II diabetes).

The initial dose is usually 2, 5 – 5 mg (1 / 2 – 1 tablet) per day, further increasing the dose to 1 / 2 – 1 tablet to achieve the optimal maintenance dose.

The maximum dose – 30 mg (6 tablets) per day. Small doses taken 1 time per day, doses over 15 mg – 2 – 3 hours.

Contraindications and precautions are the same as in the application of glibenclamide, butamida.

Form release: pills to 0, 005 g (5 mg) in a package of 30 pieces.

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