Archive for October, 2009

Codeine

Pharmacological Effects:
Antitussives central action; alkaloid fenantrenovogo series. Opiate receptor agonist, reduces the excitability of the cough center. Central antitussive effect is associated with the suppression of cough center. The analgesic activity due to stimulation of opiate receptors in different regions of CNS and peripheral tissues, leading to stimulation of the antinociceptive system and change the emotional perception of pain. To a lesser degree than morphine, respiratory depression, less likely to cause miosis, nausea, vomiting and constipation (activation of opioid receptors in the intestine causes relaxation of smooth muscles, decrease peristalsis and spasm of sphincters). The analgesic effect develops within 10-45 minutes after i / m and s / c administration and within 30-60 minutes after oral administration. The maximum effect is achieved within 30-60 minutes after i / m administration and within 1-2 h after oral administration. The duration of analgesia – 4 h, the blockade cough reflex – 4-6 hours

Indications:
Nonproductive cough (pneumonia, bronchitis, emphysema); pain mild and moderate degree (in conjunction with non-narcotic analgesics – headache, neuralgia); diarrhea.

Contraindications:
Hypersensitivity, toxic dyspepsia, diarrhea, against the background of pseudomembranous colitis caused by cephalosporins, lincosamides, penicillin, acute respiratory depression tsentra.C caution. Acute abdominal pain of unknown etiology, onset of asthma, COPD, arrhythmias, convulsions, drug dependence (including history), alcoholism, suicidal tendencies, emotional lability, gallstone disease, surgery on the gastrointestinal tract, urinary system, brain injury brain, intracranial hypertension, hepatic or renal impairment, hypothyroidism, severe inflammatory bowel disease, prostatic hyperplasia, urethral stricture, seriously ill, debilitated patient, cachexia, pregnancy, lactation period, simultaneous treatment with inhibitors, elderly, children’s age.

Side effects:
From the digestive system: more often – constipation less frequently – dry mouth, anorexia, nausea, vomiting rarely – stomachodynia, spasms in the gastrointestinal tract, biliary tract spasm, paralytic ileus, toxic megacolon (constipation, flatulence, nausea, abdominal stomach, vomiting), the frequency is unknown – hepatotoxicity (dark urine, pale stools, ikterichnost sclera and skin). From the nervous system and sensory organs: a more frequent – drowsiness, less often – dizziness, headache, fatigue, nervousness, confusion (hallucinations, depersonalization), blurred vision (including diplopia) in children – paradoxical excitement and anxiety; rare – restless sleep, nightmares, convulsions, depressed, at higher doses, muscle rigidity (especially respiratory), tremors, involuntary muscle twitching, the frequency is unknown – ringing in the ears, the deterioration of the coordination of movements of the eyeballs with visual impairment, increased tone smooth muscle (at doses above 60 mg). From the CCC: less often – arrhythmia (tachy-or bradycardia), decreased blood pressure, the frequency is unknown – increase blood pressure. On the part of the respiratory system: less often – atelectasis, inhibition of the respiratory center. From the urinary system: less frequently – reducing diuresis, ureteral spasm (difficulty and pain when urinating, frequent urge to urinate), frequency unknown – atony of the urinary bladder. Allergic reaction: less often – a skin rash, hives, itchy skin, face edema, bronchospasm, laryngeal edema, laryngospasm. Other: less often – sweating, imaginary sense of wellbeing, a feeling of discomfort, the frequency is unknown – body weight increase, with prolonged use – drug dependency syndrome “cancellation.” Overdose. Overdose. Overdose. Symptoms of acute and chronic overdose: cold clammy sweat, confusion, dizziness, drowsiness, decreased blood pressure, nervousness, fatigue, bradycardia, severe weakness, slow labored breathing, hypothermia, anxiety, miosis, spasms, in severe cases – loss of consciousness, respiratory arrest , coma. Treatment: gastric lavage, the restoration of respiration and maintenance of cardiac activity and blood pressure, in / in the introduction of a specific antagonist of opioid analgesics – naloxone.

Dosage and administration:
Inside adults in pain – 15-60 mg every 3-6 hours, with diarrhea – 30 mg 4 times a day, when you cough – 10-20 mg 4 times a day. The highest daily dose for adults – 120 mg. For children in pain – 0.5 mg / kg (15 mg / m) 4-6 times a day for diarrhea – 0.5 mg / kg 4 times a day when people cough in children younger than 2 years – not recommended, 2 — 5 years – 1 mg / kg / day divided in 4 hours, or children under 2 years of age (birth weight of 12 kg) – 3 mg every 4-6 h, the maximum dose – 12 mg / day for children aged 3 years (weight not less than 14 kg) – 3.5 mg every 4-6 hours, not more than 14 mg / day for children aged 4 years – 4 mg every 4-6 hours, not more than 16 mg / day, 5 years (body mass not less than 18 kg) – 4.5 mg every 4-6 hours, not more than 18 mg / day, 6-12 years – 5-10 mg every 4-6 hours, not more than 60 mg / day.

Cautions:
During the period of treatment should refrain from receiving ethanol and use caution when driving motor vehicles, as well as during the occupation of other potentially hazardous activities requiring a high concentration of attention and quickness of psychomotor reactions. Controlled studies for use during pregnancy has not been conducted; studies on animals have shown that a single dose of codeine into mice at a dose of 100 mg / kg causes a delay in ossification, a single dose of 120 mg / kg in rats – an increase in bone rezobtsii. The use of codeine during labor may cause a prolongation of them. It should be borne in mind that children under 2 years are more sensitive to the effects of opioid analgesics, and that they may have the paradoxical reaction. In pregnancy and during breast-feeding use is acceptable only for health reasons (possible respiratory depression and the development of drug dependence in the fetus and the newborn). Opioid analgesics reduce salivation, which may contribute to the development of caries, periodontal diseases, candidiasis of the oral mucosa. Codeine dose of 120 mg / m or 200 mg oral morphine equivalent dose of 10 mg / m

Interaction:
Enhances the inhibitory effect of ethanol on the speed of psychomotor reactions. With simultaneous application of ethanol, muscle relaxants, as well as LAN, depressing the central nervous system may increase sedation, suppression of the respiratory center and the central nervous system depression. In simultaneous reception with other opioid analgesics increases the risk of CNS depression, respiration, blood pressure lowering. Enhance effects of antihypertensive and antipsychotic LS (neuroleptics), anxiolytics (tranquilizers), barbiturates and drugs, for general anesthesia. Naloxone and naltrexone are specific antagonists. Naloxone reduces the effect of opioid analgesics, and they cause respiratory depression and central nervous system, may require higher doses to the leveling effects of butorphanol, Nalbuphine and pentazocine, have been assigned to eliminate unwanted effects dr.opioidov; can accelerate the emergence of symptoms <withdrawal> against a background of drug dependence. Naltrexone accelerates the appearance of symptoms <withdrawal> against a background of drug addiction (symptoms may occur in 5 minutes after injection of the drug, continued for 48 h, are persistent and difficult to address them) reduces the effect of opioid analgesics (analgesic, anti, antitussive); not affect the symptoms caused by histamine reaction. Drugs with anticholinergic activity, anti-LS (including loperamide) increase the risk of locking up intestinal obstruction, urinary retention, and CNS depression. Buprenorphine (including previous therapy) reduces the effect dr.opioidnyh analgesics; against the use of high doses of agonists of mu-opioid receptors reduces respiratory depression, and a background of low doses of agonists of mu-or kappa-opioid receptors – increases. Precautions should be used concurrently with MAO inhibitors because of possible overexcitation or inhibition with the emergence of hyper-or hypotensive crises (initially to assess the synergies of the dose should be reduced to 1 / 4 of the recommended). Reduces the effect of metoclopramide.

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SEROQUEL

SEROQUEL XR (quetiapine fumarate) is a psychotropic agent belonging to a chemical class, the dibenzothiazepine derivatives. The chemical designation is 2-[2-(4-dibenzo [b,f] [1,4]thiazepin-11-yl-1-piperazinyl)ethoxy]-ethanol fumarate (2:1) (salt). It is present in tablets as the fumarate salt. All doses and tablet strengths are expressed as milligrams of base, not as fumarate salt. Its molecular formula is C₄₂H₅₀N₆O₄S₂•C₄H₄O₄ and it has a molecular weight of 883.11 (fumarate salt). The structural formula is:

Quetiapine fumarate is a white to off-white crystalline powder which is moderately soluble in water.

SEROQUEL XR is supplied for oral administration as 50 mg (peach), 150 mg (white), 200 mg (yellow), 300 mg (pale yellow), and 400 mg (white). All tablets are capsule shaped and film coated.

Inactive ingredients for SEROQUEL XR are lactose monohydrate, microcrystalline cellulose, sodium citrate, hypromellose, and magnesium stearate. The film coating for all SEROQUEL XR tablets contain hypromellose, polyethylene glycol 400 and titanium dioxide. In addition yellow iron oxide (50, 200 and 300 mg tablets) are included in the film coating of specific strengths.

Each 50 mg tablet contains 58 mg of quetiapine fumarate equivalent to 50 mg quetiapine. Each 150 mg tablet contains 173 mg of quetiapine fumarate equivalent to 150 mg quetiapine. Each 200 mg tablet contains 230 mg of quetiapine fumarate equivalent to 200 mg quetiapine. Each 300 mg tablet contains 345 mg of quetiapine fumarate equivalent to 300 mg quetiapine. Each 400 mg tablet contains 461 mg of quetiapine fumarate equivalent to 400 mg quetiapine.

Elderly patients with dementia-related psychosis (having lost touch with reality due to confusion and memory loss) treated with this type of medicine are at an increased risk of death, compared to placebo (sugar pill). Seroquel XR is not approved for treating these patients.

Antidepressants have increased the risk of suicidal thoughts and actions in some children, teenagers, and young adults. Patients of all ages starting treatment should be watched closely for worsening of depression, suicidal thoughts or actions, unusual changes in behavior, agitation, and irritability. Families and caregivers should watch patients daily and report these symptoms immediately to the physician. Seroquel XR is not approved for patients under the age of 18 years.

* High blood sugar and diabetes have been reported with Seroquel XR and medicines like it. If you have diabetes or risk factors such as obesity or a family history of diabetes, ask your doctor about checking your blood sugar before starting Seroquel XR and regularly throughout treatment. If you develop symptoms of high blood sugar or diabetes, such as excessive thirst or hunger, increased urination, or weakness, contact your doctor. Complications from diabetes can be serious and even life threatening
* Increases in cholesterol and triglycerides, and weight gain have been reported with Seroquel XR
* A rare, but potentially fatal, side effect reported with Seroquel XR and medicines like it is neuroleptic malignant syndrome (NMS). Tell your doctor if you have very high fever; rigid muscles; shaking; confusion; sweating; changes in pulse, heart rate, or blood pressure; or muscle pain and weakness because treatment should be stopped if you have NMS
* Another serious side effect reported with Seroquel XR and medicines like it is tardive dyskinesia (TD)—uncontrollable movements of the face, tongue, or other parts of the body. TD may become permanent, and the risk of TD is believed to increase as the length of time on and the amount of these medications increase. While TD can develop in patients taking low doses for short periods, this is much less common. There is no known treatment for TD, but it may go away partially or completely if treatment is stopped
* Before starting treatment, tell your doctor if you have high prolactin levels or have a history of, or are at risk for, seizures or a low white blood cell (WBC) count. An eye exam for cataracts is recommended at the beginning of treatment and every 6 months thereafter
* During treatment, tell your doctor if you feel dizzy or lightheaded upon standing, or if you have trouble swallowing
* Suicidal thoughts or actions may occur; tell your doctor if you have thoughts about death or suicide
* Since drowsiness has been reported with Seroquel XR, you should not participate in activities such as driving or operating machinery until you know that you can do so safely. Avoid drinking alcohol while taking Seroquel XR because Seroquel XR increases the effects of alcohol. Avoid becoming overheated or dehydrated while taking Seroquel XR
* Common side effects: The most common side effects are drowsiness, dry mouth, increases in cholesterol and triglycerides, constipation, upset stomach, dizziness, a sudden drop in blood pressure upon standing, weight gain, increased hunger, tiredness, increases in blood sugar, difficulty speaking, and stuffy nose

This is not a complete summary of safety information. Please discuss the full Prescribing Information Adobe PDF with your health care provider.
Indications

Seroquel XR is a once-daily tablet approved to treat acute depressive episodes in bipolar disorder; acute manic or mixed episodes in bipolar disorder alone or when added to lithium or divalproex; long-term maintenance of bipolar disorder when added to lithium or divalproex; and schizophrenia.

AstraZeneca announced today that once-daily SEROQUEL XR (quetiapine fumarate extended-release tablets) and SEROQUEL (quetiapine fumarate) have been approved under the European Mutual Recognition Procedure for the prevention of recurrence of bipolar disorder in patients whose manic, mixed or depressive episode has responded to quetiapine treatment.

Following this new indication, SEROQUEL and SEROQUEL XR are the only agents approved in the European Union to treat all phases of bipolar disorder – acute depressive episodes, acute manic episodes and maintenance treatment to prevent recurrence of any mood event in bipolar disorder.

AstraZeneca will now move forward with obtaining local approvals with the Member States that take part in the Mutual Recognition Procedure.

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Indications for use. Heartburn, it turns out, very serious problem for the ever-jittery Americans. The mechanism of action and chemical structure of the drug very similar to neksium. Prevatsid slightly less effective, but better suited for use in conjunction with other drugs. In Russia, sold to many analogues prevatsida, among them – the preparation of Obolensk, called “Epicurus” in honor of the founder of the philosophy of pleasure, including grocery.

According the Court of Appeals for the District of Columbia ruled that the Israeli pharmaceutical company Teva Pharmaceuticals Industries Ltd. will not be able to market a generic versib drug to treat heartburn Prevacid to 2009 Thus, the appellate court upheld a lower court ruling that the patent for Prevacid, developed by TAP Pharmaceutical Products Inc. (a joint venture between the companies, Abbott Laboratories and Takeda Pharmaceutical Industries), is valid. Teva will be able to start producing a generic after November 10, 2009, when the patent term expires. At the beginning of this year Abbott Laboratories and Takeda stopped 30-year partnership and rights to Prevacid switched to a Japanese company.

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Pharmacological action

Inhibition of platelet aggregation. PLAVIX selectively inhibits the binding of adenosine diphosphate (ADP) receptor on platelet activation and complex GPIIb / IIIa under the action of ADP, thus inhibiting platelet aggregation. PLAVIX also inhibits platelet aggregation induced by other agonists, through blockade of activation of platelets released ADP. PLAVIX binds irreversibly to the platelet ADP receptor. Consequently, platelets, which came with him to the interaction, not susceptible to the stimulation of ADP during the entire period of their life, and normal platelet function is restored with the same speed as renovation of platelets.
From the first day of the drug showed a significant inhibition of platelet aggregation. Inhibition of platelet aggregation and increases the stable state is reached within 3-7 days. The average level of suppression of platelet aggregation in the application of a daily dose of 75 mg of 40-60%. Platelet aggregation and bleeding time returned to its initial level after an average of 5 days after cessation of treatment.
The drug has koronarorasshiryayuschee action. In the presence of atherosclerotic vascular lesions prevents the development of atherothrombosis regardless of the localization process of vascular (cerebrovascular, cardiovascular or peripheral lesions).

Indications

Prevention of ischemic disorders in patients with significant atherosclerosis, including:
- After myocardial infarction, ischemic stroke or newly diagnosed peripheral vascular disease;
- Acute coronary syndrome without lifting segment ST (unstable angina or myocardial infarction without pathological tooth Q) in combination with acetylsalicylic acid.

Dosage regimen

For the prevention of ischemic disorders in patients after myocardial infarction, ischemic stroke and newly diagnosed peripheral vascular disease for adults (including elderly patients) to designate 75 mg 1 time per day regardless of meals.
In acute coronary syndrome without segment elevation ST (unstable angina or myocardial infarction without teeth Q) treatment should be started with the appointment of a single loading dose of 300 mg and then continued at a dose of 75 mg 1 time / day (with a simultaneous appointment of acetylsalicylic acid). Since the application of acetylsalicylic acid in high doses is associated with greater risk of bleeding, the recommended dose should not exceed 100 g.
The course of treatment – up to 1 year.

Side effects

From the blood coagulation system: gastrointestinal bleeding (2%) in 0.7% of cases require hospitalization less frequently – hematoma, hematuria, and bleeding in the conjunctiva.
The part of the hemopoietic system: pronounced neutropenia (number of granulocytes <0.45h109 / L) was observed in 0.04%, severe thrombocytopenia (platelet count <80h109 / L) was 0.2%.
From the digestive system: abdominal pain, indigestion (constipation, diarrhea, nausea), gastritis, rarely – changes of liver samples.
From the central nervous system and peripheral nervous system: headache, dizziness, paresthesias.
Dermatological reactions: skin rash, itching.
Allergic reactions: seldom – bronchospasm, angioedema, anaphylactic reactions.
Other: thrombocytopenic purpura (1 / 200 000).
Other clinically significant side effects, noted in a number of major international studies, with a frequency> = 0.1%, as well as all serious side effects are presented below, in accordance with the WHO classification. Their frequency is defined as follows: frequent (> 1 / 100, but <1 / 10), uncommon (> 1 / 1000, but <1 / 100), rare (> 1 / 10000, but <1 / 1000).
From the central nervous system and peripheral nervous systems: common – headache, dizziness, paresthesia; rarely – vertigo.
From the digestive system: often – dyspepsia (diarrhea), abdominal pain, infrequent – nausea, gastritis, flatulence, constipation, vomiting, stomach ulcer and duodenal ulcer.
From the blood coagulation system: Infrequent – lengthening of bleeding time.
The part of the hemopoietic system: Infrequent – leukopenia, a decrease in the number of neutrophils and eosinophils, decrease in the number of platelets.
Dermatological reactions: rare – rash and itching.
Post-marketing data
From the blood coagulation system: reports of bleeding were the most frequent (most of the cases occurred during the first month of treatment). There are several fatal cases (intracranial, gastrointestinal and retroperitoneal bleeding), there are reports of severe cases of skin bleeding (purpura), musculoskeletal bleeding (hemarthrosis, hematoma), eye bleeding (conjunctival, ocular, retinal), epistaxis , hemoptysis, pulmonary hemorrhage, hematuria, and bleeding from the surgical wound, patients taking clopidogrel simultaneously with acetylsalicylic acid or acetylsalicylic acid and heparin, have also been reported cases of severe bleeding.
The part of the hemopoietic system: very rarely – trombogemoliticheskaya thrombocytopenic purpura (0.0005%), severe thrombocytopenia (platelet count <30h10 / l), granulocytopenia, agranulocytosis, anemia, aplastic anemia / pancytopenia.
From CNS: very rarely – confusion, hallucinations.
Since the cardiovascular system: very rarely – vasculitis, lower blood pressure.
On the part of the respiratory system: very rarely – bronchospasm.
From the digestive system: very rarely – colitis (including ulcerative or lymphocytic colitis), pancreatitis, changes in taste, hepatitis, liver function abnormalities.
On the part of the musculoskeletal system: very rarely – arthralgia, arthritis.
From the urinary system: very rarely – glomerulonephritis.
Dermatological reactions: very rare – Bullous rash (erythema multiforme), erythematous rash, eczema, lichen planus.
Allergic reactions: seldom – angioedema, urticaria, anaphylactoid reactions.
Other: very rarely – increased temperature, increased blood creatinine.

Contraindications

- Severe hepatic impairment;
- Severe bleeding, such as peptic ulcer or intracranial hemorrhage;
- Pregnancy;
- Lactation (breastfeeding);
- Children under the age of 18 years (safety and efficacy not established);
- Hypersensitivity to the ingredients.
Precautions should be prescribed the drug for liver and kidney (including moderate hepatic and / or renal insufficiency), trauma, before the operations.

Pregnancy and lactation

Lack of data is not recommended to prescribe Plavix during pregnancy and lactation (breastfeeding).

Cautions

In applying the Plavix blood test should be conducted during the first week of treatment in the case of combining medication with acetylsalicylic acid, NSAIDs, heparin, inhibitors of glycoprotein IIb / IIIa or fibrinolytics, as well as in patients at high risk of bleeding associated with trauma, surgery or other pathological conditions.
Because of the risk of bleeding and haematological side effects in case of occurrence during treatment indicating that the clinical symptoms should immediately conduct a blood test (aPTT, platelet count, tests of functional activity of platelets) and functional activity of the liver.
With the planned surgical interventions treatment Plavix should be discontinued 7 days before surgery.
PLAVIX should be used with caution in patients with risk of bleeding (particularly gastrointestinal and intraocular).
Patients should be warned that they should inform the doctor about every case of bleeding.
Because of insufficient data on the use of clopidogrel in patients with acute myocardial infarction (with teeth Q) drug treatment should not begin during the first few days after a heart attack.
Because of insufficient data clopidogrel should not be given in the acute period of ischemic stroke (in the first 7 days).
The drug should be used with caution in patients with impaired renal function.
PLAVIX should be used with caution in patients with moderate hepatic impairment, who may experience hemorrhagic diathesis.
Effects on ability to drive vehicles and management mechanisms
Unknown impact on the receiving Plavix ability to drive vehicles and management mechanisms.

Overdose

At one time oral dose of Plavix 600 mg (amount equivalent to 8 standard tablets, 75 mg) in healthy volunteers side effects are not marked. Bleeding time was prolonged to 1.7 times, which corresponds to the figure recorded after a therapeutic dose (75 mg / day).
Treatment: transfusion of platelets. No specific antidote exists.

Drug Interactions

Aspirin does not alter the inhibitory effect Plakviksa on ADP-induced platelet aggregation, but enhances the effect of Plavix acetylsalicylic acid on collagen-induced platelet aggregation. The combined use of these drugs requires caution. However, in acute coronary syndrome without ST-segment elevation recommend combined use of Plavix and acetylsalicylic acid. Safety of long-term simultaneous use of aspirin and Plavix have not been established.
In an application with heparin according to the clinical trial conducted in healthy volunteers, Plavix did not alter either the overall need for heparin, or the effect of heparin on blood clotting. Concomitant use of heparin did not change the inhibiting effect of Plavix on the aggregation of platelets. However, the safety of such combinations has not yet been established, and the simultaneous use of these drugs requires caution.
In an application with recombinant tissue plasminogen activator (rt-PA) security co-application of Plavix, rt-PA and heparin was investigated in patients with recent myocardial infarction. The frequency of clinically significant bleeding was similar to that observed in the case of joint application of rt-PA and heparin. Safety co clopidogrel with other thrombolytic not yet installed, and the simultaneous use of these drugs requires caution.
The combined use of clopidogrel with warfarin is not recommended because this combination may increase bleeding.
Appointment of NSAIDs in conjunction with Plavix requires caution.
There have not been clinically significant pharmacodynamic interactions with the application of Plavix together with atenolol, nifedipine, phenobarbital, cimetidine, estrogens, digoxin, theophylline, tolbutamide, antacid.
Appointment of inhibitors of glycoprotein IIb / IIIa with Plavix requires caution.

Posted in Plavix
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Indian Nexium

Pharmacological Effects:
Antiulcer tool – proton pump inhibitor, dextro isomer of omeprazole, decreases the secretion of HCl in the stomach by specific inhibition of proton pump in parietal cells. Being a weak base and moving into an active form in the acidic environment of the secretory tubules parietal cells of gastric mucosa, activates and suppresses the proton pump – H + / K + ATPase. Inhibits basal and stimulated secretion of HCl. The action begins at 1 h after oral administration of 20 mg or 40 mg. When receiving the drug daily for five days at a dose of 20 mg 1 time per day average maximum concentration of HCl after pentagastrin stimulation is decreased by 90%. When you receive esomeprazole 40 mg healing of reflux esophagitis occurs approximately 78% of patients after 4 weeks of therapy and in 93% – over 8 weeks. Treatment of esomeprazole 20 mg 2 times a day in combination with standard anti-bacterial BOS for 1 week leads to the successful eradication of Helicobacter pylori in approximately 90% of patients. Patients with uncomplicated ulcer, 12 duodenal ulcer after 1 week of eradication rate does not require subsequent antisecretory therapy monotherapy for the healing of sores or eliminate symptoms.

Indications:
Gastroesophageal reflux disease (GERD): erosive reflux esophagitis (treatment), prevention of relapse in patients with healed esophagitis, symptomatic treatment of GERD. As part of combination therapy: peptic ulcer and 12 duodenal ulcer associated with Helicobacter pylori (treatment and prevention).

Contraindications:
Hypersensitivity (including to substituted benzimidazole), period laktatsii.C caution. Pregnancy.

Side effects:
Frequent (0.1-1%): headache, abdominal pain, diarrhea, flatulence, nausea, vomiting, and constipation. Rare (0.01-0.1%): dermatitis, pruritus, urticaria, dizziness, dryness of rtu.Peredozirovka. Treatment: specific antidote is known, dialysis is ineffective, if necessary, being symptomatic therapy.

Dosage and administration:
Inside. Tablets should be swallowed whole, washed down with liquid. Pills can not chew or crush. Treatment of erosive reflux esophagitis: 40 mg 1 time a day for 4 weeks. Recommended an additional 4-week course of treatment in cases where after the first course of healing esophagitis does not occur or symptoms persist. Prevention of relapse in patients with healed oesophagitis: 20 mg 1 time per day. Symptomatic treatment of GERD: 20 mg 1 time per day – patients without esophagitis. If after 4 weeks of treatment the symptoms do not disappear, should undertake further examination of the patient. In combination with appropriate antibiotic therapy for eradication of Helicobacter pylori, ulcer treatment 12-duodenum associated with Helicobacter pylori, prevention of recurrence of peptic ulcers in patients with peptic ulcer disease associated with Helicobacter pylori: esomeprazole – 20 mg, amoxicillin – 1 g and clarithromycin — 500 mg 2 times a day for 7 days. Patients with renal insufficiency and for elderly patients dose adjustment is required. In severe hepatic insufficiency the dose should not exceed 20 mg / day.

Cautions:
If you have any anxiety symptoms (eg, as a large spontaneous weight loss, frequent vomiting, dysphagia, vomiting of blood or melena), as well as the presence of gastric ulcers (or suspected stomach ulcers) should eliminate the possibility of malignancy, as the treatment of esomeprazole can lead to smoothing of the symptoms and Thus delay the correct diagnosis. Patients taking the drug over a long period (especially more than 1 year), should be under regular medical supervision. During treatment with proton pump inhibitors, the concentration of gastrin in plasma increased as a result of reduced intragastric secretion of HCl. Patients taking proton pump inhibitors for a long time, often observed the formation of glandular cysts in the stomach. These phenomena are due to physiological changes as a result of inhibition of secretion of HCl. Cysts are benign and tend to disappear. There is currently no data on the use of esomeprazole during pregnancy. With the introduction of esomeprazole animals did not reveal any direct or indirect negative impact on the development of an embryo or fetus. Introduction of the racemic drug also did not exert any negative impact on the animals during pregnancy, childbirth, and during postnatal development. Nevertheless, should appoint a drug to pregnant women only if the expected benefit to the mother justifies potential risk to the fetus. It is not known whether esomeprazole is allocated to breast milk.

Interaction:
Reduces the absorption of ketoconazole and itraconazole. Esomeprazole inhibits CYP2C19 and CYP3A4, so the combined use of esomeprazole with other BOS, in the metabolism of which involved CYP2C19 (diazepam, citalopram, imipramine, clomipramine, phenytoin, etc.) may lead to an increase in their concentrations in plasma and require dose reduction. Esomeprazole does not cause clinically significant changes in the pharmacokinetics of amoxicillin, quinidine, and warfarin. By sharing a 30 mg esomeprazole and diazepam reduced by 45% clearance of the enzyme-substrate complex (CYP2C19-diazepam). In the plasma of patients with epilepsy minimum concentration of phenytoin increased by 13% when combined it with 40 mg esomeprazole. In this regard, it is recommended to control the concentration of phenytoin in the plasma at the beginning of treatment with esomeprazole and its Abolition. Simultaneous treatment with esomeprazole 40 mg cisapride leads to higher values of pharmacokinetic parameters of cisapride: AUC – 32% and T1 / 2 – 31%, but the concentration of cisapride in plasma at the same time did not significantly change; cisapride has no effect on electrophysiological parameters of heart at this combination. The combined use of esomeprazole with clarithromycin (500 mg 2 times a day), which inhibits CYP3A4, increases the AUC of esomeprazole 2 times. Corrections esomeprazole dosing regime in this case is not required.

Posted in Nexium
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Lipitor

Pharmacological Effects:
Means of lipid-lowering statin group. Selective competitive inhibitor of HMG-CoA reductase – an enzyme that converts 3-hydroxy-3-methylglutaryl coenzyme A to mevalonic acid, a precursor of sterols, including cholesterol. TG and cholesterol in the liver included in the composition of VLDL are delivered to the plasma and transported to peripheral tissues. LDL formed from VLDL during the interaction with LDL receptors. Reduces levels of cholesterol and lipoproteins in the plasma due to the oppression of HMG-CoA reductase, cholesterol synthesis in the liver and increase the number of “liver” of LDL receptors on the cell surface, which leads to increased capture and catabolism of LDL. Reduces LDL, causes marked and persistent increase in activity of LDL receptors. Lowers cholesterol in patients with homozygous familial hypercholesterolemia, which usually defies LS lipid-lowering therapy. Lowers total cholesterol of 30-46%, LDL – by 41-61%, apolipoprotein B – at 34-50% and TG – by 14-33%, a rise in cholesterol, HDL (high density lipoproteins) and apolipoprotein A. dose-dependent decreases the level of LDL in patients with homozygous hereditary hypercholesterolemia resistant to other lipid-lowering therapy LS. Reliably reduces the risk of ischemic complications (including development of death from myocardial infarction) by 16%, the risk of rehospitalization for angina, accompanied by signs of myocardial ischemia – 26%. Not carcinogenic and mutagenic action.

Indications:
The primary hypercholesterolemia (heterozygous familial hypercholesterolemia and non-family, according to Frederickson Type IIa), combined (mixed) hyperlipidaemia (Frederickson types IIb on and III), disbetalipoproteinemiya (by Frederickson Type III) (as an adjunct to diet), family endogenous hypertriglyceridemia (Frederickson on type IV), resistant to dietary treatments. Homozygous hereditary hypercholesterolemia (as a supplement to hypolipidemic therapy, including LDL autohemotransfusion purified from the blood). Diseases of the CAS against the background of dyslipidemia, secondary prevention to reduce the overall risk of death, myocardial infarction and rehospitalization for angina.

Contraindications:
Hypersensitivity, active liver disease (including chronic active hepatitis, chronic alcoholic hepatitis), increased activity of “liver” of transaminases (more than 3 times) of unknown origin, hepatic impairment (severity of A and B on the scale of Child-Pyuga) , pregnancy, laktatsii.C caution. Serious violations of electrolyte balance, endocrine and metabolic disorders, alcoholism, liver disease history, hypotension, severe acute infections, uncontrollable seizures, extensive surgery, trauma, children’s age (efficacy and safety of application is not installed).

Side effects:
From the nervous system: often 2% – insomnia, dizziness, rarely 2% – headache, fatigue, malaise, somnolence, abnormal dreams, amnesia, paresthesia, peripheral neuropathy, amnesia, emotional lability, ataxia, paralysis of the facial nerve, hyperkinesis, depression , hyperesthesia, loss of consciousness. From the senses: at least 2% – amblyopia, tinnitus, dryness of the conjunctiva, disturbance of accommodation, eye hemorrhage, deafness, glaucoma, parosmiya, loss of taste, taste perversion. From the CCC: usually 2% – pain in the chest, rarely 2% – palpitation, vasodilatation, migraine, postural hypotension, increased blood pressure, phlebitis, arrhythmia, angina. The part of the hemopoietic system: at least 2% – anemia, lymphadenopathy, thrombocytopenia. On the part of the respiratory system: often 2% – bronchitis, rhinitis, at least 2% – pneumonia, dyspnea, bronchial asthma, nasal bleeding. From the digestive system: often 2% – nausea, rarely 2% – heartburn, constipation or diarrhea, flatulence, stomachodynia, abdominal pain, anorexia, decreased or increased appetite, dry mouth, eructation, dysphagia, vomiting, stomatitis, esophagitis, glossitis, erosive and ulcerative lesions of the oral mucosa, gastroenteritis, hepatitis, biliary colic, cheilitis, duodenal ulcer 12 ulcers, pancreatitis, cholestatic jaundice, abnormal liver function, rectal bleeding, melena, bleeding gums, tenesmus. The part of the locomotor system: often 2% – arthritis, rarely 2% – spasms of the leg muscles, bursitis, peritendinitis, myositis, myopathy, arthralgia, myalgia, rhabdomyolysis, torticollis, muscular hypertonicity, contracture of joints. On the part of the digestive system: often 2% – urogenital infections, peripheral edema, rarely 2% – dysuria (including thamuria, nocturia, urinary incontinence or urinary retention, compelling urge to urination), nephritis, hematuria, vaginal bleeding, nefrourolitiaz , metrorrhagia, epididymitis, decreased libido, impotence, abnormal ejaculation. For the skin: often 2% – alopecia, dermatoxerasia, increased sweating, eczema, seborrhea, ecchymosis, petechiae. Allergic reactions: at least 2% – skin itching, skin rashes, contact dermatitis, rare – urticaria, angioedema, face edema, photosensitivity, anaphylaxis, exudative erythema multiforme (including Stevens-Johnson syndrome), toxic epidermal necrolysis (syndrome Lyell). Laboratory findings: at least 2% – hyperglycemia, hypoglycemia, increased serum CPK, albuminuria. Other: at least 2% – weight gain, gynecomastia, mammalgia, exacerbation podagry.Peredozirovka. Treatment: No specific antidote, being symptomatic therapy. Hemodialysis is ineffective.

Dosage and administration:
Inside, take at any time of day, regardless of the meal. Initial dose – 10 mg 1 time per day. Change dose at intervals of not less than 4 weeks. The maximum daily dose – 80 mg in 1 step. When the primary hypercholesterolemia and combined (mixed) hyperlipidemia appoint 10 mg 1 time a day. The effect is manifested within 2 weeks, the maximum effect is observed within 4 weeks. In homozygous familial hypercholesterolemia prescribed 80 mg 1 time per day (reduced cholesterol content of 18-45%). Before therapy the patient must assign a standard hypocholesterolemic diet, which he must comply during treatment.

Cautions:
Atorvastatin may cause an increase in serum CPK, which should be taken into account in the differential diagnosis of retrosternal pain. Should regularly monitor liver function tests before starting treatment, at 6 and 12 weeks after the start of the drug or after increasing the dose, and periodically during the entire period of application (to the complete normalization of the patients whose transaminase levels higher than normal). Improved performance of “liver” of transaminases is observed mainly in the first 3 months of treatment. It is recommended to cancel or reduce the dose of medication at higher rates AST and ALT more than 3 times. Should temporarily halt the use of atorvastatin in the development of clinical symptoms, implying the presence of acute myopathy, or in the presence of factors predisposing to the development of acute renal failure on the background of rhabdomyolysis (severe infection, hypotension, traumatic surgical interventions, trauma, metabolic, endocrine, or electrolyte disturbances expressed). Patients should be warned that they should immediately seek medical attention at the appearance of unexplained pain or weakness in muscles, especially if accompanied by malaise or fever. Women of childbearing age should use reliable methods of contraception. Children experience with atorvastatin at a dose of 80 mg / day is limited. Controlled studies in children are not held, but adverse reactions when using the drug in 8 children older than 9 years old when the family homozygous hypercholesterolemia at a dose of 80 mg / day for 1 year were not found.

Interaction:
When concomitant administration of cyclosporin, fibrates, erythromycin, clarithromycin, immunosuppressive, anti-LS (relating to azoles) and nicotinamide concentration of atorvastatin in plasma (and the risk of myopathy) increases. Antacids reduce the concentration of 35% (effect on LDL cholesterol level does not change). Concomitant use of atorvastatin with the protease inhibitors, known as inhibitors of cytochrome CYP3A4, accompanied by an increase in plasma concentrations of atorvastatin. In the application of digoxin in combination with atorvastatin at a dose of 80 mg / day of digoxin concentration increased by approximately 20%. Increases the concentration of 20% (in the appointment with atorvastatin at a dose of 80 mg / day) oral contraceptive containing norethindrone and ethinyl estradiol. Lipid-lowering effect of the combination with colestipol than that for each drug separately.

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Description of the drug Lipitor is not intended for purposes of treatment without the participation of a physician.

Posted in Lipitor
Tags: free trial offers, Lipitor, lipitor co-pay card, lipitor copay card, lipitor pfizer, lipitor side effects, lipitor tablets, only lipitor, side effects lipitor, side effects of lipitor

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