Cyprinol 500mg N10 coated pills
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Active ingredients
Ciprofloxacin
Release form
Pills
Composition
1 tablet contains: Ciprofloxacin (in the form of monohydrate hydrochloride) 500 mg Supplementary substances: sodium carboxymethyl starch, silicon dioxide anhydrous colloid, croscarmellose sodium, magnesium stearate, povidone, microcrystalline cellulose.
Pharmacological effect
Antimicrobial broad-spectrum drug from the group of fluoroquinolones. Bactericidal effect. Inhibits the DNA-enzyme enzyme of bacteria, as a result of which DNA replication and the synthesis of bacterial cellular proteins are violated. Ciprofloxacin acts on both breeding microorganisms and microorganisms that are in the resting phase. The drug is active against gram-negative bacteria: Escherichia coli, Salmonella spp., Shigella spp., Citrobacter spp., Klebsiella spp., Enterobacter spp. Proteus vulgaris, svitas, spains, spains, spains, spains, spains, spains, spains, spains, spains. Neisseria spp .; intracellular microorganisms: Legionella pneumila, Brucella spp., Chlamydia trachomatis, Listeria monocytogenes, Mycobacterium tuberculosis, Mycobacterium kansasii, Mycobacterium avium-intracellulare; Gram-positive bacteria: Streptococcus spp. (including Streptococcus pyogenes, Streptococcus agalactiae), Staphylococcus spp. (including Staphylococcus aureus, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus). Most of the stafi are at Treponema pallidum is not well understood. When taking Ziprinol, there is no development of parallel resistance to other antibiotics that do not belong to the group of inhibitors of gyrase, which makes it highly effective against bacteria that are resistant to aminoglyc zidam, penicillins, cephalosporins, tetracyclines.
Pharmacokinetics
AbsorptionAfter taking the drug inside ciprofloxacin is rapidly absorbed from the gastrointestinal tract. Food intake slows down absorption, but does not affect the Cmax value and bioavailability. Bioavailability ranges from 50% to 85%. Cmax in the serum of healthy volunteers after ingestion of the drug in a dose of 250 mg, 500 mg, 750 mg and 1000 mg is achieved in 1-1.5 h and is 0.76 mg / ml, 1.6 mg / ml, 2.5 mg / ml and 3.4 mg / ml respectively. Distribution Ciprofloxacin is well distributed in tissues and body fluids, with high concentrations in bile, lungs, kidneys, liver, gall bladder, uterus, seminal fluid, prostate tissue, tonsils, endometrium, fallopian tubes and ovaries.The concentration of ciprofloxacin in these tissues is higher than in the serum. Ciprofloxacin also penetrates well into eye fluids, bones, bronchial secretions, saliva, skin, muscles, pleura, peritoneum and lymph. Into the cerebrospinal fluid penetrates in a small amount, the concentration of ciprofloxacin in non-inflammatory cerebral membranes is 6-10% of that in serum, in case of inflammation - 14-37%. The concentration of ciprofloxacin in neutrophils is 2-7 times higher than in serum. Vd is 2-3.5 l / kg. Plasma protein binding is 30%. It penetrates the placental barrier. Metabolism and elimination Biotransformation in the liver (15-30%) with the formation of inactive metabolites (diethylciploxacin, sulfocyrofloxacin, oxycrofloxacin, formylcrofloxacin). Excreted mainly in the urine (50-70%); 15-30% - with feces. T1 / 2 is 3-5 hours. Pharmacokinetics in special clinical situations. In chronic renal failure, T1 / 2 increases to 12 hours.
Indications
Infectious and inflammatory diseases caused by susceptible microorganisms, including: - respiratory tract infections; ear, nose and throat infections; kidney and urinary tract infections; genital infections (gonorrhea, prostatitis, adnexitis, postpartum infections ); - infections of the digestive system (including the mouth, teeth, jaws), gallbladder and biliary tract; - infections of the skin, mucous membranes and soft tissues; - infections of the musculoskeletal system; - sepsis; - peritonitis; - prevention and treatment of infections in patients with sleep jured immunity (during therapy with immunosuppressants).
Contraindications
- pseudomembranous colitis (for intravenous administration); - deficiency of glucose-6-phosphate dehydrogenase (for intravenous administration); - pregnancy; - lactation period (breastfeeding); - children and adolescents up to 18 years; - hypersensitivity to ciprofloxacin or other fluoroquinolone drugs.
Precautionary measures
With caution, the drug is prescribed for atherosclerosis of cerebral vessels, disorders of cerebral circulation, mental illness, epilepsy, convulsive syndrome, severe renal or hepatic insufficiency, elderly patients.
Use during pregnancy and lactation
The drug is contraindicated for use during pregnancy and lactation (breastfeeding).
Dosage and administration
The dosage regimen is set individually, depending on the location and severity of the infection, the state of the body, age, body weight, and the kidney function of the patient. For uncomplicated kidney and urinary tract, the drug is prescribed 250 mg 2 times / day, and for complicated ones 500-750 mg 2 times / day. In case of diseases of the lower respiratory tract - 250 mg 2 times / day, in severe cases - 500-750 mg 2 times / day. When treating gonorrhea, the drug is prescribed once in a dose of 250-500 mg. , colitis severe, gynecological infections y, prostatitis, osteomyelitis - 500-750 mg 2 times / day. For diarrhea treatment - 250 mg 2 times / day. To prevent surgical infections - 500-750 mg every other day. The duration of treatment depends on the severity of the disease.
Side effects
On the part of the digestive system: nausea, vomiting, diarrhea, pseudomembranous colitis, flatulence, loss of appetite, cholestatic jaundice (especially in patients with previous liver diseases), hepatitis, hepatonecrosis, increased activity of hepatic transaminases, alkaline membrane function, side effects of the CNS and peripheral nervous system: headache, dizziness, fatigue, anxiety, tremor, increased intracranial pressure, peripheral paralgesia, insomnia, nightmares, confusion, de remission, hallucinations and other manifestations of psychotic reactions (rarely progressing to conditions in which the patient may cause harm), fainting, migraine, cerebral arteries thrombosis. On the part of the sense organs: taste and smell, visual disturbances (diplopia, change in color perception), tinnitus, hearing loss. From the cardiovascular system: tachycardia, cardiac arrhythmias, hypotension, hot flashes (with a / in the introduction). From the hematopoietic system: eosinophilia, leukopenia, thrombocytopenia, not tropeniya; granulocytopenia, anemia, thrombocytosis, hemolytic anemia are also possible with intravenous administration. From the musculoskeletal system: rarely - arthritis, tendovaginitis, tendon rupture; arthralgia, myalgia (with a / in the introduction). From the urinary system: crystalluria, interstitial nephritis, glomerulonephritis, dysuria, polyuria, albuminuria, hematuria, increased urea, creatinine; urine retentionreduction of kidney nitrogen-secretion function. Allergic reactions: pruritus, urticaria, angioedema, Stevens-Johnson syndrome, arthralgia; vasculitis, erythema nodosum, exudative erythema multiforme, Lyell's syndrome (with a / in the introduction). The side reactions associated with chemotherapeutic action: candidiasis. Others: general weakness, photosensitization; increased sweating, hyperglycemia (with a / in the introduction). Local reactions: with a / in the introduction - pain and burning, phlebitis.
Overdose
In the case of an overdose when taken orally, in several cases a reversible toxic effect on the renal parenchyma was observed. Therefore, in the case of overdose, in addition to standard measures (gastric lavage, the use of emetic preparations, the introduction of large amounts of fluid, the creation of acidic urine), it is also recommended to monitor the kidney function and take magnesium and calcium-containing antacids, which reduce the absorption of ciprofloxacin. With the help of hemo- or peritoneal dialysis, only a small amount of ciprofloxacin is excreted (less than 10%). The specific antidote is unknown. It is necessary to carefully monitor the patient's condition, to carry out the usual emergency measures, to ensure adequate intake of fluid.
Interaction with other drugs
The simultaneous intake of pills of ciprofloxacin and cation-containing preparations and mineral supplements (for example, calcium, aluminum, iron), sucralfate or antacids, and preparations with a large buffer capacity (for example, antiretroviral) containing magnesium, aluminum or calcium, reduces the absorption of ciprofloxacin. In such cases, ciprofloxacin should be taken either 1-2 hours before or 4 hours after taking these drugs. This restriction does not apply to antacids belonging to the class of histamine H2-receptor blockers. Simultaneous use of ciprofloxacin, dairy products or beverages should be avoided. enriched with minerals (for example, milk, yoghurt, calcium-rich orange juice), since this may decrease absorption of ciprofloxacin. However, calcium, which is part of other foods, does not significantly affect the absorption of ciprofloxacin. With the combined use of ciprofloxacin and omeprazole, a slight decrease in plasma Cmax and a decrease in AUC can be observed. respectively,the occurrence of theophylline-induced side effects; in very rare cases, these side effects can be life threatening for the patient. If simultaneous use of these two drugs is unavoidable, it is recommended to continuously monitor the plasma levels of theophylline and, if necessary, reduce the dose of theophylline. A combination of very high doses of quinolones (gyrase inhibitors) and some NSAIDs (excluding acetylsalicylic acid) can provoke seizures. With simultaneous therapy with ciprofloxacin and cyclosporine, a short-term increase in plasma creatinine was observed. In such cases, it is necessary to determine the concentration of creatinine in the blood twice a week. Simultaneous use of ciprofloxacin and warfarin may enhance the effect of the latter. In some cases, the simultaneous use of ciprofloxacin and glibenclamide can enhance the effect of glibenclamide (hypoglycemia). the rate of excretion of ciprofloxacin by the kidneys (up to 59%) and increases the concentration of ciprofloxacin in the blood plasma. With the simultaneous appointment of ciproflox Acin may slow down tubular transport (renal metabolism) of methotrexate, which may be accompanied by an increase in the concentration of methotrexate in the blood plasma. This may increase the likelihood of side effects of methotrexate. In this regard, patients receiving combined therapy with methotrexate and ciprofloxacin, should be carefully monitored. Metoclopramide accelerates the absorption of ciprofloxacin, reducing the period of time required to achieve its maximum plasma concentration. At the same time, the bioavailability of ciprofoxacin does not change. As a result of a clinical study involving healthy volunteers with simultaneous use of ciprofloxacin and tizanidine, an increase in plasma tizanidine concentration was found: an increase in Cmax 7 times (from 4 to 21 times), an increase in AUC by 10 times (from 6 up to 24 times). With the increase in serum tizanidine concentration, hypotensive and sedative side effects are associated. Thus, the simultaneous use of ciprofloxacin and tizanidine is contraindicated. Ciprofloxacin can be used in combination with other antibiotics.As was shown in in vitro studies, the combined use of ciprofloxacin and beta-lactam antibiotics, as well as aminoglycosides, was accompanied mainly by additive and indifferent effect; a relatively rare increase in the effects of both drugs was observed, and very rarely a weakening. Possible combinations of drugs with ciprofloxacin include:
special instructions
When severe and prolonged diarrhea develops during or after treatment with ciprofloxacin, the diagnosis of pseudomembranous colitis should be excluded, which requires immediate discontinuation of the drug and appropriate treatment. cases of inflammation and even rupture of tendons during treatment with fluoroquinolones. During the period of treatment, in order to avoid the development of crystalluria, an increase in the recommended amount is unacceptable oh daily dose. Patients should receive a large amount of fluid to maintain normal urine output and acid urine. Due to possible photosensitization during treatment with Ciprinol, contact with direct sunlight should be avoided. Effect on the ability to drive motor vehicles and control mechanisms requiring increased concentration and speed of psychomotor reactions.