Anvimax powder for preparation of solution 5g sachet N6 (lemon honey)
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Active ingredients
Paracetamol + Rimantadine + Ascorbic Acid + Loratadine + Rutoside + Calcium Carbonate
Release form
Powder
Composition
Active ingredient: paracetamol - 360 mg; ascorbic acid - 300 mg; calcium gluconate monohydrate - 100 mg; Rimantadine hydrochloride - 50 mg; Rutozid trihydrate - 20 mg; Concentration of the active substance (mg): 833 mg
Pharmacological effect
The combined drug has antiviral, interferonogenic, antipyretic, analgesic, antihistamine and angioprotective effect. the body's immune responses, compensates for vitamin C deficiency. Calcium gluconate, as a source of calcium ions, prevents the development of increased permeability and fragility of blood vessels causing hemorrhagic processes in influenza and acute respiratory viral infections, has antiallergic effect (mechanism unclear). rimantadine has antiviral activity against influenza A virus. Blocking M2 channels of influenza A virus, violates its ability to penetrate into the cells and release ribonucleoprotein, thereby inhibiting the most important stage of viral replication. Induces the production of interferon alpha and gamma. With influenza B virus, rimantadine has an antitoxic effect. Rutozid is an angioprotector. Reduces capillary permeability, swelling and inflammation, strengthens the vascular wall. It inhibits aggregation and increases the degree of deformation of erythrocytes. Loratadine is a blocker of histamine H1 receptors, prevents the development of tissue edema associated with the release of histamine.
Pharmacokinetics
Paracetamol Absorption and Distribution Absorption - High. According to the results of clinical studies, the following pharmacokinetic parameters of paracetamol were established: when using Cmax capsules of paracetamol in blood plasma, it is achieved in 1.20 ± 0.72 h and is 5.01 ± 1.70 mcg / ml, in the application of powder - in 0.7 ± 0.39 h and is 4.79 ± 1.81 mcg / ml. Binding to plasma proteins - 15%.Gets through the BBB. Metabolism and elimination. Metabolized in the liver in three main ways: conjugation with glucuronides, conjugation with sulfates, oxidation by microsomal liver enzymes. In the latter case, toxic intermediate metabolites are formed, which are subsequently conjugated with glutathione, and then with cysteine and mercapturic acid. The main isoenzymes of cytochrome P450 for this pathway are the isoenzyme CYP2E1 (predominantly), CYP1A2, and CYP3A4 (secondary role). When glutathione is deficient, these metabolites can cause damage and necrosis of hepatocytes. Additional metabolic pathways are hydroxylation to 3-hydroxy paracetamol and methoxylation to 3-methoxy paracetamol, which are subsequently conjugated with glucuronides or sulfates. In adults, glucuronidation prevails. Conjugated paracetamol metabolites (glucuronides, sulfates and conjugates with glutathione) have low pharmacological (including toxic) activity. Excreted by the kidneys as metabolites, mainly conjugates, only 3% unchanged. According to the results of clinical trials, T1 / 2 paracetamol is 3.04 ± 1.01 h when taking the drug in capsules, 2.73 ± 0.76 h - when taking the drug in powder form. Acid Absorption and Distribution Absorbed from the gastrointestinal tract (mainly in the jejunum). Diseases of the gastrointestinal tract (gastric ulcer and duodenal ulcer, constipation or diarrhea, worm infestation, giardiasis), the use of fresh fruit and vegetable juices, alkaline drink reduces the absorption of ascorbic acid in the intestine. The plasma ascorbic acid concentration is normally around 10-20 μg / ml. The time to reach Cmax in blood plasma after oral administration is 4 hours. Binding to plasma proteins is 25%. It penetrates easily into leukocytes, platelets, and then into all tissues; the greatest concentration is reached in the glandular organs, leukocytes, liver and lens of the eye; penetrates the placental barrier. The concentration of ascorbic acid in leukocytes and platelets is higher than in erythrocytes and in plasma. In deficient states, the concentration in leukocytes decreases later and more slowly and is considered as the best criterion for assessing deficiency,concentration in plasma. Metabolism and elimination Metabolized mainly in the liver to deoxyascorbic and then to oxaloacetic acid and ascorbate-2-sulphate. Excreted by the kidneys, through the intestines, with unchanged form and as metabolites. Pharmacokinetics in special clinical cases. destruction of ascorbic acid (conversion to inactive metabolites), sharply reducing reserves in the body. It is eliminated during hemodialysis. Calcium gluconate Approximately 1 / 5-1 / 3 part of orally administered calcium gluconate absorbed in the small intestine; this process depends on the presence of ergocalciferol, the pH, dietary patterns and the presence of factors capable of binding calcium ions. Absorption of calcium ions increases with its deficiency and the use of a diet with a reduced content of calcium ions. About 20% is excreted by the kidneys, the rest (80%) - by the intestines. Rimantadine Absorption and distribution After ingestion, it is almost completely absorbed in the intestine. Absorption is slow. According to the results of clinical studies, the following pharmacokinetic parameters of rimantadine were established: when using Cmax capsules in blood plasma, it is reached in 4.53 ± 2.52 h and is 68.2 ± 26.6 ng / ml, when using the drug in powder form - in 5.28 ± 2.54 h and is 69 ± 19.7 ng / ml. Binding to plasma proteins - about 40%. Vd - 17-25 l / kg. Concentration in nasal discharge is 50% higher than in plasma. Metabolism and excretion Metabolized in the liver. More than 90% is excreted by the kidneys within 72 hours, mainly in the form of metabolites, 15% - unchanged. According to the results of clinical studies, T1 / 2 rimantadine is 30.51 ± 9.83 h when using the drug in the form of capsules, 33.26 ± 12.76 h - when using the drug in powder form. Pharmacokinetics in special clinical cases In chronic renal failure, T1 / 2 increases 2-fold. In patients with renal insufficiency and in elderly people, rimantadine can accumulate in toxic concentrations if the dose is not adjusted in proportion to the decrease in CC. Hemodialysis has an insignificant effect on the clearance of rimantadine. Rutozid The time it takes to reach Cmax in the blood plasma after oral administration is 1–9 hours. It is mainly excreted in bile and to a lesser extent by the kidneys.T1 / 2 - 10-25 hours. Loratadine Absorption and distributionQuickly and completely absorbed from the gastrointestinal tract. According to the results of clinical studies, the following pharmacokinetic parameters of loratadine were established: when using the drug in the form of Cmax capsules in the blood plasma, it is reached in 2.92 ± 1.31 hours and is 2.36 ± 1.53 ng / ml, and when used in the form of a powder, after 3.28 ± 1.25 hours it is 1.85 ± 0.95 ng / ml. Binding to plasma proteins - 97%. Does not penetrate through BBB. Metabolism and elimination Metabolized in the liver with the formation of the active metabolite descarboethoxyloratadine with the participation of cytochrome CYP3A4 isoenzymes and to a lesser extent CYP2D6. It is excreted by the kidneys and with bile. According to the results of clinical studies, T1 / 2 loratadine when taking capsules is 12.36 ± 6.84 h, with the use of the drug in powder form - 11.29 ± 5.52 hours. Pharmacokinetics in special clinical cases Cmax in elderly people increases by 50%. In patients with chronic renal failure and during hemodialysis, the pharmacokinetics remain virtually unchanged
Indications
AnviMax serves as the main pharmaceutical drug that provides etiotropic treatment of influenza type A, that is, a conservative therapy aimed at eliminating the causal factors of the development of the nosological unit is carried out at the expense of the drug. As a symptomatic treatment, AnviMax can be used in the following clinical situations: catarrhal diseases; acute respiratory viral infections; pathological conditions, the course of which is accompanied by fever, muscle and headache, chills.
Contraindications
hypersensitivity, idiosyncrasy, acquired or hereditary intolerance to the constituent components of a pharmaceutical preparation; pathology of the gastrointestinal tract (especially in the acute stage); hemorrhagic diathesis; fat-soluble vitamin K deficiency; hemophilia; portal hypertension; thyroid disease; insufficient platelet count; acutely occurring diseases of the liver and kidneys (glomerulonephritis, pyelonephritis, nephrourolithiasis, renal failure, hepatitis) or chronic pathologies in the acute stage; severe hypercalcemia and hypercalciuria; chronic alcoholism; sarcoidosis; phenylketonuria; the period of pregnancy and lactation (breastfeeding); lactose intolerance, lack of absorption of glucose and galactose.There is a number of diseases when, with absolute indications for the use of a pharmaceutical preparation, it should be included in the conservative therapy regimen, but the medication should be taken under the supervision of qualified medical personnel (it is recommended to undergo treatment in a 24-hour hospital setting). These pathologies include: epilepsy; atherosclerosis of cerebral vessels; diabetes; sideroblastic anemia; increased amount of oxalate in the blood plasma; deficiency of glucose-6-phosphate dehydrogenase; suction deficiency syndrome; dehydration and exsiccosis; thalassemia; violations of the electrolyte composition of the blood; old age (especially in pathologies of the cardiovascular system, accompanied by arterial hypertension).
Precautionary measures
Do not exceed the recommended dose. With caution, you should use the drug and limit its use in epilepsy, cerebral atherosclerosis, diabetes mellitus, glucose-6-phosphate dehydrogenase deficiency, hemochromatosis, sideroblastic anemia, thalassemia, hyperoxaluria, urolithiasis, dehydration, and in the treatment of anemia, thalassemia, hyperoxaluria, urolithiasis, dehydration. a), diarrhea, malabsorption syndrome, calcium nephrorurolithiasis (in history), hypercalciuria; as well as in elderly patients with arterial hypertension (the risk of hemorrhagic stroke increases, due to rimantadine, which is part of the drug).
Use during pregnancy and lactation
Use during pregnancy and during breastfeeding is contraindicated.
Dosage and administration
Prepare a solution by adding half a glass (approximately 100 ml) of boiled warm water to the contents of the bag, and mix the contents. Immediately consume inside. Daily dosage - 1 sachet 2-3 times a day. It is recommended to take AnviMax after eating, since the adsorption capacity of the gastrointestinal tract is stimulated by the passage of a food lump. The course of treatment is usually about 5 days. It is strictly forbidden to extend the treatment yourself.
Side effects
Conservative treatment with AnviMax can cause such undesirable consequences: From the side of the central nervous system: drowsiness or irritability, tremor, excessive mobility (hyperkinesia), dizziness and headache, arterial hyperemia of the skin of the face.On the part of the gastrointestinal tract: dyspeptic disorder, damage to the duodenal mucosa and stomach, dry mouth, flatulence (abdominal bloating with intestinal gases), diarrhea, loss of appetite. On the part of the blood-forming organs: a change in blood parameters (regular diagnostic tests are necessary during conservative treatment). From other organ systems: - Inhibition of insulin production by pancreatic b cells, glucosemia, glycosuria and pronounced manifestations of diabetes mellitus, as a result. Also, a complex drug can cause allergic reactions, which manifest themselves in the form of pruritus, pigmented rashes, urticaria.
Overdose
Symptoms: during the first 24 hours after administration - pallor of the skin, nausea, diarrhea, vomiting, pain in the epigastric region; violation of glucose metabolism, metabolic acidosis, tachycardia, arrhythmia, headache, exacerbation of concomitant chronic diseases. Symptoms of abnormal liver function may appear 12-48 hours after an overdose. In severe overdose - liver failure with progressive encephalopathy, coma; acute renal failure with tubular necrosis (including in the absence of severe liver damage). Treatment: the introduction of donators of SH-groups and precursors of the synthesis of glutathione-methionine within 8-9 hours after overdose and acetylcysteine - within 8 hours. Gastric lavage symptomatic therapy. The need for additional therapeutic measures (further introduction of methionine, acetylcysteine) is determined depending on the concentration of paracetamol in the blood, as well as the time elapsed after its administration.
Interaction with other drugs
Paracetamol reduces the efficacy of uricosuric drugs. The concomitant use of paracetamol in high doses increases the effect of anticoagulant drugs. Microsomal oxidation inductors in the liver (phenytoin, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants), ethanol and hepatotomatic drugs, drugs, drugs, drugs, tricyclic antidepressants, medicinal drugs, ethanolic drugs, tricyclic antidepressants, drugs, drugs, tricyclic antidepressants, drugs, drugs, drugswhich makes it possible to develop severe intoxication even with a small overdose. If used simultaneously with metoclopramide, the absorption rate of paracetamol may be increased. Long-term use of barbiturates reduces the effectiveness of paracetamol. . Ascorbic acid increases the concentration of benzylpenicillin in the blood. Improves absorption in intestinal iron preparations (converts trivalent iron to bivalent); can increase the excretion of iron while using with deferoxamine. Increases the risk of crystalluria in the treatment of short-acting salicylates and sulfonamides, slows the kidneys excretion of acids, increases the excretion of drugs having an alkaline reaction (including alkaloids). Increases the total clearance of ethanol, which in turn reduces the concentration of ascorbic acid in the body. When used simultaneously, it reduces the chronotropic effect and barbiturates and primidone increase the excretion of ascorbic acid in the urine. Reduces the therapeutic effect.
special instructions
Duration of use - no more than 5 days. It is not necessary to use the drug in the presence of metastatic tumors. Patients who abuse alcohol should consult a doctor before starting treatment with the drug, since paracetamol may have a damaging effect on the liver. Effect on ability to drive motor vehicles and control mechanisms treatment, care must be taken when driving vehicles and engaging in other potentially hazardous activities requiring increased concentration understanding and speed of psychomotor reactions.