Polcortolon pills 4 mg 50 pcs
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Active ingredients
Triamcinolone
Release form
Pills
Composition
Active ingredient: Triamcinolone acetonide Concentration of active ingredient (mg): 4
Pharmacological effect
Synthetic glucocorticoid drug is a fluorinated derivative of prednisone. It has a strong anti-inflammatory effect and has a weak mineralocorticoid effect. It inhibits the development of symptoms of inflammation by reducing capillary permeability and reducing the accumulation of macrophages, leukocytes and other cells in the area of inflammation. It has an immunosuppressive effect, incl. by suppressing the cellular immune response. Suppresses the secretion of ACTH by the pituitary gland, which leads to a decrease in the production of GCS and androgens by the adrenal cortex. Increases protein catabolism, causes an increase in glucose concentration in the blood, affects lipid metabolism, increases the concentration of fatty acids in the blood serum. With long-term treatment, redistribution of adipose tissue is possible. Triamcinolone inhibits bone formation and reduces calcium concentration in serum, and therefore, during the administration of the drug, it is possible to suppress bone growth in children and adolescents and develop osteoporosis in patients of all age groups. It is believed that 4 mg of triamcinolone has anti-inflammatory effect, equivalent to 4 mg of methylprednisolone, 5 mg of prednisolone, 0.75 mg of dexamethasone, 0.6 mg of betamethasone and 20 mg of hydrocortisone.
Pharmacokinetics
Absorption After ingestion is easily absorbed from the gastrointestinal tract. Bioavailability - 20-30%. Taking the drug with food slows down the absorption of triamcinolone in the initial phase, but does not affect the overall bioavailability of the drug. Distribution Binding to plasma proteins (mainly globulins) is 40%. It penetrates the placental barrier and is excreted in breast milk. Metabolism and excretion Biotransformation mainly occurs in the liver. The biological half-life is approximately 5 hours. It is mainly excreted by the kidneys as inactive metabolites.
Indications
Endocrine diseases: primary and secondary insufficiency of the adrenal cortex, congenital adrenal hyperplasia, subacute thyroiditis, severe allergic diseases,resistant to other methods of treatment: contact and atopic dermatitis, serum sickness, hypersensitivity reactions to drugs, year-round or seasonal allergic rhinitis, diseases of the musculoskeletal system: psoriatic arthritis, ankylosing spondyloarthritis, acute and subacute bursitis, epicondylitis, acute tenodiagia, aspit, etc. rheumatic diseases: acute rheumatic fever, rheumatoid myocarditis, rheumatoid arthritis, juvenile rheumatoid arthritis (with resistance to other CPS, rheumatic polymyalgia, Horton’s disease, systemic connective tissue diseases: dermatomyositis, systemic lupus erythematosus, mesenteritis, granulomatous giant cell, systemic scleroderma, polyarteritis nodosa, recurrent polychondritis; erythema (Stevens-Johnson syndrome), mushroom mycosis, pemphigus, severe psoriasis, severe eczema, pemphigoid; hemato logical diseases: acquired autoimmune hemolytic anemia, congenital (erythroid) hypoplastic anemia, anemia due to bone marrow hypoplasia, secondary thrombocytopenia in adults, idiopathic thrombocytopenic purpura (Verlhof disease) in adults, hemolysis, and liver diseases: alcohol; hypercalcemia in malignant neoplasms, oncological diseases: leukemia and lymphomas in adults, acute leukemia in children, neurological diseases evania: tuberculous meningitis with a subarachnoid block or with a threat of block (in combination with appropriate anti-tuberculosis chemotherapy), multiple sclerosis during the exacerbation, eye diseases (severe acute and chronic inflammatory processes): severe sluggish anterior and posterior uveitis, optic nerve, sympathetic neuritis, sympathetic chronic inflammation) ; respiratory diseases: bronchial asthma (severe), berylliosis, Leffler syndrome (not amenable to treatment with other drugs), symptomatic sarcoidosis, fulminant or d sseminirovanny pulmonary tuberculosis (TB in combination with chemotherapy), aspiration pneumonitis, transplantation of organs and tissues for the prevention and treatment of transplant rejection (in combination with other immunosuppressive drugs).
Contraindications
systemic fungal infections, hypersensitivity to triamcinolone and other components of the drug; children's age up to 3 years (for this dosage form).
Precautionary measures
Do not exceed the recommended dose. With caution, prescribe the drug to patients with diseases of the cardiovascular system, including in recent myocardial infarction (in patients with acute and subacute myocardial infarction, the focus of necrosis may spread, slowing the formation of scar tissue and, as a consequence, rupture of the heart muscle), in chronic heart failure in the stage of decompensation, in hypertension and hyperlipidemia. Polcortolon to persons with endocrine diseases (diabetes mellitus / including in violation of the tolerance to carbohydrates /, thyrotoxicosis, hypothyroidism, Itsenko-Cushing's disease), p and chronic renal and / or hepatic insufficiency of severe degree, nephrourolithiasis, with hypoalbuminemia and conditions predisposing to its occurrence, systemic osteoporosis, myasthenia gravis, acute psychosis, grade III-IV, poliomyelitis (with the exception of the form of bulbar encephalitis), openly, and III-IV degree, poliomyelitis, except for the form of bulbar encephalitis, openly and openly, and 3-nd degree, poliomyelitis, with open and lateral encephalitis, and openly obesity; glaucoma, during pregnancy and lactation.
Use during pregnancy and lactation
Use of the drug during pregnancy is possible only in cases where the intended benefit to the mother outweighs the potential risk to the fetus. If you need to take a drug during lactation, you should decide whether to stop breastfeeding.
Dosage and administration
Set individually depending on the evidence, the effectiveness of therapy and the patient's condition. It is recommended to take the entire daily dose 1 time per day in the morning with meals (in accordance with the daily rhythm of secretion of endogenous glucocorticoids), however, in some cases, it may be necessary to take the drug more frequently. Adults and adolescents over 14 years of age are prescribed in a dose of 4-48 mg / day in one or several receptions. Children should prescribe a drug at a dose of 100-500 mcg / kg body weight / day in 1 or several doses. In case of skipping a dose, the drug should be taken as soon as possible or, if the next dose is coming, the missed dose is not taking dissolved.You should not take a double dose at once. Polcortolon is taken in the minimum effective dose. If necessary, gradually reduce the dose of the drug.
Side effects
On the part of the endocrine system: secondary adrenal and hypothalamic-pituitary insufficiency (especially during stressful situations such as illness, trauma, surgical operation), Itsenko-Cushing's syndrome (moon-shaped person, pituitary type obesity, hirsutism, increased blood pressure, dysmenorrhea, amenorrhea, myasthenia, striae), delayed sexual development and growth suppression in children, menstrual disorders, decreased carbohydrate tolerance, manifestation of latent diabetes mellitus and increased insulin or perox need nyh hypoglycemic agents in patients with diabetes mellitus, girsutizm.So the digestive system: steroid stomach ulcer and duodenal ulcer with possible perforation and hemorrhage, pancreatitis, flatulence, erosive esophagitis, dyspepsia, nausea, vomiting, increased or decreased appetite, hiccups; in rare cases - increased activity of hepatic transaminases and alkaline phosphatars. For CVS: arrhythmias, bradycardia (up to cardiac arrest), development (in susceptible patients) or increased severity of chronic heart failure, ECG changes characteristic of hypokalemia, arterial hypertension, hypercoagulation, thrombosis; in patients with acute and subacute myocardial infarction - the spread of necrosis, slowing the formation of scar tissue, which can lead to rupture of the heart muscle. On the nervous system: delirium, disorientation, euphoria, hallucinations, manic-depressive psychosis, depression, paranoia, increased ICP with congestive nipple syndrome of the optic nerve (brain pseudotumor - more often in children, usually after a too rapid dose reduction, symptoms - headache, blurred vision or double vision), vertigo, brain pseudotumor ka, convulsions, vertigo, headache, nervousness or anxiety disorders sna.So the senses: posterior subcapsular cataracts, increased intraocular pressure with possible damage to the optic nerve, glaucoma, exophthalmos, the tendency to the development of secondary bacterial,fungal or viral infections of the eyes, trophic changes of the cornea. On the side of metabolism: negative nitrogen balance due to protein catabolism, hyperglycemia, glycosuria, increased Ca2 + excretion, hypocalcemia, increased body weight, increased sweating, sodium retention and body fluids (peripheral edema) , hypernatremia, hypokalemic syndrome (hypokalemia, arrhythmia, myalgia or muscle spasm, unusual weakness and fatigue). On the part of the musculoskeletal system: growth retardation and cleavage processes Genesis in children (premature closure of the epiphyseal growth zones), osteoporosis (very rarely - pathological bone fractures, compression fracture of the spine, aseptic necrosis of the humeral head and femur, pathological fractures of the long tubular bones), muscle tendon rupture, muscle weakness, steroid myopathy, reduction muscle mass (atrophy). From the skin and mucous membranes: steroid acne, striae, delayed wound healing, thinning of the skin, petechiae, ecchymosis, hematomas, tendency to develop pyoderma and candidiasis. Allergic reactions: skin rash, itching, anaphylactic shock. Others: the development and exacerbation of infections (jointly used immunosuppressants and vaccination contribute to the occurrence of this side effect), leukocyturia, withdrawal syndrome.
Overdose
Symptoms: increased blood pressure, peripheral edema; possible enhancement of the side effects described above. Treatment: gradual dose reduction and drug withdrawal; if necessary, conduct symptomatic therapy. Reception of large doses of the drug does not cause acute intoxication. But with prolonged use of Polkortolona, especially in large doses, there is a risk of overdose.
Interaction with other drugs
With simultaneous use of Polcortolon and cardiac glycosides, the risk of developing cardiac arrhythmias and other toxic effects of glycosides associated with hypokalemia increases. When used with Polcortolon, barbiturates, anticonvulsants (phenytoin, carbamazepine), rifampicin, glutethimide accelerate the metabolism of triamcinololone, and glutothimide accelerate the metabolism of triamcinolone. ) and weaken its effect. When used simultaneously, histamine H1-receptor blockers weaken the effect of Polcortolon. When combined Mr. Polkortolona use of amphotericin B, carbonic anhydrase inhibitors increases the risk of hypokalemia,left ventricular myocardial hypertrophy and circulatory failure. With simultaneous use of Polcortolone with paracetamol, the likelihood of hypernatremia, peripheral edema, increased calcium excretion increases, the risk of hypocalcemia, osteoporosis, paracetamol hepatotoxicity increases. acne (this combination requires caution, especially in the case of liver diseases and with rdtsa). In the combined use of hormonal contraceptives containing estrogens, increase the effect of Polcortolon by increasing the concentration of globulins that bind GCS in the blood serum, slowing their metabolism and increasing T1 / 2. Anticoagulants (coumarin derivatives, indandion, heparin), streptokinase, urokinase reduce (in some patients increase) the effectiveness of Polcortolon. The dose should be determined on the basis of prothrombin time and take into account the increased risk of ulcerative lesions and bleeding from the gastrointestinal tract. The combined use of tricyclic antidepressants can exacerbate the mental disorders associated with taking Polcortolon (this combination is not recommended). increases the concentration of glucose in the blood (may require correction of the dose of hypoglycemic drugs). Menenius Polkortolona and antithyroid drugs and thyroid hormones may change the function of the thyroid gland (may require dosage adjustment or cancellation of the antithyroid drug, or thyroid hormones) .Polkortolon reduces the effect of potassium-sparing diuretics. Combined use may cause hypokalemia. Polkortolone reduces the effectiveness of laxatives, while increasing the risk of developing hypokalemia. When ephedrine is used simultaneously, biotransformation of triamcinolone is accelerated, which may require a dose adjustment of Polcortolone.development of infections, lymphomas and other lymphoproliferative diseases. When used in conjunction with isoniazid, a decrease in plasma concentration of isoniazid can occur (mainly in people with rapid acetylation), in which case a dose change is necessary. When used together, Mexiletine metabolism accelerates and its concentration decreases in blood plasma. When used simultaneously with depolarizing muscle relaxants, hypocalcemia associated with the use of Polcortolone may increase the duration of neuromuscular blockages.Polkortolon reduces the effect of NSAIDs (including acetylsalicylic acid), alcohol, while increasing the risk of ulcerative lesions and the development of bleeding from the gastrointestinal tract. With simultaneous use of Polcortolon with drugs or food containing sodium, peripheral edema and arterial hypertension may occur . In such a situation, a restriction in the sodium diet and the abolition of drugs with a high sodium content are necessary. When vaccines containing live viruses are used, while immunosuppressive doses of GCS are used, replication of viruses and the development of viral diseases, reduction of antibody production are possible (the combination is not recommended). With simultaneous use with other vaccines increases the risk of neurological complications and reduces the production of antibodies. When used together with folic acid, you may increase the need for this drug.
special instructions
In the event of stressful situations, patients taking Polcortolon, parenteral administration of GCS is recommended. Sudden cessation of treatment may cause the development of insufficiency of the adrenal cortex, so the dose of Polcortolon should be gradually reduced. Prolonged use of Polcortolon increases the risk of developing secondary fungal or viral infections. Prolonged use of Polcortolon can cause the development of cataracts, glaucoma with possible damage to the optic nerves. Patients taking Polcortolon should not be vaccinated with live virus vaccines.The introduction of an inactivated viral or bacterial vaccine may not cause the expected increase in the amount of antibodies. In addition, in patients taking SCS, there is an increased risk of neurological complications during vaccination. It should be remembered that a sudden cessation of treatment may cause the development of adrenal insufficiency, therefore the dose of Polcortolon should be reduced gradually. When the Polkortolone is suddenly canceled, especially after a long period of administration, it is possible development of the so-called withdrawal syndrome, manifested by anorexia, fever, muscle and joint pain, general weakness. These symptoms may appear even when there is no marked adrenal insufficiency. In patients with hypothyroidism or cirrhosis of the liver, the effect of triamcinolone is enhanced. During the administration of Polcortolon, mental disorders such as euphoria, insomnia, sharp changes in mood, personality changes, severe depression, symptoms of psychosis may occur. Pre-existing emotional instability or psychotic tendencies may increase during treatment. When treating patients with hypoprothrombinemia, triamcinolone and acetylsalicylic acid should be used with caution at the same time. Use in pediatricsWhen the long-term use of Polkortolone in pediatric practice, careful control of the growth and development of children is necessary.