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It reduces the degradation of bradykinin and increases the synthesis of prostaglandins. Reduces the total peripheral vascular resistance (SVR), blood pressure (BP), preload, pressure in the pulmonary capillaries, causing an increase in cardiac masteron prop output (IOC) and increase tolerance to myocardial stress in patients with chronic heart failure (CHF). Artery expands to a greater extent than veins. Some effects are explained by the influence on the tissue renin-angiotensin-aldosterone system (RAAS). With prolonged use reduces myocardial hypertrophy and arterial wall of the resistive type. It improves blood flow to ischemic myocardium. ACE inhibitors prolong the life expectancy of patients with chronic heart failure, slow the progression of left ventricular dysfunction (LV) function in patients with myocardial infarction without clinical symptoms of heart failure (HF). The beginning of the antihypertensive action – after 1 hour.Maximal effect was observed after 6-7 h. Antihypertensive effect lasts for 24 hours. The duration of the effect is also dependent on the dose. When hypertension effect noted in the first days after the start of treatment, stable effect develops in 1-2 months.

Pharmacokinetics
The mean extent of absorption of lisinopril is approximately 25%, with large inter-individual variability (6-60%). Food does not affect the absorption of lisinopril.
Maximum plasma concentration is 90 ng / ml reached after 6 hours. Bioavailability – 25%. Weakly bound to plasma proteins. Permeability through the blood brain barrier and the placental barrier – is low. The metabolism of virtually exposed and excreted by the kidneys unchanged. The half-life is 12 hours in patients with chronic heart failure, cirrhosis of the liver, patients older absorption and clearance of lisinopril reduced..
Impaired renal function leads to an increase in AUC (area under the curve “concentration in plasma – time”) and half-life of lisinopril, but these changes are clinically significant only when the glomerular filtration rate is less than 30 ml / min.

Pharmacokinetics in particular groups of patients
in patients with chronic heart failure absorption and clearance lisinopril reduced bioavailability is 16%.
In patients with renal impairment (creatinine clearance less than 30 mL / min), the concentration of lisinopril is several times higher than the concentration in the blood plasma of healthy volunteers and marked increase in the time to reach maximum concentration in the plasma and an increase in half-life.
elderly patients concentration of lisinopril in the plasma increased on average by 60% and the area under the curve “concentration-time” 2 times greater than in younger patients.
patients with cirrhosis of lisinopril reduced bioavailability by 30% and the clearance is reduced by 50% compared with patients with normal liver function.

Therapeutic indications
– Essential and renovascular hypertension (AH) (as monotherapy or in combination with other antihypertensive agents);
– Chronic heart failure (CHF) (in combination therapy);
– early treatment of acute myocardial infarction in combination therapy (in the first 24 hours with stable hemodynamics to maintain these indicators and prevention of left ventricular dysfunction and heart failure);
– diabetic nephropathy (reduction of albuminuria in patients with type 1 diabetes with normal blood pressure and patients with type 2 diabetes with hypertension).

Contraindications
– Hypersensitivity to lizinoprilu, other ACE inhibitors, and drug components;
– Angioedema in history, including during treatment with ACE inhibitors;
– hereditary angioedema or idiopathic angioedema edema
– Pregnancy
– lactation;
– age of 18 years (effectiveness and safety have not been established);
– lactose intolerance, lactase deficiency, glucose-galactose malabsorption.

Precautions
aortic stenosis, hypertrophic obstructive cardiomyopathy, bilateral renal artery stenosis, stenosis of the artery only kidney condition after kidney transplantation, severe renal impairment (creatinine clearance (CC) of less than 30 ml / min.), Primary hyperaldosteronism, hypotension, inhibition of bone marrow hematopoiesis, hyponatremia (increased risk of hypotension in patients who are at malosolevoy or salt-free diet), hypovolemic state (including diarrhea, vomiting), systemic connective tissue disease (including systemic lupus erythematosus, scleroderma), diabetes, hyperkalaemia , ischemic heart disease, cerebrovascular disease (including cerebrovascular insufficiency), severe chronic heart failure, hemodialysis using dialysis membranes vysokoprotochnyh (AN69®), advanced age.

Pregnancy and lactation
Use of the drug Lisinopril during pregnancy is contraindicated. In establishing the drug pregnancy should be stopped as soon as possible. ACE inhibitors in the II and III trimester of pregnancy has adverse effects on the fetus (subject to marked reduction of blood pressure, renal failure, hyperkalemia, hypoplasia of the skull bones, fetal death). Data about the negative effects of the drug on the fetus when used during the I trimester there. For newborns and infants who have been exposed to ACE inhibitors in utero, it is recommended to monitor for early detection of significant decrease in blood pressure, oliguria and hyperkalemia.
During the period of treatment with the drug should be abolished breastfeeding (no data on the penetration of lisinopril passes into breast milk).

Dosing and Administration
Inside, 1 time per day in the morning, regardless of the meal, preferably at the same time.
Essential hypertension: an initial dose – 10 mg / day maintenance dose – 20 mg / day, maximum daily dose – 40 mg . Stable antihypertensive effect develops in 1-2 months, which should be considered when increasing the dose. If use of the drug at the maximum dose does not cause a sufficient therapeutic effect, it is possible additional purpose other antihypertensive agents.
Patients receiving pre diuretics, you must cancel them for 2-3 days prior to the start of the drug. If unable to cancel diuretics initial dose of lisinopril should not exceed 5 mg / day.
Renovascular hypertension or other conditions with increased activity of the RAAS: the initial dose – 2.5-5 mg / day under the control of blood pressure, kidney function, potassium blood serum. The maintenance dose is set depending on the magnitude of blood pressure.
In chronic renal failure (CRF) is determined by the dose depending on creatinine clearance (CC): with CC 30-70 ml / min – 5.10 mg / day, with CC – 10-30 ml / min – 2.5-5 mg / day, less than 10 ml / min, including patients on dialysis – 2.5 mg / day. The maintenance dose is determined depending on the pressure (controlled by the kidneys, potassium and sodium content in the blood).
CCF (simultaneously with diuretics and / or cardiac glycosides): initial dose – 2.5 mg / day, with a gradual increase of 2.5 mg every 3-5 days maintenance daily dose of 5-10 mg / day. The maximum daily dose – 20 mg. If possible, the dose of diuretic should be reduced before you start taking lisinopril.
Elderly patients are often observed a more pronounced long-term antihypertensive effect, which is associated with a decrease in the rate of excretion of lisinopril (it is recommended to start treatment with 2.5 mg / day – ½ tablets of 5 mg).
Acute myocardial infarction (in combination therapy in the first 24 hours with stable hemodynamics) in the first 24 hours – 5 mg, and then 5 mg a day,
10 mg every two days and then 10 mg 1 time per day. The course of treatment -. At least 6 weeks
at the beginning of treatment or during the first 3 days after acute myocardial infarction in patients with low systolic blood pressure (120 mmHg or lower) prescribe a lower dose – 2.5 mg. In case of reduction of blood pressure (systolic blood pressure less than or equal to 100 mm Hg) a daily dose of 5 mg, if necessary, temporarily reduced to 2.5 mg. In the case of long pronounced reduction in blood pressure (systolic blood pressure below 90 mm Hg for more than 1 hour) treatment with the drug is stopped.
Diabetic nephropathy: an initial dose – 10 mg / day, which, if necessary, increased to 20 mg / day to achieve diastolic blood pressure values below 75 mm Hg measured in the “sitting” for patients with type 1 diabetes and below 90 mmHg in the “sitting” in patients with type 2 diabetes.

Side effects:
The most common side effects: dizziness, headache, fatigue, diarrhea, dry cough, nausea. Cardio – vascular system : marked reduction of blood pressure, chest pain, orthostatic hypotension, tachycardia, bradycardia, new or worsening symptoms of heart failure, violation of atrioventricular conduction, myocardial infarction, palpitations. On the part of the central nervous system : emotional lability, impaired concentration, paraesthesia, somnolence, jerking of the limbs and lips, fatigue, asthenic syndrome, confusion. From the side of hematopoiesis : leukopenia, neutropenia, agranulocytosis, thrombocytopenia, anemia (decreased concentration, hemoglobin, hematocrit, erythropenia). The respiratory system : dyspnea, dry cough, bronchospasm. From the digestive system : dryness of the oral mucosa, anorexia, dyspepsia, taste changes, abdominal pain, pancreatitis, jaundice (hepatocellular or cholestatic), hepatitis. For the skin : increased sweating, alopecia, photosensitivity, pruritus. With the genitourinary system : renal failure, oliguria, anuria, acute renal failure, uremia, proteinuria , reduced potency. Allergic reactions : angioneurotic edema of the face, extremities, lips, tongue, epiglottis and / or throat, skin rash, hives, fever, positive test results antinuclear antibodies, increased erythrocyte sedimentation rate, eosinophilia, leukocytosis, intestinal angioedema. Other : . myalgia, arthralgia / arthritis, vasculitis With simultaneous use of ACE inhibitors and gold preparations (sodium aurothiomalate) intravenously, describes a symptom, including facial flushing, nausea, vomiting, and hypotension. Laboratory indicators : hyperkalemia, masteron prophyponatremia, increased activity of “liver” transaminases, hyperbilirubinemia, hypercreatininemia, increasing concentrations of urea.

Overdose
Symptoms: marked reduction of blood pressure, dryness of the oral mucosa, drowsiness, urinary retention, constipation, fluid and electrolyte balance, renal failure, shortness of breath, tachycardia, palpitations, bradycardia, dizziness, anxiety, irritability.
Treatment: gastric lavage reception activated carbon, giving the horizontal position of the patient with elevated legs, replenishment of circulating blood volume – intravenous 0.9% sodium chloride solution or other plasma solutions, if necessary – vasopressor drugs, monitoring of the cardiovascular and respiratory systems, blood pressure, bcc , urea, creatinine, fluid and electrolyte balance. In the case of bradycardia resistant -. The use of artificial pacemaker
Hemodialysis is effective.

Interaction with other drugs
With simultaneous use of potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium supplements, salt substitutes containing potassium – increases the risk of hyperkalemia, especially in patients with impaired renal function. Therefore, they can jointly appoint only on the basis of individual decisions the doctor for regular monitoring of potassium serum levels and renal function.
In an application with beta-blockers, blockers “slow” calcium channel blockers, diuretics and other antihypertensive agents enhancement of the antihypertensive effect of the drug.
Lisinopril can be used in conjunction with beta-blockers, acetylsalicylic acid (in doses less than 300 mg / day), thrombolytics, nitrates.
while the use of vasodilators, barbiturates, phenothiazines, tricyclic antidepressants, ethanol – increased antihypertensive action of the drug.
in an application with non-steroidal anti-inflammatory drugs (NSAIDs) (including selective cyclooxygenase-2 inhibitors), estrogens and adrenostimulyatorov – reduced antihypertensive effect of lisinopril.
in an application with drugs lithium – slower excretion of lithium (increased cardiotoxic and neurotoxic effects of lithium).
at the same time use with antacids and colestyramine -. reduced absorption in the gastrointestinal tract
drug increases neurotoxicity salicylates, reduces the effect of hypoglycemic agents for oral administration, norepinephrine (noradrenaline), epinephrine (adrenaline) and protivopodagricakih preparations enhances the effects (including spin), cardiac glycosides effect peripheral muscle relaxants, reduces excretion of quinidine.
reduces the effect of oral contraceptives. At the same time taking methyldopa increased risk of hemolysis.
The combined use with selective serotonin reuptake inhibitors can lead to severe hyponatremia.
The combined use with allopurinol, procainamide, cytostatics may cause leukopenia.
With the simultaneous use of ACE inhibitors and gold preparations (sodium aurothiomalate) intravenously, describes a symptom, including facial flushing, nausea, vomiting, and hypotension.

Cautions
Marked reduction in blood pressure often occurs with a decrease in circulating blood volume caused by diuretic therapy, reducing the amount of salt in the diet, hemodialysis, diarrhea or vomiting. In patients with chronic heart failure with simultaneous renal failure or without her, perhaps marked reduction in blood pressure. It is most often diagnosed in patients with severe stage of chronic heart failure as a result of application of high doses of diuretics, hyponatremia or impaired renal function. In these patients, treatment should start under close medical supervision (with caution in selection of dosage and diuretics).Such rules must be followed in the appointment of patients with ischemic heart disease, cerebrovascular insufficiency, in which a sharp decrease in blood pressure can lead to heart attack or stroke. Prior to treatment, if possible, should be to normalize the concentration of sodium and / or fill the volume of circulating blood, carefully controlled initial dose effect on the patient. Treatment of symptomatic hypotension includes bed rest, and, if necessary, on / in the liquid (saline infusion). Transient hypotension is not a contraindication to treatment with lisinopril, however, may require the temporary cancellation of his or dose reduction.
Treatment with Lisinopril is contraindicated in case of cardiogenic shock and acute myocardial infarction, if vasodilator appointment can significantly worsen the hemodynamic parameters, such as when the systolic BP less than 100 mm Hg. v.
In patients with acute myocardial infarction decreased renal function (creatinine concentration in plasma is more than 177 umol / l and / or proteinuria greater than 500 mg / 24 h) is a contraindication for use of the drug Lisinopril. In the case of renal insufficiency during lisinopril therapy (serum creatinine concentration in the blood plasma to more than 265 mmol / l, or twice the baseline), the doctor has to decide the need for treatment discontinuation.
In bilateral renal artery stenosis and renal artery stenosis sole kidney, as well as with hyponatremia and / or reducing the volume of circulating blood or circulatory failure, hypotension caused by the intake of the drug Lisinopril may lead to a decrease in renal function and the subsequent development of reversible (after discontinuation of the drug), acute renal failure. A slight temporary increase in the concentration of urea and creatinine in the blood can be observed in cases of impaired renal function, especially against the background of simultaneous treatment with diuretics. In cases of a significant reduction in renal function (creatinine clearance less than 30 ml / min) require careful monitoring of renal function.
Angioneurotic edema of the face, extremities, lips, tongue, epiglottis and / or the larynx is rare in patients treated with ACE inhibitors, including the drug Lisinopril, It may occur at any time during treatment. In this case, treatment with lisinopril as soon as possible and stop patient monitoring set up to complete regression of symptoms. In cases where only the face and lips originated edema, a condition often goes untreated, however, possible to assign antihistamines. Angioedema with laryngeal edema can be fatal. When covered by the language, the epiglottis, or larynx airway obstruction may occur, so it is necessary to immediately carry out the appropriate therapy (0.3-0.5 ml of epinephrine solution (epinephrine) 1: 1000 subcutaneous administration of corticosteroids, antihistamines) and / or measures to ensure airway patency.
in patients with a history already had angioedema not associated with previous treatment with ACE inhibitors, the risk of its development during treatment with an ACE inhibitor can be increased.
An anaphylactic reaction is observed and in patients on hemodialysis using vysokoprotochnyh dialysis membranes (AN69®), which simultaneously receive lisinopril. In such cases it is necessary to consider the possibility of using other types of dialysis membranes or other antihypertensive agents. You may experience anaphylactic reactions during low-density lipoprotein apheresis dextran sulfate.
In some cases, desensitization to Hymenoptera venom (wasp, bee, etc..), Treatment with ACE inhibitors was accompanied by hypersensitivity reactions. Such can be avoided by previously temporarily interrupt receiving ACE inhibitors.
In patients with extensive surgery or during general anesthesia, ACE inhibitors (such as lisinopril) can block the formation of angiotensin II. Reduction in blood pressure associated with this mechanism of action, adjusted increase in circulating blood volume. Before surgery (including dental) must notify the surgeon / anesthetist on the use of Lisinopril drug.
Use of the recommended doses of the drug in elderly patients may be associated with an increased concentration of lisinopril in the blood, so the titration requires special attention and is carried out, depending on renal function and blood pressure of the patient.
However, so in the elderly and younger patients Lisinopril antihypertensive effect of the drug is masteron prop expressed in the same degree.
By the use of ACE inhibitors coughing was observed. Cough dry, long, which disappears after discontinuation of treatment with ACE inhibitors. In the differential diagnosis of cough should be considered, and cough caused by the use of ACE inhibitors.
In some cases, there is hyperkalemia. The risk for the development of hyperkalemia factors include renal failure, diabetes, intake of potassium drugs or drugs that increase potassium in the blood (eg heparin), especially in patients with impaired renal function. During the period of drug treatment requires regular monitoring of blood potassium ion plasma glucose, urea, lipids.
During the period of treatment is not recommended to drink alcohol, as alcohol increases the antihypertensive effect of the drug.
Caution must be exercised during exercise, hot weather (risk of dehydration and excessive reduction of blood pressure due to a decrease in blood volume).
Since it is impossible to eliminate the potential risk of agranulocytosis, requires periodic monitoring of blood picture.
based on the results of epidemiological studies suggest that concomitant use of ACE inhibitors and insulin and hypoglycemic agents for oral administration may lead to hypoglycemia. The greatest risk of observed within the first weeks of combination therapy, and in patients with impaired renal function. In patients with diabetes requires careful glycemic control, especially during the first month of treatment with an ACE inhibitor. ACE inhibitors may lead to the development of cholestatic jaundice with progression to fulminant hepatic necrosis, so you need to stop taking the drug with an increase in activity of “liver” transaminases and the occurrence of symptoms of cholestasis.

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Breaks down the main component of connective tissue interstitial substance – hyaluronic acid (mucopolysaccharide, which consists of acetylglucosamine and glucuronic acid, is the cementing substance of connective tissue) and reduces testosterone suspension cycle its viscosity, increases the tissue and vascular permeability, facilitates the movement of fluids in the interstices spaces; reduces tissue swelling, softens and flattens scars, increases the amount of motion in the joints, reduces contracture and prevents their formation. Hyaluronidase causes the breakdown of hyaluronic acid to glucosamine and glucuronic acid and thereby reduces its viscosity. The duration of action when administered intradermally – up to 48 hours.

Indications
Burn, traumatic, post-surgical scars; nonhealing ulcers (including radiation); Dupuytren’s contracture; joint stiffness, joint contractures (after inflammation, injuries), osteoporosis, ankylosing spondylitis, severe disease of lumbar disc; chronic tenosynovitis, scleroderma (skin manifestations), the soft tissue hematoma surface localization; preparations for dermatological and plastic surgery on the scar nodules. Tuberculosis of the lungs (bronchi complicated by nonspecific lesions), inflammation of the upper respiratory tract and bronchi with obstruction phenomena. Traumatic lesions of nerve plexus and peripheral nerves (plex neuritis).Hyphema, hemo-ftalm, retinopathy of various etiologies.

Contraindications:
Hypersensitivity, acute infectious and inflammatory diseases, recent hemorrhage, acute intercurrent disease, children under 18 years. For inhalation – pulmonary tuberculosis with severe respiratory failure; lung, bleeding, coughing up blood; malignancies, fresh vitreous hemorrhage. Concomitant estrogen. Data on the use of the drug have no children.

Precautions
Pregnancy, lactation.

Dosage and administration:
When scarring lesions of subcutaneous (under the scar-altered tissue) or intramuscularly (near the site of injury) administered 64 CU (1 ml) daily or every other day (a total of 10-20 injections).
In traumatic lesions of nerve plexus and peripheral nerves is administered subcutaneously to the affected nerve (64 UE in procaine solution) every other day; a course – 12-15 injections. The course of treatment is repeated as needed.
When used in ophthalmic practice, the drug is administered subkonyunktivalno – 0.3 ml, parabulbarno – 0.5 mL, and electrophoresis.
Patients with pulmonary tuberculosis with the productive nature of inflammation is administered in combination therapy for increasing the concentration of antibacterial drugs testosterone suspension cycle in lesions by injection and / or inhalation; Inhalation is administered daily one time with 5 ml (320 CU). The course of treatment consists of 20-25 inhalation. If necessary to repeat courses at intervals of 1.5-2 months.
Outwardly, in the form of dressings impregnated with the drug solution. To prepare the solution every 64 UE dissolved in 10 ml of sterile 0.9% sodium chloride solution or boiled water at room temperature.This solution is wetted with a sterile bandage, folded in 4-5 layers, applied it to the affected area, cover with waxed paper and fix soft bandage. The dose depends on the area affected (20-60 iu / sq cm.), On average – 300 ME on the bandage. The bandage is applied daily for 15-18 hours for 15-60 days. With prolonged use every 2 weeks make a break for 3-4 days.
When using electrophoresis method ME 300 was dissolved in 60 ml of distilled water, add 2-3 cap of 0.1% hydrochloric acid solution and injected from the anode to the affected area for 20 -30 min. The treatment course – 15-20 sessions. The applicator dosing regimen can be alternated with electrophoresis. The prepared solution should be used within 24 hours.

Side effects:
Allergic reactions; long-term use – local irritating effect.

Overdose Symptoms: fever, nausea, vomiting, dizziness, tachycardia, decreased blood pressure, local swelling, urticaria, erythema. Treatment: administration of epinephrine, corticosteroids; antihistamines.

Interaction with other drugs
improves the absorption of drugs administered subcutaneously or intramuscularly, enhances the effect of local anesthetics.

Specific guidance
solution should not be injected through the catheter in which solutions containing cations previously injected. Injectable testosterone suspension cycle solutions are prepared by 0.9% sodium chloride or 0.5% solution of procaine solution for inhalation – 0.9% sodium chloride solution for electrophoresis -. In distilled water
to test intradermal injection with 20 Before treatment advisable l of hyaluronidase.
It should not be administered in the area of infectious inflammation and swelling. In acute hemorrhages hyaluronidase does not apply. how much to inject for weight loss

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Hepatoprotective agent also has choleretic, cholelitolitic, lipid-lowering, cholesterol-lowering and immunomodulatory effects. It stabilizes hepatocyte membrane and cholangiocytes has a direct cytoprotective effect. As a result of the drug in the gastrointestinal circulation of bile acids content decreases hydrophobic (potentially toxic) acids. By reducing cholesterol absorption in the intestine and other biochemical effects having hypocholesterolemic action. Suppresses testosterone suspension reviews cell death caused by toxic bile acids.

With its high polar properties, ursodeoxycholic acid (UDCA) forms a non-toxic mixed micelles with apolar (toxic) bile acids, which reduces the ability of gastric reflyuktata damage cell membranes with biliary reflux gastritis and reflux esophagitis. In addition, UDCA forms double molecules that can be included in the composition of cell membranes, stabilize them and make immune to the effects of cytotoxic micelles. It reduces the saturation of bile cholesterol by inhibiting its absorption in the intestine, suppression of the synthesis in the liver and decrease secretion in the bile; increases the solubility of cholesterol in bile, forming with it the liquid crystals; It reduces the lithogenic index of bile. The result is the dissolution of cholesterol gallstones (a consequence of changes in the ratio of cholesterol / bile acids in bile) and preventing the formation of new stones (the result of reducing the content of cholesterol in bile). Induces cholepoiesis rich in bicarbonate, which leads to an increase in bile passages and stimulates the excretion of toxic bile acids through the intestine.

Immunomodulatory effect due to inhibition of the expression of HLA-antigens. (HLA – human leucocyte antigens – antigens histocompatibility) in the membranes of hepatocytes and cholangiocytes, normalization of natural killer activity of lymphocytes, etc. Significantly delay the progression of fibrosis in patients with primary biliary cirrhosis, cystic fibrosis and alcoholic steatohepatitis, reduces the risk of development of esophageal varices.

Pharmacokinetics :

Absorption and distribution.
UDCA in the jejunum absorbed by passive diffusion, and from the ileum by an active transport. It penetrates through the placental barrier. The concentration in plasma when administered 500 mg achieved after 30, 60, 90 min – 3.8, 5.5, 3.7 mmol / l, respectively. Distribution UDCA is characterized by a high degree of binding to plasma proteins, which may be 96-99%.

Metabolism and excretion.
As a result of the elimination of UDCA presistemna formed taurine and glycine conjugates, which are secreted into bile. Approximately 50-70% of the UDCA dose administered is excreted in the bile. The remainder of UDCA nevsosavsheysya fraction falls into the colon, where it undergoes bacterial cleavage (7-dehydroxylation) to give lithocholic acid. Lithocholic acid is partially absorbed from the gut, biotransformed in the liver and sulfolitoholilglitsinovy sulfolitoholiltaurinovy conjugates and excreted.

Indications for use:

 

  • Primary biliary cirrhosis in the absence of signs of decompensation (symptomatic therapy);
  • Dissolution of small and medium cholesterol stones in the gall bladder functioning;
  • Biliary reflux gastritis and reflux esophagitis;
  • Chronic hepatitis of various genesis;
  • Alcoholic liver disease;
  • Nonalcoholic steatohepatitis;
  • Primary sclerosing cholangitis;
  • Cystic fibrosis (cystic fibrosis);
  • Biliary dyskinesia;

Contraindications:

 

  • Increased individual sensitivity to the drug;
  • rentgenopolozhitelnye (high in calcium) gallstones;
  • non-functioning gall bladder;
  • acute inflammatory diseases of the gallbladder, bile ducts and intestines;
  • cirrhosis of the liver in the stage of decompensation;
  • expressed by the human kidney, liver, pancreas;
  • lactose intolerance;
  • lactase deficiency or glucose-galactose malabsorption;
  • Children up to age 3 years.

With caution used in children aged 3 to 4 years, as possible difficulty in swallowing tablets, although ursodeoxycholic acid has no age restrictions apply.

Pregnancy and lactation:

The use of ursodeoxycholic acid during pregnancy is possible only when the expected benefit to the mother outweighs the potential risk to the fetus (adequate well-controlled studies of ursodeoxycholic acid in pregnant women has not been).

Data on the allocation of ursodeoxycholic acid in breast milk are not currently available. If necessary, the use of ursodeoxycholic acid during lactation should decide the issue of termination of breastfeeding.

Dosage and administration:

The tablets of the drug testosterone suspension reviews is taken orally without chewing, drinking plenty of water. The tablet can be divided in half.

For the dissolution of cholesterol gallstones average daily dose of the drug . The drug is taken in the evening before bedtime. The course of treatment – 6-12 months.To prevent the recurrence of stones is recommended taking the drug for a few months after the dissolution of stones.

Symptomatic treatment of primary biliary cirrhosis: an average daily dose – 10-15 mg / kg (if necessary – up to 20 mg / kg) from 6 months to several years. The drug is taken with food, drinking plenty of fluids.

When biliary reflux gastritis and reflux esophagitis , the dose is 10 mg / kg / day – 1 time a day at bedtime. The course of treatment – from 10-14 days to 6 months, if necessary – up to 2 years.

In chronic hepatitis of various genesis (toxic, drugs, etc..), The primary nealkogolnom steatohepatitis, alcoholic liver disease , the mean daily dose is 10-15 mg / kg body weight in 2-3 hours.The duration of therapy is 6-12 months or more.

Side effect:

The calcination gallstones, increased activity of “liver” enzymes, allergic reactions (including urticaria), diarrhea, nausea, abdominal pain; in the treatment of primary biliary cirrhosis may be a transient decompensation of cirrhosis of the liver, passing after discontinuation of the drug.

Overdose:

Cases of UDCA overdose are not known. Interaction with other drugs:

Interaction with other drugs

Do not use the drug at the same time with antacids containing aluminum and ion-exchange resins, as these drugs may interfere with the absorption of ursodeoxycholic acid.

With simultaneous use of lipid-lowering medications, estrogens, progestogens, or neomycin (oral contraceptives) increase the saturation of bile with cholesterol and may reduce the ability of ursodeoxycholic acid to dissolve cholesterol gallstones.

Ursodeoxycholic acid can enhance cyclosporine absorption from the intestine, which requires monitoring of cyclosporin blood concentration, and if necessary – its correct dosing regimen.

Special instructions:

The successful dissolution requires that the stones were pure cholesterol, no larger than 15-20 mm, gallbladder filled with stones not more than half of the bile duct and retain their function.

When assigning to dissolve gallstones need to control the activity of “liver” transaminases and alkaline phosphatase, gamma-glutamyl, bilirubin concentrations. While maintaining high performance drug should be discontinued.

Holetsistografii should be performed every 4 weeks during the first 3 months of treatment in the future – every 3 months. Monitoring the effectiveness of the treatment carried out every 6 months during the ultrasound examination in the first year of therapy. After completely dissolving concrements encouraged to continue in use for at least three months, in order to facilitate the dissolution of calculi residues that are too small to be detected.

If within 6-12 months testosterone suspension reviews after initiation of therapy partial dissolution of stones did not happen, it is unlikely that treatment will be effective.

Detection during treatment nevizualiziruemaya gallbladder is a testament to the fact that the complete dissolution of the stones did not happen, and the treatment should be discontinued.

When calcified gallstones violation contractility of the gall bladder or frequent attacks of biliary colic treatment should be discontinued.

Effects on ability to drive and perform work that requires high concentration and speed of psychomotor reactions:
No data are available on the effect of UDCA on the ability to drive and use machines.

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The drug blocks the peripheral units of the cough reflex due to the following effects:

  • a local anesthetic effect, which reduces the excitability of peripheral sensory (cough) testosterone suspension gains respiratory tract receptors;
  • bronchodilator actions, through which there is suppression of the stretch receptors involved in the cough reflex;
  • a slight decrease in activity of the respiratory center (without respiratory depression)

Antitussive effect of the drug is approximately equal to that of codeine. Prenoxdiazine does not cause addiction and drug dependence. In chronic bronchitis marked anti-inflammatory effect prenoxdiazine.
Prenoxdiazine does not affect the central nervous system function, except for the possible indirect anxiolytic action.
Prenoxdiazine rapidly and largely absorbed from the gastrointestinal tract. Maximum plasma concentration achieved prenoxdiazine 30 minutes after taking the drug, its therapeutic concentration is maintained for 6-8 hours. Relationship to plasma proteins is 55-59%. The half-life is 2.6 hours. Most of the dose is metabolized in the liver, only about 1/3 of the dose of the drug is excreted unchanged in, and the rest – in the form of metabolites (emphasis prenoxdiazine metabolite 4). During the first 12 hours prenoxdiazine metabolism the most important role played by biliary excretion and its metabolites. After 24 hours, after ingestion is allocated 93% of the formulation. For 72 hours after ingestion of 50-74% of the dose is excreted in the faeces and 26-50% – with urine.

Indications

Nonproductive cough of any origin (for catarrh of the upper respiratory tract, flu, acute and chronic bronchitis, testosterone suspension gains pneumonia, emphysema, night cough in patients with heart failure, preparing patients for bronchoscopic or bronhograficheskomu study).

Contraindications

Hypersensitivity to the drug.
Diseases associated with abundant bronchial secretion.
Condition after inhalation anesthesia.
Galactose intolerance, lactase deficiency or glucose-galactose malabsorption. Precautions: children’s age.

Pregnancy and lactation

During pregnancy and lactation use libeksin possible only if the potential benefit to the mother outweighs the potential risk to the fetus or child.

Dosing and Administration

The average dose for adults is 100 mg three or four times a day (1 tablet 3-4 times a day). In more complex cases, the dose can be increased up to 200 mg three – four times or 300 mg three times a day (2 tablets 3-4 times daily or 3 tablets 3 times a day).
The average dose for children, according to the age and body weight, or 25-50 mg three to four times a day (1/4 – 1/2 4/3 tablet twice a day). The maximum single dose for children – 50 mg (1/2 tablet), for adults – 300 mg (3 tablets). The maximum daily dose for children – 200 mg (2 tablets), for adults – 900 mg (9 tablets). In preparation for bronchoscopy dose of 0.9 – 3.8 mg / kg body weight is combined with 0.5 – 1 mg atropine for 1 hour prior to the procedure.
The tablets swallowed without chewing (to avoid mucosal anesthesia mouth).

Side effect

Allergic reactions
Rare: skin rash, angioedema. On the part of the gastrointestinal tract Rare: dry mouth or throat, anesthesia (temporary numbness and loss of sensitivity) of the oral mucosa. Less than 10% of cases: stomach pain, addiction constipation, nausea. From the nervous system (when using the drug in high doses): light sedation, fatigue. it should be emphasized that, as the sedation and fatigue, occur at doses above the therapeutic, and all the symptoms spontaneously stopped within testosterone suspension gains a few hours after discontinuation of the drug

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