Analgin bufus - instructions for use, dose, side effects, contraindications

Metamizole sodium is a derivative of pyrazolone. It has analgesic, antipyretic and weak anti-inflammatory action, the mechanism of which is associated with oppression of the synthesis of prostaglandins. By the mechanism of action is practically no different from other non-steroidal anti-inflammatory drugs.

The action develops in 20-40 minutes and reaches a maximum after 2 hours.With intravenous administration, the maximum effect develops after 20-40 minutes.

Pharmacokinetics:

After administration, it is rapidly absorbed and enters the liver, where it undergoes hydrolysis with the formation of the active metabolite 4N-methylaminoantipyrine (MAA), the unchanged analgin is found in the blood in small amounts only after intravenous administration. After intravenous administration, the elimination half-life for metamizole is 14 minutes. Approximately 96% is excreted in the urine in the form of metabolites. The association of the active metabolite with the blood plasma proteins is 50-60%. It is mainly excreted by the kidneys.

Clinical efficacy is determined predominantly by MAA, and to a lesser extent by 4N-aminoantipyrine (AA) metabolites. The area under the "concentration-time" curve (AUC) AA is 25% of this value for the MAA.

Metabolites 4N-acetylaminoantipyrine (AAA) and 4N-formylaminoantipyrine (FAA) do not have pharmacological activity.

All metabolites are characterized by non-linear pharmacokinetics. The clinical significance of this phenomenon is not known. In the short-term use of cumulation of metabolites does not play a big role.

Metamizole sodium penetrates the placenta.Metabolites metamizole penetrate into breast milk. The connection with plasma proteins MAA is 58%, AA - 48%, FAA - 18% and AAA - 14%.

After a single oral intake, 85 doses are detected in the urine as metabolites, of which 3 ± 1% - MAA, 6 ± 3% - AA, 26 ± 8% - AAA and 23 ± 4% - FAA. Renal clearance after a single dose of 1 g of metamizole sodium inside for MAA is 5 ± 2 ml / min, AA - 38 ± 13 ml / min, AAA - 61 ± 8 ml / min and FAA - 49 ± 5 ml / min. The corresponding half-lives from plasma for MAA are 2.7 ± 0.5 h, AA - 3.7 ± 1.3 h, AAA - 9.5 ± 1.5 h and FAA - 11.2 ± 1.5 h.

Elderly

In elderly patients AUC increases 2-3 times. In patients with cirrhosis of the liver, the half-lives of MAA and FAA with a single dose of the drug increases approximately 3-fold, while the half-lives of AA and AAA do not follow the same pattern. Such patients should avoid the use of high doses.

Impaired renal function

According to available data, with renal failure, the rate of excretion of some metabolites (AAA and FAA) decreases. Such patients should avoid the use of high doses.

Indications:Severe acute or chronic pain syndrome with trauma and postoperative pain syndrome, with colic, with oncological diseases and other conditions,where other therapeutic measures are contraindicated. Fever is resistant to other methods of treatment.

Contraindications:

Hypersensitivity to metamizol sodium and other pyrazolone derivatives, as well as to pyrazolidines, for example, phenylbutazone (including patients who undergone agranulocytosis due to the use of these drugs), or other components of the drug. Analgesic bronchial asthma or intolerance to analgesics (hives - angioedema), i.e. patients with bronchospasm or other forms of anaphylactoid reactions (eg urticaria, angioedema) in response to the use of salicylates, paracetamol, non-steroidal anti-inflammatory drugs such as diclofenac, ibuprofen, indomethacin or naproxen. Disturbance of bone marrow hematopoiesis (for example, after cytostatic therapy) or diseases of the hematopoietic organs. Hereditary deficiency of glucose-6-phosphate dehydrogenase (hemolysis). Acute intermittent hepatic porphyria (risk of developing porphyria attack). Acute renal or hepatic insufficiency. Pregnancy and the period of breastfeeding.Infant age (up to 3 months or with a body weight of less than 5 kg). Breast children aged 3 to 12 months (contraindication only for intravenous administration).

Carefully:

Kidney disease (pyelonephritis, glomerulonephritis - including in the anamnesis), alcoholism.

Arterial hypotension (systolic blood pressure below 100 mm Hg), a decrease in the volume of circulating blood, instability of hemodynamics (myocardial infarction, multiple trauma, beginning shock), heart failure, high fever (increased risk of a sharp drop in blood pressure). Diseases in which a significant reduction in blood pressure may have an increased risk (patients with severe coronary heart disease and stenosis of the cerebral arteries). Chronic abuse of alcohol. Bronchial asthma, especially in combination with concomitant polyposis rhinosinusitis; chronic urticaria and other atopy (allergic diseases, in the development of which a significant role belongs to the hereditary predisposition to sensitization: pollinosis, allergic rhinitis, etc.) (increased risk of anaphylactic / anaphylactoid reactions).Alcohol intolerance (reaction even to small amounts of certain alcoholic beverages with symptoms such as itching, lacrimation and severe reddening of the face) (increased risk of anaphylactic / anaphylactoid reactions). Severe dysfunction of the liver and kidneys (recommended the use of low doses in connection with the possibility of slowing the excretion of metamizole sodium).

Pregnancy and lactation:

The use of the drug during pregnancy and during breastfeeding is contraindicated.

Pregnancy. Metamizole sodium penetrates the placental barrier. Data on the use of sodium metamizole during pregnancy are limited. According to the results of preclinical studies, the teratogenic effect of metamizole sodium in rats and rabbits was not detected, and fetotoxicity was observed at high doses. Since there are no adequate data on use in humans, metamizol sodium should not be taken in the first trimester of pregnancy, in the second trimester of pregnancy metamizol sodium can only be used if the expected benefit to the mother exceeds the potential risk to the fetus. Although metamizol sodium weakly inhibits the synthesis of prostaglandins, it is impossible to exclude the possibility of premature (intrauterine) closure of the arterial (Botalov) duct, as well as perinatal complications caused by a violation of platelet aggregation in the mother or newborn. therefore metamizol sodium contraindicated in the third trimester of pregnancy.

Lactation period. Metabolites metamizol sodium penetrate into breast milk, so when using the drug, and also within 48 hours after taking the last dose, it is necessary to stop breastfeeding.

Dosing and Administration:

Adults and adolescents 15 years and older: 1-2 ml of 50% (500 mg / ml) or 2-4 ml of 25% solution of metamizole sodium (intramuscular or intravenous) is recommended as a single dose, the daily dose can be up to 4-8 ml of 50% or 25% of the injection solution (no more than 2 g), divided into 2-3 doses. The maximum single dose may be 1 g (2 ml of a 50% solution or 4 ml of a 25% solution).

Children: metamizol sodium Do not take at the age of 3 months or body weight less than 5 kg.

Children metamizol sodium is prescribed in a dose of 50-100 mg per 10 kg of body weight (0.1-0.2 ml of 50 % solution or 0.2-0.4 ml of a 25% solution).

A single dose can be prescribed up to 2-3 times a day.Before administration, the solution is recommended to be heated to body temperature.

With too rapid administration of the drug, a critical drop in blood pressure and shock can occur. Intravenous administration should be slow (the rate of administration is not more than 1 ml (500 mg of metamizole per minute)) in the supine position, while monitoring blood pressure, pulse and respiration rate.

Since there is a concern that the drop in arterial pressure of non-allergic genesis is dose-dependent, the amount of methamizole sodium solution greater than 2 ml (1 g) should be administered with extreme caution.

Side effects:

Undesirable reactions are classified as follows, according to the WHO classification (World Health Organization): very often (≥1 / 10), often (≥1 / 100, <1/10), infrequently (≥1 / 1000, <1/100), rarely (≥1 / 10000, <1/1000), very rarely (<1/10000), the frequency is unknown (can not be estimated based on available data).

Heart Disease

The frequency is unknown: the syndrome of Kounis (allergic coronary syndrome, manifested by clinical and laboratory signs of angina caused by mediators of inflammation).

Immune system disorders

Rarely: anaphylactic / anaphylactoid reactions.

Very rarely: analgesic bronchial asthma.

The frequency is unknown: anaphylactic shock.

Metamizole sodium can cause anaphylactic or anaphylactoid reactions, which in very rare cases can be severe and life threatening. They can occur even if the drug was previously taken many times without any complications.

Such drug reactions can develop immediately or a few hours after taking metamizole sodium, usually within one hour.

In more mild cases, they manifest themselves as skin symptoms and symptoms from the mucous membranes (itching, burning, flushing, urticaria, edema) or in the form of dyspnea or complaints from the gastrointestinal tract. In severe cases, these reactions go to generalized urticaria, severe angioedema, especially with involvement of the larynx, severe bronchospasm, cardiac arrhythmia, a sharp decrease in blood pressure (which is sometimes preceded by an increase in blood pressure), and with the development of circulatory shock.

In persons with analgesic bronchial asthma syndrome with analgesic drugs intolerance, these reactions usually manifest as asthma attacks.

Disturbances from the skin and subcutaneous tissues

Infrequent: fixed drug dermatitis.

Rarely: skin rash.

The frequency is unknown: Stevens-Johnson syndrome, Lyell's syndrome (toxic epidermal necrolysis).

Violations of the blood and lymphatic system

Rarely: leukopenia.

Very rarely: agranulocytosis, including fatal cases and thrombocytopenia.

The frequency is unknown: aplastic anemia, pancytopenia, including fatal cases.

These reactions are immunological in nature. They can occur even if the drug was previously used many times without any complications.

Typical symptoms of agranulocytosis are mucosal lesions (oral cavity and pharynx, anorectal area and genital organs), sore throat, fever. However, with the use of antibiotics, these phenomena may be mild. Sometimes, but not always there is a slight increase in the lymph nodes or spleen. The sedimentation rate of erythrocytes is significantly increased, the content of granulocytes is sharply reduced or they are not determined. As a rule, the parameters of hemoglobin, erythrocytes and platelets remain normal, but deviations may occur.

Typical symptoms of thrombocytopenia are increased tendency to bleeding and the appearance of petechiae on the skin and mucous membranes.

If there is an unexpected deterioration in the general condition, the fever does not subside, or new or painful ulcers appear on the mucous membranes, especially in the mouth, nose or throat, the treatment tactics presuppose the immediate abolition of the drug without waiting for the results of laboratory tests.

With the development of pancytopenia, the drug should be discarded and the general blood test should be monitored before returning to normal (see "Special instructions").

Vascular disorders

Infrequent: isolated arterial hypotension.

After taking the drug, an isolated transient decrease in blood pressure is possible (possibly pharmacologically conditioned and not accompanied by other manifestations of anaphylactic / anaphylactoid reactions); in rare cases, the reduction in blood pressure can be very pronounced. With fever, a dose-dependent sharp drop in blood pressure is also possible without other signs of a hypersensitivity reaction.

Disorders from the kidneys and urinary tract

Very rarely: renal dysfunction.

Frequency unknown: interstitial nephritis.

In very rare cases, patients with impaired renal function may have acute deterioration of renal function (acute renal failure), in some cases with oliguria, anuria, or proteinuria.

General disorders

Infrequent: it is possible to stain urine red due to presence in the urine of the metabolite - rubanzonovoy acid.

Overdose:

Symptoms. In overdose may cause the following symptoms: nausea, vomiting, abdominal pain, decreased kidney / acute renal failure function oliguric (e.g., due to the development of interstitial nephritis) more rarely symptoms from the central nervous system (dizziness, somnolence, tinnitus, delirium , disturbance of consciousness, coma, convulsions) and a sharp decrease in blood pressure (sometimes progressing to shock), as well as abnormal heart rate (tachycardia), hypothermia, dyspnea, acute agranulocytosis, hemorrhagic syn drome, paralysis of the respiratory muscles. After taking high doses, excretion through the kidneys of a nontoxic metabolite(rubric acid) can cause red staining of urine.

Treatment. The specific antidote is not known. If after taking the drug did not take more than 1-2 hours, you can induce vomiting, conduct a gastric lavage through the probe; appoint salt laxatives, Activated carbon. Overdose shows forced diuresis. The main metabolite - MAA can be excreted by hemodialysis, haemofiltration, hemoperfusion or filtration of blood plasma. When development of convulsive syndrome - intravenous diazepam and high-speed barbiturates.

Interaction:

With cyclosporine

When used simultaneously with cyclosporine, there may be a decrease in its concentration in the blood, so when combined, monitoring of the concentration of cyclosporin in the blood is required.

With other non-narcotic analgesics

Simultaneous use of metamizole sodium with other non-narcotic analgesic drugs can lead to a mutual enhancement of toxic effects.

With tricyclic antidepressants, oral contraceptives, allopurinol

Tricyclic antidepressants, oral contraceptives, allopurinol disrupt the metabolism of metamizole sodium in the liver and increase its toxicity.

With barbiturates, phenylbutazone and other inducers microsomal liver enzymes

Barbiturates, phenylbutazone and other inducers of microsomal liver enzymes weaken the action of metamizole sodium.

With sedatives and tranquilizers

Sedatives and tranquilizers increase the analgesic effect of metamizole sodium. Simultaneous use with chlorpromazine or other phenothiazine derivatives can lead to the development of severe hypothermia.

With drugs that are highly associated with plasma proteins (oral hypoglycemic agents, indirect anticoagulants, glucocorticosteroids and indomethacin)

Metamizole sodium, displacing from the connection with plasma proteins, hypoglycemic agents for oral administration, indirect anticoagulants, glucocorticosteroid agents and indomethacin, increase their activity.

With myelotoxic drugs

Myelotoxic drugs increase the manifestation of hematotoxicity of metamizole sodium.

With methotrexate

The simultaneous use of metamizole sodium with methotrexate may increase the hematotoxic effect of methotrexate, especially in elderly patients. Therefore, it is recommended to avoid their simultaneous application.

FROM thiamazole and sarcolysin

Thiamazole and sarcolysin increase the risk of developing leukopenia.

With codeine, blockers H₂-gistaminovyh receptors and propranolol

Codeine, blockers H₂-gistaminovyh receptors and propranolol enhance the effects of metamizole sodium.

With radiocontrast substances, colloidal blood substitutes and penicillin

Radiocontrast agents, colloidal blood substitutes and penicillin should not be used during treatment with metamizole sodium (an increased risk of anaphylactic / anaphylactoid reactions). With acetylsalicylic acid (ASA)

When combined metamizol sodium can reduce the effect of ASA on platelet aggregation. Therefore, this combination should be used with caution in the treatment of patients taking ASA as an antiplatelet agent.

FROM bupropion

Metamizole sodium can reduce the concentration of bupropion in the blood,which should be taken into account when applying simultaneously.

Special instructions:

The preparation contains a pyrazolone derivative - metamizol sodium, which occasionally can cause life-threatening shock and agranulocytosis (see section "Side effect").

In the treatment of patients receiving cytotoxic drugs and children under 5 years of treatment with metamizole sodium should only be carried out under the supervision of a doctor.

Patients who have anaphylactoid reactions in response to metamizole sodium use are also at risk of developing them in response to other non-narcotic analgesics / NSAIDs.

Patients who have anaphylactic or other immuno-mediated reactions (eg agranulocytosis) in response to metamizole sodium use are also at risk of developing them in response to the use of other pyrazolones and pyrazolidines.

Anaphylactic / anaphylactoid reactions

An increased risk of hypersensitivity reactions metamizol sodium stipulates the following states:

- analgesic bronchial asthma or intolerance to analgesics;

bronchial asthma, especially with concomitant polyposis rhinosinusitis;

- chronic urticaria;

- alcohol intolerance (hypersensitivity to alcohol), against which even with the intake of a small amount of some alcoholic drinks, patients experience sneezing, lacrimation, and severe reddening of the face. Alcohol intolerance may indicate a previously unidentified syndrome of aspirin asthma;

- intolerance or hypersensitivity to dyes (eg, tartrazine) or to preservatives (eg benzoate).

Before using metamizole sodium it is necessary to conduct a thorough questioning of the patient in order to reveal anamnestic information.

In the case of sodium metamizole, these patients need strict medical supervision of their condition and need to have the means to provide them with emergency care in case of anaphylactic / anaphylactoid reactions.

In predisposed patients, anaphylactic shock can occur, so patients with asthma or atopy metamizol sodium should be administered with caution.

Severe skin reactions

With the use of metamizole sodium, life-threatening skin reactions, such as Stevens-Johnson syndrome (SSD) and toxic epidermal necrolysis (TEN), have been described.When symptoms of SS or TENS (such as a progressive skin rash often with blisters or mucosal lesions) appear, treatment with metamizole should be stopped immediately, and should not be re-started.

Patients should be aware of the symptoms of these diseases. They should carefully monitor skin reactions, especially during the first weeks of treatment.

Agranulocytosis / pancytopenia

With prolonged use, it is necessary to monitor the picture of peripheral blood. Against the background of taking metamizole sodium, the development of agranulocytosis is possible. It occurs very rarely, lasts at least a week, does not depend on the dose, can be severe, threaten life and even lead to the death of the patient.

In this regard, if symptoms of fever, chills, sore throat, difficulty swallowing, stomatitis, erosive-ulcerative lesions of the oral cavity, vaginitis or proctitis are detected, a decrease in the number of neutrophils in the peripheral blood is less than 1500 / mm³ it is necessary to stop taking the drug and consult a doctor.

In case of development of pancytopenia, treatment should be stopped immediately, it is necessary to monitor the indicators of the developed blood test up to their normalization.

All patients should be aware that when symptoms of abnormal blood changes (eg, general malaise, infections, persistent fever, formation of hematomas, bleeding, pallor) appear against the background of metamizole sodium intake, seek medical help immediately.

Isolated hypotensive reactions

Metamizole sodium can cause hypotensive reactions (see also the "Side effect" section). These reactions can be dose-dependent. The risk of such reactions is also increased with: previous arterial hypotension, decreased circulating blood volume or dehydration, unstable hemodynamics or acute circulatory disturbance (eg, in patients with myocardial infarction or trauma), in patients with fever.

In this regard, these patients should be carried out detailed diagnostics and establish close monitoring. In order to reduce the risk of hypotensive reactions, preventive measures (stabilization of hemodynamics) may be required.

In patients in whom a reduction in blood pressure should be avoided at all costs (eg, in severe coronary heart disease or significant stenosis of the cerebral arteries), metamizol sodium It can only be used with careful monitoring of hemodynamic parameters.

Abdominal pain

It is inadmissible to use the drug to relieve acute pain in the abdomen (until finding out their cause).

Dysfunction of the liver and kidneys

In patients with impaired liver or kidney function, it is recommended to avoid the use of metamizole sodium in high doses.

Excipients

Since the drug contains sodium, this should be taken into account for people on a diet low in sodium.

If there is no effect within 3 days, stop taking the drug and consult a doctor.

Effect on the ability to drive transp. cf. and fur:

When taking the recommended doses, there was no undesirable effect on concentration of attention and reactivity. However, when using high doses, consideration should be given to the potential for impaired concentration and reactivity, which poses a risk when performing manipulations of particular importance (for example, driving a vehicle or machinery), especially after drinking alcohol.

Form release / dosage:

Solution for intravenous and intramuscular injection 500 mg / ml.

Packaging:

2 ml per ampoule of neutral glass.

10 ampoules of neutral glass with instructions for use and scarifier in the box.

When packing ampoules with notches, rings and dots of knives, ampoules or scarifiers do not.

Storage conditions:

In a dark place at a temperature of at least 5 ° C.

Do not freeze. Keep out of the reach of children.

Shelf life:

3 years. Do not use after the expiry date printed on the package.

Terms of leave from pharmacies:On prescription

Registration number:LP-000194

Date of registration:04.02.2011 / 27.05.2016

Expiration Date:Unlimited

The owner of the registration certificate:UPDATE OF PFC, CJSC UPDATE OF PFC, CJSC Russia

Manufacturer: & nbsp

UPDATE, PFC CJSC Russia

Representation: & nbspUPDATE OF PFC, CJSCUPDATE OF PFC, CJSC

Information update date: & nbsp27.08.2017

Illustrated instructions

Instructions

Analgin boufus (Analgin bufus)