Active substanceAzithromycinAzithromycin
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  • Dosage form: & nbspfilm-coated tablets
    Composition:

    1 tablet 250 mg / 500 mg contains:

    Active substance: azithromycin dihydrate 262.05 mg / 524.10 mg (equivalent to azithromycin 250.00 mg / 500.00 mg).

    Excipients: cellulose microcrystalline 22,00 mg / 44,00 mg, pregelatinized starch 42,55 mg / 85,10 mg, sodium lauryl sulfate 1.50 mg / 3.00 mg, hypromellose 7.90 mg / 15.80 mg, croscarmellose sodium 3 , 50 mg / 7.00 mg, silicon dioxide colloid 3.50 mg / 7.00 mg, magnesium stearate 7.00 mg / 14.00 mg.

    Film sheath:

    * Drop off white Y-1-7000 7.00 mg / 14.00 mg

    * Drop off white Y-1-7000 contains: hypromellose 4.375 mg / 8.75 mg, titanium dioxide (E171) 2.1875 mg / 4.375 mg, macrogol 400 0.4375 mg / 0.875 mg

    Description:

    250 mg tablets:

    The capsule-shaped tablet, coated with a film sheath of white or almost white, with an engraving "S19 "on one side.

    Cross-sectional view: rough mass of white or almost white color with a film shell of white or almost white color.

    Tablets 500 mg:

    The capsule-shaped tablet, coated with a film sheath of white or almost white, with an engraving "S5 "on one side and risk on the other side.

    Cross-sectional view: rough mass of white or almost white color with a film shell of white or almost white color.

    Pharmacotherapeutic group:Antibiotic-azalide
    ATX: & nbsp

    J.01.F.A.10   Azithromycin

    Pharmacodynamics:

    Azithromycin is a bacteriostatic broad-spectrum antibiotic from the group of macrolides-azalides. It has a wide spectrum of antimicrobial action. The mechanism of action of azithromycin is associated with the suppression of protein synthesis of a microbial cell. By binding to the 50S subunit of the ribosome, it inhibits the peptidranslokase at the translation stage and suppresses protein synthesis, slowing the growth and multiplication of bacteria. In high concentrations has a bactericidal effect.

    It has activity against a number of gram-positive, gram-negative, anaerobic, intracellular and other microorganisms.

    Microorganisms may initially be resistant to the action of the antibiotic or may acquire resistance to it.

    The sensitivity scale of microorganisms to azithromycin (Minimum inhibitory concentration /MIC /, mg / l)

    Microorganisms

    MIC, mg / l

    Sensitive

    Sustainable

    Staphylococcus

    1

    >2

    Streptococcus A, B, C, G

    ≤0,25

    >0,5

    Streptococcus pneumoniae

    ≤0,25

    >0,5

    Haemophilus influenzae

    ≤0,12

    >4

    Moraxella catarrhalis

    ≤0,5

    >0,5

    Neisseria gonorrhoeae

    ≤0,25

    >0,5

    In most cases, sensitive microorganisms

    1. Gram-positive aerobes

    Staphylococcus aureus methicillin-sensitive

    Streptococcus pneumoniae penicillin-sensitive

    Streptococcus pyogenes

    2. Gram-negative aerobes

    Haemophilus influenzae

    Haemophilus parainfluenzae

    Legionella pneumophila

    Moraxella catarrhalis

    Pasteurella multocida

    Neisseria gonorrhoeae

    3. Anaerobes

    Clostridium perfringens

    Fusobacterium spp.

    Prevotella spp.

    Porphyromonas spp.

    4. Other microorganisms

    Chlamydia trachomatis

    Chlamydophila pneumonia

    Chlamydophila psittaci

    Mycoplasma pneumoniae

    Mycoplasma hominis

    Borrelia burgdorferi

    Microorganisms, able to develop resistance to azithromycin

    1. Gram-positive aerobes

    Streptococcus pneumoniae penicillin-resistant

    Initially, resistant microorganisms

    1. Gram-positive aerobes

    Enterococcus faecalis

    Staphylococcus (methicillin-resistant staphylococci with very high frequency have acquired resistance to macrolides)

    Gram-positive bacteria resistant to erythromycin

    2. Anaerobes

    Bacteroides fragilis

    Pharmacokinetics:

    After oral administration azithromycin well absorbed and quickly distributed in the body. After a single dose of 500 mg: bioavailability - 37% (the effect of "primary transmission"), the maximum concentration (CmOh) (0.4 mg / l) in blood plasma is achieved after 2-3 hours, the apparent volume of distribution is 31.1 l / kg, binding to plasma proteins is inversely proportional to serum concentration and is 7-50%. Penetrates through cell membranes (effective for infections caused by intracellular pathogens). It is transported by phagocytes to the site of infection, where it is released in the presence of bacteria. Easily passes through the histohematological barriers and enters the tissues. Concentration in tissues and cells is 10-50 times higher than in plasma, and in the focus of infection - 24-34% more than in healthy tissues.

    In azithromycin, a very long half-life is 35-50 hours. The half-life of the tissues is much longer. The therapeutic concentration of azithromycin is maintained up to 5-7 days after the last dose. Azithromycin is deduced, basically in the not changed kind - 50% through an intestine, 6% - kidneys. In the liver, demethylated, losing activity.

    Indications:

    Infectious-inflammatory diseases caused by microorganisms sensitive to the preparation:

    - infections of the upper respiratory tract and ENT organs (pharyngitis / tonsillitis, sinusitis, otitis media);

    - infections of the lower respiratory tract: acute bronchitis, exacerbation of chronic bronchitis, pneumonia, incl. caused by atypical pathogens;

    - infections of the skin and soft tissues (acne vulgaris of moderate severity, erysipelas, impetigo, secondarily infected dermatoses);

    - the initial stage of Lyme disease (borreliosis) - migrating erythema (erythema migrans);

    - urinary tract infections caused by Chlamydia trachomatis (urethritis, cervicitis).

    Contraindications:

    Hypersensitivity to azithromycin, erythromycin, other macrolides or ketolides, or other components of the drug, severe liver failure (class C according to Child-Pugh classification), impaired renal function of severe degree (creatinine clearance [CC] less than 40 ml / min), Children under 12 years of age with a body weight of less than 45 kg (for this dosage form and dosage), simultaneous reception with ergotamine and dihydroergotamine.

    Carefully:

    Myasthenia gravis, mild and moderate liver function disorder (Child-Pugh class A and B), mild and moderate renal dysfunction (KC more than 40 mL / min), in patients with pro-arrhythmic factors (especially in elderly patients age): with congenital or acquired lengthening of the interval QT, in patients receiving antiarrhythmic drug therapy classes IA (quinidine, procainamide), III (dofetilide, amiodarone and sotalol), cisapride, terfenadine, antipsychotic drugs (pimozide), antidepressants (citalopram), fluoroquinolones (moxifloxacin and levofloxacin), with disturbances of water-electrolyte balance, especially in case of hypokalemia or hypomagnesemia, with clinically significant bradycardia, cardiac arrhythmia or severe heart failure, simultaneous use of digoxin, warfarin, cyclosporine.

    Pregnancy and lactation:

    In pregnancy and during breastfeeding apply only if the intended benefit to the mother exceeds the potential risk to the fetus and the baby.

    If you need to use the drug Azibiot® during breastfeeding it is recommended to cancel breastfeeding.

    The World Health Organization (WHO) recommends azithromycin as a drug of choice in the treatment of chlamydial infection in pregnant women.

    Dosing and Administration:

    Inside, not liquid, at least 1 hour before or 2 hours after eating, once a day.

    Adults and children over 12 years of age with a body weight of more than 45 kg

    With infections of the upper and lower respiratory tract, ENT organs, skin and soft tissues: 1 tablet (500 mg) or 2 tablets (250 mg) once a day for 3 days (course dose of 1.5 g).

    With acne vulgaris of moderate severity: 1 tablet (500 mg) or 2 tablets (250 mg) once a day for 3 days, then 1 tablet (500 mg) or 2 tablets (250 mg) once a week for 9 weeks ( course dose 6.0 g).

    The first weekly tablet of 500 mg (or 2 tablets of 250 mg) should be taken 7 days after taking the first daily tablet of 500 mg (or 2 tablets of 250 mg) (day 8 from the start of treatment), subsequent 8 weekly 500 mg tablets (or 2 tablets of 250 mg) - with an interval of 7 days.

    With Lyme disease (the initial stage of borreliosis) - migratory erythema (erythema misrans): 1 time per day for 5 days: 1st day - 1.0 g (2 tablets of 500 mg or 4 tablets of 250 mg), then from 2 to 5 days - 1 tablet (500 mg) or 2 tablets (250 mg) (course dose 3.0 g).

    In cases of urinary tract infections caused by Chlamydia trachomatis (urethritis, cervicitis): uncomplicated urethritis / cervicitis - 1.0 g (2 tablets of 500 mg or 4 tablets of 250 mg) once.

    In case of impaired renal function: when used in patients with impaired renal function of mild and moderate severity (QC more than 40 ml / min), dose adjustment is not required.

    When a violation of liver function: when used in patients with impaired liver function of mild and moderate severity, dose adjustment is not required.

    Elderly patients: correction of the dose is not required. Because elderly patients may already have current pro-rhythmogenic conditions, caution should be exercised when using Azibiot® because of the high risk of developing cardiac arrhythmias, including pirouette-type arrhythmias.

    Side effects:

    The incidence of adverse events is classified according to WHO recommendations: very often - not less than 10%; often - not less than 1%, but less than 10%; infrequently - not less than 0,1%, but less than 1%; rarely - not less than 0.01%, but less than 0.1%; very rarely - less than 0.01%; The unknown frequency can not be estimated from the available data.

    Infectious diseases:

    infrequently: candidiasis, including mucous membranes of the mouth and genitals, pneumonia, pharyngitis, gastroenteritis, respiratory diseases, rhinitis;

    unknown frequency: pseudomembranous colitis.

    On the part of the blood and lymphatic system:

    infrequently: leukopenia, neutropenia, eosinophilia;

    very rarely: thrombocytopenia, hemolytic anemia.

    From the side of metabolism and nutrition:

    infrequently: anorexia.

    Allergic reactions:

    infrequently: angioedema, hypersensitivity reaction;

    unknown frequency: anaphylactic reaction.

    From the nervous system:

    often: headache;

    infrequently: dizziness, dyspnoea, paresthesia, drowsiness, insomnia, nervousness;

    rarely: agitation;

    unknown frequency: hypesthesia, anxiety, aggression, fainting, convulsions, psychomotor hyperactivity, loss of smell, perversion of smell, loss of taste sensations, myasthenia gravis, delirium, hallucinations.

    From the side of the organ of vision:

    often: impaired vision.

    From the side of the hearing organ and labyrinthine disorders:

    infrequently: hearing disorder, vertigo;

    unknown frequency: hearing impairment, including deafness and / or tinnitus.

    From the side of the cardiovascular system:

    infrequent: a feeling of palpitations, "tides" of blood to the skin of the face;

    unknown frequency: lowering blood pressure, lengthening the interval QT on the electrocardiogram, arrhythmia of the type "pirouette", ventricular tachycardia.

    From the respiratory system:

    infrequently: shortness of breath, nosebleed.

    From the digestive system:

    very often: diarrhea;

    often: nausea, vomiting, abdominal pain;

    infrequent: flatulence, dyspepsia, constipation, gastritis, dysphagia, bloating, dryness of the oral mucosa, belching, ulcers of the oral mucosa, increased secretion of the salivary glands;

    very rarely: discoloration of the tongue, pancreatitis.

    From the liver and biliary tract:

    infrequently: hepatitis;

    rarely: a violation of the liver, cholestatic jaundice;

    unknown frequency: hepatic insufficiency (in rare cases with a fatal outcome, mainly on the background of a severe liver function disorder), liver necrosis, fulminant hepatitis.

    From the skin and subcutaneous tissues:

    infrequently: skin rash, itchy skin, hives, dermatitis, dry skin, increased sweating;

    rarely: the reaction of photosensitization;

    unknown frequency: Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme.

    From the side of the musculoskeletal system:

    infrequently: osteoarthritis, myalgia, back pain, neck pain;

    unknown frequency: arthralgia.

    From the side of the kidneys and urinary tract:

    infrequently: dysuria, pain in the kidney area;

    unknown frequency: interstitial nephritis,acute renal failure.

    From the genitals and breast:

    infrequently: metrorrhagia, dysfunction of testicles.

    Other:

    infrequently: asthenia, malaise, fatigue, face swelling, chest pain, fever, peripheral edema.

    Laboratory data:

    often: a decrease in the number of lymphocytes, an increase in the number of eosinophils, an increase in the number of basophils, an increase in the number of monocytes, an increase in the number of neutrophils, a decrease in the concentration of bicarbonates in the blood plasma;

    infrequently: increased activity of aspartate aminotransferase, alanine aminotransferase, increased bilirubin concentration in blood plasma, increased urea concentration in blood plasma, increased plasma creatinine concentration, changes in potassium content in blood plasma, increased activity of alkaline phosphatase in blood plasma, increased levels of chlorine in blood plasma , increased blood glucose, increased platelet count, increased hematocrit, increased bicarbonate concentration in blood plasma, a change in the content sodium in the blood plasma.

    Overdose:

    Symptoms: temporary loss of hearing, nausea, vomiting, diarrhea.

    Treatment: symptomatic.

    Interaction:

    Antacid preparations

    Antacid preparations do not affect the bioavailability of azithromycin, but reduce CmOh in blood plasma by 30%, so the drug Azibiot® should be taken at least 1 hour before or 2 hours after taking antacids and food.

    Cetirizine

    Simultaneous use of azithromycin with cetirizine (20 mg) for 5 days in healthy volunteers did not lead to a pharmacokinetic interaction and a significant change in the interval QT.

    Didanosine (dideoxyinosine)

    The simultaneous use of azithromycin (1200 mg / day) and didanosine (400 mg / day) in 6 HIV-infected patients showed no change in the pharmacokinetic indices of didanosine compared with the placebo group.

    Digoxin (substrates of P-glycoprotein)

    Simultaneous use of macrolide antibiotics, including azithromycin, with P-glycoprotein substrates, such as digoxin, leads to an increase in the concentration of substrate P-glycoprotein in the blood serum. Thus, with the simultaneous use of azithromycin and digoxin, it is necessary to take into account the possibility of increasing the concentration of digoxin in the blood serum.

    Zidovudine

    The simultaneous use of azithromycin (a single dose of 1000 mg and repeated administration of 1200 mg or 600 mg) has little effect on the pharmacokinetics, including the excretion of zidovudine or its glucuronide metabolite by the kidneys. However, the use of azithromycin caused an increase in the concentration of phosphorylated zidovudine, a clinically active metabolite in peripheral blood mononuclear cells. The clinical significance of this fact is unclear.

    Azithromycin weakly interacts with isoenzymes of the cytochrome P450 system. It was not revealed that azithromycin participates in pharmacokinetic interactions similar to erythromycin and other macrolides. Azithromycin It is not an inhibitor and inducer of cytochrome P450 isoenzymes.

    Alkaloids of ergot

    Given the theoretical possibility of the emergence of ergotism, the simultaneous use of azithromycin with derivatives of ergot alkaloids is not recommended.

    Pharmacokinetic studies of the simultaneous use of azithromycin and drugs whose metabolism occurs with the participation of cytochrome P450 isoenzymes have been carried out.

    Atorvastatin

    Simultaneous use of atorvastatin (10 mg daily) and azithromycin (500 mg daily) did not cause a change in the concentrations of atorvastatin in blood plasma (based on the inhibition of HMG-CoA reductase). However, in the post-marketing period, separate reports were received on cases of rhabdomyolysis in patients receiving concomitantly azithromycin and statins.

    Carbamazepine

    In pharmacokinetic studies involving healthy volunteers, there was no significant effect on the concentration of carbamazepine and its active metabolite in blood plasma in patients receiving concomitantly azithromycin.

    Cimetidine

    In pharmacokinetic studies of the effect of a single dose of cimetidine on the pharmacokinetics of azithromycin, no changes in the pharmacokinetics of azithromycin were observed, provided cimetidine was administered 2 hours before the administration of azithromycin.

    Anticoagulants of indirect action (coumarin derivatives)

    In pharmacokinetic studies azithromycin did not affect the anticoagulant effect of a single dose of 15 mg of warfarin taken by healthy volunteers. Potential anticoagulant effect was reported after simultaneous use of azithromycin and indirect anticoagulants (coumarin derivatives).Although a causal relationship has not been established, the need for frequent prothrombin time monitoring with azithromycin in patients who receive indirect anticoagulants for ingestion (coumarin derivatives) should be considered.

    Cyclosporin

    In a pharmacokinetic study involving healthy volunteers who within 3 days were ingested azithromycin (500 mg / day once), and then ciclosporin (10 mg / kg / day once), there was a significant increase in CmOh and the area under the "concentration-time" curve from 0 to 5 hours (AUC0-5) of cyclosporine in blood plasma. Care should be taken when using these drugs at the same time. In case of simultaneous use of these drugs, it is necessary to monitor the concentration of cyclosporine in the blood plasma and, accordingly, adjust the dose.

    Efavirenz

    Simultaneous use of azithromycin (600 mg / day once) and efavirenz (400 mg / day) daily for 7 days did not cause any clinically significant pharmacokinetic interaction.

    Fluconazole

    Simultaneous use of azithromycin (1200 mg once) did not change the pharmacokinetics of fluconazole (800 mg once). The total exposure and the half-life of azithromycin did not change with the simultaneous use of fluconazole, but a decrease in CmOh azithromycin (by 18%) in blood plasma, which had no clinical significance.

    Indinavir

    Simultaneous use of azithromycin (1200 mg once) did not cause a statistically significant effect on the pharmacokinetics of indinavir (800 mg 3 times daily for 5 days).

    Methylprednisolone

    Azithromycin does not significantly affect the pharmacokinetics of methylprednisolone.

    Nelfinavir

    Simultaneous use of azithromycin (1200 mg) and nelfinavir (750 mg 3 times a day) causes an increase in the equilibrium concentration of azithromycin in the blood serum. Clinically significant side effects were not observed and correction of the dose of azithromycin with its simultaneous application with nelfinavir is not required.

    Rifabutin

    Simultaneous use of azithromycin and rifabutin does not affect the concentration of each of the drugs in the blood serum. With the simultaneous use of azithromycin and rifabutin, neutropenia was sometimes observed.

    Despite the fact that neutropenia was associated with the use of rifabutin, a causal relationship between the use of a combination of azithromycin and rifabutin and neutropenia has not been established.

    Sildenafil

    When used in healthy volunteers, evidence of the effect of azithromycin (500 mg / day daily for 3 days) on AUC and CmOh sildenafil or its main circulating metabolite in blood plasma.

    Terfenadine

    In pharmacokinetic studies, no evidence was found for the interaction between azithromycin and terfenadine. Individual cases were reported where the possibility of such interaction could not be ruled out completely, but there was not one concrete proof that such an interaction took place.

    It was found that the simultaneous use of terfenadine and macrolides can cause arrhythmia and lengthening of the interval QT.

    Theophylline

    There was no interaction between azithromycin and theophylline.

    Triazolam / midazolam

    Significant changes in pharmacokinetic parameters with the simultaneous use of azithromycin with triazolam or midazolam in therapeutic doses are not revealed.

    Trimethoprim / sulfamethoxazole

    Simultaneous use of trimethoprim / sulfamethoxazole with azithromycin did not reveal a significant effect on CmOh in blood plasma, total exposure or excretion by the kidneys of trimethoprim or sulfamethoxazole. The concentrations of azithromycin in the serum corresponded to the detectable concentrations in other studies.

    Special instructions:

    If you miss a dose of Azibiot®, the missed dose should be taken as soon as possible, and the subsequent dose should be taken with interruptions of 24 hours.

    Azibiot ® should be taken at least 1 hour before or 2 hours after taking antacid preparations.

    Azibiot ® should be used with caution in patients with mild to moderate liver function disorder due to the possibility of developing fulminant hepatitis and severe hepatic insufficiency.

    In the presence of symptoms of impaired liver function, such as rapidly accruing asthenia, jaundice, darkening of the urine, a tendency to bleeding, hepatic encephalopathy with Azibiot® it is necessary to stop and conduct a study of the functional state of the liver.

    If the kidneys of mild and moderate severity (KK more than 40 ml / min), therapy with Azibiot ® should be performed with caution under the control of the state of kidney function.

    As with other antibacterial drugs, with Azibiot® should regularly monitor patients for the presence of non-susceptible microorganisms and signs of development of superinfections, including fungal.

    Azibiot ® should not be used with longer courses than indicated in the instructions, since the pharmacological properties of azithromycin allow us to recommend a short and simple dosing regimen.

    There is no data on the possible interaction between azithromycin and ergotamine derivatives, but due to the development of ergotism with the simultaneous use of macrolides with derivatives of ergotamine and dihydroergotamine, this combination is not recommended.

    With prolonged use of Azibiot ®, the development of pseudomembranous colitis caused by Clostridium difficile, both in the form of mild diarrhea, and severe colitis. With the development of antibiotic-associated diarrhea against the background of taking Azibiot®, as well as 2 months after the end of therapy, clostridial pseudomembranous colitis should be excluded.

    When treating macrolides, including azithromycin, prolonged cardiac repolarization and interval QT, increasing the risk of developing cardiac arrhythmias, including arrhythmias such as "pirouette."

    Caution should be exercised when using Azibiot ® in patients with proarrhythmogenic factors (especially in elderly patients), including congenital and acquired lengthening of the interval QT, in patients taking antiarrhythmic drugs classes IA (quinidine, procainamide), III (dofetilide, amiodarone and sotalol), cisapride, terfenadine, antipsychotics (pimozide), antidepressants (citalopram), fluoroquinolones (moxifloxacin and levofloxacin), in patients with disturbed water-electrolyte balance, especially in the case of hypokalemia or hypomagnesemia, clinically significant bradycardia, cardiac arrhythmia or severe heart failure.

    The use of Azibiot ® can provoke the development of myasthenic syndrome or cause an exacerbation of myasthenia gravis.

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

    With the development of undesirable effects from the nervous system and the organ of vision, care must be taken when performingActions requiring an increased concentration of attention and speed of psychomotor reactions.

    Form release / dosage:

    Film coated tablets, 250 mg and 500 mg.

    Packaging:

    250 mg tablets:

    For 6 tablets in a blister of the combined material PVC / PVDH-foil aluminum. For 1 blister is placed in a pack of cardboard along with instructions for use.

    Tablets 500 mg:

    For 3 tablets in a blister of the combined material PVC / PVDH-foil aluminum. For 1 blister is placed in a pack of cardboard along with instructions for use.

    Storage conditions:

    At a temperature of no higher than 25 ° C, in the original packaging.

    Keep out of the reach of children.

    Shelf life:

    250 mg tablets: 4 of the year.

    Tablets 500 mg: 5 years.

    Do not use the drug after the expiration date.

    Terms of leave from pharmacies:On prescription
    Registration number:LP-003498
    Date of registration:14.03.2016
    Expiration Date:14.03.2021
    The owner of the registration certificate:KRKA, dd, Novo mesto, AOKRKA, dd, Novo mesto, AO
    Manufacturer: & nbsp
    KRKA, d.d. Slovenia
    Representation: & nbspKRKA, dd, Novo mesto, AOKRKA, dd, Novo mesto, AO
    Information update date: & nbsp04.02.2017
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