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

    1 tablet, film-coated, contains

    Active substance:

    Azithromycin dihydrate (equivalent to anhydrous azithromycin) - 524 mg (500 mg).

    Excipients: Starch pregelatinized 63 mg, giproloza 63 mg, 36 mg copovidone, crospovidone 31.5 mg Calcium hydrogen phosphate anhydrous 142 mg Talc 22.5 mg Sodium lauryl sulfate 7.2 mg magnesium stearate 10.8 mg.

    Sheath: hypromellose 13.6 mg, macrogol 6000 2.7, talc 15 mg, titanium dioxide 3.6 mg, dimethicone 0.1 mg.

    Description:

    Oval biconvex tablets covered with a film shell, white, with a transverse notch on one side, dividing the tablet into two equal halves. A white core and a thin white film coating are visible on the cross-section of the tablet.

    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. Communicating with 50S-subunit ribosome, inhibits peptidranslokase at the stage of translation 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, anaerobes, intracellular and other microorganisms.

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

    In most cases, sensitive microorganisms

    - Gram-positive aerobes

    Staphylococcus aureus - Methicillin-sensitive, Streptococcus pneumoniae - penicillin-sensitive, Streptococcus pyogenes

    - Gram-negative aerobes

    Haemophilus influenzae, Haemophilus parainfluenzae, Legionella pneumophila, Moraxella catarrhalis, Pasteurella multocida, Neisseria gonorrhoeae

    - Anaerobes

    Clostridium perfringens, Fusobacterium spp., Prevotella spp., Porphyriomonas spp.

    - Other microorganisms

    Chlamydia trachomatis, Chlamydia pneumoniae, Chlamydia psittaci, Mycoplasma pneumoniae, Mycoplasma hominis, Borrelia burgdorferiMicroorganisms capable of developing resistance to azithromycin
    Gram-positive aerobes
    Streptococcus pneumoniae penicillin-resistant
    Initially, resistant microorganisms

    - Gram-positive aerobes

    Enterococcus
    faecalis, Staphylococci (methicillin-resistant staphylococci exhibit a very high degree of resistance to macrolides)
    Gram-positive bacteria resistant to erythromycin.

    Anaerobes

    Bacteroides
    fragilis
    Pharmacokinetics:

    After oral administration azithromycin well absorbed and quickly distributed in the body. After a single dose of 500 mg bioavailability is 37% (the effect of "first pass"), the maximum concentration (0.4 mg / ml) in the blood is created after 2-3 hours, the apparent volume of distribution is 31.1 l / kg, protein binding back is proportional to the concentration in the blood 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 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 unchanged form - 50% of the intestine, 6% - by the kidneys. In the liver, demethylated, losing activity.

    Indications:

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

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

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

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

    - 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, ketolides or other components of the drug.

    - Violation of liver function of a serious degree (more than 9 points on the Child-Pugh scale).

    - Severe renal impairment (creatinine clearance less than 40 mL / min).

    - Children under 12 years old weighing less than 45 kg.

    - Breastfeeding period.

    - Simultaneous reception with ergotamine and dihydroergotamine.

    Carefully:

    Myasthenia gravis; violation of liver function of mild and moderate severity (less than 9 on the Child-Pugh scale); disturbance of renal function of mild and moderate severity (creatinine clearance more than 40 ml / min); at arrhythmias, in patients with proarrhythmogenic factors (especially in elderly patients): 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; in elderly patients; with neurological or mental illness; during pregnancy.

    Pregnancy and lactation:

    In pregnancy, the drug is prescribed only if the expected benefit for the mother exceeds the potential risk to the fetus.

    If you need to use the drug during lactation, you should decide whether to stop breastfeeding for the duration of the drug.

    Dosing and Administration:

    Inside, 1 time per day, at least 1 hour or 2 hours after meals. Adults (including the elderly) and children over 12 years of age with a body weight of over 45 kg.

    When infections of the upper, lower respiratory tract, ENT organs, skin and soft tissues - 0.5 g / day for 1 reception for 3 days (course dose - 1.5 g).

    With migrating erythema (Lyme disease) for treatment of stage I - once a day for 5 days: 1st day - 1.0 g, then from day 2 to day 5 - 0.5 g daily (course dose - 3 g). Acne vulgaris - 6 grams a course dose, 0.5 g / day for 1 reception for 3 days, then 0.5 g / day 1 time per week for 9 weeks. The first weekly tablet should be taken 7 days after takingof the daily tablet (8 days from the start of treatment), the subsequent 8 weekly tablets - with an interval of 7 days.

    For infections of the urogenital tract caused by Chlamydia trachomatis (uncomplicated urethritis or cervicitis) - once 1 g.

    Assignment to patients with impaired renal function: for patients with impaired renal function of mild and moderate severity (creatinine clearance> 40 ml / min) dose adjustment is not required. Assignment to patients with impaired liver function: for patients with impaired liver function of mild and moderate severity, dose adjustment is not required. When appointing patients older (over 65 years), dose adjustment is not required. It should be taken into account that among elderly patients there may be people with the presence of arrhythmogenic factors (see the section "With caution").

    Side effects:

    The incidence of side effects listed below was determined according to the following (classification of the World Health Organization): very often (more than 10%), often (more than 1% and less than 10%), infrequently (more than 0.1% and less than 1%), rarely (more than 0.01% and less than 0.1%), very rarely (less than 0.01%), including individual messages, the frequency is unknown (can not be estimated using available data).

    From the blood and lymphatic systems: often - eosinophilia, lymphocytopenia; infrequently - leukopenia, neutropenia; rarely - thrombocytopenia, hemolytic anemia.

    From the nervous system: often - headache, dizziness, paresthesia; infrequently - hypoesthesia, drowsiness, insomnia; very rarely - fainting, convulsions, psychomotor hyperactivity, myasthenia gravis.

    Disorders of the psyche: infrequently - nervousness; rarely - agitation; frequency is unknown - aggressiveness, anxiety, delirium, hallucinations.

    From the sense organs: often - impaired vision, raceshearing, reversible hearing loss, including deafness (when taking high doses for a long time), vertigo, a violation of taste sensations; infrequently, noise in the ears; very rarely - loss of smell (or anosmia), perversion of smell, loss of taste sensations.

    From the cardiovascular system: infrequently - a feeling of palpitations, "tides" of blood to the face; very rarely - lowering blood pressure, arrhythmia such as "pirouette", ventricular tachycardia, lengthening interval QT.

    From the gastrointestinal tract: very often - nausea, flatulence, diarrhea; often - vomiting, abdominal pain / spasms, dyspepsia, gastroenteritis; infrequent - constipation, gastritis, dysphagia, dryness of the oral mucosa, belching, ulcers of the oral mucosa, increased secretion of the salivary glands; very rarely - a discoloration of the tongue, pancreatitis.

    From the side of metabolism and nutrition: often - anorexia.

    From the liver and bile ducts: infrequently - hepatitis; rarely - a violation of the liver, cholestatic jaundice; frequency unknown - hepatic insufficiency (in rare cases with a fatal outcome, mainly on the background of a violation of liver function), fulminant hepatitis, liver necrosis.

    From the side of the kidneys and urinary tract: infrequently - an increase in the concentration of urea and creatinine in the blood plasma, dysuria, pain in the kidneys; very rarely - interstitial nephritis, acute renal failure.

    From the genitals and the breast: infrequently - metrorrhagia, dysfunction of testicles.

    From the immune system: infrequently - hypersensitivity reactions, angioedema; rarely - anaphylactic reactions (in rare cases, fatal).

    From the skin and subcutaneous tissues: often - itching, skin rash; infrequently - Stevens-Johnson syndrome, photosensitivity, urticaria, dry skin, sweating, dermatitis; rarely - erythema multiforme, toxic epidermal necrolysis.

    From the osteomuscular system and connective tissue: often - arthralgia; infrequently - osteoarthritis, myalgia, back pain, neck pain.

    Infectious diseases: infrequently - candidiasis, including oral and genital mucosa, vaginal infections, fungal infections, bacterial infections; frequency unknown - pseudomembranous colitis.

    From the respiratory system, chest and mediastinum: infrequently - pneumonia, pharyngitis, respiratory diseases, rhinitis, nosebleeds, dyspnea.

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

    Laboratory and instrumental data: often - an increase in the number of basophils, monocytes, neutrophils, a decrease or increase in the concentration of bicarbonates in the blood plasma; infrequent increase in the activity of "liver" transaminases, an increase in the concentration of bilirubin in the blood plasma, an increase in the activity of alkaline phosphatase, an increase in the level of chlorine in the blood plasma, an increase in the concentration of glucose in the blood plasma, an increase in the number of platelets, an increase in hematocrit, a change in the concentration of potassium and sodium in the blood plasma .

    Overdose:

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

    Treatment: reception of activated carbon, gastric lavage, symptomatic therapy.
    Interaction:

    Antacids (aluminum and magnesium-containing) do not affect the bioavailability of azithromycin, but reduce the maximum concentration of azithromycin in the blood plasma by 30%, so the drug should be taken at least one hour before or two hours after taking these drugs and food. Simultaneous use of atorvastatin and azithromycin did not cause a change in the concentration of atorvastatin in the blood plasma. However, separate reports of cases of rhabdomyolysis in patients receiving both azithromycin and statins were obtained.

    With the simultaneous use of azithromycin and cyclosporine, a significant increase in the maximum plasma concentration and area under the "concentration-time" curve of cyclosporine was detected. In case of necessity of simultaneous application of these preparations, it is necessary to control the concentration of cyclosporine in the blood plasma and, accordingly, to adjust its dose.

    With the joint administration of digoxin and azithromycin, it is necessary to control the level of digoxin in the blood, since many macrolides increase the absorption of digoxin in the intestine,thereby increasing its concentration in the blood plasma.

    If necessary, a joint intake of azithromycin with an anticoagulant means of indirect action (such as warfarin and other anticoagulants of the coumarin type), it is possible to increase the anticoagulant effect, it is recommended to conduct careful monitoring of prothrombin time.

    Simultaneous use of azithromycin and rifabutin does not affect the concentration of each drug in the blood plasma. 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.

    Care must be taken when using terfenadine and azithromycin concomitantly, since it has been established that simultaneous administration of terfenadine and antibiotics of the macrolide class causes arrhythmia and prolongation of the QT interval. Proceeding from this, it is impossible to exclude the aforementioned complications in the joint administration of terfenadine and azithromycin. With the simultaneous use of azithromycin with zidovudine, azithromycin has little effect on the pharmacokinetics, including the excretion of zidovudine and its glucuronide metabolite by the kidneys. The concentration of the active metabolite - phosphorylated zidovudine in multinucleated cells of peripheral vessels also increases. The clinical significance of this fact is not clear.

    With the simultaneous administration of macrolides with ergotamine and dihydroergotamine, their toxic effect (vasospasm, dysesthesia) is possible. There is no data on the possible interaction between azithromycin and derivatives of ergotamine and dihydroergotamine, but because of the development of ergotism with the simultaneous use of macrolides with derivatives of ergotamine and dihydroergotamine, these combinations are contraindicated.

    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 plasma. Clinically significant side effects were not observed and correction of the dose of azithromycin with its simultaneous application with nelfinavir is not required.

    Azithromycin weakly interacts with cytochrome P450 isoenzymes, it was not revealed that azithromycin participates in pharmacokinetic interactions similar to erythromycin and other macrolides, azithromycin It is not an inducer and inhibitor of cytochrome P450 isoenzymes. Azithromycin does not affect the concentration of carbamazepine, didanosine, rifabutin and methylprednisolone in the blood in a joint use.

    Azithromycin does not affect the pharmacokinetics of theophylline, but when combined with other macrolides, the concentration of theophylline in the blood plasma may increase. Simultaneous use of azithromycin with cetirizine (20 mg) for 5 days in healthy volunteers did not lead to pharmacokinetic interaction and a significant change in the interval QT.

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

    Simultaneous use of azithromycin (1200 mg once) did not change the pharmacokinetics of fluconazole (800 mg once). The total exposure and half-life did not change with the simultaneous use of fluconazole, however, a decrease in the maximum concentration of azithromycin by 18% was noted, which was not clinically significant.

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

    When used in healthy volunteers, there was no evidence of the effect of azithromycin (500 mg / day daily for 3 days) on the maximum concentration in the blood plasma and the area under the concentration-time curve of sildenafil and its main metabolite. Significant changes in pharmacokinetic parameters with the simultaneous use of azithromycin with triazolam or midazolam in therapeutic doses are not revealed. Simultaneous use of trimethoprim / sulfamethoxazole with azithromycin did not reveal a significant effect on the maximum concentration, total exposure or excretion of trimethoprim or sulfamethoxazole by the kidneys.The concentration of azithromycin in the blood plasma was consistent with that found in other studies.

    Special instructions:

    If you miss one dose of the drug - the missed dose should be taken as soon as possible, and the subsequent dose - with an interval of 24 hours. Azithromycin should be taken at least one hour before or two hours after taking antacid preparations.

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

    In the presence of symptoms of impaired liver function, such as rapidly increasing asthenia, jaundice, darkening of the urine, a tendency to bleeding, hepatic encephalopathy, azithromycin therapy should be discontinued and an examination of the functional state of the liver should be carried out. For violations of kidney function of mild and moderate severity (creatinine clearance more than 40 ml / min), therapy azithromycin should be performed with caution under the control of the state of kidney function.

    The development of resistance of microorganisms is possible if the recommended duration of therapy is not observed.

    As with the use of other antibacterial drugs, with drug therapy azithromycin should regularly monitor patients for the presence of non-susceptible microorganisms and signs of development of superinfections, including fungal. A drug azithromycin do not use longer courses than indicated in the instructions, since the pharmacokinetic properties of azithromycin allow us to recommend a short and simple dosing regimen.

    Azithromycin is not a drug of choice for the prevention of mincemeat / tonsillitis caused by Streptococcus pyogenes, as well as for the prevention of acute rheumatic fever.

    With prolonged use of azithromycin, the development of pseudomembranous colitis caused by Clostridium difficile, as in the form of mild diarrhea, and severe colitis. With the development of diarrhea against the background of taking azithromycin, and also 2 months after the end of therapy, clostridial pseudomembranous colitis should be excluded. In mild cases, it is sufficient to cancel the treatment and apply ion-exchange resins (colestramine, colestipol), in severe cases, compensation for loss of fluid, electrolytes and protein, the appointment of vancomycin,bacitracin or metronidazole. When suspected of pseudomembranous colitis, drugs that inhibit intestinal motility, contraindicateds. Since it is possible to extend the interval QT in patients receiving macrolides, including azithromycin, when using azithromycin, caution should be exercised in patients with known risk factors for lengthening the interval QT: heart disease (heart failure, myocardial infarction, bradycardia), elderly age, electrolyte imbalance (hypokalemia, hypomagnesemia), congenital QT interval prolongation syndrome, simultaneous administration of drugs capable of prolonging the QT interval (including antiarrhythmics IA and III classes, tricyclic and tetracyclic antidepressants, neuroleptics, fluoroquinolones). The use of azithromycin may provoke the development of a myasthenic syndrome or cause an exacerbation of myasthenia gravis.

    Effect on the ability to drive transp. cf. and fur:During the treatment period it is necessary to refrain from driving motor vehicles and practicing potentially dangerous activities that require an increased concentration of attention and speed of psychomotor reactions.
    Form release / dosage:

    Tablets, film-coated, 500 mg.

    Packaging:

    For 3 tablets in a blister of PVC / PVDC film and foil of aluminum printed lacquered, one blister is placed in a cardboard box together with instructions for use.

    Storage conditions:In the dark place at a temperature of no higher than 25 ° C. Keep out of the reach of children!
    Shelf life:

    2 years. Do not use after expiry date.

    Terms of leave from pharmacies:On prescription
    Registration number:LSR-002099/10
    Date of registration:16.03.2010
    The owner of the registration certificate:REPLEK FARM Skopje, OOOREPLEK FARM Skopje, OOO Macedonia
    Manufacturer: & nbsp
    Information update date: & nbsp26.10.2015
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