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

    For 1 tablet of 125 mg

    Active substance: azithromycin dihydrate - 133.00 mg, in terms of azithromycin - 125,0 mg.

    Excipients (core): cellulose microcrystalline - 149.70 mg, pregelatinized starch - 36.70 mg, croscarmellose sodium - 7.30 mg, magnesium stearate - 3.30 mg.

    Auxiliary substances (shell): Opapray II 85F48105 White - 10,00 mg, incl. polyvinyl alcohol - 4.69 mg, macrogol 3350 - 2.36 mg, talc - 1.74 mg, titanium dioxide - 1.21 mg.

    For 1 tablet of 500 mg

    Active substance: azithromycin dihydrate - 531.00 mg, in terms of azithromycin - 500.0 mg.

    Excipients (core): cellulose microcrystalline - 240.00 mg, pregelatinized starch - 100.00 mg, croscarmellose sodium - 20.00 mg, magnesium stearate - 9.00 mg.

    Auxiliary substances (shell): Opapray II 85F48105 White - 30,00 mg, incl. polyvinyl alcohol - 14.07 mg, macrogol 3350 - 7.08 mg, talc - 5.22 mg, titanium dioxide - 3.63 mg.

    Description:

    Dosage of 125 mg. Round biconvex tablets coated with a white or almost white-colored film shell, on the transverse section are visible two layers - the nucleus of white or almost white in color and shell.

    Dosage of 500 mg. Oval biconvex tablets with a risk on one side, covered with a film shell of white or almost white color, on the cross-section two layers - a core of white or almost white color and a shell.

    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 of ribosomes of bacterial cells, inhibits peptidranslokase at the stage of translation and inhibits 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.

    Sensitive:

    aerobic Gram-positive microorganisms - Staphylococcus aureus (methicillin-sensitive), Streptococcus pneumoniae (penicillin-sensitive), Streptococcus pyogenes, Streptococcus groups A, B, C, G;

    aerobic gram-negative microorganisms - Haemophilus influenzae, Haemophilus parainfluenzae, Legionella pneumophila, Moraxella catarrhalis, Pasteurella multocida, Neisseria gonorrhoeae;

    anaerobic microorganisms - Clostridium perfringens, Fusobacterium spp., Prevotella spp., Porphyromonas spp.;

    other - Chlamydia trachomatis, Chlamydia pneumoniae, Chlamydia psittaci, Mycoplasma pneumoniae, Mycoplasma hominis, Borrelia burgdorferi.

    Microorganisms, capable of developing resistance to azithromycin: gram-positive aerobes - Streptococcus pneumoniae (penicillin-resistant strains).

    Microorganisms with natural resistance: Gram-positive aerobes - Enterococcus faecalis, Staphylococcus spp. (methicillin-resistant strains); anaerobes - Bacteroides fragilis.

    Cases of cross resistance are described Streptococcus pneumoniae, Streptococcus pyogenes (beta-hemolytic group streptococcus A), Enterococcus faecalis and Staphylococcus aureus, including Staphylococcus aureus (methicillin-resistant strains) to erythromycin, azithromycin, other macrolides and lincosamides.

    Pharmacokinetics:

    After oral administration azithromycin well absorbed and quickly distributed in the body. After a single administration, 500 mg bioavailability is 37% (the effect of "primary transmission"),the maximum concentration in the blood plasma (Cmax) - 0.4 mg / l is created after 2-3 hours, the volume of distribution is 31 l / kg. Binding to plasma proteins is inversely 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, polymorphonuclear leukocytes and macrophages 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. The 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 output, basically, in the unchanged form - 50% of the intestine, 6% kidneys. In the liver, demethylated, losing activity.

    Indications:

    Infectious-inflammatory diseases caused by microorganisms susceptible to azithromycin:

    - 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, including caused by atypical pathogens);

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

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

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

    Contraindications:

    Hypersensitivity to azithromycin, other macrolides or ketolides, or other components of the drug; impaired hepatic function of a serious degree (Child-Pugh class C); impaired renal function of severe degree (CC less than 40 ml / min); Children under 12 years of age with a body weight of less than 45 kg (for tablets 500 mg); children under 3 years (for tablets 125 mg); the period of breastfeeding; simultaneous reception with ergotamine and dihydroergotamine.

    Carefully:

    Myasthenia gravis; impaired liver function of mild and moderate severity; disturbance of renal function of mild and moderate severity (QC more than 40 ml / min); arrhythmia, in the presence of proarrhythmogenic factors (especially in elderly patients), including congenital or acquired lengthening of the interval QT; in patients receiving antiarrhythmic drug therapy classes IA (quinidine, procainamide), III (dofetil, amiodarone, sotalol), cisapride, terfenadine, antipsychotic drugs (pimozide), antidepressants (citalopram), fluoroquinolones (moxifloxacin, levofloxacin), in patients with disturbed water-electrolyte balance, especially in the case of hypokalemia or hypomagnesemia, clinically significant bradycardia, severe heart failure; simultaneous use of warfarin, digoxin, cyclosporine.

    Pregnancy and lactation:

    The use of the drug during pregnancy is possible only in cases where the intended benefit to 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.

    Dosing and Administration:

    Inside, not liquid, 1 time per day, at least 1 hour before or 2 hours after meals.

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

    With infections of the upper and lower respiratory tract, ENT organs, skin and soft fabrics: 500 mg once a day for 3 days (course dose 1.5 g).

    The initial stage of Lyme disease: 1 time per day for 5 days: 1st day - 1000 mg, then from 2nd to 5th day - 500 mg (exchange dose 3.0 g).

    In cases of urinary tract infections caused by Chlamydia trachomatis (urethritis, cervicitis): uncomplicated urethritis / cervicitis - 1000 mg once.

    Acne vulgaris of medium severity: the course dose is 6 g: 500 mg once a day for 3 days, then 500 mg once a week for 9 weeks. The first weekly tablet should be taken 7 days after taking the first daily tablet (the 8th day from the start of treatment), the subsequent 8 weekly tablets - with an interval of 7 days.

    Children aged 3 to 12 years with a body weight of less than 45 kg.

    With infections of the upper and lower respiratory tract, ENT organs, skin and soft tissues: at the rate of 10 mg / kg body weight 1 time per day for 3 days (course dose 30 mg / kg). For the convenience of dosing, it is recommended to use the table number 1.

    Table №1. Dose calculation Azithromycin for children weighing less than 45 kg.

    Body mass

    The dose of azithromycin in tablets 125 mg

    18-30 kg

    2 tablets (250 mg of azithromycin)

    31-44 kg

    3 tablets (375 mg of azithromycin)

    Not less than 45 kg

    Apply doses recommended for adults

    With pharyngitis / tonsillitis caused by Streptococcus pyogenes:

    At the rate of 20 mg / kg / day for 3 days (exchange dose of 60 mg / kg). The maximum daily dose is 500 mg.

    The initial stage of Lyme disease:

    On the 1st day - at a dose of 20 mg / kg of body weight 1 time per day, then from 2 to 5 days - daily at a dose of 10 mg / kg of body weight 1 time per day (exchange dose of 60 mg / kg).

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

    If there is a violation of the liver: if the liver function is mild and moderate Dose correction is not required.

    Elderly patients: correction of the dose is not required. Since older people may have proarrhythmogenic conditions, care should be taken when applying drug, due to the high risk of developing cardiac arrhythmias, including arrhythmias such as "pirouette."

    Side effects:

    The incidence of side effects is classified according to the recommendations of the World Health Organization: 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% (including isolated cases).

    Infectious diseases: infrequently - candidiasis, including mucous membranes of the mouth and genitals, pneumonia, pharyngitis, gastroenteritis, respiratory diseases, rhinitis; very rarely - pseudomembranous colitis.

    On the part of the blood and lymphatic system: often - eosinophilia, lymphopenia, basophilia, monocytosis, increasing the number of neutrophils; infrequently - leukopenia, neutropenia; very rarely - thrombocytopenia, hemolytic anemia.

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

    Allergic reactions: often - itching, skin rash; infrequently - hypersensitivity reactions, photosensitization reaction, dermatitis, dry skin, sweating, urticaria, Stevens-Johnson syndrome, angioedema; very rarely - anaphylactic reaction, erythema multiforme, toxic epidermal necrolysis.

    From the nervous system: often - headache, dizziness, paresthesia, a violation of taste sensations; infrequently - hypoesthesia, drowsiness, insomnia, nervousness, agitation; very rarely - anxiety, aggression, fainting, convulsions, psychomotor hyperactivity, loss of smell (or anosmia) and taste sensations, perversion of smell, myasthenia gravis, delirium, hallucinations.

    From the side of the hearing organ and labyrinthine disorders: often - hearing disorder, deafness; infrequently, noise in the ears; rarely - vertigo.

    From the side of the organ of vision: often - impaired vision.

    From the side of the cardiovascular system: rarely - a feeling of palpitations, "tides" of blood to the face; very rarely - lowering blood pressure, increasing the interval QT on electrocardiogram, arrhythmia of the type "pirouette", ventricular tachycardia.

    From the respiratory system: infrequently - shortness of breath, nosebleed.

    From the gastrointestinal tract: very often - nausea, diarrhea, pain in abdomen, flatulence; often - indigestion, vomiting; infrequent - constipation, gastritis, dysphagia, bloating, 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 liver and bile ducts: infrequently - increased activity of "liver" transaminases, increased concentrations of bilirubin, hepatitis; rarely - a violation of the liver, cholestatic jaundice; very rarely - liver failure (in rare cases with a fatal outcome, mainly against a background of severe impairment of liver function); liver necrosis, fulminant hepatitis.

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

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

    From the genitals and mammary glands: infrequently - metrorrhagia, dysfunctions of testicles.

    Laboratory indicators: often - a decrease in the concentration of bicarbonates in the blood plasma; infrequently, a change in the potassium concentration in the blood plasma, an increase in the activity of alkaline phosphatase, an increase in the concentration of chlorine and glucose in the blood plasma, an increase in the number of platelets, an increase in hematocrit, an increase in the concentration of bicarbonates and a change in the concentration of sodium in the blood plasma.

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

    Overdose:

    Symptoms: temporary loss of hearing, nausea and vomiting, diarrhea. Treatment: symptomatic.

    Interaction:

    Antacid preparations do not affect the bioavailability of azithromycin, but reduce the maximum concentration of azithromycin in the blood by 30%, so azithromycin should be taken 1 hour before or 2 hours after taking antacids.

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

    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.

    Simultaneous use of macrolide antibacterial drugs, including azithromycin, with substrates of P-glycoprotein, such as digoxin, leads to an increase in the concentration of the P-glycoprotein substrate in the blood plasma. Thus, with the simultaneous use of digoxin and azithromycin, it is necessary to consider the possibility of increasing the concentration of digoxin in the blood plasma.

    Simultaneous use of azithromycin (a single dose of 1000 mg and repeated administration of 1200 mg or 600 mg) has a slight effect on pharmacokinetics, including kidney excretion, zidovudine or its glucuronide metabolite.Nevertheless, the concentration of the active metabolite - phosphorylated zidovudine - increases 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.

    Given the theoretical possibility of the development of ergotism, the simultaneous use of azithromycin with derivatives of ergot alkaloids (ergotamine, dihydroergotamine) 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 changes in the concentration of atorvastatin in the blood plasma (based on the inhibition of HMG-CoA reductase). However, reports were received of cases of rhabdomyolysis in patients receiving concomitantly azithromycin and statins.

    Carbamazepine: in pharmacokinetic studies involving healthy There was no significant effect on the concentration of carbamazepine and Its active metabolite in blood plasma when used simultaneously with 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 azithromycin.

    Anticoagulants of indirect action (coumarin derivatives): in pharmacokinetic studies azithromycin did not affect the anticoagulant effect of warfarin in a single dose of 15 mg, taken by healthy volunteers. Potential anticoagulant effect was reported after simultaneous use of azithromycin and indirect anticoagulants (coumarin derivatives). Despite the fact that a causal relationship has not been established, it is recommended to carefully monitor prothrombin time in patients, while using azithromycin and indirect anticoagulants (coumarin derivatives).

    Cyclosporin: in pharmacokinetic studies involving healthy volunteers who within 3 days took in azithromycin (500 mg / day once), and then ciclosporin (10 mg / kg / day once), a significant increase in the maximum plasma concentration and area under the "concentration-time" curve of cyclosporine was detected. 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 adjust the dose accordingly.

    Efavirenz: Simultaneous application of azithromycin (600 mg / day one) and efavirenz (400 mg / day) daily for 7 days did not cause any clinically significant pharmacokinetic interactions.

    Fluconazole: 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.

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

    Methylprednisolone: azithromycin does not significantly affect pharmacokinetics of methylprednisolone.

    Nelfinavir: simultaneous use of azithromycin (1200 mg) and nelfinavir (750 mg three times a day) causes an increase in the equilibrium concentration of azithromycin in blood plasma. Clinically significant side effects were not observed and correction dose of azithromycin when it is used simultaneously with nelfinavir is not required.

    Rifabutin: simultaneous use of azithromycin and rifabutin does not affect the concentration of each drug in the blood plasma. With simultaneous application azithromycin and rifabutin, neutropenia was sometimes observed. Although neutropenia was associated with the use of rifabutin, a cause-and-effect relationship between the use of a combination of azithromycin and rifabutin and neutropenia is not installed.

    Sildenafil: when used in healthy volunteers, no evidence of the effect of azithromycin (500 mg / day daily for 3 days)to the maximum concentration in the blood plasma and the area under the concentration-time curve of sildenafil and its main metabolite.

    Terfenadine: in pharmacokinetic studies, there was no evidence of interaction between azithromycin and terfenadine. Individual cases were reported where the possibility of such interaction could not be completely excluded, but there was no specific evidence that such an interaction took place. It was found that the simultaneous use of terfenadine and antibiotics of the macrolide class causes arrhythmia and lengthening of the interval QT.

    Theophylline: there was no interaction between azithromycin and theophylline.

    Triazolam / midazolam: no significant changes in pharmacokinetic parameters were observed with simultaneous use of azithromycin with triazolam or midazolam in therapeutic doses.

    Trimethoprim / sulfamethoxazole: simultaneous application trimethoprim / sulfamethoxazole with azithromycin showed no 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:

    In case of missing one dose of the drug Azithromycin - The missed dose should be taken as soon as possible, and the following - with interruptions of 24 hours. Azithromycin should be taken at least 1 hour before or 2 hours after taking antacid medicines.

    A drug Azithromycin should be used with caution in patients with impaired liver function of mild and moderate severity due to the possibility of development 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, drug therapy Azithromycin it is necessary to stop and conduct a study of the functional state of the liver.

    For violations of kidney function of mild and moderate severity (CC more than 40 ml / min), drug therapy Azithromycin should be conducted with caution under the control of the state of kidney function.

    It should be remembered that for the prevention of pharyngitis / tonsillitis caused by Streptococcus pyogenes, as well as for the prevention of acute rheumatic fever, the drug of choice is usually penicillin.

    As with the use of other antibacterial drugs, with drug therapy Azithromycin should regularly monitor patients for the presence of unresponsive microorganisms and signs of development of superinfection, 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 convenient dosage regimen.

    There is no data on the possible interaction between azithromycin and derivatives of ergotamine and dihydroergotamine, but due to the development of ergotism with the simultaneous use of macrolides with derivatives of ergotamine and dihydroergotamine, this combination is contraindicated.

    With prolonged intake of the drug Azithromycin possible development 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 abolish azithromycin and use ion-exchange resins (colestramine, colestipol), in severe cases, compensation for loss of fluid, electrolytes and protein, the appointment of vancomycin or metronidazole. Do not use drugs that inhibit the intestinal peristalsis.

    Syndrome of delayed repolarization of the ventricles - syndrome of lengthening the interval QT - increases the risk of arrhythmia, including arrhythmias such as "pirouette" against the background of taking macrolides, as well as the drug Azithromycin. Caution when applying azithromycin should be observed in patients with proarrhythmogenic factors (especially in elderly patients), including those with congenital or acquired lengthening of the interval QT: in patients receiving antiarrhythmic drugs in classes IA (quinidine, procainamide), III (dofetil, amiodarone, sotalol), cisapride, terfenadine, antipsychotic drugs (pimozide), antidepressants (citalopram), fluoroquinolones (moxifloxacin, 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 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:

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

    Form release / dosage:

    Tablets, film-coated 125 mg and 500 mg.

    Packaging:

    For 3, 6 tablets in a contour mesh box made of polyvinylchloride film and aluminum foil printed lacquered.

    For 10, 20, 30, 40, 50, 60 or 100 tablets in a can of polyethylene terephthalate or a polymer can for drugs.

    One jar or 1, 2, 3, 4, 5 or 6 contour squares, together with the instructions for use, are placed in a pack of cardboard.

    Storage conditions:

    In the dark place at a temperature of no higher than 25 ° C.

    Keep out of the reach of children.

    Shelf life:

    3 years. Do not use the drug after the expiration date.

    Terms of leave from pharmacies:On prescription
    Registration number:LP-002782
    Date of registration:24.12.2014
    Expiration Date:24.12.2019
    The owner of the registration certificate:ATOLL, LLC ATOLL, LLC Russia
    Manufacturer: & nbsp
    Representation: & nbspOZONE LLC OZONE LLC Russia
    Information update date: & nbsp22.06.2017
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