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

    One tablet contains:

    Active substance:

    Azithromycin dihydrate 262.02 mg / 524.4 mg

    equivalent to azithromycin 250.0 mg / 500.0 mg

    Excipients: Calcium hydrogen phosphate (26.48 mg / 52.96 mg), pregelatinized starch (22.50 mg / 45.00 mg), crospovidone (29.50 mg / 59.00 mg), polysorbate 80 (30.00 mg / 60 , 00 mg), silicon dioxide (8.00 mg / 16.00 mg), microcrystalline cellulose (125.50 mg / 250.00 mg), sodium lauryl sulfate (8.00 mg / 16.00 mg), talc (3 , 02 mg / 6.09 mg), magnesium stearate (2.50 mg / 5.00 mg).

    Film Sheath:

    Hypromellose (7.00 mg / 14.40 mg), titanium dioxide (1.50 mg / 3.51 mg), macrogol 400 (0.98 mg / 2.00 mg).

    Description:

    Tablets with a dosage of 250 mg: capsular, biconvex tablets, covered with a film coat of white or almost white color.

    Tablets with a dosage of 500 mg: capsular, biconvex tablets, covered with a film shell of white or almost white color with a risk on one side.

    Pharmacotherapeutic group:Antibiotic - azalide
    ATX: & nbsp

    J.01.F.A.10   Azithromycin

    Pharmacodynamics:

    Azithromycin suppresses protein synthesis in microbial tissue, by binding to 50Ssubunit of the ribosomes. Azithromycin has a broad spectrum of antibacterial action. It is active against Gram-positive aerobic microorganisms: Streptococcus spp. (groups A, B, C, G), Streptococcus pneumoniae (penicillin-sensitive), Streptococcus pyogenes, Staphylococcus aureus (methicillin-sensitive); Gram-negative aerobic microorganisms: Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis, Legionella pneiunophila, Neisseria gonorrhoeae, Pasteurella multocida; some anaerobic microorganisms: Prevotella spp., Clostridium perfringens, Fusobacterium spp., Porphyriomonas spp.; and Chlamydia trachomatis, Chlamydia pneumoniae, Chlamydia psittaci, Mycoplasma pneumoniae, Mycoplasmahominis, Borrelia burgdorferi.

    Microorganisms able to develop resistance to azithromycin: gram-positive aerobes (Streptococcus pneumoniae (penicillin-resistant)). Initially, stable microorganisms: gram-positive aerobes (Enterococcus faecalis, Staphylococcus spp. (methicillin-resistant staphylococci exhibit a very high degree of resistance to macrolides), Gram-positive bacteria resistant to erythromycin); anaerobes (Bacteroides fragilis).
    Pharmacokinetics:

    Suction

    Azithromycin is rapidly absorbed from the gastrointestinal tract, which is due to its stability in an acidic environment and lipophilicity.After a single oral intake in dose 500 mg value of the maximum concentration (CmaX) of azithromycin in blood plasma is achieved through 2.5 - 2.96 hours and is 0.4 mg / l. Bioavailability is 37%, the apparent volume of distribution is 31.1. l / kg, the amount of binding with proteins is inversely proportional to the concentration in the blood and is 7-50%.

    Distribution

    Azithromycin well penetrates the respiratory tract, organs and tissues of the urogenital tract (in particular, into the prostate gland), into the skin and soft tissues. High concentration in tissues (10-50 times higher than in blood plasma) and a long half-life (T1 / 2) are due to the low binding of azithromycin to blood proteins, as well as its ability to penetrate into eukaryotic cells, and to concentrate in a medium with a low pH surrounding the lysosome. This, in turn, determines a large apparent volume of distribution and high clearance in the blood plasma. The ability of azithromycin to accumulate mainly in lysosomes is especially important for the elimination of intracellular pathogens. It is proved that phagocytes deliver azithromycin in the localization of infection, where it is released in the process phagocytosis.The concentration of azithromycin in the foci of infection is significantly higher than in healthy tissues (an average of 24 -34%) and correlates with the severity of the inflammatory edema. Despite the high concentration in phagocytes, azithromycin does not have a significant effect on their function. Azithromycin is retained in bactericidal concentrations in the inflammatory focus within 5 to 7 days after the last dose, which makes it possible to develop short 3-day and 5-day courses.

    Excretion

    Excretion of azithromycin from the blood plasma takes place in two stages: the half-life is 14-20 hours in the interval from 8 to 24 hours after taking the drug and 41 hours in the interval from 24 to 78 hours, which allows taking the drug once a day. Azithromycin is not metabolized in the patient's body, does not suppress isoenzymes of the cytochrome P450 system. The patient is excreted mainly by the intestine and partly by the kidneys (~ 20%).

    Eating changes the pharmacokinetics, azithromycin (depending on the dosage form), when taking tablets together with food, the maximum concentration (Cmax) by 31%, the area under the pharmacokinetic curve "concentration-time" does not change (AUC).

    When taking azithromycin by women increases value the maximum concentration in plasma, but these changes are insignificant and do not require dose adjustment.

    In elderly patients (over 65 years of age), the volume of distribution is somewhat higher (by 30%) compared with patients less than 45 years old, which is clinically insignificant and does not require a change in dosage.

    For patients with moderate impairment of renal function (creatinine clearance (CK)> 40 ml / min), dose adjustment is not required.

    Indications:

    Infectious-inflammatory diseases caused by susceptible to the drug pathogens:

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

    - Infections of the lower respiratory tract (acute bronchitis, exacerbation of chronic bronchitis, pneumonia, including caused by atypical pathogens);

    - skin and soft tissue infections (erysipelas, impetigo, secondarily infected dermatoses;

    - ordinary eels of moderate severity);

    - infection of the urogenital tract (urethritis and / or cervicitis);

    - Lyme disease (borreliosis), for treatment of the initial stage (erythema migrans).

    Contraindications:

    - hypersensitivity to azithromycin, other antibiotics of the macrolide group, or to ingredients that make up the finished dosage form;

    - severe hepatic insufficiency (class C on the Child-Pugh scale);

    - severe renal failure (CC less than 40 ml / min);

    - lactation period;

    - children under 12 years of age and body weight less than 45 kg;

    - simultaneous reception with ergotamine and dihydroergotamine.

    Carefully:

    Carefully use in patients with hepatic failure (classes A and B Child-Pugh), renal failure (creatinine clearance of more than 40 ml / min) at arrhythmias or susceptibility to arrhythmias and elongation interval QT, with the co-administration of terfenadine, warfarin, digoxin, and myasthenia gravis.

    Pregnancy and lactation:

    Azithromycin penetrates the placental barrier. Use in pregnancy is possible only in cases where the intended benefit to the mother exceeds the potential risk to the fetus.

    Action category for the fetus by FDA - AT.
    If azithromycin is to be used during lactation, the question of stopping breastfeeding should be resolved.
    Dosing and Administration:

    Inside, not crushing the tablet and not chewing, 1 time per day, 1 hour before meals or 2 hours after eating.

    Adults with infections of the upper and lower respiratory tract, upper respiratory tract, skin and soft tissue - 500 mg once daily for 3 days (a course dose 1.5 g).

    For sexually transmitted infections - uncomplicated urethritis / cervicitis - 1 g once; complicated, long-term urethritis / cervicitis caused by Chlamydia trachomatis - 1 g three times with an interval of 7 days (1-7-14). The course dose is 3 g.

    With Lyme disease - for treatment of stage I (erythema migrans) - 1 g on the first day and 500 mg daily once a day from 2 to 5 days (course dose - 3 g).


    - Children from 12 months to 12 years are prescribed the drug only in the form of a suspension.

    - Children are prescribed at a rate of 10 mg / kg 1 time per day for 3 days or on the first day - 10 mg / kg, then 4 days - 5-10 mg / kg / day. for 3 days (the course dose is 30 mg / kg).

    - When treating the initial stage of Lyme disease (erythema migrans) in children, the dose is 20 mg / kg on the first day and 10 mg / kg every 2 to 5 days.

    Side effects:

    Determination of the frequency of adverse reactions: often (> 1/100 and <1/10), sometimes (> 1/1000 and < 1/100), rarely (> 1/10 000 and <1/1000), very rarely (<1/10 000).

    On the part of the hematopoiesis system: rarely - thrombocytopenia, neutropenia, eosinophilia, lymphopenia, leukopenia, hemolytic anemia.

    From the central and the peripheral nervous system: sometimes - dizziness / vertigo, headache, drowsiness, convulsions; rarely - paresthesia, asthenia, insomnia, hyperactivity, aggressiveness, anxiety, nervousness, fainting, myasthenia gravis, weakness;

    From the sense organs: rarely - noise in the ears; reversible hearing loss up to deafness (when taken in high doses for a long time), violation perception of taste and smell, impaired clarity of visual perception;

    From the side of the cardiovascular system: rarely - malaise, chest pain, lower blood pressure, palpitations, arrhythmia, including ventricular tachycardia, increased interval QT, bidirectional ventricular tachycardia;

    From the digestive system: often - nausea, vomiting, diarrhea, abdominal pain and cramps; sometimes - flatulence, digestive disorders, anorexia; rarely - constipation, discoloration of the tongue, gastritis, pancreatitis, pseudomembranous colitis, cholestatic jaundice, hepatitis, fulminant hepatitis, change of values ​​of laboratory indicators of liver function; hyperbilirubinemia, hyperglycemia; rarely - violations of the liver and necrosis of the liver (possibly fatal).

    Allergic reactions: sometimes itching, skin rashes; rarely - angioedema, urticaria, photosensitivity, anaphylactic reaction (in rare cases with a fatal outcome), erythema multiforme; syndrome Stevens-Johnson, toxic epidermal necrolysis.

    From the musculoskeletal system: sometimes - arthralgia.

    From the urinary system: rarely interstitial nephritis, acute renal failure, increased urea and creatinine concentrations in the blood plasma, peripheral edema.

    Other: rarely - vaginitis, candidiasis, increased fatigue; conjunctivitis.
    Overdose:

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

    Measures to help with overdose
    Gastric lavage, symptomatic therapy.
    Interaction:

    Antacids (aluminum and magnesium-containing) do not affect the bioavailability, but reduce the concentration of azithromycin in the blood by 30%, so the interval between their intake should be 1 hour before or 2 hours after taking these drugs.

    With simultaneous applications with derivatives, ergotamine and dihydroergotamine, toxic effects (vasospasm, dysesthesia) of the latter are possible.

    When combined with anticoagulants indirect effect of the coumarin series (warfarin) and azithromycin (in usual doses) patients need careful monitoring of prothrombin time.

    Caution should be exercised in the joint use of terfenadine and azithromycin, since it was found that the simultaneous administration of terfenadine and macrolides causes arrhythmia and lengthening QT interval. Proceeding from this, it is impossible to exclude the aforementioned complications in the joint administration of terfenadine and azithromycin.

    When used simultaneously with cyclosporine, it is necessary to monitor concentration of cyclosporine in the blood.

    When used simultaneously with digoxin, monitoring, concentration digoxin in the blood (possibly increasing absorption of digoxin in the intestine).

    When simultaneous application with nelfinavir is possible, an increase in the frequency of adverse reactions of azithromycin (decreased hearing, increased activity of "hepatic" transaminases).

    With concomitant use with zidovudine azithromycin does not affect pharmacokinetic parameters of zidovudine in blood plasma or for kidney excretion he and his glucuronide metabolite, but the concentration of the active metabolite phosphorylated zidovudine in mononuclear cells of peripheral vessels. The clinical significance of this fact is not determined.

    The possibility of inhibiting the isoenzyme should be considered CYP3A4 azithromycin with simultaneous application with cyclosporine, terfenadine, alkaloids ergot, cisapride, pimozide, quinidine, astemizole and other drugs whose metabolism occurs with the participation of this enzyme.

    Azithromycin does not affect the concentration of carbamazepine, cimetidine, didanosine, efavirenz, fluconazole, indinavir, midazolam, theophylline, triazolam, trimethoprim / sulfamethoxazole, cetirizine, sildenafil, atorvastatin, rifabutin and methylprednisolone in the blood with simultaneous application.

    Special instructions:

    The drug does not have the features of the action at the first reception or upon its cancellation. In case of missed dose, the missed dose should be taken as soon as possible, and the subsequent dose should be taken at intervals of 24 hours.

    The drug should be taken 1 hour before or 2 hours after taking antacid medications means.

    Take with caution patients with moderate hepatic impairment due to the possibility of developing fulminant hepatitis and severe hepatic insufficiency in such patients. In the presence of symptoms of impaired liver function (fast increasing asthenia, jaundice, darkening of urine, a tendency to bleeding, hepatic encephalopathy) therapy with azithromycin should be stopped and conduct study of the functional state of the liver.

    With moderate renal failure (CC greater than 40 mL / min), the use of

    azithromycin should be performed under the control of kidney function.

    Contraindicated simultaneous administration of azithromycin with ergotamine derivatives and dihydroergotamine because of the possible development of ergotism.

    When using the drug both on the background of the reception, and after 2-3 weeks after discontinuation of treatment possible development of diarrhea caused by Clostridium difficile (pseudomembranous colitis). In mild cases, treatment can be withdrawn and application of ion-exchange resins (colestramine, colestipol), in severe cases shown compensation for fluid loss, electrolytes and protein, the appointment of vancomycin, bacitracin or metronidazole. Do not use drugs that inhibit peristalsis of the intestine.

    Since it is possible to extend the interval QT in patients receiving macrolides, including azithromycin, with the use of azithromycin,caution should be exercised in patients with known risk factors for lengthening the interval QT: elderly age; disturbance of electrolyte balance, (hypokalemia, hypomagnesemia); congenital lengthening syndrome QT; heart disease (heart failure, myocardial infarction, bradycardia); simultaneous reception of drugs that can lengthen the interval QT (including antiarrhythmic drugs IA and III classes, tricyclic and tetracyclic antidepressants, neuroleptics, fluoroquinolones).

    With the use of azithromycin, the development of myasthenic syndrome or myasthenia exacerbation is possible.

    Special precautions for the destruction of the drug

    Special precautions for the destruction of an unused medicinal product or a drug with an expired shelf life is not required.

    Effect on the ability to drive transp. cf. and fur:During the treatment period, care must be taken when driving vehicles and practicing other potentially dangerous activities that require increased concentration and speed of psychomotor reactions.
    Form release / dosage:Tablets 250 mg, 500 mg.
    Packaging:

    Tablets with a dosage of 250 mg:

    By 6 tablets in a strip of aluminum foil; 1 strip with instructions for use in a cardboard box.

    Tablets with a dosage of 500 mg:

    3 tablets per strip of aluminum foil; 1 strip with instructions for use in a cardboard box.

    Storage conditions:

    Store in a dry, 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 the product after the expiry date printed on the package.

    Terms of leave from pharmacies:On prescription
    Registration number:LP-001114
    Date of registration:03.11.2011
    The owner of the registration certificate:McLeodz Pharmaceuticals Co., Ltd. McLeodz Pharmaceuticals Co., Ltd. India
    Manufacturer: & nbsp
    Representation: & nbspAdvansd Trading, OOOAdvansd Trading, OOO
    Information update date: & nbsp23.08.2015
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