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

    Composition per one tablet.

    Active substance: azithromycin dihydrate (in terms of azithromycin) 500 mg.

    Excipients:

    Kernel composition: calcium stearate - 7.6 mg, starch 1500 - 30.4 mg, potato starch 33.0 mg, crospovidone (kollidone CL-M) (type B) 22.8 mg, povidone (low molecular weight polyvinylpyrrolidone medical 12600 g 2700, plasdon K-17) - 10.7 mg, lactose monohydrate (sugar milk) - 51.7 mg; thawed 22.8 mg , microcrystalline cellulose - 81.0 mg

    Shell composition: hypromellose (hydroxypropylmethylcellulose) 35.4 mg; Macrogol 4000 (polyethylene oxide 4000, polyethylene glycol 4000) 1.84 mg, titanium dioxide (titanium dioxide) - 2.76 mg.

    Description:Oval pills covered with a film membrane, white or white with a yellowish color.
    Pharmacotherapeutic group:Antibiotic - azalide
    ATX: & nbsp

    J.01.F.A.10   Azithromycin

    Pharmacodynamics:

    Azithromycin is a bacteriostatic broad-spectrum antibiotic from the macrolide-azalide group. 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 5OS subunit ribosome, it inhibits the peptidranslucase in step translation and suppresses the synthesis of protein, slowing the growth and reproduction 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.

    Sensitive microorganisms:

    aerobic Gram-positive microorganisms - Staphylococcus aureus (methicillin-sensitive strains). Streptococcus pneumoniae (penicillin-sensitive strains), Streptococcus pyogenes.

    aerobic gram-negative microorganisms - Haemophilus influenzae. Ilaemoplulus pcirainfluenzae, Legionella pneumophila. Moraxella catarrhalis. Pasteurella mullocida. Neisseria gonorrhoeae:

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

    others microorganisms - Chlamydia trachomatis. Chlamydia pneumoniae. Chlamydia psittaci. Mycoplasma pneumoniae. Mycoplasma hominis. Borrelia burgdorferi.

    Microorganisms that can develop resistance to azithromycin: aerobic Gram-positive microorganisms - Streptococcus pneumoniae (penicillin-resistant strains and strains with an average sensitivity to penicillin)

    Microorganisms with initial resistance:

    aerobic Gram-positive microorganisms - Enterococcus faecalis, Staphylococei (methicillin-resistant strains);

    anaerobic gram-positive microorganisms - Baderaides fragilis.

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

    Microorganisms

    MI

    K, mg / L *

    Sensitive

    Sustainable

    Staphylococcus

    ns more 1

    more than 2

    Streptococcus A. AT. FROM. G

    ns more than 0,25

    more than 0.5

    Streptococcus pneumoniae

    not more than 0.25

    more than 0.5

    Haemophilus influenzae

    ns more than 0.12

    more than 4

    Moraxella catarrhalis

    no more than 0.5

    more than 0.5

    Neisseria gonorrhoeae

    ns more than 0,25

    more than 0.5

    Pharmacokinetics:

    Azithromycin is rapidly absorbed from the gastrointestinal tract, which is due to its stability in an acidic environment and lipophilicity. Rapidly distributed throughout the body, with a high copy of the antibiotic's grace achieved in the tissues. After ingestion of 500 mg, the maximum concentration of azithromycin in the blood plasma is achieved after 2.5-2.9 hours and is 0.4 mg / l. Bioavailability is 37.5%. Azithromycin well penetrates the respiratory tract, organs and tissues of the urogenital tract (in particular, the prostate gland), the skin and soft tissues High concentration in tissues (10-50 times higher,than in a blood plasma) and a long half-life are due to low binding of azithromycin to blood plasma 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 the large apparent volume of red-earth red (31.1 l / kg) and high plasma clearance. The ability of azithromycin to accumulate mainly in lysosomes is particularly important for the elimination of intracellular pathogens It is proved that phagocytes deliver azithromycin in places of infection localization, where it is released during 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 degree of inflammatory edema. Azithromycin remains in bactericidal concentrations for 5-7 days after the last dose, which allowed the development of short (3-day and 5-day) courses of treatment.

    In the liver demethylated, the metabolites formed are not active.

    Excretion of azithromycin from the blood plasma takes place in 2 stages: the half-life period 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 72 hours, which allows using the drug once a day.

    The drug is output mainly through the intestines in an unchanged form of 50%, a small part is excreted by the kidneys - 6%.

    Indications:

    Infectious-inflammatory diseases caused by microorganisms sensitive to azithromycin

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

    - infection 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 (acne vulgar mild, rye, impetigo, secondarily infected dermatoses);

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

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

    Contraindications:

    Hypersensitivity to azithromycin, erythromycin, other macrolides or ketolides, or other components of the drug; hepatic dysfunction of severe degree (Child-Pugh class C); renal dysfunction of severe degree (creatinine clearance (CK) less than 40 ml / min); lactose intolerance, lactase / isomaltase deficiency, glucose-galactose malabsorption; simultaneous administration with ergotamine and dihydroergotamine; the period of breastfeeding; children under 12 years of age and / or body weight less than 45 kg.

    Carefully:Pregnancy; myasthenia gravis; violations of liver function of mild and moderate severity; renal dysfunction of mild and moderate severity (QC more than 40 ml / min); diabetes; in patients with proarrhythmogenic factors (especially in elderly patients): with congenital or acquired lengthening of the interval QT, in patients receiving therapy with antiarrhythmic drugs of classes IA (quinidine, procainamide), III (dofetilide, amiodarone, sotalol), cisapride. terfenadine, antipsychotic drugs (pimozide), antidepressants (citalopram), fluoroquinolones (moxifloxacin and levofloxacin), with disturbances of the water-electrolyte balance, especially in the case of hypokalemia or hypomagnesemia, with clinically significant bradycardia, cardiac arrhythmia or severe heart failure; simultaneous use of warfarin, digoxin, cyclosporine.
    Pregnancy and lactation:

    The use of the drug during pregnancy is possible only if the intended benefit for the mother exceeds the potential risk to the fetus.

    If it is necessary to prescribe the drug during lactation, breastfeeding should be stopped (it is excreted in breast milk).

    Dosing and Administration:

    Inside, without chewing, 1 hour before or 2 hours after eating 1 time per day.

    Adults and children over 12 years of age with a body weight above 45 kg infections of the upper and lower respiratory tract. ENT-organs, skin and soft tissues - 0.5 g / day (1 tablet) for 1 reception for 3 days (the course dose is 1.5 g (3 tablets)).

    In cases of urinary tract infections caused by Chlamydia trachomatis (urethritis, cervicitis) - once 1 g (2 tablets).

    At the initial stage of Lyme disease (borreliosis) - migratory erythema (erythema migrans) - 1 g (2 tablets) on the first day and 0.5 g (1 tablet) daily from 2 to 5 days (course dose - 3 g (6 tablets)).

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

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

    Elderly patients: in elderly patients, dose adjustment is not required. Because elderly people may already have current pro-rhythmogenic conditions, caution should be exercised when using AzitRus® FORTE 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 I%; 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; an unknown frequency is pseudomembranous colitis.

    From the side 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, reaction hypersensitivity, unknown frequency - anaphylactic reaction.

    From the nervous system: often - headache: rare - dizziness, paraesthesia, taste disturbance, nose running, insomnia, nervousness seldom - agitation: unknown frequency - hypoesthesia. anxiety, aggression, fainting, seizures, psychomotor hyperactivity, loss of smell, sense of smell distortion, loss of taste, myasthenia gravis, delusions, hallucinations

    From the side of the organ of vision: infrequent - impaired vision

    From the side of the hearing organ and labyrinthine disorders: infrequently - hearing disorder, vertigo; unknown frequency - hearing impairment, including deafness and / or "noise" in the ears

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

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

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

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

    From the skin and subcutaneous tissues: infrequent - skin rash, itching, hives, dermatitis, dry skin, sweating, rarely - photosensitivity reaction, unknown frequency - Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme.

    From 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, unknown frequency - interstitial nephritis, acute renal failure.

    From the genitals and the breast: infrequently metrorrhagia. dysfunction of the testes

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

    Laboratory summer cottage: 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 or increase in the concentration of bicarbonates in the blood plasma; infrequently - increased activity aspartate aminotransferase, alanine aminotransferase, increased bilirubin concentration in the blood plasma,an increase in the concentration of urea in the blood plasma, an increase in the concentration of creatinine in the blood plasma, a change in the potassium content in the blood plasma, an increase in the activity of alkaline phosphatase in the blood plasma, an increase in the level of chlorine in the blood plasma, an increase in the concentration of glucose in the blood, an increase in the number of platelets, increase in hematocrit, sodium content in blood plasma.

    Overdose:

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

    Treatment: symptomatic therapy; gastric lavage.
    Interaction:

    Antacid preparations

    Antacid drugs do not affect the bioavailability of azithromycin, but reduce the maximum concentration in blood plasma by 30%, so azithromycin should be taken at least one hour before or two hours after taking these drugs and food.

    Cetirizine

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

    Didanosine (didexyinosine)

    Simultaneous use of azithromycin (1200 mg / day) and didanosine (400 mg / sug) did not reveal changes in the pharmacokinetic indications of didanosine.

    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 the P-glycoprotein substrate in the blood plasma. Thus, with the simultaneous use of azithromycin and digoxin, it is necessary to consider the possibility of increasing the concentration of digoxin in the blood plasma.

    Zidovudine

    Simultaneous use of azithromycin (single dose 1000 mi and repeated intake of 1200 mg or 600 mg) with zidovudine has little effect on pharmacokinetics, including the excretion of zidovudine or its glucuronide metabolite in the night. However, the use of azithromycin causes 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.

    Isozymes of cytochrome R450

    Azithromycin weakly interacts with isoenzymes of the cytochrome system R450. 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.

    The pharmacokinetic studies of the simultaneous use of azithromycin and drugs whose metabolism occurs with the participation of isoenzymes of the cytochrome system R450.

    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.

    Atorvastatin

    The simultaneous use of atorvastatin (10 mg daily) and azithromycin (500 mg daily) does not lead to changes in the concentrations of atorvastatin in the blood plasma (based on the inhibition of HMG-CoA reductase). However, separate reports were received on cases of rhabdomyolysis in patients receiving concomitantly azithromycin and statins.

    Carbamazepine

    There was no significant effect on the concentration of carbamazepine and its active metabolite in blood plasma in patients receiving concomitantly azithromycin.

    Cimetidine

    There was no effect of a single dose of cimetidine on the pharmacokinetics of azithromycin provided cimetidine was administered 2 hours before the use of azithromycin

    Anticoagulants of indirect action (coumarin derivatives)

    In pharmacokinetic studies azithromycin did not affect the anticoagulant affect of a single dose of 15 mg of warfarin. Potential anticoagulant effect was reported after simultaneous use of azithromycin and indirect anticoagulants (coumarin derivatives). Although a causal relationship has not been established, consideration should be given to the need for frequent monitoring of prothrombin time when azithromycin is used in patients who receive oral anticoagulants of indirect action (coumarin derivatives).

    Cyclosporin

    With the simultaneous use of azithromycin (500 mg / day once) and cyclosporine (10 mg / kg / day once), a significant increase in the maximum concentration in the blood plasma (Cmax) and the area under the "concentration-time" curve (AUC) cyclosporine. Care should be taken when using these drugs at the same time, it is necessary to monitor the concentration of cyclosporine in the blood plasma and adjust the dose accordingly.

    Efavirenz

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

    Fluconazole

    Simultaneous use of azithromycin (1200 mg once) and fluconazole (800 mg once) does not change the pharmacokinetics of the latter. The total exposure and half-life of azithromycin did not change, but a decrease in Cmah azithromycin (by 18%), which has no clinical significance.

    Indinavir

    Simultaneous use of azithromycin (1200 mg once) ns causes a statistically significant effect on the pharmacokinetics of indinavir (800 mg 3 times / day for 5 days)

    Methylprednisolone

    Azithromycin does not significantly affect the pharmacokinetics methylprednisolone.

    Nelfinavir

    Simultaneous use of azithromycin (1200 mg) and nelfinavir (750 mg 3 times a day) causes an increase in the equilibrium concentrations of azithromycin in the blood plasma. Clinically significant side effects of nc have been observed and dose adjustment 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 the simultaneous use of azithromycin and rifabutin, neutropenia was sometimes observed.Despite the fact that neutropenia was associated with rifabutin, a causal relationship between the combination of these drugs and neutropenia has not been established.

    Sildenafil

    With simultaneous application, no effect of azithromycin (500 mg / day daily for 3 days) on AUC and Cmah sildenafil or its main circulating metabolite.

    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 may 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 ns revealed.

    Trimethoprim / sulfamethoxazole

    Simultaneous use of trimethoprim / sulfamethoxazole with azithromycin did not reveal a significant effect on Cmah, total exposure or excretion by the kidneys trimethoprim or sulfamethoxazole concentrations of azithromycin in the blood plasma were consistent with those identified in other studies.

    Special instructions:

    Do not take with a beggar

    In case of missed intake of a single dose of the drug, the missed dose should be taken as soon as possible, and the following - with interruptions of 24 hours.

    The drug AzitRus® FORTE should be taken at least 1 hour before or 2 hours after taking antacid preparations.

    AzitRus® FORTE The drug should be used with caution in patients with impaired liver function and mild to moderate severity due to the possibility of development of fulminant hepatitis and severe hepatic insufficiency.

    In the presence of liver disease symptoms, such as rapidly increasing fatigue, jaundice, dark urine, bleeding tendency, hepatic encephalopathy, drug therapy should be discontinued AzitRus® FORTE n conduct a study of the functional state of the liver.

    For violations of kidney function of mild and moderate severity (QC more than 40 ml / min), therapy with the drug AsitRus® FORTE should be performed with caution under the control of the state of kidney function.

    As with the use of other antibacterial drugs, with the drug AsitRus® FORTE should regularly monitor patients for the presence of unresponsive microorganisms and signs of development of superinfections, including fungal ones.

    The preparation AzitRus® FORTE should not be used for longer courses than indicated in the instructions, since the pharmacokinetic properties of azithromycin allow us to recommend a short and simple dosing regimen

    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, this combination is not recommended.

    With long-term admission of the drug AsitRus® FORTE, 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 in the background as well as 2 months after the end of therapy, clostridial pseudomembranous colitis should be excluded. Drugs that inhibit intestinal peristalsis are contraindicated

    In the treatment of macrolides, including azithromycin, prolonged cardiac repolarization and interval QT, which increase the risk of developing cardiac arrhythmias, including pirouette-type arrhythmias that can lead to cardiac arrest Caution should be exercised when using AzitRus® FORTE in patients with pro-arrhythmic 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), in patients with disturbances of water-electrolyte balance, especially in the case of hypokalemia or hypomagnesemia, with clinically significant bradycardia, cardiac arrhythmia or severe heart failure.The use of the drug AzitRus® FORTE may provoke the development of myasthenic syndrome or cause an exacerbation of myasthenia gravis.

    After the withdrawal of the treatment, hypersensitivity reactions in some patients may persist, which requires specific therapy under the supervision of a physician.
    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:Film coated tablets 500 mg.
    Packaging:

    3 or 6 tablets in a contiguous cell pack 3 or 6 tablets in a polymer can.

    Each bank, 1 or 2 contourcell packs of 3 tablets, 1 contour pack of 6 tablets together with instructions for use 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 expiration date printed on the package.
    Terms of leave from pharmacies:On prescription
    Registration number:LSR-005758/08
    Date of registration:22.07.2008 / 21.10.2013
    Expiration Date:Unlimited
    The owner of the registration certificate:SYNTHESIS, JSC Joint-stock Kurgan Society of Medical Preparations and Products SYNTHESIS, JSC Joint-stock Kurgan Society of Medical Preparations and Products Russia
    Manufacturer: & nbsp
    Information update date: & nbsp22.06.2017
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