Lasik - instructions for use, dose, side effects, contraindications

In 1 ml of solution contains: active substance: furosemide - 10,00 mg. Excipients: Sodium chloride 7.50 mg, sodium hydroxide 1.28 mg (sodium hydroxide, which is required to convert furosemide to sodium furosemide), sodium hydroxide 0.44 mg (approximately) (sodium hydroxide, which is required to adjust the pH to 9 , 0-9.3), water for injection 1.00 ml.

Description:Clear colorless solution

Pharmacotherapeutic group:diuretic

ATX: & nbsp

C.03.C.A.01 Furosemide

Pharmacodynamics:

Lasix® is a high-speed diuretic, which is a sulfonamide derivative. Lasix® blocks the ion transport system Na +, K +, Cl + in the thick segment of the ascending knee of the Henle loop, in connection with which, his saluretic action depends on the receipt of the drug in the lumen of the renal tubules (due to the mechanism of anion transport). The diuretic effect of the drug Lasix® is associated with the inhibition of the reabsorption of sodium chloride in this section of the Henle loop.Secondary effects in relation to the increase in sodium excretion are: an increase in the amount of urine released (due to osmotically bound water) and an increase in secretion potassium in the distal part of the renal tubule. At the same time, the excretion of calcium and magnesium ions increases.

With the repeated administration of the drug Lasix®, its diuretic activity does not decrease, as the drug interrupts the tubular-glomerular feedback in Macula densa (tubular structure closely connected with the juxtaglomerular complex). Lasix® causes dose-dependent stimulation of the renin-angiotensin-aldosterone system.

With heart failure, Lasix® quickly reduces preload (by expanding the veins), reduces pulmonary artery pressure and the filling pressure of the left ventricle. This rapidly developing effect appears to be mediated through the effects of prostaglandins and therefore the condition for its development is the absence of disturbances in the synthesis of prostaglandins, in addition to which this effect also requires sufficient preservation of kidney function.

The drug has antihypertensive effect,which is due to an increase in sodium excretion, a decrease in the volume of circulating blood and a decrease in the response of the smooth muscles of the vessels to vasoconstrictive effects (due to the natriuretic effect furosemide reduces the response of blood vessels to catecholamines, whose concentration in patients with hypertension is increased).

Dose-dependent diuresis and natriuresis is observed when taking Lasix® at a dose of 10 mg to 100 mg (healthy volunteers). After intravenous administration of 20 mg of the drug Lasix®, the diuretic effect develops after 15 minutes and lasts for about 3 hours.

The relationship between the intracanular concentrations of unbound (free) furosemide and its natriuretic effect is in the form of a sigmoid curve with a minimum effective furosemide excretion rate of about 10 μg / min. Therefore, prolonged infusion of furosemide is more effective than repeated bolus administration. In addition, when a certain bolus dose is exceeded, no significant increase in the effect is observed. When the tubular secretion of furosemide decreases or when the drug binds to the albumin located in the lumen of the tubules (for example, in a nephrotic syndrome), the effect of furosemide decreases.

Pharmacokinetics:

The volume of distribution of furosemide is 0.1-0.2 l / kg body weight and varies significantly depending on the underlying disease. Furosemide very strongly binds to blood plasma proteins (more than 98%), mainly with albumins. Furosemide is excreted mainly unchanged and mainly through secretion in the proximal tubules. After intravenous administration of furosemide, 60-70% of the administered dose is excreted by this route. Glucuronated furosemide metabolites are 10-20% of the kidney-excreted drug. The remaining dose is secreted through the intestine, apparently by biliary secretion.

The final half-life of furosemide after intravenous administration is approximately 1-1.5 hours.

Furosemide penetrates the placental barrier and is excreted in the mother's milk. Its concentration in the fetus and the newborn is the same as that of the mother.

Peculiarities of pharmacokinetics in selected groups of patients

With renal insufficiency the elimination of furosemide slows down, and the half-life increases; with severe renal failure, the final half-life can increase up to 24 hours.

With nephrotic syndrome a decrease in plasma protein concentrations leads to an increase in the concentrations of unbound furosemide (its free fraction), and the risk of developing an ototoxic effect increases. On the other hand, the diuretic effect of furosemide in these patients can be reduced by binding furosemide to albumin in the tubules and reducing the tubular secretion of furosemide.

With hemodialysis and peritoneal dialysis and permanent ambulatory peritoneal dialysis furosemide output is insignificant.

With hepatic insufficiency the half-life of furosemide is increased by 30-90%, mainly due to an increase in the volume of distribution. Pharmacokinetic parameters in this category of patients can vary greatly.

With heart failure, severe degree, arterial hypertension and in the elderly the excretion of furosemide is slowed by a decrease in renal function.

In preterm and full-term children, excretion of furosemide can be slowed down, which depends on the degree of maturity of the kidneys, the metabolism of the drug in infants can also be slowed down, since their glucuric ability is inadequate.In children, whose age after conception exceeds 33 weeks, the final half-life does not exceed 12 hours. In infants at the age of two months and older, excretion of furosemide does not differ from that in adults.

Indications:

Hydropic syndrome in chronic heart failure.
Edema syndrome with acute heart failure.
Hydropic syndrome in chronic renal failure.
Sharp renal failure, including those during pregnancy and burns (to maintain fluid excretion).
Hydropic syndrome with nephrotic syndrome (with nephrotic syndrome in the foreground is the treatment of the underlying disease).
Edema syndrome with liver disease (if necessary in addition to treatment antagonists of aldosterone).
Hypertensive crisis.
Maintaining forced diuresis with poisoning with chemical compounds, the kidneys being excreted unchanged.

Contraindications:

Hypersensitivity to the active substance or to any of the components of the drug; in patients with an allergy to sulfonamides (sulfanilamide antimicrobial agents or sulfonylureas) may develop"cross" allergy to furosemide.
Renal failure in anuria, which does not respond to the administration of furosemide.
Hepatic precoma and coma.
Pronounced hypokalemia.
Pronounced hyponatremia.
Hypovolemia (with or without arterial hypotension) or dehydration.
Sharply expressed violations of the outflow of urine of any etiology (including unilateral urinary tract damage).
Pregnancy (see "Pregnancy and lactation").
The period of breastfeeding.

Carefully:

With arterial hypotension;
In conditions in which excessive reduction in blood pressure is particularly dangerous (stenosing lesions of coronary and / or cerebral arteries);
With acute myocardial infarction (increased risk of developing cardiogenic shock);
With latent-flowing or manifested diabetes mellitus;
With gout;
With hepatorenal syndrome (that is, with functional renal failure associated with liver disease);
With hypoproteinemia (for example, with nephrotic syndrome, when it is possible to reduce the diuretic effect and increase the risk of developing ototoxic effect of furosemide,the choice of dose in such patients should be carried out with extreme caution);
With partial obstruction of the urinary tract (hyperplasia of the prostate glands, narrowing of the urethra);
At an increased risk of development of water-electrolyte balance disorders and acid-base state or in case of significant additional fluid losses (vomiting, diarrhea, regular monitoring of kidney function is required and ultrasound examination of the kidneys is required.
With simultaneous prescription of risperidone in elderly patients with dementia (risk of increased mortality).

Pregnancy and lactation:

Furosemide penetrates through placental barrier, so it is not should be administered during pregnancy without strict medical evidence.

If for life reasons the drug Lasix is prescribed pregnant, it is necessary careful monitoring of the condition and development of the fetus.

During the period of breastfeeding, the drug Lasis is contraindicated, because it suppresses lactation.

Women should not be fed if they take preparation Lasix®.

Dosing and Administration:

When using the drug Lasix, it is recommended to administer it at the lowest doses sufficient to achieve necessary

therapeutic effect.

The drug Lasix is administered intravenously and, in exceptional cases, intramuscularly (when it is impossible intravenous

administration or ingestion). Intramuscular administration of the drug is not suitable for the treatment of acute conditions, such as pulmonary edema. Intravenous introduction of the drug Lasix is carried out only when the intake of the drug inside is impossible or there is a violation of absorption of the drug in the small intestine, as well as when it is necessary to obtain the most rapid effect. With intravenous administration of the drug Lasix it is always recommended, as soon as possible, to switch to taking Lasik's medication inside.

When administered intravenously, Lasix should be administered slowly. The rate of intravenous administration should not exceed 4 mg per min. In patients with severe renal failure (serum creatinine concentration> 5 mg / dL), it is recommended that the intravenous rate of Lasix does not exceed 2.5 mg per min.To achieve optimum efficiency and suppression counterregulation (activation of the renin-angiotensin antinatriuretic and neurohumoral regulation units) is more preferred continuous intravenous infusion Lasix drug than its repeated intravenous bolus. If after one or more bolus intravenous injections in acute conditions there is no possibility for a continuous intravenous infusion, it is more preferable to administer low doses at short intervals between administrations (approximately 4 hours) than intravenous bolus administration of higher doses with longer time intervals between the introductions.

The solution for parenteral administration has a pH of about 9 and does not have buffer properties. At pH below 7 it is possible fallout of the active substance in the sediment, so when diluted Laxix is necessary strive for the pH value The solution obtained was from neutral to slightly alkaline.

For dilution, 0.9% sodium chloride solution can be used.

Diluted drug solution Lasix should be used, if possible, immediately after cooking.

Recommended maximum daily dose for intravenous administration in adults is 1500 mg and in children - 20 mg. The duration of treatment in children and adults is determined by a doctor individually in depending on the readings.

Special recommendations for dosing regimen

Children

In children, the dose should be reduced in accordance with the body weight. Children The recommended dose for parenteral administration is 1 mg / kg / body weight per day, but ns more than 20 mg / day.

Adults

Edema syndrome with liver diseases

The drug Lasix is used in addition to treatment antagonists of aldosterone in the case of their insufficient effectiveness. For prevention complications, such as a violation of orthostatic regulation blood circulation, water-electrolyte balance disturbance or acid-base state, careful dose selection is required so that fluid loss occurs gradually (at the beginning of treatment, a loss of fluid up to about 0.5 kg of body weight per day is possible). If intravenous administration is absolutely necessary, the initial dose for intravenous administration is 20-40 mg.

Edema Syndrome in Chronic Renal Failure

The sodium reaction to the Lasix drug depends on several factors, including the severity of renal failure and the sodium content in the blood, so the effect of the dose can not be exactly predictable. In patients with chronic renal failure require careful dose selection by its gradual rise so that the fluid loss occurs gradually (at the beginning of treatment available fluid loss up to about 2 liters per day, which can be up to 280 mmole Na + per day). In patients on hemodialysis, the usual maintenance dose is 250-1500 mg / day orally.

When administered intravenously, the dose of the drug Lasix can be determined as follows: treatment is started with intravenous drip at a rate of 0.1 mg per minute, and then gradually increase the rate of administration every 30 minutes, depending on the therapeutic effect.

Acute kidney failure (to maintain the excretion liquid)

Before starting treatment with the drug Lasix should be eliminated hypovolaemia, arterial hypertension hypotension and significant violations of water-electrolyte balance and / or acid-base state. It is recommended that the patient, as soon as possible, be transferred from an intravenous introduction of the drug Lasix on the reception of tablets Lasix (dose tablets of Lasix depends on selected dose for intravenous administration).

The recommended initial dose for intravenous administration is 40 mg. If after its introduction, no achieved the necessary diuretic effect, the drug Lasix can be injected into continuous intravenous infusion, starting with speed introduction of 50-100 mg per hour.

Edema with nephrotic syndrome

The recommended initial dose is 20-40 mg per day. The necessary dose is selected depending on the diuretic effect. The daily dose can be administered once or divided into several injections (see the sections "Pharmacokinetics" and "Special instructions").

Edema Syndrome in Chronic Heart Failure

The recommended initial dose is 20-80 mg per day. The necessary dose is selected depending on the diuretic response. It is recommended that the daily dose be divided into 2-3 injections.

Edema in acute heart failure The recommended initial dose of the drug Lasix is 20-40 mg as an intravenous bolus. If necessary, the dose of Lasix can be adjusted depending on the therapeutic effect.

Hypertensive crisis

The recommended initial dose is 20-40 mg by intravenous bolus administration. The dose can be adjusted depending on the effect.

Maintenance of forced diuresis in poisoning

The drug Lasix is used in addition to intravenous infusion of electrolyte solutions. The recommended initial dose for intravenous administration is 20-40 mg. The dose depends on the reaction to the drug Lasix. Before and during treatment, Lasix should monitor and repair fluid and electrolyte losses. In case of poisoning with substances with acidic or alkaline reaction, their excretion can be accelerated additional alkalinization, or an increase in the acidity of urine, respectively.

Side effects:

Frequency occurrence undesirable reactions / adverse events (HP / AE) was obtained from literature and clinical studies.If the frequency of occurrence for the same HP / A in the literature and data from clinical trials varied, the highest incidence of HP / AH was indicated. The following gradations of the frequency of occurrence of HP / AH by classification CIOMS (Council of People's Medical Scientific Organizations): very often> 10 %; often> 1 % and < 10%; infrequently> 0.1% and < 1 %; rarely> 0.01% and <0.1 %; rarely < 0,01 %, frequency unknown (it is not possible to determine the frequency of occurrence of HP / AH from the available data).

Disorders from the metabolism and nutrition

Often

- Violations of the water-electrolyte balance, including those occurring with clinical symptoms. Symptoms that indicate the development of violations of water electrolyte balance may include headache, convulsions, tetany, muscle weakness, heart rhythm disturbances and dyspeptic disorders. These disorders can develop either gradually (for a long time) or quickly (for a very short time, for example, in the case of high doses of furosemide in patients with normal renal function). The factors,contributing to the development of violations vodnoehlektrolitnogo balance, are the main diseases (for example, cirrhosis of the liver or heart failure); concomitant therapy with means that change the water-electrolyte balance; malnutrition and drinking regimen; vomiting, diarrhea, profuse sweating.

- Dehydration and hypovolemia (decrease in the volume of circulating blood), especially in elderly patients, which can lead to hemoconcentration with a tendency to develop thrombosis (see subsection "Vascular disorders" below).

- Increase in the concentration of creatinine in the blood.

- Increase in the concentration of triglycerides in the blood.

Often

- Hyponatremia, hypochloraemia, hypokalemia, increased cholesterol concentration in the blood, increased concentration of uric acid in the blood and development of an attack of gout.

Infrequently

- Decreased glucose tolerance. Possible manifestation of latent diabetes mellitus (see section "Special instructions").

Frequency unknown

- Hypocalcemia, hypomagnesemia, increased concentration and urea in the blood, metabolic alkalosis, Barter's pseudosyndrome with incorrect and / or prolonged use of furosemide.

Vascular disorders

Often (for intravenous infusion)

- Reduction of blood pressure (BP), including orthostatic hypotension.

Rarely

- Vasculitis.

Frequency unknown

- Thrombosis.

Disorders from the nochek and urinary tract

Often

- Increase the volume of urine.

Rarely

- Tubulointerstitial nephritis.

Frequency unknown

- Increase in the content of sodium and chloride in the urine; urinary retention (in patients with partial obstruction of the urinary tract, see section "Special instructions");

nephrocalcinosis / nephrolithiasis in premature infants (see section "Special instructions"), renal failure (see section "Interaction with other drugs"). Disorders from the digestive system

Infrequently

- Nausea.

Rarely

- Vomiting, diarrhea.

Rarely

- Acute pancreatitis.

Disturbances from the liver and bile ducts

Rarely

- Cholestasis, an increase in the activity of "liver" transaminases. Disturbances from the nervous system

Often

- Hepatic encephalopathy in patients with hepatocellular insufficiency (see the section "Contraindications").

Rarely

- Paresthesia.

Hearing disorders and labyrinthine disorders

Infrequently

- Hearing disorders, usually transient, especially in patients with renal insufficiency, hypoproteinemia (eg, with nephrotic syndrome) and / or too fast intravenous administration of furosemide. There have been reported cases of deafness, sometimes irreversible, after taking furosemide by mouth or intravenously.

Rarely

- Noise in ears.

Disturbances from the skin and subcutaneous tissues

Infrequently

- Skin itching, hives, rashes, bullous dermatitis, erythema multiforme, pemphigoid, exfoliative dermatitis, purpura, photosensitization reactions.

Frequency unknown

- Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, DRESS-siydrome: drug rash with eosinophilia and systemic symptoms.

Immune system disorders

Rarely

- Severe anaphylactic or anaphylactoid reactions until the development of anaphylactic shock.

Frequency unknown

- Weighting of the flow or exacerbation of systemic lupus erythematosus.

Violations of the blood and lymphatic system

Often

- Haemoconcentration.

Infrequently

- Thrombocytopenia.

Rarely

- Leukopenia, eosinophilia.

Rarely

- Agranulocytosis, aplastic anemia or hemolytic anemia.

Congenital, hereditary and genetic disorders

Frequency unknown

- Increased risk of non-invasion of the arterial duct, when furosemide is introduced to premature infants during the first weeks of life.

General disorders and disorders at the site of administration

Rarely

- Fever.

Frequency unknown

- After intramuscular injection, a local reaction in the form of pain is possible.

Since some adverse reactions (such as a change in the blood picture, severe anaphylactic or anaphylactoid reactions, severe skin allergic reactions) may, under certain conditions, threaten the life of patients, then any side effects should immediately be reported to the doctor.

Overdose:

The clinical picture of acute or chronic overdose of the drug depends mainly on the extent and consequences of fluid loss and electrolytes; overdose may be manifested by hypovolemia, dehydration, hemoconcentration, cardiac rhythm disturbances and conduction (including atrioventricular block and ventricular fibrillation).Symptoms of these disorders are a decrease in blood pressure, progressing up to the development of shock, acute renal failure, thrombosis, delirious condition, flaccid paralysis, apathy and confusion.

The treatment is aimed at correction of clinically significant violations of water-electrolyte balance and acid-alkaline balance under the control of serum concentrations of electrolytes, acid-base balance, hematocrit, and prevention or therapy of possible serious complications developing against these disorders.

Interaction:

Unsupported combinations

- Chloral hydrate - intravenous infusion of furosemide for a 24-hour period after the application of chloral hydrate may lead to hyperemia of the skin, excessive sweating, anxiety, nausea, increased blood pressure and tachycardia, the use of chloral hydrate at the same time is recommended.

- Aminoglycosides - delayed excretion of aminoglycosides by the kidneys when they are used simultaneously with furosemide and an increased risk of developing ototoxic and nephrotoxic action of aminoglycosides.For this reason, the use of this combination of drugs should be avoided, except when necessary for vital signs, in which case a correction (decrease) of supporting doses of aminoglycosides.

Combinations where caution should be exercised

- Ototoxic drugs - furosemide potentiates their ototoxicity. Since the ego can drive to irreversible damage to the hearing organ, such remedies can be used concomitantly with furosemide only by strict

medical indications.

- Cisplatinum - when used with furosemide, there is a risk of developing ototoxic effect. In addition, it is possible an increase in the nephrotoxic effect of cisplatin in the application of furosemide to perform forced diuresis during treatment with cisplatin, if furosemide is not used in low doses (for example, 40 mg in patients with normal renal function) and in combination with sufficient hydration of the patient.

- Angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists - use of an ACE inhibitor or angiotensin II receptor antagonist inpatients previously treated with furosemide may result in an excessive reduction arterial pressure with impaired renal function, and in some cases - the development of acute renal failure. Therefore, three days before the start of treatment or increasing the dose of ACE inhibitors or antagonists receptors angiotensin II recommended cancellation of furosemide, or reduction of its dose.

- Lithium salts - influenced furosemide decreases elimination of lithium, due to which increases lithium content in the serum, that increases the risk of developing it toxic actions, including its damaging impact at the heart and nervous system. Therefore, when application of this combination required monitoring serum lithium content blood.

- Risperidone -is necessary follow caution, carefully weighing ratio risk and benefit, before applying the combination risperidone furosemide or other strong diuretics because of was observed enlargement mortality rate in patients elderly people with dementia who received concurrent treatment risperidone and furosemide.

Interactions that should be taken into account Cardiac glycosides, drugs that cause interval lengthening QT - in case of development against the background of the introduction of furosemide violations of water electrolyte balance (hypokalemia or hypomagnesemia) increases the toxic effect cardiac glycosides and means causing interval lengthening QT (the risk of development increases disturbances in the rhythm of the heart). Glucocorticosteroids, carbenoxolone, licorice preparations in large quantities and prolonged use of laxatives when combined with furosemide increase the risk of hypokalemia.

- Medicines with nephrotoxic action - when combined with furosemide, the risk of developing their nephrotoxic effect increases.

- High doses of some cephalosporins (excreted mainly by the kidneys) - in combination with furosemide increases risk of nephrotoxic effect of cephalosporins.

- Non-steroidal anti-inflammatory drugs (NSAIDs) - NSAIDs, including acetylsalicylic acid, can reduce the diuretic effect of furosemide. In patients with hypovolemia and dehydration (including furosemide), NSAIDscan cause the development of acute renal failure. Furosemide can increase the toxicity of salicylates.

- Phenytoin - reduction of diuretic action of furosemide.

- Hypotensive drugs, diuretics or other means that can reduce blood pressure - when combined with furosemide, a more pronounced decrease in blood pressure is possible.

- Probenecid, methotrexate or other drugs that, like furosemide, excreted in the renal tubules, can reduce the effects of furosemide (the same pathway of renal excretion); on the other hand furosemide can lead to a decrease in the excretion of these drugs by the kidneys. All this increases the risk of side effects like furosemide, So and taken simultaneously with the above medicines.

- Hypoglycemic agents (and for oral administration, and insulin), pressor amines (epinephrine, norepinephrine) - weakening effects when combined with furosemide.

- Theophylline, diazoxide, curare like muscle relaxants - enhancing effects when combined with furosemide.

- Sucralfate - decrease in absorption of furosemide with joint ingestion (does not belong to this dosage form) and weakening of its effect (furosemide ingestion and sucralfate should be taken at intervals of not less than two hours).

- Cyclosporin A - when combined with furosemide, the risk of developing gouty arthritis due to furosemide-induced hyperuricemia and impaired excretion of urate by the kidneys under the influence of cyclosporine increases.

- Radiopaque substances - in patients with a high risk of developing nephropathy for the introduction of radiopaque preparations that received furosemide, a higher incidence of renal dysfunction after administration of radiocontrast preparations was observed compared with patients at high risk of developing radiopaque induced nephropathy who received only intravenous administration prior to administration of the radiocontrast drug fluid (hydration).

- Intravenously administered The drug Lasix has a slightly alkaline reaction, so it should not be mixed with drugs with a pH of less than 5.5.

Special instructions:

Before starting treatment with Lasix, the presence of severe abnormalities outflow of urine, including one-sided.

Patients with partial impairment outflow of urine need careful monitoring, especially at the beginning of drug treatment Lasix.

During treatment with Lasix, regular monitoring of sodium, potassium and concentration serum creatinine; especially close monitoring should be performed in patients with high risk of development violations of water-electrolyte balance in the cases of additional losses of liquid and electrolytes (for example, due to vomiting, diarrhea or intense sweating).

Before and during treatment with Lasix, monitor and, in the case of arise, eliminate hypovolemia or dehydration, as well as clinically significant disorders of water-electrolyte balance and / or acid-base state, for which it can short-term discontinuation of treatment with Lasix.

When treating with Lasix it is always advisable to use food rich in potassium (low-fat meat, potatoes, bananas, tomatoes, cauliflower, spinach, dried fruits, etc.). AT some cases may be shows the intake of potassium preparations or the intake of potassium-sparing drugs.

In patients with hypoproteinemia, for example, associated with nephrotic syndrome a cautious change in the dose of Lasix is required (possibly a decrease in the effectiveness of furosemide and an increase in its ototoxicity).

Preterm infants require regular monitoring of kidney function and ultrasound kidney examination (the possibility of nephrolithiasis and nephrocalcinosis).

There was a large frequency deaths in patients elderly people with dementia, simultaneously treated risperidoy and furosemide, according to compared with patients who received or only furosemide, or only risperidone.

Pathophysiological mechanism this effect is not established.

Simultaneous application risperidone with other diuretics (mainly with low doses of thiazide diuretics) was not associated with increased mortality in elderly patients with dementia. In elderly patients age with dementia followed with caution, carefully weighing the ratio of use and risk, apply furosemide and risperidone simultaneously. As dehydration is a common increased risk factor mortality, when making a decision on the application of this combination of elderly patients with Dehydration should avoid dehydration of the patient.

Possible weighting of the flow or exacerbation of systemic lupus erythematosus.

Selection of the dosing regimen patients with ascites against the background cirrhosis of the liver should be carried out in hospital (violations of water electrolyte balance can entail the development of hepatic coma).

Compatibility Guidelines

Lasix should not mix in one syringe with other medicinal means.

Emergency activities for development of anaphylactic shock

As a rule, it is recommended the following activities:

At the first signs (sharp weakness cold sweat, nausea, cyanosis) stop the injection, leaving the needle in the vein. Along with other usual urgent activities to ensure a low position head and trunk and maintain airway patency.

Urgent medication (recommendations for dosage are calculated for an adult patient with normal body weight, in the treatment of children, the dosage should be reduced in proportion to the body weight). Immediate intravenous injection of epinephrine (adrenaline): after diluting 1 ml of a standard solution of adrenaline 1: 1000 to 10 ml at the beginningslowly injected 1 ml of the resulting solution (= 0.1 mg of epinephrine) under the control of the heart rate, blood pressure and heart rate. If necessary, the introduction of epinephrine can be continued by intravenous infusion. Simultaneously with the introduction of epinephrine, intravenous glucocorticosteroids (250-1000 mg of methylprednisolone or prednisolone) are produced, which can be repeated if necessary.

In addition to these activities to fill the volume circulating blood is administered intravenously infusional introduction of plasma substitutes and / or electrolyte solutions. If necessary: artificial respiration, inhalation of oxygen, antihistamines.

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

Some side effects (eg, a significant reduction in blood pressure) can impair the ability to concentrate and reduce the speed of psychomotor reactions, which can be dangerous when driving vehicles or when engaging in other potentially hazardous activities. Especially it refers to the period of starting treatment or increasing the dose of the drug, as well as to cases of simultaneous use of antihypertensive drugs or alcohol.

In such cases it is not recommended manage transport means or deal with potentially dangerous species activities.

Form release / dosage:

Solution for intravenous and intramuscular injection 10 mg / ml.

Packaging:

2 ml of the drug in dark glass ampoules (type I) with a break point. For 10 ampoules in a plastic contour mesh package without coating (pallet). 1 pallet together with instructions for use in a cardboard box.

Storage conditions:

At a temperature of no higher than 25 ° C in the place protected from light.

Keep out of the reach of children place.

Shelf life:3 years. Do not use after expiry date.

Terms of leave from pharmacies:On prescription

Registration number:П N014865 / 02

Date of registration:16.05.2008

The owner of the registration certificate:Sanofi India LimitedSanofi India Limited India

Manufacturer: & nbsp

SANOFI INDIA, Limited India

Information update date: & nbsp16.11.2015

Illustrated instructions

Instructions

Lasix® (Lasix®)