Moxinspiration - instructions for use, doses, side effects, contraindications

Excipients: lactose monohydrate 230.17 mg, povidone K 29/32 (Plasdon K 29/32) 11.00 mg, lactose anhydrous 5.00 mg, croscarmellose sodium (Ac-Di-Sol) 16.50 mg, silicon dioxide colloid 2.00 mg, magnesium stearate 4,00 mg.

Shell composition: Rip off brown 03B86891: (hypromellose (E464) - 62.500%, titanium dioxide (E171) - 28.680%, macrogol (E1521) - 6.250%, ferric oxide red oxide (E172) - 2.570%) 15.00 mg.

Description:Oblong tablets covered with a film coat of a brownish-red color. On the cross section, the core is light yellow in color.

Pharmacotherapeutic group:Protivomicrobial agent-fluoroquinolone

ATX: & nbsp

J.01.M.A.14 Moxifloxacin

Pharmacodynamics:

Antimicrobial drug group of fluoroquinolones. Has a bactericidal effect.

The mechanism of action is due to the inhibition of bacterial topoisomerase II (DNA gyrase) and topoisomerase IV, which leads to a disruption in the synthesis of DNA from the microbial cell.

In vitro moxifloxacin is active against a wide range of gram-negative and gram-positive bacteria, anaerobic, acid-fast and atypical bacteria.

Effective against bacteria resistant to beta-lactam and macrolide antibiotics.

To moxifloxacin are sensitive aerobic gram-positive bacteria: Gardnerella vaginalis, Streptococcus pneumoniae (including strains resistant to penicillin and strains, with multiple antibiotic resistance) *, Streptococcus pyogenes (group A) *, Streptococcus milleri, Streptococcus angiosus *, Streptococcus constellatus *, Streptococcus intermedius *, Streptococcus viridans ( Streptococcus viridans, Streptococcus mutans, Streptococcus mitis, Streptococcus sanguinis, Streptococcus salivarius, Streptococcus thermophiles, Streptococcus constellatus), Streptococcus agalactiae, Streptococcus dysgalactiae, Staphylococcus aureus (sensitive to methicillin strains) *, Staphylococcus cohnii (sensitive to methicillin strains), Staphylococcus epidermidis ( sensitive to methicillin strains), Staphylococcus haemolyticus (sensitive to methicillin Well strains), Staphylococcus hominis (methicillin sensitive strains), Staphylococcus saprophyticus (methicillin sensitive strains), Staphylococcus simulans (methicillin sensitive strains). aerobic gram-negative bacteria: Haemophilus influenzae (including strains producing and not producing beta-lactamase) *, Haemophilus parainfluenzae *, Moraxella catarrhalis (including strains producing beta-lactamase) *, Bordetella pertussis, Acinetobacter baumanii, Proteus vulgaris.

anaerobic bacteria: Fusobacterium spp., Porphyromonas spp., Prevotella spp., Propionibacterium spp.

Atypical: Chlamydia pneumoniae *, Chlamydia trachomatis *, Mycoplasma pneumoniae *, Legionella pneumophila *, Mycoplasma hominis, Mycoplasma genitalium, Coxiella burnettii.

Moderately sensitive:

Aerobic Gram-positive bacteria: Enterococcus faecalis (strains sensitive to vancomycin and gentamicin only) *, Enterococcus avium *, Enterococcus faecium *.

Aerobic Gram-negative bacteria: Escherichia coli *#, Klebsiella pneumoniae *#, Klebsiella oxytoca, Citrobacter freundii *, Enterobacter spp. (Enterobacter aerogenes, Enterobacter intermedius, Enterobacter sakazakii), Enterobacter cloacae *, Pantoea agglomerans, Pseudomonas fluorescens, Burkholderia cepacia, Stenotrophomonas maltophilia, Proteus mirabilis *, Morganella morganii, Neisseria gonorrhoeae *, Providencia rettgeri, Providencia stuartii.

Anaerobic bacteria: Bacteroides distasonis *, Bacteroides vulgaris *, Bacteroides fragilis *, Bacteroides ovatus * Bacteroides thetaiotaomicron *, Bacteroides uniformis *, Peptostreptococcus spp. * Clostridium spp. *

* - Sensitivity to moxifloxacin is confirmed by clinical data.

# - Possible development of acquired resistance

The following microorganisms are resistant to moxifloxacin:

Staphylococcus aureus (methicillin / ofloxacin resistant strains), coagulase-negative Staphylococcus spp. (methicillin-resistant strains of Staphylococcus cohnii, Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus, Staphylococcus simulans), Pseudomonas aeruginosa.

There is no cross-resistance with penicillins, cephalosporins, aminoglycosides, macrolides and tetracyclines. The overall incidence of resistance is low.

In vitro studies have shown that resistance to moxifloxacin develops slowly as a result of a number of consecutive mutations. Between drugs from the group of fluoroquinolones develops cross-resistance. However, some Gram-positive and anaerobic microorganisms resistant to other fluoroquinolones are susceptible to moxifloxacin.

Pharmacokinetics:

After oral administration moxifloxacin absorbed quickly and almost completely. Absolute bioavailability is about 91%.

After a single dose of 400 mg of moxifloxacin, the maximum concentration (C_max) is achieved within 0.5-4 hours and is about 3 μg / ml.

Moxifloxacin is rapidly distributed in tissues and organs and binds to blood proteins (mainly albumins) by about 45%. The distribution volume is approximately 2 l / kg. High concentrations of moxifloxacin, exceeding those in plasma, are created in lung tissue, in alveolar macrophages, bronchial mucosa, in the mucous membrane of the nasal sinuses, in foci of inflammation (in the contents of blisters in skin lesions). In the interstitial fluid and in the saliva moxifloxacin is determined in a free, non-protein-bound form at a concentration higher than in the plasma. In addition, high concentrations of the drug are determined in the tissues of the abdominal cavity, peritoneal fluid and female genital organs.

Moxifloxacin undergoes biotransformation of the 2nd phase and is excreted from the body by the kidneys, as well as the intestines both in unmodified form and in the form of inactive sulfo compounds and glucuronides. Moxifloxacin does not undergo biotransformation by the microsomal system of cytochrome P450.

The half-life of moxifloxacin is approximately 12 hours. The average total clearance after administration in a dose of 400 mg is from 179 to 246 ml / min. About 22% of a single dose (400 mg) is excreted unchanged by the kidneys, about 26% by the intestine.

Pharmacokinetics in special clinical cases:

Age, gender and ethnicity

In studies of the pharmacokinetics of moxifloxacin in men and women, differences in 33% in terms of the area under the pharmacokinetic curve of concentration-time (AUC) and C_max. Absorption of moxifloxacin did not depend on sex. Differences in AUC and C_max were due more to the difference in body weight than sex and are not clinically relevant.

There were no clinically significant differences in the pharmacokinetics of moxifloxacin in patients of different ethnic groups and ages.

Children

The pharmacokinetics of moxifloxacin in children have not been studied.

Renal insufficiency

There were no significant changes in the pharmacokinetics of moxifloxacin in patients with impaired renal function (including patients with creatinine clearance <30 mL / min / 1.73 m²) and in patients on continuous hemodialysis and long-term outpatient peritoneal dialysis.

Impaired liver function

The concentration of moxifloxacin in patients with impaired liver function (classes A, B on the Child-Pugh scale) did not differ significantly from that in healthy volunteers or in patients with normal liver function.

Indications:

Infectious-inflammatory diseases caused by micro-organisms sensitive to moxifloxacin:

- Acute sinusitis;

- exacerbation of chronic bronchitis;

- Community acquired pneumonia, including CAP pathogens which microorganisms are strains of multidrug resistance to antibiotics *;

- skin and soft tissue infections;

- complicated intra-abdominal infections;

- uncomplicated infections of the pelvic organs.

* Streptococcus pneumoniae with multiple resistance to antibiotics include strains that are resistant to penicillin, and strains resistant to two or more antibiotics from the groups such as the penicillins (minimum inhibitory concentration ≥ 2 ug / ml), II-generation cephalosporins (cefuroxime), macrolides, tetracyclines, trimethoprim / sulfamethoxazole.

It is necessary to take into account the current official guidelines on the rules for the use of antibacterial drugs.

Contraindications:

- Hypersensitivity to moxifloxacin, other quinolones and components of the drug;

- Pregnancy;

- lactation period;

- age up to 18 years;

- epilepsy;

severe diarrhea;

- damage to the tendons during the previous treatment with quinolones;

- syndrome of congenital or acquired lengthening of the QT interval;

- clinically significant bradycardia, clinically significant heart failure with a lower left ventricular ejection fraction, a history of rhythm disorders accompanied by clinical symptoms;

- simultaneous reception of drugs that extend the QT interval;

- pronounced electrolyte imbalance (uncorrectable hypokalemia);

- severe hepatic insufficiency (Child-Pugh class C) and an increase in the content of transaminases more than five times higher than the upper limit of the norm, due to the limited amount of clinical data.

- Congenital lactose intolerance, lactase deficiency, glucose-galactose malabsorption (since the formulation includes lactose).

Carefully:Convulsive syndrome (in the anamnesis), diseases of the central nervous system predisposing to occurrence of seizures and lowering the threshold of convulsive activity; in patients with psychoses and psychiatric illnesses in the anamnesis; in patients with acute myocardial ischemia; with cirrhosis of the liver; in women and elderly patients; myasthenia gravis; with the simultaneous administration of drugs that reduce the concentration of potassium; deficiency of glucose-6-phosphate dehydrogenase.

Dosing and Administration:

The recommended dosage regimen of the drug is Moxinsensioner: 400 mg (1 tablet) 1 time per day. Do not exceed the recommended dose. The tablet should be swallowed whole, not liquid, squeezed with enough water, regardless of food intake.

Duration of therapy

The duration of treatment is determined by the localization and severity of the infection, as well as clinical effect.

Exacerbation of chronic bronchitis: 5-10 days.

Acute sinusitis: 7 days.

Uncomplicated skin and soft tissue infections: 7 days.

Community-acquired pneumonia: 7-14 days.

Complicated infections of the skin and subcutaneous structures: 7-21 days.

Complicated intra-abdominal infections: 5-14 days.

Uncomplicated infections of the pelvic organs: 14 days.

Do not exceed the recommended duration of treatment.

Elderly patients

Changes in the dosing regimen in elderly patients are not required.

Violation of liver function

Patients with impaired liver function (class A, B by Child-Pugh) do not need to change the dosage regimen.

Renal insufficiency

In patients with impaired renal function (including with creatinine clearance <30 ml / min), as well as in patients on continuous hemodialysis and long-term outpatient peritoneal dialysis, changes in the dosing regimen are not required.

Side effects:

Undesirable reactions listed in the "frequently" group occurred at a frequency below 3%, with the exception of nausea and diarrhea. In each frequency group, undesirable drug reactions are listed in order of decreasing significance. The frequency is determined as follows: often (from ≥ 1/100 to <1/10), infrequently (from ≥1 / 1000 to <1/100), rarely (from ≥ 1/10 000 to <1/1000), very rarely (<1/10 000).

Systems of organs

Often

Infrequently

Rarely

Infectious and parasitic diseases

Fungal superinfections

On the part of the hematopoiesis system

Anemia

Leukopenia

Hettropenia

ThrombocytoPthe

Thrombocytosis

Prothrombol extensioninThe increase in the international standardized ratio (INR)

Change in the concentration of thromboplastin

Increase

concentrations

prothrombin /

decrease

INR

From the immune system

Allergic reactions

Itching

Rash

Hives

EosiMr.officilia

Anaphylactic / aMr.affilactoid reactions

Angioedema, including laryngeal edema (potentially life-threatening)

Anaphylactic / anaphylactoid shock (including potentially life-threatening).

From the side of metabolism

Hyperlipidemia

Hyperglycaemia

Hyperuricemia

Mental disorders

Anxiety

Psychomotor

hyperreactivityMr.awn / agitationandI

Emotional lability Depression (in very rare cases, behavior with a tendency to self-extinguisherailwayesuch as suicidal ideation or suicide attempts)

Hallucinations

Depersonalizedand I

Psychotic reactions (potentially manifested in behavior with a tendency to self-harm, such as suicidal thoughts or suicidal attempts)

From the nervous system

Headache Dizzinesse

Paresthesia /

Dysaesthesia

Disturbance of taste is sensitiveart.and (including in very rare cases, agevia)

Confusion and disorientation

Vertigo

Drowsiness

Tremor

Sleep Disorders

Hypostezia

Abnormalities of smell (including anosmia)

Atypical dreams

Disturbance of coordination (including gait disturbance due to dizziness or vertigo, in very rare cases leading to trauma from falling, especially in elderly patients)

Seizures with various clinical manifestations (including "grand mal" seizures)

Violations of attention

Violations of speech

Amnesia

Peripheral neuropathy and polyneuropathy

Diperesthesia

From the side of the organ of vision

Visual disturbances (especially in reactions from the central nervous system (CNS))

Transient loss of vision (especially with CNS reactions).

From the side of the hearing organ and labyrinthine disorders

Noise in ears

Deterioration of hearing, including deafness (usually reversible)

From the side of the cardiovascular system

Elongation of the QT interval in patients with concomitant hypokalemiamission

QT interval extension

Heart palpitations

Tachycardia

Vasodilation

Ventricular tachyarrhythmias

Fainting

Increase blood pressure

Decrease

arterial

pressures

Nonspecific arrhythmias

Polymorphic ventricular tachycardia (Torsade de pointes)

Heart failure (mainly in people with predisposing to arrhythmias, such as clinically significant bradycardia, acute myocardial ischemia)

On the part of the respiratory system, the organs of the thorax and the mediastinum

Shortness of breath (including asthmatic condition)

From the gastrointestinal tract

Nausea

Vomiting

Stomach ache

Diarrhea

Reduced appetite and reduced food intake

Constipation

Dyspepsia

Flatulence

Gastroenteritis (other than erosive gastroenteritis)

Increase activity

amylase

Dysphagia

Stomatitis

Pseudomembranous colitis (in very rare cases associated with life-threatening complications)

From the liver and biliary tract

Increased activity of "liver" transaminases

Dysfunction of the liver (including increased activity of lactate dehydrogenase)

Increased bilirubin concentration

Increase in activity of gamma glutamyl transferase

Increase in blood activity of alkaline phosphatase

Jaundice

Hepatitis

(predominantly cholestatic)

Fulminant hepatitis, potentially leading to life-threatening hepatic insufficiency (including fatal cases)

From the skin and soft tissues

Bullous skin reactions, for example, Stevens-Johnson syndrome or toxic epidermal nerveerabies (potentially life-threatening).

From the side of skeletal-muscular and connective tissue

Arthralgia

Myalgia

Tendonitis

Increase

muscular

tone and

convulsions

Muscular

weakness

Tendon tendons

Arthritis

Violation of the gait due to damage to thePOrno-engineTheth system

Increased myasthenia gravis symptoms gravis

From the side of the urinary tract

Dehydration (caused by diarrhea or decreased fluid intake)

Renal impairment Renal failure due to dehydration, which can lead to kidney damage, especially in elderly patients with pre-existing impaired renal function)

General disorders and injuries at the site of administration

General malaise

Bol without a clear reason

Sweating

The frequency of development of the following adverse reactions was higher in the group receiving stepwise therapy (intravenous administration of moxifloxacin followed by oral administration):

Often: increased activity of gamma glutamyl transferase

Infrequently: ventricular tachyarrhythmias, lowering of arterial pressure, edema,pseudomembranous colitis (in very rare cases associated with life-threatening complications), seizures with various clinical manifestations (including "grand mal" seizures), hallucinations, impaired renal function, renal failure (as a result of dehydration, which can lead to damage kidney, especially in elderly patients with pre-existing impaired renal function).

Overdose:There are limited data on the overdose of moxifloxacin. In case of an overdose, one should be guided by the clinical picture and carry out symptomatic maintenance therapy with ECG monitoring.

Interaction:

When combined with atenolol, ranitidine, calcium-containing additives, theophylline, oral contraceptives, glibenclamide, itraconazole, digoxin, morphine, probenecid (no clinically significant interaction with moxifloxacin was confirmed), dose adjustment is not required.

Drugs that extend the RT interval.

Consider the possible additive effect of prolonging the QT interval of moxifloxacin and other drugs that affect the prolongation of the QT interval.Due to the combined use of moxifloxacin and drugs that affect the prolongation of the QT interval, the risk of ventricular arrhythmia increases, including polymorphic ventricular tachycardia (Torsade de pointes).

Contraindicated the combined use of moxifloxacin with the following drugs that affect the prolongation of the QT interval:

- Antiarrhythmic drugs of class IA (quinidine, hydroquinidine, disopyramide, etc.);

- Antiarrhythmic drugs of class III (amiodarone, sotalol, dofetilide, ibutilide, etc.);

- Neuroleptics (phenothiazine, pimozide, sertindole, haloperidol, sultopride, etc.);

- Tricyclic antidepressants;

- Antimicrobials (sparfloxacin, erythromycin for intravenous administration, pentamidine, antimalarial drugs, especially halofantrine);

- Antihistamines (terfenadine, astemizole, misolastine);

- Others (cisapride, wincamine for intravenous administration, bepridil, difemanyl).

Antacid preparations, multivitamins and minerals

The use of moxifloxacin concomitantly with antacids, multivitamins and minerals can lead to impaired moxifloxacin absorption due to the formation of chelate complexes. As a result, the concentration of moxifloxacin in the blood plasma may be significantly lower than desired.In this regard, antacid preparations, antiviral (HIV) agent (didanosine), preparations containing vitamins, magnesium, aluminum, iron or zinc salts, sucralfate should be taken at least 4 hours before or 4 hours after ingestion of moxifloxacin.

Warfarin

When combined with warfarin prothrombin time and other parameters of blood coagulation do not change.

Change the value of INR. In patients who received anticoagulants in combination with antibacterial drugs, including moxifloxacin, there are cases of increased anticoagulant activity of anticoagulants. Risk factors are the presence of an infectious disease (and concomitant inflammatory process), the age and general condition of the patient. Although the interaction between moxifloxacin and warfarin has not been revealed, in patients receiving concomitant treatment with these drugs, it is necessary to monitor the INR and, if necessary, adjust the dose of indirect anticoagulants.

Digoxin

Moxifloxacin and digoxin do not significantly affect the pharmacokinetic parameters of each other.When repeated doses of moxifloxacin were used, the maximum digoxin concentration increased by approximately 30%, while the area under the concentration-time curve (AUC) and the minimum digoxin concentration did not change.

Activated carbon

With the simultaneous use of activated carbon and moxifloxacin, the systemic bioavailability of moxifloxacin is reduced by more than 80% as a result of inhibition of its absorption.

Dairy products and food intake

Absorption of moxifloxacin does not change with simultaneous intake of food (including dairy products).

With the simultaneous use of the drug Moxinsenter and glucocorticosteroids, the risk of developing tendovaginitis and rupture of the tendon increases.

Special instructions:

In some cases, after the first use of the drug may develop hypersensitivity and allergic reactions, which should immediately inform the doctor. Very rarely even after the first use of the drug, anaphylactic reactions can progress to a life-threatening anaphylactic shock. In these cases, the treatment with moxifloxacin should be discontinued and immediately begin the necessary medical measures (incl.anti-shock).

When moxifloxacin is used, prolongation of the QT interval may be noted in some patients. Since women have a longer QT interval than men, they may be more sensitive to drugs that extend the QT interval. Elderly patients are also more prone to drugs that affect the QT interval. The degree of elongation of the QT interval may increase with increasing drug concentration, therefore, do not exceed the recommended dose. However, in patients with pneumonia, there was no correlation between the concentration of moxifloxacin in the blood plasma and the prolongation of the QT interval. The prolongation of the QT interval is associated with an increased risk of ventricular arrhythmias, including polymorphic ventricular tachycardia. None of the 9,000 patients who received moxifloxacin, there were no cardiovascular complications and lethal cases associated with prolongation of the QT interval.

With the use of moxifloxacin, the risk of developing ventricular arrhythmias in patients with predisposing arrhythmias may increase. Concerning moxifloxacin contraindicated in:

- Changes in the electrophysiological parameters of the heart, expressed in QT interval elongation: congenital or acquired documented QT interval prolongations, electrolyte disturbances, especially uncorrected hypokalemia, clinically significant bradycardia; clinically significant heart failure with a reduced fraction of the left ventricular ejection; in the presence of a history of rhythm disturbances, accompanied by clinical symptoms (since it is impossible to exclude the risk of developing an extension of the QT interval;

- Use with other drugs that extend the QT interval (see section "Interaction with other medicinal products").

When moxifloxacin was used, cases of fulminant hepatitis, potentially leading to hepatic insufficiency (including fatal cases) were reported (see "Side effect"). The patient should be informed that if symptoms of hepatic insufficiency (anorexia, jaundice, darkening of the urine, pruritus, abdominal pain) appear, you should consult your doctor before continuing with moxifloxacin.

When moxifloxacin was used, cases of developing bullous skin lesions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis, were reported.The patient should be informed that in case of symptoms of skin or mucous membrane damage, the doctor should be consulted before continuing with moxifloxacin.

The use of drugs quinolone series is associated with a possible risk of seizures. Moxifloxacin should be used with caution in patients with CNS diseases and CNS disorders, predisposing to the onset of seizures or reducing the threshold of seizure activity.

The use of broad-spectrum antibacterial drugs, including moxifloxacin, is associated with a risk of developing pseudomembranous colitis. This diagnosis should be kept in mind in patients who have severe diarrhea with moxifloxacin. In this case, immediate therapy should be prescribed. Drugs that inhibit the peristalsis of the intestine are contraindicated in the development of severe diarrhea.

Moxifloxacin should be used with caution in patients with myasthenia gravis in connection with possible exacerbation of the disease.

Against the background of quinolone therapy, including moxifloxacin, tendonitis and tendon rupture are possible, especially in the elderly and patients,receiving glucocorticosteroids. Cases which have arisen within several months after the end of treatment are described. At the first symptoms of pain or inflammation at the site of damage, the drug should be stopped and unloaded.

If there is a violation of the vision, consultation of the ophthalmologist is necessary.

When applying quinolones, photosensitivity reactions are noted. However, in pre-clinical and clinical studies, as well as with the use of moxifloxacin, no photosensitivity reactions were observed in practice. However, patients who use moxifloxacin, should avoid exposure to direct sunlight and ultraviolet light.

It is not recommended to use moxifloxacin for the treatment of infections caused by Staphylococcus aureus strains resistant to methicillin (MRSA). In the case of suspected or confirmed infections caused by MRSA, treatment should be prescribed with appropriate antibacterial drugs.

The ability of moxifloxacin to inhibit the growth of mycobacteria can cause in vitro interaction of moxifloxacin with a test for Mycobacterium spp.,leading to false-negative results in the analysis of samples of patients treated with moxifloxacin during this period.

In patients treated with quinolones, including moxifloxacin, cases of sensory or sensorimotor axonal polyneuropathy are described,

Affects small and (or) large axons, and leads to paresthesia of hypostasis, dysesthesia and weakness. Symptoms may appear immediately after application and be irreversible. Patients undergoing treatment with moxifloxacin should be warned of the need for immediate medical attention in the event of neuropathy symptoms including pain, burning, tingling, numbness and / or weakness or other sensitivity disorders, including tactile, pain, temperature, vibration sensitivity and feeling position (see section "Side effect"), Moxifloxacin must be immediately canceled.

Reactions from the psyche may occur even after the first use of fluoroquinolones, including moxifloxacin. In very rare cases, depression or psychotic reactions progress to the occurrence of suicidal thoughts and behavior with a tendency toself-harm, including suicide attempts (see section "Side effect"). In case of development of such reactions in patients it is necessary to cancel moxifloxacin and take the necessary measures. Caution should be exercised in prescribing moxifloxacin to patients with psychoses and patients with psychiatric illnesses in the anamnesis.

Because of the widespread and growing incidence of infections caused by Neisseria gonorrhoeae resistant to fluoroquinolones, monotherapy with moxifloxacin should not be carried out in the treatment of patients with pelvic inflammatory disease. Except in cases where the presence of a resistant to fluoroquinolones, Neisseria gonorrhoeae is excluded. If there is no way to exclude the presence of Neisseria gonorrhoeae resistant to fluoroquinolones, the question of supplementing empirical therapy with moxifloxacin, an appropriate antibacterial drug that is active against Neisseria gonorrhoeae, should be addressed.

Effect on the ability to drive transp. cf. and fur:Fluoroquinolones, including moxifloxacin, can disrupt the ability of patients to drive a car and engage in other potentially hazardous activities,requiring increased attention and speed of psychomotor reactions, due to influence on the central nervous system and visual impairment.

Form release / dosage:Film-coated tablets 400 mg.

Packaging:

For 5 tablets in a contour mesh box made of PVC / PVDC / aluminum foil.

For 3 contour packs with instructions for use in a cardboard box.

Storage conditions:

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

Keep out of the reach of children.

Shelf life:

2 years.

Do not use after the expiration date.

Terms of leave from pharmacies:On prescription

Registration number:LP-002777

Date of registration:19.12.2014

Expiration Date:19.12.2019

The owner of the registration certificate:MLS Laboratories Private LimitedMLS Laboratories Private Limited India

Manufacturer: & nbsp

MSN Laboratories Private Limited India

Representation: & nbspSharan Pharma, LLCSharan Pharma, LLC

Information update date: & nbsp11.06.2018

Illustrated instructions

Instructions

Moxinsensioner (Moxispenser)