Included in the formulation
Included in the list (Order of the Government of the Russian Federation No. 2782-r of 30.12.2014):ONLS
АТХ:
B.01.A.A.07 Acenocoumarol
Pharmacodynamics:Derivative of dihydrogenic acid. Prevents coagulation, disrupting synthesis in the liver of prothrombin II (prothrombin), VII (proconvertin), IX (Christmass), X (Stuart-Prower) - vitamin K-dependent factors of blood coagulation.
Pharmacokinetics:After oral administration, it is absorbed in the digestive tract. The maximum concentration of the drug in the blood plasma is achieved after 3 hours. It binds to plasma proteins by 99%. When you re-receive cumulates. Passes through the placental barrier, enters the breast milk.
Half-Elimination (half-life) of the drug is 8-9 hours. Metabolised in the liver. Elimination of 60% kidney, in the form of metabolites, 40% - with feces.
The increase in prothrombin time and prothrombin index does not depend on the concentration of the drug in the blood plasma.
Indications:It is used for thrombosis, thrombophlebitis, myocardial infarction, with the aim of preventing thromboembolic complications after surgical interventions.
IX.I20-I25.I21 Acute myocardial infarction
IX.I20-I25.I25.2 Postponed myocardial infarction
IX.I70-I79.I74 Embolism and thrombosis of the arteries
Contraindications:Hemorrhagic diathesis, renal and hepatic insufficiency, malignant neoplasms, hypoprothrombinemia (below 70%), hemorrhagic stroke, threatening miscarriage, peptic ulcer and duodenal ulcer, postpartum preeclampsia and eclampsia, pericarditis, post-lumbar puncture, organ biopsies.
Individual intolerance.
Carefully:Physical exhaustion, hypovitaminosis C. Women of childbearing age in a state where pregnancy is not excluded.
Dosing and Administration:The dose of the drug depends on the initial indices of hemostasis. By the standard scheme is prescribed inside: the first day 6-8 mg per day, then up to 4 mg per day with prothrombin time in the range of 2-3.5 seconds. It is taken once a day at the same time.
The highest daily dose: 16 mg.
The highest single dose: 16 mg.
Side effects:Central and peripheral nervous system: headache.
Blood coagulation system: hemorrhages on the skin and mucous membranes, petechiae, post-traumatic hematomas, metrorrhagia, hemarthroses.
Digestive system: dyspeptic disorders, diarrhea.
Skin: alopecia, necrosis, "purple stop".
Allergic reactions.
Overdose:Hemorrhagic diathesis, epistaxis, bleeding gums, metrorrhagia, hematuria.
Treatment: intravenous administration of 5-10 mg of phytomenadione (vitamin K), transfusion of freshly frozen blood plasma: 10-15 ml / kg of weight.
Interaction:The effect of the drug is reduced when eating foods containing vitamin K: cauliflower, lettuce, liver, green peas, soy.
Acenocoumarol enhances the effect of oral hypoglycemic drugs, ulcerogenic effects of glucocorticoids, toxic effects of phenytoin.
Strengthen the effect of the drug some antibiotics: aminoglycosides, macrolides, tetracyclines, fluoroquinolones. The following preparations also increase the effect of acenocoumarol: cimetidine, tamoxifen, glucagon, non-steroidal anti-inflammatory drugs, metronidazole, methyldopa, pentoxifylline.
Weaken the effects of acenocoumarol: barbiturates, oral contraceptives, ascorbic acid, antihistamines.
Special instructions:Monitoring of hemostasis, control of general urine analysis.
Patients receiving acenocoumarol, intramuscular injections should be avoided.
The drug is withdrawn gradually, since there is a risk of thrombus formation.