Before the start of therapy, a thorough history review should be made for possible sensitization to penicillins and / or other beta-lactam antibiotics.When treating the drug can be severe (up to the development of anaphylactic shock), and sometimes fatal allergic reactions. The patient should be informed of the possible symptoms of allergies and the need to immediately inform the doctor of their occurrence. In case of allergic reactions, the drug should be discontinued immediately and, if necessary, symptomatic therapy should be prescribed.
In 5-10% of cases, allergic reactions to penicillin can be crossed with allergic reactions to cephalosporins. In connection with this, when indicating in an anamnesis, allergic reactions to cephalosporins are contraindicated in the use of penicillins.
Special care should be taken with regard to the following patient groups:
- patients with bronchial asthma, skin allergic rash have an increased risk of hypersensitivity reactions. Such patients should remain under medical supervision, at least 30 minutes after the injection of the drug. In case of allergic reactions, the drug should be withdrawn, if necessary, symptomatic and / or anti-shock therapy is indicated;
- patients with renal and / or liver failure (see also section "Dosing and Administration");
- patients with concomitant dermatomycosis (possible the development of parallergic reactions).
In the treatment of syphilis, due to the massive lysis of bacteria and the release of endotoxins, the Yarisch-Gerxheimer reaction (fever, chills, other common and local symptoms) may develop. The patient should be informed of the possibility of this reaction, in case of its occurrence, appropriate symptomatic therapy should be carried out.
In patients with diabetes mellitus, due to impaired peripheral circulation, it is possible to slow the absorption of the drug into the systemic circulation.
The drug Retarpen® should not be introduced into tissues with compromised perfusion. Do not administer subcutaneously, intravenously, endolumbally, or in the body cavity.
Periodic monitoring of kidney function and peripheral blood pattern should be performed.
In case of accidental subcutaneous injection, a painful compaction may occur at the site of administration. Soreness may decrease after applying ice to the injection site.
With occasional intravascular administration of the drug, there may be a transient sense of anxiety and visual impairment (Hoin's syndrome). Symptoms usually last for an hour. If the symptoms are severe, sedation may be necessary.
Against the background of the use of the drug, the development of the Nikolaus syndrome, acute drug embolism of the skin vessels is possible. The Nicolau syndrome is a rare complication arising from intramuscular injection of drugs, whose manifestations include necrosis of the skin and / or underlying tissues of varying severity. With occasional intra-arterial administration of the drug, especially in children, serious complications can occur, such as arterial thrombosis and tissue necrosis (gangrene). The initial manifestations of these complications may be pale "spots" on the skin of the gluteal region. As a result of high pressure at the injection site, a retrograde transfer of the drug to the common iliac artery, aorta, or spinal arteries can be observed.
In children and adolescents, the peripheral region of the outer upper quadrant of the buttock should be used to administer the drug only in exceptional cases (for example, with common burns) in order to avoid damage to the sciatic nerve.
In order to avoid accidental intravascular injection of the drug, it is recommended to perform aspiration before intramuscular injection to detect a possible needle drop into the vessel.
Rubbing the buttocks after the injection is not recommended.
When treating venereal diseases, if there is a suspicion of syphilis, darkfield microscopy should be performed before the start of therapy and then serological tests should be performed within 4 months. In the case of congenital syphilis, the cerebrospinal fluid (CSF) should also be examined. If involvement of the CNS (neurosyphilis) can not be ruled out, other penicillin preparations that penetrate CSF better should be used.
In severe purulent-inflammatory diseases (severe pneumonia, empyema, sepsis, meningitis, peritonitis), drugs are required that create a higher concentration of benzylnenicillin in the blood plasma. Use water-soluble salts of the drug.
In case of severe, persistent diarrhea, pseudomembranous colitis should be suspected (possible symptoms - a watery stool with blood / mucus contamination, tenesmus, diffuse abdominal pain, fever).This condition can be life threatening, therapy with Retarpen® should be immediately canceled, appropriate therapy based on the sensitivity of the detected pathogen (for example, vancomycin inside 250 mg, 4 times a day). Drugs that inhibit the intestinal peristalsis are contraindicated.
In connection with the possibility of developing fungal lesions, it is advisable to use vitamin B and vitamin C in the treatment with benzylpenicillin. In case of suspected development of fungal infection, the use of antifungal drugs, for example, nystatin or levorin, is indicated according to the current instructions for the use of these medicines.
The sodium content of 1200000 ME of the drug is 11.0 mg or 0.48 mmol, at 2,400,000 ME - 22.0 mg or 0.96 mmol, which should be taken into account when carrying out hyposalt diet.
It should be borne in mind that the use of the drug in insufficient doses or too early cessation of treatment often leads to the emergence of resistant strains of pathogens.
The possibility of the emergence of resistant strains of pathogens should be considered in long-term treatment.If secondary infections (superinfections) occur, appropriate measures should be taken.
It is impossible to exclude (in very rare cases) the possibility of accumulating povidone (an auxiliary substance in the formulation) in the reticuloendothelial system, followed by the development of a granuloma, from which, subsequently, tumors can develop.