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

Core: corn starch - 32,70 mg, microcrystalline granulated cellulose - 22,35 mg, crospovidone - 18,75 mg, povidone 25 - 3,95 mg, magnesium stearate - 3,75 mg, silicon dioxide colloid - 2,50 mg Mass of the core - 375.00 mg.

Sheath: opadrai white 06F28313 - 15.00 mg (hypromellose 15-4,000 mg, hypromellose 5-4.875 mg, macrogol 4000-2.625 mg, titanium dioxide 3.500 mg).

Nominal tablet weight - 390.00 mg

Description:

Round, biconvex tablets, film-coated, white or almost white.

Pharmacotherapeutic group:Antimicrobial agent, fluoroquinolone.

ATX: & nbsp

J.01.M.A.02 Ciprofloxacin

Pharmacodynamics:

The broad-spectrum antimicrobial agent, a quinolone derivative, inhibits bacterial DNA gyrase (topoisomerases II and IV, responsible for the process of supercoiling the chromosomal DNA around nuclear RNA when reading genetic information), disrupts DNA synthesis, grows and divides bacteria, causes marked morphological changes (in t.h, cell wall and membranes) and rapid death of a bacterial cell.

It acts bactericidal on gram-negative microorganisms during rest and division (since it affects not only DNA-gyre, but also causes lysis of the cell wall), gram-positive microorganisms only during the fission period. Low toxicity for macroorganism cells is explained by the absence of DNA-gyrase in them. While receiving ciprofloxacin occurs parallel generating resistance to other antibiotics, does not belong to the group of gyrase inhibitors, which makes it highly effective against bacteria which are resistant, such as aminoglycosides, penicillins, cephalosporins, tetracyclines.

Gram-negative aerobic bacteria are sensitive to ciprofloxacin: enterobacteria (Escherichia coli, Salmonella spp., Shigella spp., Citrobacter spp., Klebsiella spp., Enterobacter spp., Proteus mirabilis, Proteus vulgaris, Serratia marcescens, Hafnia alvei, Edwardsiella tarda, Providencia spp. , Morganella morganii, Vibrio spp., Yersinia spp :), other gram-negative bacteria (Haemophilus spp., Pseudomonas aeruginosa, Moraxella catarrhalis, Aeromonas spp., Pasteurella multocida, Plesiomonas shigelloides, Campylobacter jejuni, Neisseria spp.); some intracellular pathogens: Legionella pneumophila, Brucella spp., Mycobacterium tuberculosis, Mycobacterium kansasii; Gram-positive aerobic bacteria: Staphylococcus spp. (Staphylococcus aureus, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus), Streptococcus spp. (Streptococcus pyogenes, Streptococcus agalactiae). The majority of staphylococci, resistant to methicillin, are resistant to ciprofloxacin.

The sensitivity of Bacillus anthracis, Streptococcus pneumoniae, Enterococcus faecalis, Mycobacterium avium, located intracellularly-moderate (their suppression requires high concentrations).

Ciprofloxacin is resistant: Bacteroides fragilis, Pseudomonas cepacia, Pseudomonas maltophilia, Ureaplasma urealyticum, Clostridium difficile, Nocardia asteroides, Listeria monocytogenes. Resistance develops very slowly, because on the one hand, after the action of ciprofloxacin are left with persistent microorganisms, and on the other - the bacterial cells do not have the enzymes that inactivate it.

Low effective against pneumococcus Streptococcus pneumoniae.

Not effective against Treponema pallidum.

Pharmacokinetics:

When taken orally, it is quickly and fairly fully absorbed from the gastrointestinal tract (GIT), mainly in the 12-finger and jejunum. Eating slows down absorption, but does not change the maximum concentration (C_max) and bioavailability. Bioavailability is 50-85%, the volume of distribution is 2-3.5 l / kg, the connection with plasma proteins is 20-40 %. Time to reach the maximum concentration of the drug in the blood (TS_max) with oral intake - 60-90 min; FROM_max linearly depends on the value of the dose taken and is at doses of 0.25, 05, 0.75 and 1 g, respectively, 1.2; 2.4; 4,3 and 5,4mkg / ml. 12 hours after ingestion of 0.25, 0.5 and 0.75 g the concentration of the drug in the plasma is reduced to 0.1; 0.2 and 0.4 μg / ml, respectively.

Well distributed in the tissues of the body, excluding tissue that is rich in fats, for example, nerve tissue. Concentration in tissues is 2-12 times higher than in plasma. Therapeutic concentrations achieved in saliva, tonsil, liver, gallbladder, bile, intestine, abdominal and pelvic (endometrium, fallopian tubes and ovaries, uterus), semen, prostate tissue, kidney and urinary organs, lung tissues, bronchial secretions , bone tissue, muscles, synovial fluid and articular cartilage, peritoneal fluid, skin. The cerebrospinal fluid penetrates in a small amount where its concentration in the absence of inflammation of the meninges is 6-10% of that in the serum and in inflammation of the meninges -14-37%.

Ciprofloxacin well penetrates also into the eye fluid, pleura, peritoneum, lymph, through the placenta. The concentration of ciprofloxacin in blood neutrophils is 2-7 times higher than in blood serum.

The activity is somewhat reduced at pH values less than 6.

Metabolised in the liver (15-30%) with the formation of low-activity metabolites (diethylciprofloxacin, sulfociprofloxacin, oxocycloploxacin, formyl ciprofloxacin).

The half-life period (T1 / 2) is about 4 hours, with chronic renal failure (CRF) up to 12 hours. It is mainly excreted by the kidneys by tubular filtration and tubular secretion in unchanged form (40-50%) and in the form of metabolites ( 15%), the rest - through the gastrointestinal tract. A small amount is excreted in breast milk.

Kidney clearance - 3-5 ml / min / kg; total clearance - 8-10 ml / min / kg.

In chronic renal failure (creatinine clearance (CK) above 20 ml / min), the percentage of ciprofloxacin excreted through the kidneys decreases, but cumulation in the body does not occur due to a compensatory increase in the metabolism of the drug and excretion through the gastrointestinal tract.

Indications:

Uncomplicated and complicated infections and inflammatory diseases caused by microorganisms susceptible to ciprofloxacin:

Adults

diseases of the lower respiratory tract (acute and chronic (at the stage of exacerbation) bronchitis, pneumonia, bronchiectatic disease, infectious complications of cystic fibrosis);
infection of ENT organs (acute sinusitis, chronic purulent otitis media of the middle ear);
infection of the kidneys and urinary tract (cystitis, pyelonephritis, chronic bacterial prostatitis);
Complicated intra-abdominal infections (in combination with metronidazole), including, peritonitis;
typhoid fever, campylobacteriosis, shigellosis, diarrhea of "travelers";
uncomplicated gonorrhea;
infections of the skin and soft tissues (infected ulcers, wounds, burns, abscesses, phlegmon);
infection of bones and joints (osteomyelitis, septic arthritis);
septicemia; infection or prevention of infections in patients on the background of immunodeficiency, which occurs with the treatment of immunosuppressive drugs or in patients with neutropenia;
prevention and treatment of pulmonary form of anthrax.

Children

treatment of complications caused by Pseudomonas aeruginosa, in children with cystic fibrosis of the lungs from 5 to 17 years;
prevention and treatment of pulmonary form of anthrax (infection with Bacillus anthracis).

Contraindications:

Increased sensitivity to ciprofloxacin or other drugs from the group of fluoroquinolones, as well as to auxiliary substances; simultaneous reception with tizanidine (risk of pronounced reduction in blood pressure, drowsiness); pseudomembranous colitis; children under 18 years of age (except for the treatment of complications caused by Pseudomonas aeruginosa in children with cystic fibrosis of the lungs from 5 to 17 years old, and prevention and treatment of pulmonary form of anthrax); pregnancy; lactation period.

Carefully:

Severe atherosclerosis of the cerebral vessels, cerebral circulation disorder, congenital QT interval prolongation syndrome, heart disease (heart failure, myocardial infarction, bradycardia), electrolyte imbalance (eg, hypokalemia, hypomagnesemia), simultaneous administration of drugs prolonging the QT interval (in t (antiarrhythmics of IA and III classes), simultaneous application with inhibitors of CYP450 1A2 enzymes (incl. theophylline, methylxanthine, caffeine, duloxetine, clozapine); patients with a history of indications of tendon diseases associated with the administration of quinolones; mental illness, convulsions, epilepsy; marked renal and / or liver failure; elderly age.

Pregnancy and lactation:

Available limited data on the use of ciprofloxacin in pregnant women do not confirm the presence of embryotoxic and teratogenic effects of the drug. Studies in animals have not detected direct and indirect reproductive toxicity. However, a study of the effect of quinolones on fetuses / calves, carried out on experimental animals, revealed damage to immature cartilaginous tissue.Thus, it is impossible to exclude the negative effect of the drug on the fetus / newborn. In this regard, it is not recommended to take the drug Tsifloksinal® during pregnancy.

Ciprofloxacin penetrates into breast milk. Taking into account the potential risk of exposure to cartilaginous tissue, it is also not recommended to take Cyfloxinal® during breastfeeding.

Dosing and Administration:

Inside. Tablets should be swallowed whole, washed down with a large amount of liquid, regardless of at the same time. When taking a tablet on an empty stomach, the active substance is absorbed more quickly.

If you miss a drug, do not take a double dose to compensate for the missed, but you need to continue taking the prescribed schedule.

Adults

For infections of the lower respiratory tract of mild and moderate degree - 0.5 g 2 times a day, in severe cases - 0.75 g 2 times a day. The course of treatment is 7-14 days.

With an infection of the ENT organs - 0.5-075 g 2 times a day. The course of treatment is 7-14 days.

For infections of the skin and soft tissues of mild and moderate degree - 0.5 g 2 times a day, in severe cases - 0.75 g 2 times a day. The course of treatment is 7-14 days.

For infections of bones and joints - light and medium degree - 0.5 g 2 times a day, in severe cases - 0.75 g 2 times a day. The course of treatment - up to 4-6 weeks, maximum - up to 12 weeks.

With infections of the urinary tract: with uncomplicated cystitis - 0.25-0.5 g 2 times a day, treatment course - 3 days (for women before menopause appoint 0.5 g per day); with complicated cystitis and uncomplicated pyelonephritis - 0.5 g 2 times a day, treatment course - 7 days; with complicated pyelonephritis - 0,5-0,75 g 2 times a day, the course of treatment - at least 10 days, with a severe course of the disease, treatment can last up to 21 days or more; with prostatitis - 0,5-0,75 g 2 times a day, the course of treatment - from 14 days (acute prostatitis) to 4-6 weeks (chronic prostatitis).

With infections of the genitals: with uncomplicated gonorrhea - 0.5 g once; with epididymitis-orchitis - 0.5-0.75 g 2 times a day, the course of treatment - at least 14 days.

With diarrhea "travelers" - 0.5 g 1-2 times a day.

With infectious diarrhea - 0.5 g 2 times a day, the course of treatment - 5-7 days.

With typhoid fever - 0.5 g 2 times a day; course of treatment - 7-10 days.

For complicated intra-abdominal infections, 0.5-0.75 g every 12 hours for 5-14 days.

For the prevention and treatment of infections in patients with neutropenia - 0.5-0.75 g 2 times a day.The course of treatment - throughout the neutropenia period.

For the prevention and treatment of pulmonary form of anthrax - 0.5 g 2 times a day for 60 days.

For the prevention of invasive infections - 0.5 g, once.

In the treatment of elderly patients, the lowest possible doses of ciprofloxacin should be used, based on the severity of the disease and the clearance of creatinine (CC).

For patients with impaired liver function, there is no need to adjust the dosage.

In patients with chronic renal failure: with QC more than 60 ml / min dose adjustment is not required; with KK 30-60 ml / min - 0.25-0.5 g every 12 hours; with KK 5-29 ml / min - 0.25-0.5 g every 24 hours. If the patient undergoes hemodialysis or peritoneal dialysis - 0.25-0.5 g / day, but take the drug should be after the hemodialysis session.

Children

When treating complications caused by Pseudomonas aeruginosa, in children with cystic fibrosis of the lungs from 5 to 17 years - 20 mg / kg 2 times a day (maximum single dose of 0.75 g), treatment course - 10-14 days; with pulmonary form of anthrax (prevention and treatment) - 10-15 mg / kg 2 times a day. The maximum single dose is 0.5 g. The course of treatment is not less than 60 days.

The dosage regimen in children with renal and hepatic insufficiency has not been studied.

Side effects:

Frequency of occurrence of side effects (number of cases / number of observations): very often (≥ 1/10); often (≥ 1/100 to <1/10); infrequently (≥ 1/1000 to <1/100); rarely (≥ 1/10000 to <1/1000); very rarely (<1/10 000).

From the nervous system: infrequently - dizziness, headache, insomnia, anxiety, confusion; rarely - migraine, hallucinations, sweating, paresthesia, anxiety, nightmares, depression, tremors, convulsions, hypesthesia; very rarely - hyperesthesia, psychosis, pronounced seizures, increased muscle tone, increased intracranial pressure, ataxia.

From the digestive system: often - nausea, diarrhea; infrequently - vomiting, abdominal pain, flatulence, dyspepsia, anorexia; rarely - candidiasis of the oral cavity, jaundice, including cholestatic, pseudomembranous colitis; very rarely - candidiasis, hepatitis, necrosis of liver tissue (in extremely rare cases progressing to life-threatening liver failure), life-threatening pseudomembranous colitis with possible fatal outcome, pancreatitis.

From the cardiovascular system: rarely - tachycardia, a sensation of "tide" of blood to the face, hypotension, fainting; very rarely - vasculitis, exacerbation of myasthenia gravis symptoms.

On the part of the respiratory system: rarely - dyspnoea, swelling of the larynx.

From the sense organs: infrequently - a taste disorder; rarely - noise in the ears, temporary hearing impairment, visual impairment (diplopia, color perception disorder); very rarely - parosmia, anosmia.

From the hematopoietic system: infrequently - eosinophilia; rarely - leukopenia, anemia, leukocytosis, increase or decrease in the level of prothrombin, thrombocytopenia, thrombocytosis; very rarely - hemolytic anemia, pancytopenia (including life-threatening), agranulocytosis, in extremely rare cases, life-threatening bone marrow depression.

From the urinary system: infrequently - increased levels of creatinine and urea nitrogen; rarely - acute renal failure, vaginal candidiasis, hematuria, crystalluria, interstitial nephritis.

From the musculoskeletal system: infrequently - arthralgia; rarely - myalgia, swelling of the joints; very rarely - tendonitis (predominantly Achilles tendons), partial or complete rupture of tendons (mainly Achilles), exacerbation of myasthenia gravis symptoms.

From the skin: infrequently - a rash, itching, hives; rarely photosensitivity reactions; very rarely - point hemorrhages on the skin (petechiae), multiform erythema, nodular erythema,Stevens-Johnson syndrome (malignant exudative erythema), Lyell's syndrome (toxic epidermal necrolysis), persistent rashes on the skin.

Allergic reactions: rarely - edema, angioedema; very rarely - skin rash, similar to serum sickness, anaphylactic shock.

From the laboratory indicators: infrequently - increased activity of "hepatic" transaminases (alanine aminotransferase, aspartate aminotransferase), alkaline phosphatase, hyperbilirubinemia; rarely - hyperglycemia; very rarely - increased activity of amylase, lipase.

Other: rarely - pain in the back, in the chest, peripheral edema.

Overdose:

Nonspecific symptoms of overdose are: dizziness, tremor, headaches, fatigue, seizures, hallucinations, confusion, abdominal discomfort, decreased kidney and liver function, crystalluria, hematuria, and reversible renal toxicity.

Treatment: recommended gastric lavage and other emergency measures, careful monitoring of the patient's condition, ensuring sufficient fluid flow into the body. It should be monitored for the functional activity of the kidneys,including urine pH, if necessary, measures should be taken to increase the acidity of urine (prevention of crystalluria). With the help of hemo- or peritoneal dialysis, only a small (less than 10%) amount of ciprofloxacin can be excreted.

The specific antidote is not known.

Interaction:

Due to a decrease in the activity of microsomal oxidation in hepatocytes ciprofloxacin increases the concentration and prolongs the half-life (T1) of theophylline and other xanthines, for example, caffeine, oral hypoglycemic drugs, indirect anticoagulants, helps to reduce the prothrombin index.

When combined with other antimicrobial drugs (beta-lactam antibiotics, aminoglycosides, clindamycin, metronidazole) synergy is usually observed; can be successfully used in combination with azlocillin and ceftazidime in infections caused by Pseudomonas spp .; with mezlocillin, azlocillin and other beta-lactam antibiotics - with streptococcal infections; with isoxazolylpenicillins and vancomycin - with staphylococcal infections; with metronidazole and clindamycin - with anaerobic infections.

Simultaneous reception of ciprofloxacin with iron-containing drugs, sucralfate, antacids and preparations with a large buffer capacity (for example, antiretroviral, didanosine), containing ions of magnesium, calcium and aluminum, leads to a decrease in absorption of ciprofloxacin, therefore it should be prescribed 1 to 2 hours before or 4 hours after the administration of the above medicines. This restriction does not apply to antacids belonging to the class of blockers H₂receptors.

It is not recommended simultaneous reception of ciprofloxacin with food additives, dairy products and beverages enriched with minerals, which also reduces the absorption of ciprofloxacin.

Simultaneous use of ciprofloxacin with probenecid results in an increase in plasma concentrations of ciprofloxacin (probenecid slows the rate of ciprofloxacin excretion by the kidneys).

The simultaneous use of ciprofloxacin with methotrexate is not recommended: ciprofloxacin slows the tubular transport (renal metabolism) of methotrexate, leading to an increase in plasma concentrations of methotrexate. This may increase the likelihood of side effects of methotrexate.

The simultaneous use of duloxetine and potent inhibitors of the isoenzyme CYP450 1A2 (such as fluvoxamine) can lead to an increase in the minimum inhibitory concentration (MIC) and C_max duloxetine.

The combination of very high doses of quinolones and some non-steroidal anti-inflammatory drugs, excluding acetylsalicylic acid, can provoke convulsions. Ciprofloxacin increases the nephrotoxic effect of cyclosporine: a short-term increase in the concentration of creatinine in the blood plasma. Such patients need control of this indicator 2 times a week.

The simultaneous use of ciprofloxacin and warfarin may lead to an increase in the effect of the latter.

With simultaneous application increases the effect of indirect anticoagulants, therefore it is often necessary to monitor the international normalized ratio (INR) during co-administration with ciprofloxacin and for a short time after completion of the combination therapy.

When used simultaneously with drugs that extend the QT interval (antiarrhythmic IA and III classes), an extension of the RT interval is possible.

In some cases, the simultaneous use of ciprofloxacin and glibenclamide can enhance the effect of glibenclamide (hypoglycemia).

Metoclopramide accelerates the absorption of ciprofloxacin, shortening the time period necessary to achieve its maximum concentration in the blood plasma. In this case, the bioavailability of ciprofloxacin does not change.

With simultaneous use with ciprofloxacin, a decrease or increase in the concentration of phenytoin in the blood plasma is possible. The interaction is ambiguous. The results of the clinical study indicate that the simultaneous use of ciprofloxacin and ropinirole, the average force of the inhibitor of the isoenzyme CYP450 1A2, leads to an increase in the values of C_max and AUC of ropinirole (area under the concentration-time curve) by 60% and 84%, respectively. It is necessary to monitor the side effects of ropinirole during its joint with ciprofloxacin and for a short time after the completion of the combination therapy.

After a seven-day simultaneous administration of ciprofloxacin with clozapine, an increase in the concentration of clozapine and N-desmethylclozapine in serum by 29% and 31%respectively (correction of the dosage regimen of clozapine during its simultaneous use with ciprofloxacin and a short time after completion of the combination therapy is necessary).

With simultaneous use of ciprofloxacin in a dose of 0.5 g and sildenafil at a dose of 0.05 g there was an increase in C_max and IPC sildenafil in 2 times (the application of this combination is possible only after the evaluation of the benefit / risk ratio).

Simultaneous use of ciprofloxacin and theophylline may cause an undesirable increase in the concentration of theophylline in the crock plasma and, accordingly, the occurrence of theophylline-induced side effects; in very rare cases, these side effects can be life threatening to the patient. If the simultaneous use of these two drugs is inevitable, it is recommended that continuous monitoring of the level of theophylline in the blood plasma and, if necessary, reduce the dose of theophylline. Simultaneous use of uricosuric medicines leads to a delay in excretion (up to 50 %) and increased plasma concentrations of ciprofloxacin. With the simultaneous use of ciprofloxacin and omeprazole, there may be a slight decreasemaximum concentration of ciprofloxacin in the blood plasma and a decrease in the area under the concentration-time curve.

Ciprofloxacin increases C_max in 7 times (the range of increase from 4 to 21 times) and AUC in 10 times (the range of increase from 6 to 24 times) of tizanidine, which leads to a marked decrease in blood pressure and drowsiness.

Special instructions:

It was found that ciprofloxacin, like other drugs of this class, causes arthropathy of large joints in animals. When analyzing the current data on the safety of the use of ciprofloxacin in children under 18 years old, most of whom suffer from cystic fibrosis of the lungs, there is no association between cartilage damage and joints with drug administration. It is not recommended to use ciprofloxacin in children for the treatment of other diseases, except for the treatment of complications of cystic fibrosis of the lungs (in children from 5 to 17 years) associated with Pseudomonas aeruginosa, and for the treatment and prevention of pulmonary anthrax form (after the alleged or proven infection with Bacillus anthracis).

In the treatment of severe infections, staphylococcal infections and infections caused by anaerobic bacteria, ciprofloxacin should be used in combination with appropriate antibacterial agents.

For outpatient treatment of patients with pneumonia caused by bacteria of the genus Pneumococcus, ciprofloxacin Do not use as a drug of first choice.

For infections suspected to be caused by Neisseria gonorrhoeae resistant to fluoroquinolones, local information on ciprofloxacin resistance should be taken into account and the sensitivity of the causative agent in laboratory tests should be confirmed.

In some cases, symptoms from the central nervous system (CNS) can be observed immediately after the first dose of ciprofloxacin. In rare cases, depression or psychosis can progress to a state that poses a danger to the life and health of the patient. In connection with the threat of the development of adverse reactions from the central nervous system ciprofloxacin should be used only in those cases when the expected clinical effect exceeds the possible side effect of the drug. Ciprofloxacin is a moderate inhibitor of CYP450 1A2 isoenzymes. Caution should be exercised with the simultaneous use of ciprofloxacin and drugs metabolized by these enzymes (including theophylline, methylxanthine, caffeine, duloxetine, clozapine), sincean increase in the concentration of these drugs in the blood serum, caused by the inhibition of their metabolism by ciprofloxacin, can cause specific undesirable reactions.

If a severe and prolonged diarrhea occurs during or after treatment with ciprofloxacin, the diagnosis of pseudomembranous colitis should be ruled out, which requires immediate discontinuation of the drug and the appointment of appropriate treatment (vancomycin inside in a dose of 250 mg 4 times a day).

If pain occurs in the tendons or when the first signs of tendovaginitis appear, ciprofloxacin treatment should be discontinued.

To avoid the development of crystalluria, exceeding the recommended daily dose of the drug is inadmissible, it is also necessary to ensure the intake of a sufficient amount of liquid and the maintenance of acidic urine reactions.

Patients with epilepsy, seizures history of seizures, vascular diseases and organic brain lesions due to the risk of developing adverse reactions CNS ciprofloxacin should be prescribed only for "vital" indications. Contraindicated simultaneous use of ciprofloxacin with drugs that suppress the intestinal motility.

Patients, especially those suffering from liver disease, may experience cholestatic jaundice, as well as a temporary increase in hepatic transaminase and alkaline phosphatase activity.

Compliance with the appropriate dosing regimen is required when administering the drug to patients with renal and hepatic insufficiency, as described in the section "Dosing and Administration".

Sometimes, after taking the first dose of ciprofloxacin, allergic reactions can occur. In very rare cases - anaphylactic shock. Ciprofloxacin should be discontinued immediately and treated accordingly.

In elderly patients with tendon diseases or previously treated with glucocorticosteroids, tendon rupture (predominantly Achilles tendon) can occur.

During treatment with ciprofloxacin, direct sunlight and UV irradiation should be avoided in the solarium, as photosensitivity reactions may occur. In such cases, treatment should be discontinued.

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

In connection with the possible development of adverse neurological effects during treatment with ciprofloxacin should be refrained from practicing potentiallydangerous activities that require increased attention and speed of psychomotor reactions, especially when used concomitantly with alcohol.

Form release / dosage:

Tablets, film-coated, 250 mg.

Packaging:

For 10 tablets, film-coated, in a blister of PVC / aluminum foil.

1 or 2 blisters together with instructions for medical use are placed in a cardboard box.

Storage conditions:

In a dry, dark place at a temperature of 15-25 ° C.

Keep out of the reach of children!

Shelf life:

3 years.

Do not use after the expiration date!

Terms of leave from pharmacies:On prescription

Registration number:П N014615 / 01-2002

Date of registration:11.12.2008

The owner of the registration certificate:PRO.MED.CS Prague as.PRO.MED.CS Prague as. Czech Republic

Manufacturer: & nbsp

PRO.MED.CS Praha, a.s. Czech Republic

Information update date: & nbsp19.10.2015

Illustrated instructions

Instructions

Cyfloxinal® (Cifloxinal®)