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

Excipients: trometamol (tromethamine) -1.21 mg; sodium calcium edetate (calcium edetate disodium salt) - 0.10 mg; 1 M solution of hydrochloric acid - to pH 6.8-7.6; water for injection - up to 1 ml.

Physicochemical characteristics

Yogexol is a nonionic, monomeric, triiodinated, water-soluble radiocontrast agent, the pH of the preparation is 6.8-7.6.

The osmolality and viscosity of Yogexol are listed below:

Concentration	Osmolality (Osm / kg H₂ABOUT) 37 ° C	Viscosity (mRa^.from)
Concentration	Osmolality (Osm / kg H₂ABOUT) 37 ° C	20 ° С	37 ° C
240 mg iodine / ml	0,51	5,6	3,3
300 mg iodine / ml	0,64	11,6	6,1
350 mg iodine / ml	0,78	23,3	10,6

Description:

Transparent, colorless or slightly yellowish solution.

Pharmacotherapeutic group:X-ray contrast medium

ATX: & nbsp

V.08.A Radiocontrast iodine-containing substances

Pharmacodynamics:

Yogexol is a nonionic low-osmolar iodine-containing radiopaque preparation. Time to achieve maximum radiopaque in normal myelography - up to 30 min. With computed tomography, radiocontrast imaging in the thoracic region is possible within 1 hour, the cervical region - about 2 hours, basal cisterns - 3-4 hours. Radiocontrastation of articular cavities, uterine cavity, fallopian tubes, peritoneal protrusions, pancreatic and biliary ducts, bladder is achieved immediately after administration.

Pharmacokinetics:

Almost 100% of injected yogexol is excreted unchanged through normally functioning kidneys within 24 hours. The maximum concentration of iohexol in the urine is determined approximately 1 hour after the injection.

The half-life of the drug in patients with normal renal function is about 2 hours. There are no metabolites of the drug.The binding of yogexol to plasma proteins is so small (less than 2%) that it has no clinical significance.

Indications:

Yogexol is intended only for diagnostic purposes.

Radiopaque means for use in children and adults, designed to perform:

- cardioangiography, arteriography, urography, phlebography and radiopaque enhancement in computed tomography (CT);

- lumbar, thoracic and cervical myelography;

- CT-cisternography after subarachnoidal administration;

- arthrography, endoscopic retrograde pancreatography (ERGG), endoscopic retrograde cholangiopancreatography (ERCP), hysterosalpingography, herniography, sialography and gastrointestinal tract research.

Contraindications:

Hypersensitivity to the active substance or any auxiliary component of the drug; clinically manifested thyrotoxicosis.

Carefully:

When using non-ionic radiocontrast agents, care should be taken:

- if there is a history of allergy, bronchial asthma or other undesirable reactions to iodine-containing radiopaque agents.Premedication with glucocorticosteroids or H blockers is recommended.₁-gistaminovyh receptors;

- in the study of patients with severe cardiovascular diseases and pulmonary hypertension due to the risk of developing hemodynamic disorders or arrhythmias;

- in the study of patients with acute cerebral pathology, tumors or epilepsy in the anamnesis in connection with the predisposition of this category of patients to convulsions. The risk of seizures and neurological reactions is also increased in patients with alcoholism or drug dependence;

- in the study of patients with severe combined disorders of the liver and kidneys, since they significantly reduced the clearance of radiocontrast agents;

- to prevent the development of acute renal failure after the introduction of radiopaque means should pay special attention to patients at increased risk of kidney failure and diabetes, as well as patients with paraproteinaemia (myelomatosis and macroglobulinemia Waldenstrem);

- in the study of patients with pheochromocytoma, myasthenia gravis, pollinosis, food allergy, multiple sclerosis, sickle cell anemia,obliterating thromboangiitis, acute thrombophlebitis, severe atherosclerosis;

- in the study of patients with hyperthyroidism. In patients with multinodular goitre after the introduction of iodine-containing radiocontrast agents, there is a risk of developing hyperthyroidism. With the introduction of radiopaque means for premature infants, consideration should be given to the possibility of developing transient hyperthyroidism;

- when examining patients with hypovolemia, adequate rehydration should be provided, at least 100 ml every hour for four hours before the study and 24 hours after the test;

- in the study of patients with multiple myeloma, diabetes mellitus, impaired renal function, newborns, children under one year and elderly patients, adequate rehydration should be carried out before and after the administration of the radiopaque. In emergency cases, when renal function is unknown, the physician should assess the risk / benefit ratio of using radiopaque: stop the use of metformin, rehydrate, monitor kidney function, monitor the appearance of the initial signs of lactic acidosis.

Pregnancy and lactation:

Yogexol should not be used in pregnant women, unless the expected benefit from its use for the mother exceeds the possible risk to the fetus and such a study is prescribed by the doctor as necessary.

Hysterosalpingography should not be performed in pregnant women and in the presence of acute pelvic peritonitis.

Radiopaque means are excreted to breast milk and are minimally absorbed in the intestines, so the likelihood of harm to the child during breastfeeding is unlikely. However, if you need to administer the drug, you should stop breastfeeding before you start the drug and do not resume at least 24 hours after the test.

Dosing and Administration:

General information

The drug is intended for intravascular (intra-arterial, intravenous), intrathecal, intracavitary, oral and rectal administration.

Like all preparations for parenteral administration, Yogexol Before use, it should be visually inspected for lack of insoluble particles, discoloration, and integrity of the package.

Yoghexol should be injected into the syringe immediately before use. Unused remnants of the drug for further use are not allowed.

Yogexol should not be mixed with other medicines (separate syringe and needle should be used).

When the drug is administered, the patient should be in a horizontal position. Within 30 minutes after the end of the procedure, the patient is monitored physically, since most adverse reactions occur during this period.

Intrathecal administration:

After performing myelography, the patient should be at rest for at least 1 hour, lying with a head raised by 20 °. If suspicion of a low threshold of seizures is necessary, follow up for 6 hours. Patients on an outpatient schedule should avoid tilting. Outpatient patients can not be left unattended in the first 24 hours after the administration of radiopaque.

The dosage of the drug depends on the type of study, the age and body weight of the patient, as well as the state of hemodynamics, the general state of health, as well as the methods used and the technique for performing the study.Typically, the same concentrations of iodine and the amounts of administration of the drug are used, as with other modern iodine-containing radiopaque agents.

The recommended dosage regimen is given in the table:

Indication / Examination	Concentration	Scope	Notes
Intravenous (iv) administration
Urography
Adults	300 mg iodine / ml or 350 mg iodine / ml	40-80 ml	In some cases, the administration of more than 80 ml
Children (body weight <7 kg)	240 mg iodine / ml	4 ml / kg
	or 300 mg iodine / ml	3 ml / kg
Children (body weight> 7 kg)	240 mg iodine / ml	3 ml / kg
	or 300 mg iodine / ml	2 ml / kg (not more than 40 ml)
Phlebography (lower limbs)	240 mg iodine / ml or 300 mg iodine / ml	20-100 ml / finiteness
Digital subtraction angiography	300 mg iodine / ml or 350 mg iodine / ml	20-60 ml per injection
CT scan			Total iodine is usually 30-60 g
Adults	240 mg iodine / ml	100-250 ml
	or 300 mg iodine / ml	100-200 ml
	or 350 mg iodine / ml	100-150 ml
Children	240 mg iodine / ml or	2-3 ml / kg of body weight - up to 40 ml	In rare cases, you can apply up to 100 ml per child, but no more
	300 mg iodine / ml	1-3 ml / kg body weight - up to 40 ml
Intraarterial (w / a) administration
Arteriography
Aortic arch	300 mg iodine / ml	30-40 ml per injection	The volume of injection depends on the site of administration
Selective cerebral angiography	300 mg iodine / ml	5-10 ml per injection
Aortography	350 mg iodine / ml	40-60 ml per injection
Femoral arteriography	300 mg iodine / ml or 350 mg iodine / ml	30-50 ml per injection
Other	300 mg iodine / ml	depends on the type of study
Cardioangiography
Adults
Left ventricle and aorta root	350 mg iodine / ml	30-60 ml per injection
Selective coronary angiography	350 mg iodine / ml	4-8 ml per injection
Children	300 mg iodine / ml or 350 mg iodine / ml	depending on age, weight and pathology (max 8 ml / kg)
Digital subtraction angiography	240 mg iodine / ml or 300 mg iodine / ml	1-15 ml per injection	Depending on the site of injection, large volumes (up to 30 ml)
Intrathecal administration
Lumbar and thoracic myelography (lumbar injection)	240 mg iodine / ml	8-12 ml
Cervical myelography (lumbar injection)	240 mg iodine / ml	10-12 ml
Cervical myelography (lumbar injection)	or 300 mg iodine / ml	7-10 ml
Cervical myelography (lateral cervical injection)	240 mg iodine / ml	6-10 ml
Cervical myelography (lateral cervical injection)	or 300 mg iodine / ml	6-8 ml
CT Cisternography (lumbar injection)	240 mg iodine / ml	4-12 ml
Myelography in children
< 2 years	Dilute with water until a concentration of about 180 mg iodine / ml	2-6 ml	Example: dissolve Yogexol 350 mg iodine / ml with water 1: 1
2-6 years		4-8 ml
> 6 years		6-12 ml
To minimize possible side reactions, the total dosage should not exceed 3 g.
Introduction to the body cavity
Arthrography	240 mg iodine / ml	5-20 ml
	or 300 mg iodine / ml	5-15 ml
	or 350 mg iodine / ml	5-10 ml
ERCP / ERGG	240 mg iodine / ml	20-50 ml
Gerniography	240 mg iodine / ml	50 ml	The dose depends on the size of the hernia
Hysterosalpingography	240 mg iodine / ml	15-50 ml
Hysterosalpingography	or 300 mg iodine / ml	15-25 ml
Sialografiya	240 mg iodine / ml or 300 mg iodine / ml	0.5-2 ml
Gastrointestinal tract examination
Orally Adults	240 mg iodine / ml or 350 mg iodine / ml	is selected individually
Children
-esophagus	300 mg iodine / ml or 350 mg iodine / ml	2-4 ml / kg body weight	Max, a dose of 50 ml
-stomach	Dilute with water to a concentration of about 140 mg iodine / ml	4-5 ml / kg body weight	Example: dilute Yogexol 240 mg iodine / ml, 300 mg iodine / ml with water 1: 1
Premature babies	350 mg iodine / ml	2-4 ml / kg body weight
Rectal administration
Children	Dilute with water to a concentration of about 100-150 mg iodine / ml	5-10 ml / kg body weight	Example: dilute Yogexol 240 mg iodine / ml, 300 mg iodine / ml with water 1: 1 or Yogexol 350 mg iodine / ml with water 1: 2
CT scan
Oral:
Adults	Dilute with water to a concentration of about 6 mg iodine / ml	800-2000 ml of diluted solution for one period of time	Example: dilute Yogexol 300 mg iodine / ml with water 1:50
Children	Dilute with water to a concentration of about 6 mg iodine / ml	15-20 ml / kg body weight diluted solution
Rectal administration:
Children	Dilute with water to a concentration of about 6 mg iodine / ml	individually	Example: dilute Yogexol 300 mg iodine / ml with water 1:50

Side effects:

Common Adverse Reactions (for all indications for the use of iodine-containing radiocontrast agents)

Hypersensitivity reactions can occur regardless of the dose and mode of administration, mild symptoms may be harbingers of a serious anaphylactoid reaction / shock. In this case, the administration of the radiopaque means should be immediately stopped and, if necessary, the intravascular administration of specific therapeutic agents is started.

After the administration of the iodine-containing radiopaque agent, an insignificant transient increase in the serum creatinine concentration is observed, possibly the development of contrast-induced nephropathy.

Yodizm - a rare reaction to the introduction of iodine-containing radiocontrast agents, expressed in the increase and soreness of the salivary glands after a study of up to 10 days.

The incidence of adverse events is classified as follows: very often (≥ 1/10), often from (≥ 1/100 to <1/10), infrequently from (≥ 1/1000 to <1/100), rarely from (≥ 1 / 10,000 to <1/1000), very rarely from (<1/10000), the frequency is unknown (the frequency can not be determined from the available data).

Immune system disorders: rarely - hypersensitivity reactions (including dyspnea, rash, erythema, urticaria, pruritus, skin reactions, vasculitis, angioedema, laryngeal edema, laryngospasm, bronchospasm or noncardiogenic pulmonary edema) (reactions may occur immediately after injection or several days later); unknown - anaphylactic / anaphylactoid reaction, anaphylactic / anaphylactoid shock.

Disturbances from the nervous system: rarely - headache; very rarely - dysgeusia (transient sensation of a "metallic" taste in the oral cavity); unknown - faint.

Disorders from the cardiovascular system: rarely - aetiology.

Vascular disorders: very rarely - increased blood pressure, lower blood pressure.

Disorders from the gastrointestinal tract: infrequently - nausea; rarely vomiting; very rarely - diarrhea, pain / discomfort in the abdomen; unknown - an increase in the salivary glands.

General disorders and disorders at the site of administration: often - a feeling of heat; rarely - a fever; very rarely - chills.

Trauma, intoxication and complications of manipulation: unknown - iodism.

Intravascular administration (intraarterially and intravenously)

The nature of adverse reactions that occur with intra-arterial administration depends on the site of injection and the dose administered. Selective angiography and other procedures in which high concentrations of radiopaque means reach a particular organ may be accompanied by the development of complications in this organ.

Immune system disorders: unknown - severe skin reactions in the form of pustules or bullae.

Disorders from the endocrine system: unknown - thyrotoxicosis, transient hypothyroidism.

Disorders of the psyche: unknown - confusion of consciousness.

Impaired nervous system: rarely - dizziness; very rarely - convulsions, impaired consciousness, encephalopathy, stupor, disorders in the sensory sphere (including hypoesthesia), paresthesia, tremor; unknown - transient motor dysfunction (including speech disturbance, aphasia, dysarthria), transient memory loss, disorientation, coma and retrograde amnesia.

Disturbances on the part of the organ of sight: unknown - transient cortical blindness.

Hearing disorders and labyrinthine disorders: unknown - transient hearing loss.

Disorders from the cardiovascular system: rarely - arrhythmia (including bradycardia, tachycardia); very rarely - myocardial infarction; unknown - severe complications (including cardiac arrest, cardiac arrest and respiration), spasm of the coronary arteries, pain in the chest.

Vascular disorders: very rarely - "tides"; unknown - shock, arterial spasm, ischemia, thrombophlebitis and thrombosis.

Disturbances from the respiratory system, chest and mediastinal organs: rarely - cough; very rarely - shortness of breath, noncardiogenic pulmonary edema; unknown - severe symptoms and signs of respiratory disorders, bronchospasm, laryngospasm, attack of bronchial asthma.

Disorders from the gastrointestinal tract: rarely diarrhea; unknown - exacerbation of pancreatitis, acute pancreatitis.

Disturbances from the skin and subcutaneous tissues: unknown - bullous dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash, accompanied by eosinophilia and general symptoms, exacerbation of psoriasis.

Disturbances from musculoskeletal and connective tissue: unknown - arthralgia.

Disorders from the kidneys and urinary tract: rarely - a violation of kidney function, including acute renal failure.

General disorders and disorders at the site of administration: often - a feeling of heat; infrequently - pain and discomfort; rarely - asthenic condition (for example, malaise, fatigue); unknown - reactions at the injection site (including extravasation), back pain.

Intrathecal administration

In case of intrathecal administration, unwanted reactions can occur after several hours or even days after the diagnostic procedure. The frequency of adverse reactions is the same as after lumbar puncture.

Headache, nausea, vomiting or dizziness can be largely caused by a decrease in pressure in the subarachnoid space due to leakage of liquor through the puncture hole. To minimize the pressure drop, you must avoid removing too much cerebrospinal fluid.

Disorders of the psyche: unknown - confusion of consciousness.

Impaired nervous system: very often - headache (can be severe and prolonged); infrequently - aseptic meningitis (including chemical meningitis); rarely - convulsions,dizziness; unknown - abnormalities on the electroencephalogram, meningism, transient encephalopathy, including temporary memory loss, coma, stupor and retrograde amnesia, motor dysfunction (including speech disorders, aphasia, dysarthria), paresthesia, hypesthesia and impaired sensory function.

Disturbances on the part of the organ of sight: unknown - transient cortical blindness, photophobia.

Hearing disorders and labyrinthine disturbances: unknown - transient hearing loss.

Disorders from the gastrointestinal tract: often - nausea, vomiting.

Disturbances from musculoskeletal and connective tissue: rarely - pain in the neck, back pain; unknown - muscle spasms.

General disorders and disorders at the site of administration: rarely - pain in the limbs; unknown - reactions at the site of administration of the drug.

Intracavernal administration

Endoscopic retrograde cholangiopancreatography (ERCP)

Disorders from the gastrointestinal tract: often - pancreatitis, increased activity of amylase in the blood.

Oral administration

Disorders from the gastrointestinal tract: very often diarrhea; often - nausea, vomiting; infrequently - pain in the abdomen.

Hysterosalpingography (GHA)

Disorders from the gastrointestinal tract: very often - pain in the lower abdomen.

Arthrography

Disturbances from musculoskeletal and connective tissue: unknown - arthritis.

General disorders and disorders at the site of administration: very often - pain.

Gerniography

General disorders and disorders at the site of administration: unknown - the pain after the procedure.

Description of some unwanted reactions

There have been reports of thromboembolic complications in radiopaque cardioangiography and angiography of the cerebral, renal and peripheral arteries. The introduction of radiopaque means could contribute to the development of these complications. Cases of cardiac complications, including acute myocardial infarction, during or after coronary angiography with radiopaque enhancement are described. In elderly patients or in the presence of severe coronary artery disease, unstable angina and left ventricular dysfunction, the risk of cardiac complications is increased.

In very rare cases, the radiopaque can pass through the blood-brain barrier into the cerebral cortex,which can lead to the emergence of transient neurological reactions, in particular, convulsions, transient motor or sensory disturbances, confusion, loss of memory and encephalopathy.

Anaphylactoid reaction and shock can develop severe arterial hypotension and associated hypoxic encephalopathy, renal and hepatic insufficiency. In some cases, extravasation of radiopaque means there are local pain and swelling, but these symptoms are resolved without consequences. Cases of inflammation, tissue necrosis and the appearance of compartmental syndrome are described.

Pediatric Use

There have been reports of cases of transient hypothyroidism in children, including preterm and newborns, after the introduction of iodine-containing radiopaque agents. Premature babies are particularly sensitive to iodine effects. The case of transient hypothyroidism in a preterm child was reported. An adequate rehydration is necessary before and after the introduction of radiopaque means, this is especially important for young children. Nephrotoxic drugs should be discontinued.Reduced glomerular filtration, characteristic of young children, can also lead to a delayed removal of radiopaque substances.

Overdose:

Overdose is unlikely in patients with normal renal function. In the case of using high doses of the drug, the duration of the study (the half-life of the drug is approximately 2 hours) has a large effect on the kidneys. Specific antidote ns exists, treatment is symptomatic, it is possible to conduct hemodialysis.

Interaction:

When used concurrently with antipsychotic drugs, analgesics and antidepressants yogexol can reduce the convulsive threshold, increasing the risk of adverse reactions.

Use of yogexol in patients with diabetic nephropathy who take biguanides (metformin), can lead to a transient disruption of kidney function and the development of lactic acidosis. As a precaution, it is necessary to stop taking biguanides 48 hours before the test and resume after complete stabilization of the kidneys.

Patients who took less than 2 weeks before the study of interleukin-2 are prone to an increased incidence of delayed adverse reactions (flu-like conditions or skin reactions).

In patients taking beta-adrenoblockers, the manifestations of anaphylaxis with the use of yogexol can be atypical and mistaken for vagal reactions.

Special instructions:

Preparation of the patient and the procedure for administering the drug

Before applying radiopaque, you need to obtain accurate information about the patient, including laboratory data (including the concentration of serum creatinine, electrocardiogram, the presence of a history of allergies).

Prior to the study, the patient should eliminate disturbances in the water-electrolyte balance and ensure sufficient supply of fluid and electrolytes. This is especially true for patients with multiple myeloma, diabetes, polyuria or gout, as well as newborns, children under one year, and elderly patients.

2 hours before the procedure, the patient should stop eating.

It is not recommended to perform preliminary testing of individual sensitivity with the use of small doses of the drug, due to the risk of severe hypersensitivity reactions.

Patients who are afraid of waiting before the procedure need premedication with sedatives.

The risk of developing severe adverse reactions to Yogexol small. However, iodine-containing radiopaque agents can cause anaphylactoid reactions or other manifestations of hypersensitivity. For this reason, it is necessary to foresee the sequence of medical measures in case of their occurrence and to have the necessary drugs and equipment for immediate medical care.

It is recommended to always install a cannula or catheter to ensure rapid intravenous access throughout the radiographic procedure.

You should use a separate syringe and needle for the administration of Yogexol and do not mix it with other medicines.

Compared with ionic preparations, non-ionic radiopaque agents less influence in vitro on the blood coagulation system. When performing angiographic studies, one should carefully observe their technique and often flush the catheters (for example, 0.9% solution of sodium chloride with the addition of heparin) to minimize the risk of thrombosis and embolism associated with the intervention.

The introduction of iodine-containing radiocontrast agents may aggravate the symptoms of myasthenia gravis.

All iodine-containing radiopaque agents distort the results of thyroid radioisotope studies (the iodo-binding capacity of the thyroid tissue remains reduced within 2 weeks after administration).

High concentrations of radiocontrast in blood plasma or urine can influence the results of biochemical tests to determine the concentration of bilirubin, proteins or inorganic substances (for example, iron, copper, calcium and phosphates). Therefore, such tests should not be performed on the day of the study.

Patients with diabetes who take metformin, before intravascular administration of iodine-containing radiocontrast agents, the drug should be discontinued for at least 48 hours before and within 48 hours after the procedure.

In emergency cases, when the kidney function is unknown, the doctor should evaluate the risk / benefit ratio of using radiopaque, stop using metformin, rehydrate, monitor kidney function, monitor the appearance of the initial signs of lactic acidosis.

When conducting a diagnostic study in patients with pheochromocytoma, it is necessary forprevent the development of hypertensive crisis, introduce alpha-adrenoblockers and apply low doses of the drug with constant monitoring of blood pressure.

In patients who have a history of allergies, bronchial asthma, as well as in the case of an earlier allergic reaction to the introduction of iodine-containing radiocontrast agents, it is recommended that glucocorticosteroids and blockers be premedicated H₁-gistaminovyh receptors.

In patients with acute cerebral pathology or epilepsy in history, predisposing to seizures, it is recommended that premedication with barbiturates or phenytoin.

Measures for the prevention of adverse reactions:

- identification of patients at high risk;

- ensuring adequate rehydration. If necessary, it can be achieved with the help of a permanent intravenous infusion, started before the introduction of the radiopaque preparation and continuing until it is excreted by the kidneys;

- prevention of additional burden on the kidneys arising from the use of nephrotoxic drugs, drugs for oral administration during cholecystography, clamping of the renal arteries,angioplasty of the renal arteries or extensive surgical operations, before removal of radiopaque material from the body;

- repeated radiopaque studies should be performed no earlier than the moment when the kidney function is restored;

- special care should be taken in patients with severe combined disorders of the liver and kidneys, as they have significantly reduced the clearance of radiocontrast agents;

- performing radiopaque studies in patients on hemodialysis is possible provided that dialysis will be performed immediately after the study.

Intrathecal administration:

After myelography, the patient should be in a horizontal position for 1 hour with a raised head and chest raised to 20 °. After that, the patient can walk gently, but should not bend over. If the patient remains in bed, then within 6 hours his head and chest should remain elevated. In case of suspicion of a low convulsive threshold, the patient should remain under the supervision of the doctor during this period of time. Outpatient patients can not be left unattended in the first 24 hours after the administration of radiopaque.

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

Studies on the effect on the ability to drive vehicles, mechanisms have not been carried out. It is not recommended to drive vehicles and engage in other potentially hazardous activities requiring increased concentration and speed of psychomotor reactions within 24 hours after the study.

Form release / dosage:

Solution for injection, 240 mg / ml, 300 mg / ml and 350 mg / ml.

Packaging:

For dosages of 240 mg iodine / ml, 300 mg iodine / ml, 350 mg iodine / ml

For 20 ml of the drug in flasks of light-protective neutral or colorless glass or 50 ml, 100 ml of preparation in orange glass bottles, hermetically sealed with rubber stoppers, crimped aluminum caps or caps combined aluminum with plastic caps.

1 bottle with instruction for use is placed in a pack of cardboard.

50 bottles of 20 ml of the drug with an equal number of instructions for use are placed in a box of cardboard for delivery to hospitals.

35 bottles of 50 ml or 100 ml of the preparation with an equal number of instructions for use are placed in a box of corrugated cardboard for delivery to hospitals.

Storage conditions:

In a place protected from light and secondary X-ray radiation, at a temperature not exceeding 30 ° С.

Keep out of the reach of children.

Shelf life:

3 years.

Do not use after expiry date.

Terms of leave from pharmacies:On prescription

Registration number:LP-004156

Date of registration:22.02.2017

Expiration Date:22.02.2022

The owner of the registration certificate:VELFARM, LLC VELFARM, LLC Republic of San Marino

Manufacturer: & nbsp

SYNTHESIS, OJSC Russia

Information update date: & nbsp29.03.2017

Illustrated instructions

Instructions

Yogexol (Iohexol)