Active substanceLinezolidLinezolid
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  • Dosage form: & nbspfilm-coated tablets
    Composition:

    1 film-coated tablet contains

    active substance: linezolid - 600 mg;

    Excipients: [microcrystalline cellulose, colloidal silicon dioxide] 88.375 mg, sodium carboxymethyl starch 79.500 mg, microcrystalline cellulose 53,000 mg, povidone-K 90 17.500 mg, magnesium stearate 11.625 mg; tablet shell: hypromellose - 16,783 mg, propylene glycol - 3,350 mg, titanium dioxide E171 - 3,312 mg, talc - 1,517 mg, dye crimson [Ponso 4R] E124 - 0.038 mg.

    Description:

    Biconvex tablets are oval, covered with a pink film membrane, on a break from white to almost white.

    Pharmacotherapeutic group:Antibiotic-oxazolidinone
    ATX: & nbsp

    J.01.X.X.08   Linezolid

    J.01.X.X   Other antibacterial drugs

    Pharmacodynamics:

    Antimicrobial agent, oxazolidinone. Selectively suppresses protein synthesis in bacteria by binding to bacterial ribosomes and prevents the formation of a functional initiating complex 70S, which is an important component of the translation process in protein synthesis.

    Active in vitro and in vivo in a relationship Gram-positive aerobes: Enterococcus faecium (including strains resistant to vancomycin), Staphylococcus aureus (including methicillin-resistant strains), Streptococcus agalactiae, Streptococcus pneumoniae (including multidrug-resistant strains), Streptococcus pyogenes.

    Active in vitro in a relationship Gram-positive aerobes; Enterococcus faecalis (including strains resistant to vancomycin), Enterococcus faecium (strains sensitive to vancomycin), Staphylococcus epidermidis (including methicillin-resistant strains), Staphylococcus haemolyticus, Streptococcus spp. groups Viridians; Gram-negative aerobes: Pasteurella multocida.

    Resistant to linezolid microorganisms: Haemophilus influenzae, Moraxella catarrhalis, Neisseria spp., Enterobacteriaceae spp., Pseudomonas spp.

    Cross-resistance between linezolid and antimicrobial drugs of other classes (eg, aminoglycosides, beta-lactam antibiotics, folic acid antagonists, glycopeptides, lincosamides, quinolones, rifamycins, tetracyclines and chloramphenicol) is not present. Linezolid is active against pathogenic microorganisms, both sensitive and resistant to these drugs. Resistance to linezolid develops very slowly through a multistage mutation 23 S ribosomal RNA.

    In addition to the main antimicrobial action, it exhibits the properties of a reversible nonselective monoamine oxidase inhibitor (MAO).

    Pharmacokinetics:

    Suction. Absorption is high. Food intake does not affect the degree of absorption. Absolute bioavailability is about 100%.After a single dose of 600 mg and after taking 2 times a day, the maximum concentration of linezolid in the blood plasma (Cmax) - 12.70 μg / ml and 21.2 μg / ml, respectively; time to reach the maximum concentration (TCmax) - 1.28 and 1.03 h; the area under the concentration-time curve (AUC) - 91.4 and 138 μg * h / ml; half-life (T / g) - 4.26 and 5.4 h; clearance - 127 and 80 ml / min. The equilibrium concentration (Css) drug in the blood is achieved on the 2-3 day of application.

    Distribution. Rapidly distributed in tissues with good perfusion. The volume of distribution upon reaching Css in a healthy adult averages 40-50 liters. The connection with plasma proteins is 31% and does not depend on the concentration of linezolid in the blood.

    Metabolism. Metabolized as a result of a non-enzymatic process. The metabolic oxidation of the morpholine ring leads, first of all, to the formation of two inactive carboxylic acid derivatives with an open ring. Metabolite hydroxyethylglycine (A) is the main metabolite in humans and is formed as a result of a non-enzymatic process. Another metabolite, aminoethoxyacetic acid (B), is formed in smaller amounts.Other "small" inactive metabolites are also described.

    It was found that cytochrome P450 isoenzymes do not participate in the metabolism of linezolid in vitro So what linezolid Does not inhibit and does not potentiate the activity of clinically important isozymes CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A4.

    Excretion. The extrarenal clearance is about 65% of the linezolid clearance. It is excreted by the kidneys in the form of metabolite A (40%), unchanged drug (30-35%) and metabolite B (10%). 6% of metabolite A and 3% of metabolite B are secreted through the intestine.

    Pharmacokinetics in selected patient groups

    Patients with renal insufficiency. In patients with chronic renal failure, correction of the dosing regimen is not required, because There is no relationship between the clearance of creatinine and the excretion of the drug through the kidneys. Since 30% of the dose is withdrawn within 3 hours of hemodialysis, in patients on hemodialysis, linezolid should be prescribed after dialysis.

    Patients with hepatic insufficiency. The pharmacokinetics of linezolid does not change in patients with moderate or moderate hepatic impairment (Child-Pugh class A and B), so there is no need to adjust the dosage regimen.The pharmacokinetics of linezolid in patients with severe hepatic impairment (Child-Pugh class C) has not been studied.

    Children and teens. The clearance of linezolid is higher in children and decreases with age. In adolescents (12-17 years), the pharmacokinetics of linezolid, taken in a dose of 600 mg, did not differ from the kinetics of adults.

    Elderly. In elderly patients aged 65 years and older, the pharmacokinetics of linezolid do not change significantly.

    Women. Women have lower distribution and clearance (20% less) and a higher plasma concentration than men. T1/2 linezolid in women and men does not differ significantly, there is no need to correct the dosage regimen.

    Indications:

    Treatment of infectious and inflammatory diseases, if known or suspected, that they are caused by linezolid-sensitive aerobic and anaerobic Gram-positive microorganisms (including infections accompanied by bacteremia):

    - community-acquired pneumonia caused by Streptococcus pneumoniae (including multidrug-resistant strains), including cases accompanied by bacteraemia, or Staphylococcus aureus (only methicillin-sensitive strains);

    - hospitalized pneumonia caused by Staphylococcus aureus (including methicillin-sensitive and methicillin-resistant strains) or Streptococcus pneumoniae (including multidrug-resistant strains);

    - complicated infections of the skin and soft tissues, including infections with diabetic foot syndrome, not accompanied by osteomyelitis, caused by Staphylococcus aureus (including methicillin-sensitive and methicillin-resistant strains), Streptococcus pyogenes or Streptococcus agalactiae;

    - uncomplicated skin and soft tissue infections caused by Staphylococcus aureus (only methicillin-sensitive strains) or Streptococcus pyogenes;

    - infections caused by vancomycin-resistant Enterococcus faecium, including those accompanied by bacteremia.

    Contraindications:

    Hypersensitivity to linezolid and other components of the drug, children under 12 years (for this dosage form).

    Simultaneous reception of linezolid with preparations that inhibit MAO A and B (for example, phenelzine, isocarboxazide), and also within two weeks after stopping the intake of such drugs.

    In the absence of monitoring of blood pressure should not be appointed linezolid patients with uncontrolled arterial hypertension, pheochromocytoma, thyrotoxicosis and / or patients receiving the following types of drugs: adrenomimetics (for example,pseudoephedrine, phenylpropanolamine, epinephrine, norepinephrine, dobutamine), dopaminomimetics (for example, dopamine).

    In the absence of careful monitoring of patients with possible development of serotonin syndrome, one should not prescribe linezolid persons with a carcinoid syndrome and / or patients receiving the following drugs: serotonin reuptake inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists (tryptanes), pethidine or buspirone.

    Carefully:

    In patients with severe renal failure, severe hepatic insufficiency (only if the intended benefit exceeds the potential risk).

    In patients with systemic infections that present a life-threatening risk, such as those associated with venous catheters in intensive care units.

    Pregnancy and lactation:

    There were no studies of the safety of linezolid in pregnancy. The use of linezolid in pregnancy is possible only if the intended benefit from therapy for the mother exceeds the potential risk to the fetus. If necessary, use during lactation should stop breastfeeding.

    Dosing and Administration:

    Inside.The drug can be taken as during meals, and between meals. Adults and children over 12 years of age: 600 mg every 12 hours.

    The duration of treatment depends on the pathogen, the localization and severity of the infection, and also on the clinical effect. Recommended duration:

    - community-acquired pneumonia caused by Streptococcus pneumoniae (including multidrug-resistant strains), including cases accompanied by bacteraemia, or Staphylococcus aureus (only methicillin-sensitive strains); hospital pneumonia caused by Staphylococcus aureus (including methicillin-sensitive and methicillin-resistant strains) or Streptococcus pneumoniae (including multidrug-resistant strains); complicated skin and soft tissue infections, including infections with diabetic foot syndrome not accompanied by osteomyelitis, caused by Staphylococcus aureus (including methicillin-sensitive and methicillin-resistant strains), Streptococcus pyogenes or Streptococcus agalactiae; Uncomplicated skin and soft tissue infections caused by Staphylococcus aureus (only methicillin-sensitive strains) or Streptococcus pyogenes - 10-14 days;

    - infections caused by vancomycin-resistant Enterococcus faecium, including those accompanied by bacteremia - 14-28 days.

    Older patients: correction of the dose is not required.

    Patients with impaired hepatic function: correction of the dose is not required.

    Patients with impaired renal function: correction of the dose is not required. Due to the fact that 30% of linezolid is removed during hemodialysis within 3 hours, linezolid should be taken after dialysis to patients who need it.

    Side effects:

    Classification of adverse reactions according to the frequency of development: very often - more than 10%, often - 1-10%, infrequently - 0.1-1%, rarely - 0.01-0.1%, very rarely - less than 0.01%. The undesirable phenomena associated with taking linezolid are usually of mild or moderate severity. Most often, diarrhea, headache and nausea are noted.

    Adult patients

    From the digestive system: often - diarrhea, nausea, vomiting, constipation, abdominal pain (including spastic), flatulence, candidiasis of the oral mucosa; infrequently, a change in the coloration of the tongue.

    Laboratory indicators: often - thrombocytopenia; infrequently - increase concentration of triglycerides in the blood, increased activity of "hepatic" enzymes (including alanine aminotransferase (ALT), aspartate aminotransferase (ACT), alkaline phosphatase (LF), lactate dehydrogenase (LDH), lipase, amylase, total bilirubin and creatinine concentrations), increasing prolactin concentration.

    From the nervous system: often - headache, dizziness, convulsions, insomnia; infrequently - a perversion of taste.

    From the genitourinary system: often vaginal candidiasis.

    From the skin: often - a rash.

    Other: often - fever; infrequently an opportunistic fungal infection.

    Also were noted: increased blood pressure, dyspepsia, itching.

    Adolescents (12 to 17 years of age)

    From the digestive system: often - diarrhea, nausea, vomiting, abdominal pain (local and generalized), loose stools.

    Laboratory indicators: infrequently - eosinophilia, increased concentration triglycerides in the blood, increased activity of ALT, lipase, creatinine concentration.

    From the nervous system: often - headache, vertigo.

    From the skin: often - a rash, infrequently - itching.

    From the respiratory system: often - infections of the upper respiratory tract, pharyngitis, cough.

    Other: often - fever, pain of unspecified localization.

    Postmarketing experience.

    Laboratory indicators: reversible myelosuppression (thrombocytopenia, anemia, leukopenia, pancytopenia).

    From the sense organs: cases of neuropathy of the optic nerve, sometimes leading to loss of vision.

    Allergic reactions: anaphylaxis.

    From the skin: rash, angioedema; Bullous skin lesions, similar to Stevens-Johnson syndrome.

    From the side of metabolism: lactic acidosis.

    From the nervous system: peripheral neuropathy, convulsions.

    From the digestive system: change in color of tooth enamel.

    Other: chills, fatigue, serotonin syndrome.

    Overdose:

    No cases of overdose of linezolid were reported. Symptomatic therapy is recommended (including the need to maintain the glomerular filtration rate). Approximately 30% of the dose is excreted within 3 hours of hemodialysis.

    Interaction:

    Linezolid is a weak reversible non-selective MAO inhibitor, and therefore can cause a moderate reversible enhancement of the pressor action of pseudoephedrine and phenylpropanolamine. When combined, it is recommended to reduce the initial doses of adrenomimetics (for example, pseudoephedrine, phenylpropanolamine, epinephrine, norepinephrine, dobutamine), dopamine receptor agonists (dopamine) and further titration of the dose.

    Simultaneous reception with selective serotonin reuptake inhibitors (SSRIs) is a risk of developing serotonin syndrome.

    With simultaneous use with aztreonam and gentamycin, there was no change in the pharmacokinetics of linezolid.

    Rifampicin caused a decrease in CmOh and AUC linezolid on average by 21% and 32%, respectively.

    Special instructions:

    When an infection (or suspected infection) is established, caused by concomitant Gram-negative microorganisms, an additional The use of funds acting on gram-negative flora.

    In some patients receiving linezolid, reversible myelosuppression (anemia, thrombocytopenia, leukopenia and pancytopenia) may occur, depending on the duration of therapy. Therefore, during the treatment period, it is necessary to monitor the blood counts in patients with an increased risk of bleeding, myelosuppression in a history, and also with the simultaneous use of drugs that reduce hemoglobin or the number of platelets in the blood and / or their functional properties, receiving linezolid more than 2 weeks.

    In patients taking antibacterial drugs, including linezolid, should take into account the risk of developing pseudomembranous colitis of varying severity.

    About cases of diarrhea associated with Clostridium difficile, reported in connection with the use of almost all antibacterial drugs, including linezolid. The severity of diarrhea can range from mild to severe forms. Treatment with antibacterial drugs disrupts the normal intestinal microflora, which leads to excessive growth Clostridium difficile. Clostridium difficile produces toxins A and B, which lead to the development of diarrhea. Excessive amount of toxins produced by strains Clostridium difficile, may cause an increase in mortality among patients, since such infections can be resistant to antimicrobial therapy, and may require a colonectomy.

    The possibility of developing diarrhea associated with Clostridium difficile, should be considered in all patients with diarrhea, followed by the use of antibiotics. Patients who have had diarrhea associated with Clostridium difficile After the introduction of antibacterial drugs, careful medical supervision is necessary for 2 months.

    When symptoms of impaired visual function appear, such as changes in visual acuity, changes in color perception, blurred vision, visual field defects, it is recommended that you urgently consult an ophthalmologist for advice. Monitor visual function in all patients taking linezolid for a long time (more than 3 months), as well as in all patients with newly emerging symptoms of visual disturbances, regardless of the duration of therapy. In the case of peripheral neuropathy and optic nerve neuropathy, the risk / benefit ratio of linezolid therapy in these patients should be assessed.

    In connection with the use of linezolid, lactoacidosis was reported. Patients who, on the background of taking linezolid, experience repeated nausea or vomiting, unexplained acidosis or there is a decrease in the concentration of hydrocarbonate anions, require careful monitoring by the doctor.

    Cramping was reported in patients taking linezolid, and in most cases in the history there was an indication of convulsions or the presence of risk factors for their development.

    If necessary, the use of linezolid in combination with SSRIs should constantly monitor patients to identify signs and symptoms of serotonin syndrome, such as cognitive impairment, hyperthermia, hyperreflexia, and impaired coordination of movements. If these symptoms appear, you should cancel one or both of the drugs taken. When discontinuing the use of a serotonergic agent, symptoms of the withdrawal syndrome may be observed. There have been reports of reversible surface changes in tooth enamel staining with linezolid. These changes in staining were removed by professional dental cleaning.

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

    During treatment with linezolid, it is not recommended to operate vehicles, mechanisms or engage in activities that require an increased concentration of attention and speed of psychomotor reactions.

    Form release / dosage:

    Film-coated tablets, 600 mg.

    Packaging:

    For 10 tablets per blister PVC / PVDC and aluminum foil. 1 blister with instructions for use in a pack of cardboard.

    Storage conditions:

    In the dark place at a temperature of 15 to 25 ° C.

    Keep out of the reach of children!

    Shelf life:5 years.
    Do not use after expiry date.
    Terms of leave from pharmacies:On prescription
    Registration number:LP-001785
    Date of registration:24.07.2012 / 09.06.2016
    Expiration Date:24.07.2017
    The owner of the registration certificate:Hemofarm ADHemofarm AD Serbia
    Manufacturer: & nbsp
    Representation: & nbspNizhpharm, JSCNizhpharm, JSCRussia
    Information update date: & nbsp01.09.2016
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