Catad_pgroup Antipsychotics (Neuroleptics)

Thiodazine - instructions for use

INSTRUCTIONS
(information for specialists)
on the medical use of the drug

Registration numberП№ 014622/01-2002

Tradename: Thiodazine

International non-proprietary name:

Thioridazine

Chemical Name:
10--2-(methylthio)-10H-phenothiazine (as hydrochloride or tartrate)

Dosage form:

film-coated tablets.

The composition of the drug:
1 film-coated tablet contains:
active substances: Thioridazine hydrochloride 10, 25, 50 or 100 mg
inactive substances: lactose, starch, microcrystalline cellulose, magnesium stearate, colloidal silicon dioxide, talc, eudragit E 100, sodium lauryl sulfate, polyethylene glycol.
Dyes: sunset yellow, indigo carmine, titanium dioxide.

Description:
Tablets 10 mg: Round, film-coated tablets from light orange to light orange with a pink tint, scored on one side.
Tablets 25 mg: Blue, round, film-coated tablets with a score line on one side.
Tablets 50 mg: Round, film-coated tablets, yellow, scored on one side.
Tablets 100 mg: Round, film-coated tablets of blue color, without dividing line.

Pharmacotherapeutic group:

antipsychotic (neuroleptic).

ATC code .

Pharmachologic effect:
Thioridazine - the active substance of the drug THIODAZINE - belongs to the group of piperidine derivatives of phenothiazine.
The main pharmacological properties of thioridazine are similar to those of other phenothiazines, but its clinical spectrum differs significantly from that of other drugs of this class. Distinctive features of Thiodazine are the low ability to cause extrapyramidal disorders, its rather pronounced sedative and anxiolytic activity. It has a moderate alpha-adrenergic blocking and M-anticholinergic action. Causes hypotensive and antiemetic effects. When applied in low doses Thiodazine has an anxiolytic effect. Relieves feelings of tension and anxiety; It is also effective in mild depressive disorders. When using thiodazine, there is an improvement in the adaptation of patients to the surrounding reality.
When applied in high doses Thiodazine has an antipsychotic effect. Thiodazine has a wide therapeutic range. When used in the recommended dose range, the drug is well tolerated.

Pharmacokinetics:
Suction . Thiodazine is rapidly absorbed from the gastrointestinal tract. Peak plasma concentrations are reached 2-4 hours after ingestion. Bioavailability averages about 60%. Significant interindividual variability of this indicator was noted. Protein binding is high (over 95%).
Thiodazine crosses the placenta and is excreted in breast milk. Thiodazine and its main metabolites (sulforidazine and mesoridazine) penetrate the blood-brain barrier and are found in the cerebrospinal fluid. The ratio of the concentration of metabolites in the cerebrospinal fluid to their concentration in plasma is higher than the same ratio for the unchanged drug, which indicates a significant role of metabolites in the realization of the antipsychotic effect of the drug.
Withdrawal. Excretion is carried out mainly with feces (50%), as well as through the kidneys (less than 4% in the form of an unchanged drug, about 30% in the form of metabolites). The plasma half-life is approximately 10 hours.

Indications for use:

A) Schizophrenia and other psychoses

Treatment of exacerbations of schizophrenia.

Treatment of chronic schizophrenia. Thiodazine is also indicated for the long-term treatment of inpatients and the long-term maintenance treatment of outpatients with schizophrenia.
B) Syndromes of anxiety and depression

In psychiatric practice - as monotherapy or as part of combination therapy in patients with agitated depression.

In general medical practice - as a sedative and anxiolytic - treatment of various syndromes characterized by anxiety, a combination of anxiety and depression, tension and agitation, psychosomatic disorders and emotional disorders.

Long-term treatment of mixed anxiety-depressive states or psychotic depression.
b) Indications in geriatric practice

As an antipsychotic and antipsychotic agent - treatment of severe cognitive disorders and behavioral disorders in geriatric patients with organic brain damage of varying severity.

As an anxiolytic or sedative - treatment of anxiety, mixed anxiety-depressive states, senile agitation and insomnia.
G) Indications in pediatric practice

As a neuroleptic - treatment of childhood schizophrenia, as well as severe behavioral disorders against the background of mental retardation and organic brain damage.

As an anxiolytic or sedative - treatment of anxiety, tension, agitation; treatment of attention disorders in children with severe behavioral disorders; treatment of cases of hyperactivity resistant to stimulants; treatment of sleep disorders.
D) Other indications

Treatment of severe behavioral disorders in mentally retarded adults and patients with deficient symptoms.

To reduce the severity of such mental manifestations as anxiety, agitation, hostility and hallucinations in alcohol withdrawal syndrome.

Vomiting of central origin.

Contraindications:

Hypersensitivity to thioridazine hydrochloride, thioridazine base or any other component of the drug. Coma or severe depression of the central nervous system, anamnestic information about serious hematological diseases, in particular, oppression of bone marrow hematopoiesis.
History of individual hypersensitivity reactions such as severe photosensitivity or hypersensitivity to other phenothiazines.
Severe heart disease, especially clinically significant arrhythmias (in particular, ventricular tachycardia). Pregnancy, breastfeeding period.
THIODAZINE should not be given to children under 2 years of age.

Dosage and administration:

The dose and time of taking the drug should be selected individually depending on the disease and the severity of the symptoms. It is recommended to start treatment with doses that are at the lower limit of this range. Then, in the course of treatment, the dose is gradually increased until the maximum effective one is reached. When the maximum therapeutic effect is achieved, the dose is gradually reduced to a maintenance dose. The daily dose is usually divided into 2-4 doses.
Schizophrenia and other psychoses
Exacerbations of schizophrenia in adult hospitalized patients: 100-600 mg / day - up to a maximum dose of 800 mg / day.
Chronic schizophrenia: 100-600 mg / day. in hospitalized patients; 50-300 mg / day - in outpatients.
Syndromes of anxiety and depression
In psychiatric practice, patients with agitated depression: 25-200 mg / day.
In general medical practice as a sedative and anxiolytic: 10-75 mg/day.
In geriatric practice
As an antipsychotic/antipsychotic agent: 25-200 mg/day. As an anxiolytic/sedative: 10-75 mg/day.
In pediatric practice
As a neuroleptic for the treatment of severe mental and emotional disorders in children over the age of 2 years: 1-3 mg / kg / day.
As an anxiolytic / sedative in children over the age of 2 years: 0.5-2 mg / kg / day.
Other indications
Treatment of severe behavioral disorders in mentally retarded adult patients and patients with deficient symptoms: 100-600 mg / day; the maximum dose is 800 mg / day. To reduce the severity of mental disorders in alcohol withdrawal syndrome: 100-200 mg / day.
Treatment of patients with underweight, impaired renal and / or liver function, as well as elderly patients and children, is recommended to be carried out under close supervision and to start with especially small doses and increase them very slowly.
In patients with schizophrenia who are hospitalized, a clear positive effect is usually achieved after 2-3 weeks or more from the start of treatment. In patients with chronic psychoses, it may take from 6 weeks to 6 months to achieve the most pronounced effect. On the contrary, in patients with acute psychosis, improvement can be noted after 24-48 hours.
In case of cancellation of long-term therapy with thiodazine, it is recommended to reduce its dose gradually, over several weeks, since sudden cancellation in patients who received the drug for a long time or in high doses can lead in some cases to such phenomena as nausea, vomiting, tremor, dizziness, anxiety, agitation, insomnia, transient dyskinesias. These phenomena can create an erroneous impression that the patient has a depressive or psychotic state.

Side effect:

Side effects of thiodazine, like other phenothiazines, depend on the dose and, as a rule, are due to the pronounced pharmacological effects of the drug. When using the drug in the recommended dose range, adverse events in most cases are mild and transient. Severe events have been reported with high doses of thiodazine.
From the side of the central nervous system: sedation, drowsiness; dizziness; sometimes - impaired consciousness, psychomotor agitation, hallucinations, irritability, headache; rarely - convulsions, extrapyramidal symptoms (tremor, muscle rigidity, akathisia, dyskinesia, dystonia), tardive dyskinesia; very rarely - depression, insomnia, neuroleptic malignant syndrome.
From the side of the autonomic nervous system / anticholinergic effects: often - dry mouth, blurred vision, paresis of accommodation, nasal congestion; sometimes - nausea, vomiting, diarrhea, constipation, loss of appetite, urinary retention or incontinence; rarely, pallor, tremor; very rarely - paralytic ileus.
From the side of the cardiovascular system: often - orthostatic hypotension; sometimes ECG changes (prolongation of the QT interval), tachycardia; rarely - arrhythmias; very rarely - flutter-flicker of the ventricles, sudden death.
From the endocrine system: often, with prolonged use - hyperprolactinemia, galactorrhea; sometimes - amenorrhea, menstrual disorders, changes in body weight, erectile dysfunction and ejaculation; rarely - priapism; very rarely - breast engorgement, gynecomastia, peripheral edema.
From the side of peripheral blood: rarely - leukopenia, agranulocytosis, thrombocytopenia; very rarely - anemia, leukocytosis.
From the side of the liver: sometimes - deviations from the norm of activity of liver enzymes; rarely hepatitis.
From the side of the skin: rarely - dermatitis, skin rash (including allergic), urticaria, increased photosensitivity, angioedema.
Others: rarely - swelling in the parotid gland, hyperthermia, respiratory depression. With long-term therapy with thiodazine, there are reports of rare cases of retinopathy pigmentosa that developed in patients who received the drug at a dose exceeding the recommended maximum dose of 800 mg per day. Drug Interactions:
Metabolism mediated by cytochrome P450 2V6. THIODAZINE is metabolized by the enzyme cytochrome P450 2B6, and, in addition, is itself an inhibitor of this metabolic pathway. In this regard, drugs that inhibit this isoenzyme (for example, cimetidine, fluoxetine, paroxetine, moclobemide) may enhance and prolong the effects of thiodazine.
Tricyclic antidepressants. The simultaneous use of tricyclic antidepressants and phenothiazine derivatives can lead to an increase in plasma concentrations of these drugs and / or a phenothiazine derivative, which can lead to cardiac arrhythmias.
Anticonvulsants. Thiodazine, like other phenothiazines, may lower the seizure threshold. With simultaneous use with thiodazine, an increase or decrease in the serum concentration of phenytoin is possible, and therefore its dose adjustment may be required. With the combined use of thiodazine and carbamazepine, the concentrations of these drugs in serum do not change.
Antihypertensive agents and beta-blockers. Due to the suppression of metabolism, the combined use of these drugs with thiodazine can lead to increased plasma concentrations of each of the drugs, which can probably lead to severe hypotension, cardiac arrhythmias or CNS side effects.
Indirect anticoagulants. Combined use with thiodazine can cause an increase in hypoprothrombinemic action, which is mainly due to competitive interaction at the enzyme level. In this case, careful monitoring of the concentration of prothrombin in plasma is necessary.
Means with a depressant effect on the central nervous system. Thiodazine may enhance the effects of alcohol and other drugs that have a depressant effect on the central nervous system, benzodiazepines, narcotic analgesics, barbiturates, antidepressants and anesthetics.
MAO inhibitors. The simultaneous use of an MAO inhibitor and thiodazine may prolong and enhance the sedative and antimuscarinic effects of each of the drugs.
Lithium preparations. Severe neurotoxic complications, extrapyramidal disorders and somnambulism may occur in patients receiving both a lithium preparation and a phenothiazine derivative, including thiodazine.
Means with anticholinergic action. With simultaneous use with Thiodazine, it is possible to increase the anticholinergic effects of M-cholinergic blockers (atropine-like drugs), antihistamines and tricyclic antidepressants, up to such manifestations as "atropine psychosis", severe constipation, paralytic ileus, hyperpyrexia with possible heat stroke. In these cases, careful monitoring of the patient and dose adjustment of drugs are indicated.
Antiparkinsonian drugs. With the simultaneous use of thiodazine and levodopa, the effects of each of the drugs may be weakened.
Vasoconstrictors. Due to its α-adrenergic blocking properties, thiodazine can weaken the pressor effect of vasoconstrictors (epinephrine, dopamine, ephedrine, phenylephrine).
Quinidine. With the simultaneous use of quinidine and thiodazine, it is possible to increase the inhibitory effect of quinidine on the myocardium.
Antiarrhythmics/QT prolongation. Given that phenothiazines, including thiodazine, can cause ECG changes such as prolongation of the QT interval, caution should be exercised when they are used simultaneously with drugs with a similar property.
thiazide diuretics.. The simultaneous use of thiodazine and a thiazide diuretic can lead to severe arterial hypotension. In addition, diuretic-induced hypokalemia may enhance the cardiotoxic effects of thiodazine.
Antidiabetic agents. Thiodazine affects carbohydrate metabolism, and therefore, when it is used, the patient's stable state, achieved during treatment with antidiabetic agents, may be disturbed.
Antacids and antidiarrheals may reduce absorption from the gastrointestinal tract of thiodazine. Warnings
It is used with extreme caution in patients with glaucoma (especially angle-closure form), with cardiovascular diseases, severe respiratory diseases, renal failure, Parkinson's disease, epilepsy, prostatic hypertrophy, myasthenia gravis, pheochromocytoma.
During the period of treatment with Thiodazine, it is forbidden to drink alcohol, as well as driving vehicles, working with mechanisms and other activities that require a quick reaction. Overdose.
Increased side effects, the appearance of acute neuroleptic reactions. Of particular concern should be an increase in body temperature, which may be one of the symptoms of neuroleptic malignant syndrome. In severe cases of overdose, various forms of impaired consciousness can be observed, up to coma.
Assistance measures: termination of therapy with Thiodazine and any other antipsychotic drugs (neuroleptics), prescription of correctors (central anticholinergics), administration of high doses of activated charcoal, gastric lavage, intravenous administration of diazepam, glucose solution, nootropic drugs, vitamins B and C, careful monitoring of the functions of the cardiovascular, respiratory and central nervous systems, symptomatic therapy.
Barbiturates should be avoided in convulsions, as they may aggravate the respiratory depression caused by the phenothiazine derivative.

Release form:

10 tablets in aluminum strips, 10 strips in a cardboard box.

Conditions for dispensing from pharmacies:

List B.
Released by prescription.

Storage conditions:

At a temperature not higher than + 25 ° C, in a dry, dark place, out of the reach of children.

Best before date:

4 years.
Do not use after the expiration date.

Manufacturer:

Sun Pharmaceutical Industries Ltd., India. 117420, st. Profsoyuznaya, house 57, office 722

Dosage form: Tablets are blue, round, biconvex, film-coated.

Read the entire package leaflet carefully before taking your medicine:

Do not throw away this leaflet. It may be necessary to re-read it.

If you have any questions, ask your doctor or pharmacist.

This medicine must be prescribed by your doctor. Do not pass it on to others. It can harm them even if their symptoms are the same as yours.

If any of the side effects get serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

What Norfloxacin is and what it is used for: Each Norfloxacin tablet contains the active substance: 200 mg or 400 mg of norfloxacin and excipients: dibasic calcium phosphate, corn starch, lactose monohydrate, gelatin, talc, magnesium stearate, anhydrous colloidal silicon dioxide, sodium starch glycolate, propylene glycol, brilliant blue sancoat (hydroxypropyl methylcellulose, titanium dioxide, talc, polyethylene glycol 400), brilliant blue (E 133). This drug belongs to the group of quinolones, antimicrobial agents for systemic use. Inhibits the growth of microorganisms that cause infections.

Norfloxacin is used in the following cases: indicated for the treatment of infections caused by susceptible organisms.

Urinary tract infections:

uncomplicated urinary tract infections (including cystitis);

complicated urinary tract infections.

Sexually transmitted diseases:

uncomplicated urethral and cervical gonorrhea caused by Neisseria gonorrhea;

prostatitis.

Before starting treatment, it is necessary to determine the sensitivity of microorganisms to norfloxacin. Norfloxacin therapy may be initiated before test results are available. In this case, before starting therapy, it is necessary to select material for laboratory diagnostics in order to be able to change the treatment in the absence of sensitivity of infectious agents to norfloxacin. To reduce the possibility of developing bacterial resistance and reduce efficacy, norfloxacin should only be used to treat infections caused by susceptible pathogens.

Do not take Norfloxacin if:

hypersensitivity to norfloxacin, other quinolones or excipients of this drug;

liver failure;

terminal stage of chronic renal failure;

pregnancy and lactation;

children and adolescents (up to 18 years);

lactase deficiency, lactose intolerance, glucose-galactose malabsorption;

a history of tendonitis or tendon ruptures associated with treatment with quinolone derivatives.

When prescribing Norfloxacin, be sure to inform your doctor about taking any of the following medicines, it is necessary to take into account their interaction when taken together:

Drugs with an established risk factor for prolongation of the QT interval on the ECG (antiarrhythmic drugs of class IA and III, antidepressants, macrolides, antipsychotics). The risk of developing arrhythmias and lengthening the QT interval on the ECG. ECG control.

Nitrofurantoin. The drugs are antagonists, joint administration is not recommended.

Probenecid. Reduces the excretion of norfloxacin by the kidneys, but does not affect its concentration in the blood.

Cyclosporine. An increase in the concentration of cyclosporine in the blood serum is possible. It is recommended to control the concentration of cyclosporine in the blood serum, if necessary - dose adjustment.

Warfarin and its derivatives (phenprocoumon, acenocoumarol). Possible potentiation of the action of anticoagulants. Laboratory monitoring of blood coagulation parameters is recommended.

Hormonal contraceptives. It is possible to reduce the contraceptive effect when taking norfloxacin. Additional methods of contraception are recommended during the treatment period.

Fenbufen. Joint reception can provoke an epileptic seizure, the combination should be avoided.

Clozapine, ropinirole. When taking norfloxacin, dose adjustment of clozapine or ropinirole may be necessary for patients already taking these drugs.

Glibenclamide. There may be a sharp drop in blood sugar. Blood sugar control is recommended.

Didanosine. Drugs can prevent one another from being absorbed. Didanosine is taken two hours after taking norfloxacin.

Non-steroidal anti-inflammatory drugs (NSAIDs). The combination is used with caution, stimulation of the central nervous system with convulsive attacks is possible.

Antacids containing aluminum or magnesium hydroxide; preparations or products containing calcium salts (including milk), iron and zinc. The absorption of norfloxacin is reduced. Norfloxacin should be taken 1-2 hours before or at least 4 hours after taking these drugs.

Theophylline. It is possible to increase the concentration of theophylline in the blood and the development of side effects. It is recommended to control the concentration of theophylline in the blood, if necessary - dose adjustment.

Antihypertensive drugs. Perhaps a sharp decrease in blood pressure. With the simultaneous administration of a combination with drugs that reduce the convulsive threshold of the brain (theophylline) - epileptiform seizures.

Nitrofurans. Norfloxacin reduces the effect of nitrofurans.

corticosteroid hormones. Increased risk of tendon rupture, especially in elderly patients.

The use of Norfloxacin during pregnancy and lactation: Contraindicated.

Influence on the ability to drive vehicles and control mechanisms: The ability to drive a car and other mechanisms may decrease due to the effect of norfloxacin on the reaction rate.

Dosage and administration

Dosage for patients with normal renal function.

Uncomplicated urinary tract infections (cystitis): 400 mg 2 times a day for 3-10 days.

Complicated urinary tract infections: 400 mg 2 times a day for 10-21 days.

Sexually transmitted diseases: 800 mg once.

Prostatitis (acute, chronic): 400 mg 2 times a day for 28 days.

Dosage in patients with renal insufficiency:

In patients with a creatinine clearance of 30 ml / min / 1.73 m 3 or less, the recommended dose is 400 mg once a day for the duration of treatment indicated above.

With a known level of creatinine clearance, the following formula is used to calculate the dose (taking into account the sex, weight and age of the patient):

Men =

Women \u003d (0.85) x (value above)

Elderly patients. With normal renal function, dose adjustment is not required.

Possible side effects:

From the side of the cardiovascular system: prolongation of the QT interval on the ECG, ventricular arrhythmia.

From the gastrointestinal tract: vomiting, heartburn, pancreatitis.

From the nervous system: dizziness, hallucinations, mood changes, sensitivity disorders, insomnia, depression, anxiety, irritability, euphoria, disorientation, anxiety, polyneuropathy, including Guillain-Barré syndrome, convulsive seizures, mental disorders, tremor, twitching of large muscles.

On the part of the hematopoietic system: a decrease in the number of neutrophils, platelets in the blood, anemia.

From the urinary system: inflammation of the kidney.

From the musculoskeletal system and connective tissue: joint pain, inflammation of the ligaments / tendons, tendon ruptures, muscle pain, arthritis, very rarely - inflammation of the Achilles tendon and rupture.

On the part of the skin and subcutaneous tissue: itching, swelling, rashes, small hemorrhages, hemorrhagic bullae and papules with the formation of a crust as a manifestation of vascular damage.

From the immune system: angioedema; in isolated cases - exfoliative dermatitis, Stevenson-Johnson syndrome, Lyell's syndrome, exudative polymorphic erythema, photosensitivity.

Changes in laboratory parameters: increased levels of glutomate-oxaloacetate transaminase,

glutamate-pyruvate transaminase, alkaline phosphatase in the blood.

Others: vaginal candidiasis, increased lacrimation, tinnitus, hearing loss, shortness of breath, taste disorders.

If you have taken more Norfloxacin than your doctor recommended: If you take more pills per day than your doctor recommended, or if your child swallows the pills, call your doctor or call an ambulance! Stop taking the medicine! Overdose can be manifested by dizziness, headache, fatigue, convulsions, hallucinations, confusion, abdominal discomfort, impaired kidney and liver function, the presence of crystals and blood in the urine. As a first aid, it is recommended to wash the stomach and take antacids.

Precautions and special instructions while taking Norfloxacin:

Hypersensitivity. After taking a single dose of the drug, hypersensitivity reactions, including anaphylactic and anaphylactoid reactions, are life-threatening conditions. Stop taking the medicine immediately, immediately inform the doctor or call an ambulance!

Pseudomembranous colitis. If pseudomembranous colitis is suspected (loose stools for a long time, possibly with an admixture of blood or mucus in it), you should immediately stop taking it and immediately consult a doctor for appropriate treatment! Do not use drugs that inhibit intestinal motility.

Central nervous system. It is known that quinolones can lower the seizure threshold and initiate seizures. It is used with caution in patients with diseases of the central nervous system that provoke convulsive seizures. Cases of polyneuropathy (pain, burning, a feeling of excitement, tinnitus, muscle weakness, sensitivity disorders, including tactile, pain, temperature, vibration and musculo-articular) have been reported. If these phenomena occur, stop taking the drug! Immediately inform the doctor!

The cardiovascular system. Since the use of norfloxacin is associated with cases of prolongation of the QT interval on the ECG, care must be taken when treating patients at risk of developing arrhythmias: congenital prolongation of the QT interval; concomitant use of class IA and III antiarrhythmic drugs, antidepressants, macrolides, neuroleptics; electrolyte disturbances; women and elderly patients are more sensitive; heart disease.

Musculoskeletal system. Norfloxacin should not be used in patients with tendon disease or tendon disorders who have received quinolones in the past. If it is necessary to treat severe infectious diseases in such patients, a microbiological study and an assessment of the risk-benefit ratio are carried out. Inflammation or tendon rupture may occur, predominantly in elderly patients or concomitantly taking corticosteroids. With any signs of the specified disease (edema, inflammation), stop taking the drug and immobilize the affected limb. Use with caution in patients with myasthenia gravis.

Photosensitivity. Patients taking norfloxacin should avoid direct exposure to sunlight and UV radiation.

Syphilis. Norfloxacin is not indicated for the treatment of syphilis. Antimicrobial drugs used in high doses for a short period of time to treat gonorrhea may mask or delay the symptoms of developing syphilis. All patients with gonorrhea should have a serological test for syphilis at the time of diagnosis and again (3 months later) after norfloxacin.

surgical reactions. Warn the doctor about taking norfloxacin: monitoring of the state of the blood coagulation system is recommended (an increase in the prothrombin index is possible).

Deficiency of glucose-6-phosphate dehydrogenase. Perhaps the development of hemolytic reactions. The drug is not prescribed to such patients, except in cases where the potential benefit outweighs the possible risk.

Excipients. Not to be taken in cases of congenital galactose intolerance and Lapp lactase deficiency or malabsorption of glucose and galactose (contains lactose).

General information. It is used with caution in atherosclerosis of cerebral vessels, cerebrovascular accident, epilepsy and convulsive syndrome, impaired renal and liver function.

Storage conditions:

Store in a place protected from moisture and light, at a temperature not exceeding 25°C. Keep out of the reach of children.

Best before date:

3 years. Do not use the medicinal product after the expiration date.

Leave conditions:

By prescription.

Package:

10 or 20 tablets in polymer jars. 1 bank together with the leaflet in a pack.

10 tablets in a blister pack. 1 or 2 blisters in a pack.

Manufacturer information:

Manufactured by: “Belarusian-Dutch Joint Venture Limited Liability Company “Pharmland” (JV LLC “Pharmland”), Republic of Belarus, Nesvizh, st. Leninskaya, 124 - 3.

Pain is an unpleasant sensation that occurs in the human body for various reasons (injuries, impaired functionality of internal organs, etc.). The purpose of pain is to give a signal about the destructive effect of the stimulus, which must be eliminated or at least reduced its negative impact. The occurrence of pain is explained by irritation of the receptors of the nervous system, which are divided into 2 categories:

1. Receptors located on the skin and mucous membranes and responding to mechanical displacement of tissues (stretching, injections, etc.).
2. Receptors located on the skin, internal organs and mucous membranes and reacting to certain chemicals, the concentration of which increases during various pathological processes. A large number of such substances leads to an increase in pain.

Classification of pain

Due to the occurrence

• Protopathic. It appears due to the action of a non-damaging factor (temperature, touch).
• Epicritical. Appears due to a damaging factor with precise localization.

According to the nature of the manifestation

• Acute. It is characterized by a short effect in the form of seizures.
• Chronic. Pain of prolonged exposure, in a constant mode.

By affected area

• Superficial somatic. It manifests itself in lesions of the skin, subcutaneous tissue and mucous membranes.
• Deep somatic. Occurs when muscles and joints are damaged.
• Visceral. Appears with lesions of internal organs.

The history of the discovery of anesthesia. Photo: yandex.ru

Since ancient times, intoxicating substances have been used as the main method of anesthesia. Hippocrates also invented inhalation anesthesia - inhalation of vapors of opium, belladonna, hemp to create an analgesic effect. Then they began to rub the skin with the Memphis stone, which caused local cooling, then cold water, ice, and tugging of the limb were used for these purposes. Of course, this did not give good pain relief. And until the middle of the 19th century, they could not find such a method of anesthesia, which would not eventually lead to torment and death of the patient.

On October 16, 1846, an operation under ether anesthesia was performed for the first time: surgeon John Warren removed a vascular tumor in the submandibular zone to a patient in a Boston hospital. Also, this type of anesthesia was used for tooth extraction. Later, chloroform was used as an anesthetic, but it turned out to have increased toxicity. In 1853, syringes and needles were invented - this was a revolutionary discovery, because now it was possible to inject drugs into tissues.

After that, morphine was used as an anesthetic, then cocaine, which was used first in operations in otolaryngology and ophthalmology, and only then in surgery. It was later abandoned due to its high toxicity. They began to use spinal, infiltration, conduction anesthesia. In 1905, novocaine was synthesized, which is still actively used as an anesthetic.

Classification of painkillers

You can eliminate or reduce pain with the help of drugs - analgesics.

Painkillers are classified according to the degree of impact:

• General anesthesia (narcosis).
• Local anesthesia (temporary anesthesia of a small area).
• Regional anesthesia (disabling the sensitivity of a certain part of the patient's body).
• Sedation (introduction to a peaceful, calm state in which the patient is relaxed, but can follow the instructions of the doctor during the medical procedure).

Introduction to the state of anesthesia may be necessary during surgical operations. The patient not only does not feel pain, while his muscles are sufficiently relaxed, and there will be no memory of the operation in his memory. Local anesthesia may be required for minor surgical or dental procedures. The anesthetic is administered as an injection in the area of ​​the site, the sensitivity of which must be turned off. A few minutes after the administration of the drug, the pain syndrome of the operated area is completely blocked.

The principle of operation of the anesthetic in regional anesthesia is to turn off the sensitivity of the nerves responsible for a certain part of the body (arm, leg, etc.). The analgesic effect persists for several hours after the operation.

The action of the painkiller

The principle of operation of modern ones is aimed at suppressing pain, and not at treating the disease that causes pain. Depending on the active substance, analgesics act either on the brain, or on, or produce a local anesthetic effect.

So, centrally acting painkillers block pain centers at different levels in the brain. Peripheral anesthetics block the formation of substances that can stimulate pain centers, that is, they suppress pain sensations outside the brain. The action of local anesthetics is aimed at preventing the passage of a pain impulse from neuronal endings by blocking sodium channels.

Types of painkillers

The main classification division consists in the allocation of 2 groups of painkillers according to pharmacological characteristics:

1. Non-narcotic.
2. Narcotic.

The first group of painkillers includes drugs that do not have an excessive effect on the nervous system. They are not addictive, and also do not have a sedative or hypnotic effect. These medicines can eliminate inflammatory processes.

The second group includes drugs whose action is aimed at suppressing the functionality of the central nervous system. They change the nature of pain by affecting certain parts of the brain. Often, such drugs cause a feeling of euphoria, and with prolonged use, addiction is developed. They are prescribed mainly for serious diseases of the cardiovascular system or for oncology.

Separately, it is worth noting painkillers - antispasmodics, which can eliminate attacks of spastic pain. This pain syndrome is manifested due to spasms of the smooth muscles of the internal organs. Spasms can be caused by various chronic diseases, malnutrition, or other causes. It is the reception of antispasmodics that is most effective in this case, since the elimination of spasms will lead to the elimination of pain.

Painkillers

All painkillers are divided into groups depending on the active substances used:

1. Metamizole sodium. Suppresses the activity of cyclooxygenase and prevents the spread of pain impulses. It is indicated for various types of pain (dental, intestinal, headache, injuries, bites, burns, etc.). Not recommended for frequent use. With this composition, the drug can be attributed.
2. Pitophenone. It is an antispasmodic and is often used with other painkillers, which together enhance the effect of each other. It is prescribed for both adults and children with fever, colic, headache and other types of pain caused by muscle spasms.
3. . It is a derivative of acetic acid. Belongs to the category of non-steroidal anti-inflammatory drugs. N-r, the drug Aertal.
4. . Prevents the destruction of cartilage.
5. . Used for arthritis and joint pain.
6. . Eliminates pain of a weak or moderate nature, caused by various reasons.
7. . It is prescribed for arthritis and arthrosis, pain in the spine, and also as an adjuvant for infectious and inflammatory diseases.

Almost all substances that have an analgesic effect additionally have anti-inflammatory and antipyretic effects.

List of pain pills

There are several painkillers that fall into the category of potent drugs. These include prescription drugs and over-the-counter drugs.

Aertal

• Active substance- Aceclofenac.
• Compound- Microcrystalline cellulose, croscarmellose sodium, glyceryl palmitostearate, povidone.
• The form- Tablets in a film shell (additionally produced in the form of a powder for the preparation of a suspension for oral administration and a cream for external use).
• Indications- Rheumatoid arthritis, spondylitis, osteoarthritis.
• Contraindications-, violation of hematopoiesis, liver and kidney disease, children under 18 years of age, during pregnancy and.
• Dosage and application- 100 mg twice a day with plenty of liquid.
• Side effects- Rash, headache, dysfunction of the digestive tract, liver and kidneys, leukopenia.
• Recommendations- During the period of admission, exclude, regularly monitor tests.
• Vacation from pharmacies - prescription .

nise

• Active substance- Nimesulide.
• Compound- Microcrystalline cellulose, calcium hydrogen phosphate, silicon dioxide, magnesium stearate, sodium carboxymethyl starch, talc, corn starch.
• The form- Biconvex tablets with a smooth surface (additionally produced in the form of a gel for external use).
• Indications- Rheumatoid arthritis, inflammation of soft tissues, ligaments and tendons, spondyloarthritis, osteochondrosis, osteoarthritis, as well as dental, headache, postoperative pain.
• Contraindications- Bronchial asthma, changes in the functioning of the digestive tract, kidney, heart and liver failure, hemophilia, children under 12 years of age, during pregnancy and lactation.
• Dosage and application- 1 tablet twice a day with a glass of water.
• Side effects- Violations of the functionality of the digestive tract and kidneys, itching, rash, dizziness, allergic reactions.
• Recommendations- If there are signs of visual impairment, you should stop taking and visit an ophthalmologist. Patients with kidney pathologies are shown a lower dosage.
• Vacation from pharmacies - prescription .

Movalis

• Active substance- Meloxicam.
• Compound- Sodium citrate dihydrate, silicon dioxide, microcrystalline cellulose, lactose monohydrate, crospovidone, magnesium stearate.
• The form- - these are round, convex yellow tablets with a bevelled edge (in addition, the drug is produced in the form of a solution for intramuscular injection and rectal suppositories).
• Indications- Degenerative inflammation of the joints, rheumatoid arthritis, spondylitis, osteoarthritis.
• Contraindications- Bronchial asthma, disorders in the functioning of the digestive tract, kidney, heart and liver failure, children under 12 years of age, during pregnancy and lactation.
• Dosage and application- For adolescents: 0.25 mg / kg of body weight and not to exceed 15 mg. For adults: 7.5-15 mg / kg of body weight, depending on the disease. Take 1 time per day after meals with water.
• Side effects- Violations of the digestive tract and kidneys, changes in the leukocyte formula, bronchial asthma, allergic manifestations, dizziness, conjunctivitis.
• Recommendations- It is necessary to monitor the performance of the kidneys.
• Vacation from pharmacies - prescription .

Nimesil

• Active substance- Nimesulide.
• Compound- Ketomacrogol, maltodextrin, sucrose, citric acid, orange flavor.
• The form- light yellow powder.
• Indications- With severe pain in the back, lower back, as well as during menstruation, with sprains, injuries, toothache and osteoarthritis.
• Contraindications- Fever, bronchial asthma, heart, kidney and liver failure, inflammatory processes in the intestines, blood clotting disorders, children under 12 years of age, during pregnancy and lactation.
• Dosage and application- 1 sachet twice a day orally after meals. Dissolve the powder in 100 ml of water.
• Side effects- Anemia, thrombocytopenia, manifestations, dizziness, tachycardia, shortness of breath, diarrhea,.
• Recommendations- Patients with chronic diseases should take the drug with caution (reduce the dosage and course).
• Vacation from pharmacies - prescription

Ibuklin

• Active substance- Ibuprofen, Paracetamol.
• Compound- Microcrystalline cellulose, glycerol, silicon dioxide, starch, sodium carboxymethyl starch, magnesium stearate, talc.
• The form- Tablets in an orange film shell (for children from 2 years old they are produced in the form of dispersible tablets -).
• Indications- Fever, neuralgia, pain in the back, joints and during menstruation, toothache, bruises, dislocations and after operations.
• Contraindications- Pathologies of the circulatory system and organs of the gastrointestinal tract, bronchial asthma, renal and hepatic insufficiency, children under 12 years old (up to 2 years for a children's dosage form), 3rd trimester of pregnancy and during lactation.
• Dosage and application- For adults: 1 tablet three times a day. For children over 12 years old: 1 tablet twice a day. Take before meals or 2-3 hours after and drink water.
• Side effects- Nausea, vomiting, headache, heartburn, pressure surges, anemia, shortness of breath, allergic reactions.
• Recommendations- Do not take with other nonsteroidal drugs. With a course of more than 5-7 days, spend.
• Vacation from pharmacies - OTC .

Next

• Active substance- Ibuprofen, Paracetamol.
• Compound- Calcium hydrogen phosphate, croscarmellose sodium, hyprolose, magnesium stearate, talc, silicon dioxide.
• The form- Biconvex oval-shaped tablets with a red film shell (optionally available in capsules).
• Indications- Migraine, neuralgia, toothache, pain in the joints and back, fever, as well as bruises, fractures, sprains.
• Contraindications- Renal and liver failure, bronchial asthma, pathologies of the digestive tract, children under 18, 3rd trimester of pregnancy.
• Dosage and application- For adults: 1 tablet three times a day.
• Side effects- Tachycardia, dizziness, shortness of breath, vomiting, hearing or visual impairment, anemia, nausea, allergic reactions.
• Recommendations- The duration of admission is not more than 5 days for pain relief and not more than 3 days to reduce the temperature. With an increased course, control the analyzes.
• Vacation from pharmacies OTC .

Pentalgin

• Active substance- Paracetamol, Naproxen, Drotaverine hydrochloride, Pheniramine maleate, Caffeine.
• Compound- Microcrystalline cellulose, hyprolose, magnesium stearate, E321, croscarmellose sodium, starch.
• The form- Tablets in a film shell (additionally produced in the form of a gel for external use).
• Indications- For a variety of pains, including those caused by spasms, as well as colds.
• Contraindications- Tachycardia, pathologies of the gastrointestinal tract, renal and hepatic insufficiency, children under 18 years of age, pregnancy and lactation.
• Dosage and application- 1 tablet 1-3 times a day. No more than 4 tablets per day.
• Side effects- Allergic reactions, hearing loss, impaired kidney function, headache, vomiting, nausea.
• Recommendations- The duration of admission is not more than 5 days for pain relief and not more than 3 days to reduce the temperature.
• Vacation from pharmacies OTC .

Nurofen Express Forte

• Active substance- Ibuprofen.
• Compound- Potassium hydroxide, macrogol, water.
• The form— Oval capsules with light pink liquid.
• Indications- Headache and toothache, rheumatic pain syndrome, fever, neuralgia, migraine.
• Contraindications- Bronchial asthma, kidney, heart and liver failure, pathology of the digestive tract, hemophilia, days up to 12 years, pregnancy (3rd trimester).
• Dosage and application- A single dose is 400-800 mg. The maximum dose for adults is 2400 mg. Drink water.
• Side effects- Violation of hematopoiesis, allergic reactions, abdominal pain, shortness of breath, nausea, changes in laboratory parameters during blood tests.
• Recommendations- The interval between doses is at least 4 hours. With long-term treatment, check the blood, the condition of the liver and kidneys.
• Vacation from pharmacies - OTC .

Contraindication for all drugs is individual intolerance and hypersensitivity to the components of the drug!

How to choose a pain reliever

The basis of proper treatment is to eliminate the cause of pain. Sometimes antispasmodics are enough to relieve pain. In some cases, taking painkillers can prevent an accurate diagnosis, because abdominal pain, as well as headaches along with vomiting, are a sign of serious illness. The safest way is to take pain medication as prescribed by your doctor.

With an unexpected and sharp pain syndrome, combined preparations have the best effect, in which, in addition to the active substance - a pain inhibitor, there are additional components that enhance its effect.

Despite the fact that most analgesics help against a wide variety of pain, for each specific cause of pain, you can choose a specific drug. Before buying painkillers, it is recommended to carefully read the instructions.

Ecstasy is a popular drug among young people. It is shipped to Russia from European countries and China. Spread ecstasy tablets in nightclubs. They are also ordered online. The average price of the drug in Moscow is 1200-1500 rubles per tablet.

What do ecstasy pills look like and how are they different?

The design of the tablets is amazing. Often they are bright, made in the form of fairy-tale characters. The parent, having discovered them, will not even immediately understand that he has ecstasy tablets in front of him. The drug can easily be mistaken for small (7-9 mm in diameter) sucking candies or chewing gum.

In Russia, such types are very popular ecstasy tablets:

• HelloKitty - pink or blue kitty-shaped ecstasy pills.
• Love, or Heart - pills in the shape of a heart.
• Rolls-Royce - yellow rectangular tablets with a large "R" embossed.
• Apple - tablets with an image of an apple stamped on them.
• Minions - ecstasy tablets in the form of cartoon characters. Yellow on one side, blue on the other.
• Heineken - green tablets with the inscription "Heineken", shaped like a beer keg.
• Bugatti - oval red ecstasy tablets with the appropriate inscription.
• Gold - preparations imitating gold bars.

Pills in the form of strawberries, diamonds, dominoes, with an imprint of an animal's paw and the Chupa Chups emblem are also in demand. It is believed that there are over a thousand varieties of ecstasy tablets. Usually drug addicts identify for themselves 2-3 favorite types that they use regularly. What are their differences, besides design?

1. In manufacturers and parties. Registration serves as a conditional indicator for a drug addict. So he can buy an already familiar or “well-established” product.
2. In the composition. Ecstasy is considered to be MDMA, but other amphetamine-type drugs in the form of tablets (MDA, MDEA) are also called in a broad sense. And in addition to the central components, other substances are added: ephedrine, ketamine, etc.
3. In the concentration of the main active substance. If we are talking specifically about MDMA, then the average concentration of the drug in one tablet is approximately 125 mg - this is a standard single dose. Beginning drug addicts sometimes take half a tablet. But recently, enhanced ecstasy with an MDMA content of 150 to 200 mg has become increasingly popular in everyday life.

The Secret of MDMA's Attractiveness

Ecstasy tablets are entactogen empathogens; they stimulate the release of oxytocin (attachment hormone) and serotonin (pleasure hormone). This means that a sense of belonging is growing, unconditional trust in people arises, and internal barriers disappear. This is why ecstasy is a group drug, almost never taken alone. And therein lies the reason for the attractiveness of the drug.

For young people, the drug becomes a gateway to communication, it helps to relax and forget about the complexes. Often, pills are swallowed not only during parties, but also in an intimate setting to enhance the experience during intercourse. The state of euphoria lasts 4-8 hours. However, you have to pay for the pleasure.

Side effects and consequences

On average, ecstasy tablets are used 3-4 times a month, this is a “weekend drug”. Nevertheless, the main consequence of the reception is drug addiction.

Ecstasy users are confident that drug addiction does not threaten them. Indeed, MDMA, when compared to other drugs, is almost never physically addictive. But it does evoke the psychic. People use the substance again and again to experience ecstasy. They can no longer achieve a sense of harmony and happiness in other ways.

In addition, taking "magic" pills leads to other bad consequences:

• Hyponatremia is a violation of electrolyte metabolism.
• Hyperthermia, or overheating. Especially often it occurs when MDMA is combined with DXM (dextromethorphan), which suppresses the work of the sweat glands.
• Loss of appetite.
• Nausea and dizziness.
• Deterioration of thinking.
• Increased heart rate, increased blood pressure.
• Hallucinations (at high doses).
• Depression following drug withdrawal.

The most terrible consequence of taking ecstasy tablets is an overdose. Its risk increases if a person uses other drugs, antidepressants, or cimetidine (an ulcer medicine) at the same time as MDMA. Ecstasy is especially dangerous for people with heart and vascular diseases, kidney failure, and diabetes.

Registration number
Tradename: HELEX ®
International (non-proprietary) name: ALPRAZOLAM

Dosage form:

tablets

Compound.
1 tablet contains: active substance alprazolam 0.25 mg
Excipients: lactose monohydrate, corn starch, povidone, polysorbate 80, crospovidone, magnesium stearate.
1 tablet contains: active substance alprazolam 0.5 mg
Excipients: lactose monohydrate, corn starch, povidone, polysorbate 80, crospovidone, quinoline yellow E 104, magnesium stearate.
1 tablet contains: active substance alprazolam 1 mg
Excipients: lactose monohydrate, corn starch, povidone, polysorbate 80, crospovidone, blue dye (patent blue dye E 131 + brilliant black dye E151), magnesium stearate.

Description.
Tablets 0.25 mg: Round, slightly bifid white tablets with a beveled edge and a notch on one side.
Tablets 0.5 mg: Round, slightly biconvex tablets of light yellow color, white inclusions are allowed, with a beveled edge and a notch on one side.
Tablets 1 mg: Round, slightly biconvex tablets of light blue color, blotches of white and blue are allowed, with a beveled edge and a notch on one side.

Pharmacotherapeutic group:

anxiolytic agent (tranquilizer).
ATX code

pharmacological properties.
Strong substance (approved at the meeting of the Standing Committee on Narcotics Control on April 17, 2002, Protocol No. 1/84-2002)
Alprazolam is a drug from the group of benzodiazepine derivatives with an average duration of action, it also has a sedative-hypnotic effect. Stimulates benzodiazepine receptors, supramolecular GABA-benzodiazepine-chlorionophore prescription complex, leading to activation of the GABA receptor, causing a decrease in the excitability of the subcortical structures of the brain, inhibition of polysynaptic spinal reflexes, reduces the excitability of the subcortical structures of the brain (limbic system, thalamus, hypothalamus). It has anxiolytic (eliminates anxiety and fear), sedative, antidepressant, hypnotic, anticonvulsant, central muscle relaxant action. The anxiolytic effect is manifested in the reduction of emotional stress, the weakening of anxiety, fear, anxiety.
Pronounced anxiolytic activity is combined with a moderate hypnotic effect; shortens the period of falling asleep, increases the duration of sleep, reduces the number of night awakenings.
Pharmacokinetics. Absorption after oral administration is rapid and complete. The maximum concentration in blood plasma is reached after 1-2 hours. Communication with plasma proteins is 80%. Penetrates through the placental and blood-brain barrier, penetrates into breast milk. The equilibrium concentration in the blood plasma is reached within 2-3 days. Metabolized in the liver. The half-life is 11-16 hours (applies to benzodiazes with an average half-life). It is excreted mainly by the kidneys in the form of compounds with glucuronic acid.

Indications for use
The drug is used strictly according to the doctor's prescription:

• Anxiety disorders (without symptoms of depression), accompanied by a sense of anxiety, danger, tension, agitation, irritability, insomnia.
• Anxiety associated with depression.
• Anxiety disorders and mixed anxiety-depressive states, against the background of somatic diseases, withdrawal syndrome in the phase of chronic alcoholism.
• panic disorder.

Contraindications
Helex ® is contraindicated in patients with hypersensitivity to alprazolam or other ingredients of the drug, as well as other benzodiazepines.
Acute attack of angle-closure glaucoma, shock, myasthenia gravis, acute alcohol poisoning (with weakening of vital functions), narcotic analgesics, hypnotics, acute respiratory failure, sleep apnea, chronic obstructive pulmonary disease, severe liver and kidney dysfunction, epilepsy. Pregnancy (especially I trimester) and lactation, age up to 18 years (safety and efficacy have not been established).
The drug is not recommended for the treatment of patients with severe depression and suicidal tendencies.
Carefully: liver failure, chronic renal failure, cerebral and spinal ataxia, history of drug dependence, hyperkinesis, organic brain diseases, psychosis (paradoxical reactions are possible), hypoproteinemia, old age.

Pregnancy and lactation
During pregnancy, they are used only in exceptional cases and only for health reasons. It has a toxic effect on the fetus and increases the risk of congenital malformations when used in the first trimester of pregnancy. Taking therapeutic doses of the drug during pregnancy can cause depression of the central nervous system of the newborn and lead to physical dependence with the development of the "withdrawal" syndrome in the newborn. The use of the drug immediately before or during childbirth may cause respiratory depression, decreased muscle tone, hypotension, hypothermia, and a weak act of sucking (“sluggish baby syndrome”) in the newborn.

Dosage and administration
The optimal dose of Helex is determined individually based on the severity of the symptoms and the individual response of the patient. The table shows the regimen for the use of the drug, which meets the needs of most patients. If patients require higher doses, they should be increased with caution to avoid side effects. First, increase the evening dose of the drug, and then the daily dose.

Initial doses should be reduced if side effects are observed during their administration. Cancellation of Helexa ® should be carried out gradually, since an abrupt interruption of the course can cause a withdrawal syndrome. The phase-out should take a long period of time, i.e. if the patient takes 0.5 mg in the morning, 0.5 mg in the afternoon and 1 mg in the evening, then he should reduce the daily dose by no more than 0.25 mg every three days.

Side effect
From the nervous system: at the beginning of treatment (especially in elderly patients), drowsiness, fatigue, dizziness, decreased ability to concentrate, ataxia, gait instability, mental and motor reactions slowdown; rarely - headache, euphoria, depression, tremor, memory loss, impaired coordination of movements, confusion, diastolic extrapyramidal reactions, weakness, myasthenia gravis, dysarthria; extremely rarely - paradoxical reactions (outbursts of aggression, psychomotor agitation, fear, suicidal tendencies, muscle spasm, hallucinations, agitation, irritability, anxiety, insomnia).
On the part of the hematopoietic organs: leukopenia, neutropenia, agranulocytosis, anemia, thrombocytopenia.
On the part of the digestive system: dry mouth or salivation, heartburn, nausea, vomiting, loss of appetite, constipation, or diarrhea, abnormal liver function, increased activity of "liver" transaminases and alkaline phosphatase, jaundice.
From the genitourinary system: urinary incontinence, urinary retention, impaired renal function, decreased or increased libido, dysmenorrhea.
Allergic reactions: skin rash, itching.
Others: addiction, drug dependence, lowering blood pressure; rarely - visual impairment (diplopia), weight loss, tachycardia. With a sharp decrease in the dose or discontinuation of the intake, the “withdrawal” syndrome (irritability, nervousness, sleep disturbances, dysphoria, spasm of the smooth muscles of the internal organs and skeletal muscles, increased sweating, depression, nausea, vomiting, tremor, perception disorders, hyperacusis, paresthesia, photophobia , tachycardia, convulsions; rarely, acute psychosis).
Effect on the fetus: teratogenicity, CNS depression, respiratory failure and suppression of the sucking reflex in newborns, if the mother takes the drug during pregnancy.

Overdose
Symptoms: when taking 500-600 mg of alprazolam or more - drowsiness, confusion, decreased reflexes, nystagmus, tremor, bradycardia, shortness of breath or shortness of breath, lowering blood pressure, coma.
Treatment: gastric lavage, activated charcoal. Symptomatic therapy (maintaining breathing and blood pressure, the introduction of flumazenil (in a hospital). Hemodialysis is ineffective.

Interaction with other drugs
With the simultaneous appointment of Helexa ® (as well as all benzodiazepines) with other antipsychotics (neuroleptics, antidepressants, anesthetics, anticonvulsants and antihistamines), an increase in the inhibitory effect on the central nervous system may occur.
Alprazolam reduces the effectiveness of levodopa in patients with parkinsonism.
Helex ® may enhance the effect of alcohol, so patients should refrain from drinking alcohol during the treatment period.
With the simultaneous appointment of alprazolam in doses up to 4 mg with imipramine and clomipramine, stable plasma concentrations of the latter can increase by 30% and 20%, respectively.
Antihypertensive drugs can increase the severity of lowering blood pressure.
Co-administration of alprazolam and fluvoxamine causes an increase in plasma concentrations of alprazolam by approximately 30%.
Inducers of microsomal liver enzymes - reduce the effectiveness of alprazolam.
Simultaneous administration of alprazolam with ketoconazole, itraconazole and other antifungal drugs of the azole group, antibiotics - macrolides (erythromycin, oleandomycin, etc.), cimetidine, oral contraceptives, fluoxetine, sertraline, deltiazem, nefazodone can reduce the metabolism of alprazolam in the liver and enhance its effect.

special instructions
Alprazolam is not recommended for patients with primary signs of depression with psychomotor retardation, as well as for bipolar depression and psychotic symptoms. Because of the increased risk of suicidal behavior, all patients with depressive disorders should be monitored, especially at the start of treatment.
Long-term treatment should be discontinued gradually (see section "dosage and administration").
With a sudden cessation of taking the drug, a "withdrawal" syndrome may occur, especially with prolonged use of more than 8-12 weeks.
Elderly patients should be given the lowest effective dose as they may develop ataxia or become too sedated.
Influence on the ability to drive a car and work with mechanisms.
The drug has an effect on psychophysical abilities, especially if taken with alcohol or tranquilizers. During the period of treatment, care must be taken when engaging in potentially hazardous activities that require an increased concentration of attention and speed of psychomotor reactions.

Release form.
Tablets of 0.25, 0.5 and 1 mg. 15 tablets in a blister. 2 blisters in a cardboard box along with instructions for use.

Storage conditions.
List No. 1 of potent substances PKKN.
Store in a dry place, at a temperature not exceeding 30 °C.
Keep out of the reach of children.

Best before date.
5 years.
Do not use the drug after the expiration date.

Conditions for dispensing from pharmacies.
On prescription.

Manufacturer:

Krka, d.d., Novo mesto, Šmarješka cesta 6, 8501 Novo mesto, Slovenia

For all questions, please contact the Representative office in the Russian Federation:
123022, Moscow, 2nd Zvenigorodskaya st., 13, building 41