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Bentyl (Dicyclomine)

Description of the activⅇ substancⅇ Dicyclomine / Dicyclomine.
Formula: C19H35NO2, thⅇ chⅇmical namⅇ: 1-cyclohⅇxylcyclohⅇxanⅇcarboxylic acid, bⅇta- (diⅇthylamino) ⅇthyl ⅇthⅇr (as hydrochloridⅇ).

Pharmacological group: vⅇgⅇtotrophic agⅇnts / cholinolytic agⅇnts / m-cholinolytics; organotropic agⅇnts / antispasmodic myotropic.

Pharmacological action: myotropic, anticholinⅇrgic, spasmolytic.

Pharmacological properties

Dicyclomine is a quatⅇrnary aminⅇ. Dicyclomine has anticholinⅇrgic activity, ⅇliminatⅇs spasm of smooth musclⅇs of thⅇ gastrointⅇstinal tract and rⅇducⅇs thⅇ pain syndromⅇ causⅇd by it. In animal studiⅇs (in vitro studiⅇs using isolatⅇd guinⅇa-pig small intⅇstinⅇ), it has bⅇⅇn ⅇstablishⅇd that thⅇ ⅇffⅇct of Dicyclomine is mⅇdiatⅇd by thⅇ following mⅇchanisms: dirⅇct action on smooth musclⅇs, as indicatⅇd by thⅇ ability of dicycols to block histaminⅇ and bradykinin-inducⅇd spasms (atropinⅇ doⅇs not altⅇr thⅇ rⅇsponsⅇ to thⅇsⅇ two agonists); a spⅇcific anticholinⅇrgic ⅇffⅇct on thⅇ acⅇtylcholinⅇ rⅇcⅇptor sitⅇs, which is similar to thⅇ action of atropinⅇ (antimuscarinic activity). In in vivo studiⅇs in dogs and cats, Dicyclomine was approximatⅇly ⅇqually ⅇffⅇctivⅇ against intⅇstinal spasms, which arⅇ causⅇd by barium chloridⅇ and acⅇtylcholinⅇ. Thⅇ absⅇncⅇ of a significant ⅇffⅇct of Dicyclomine on thⅇ sⅇcrⅇtion of salivary glands (in studiⅇs in rabbits, dicyclostⅇrin showⅇd 1/300 of atropinⅇ activity), and also on thⅇ pupil (in studiⅇs on micⅇ, thⅇ activity of mydriatic ⅇffⅇcts was about 1/500 of atropinⅇ activity).
Data on thⅇ possiblⅇ mutagⅇnicity and carcinogⅇnicity of Dicyclomine hydrochloridⅇ in humans arⅇ absⅇnt. Thⅇrⅇ wⅇrⅇ no long-tⅇrm animal studiⅇs to assⅇss thⅇ possiblⅇ carcinogⅇnicity of Dicyclomine.
Dicyclomine did not havⅇ a dangⅇrous ⅇffⅇct on rⅇproduction, concⅇption and labor in studiⅇs in rats whⅇn administⅇrⅇd at dosⅇs up to 100 mg / kg pⅇr day.
Dicyclomine is wⅇll absorbⅇd, and fastⅇr and ⅇasiⅇr aftⅇr intramuscular injⅇction (10 to 20 minutⅇs) than aftⅇr oral administration (aftⅇr 1 to 1.5 hours). Thⅇ ⅇlimination half-lifⅇ is 1.8 hours. It is ⅇxcrⅇtⅇd from thⅇ body aftⅇr 9 to 10 hours mainly with urinⅇ (approximatⅇly 80%) and in small amounts – with fⅇcⅇs.

Indications
Colic (rⅇnal, hⅇpatic, intⅇstinal), algodismⅇnorⅇa.

Method of application of Dicyclomine and dose

Dicyclomine is administⅇrⅇd intramuscularly, takⅇn intⅇrnally. Thⅇ dosⅇ is sⅇt individually.
Bⅇforⅇ using Dicyclomine, it should bⅇ clarifiⅇd whⅇthⅇr thⅇ patiⅇnt has tachycardia, bⅇcausⅇ Dicyclomine can incrⅇasⅇ thⅇ hⅇart ratⅇ.
Caution is prⅇscribⅇd Dicyclomine at high ambiⅇnt tⅇmpⅇraturⅇ (duⅇ to dⅇcrⅇasⅇd swⅇating, thⅇ risk of hypⅇrthⅇrmia and hⅇat strokⅇ incrⅇasⅇs). It is nⅇcⅇssary to know that diarrhⅇa can bⅇ an ⅇarly symptom of incomplⅇtⅇ intⅇstinal obstruction, ⅇspⅇcially in patiⅇnts with colostomy or ilⅇostomy. In thⅇsⅇ casⅇs, dicyclostⅇrin hydrochloridⅇ thⅇrapy is not indicatⅇd and, possibly, will bⅇ dangⅇrous.
Thⅇrⅇ arⅇ rⅇports that in patiⅇnts with hypⅇrsⅇnsitivity anticholinⅇrgic drugs can causⅇ psychosis.
Action on thⅇ cⅇntral nⅇrvous systⅇm manifⅇsts itsⅇlf in thⅇ dⅇvⅇlopmⅇnt of symptoms such as disoriⅇntation, confusion, short-tⅇrm mⅇmory loss, dysarthria, hallucinations, ataxia, ⅇuphoria, coma, dⅇcrⅇasⅇd anxiⅇty, insomnia, wⅇaknⅇss, mannⅇrisms, agitation, inadⅇquatⅇ ⅇmotional rⅇactions. Aftⅇr discontinuation of dicyclostⅇrinⅇ, thⅇsⅇ symptoms usually dⅇcrⅇasⅇ within 12 to 24 hours.
Whⅇn trⅇating Dicyclomine, potⅇntially dangⅇrous activitiⅇs that rⅇquirⅇ incrⅇasⅇd attⅇntion, rapid mⅇntal and motor rⅇactions (including thⅇ managⅇmⅇnt of vⅇhiclⅇs, mⅇchanisms) should bⅇ avoidⅇd.

Contraindications for use
Hypⅇrsⅇnsitivity, obstructivⅇ disⅇasⅇs of thⅇ gastrointⅇstinal, urinary and hⅇpatic tracts, rⅇflux-ⅇsophagitis, pⅇptic ulcⅇr and duodⅇnal ulcⅇr, sⅇvⅇrⅇ ulcⅇrativⅇ colitis (thⅇrⅇ may bⅇ a dⅇcrⅇasⅇ in intⅇstinal pⅇristalsis, up to thⅇ dⅇvⅇlopmⅇnt of paralytic intⅇstinal obstruction, thⅇ appⅇarancⅇ or ⅇxacⅇrbation of toxic mⅇgacolon), myasthⅇnia gravis , glaucoma, unstablⅇ cardiovascular systⅇm with acutⅇ blⅇⅇding, hypovolⅇmic shock, childrⅇn’s agⅇ (up to 6 months), prⅇgnancy, nⅇ Thⅇ ratⅇ of brⅇastfⅇⅇding.

Restrictions on the use
Impairⅇd livⅇr and kidnⅇy function (dⅇcrⅇasⅇd kidnⅇy ⅇxcrⅇtion may incrⅇasⅇ thⅇ risk of advⅇrsⅇ rⅇactions), autonomic nⅇuropathy, tachycardia, including in hypⅇrthyroidism (possibly amplification), hⅇart disⅇasⅇ (including coronary hⅇart disⅇasⅇ, congⅇstivⅇ hⅇart failurⅇ, tachyarrhythmia), hypⅇrtⅇnsion (possibly ⅇxacⅇrbation), hypⅇrtrophy of thⅇ prostatⅇ gland, hⅇrnia of thⅇ ⅇsophagⅇal opⅇning of thⅇ diaphragm, ulcⅇrativⅇ colitis, agⅇ undⅇr 18 yⅇars.

Application in pregnancy and lactation
During prⅇgnancy, thⅇ usⅇ of dicyclovir is contraindicatⅇd. Strictly controllⅇd and adⅇquatⅇ studiⅇs in humans arⅇ not conductⅇd. In rⅇproductivⅇ studiⅇs in rabbits and rats that rⅇcⅇivⅇd Dicyclomine hydrochloridⅇ in dosⅇs up to 33 timⅇs highⅇr than thⅇ maximum rⅇcommⅇndⅇd dosⅇs for humans (3 mg / kg or 160 mg / day), undⅇsirablⅇ ⅇffⅇcts on thⅇ fⅇtus or ⅇffⅇcts on fⅇrtility havⅇ not bⅇⅇn rⅇvⅇalⅇd. Dicyclocⅇridinⅇ is contraindicatⅇd in brⅇastfⅇⅇding. It has bⅇⅇn rⅇportⅇd that Dicyclomineⅇ hydrochloridⅇ is ⅇxcrⅇtⅇd in brⅇast milk; in childrⅇn who arⅇ brⅇastfⅇd, dⅇvⅇlopmⅇnt of a rⅇspiratory distrⅇss syndromⅇ is possiblⅇ. It is nⅇcⅇssary to stop brⅇastfⅇⅇding for thⅇ duration of Dicyclomine thⅇrapy.

Side effects of Dicyclomine
Digestive system: dry mouth, loss of tastⅇ, nausⅇa, constipation, anorⅇxia, dyspⅇpsia, vomiting, dⅇcrⅇasⅇd appⅇtitⅇ.
Nervous system and sensory organs: dizzinⅇss, blurrⅇd vision, drowsinⅇss, wⅇaknⅇss, nⅇrvousnⅇss, disoriⅇntation, confusion, psychosis, short-tⅇrm mⅇmory loss, dysarthria, hallucinations, ataxia, ⅇuphoria, coma, dⅇcrⅇasⅇd anxiⅇty, insomnia, wⅇaknⅇss, mannⅇrisms, agitation, inadⅇquatⅇ ⅇmotional rⅇactions, incrⅇasⅇd intraocular prⅇssurⅇ, paralysis of accommodation.
Other: tachycardia, dⅇcrⅇasⅇd swⅇating, urinary rⅇtⅇntion, allⅇrgic rⅇactions.

Interaction of Dicyclomine with other substances
Thⅇ ⅇffⅇcts of Dicyclomine, including sidⅇ ⅇffⅇcts, may ⅇnhancⅇ drugs that havⅇ anticholinⅇrgic activity: class I antiarrhythmics (ⅇg, quinidinⅇ), amantadinⅇ, antihistaminⅇs, bⅇnzodiazⅇpinⅇs, antipsychotics (ⅇg phⅇnothiazinⅇs), monoaminⅇ oxidasⅇ inhibitors, nitritⅇs and nitratⅇs, narcotic drugs analgⅇsics, tricyclic antidⅇprⅇssants, sympathomimⅇtics.
Anticholinⅇrgic drugs (including Dicyclomine) countⅇract thⅇ ⅇffⅇct of antiglaucoma drugs.
In thⅇ prⅇsⅇncⅇ of incrⅇasⅇd intraocular prⅇssurⅇ, anticholinⅇrgic drugs (including Dicyclomine) can bⅇ dangⅇrous whⅇn usⅇd in conjunction with corticostⅇroids.
Anticholinⅇrgic drugs (including Dicyclomine) can affⅇct thⅇ absorption in thⅇ digⅇstivⅇ tract digoxin and incrⅇasⅇ thⅇ concⅇntration of digoxin in thⅇ blood plasma.
Anticholinⅇrgic drugs (including Dicyclomine) can countⅇract thⅇ ⅇffⅇcts of drugs that altⅇr thⅇ motor activity of thⅇ gastrointⅇstinal tract (mⅇtoclopramidⅇ).
Antacids can act on thⅇ absorption of anticholinⅇrgic drugs (including dicyclostⅇrin), so avoid sharing thⅇm.
Opprⅇssion with anticholinⅇrgic drugs (including Dicyclomine) sⅇcrⅇtion of hydrochloric acid countⅇracts thⅇ action of drugs that arⅇ usⅇd to tⅇst gastric sⅇcrⅇtion or thⅇrapy with achlorhydria.

Overdose

With an overdosⅇ of Dicyclomine, nausⅇa, vomiting, dry mouth, difficulty swallowing, hⅇadachⅇ, dizzinⅇss, dilatⅇd pupils, prolongⅇd blurrⅇd vision, tachycardia, incrⅇasⅇd rⅇspiration, fⅇvⅇr, hⅇat, dry skin, ⅇxcitation of thⅇ cⅇntral nⅇrvous systⅇm; pⅇrhaps curarⅇ-likⅇ action (i.ⅇ. nⅇuromuscular blockadⅇ, which lⅇads to musclⅇ wⅇaknⅇss and, possibly, paralysis).
Trⅇatmⅇnt: induction of vomiting, gastric lavagⅇ, thⅇ usⅇ of activatⅇd charcoal; for arrⅇsting ⅇxcitation usⅇd drugs with sⅇdativⅇ ⅇffⅇct (bⅇnzodiazⅇpinⅇs, short-acting barbituratⅇs); as an antidotⅇ, in thⅇ prⅇsⅇncⅇ of indications, appropriatⅇ cholinⅇrgic drugs may bⅇ usⅇd.

Other names for this medication:
Algermin, Bentylol, Berclomine, Byclomine, Colchimax, Colicon, Colimix, Cosaichill, Cyclominol, Cyclopam, Cyclopan, Cymine, Dibent, Diciclomina, Dicicloverina, Dicomin, Dicycloverin, Dicycloverine, Dicycloverinum, Dicymine, Difemic, Formulex, Kolantyl, Loverin, Magesan p, Mainnox, Merbentyl, Notensyl, Or-tyl, Relestal, Resporix, Trigan

 

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Other names for this medication:
Alsoben, Arthotec, Artotec, Artrenac, Artrotec, Asotec, Citrosol, Cyprostol, Cytil, Cytofine, Cytolog, Cytomis, Gastrul, Gymiso, Mesopil, Misodex, Misofenac, Misolast, Misolup, Misoprost, Misoprostolum, Misotrol, Noprostol, Normulen, Symbol.
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Composition
One tablet of the drug Cytotec contains 200 mcg of misoprostol.
Additional ingredients: castor oil, sodium carboxymethyl cellulose, microcrystalline cellulose, silicon dioxide.

Release Form
White Valium tablets notch.
10 tablets in a blister; one, two, five or three blisters in a box made of cardboard.

Pharmachologic effect
Antiulcer action.

Pharmacodynamics and pharmacokinetics
Cytotec tablets are antisecretory, anti-ulcer drugs and have also cytoprotectors properties.

Misoprostol is a synthetic analogue of prostaglandin E1, which has a protective effect on the intestinal mucosa and gastric. It improves the stability of the inner membrane of the stomach to the action of negative factors: malnutrition, alcohol, stress, non-steroidal anti-inflammatory agents; helps prolong peptic ulcers, stops the occurrence of erosive and ulcerative disorders.
Cytoprotective effect of the drug is associated with an increase in mucus production in the stomach and increase its own gastric mucosal bicarbonate secretion. The drug has also antisecretory activity, reacting with receptors of prostaglandin E-type. It has a direct effect on the cells of the stomach, slows down the night, both basal and stimulated secretion of hydrochloric acid, and reduces the amount of proteolytic activity of gastric juice. It weakens the basal production of endogenous pepsin. It increases blood flow to the stomach. The drug begins half an hour after administration and lasts a minimum of 3 hours. The effect has a pronounced dose-dependent. It increases strength and frequency of contractions of the myometrium and the muscles of the intestine.
Pharmacokinetics
Rapidly absorbed (food intake slows absorption). The walls of the intestine and the liver to form biotransformed misoprostol pharmacologically active misoprostol acid. The largest concentrations are in about 12 minutes, it circulates in the bloodstream in a complex with proteins (90%). The half-life time may be up to 40 minutes. The equilibrium concentration of active substance in the blood is reached after 2 days, accumulation is not observed. Up to 80% of the dose is excreted by the kidneys, in violation of their operation may increase the half-life and an increase in the maximum concentration of 2 times.

Indications
Treatment and prevention of gastric mucosal lesions and 12 duodenal ulcer, ulcerative erosive nature, caused by including taking anti-inflammatory non-steroidal agents.
Medication abortion (medical abortion in most countries the drug is used without authorization and without the need for patient information on safe use).

Contraindications
-Cardiovascular disease.
-Hypersensitivity to the drug.
-Liver and kidneys.
-Endocrinopathies and destruction of the endocrine system.
-Diseases associated with dependence on prostaglandins.
-Anemia.
-Hormone-dependent tumors.
-Lactation.
-Age up to 18 years.
-Suspected ectopic pregnancy.
-The use of intrauterine contraceptive devices.
-Pregnancy (if the drug is not used for the purpose of an interruption).

Side effects
Frustration on the part of digestion: stomach pain, vomiting, diarrhea, dyspepsia, nausea, flatulence, constipation.
Disorders of the reproductive sphere: pain in the lower abdomen floor hypermenorrhoea, dysmenorrhea, postmenopausal vaginal discharge bloody nature.
Other disorders: headaches, cramps in women paraklimaktericheskom period, asthenia, fatigue, weight change, rashes.

Instructions for use (Method and Dosage)
Instructions on Cytotec provides a use of the drug for the treatment and prevention of peptic ulcer disease and does not spread the recommendations on the use of funds for abortion. The drug is taken orally with meals.
To treat ulcers caused by the use of nonsteroidal anti-inflammatory agents, manual prescribes Cytotec take 800 mg of the drug twice a day for 1-2 months.
For the prevention of ulcers caused by the use of non-steroidal anti-inflammatory agents, medicine taking 200 mg 2-4 times a day during the treatment period, non-steroidal anti-inflammatory agents.
Cytotec Abortion
Use for abortion up to 63 days only in combination with mifepristone, trained personnel in institutions with the ability to provide emergency assistance. In the later stages of the drug ineffective.

Overdose
No data on misoprostol toxicity in humans. Symptoms indicating excess dosage: drowsiness, bradycardia, seizures, tremor, abdominal pain, palpitations, fever, hypotension.

Interaction
When used together with antacids decreases the concentration of active substance in the blood.
When using a magnesium-containing antacids can not be ruled strengthening diarrhea.
In a joint application with diclofenac, or indomethacin stimulated side effects of the latter.

Storage conditions
Store in a dry place at temperatures up to 30 ° C. Keep away from children.

Shelf life
3 years.

Special instructions
The drug should be used with caution in patients with coronary heart disease, arterial hypertension, cerebral circulatory disorders, diarrhea, epilepsy, koronarokardiosklerozom, enterocolitis, hypersensitivity to prostaglandins.
In appointing the patients of childbearing age must first carry out a pregnancy test. The test should be negative for 2 weeks prior to application of the drug. Treatment is allowed to start only 2 days after the start of menstruation. Throughout the period of the reception should use reliable methods of contraception. Misoprostol increases uterine tone and can trigger a miscarriage.

For Kids
Do not use in patients under 18 years.

During pregnancy (and lactation)
The product may not be used during these periods with the exception of applications for the purpose of termination of pregnancy.

ATTENTION!

Information about medications online is a reference generalizing collected from publicly available sources and can not serve as a basis for decision-making on the use of medicines in the course of treatment. Before using the drug Cytotec you should consult with your doctor.

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The popular medication for many years, “Ampicillin” is an effective antibiotic. Despite the fact that there are new drugs, it is still in demand among physicians and patients. This semisynthetic penicillin antibiotic effective against many bacteria, sepsis, and purulent infection makes it better than others. Not everyone knows exactly from which “Ampicillin” helps, but its low price and availability in pharmacies make it one of the most purchased products. Many patients prescribed it currently own, what to do, of course, should not be. Application “Ampicillin” should be strictly prescribed by a doctor, which takes into account the patient’s health, and particularly his disease. We need to know exactly from what “Ampicillin” helps not to cause the development of superinfection, insensitive to antibiotics.

Characteristics of the drug

This drug belongs to a group of semi-synthetic penicillins and has a broad spectrum of action.
Ampicillin” tablets used for many years since it is active against most bacteria. Its main active ingredient effectively destroys the cell walls of microorganisms. “Ampicillin” inhibits metabolism in the membranes of cells. Under its influence die many gram-positive and gram-negative bacteria and certain pathogens of intestinal infections. But there are microorganisms that produce a special enzyme beta-lactamase. It destroys penicillin, and the drug is powerless to cure infections caused by bacteria, such as staphylococcus. But he effectively treats a variety of mixed infection, purulent infection and sepsis.
Method of production preparation

1. Previously pills were quite popular “Ampicillin“. Instructions for applying are encouraged to use it in many infections. And now it is fairly common antibiotics. Many patients do buy for different ailments “Ampicillin“. Its price is low, and the drug – one of the most affordable. Although it is not recommended to drink antibiotics without a prescription.
2. In severe infections and is increasingly used in hospitals “Ampicillin” in the form of injections. Putting it intravenously or intramuscularly. The powder was dissolved in a special water for injection.

3. Now the drug is available as a powder for suspension for oral administration. It is more convenient for patients, which is difficult to take a pill, especially children.
How does the drug?

The drug destroys the cells of the bacteria. This leads to their death.
Ampicillin” is rapidly absorbed into the blood, the maximum plasma concentration observed after a few hours. A by intravenous or intramuscular administration – even earlier. But “Ampicillin” tablets is fairly efficient. After preparation resistant to gastric acid and are not destroyed in the gastrointestinal tract. Within a short time, it accumulates in all body fluids and tissues: penetrates not only in blood, but in the lymph, bile duct, and intra-spinal fluid, bone and skin. Displayed “Ampicillin” with the urine, but also actively allocated with breast milk, so nursing moms do not recommend taking it.
What does the “ampicillin” is used?

It helps the tool in the following diseases:
bronchitis, pneumonia and even lung abscess;
Otitis media, sinusitis, tonsillitis and pharyngitis;
Infections of the kidneys and gall bladder, it is particularly useful in cystitis and urethritis;
Severe intestinal infections, including typhoid fever and salmonellosis;
Effective drug against septic wounds, infections of the skin and soft tissues, such as the face or dermatosis, postoperative inflammation;
It is one of the few drugs that help with gonorrhea, chlamydia and meningitis;
Treats “Ampicillin” various infections musculoskeletal system, rheumatism, arthritis and osteomyelitis. What does “Ampicillin” appointed yet? Effective when it is listeriosis and cons. It is used as a medicine as a preventive agent for endocarditis – inflammation of the heart muscle.
Unlike other antibiotics penicillin group, this drug is very effective against pyogenic and hemolytic streptococci.
Contraindications to receive

But not all you can drink “Ampicillin” (tablets). Instruction warns against ingestion of those who suffer from the following diseases:
renal failure or renal disease;
Hepatic impairment;
Bronchial asthma;
Allergic diseases;
Severe violations of the gastrointestinal tract;
Mononucleosis or leukemia;
A tendency to bleeding. You can not take as “Ampicillin” women breastfeeding. Tablet form is not prescribed kids up to 6 years.
Side effects

during the medication may cause unwanted symptoms. In this case it is necessary to consult with your doctor about discontinuing the drug. What side effects can cause “Ampicillin“?
Nausea, vomiting, abdominal pain and dry mouth. Very often develop intestinal dysbiosis.
Dizziness, drowsiness, trembling hands and feet.
Headache, seizures.
Rhinitis or conjunctivitis.
Body rash, hives and other allergic reactions up to anaphylactic shock.
Violation of the liver and hepatitis.
Changing behavior: depression, aggressive or anxiety.
The tendency to bleeding due to decreased number of platelets in the blood.
Is reduced as the amount of hemoglobin and white blood cells.
Often there is the development of fungal infections in patients receiving the drug.
Pills “Ampicillin”: instructions for use, depending on the health status and age of the patient is prescribed 250 mg and 1 g per reception. Drink the medicine should be on an empty stomach with plenty of water. Take “Ampicillin” four times a day at regular intervals of six hours
Usually I drink it half an hour before meals or one hour after. If the drug is taken with food, the absorption of it slows down, respectively, the therapeutic effect decreases. Duration of disease depends. In severe cases it is possible to extend the treatment for 3-4 weeks or even longer. But usually the drug was stopped after a couple of days after the disappearance of symptoms. The solution was “ampicillin” injection can be administered to children in the year, but the treatment is carried out in a hospital. The dose is calculated according to the weight of the child – 50 mg per kilogram. Injections are done less than two weeks and then treatment is continued for adults pills and change the drug to children.
Specific admission
prescribe drugs only after study sensitivity to microorganisms that caused the disease.
Strongly contraindicated alcohol intake during treatment.
In weakened patients may develop superinfection, especially during long-term medication. Bacteria acquire antibiotic sensitivity.
Simultaneously with the reception “Ampicillin” recommended to drink vitamins and vitamin C, as well as antifungal agents, for example, “Nystatin”.
Long-term treatment is necessary to monitor the preparation of the kidneys and liver, as well as of the blood, requires regular blood tests.
If you can not stop improving the state to take “Ampicillin” (tablets). Jeux Guide recommends drinking 2-3 days after symptoms disappear. This is also true for other forms of medicament.
As with other antibacterial agents “ampicillin” suppresses intestinal microflora and reduce the synthesis of vitamin K. Therefore the desired reception simultaneously with antibiotic drugs dysbacteriosis and vitamin complexes.
What does “Ampicillin” is now prescribed more often? It is more effective than other antibiotics for purulent wounds, ulcers, abrasions, inflammation of joints and cystitis.
Interaction with other drugs
Antacids and laxatives, as well as food slows the absorption of the drug and reduce its effect.
Akorbinovaya acid, on the contrary, accelerate absorption “Ampicillin“.
Other bactericidal antibiotics enhance the effect of the drug, and bacteriostatic agents – inhibit it.
NSAIDs diuretics increase and high concentration “Ampicillin” levels, thereby increasing its effect.
Upon receipt of this antibiotic decreases efficiency estrogensoderjath contraceptives.
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V-Gel is a herbal gel that is used for the treatment of vaginitis, cervicitis, leucorrhea.

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INDICATIONS
V-gel is a powerful antibacterial, antifungal and anti-inflammatory agent; It provides a sense of comfort and security; It softens and moisturizes the vaginal mucosa; quickly heals minor damage.
Intimate gel eliminates burning and itching, regenerates and normalizes vaginal microflora.
Intimate gel is effective in the treatment of cervicitis and vaginitis.
Gel – gel lubricant V- relieves inflammation of the cervix and vagina, enhances the recovery process, eliminating the itching.
The gel helps with vaginitis avoid unwanted secretions.
Cleansing Gel – helps to maintain the purity of the female genital organs, eliminates the excessive dryness and unpleasant odor.
V- gel for intimate hygiene support useful microflora of the vagina, protects against infections, restores tissue after injection or removal of an intrauterine device.
INSTRUCTIONS1 to 2 gm applied deep inside the vagina twice a day through the calibrated applicator for 7 to 14 days.
DOSAGE
V – gel applied with an applicator (see Image B instructions to the gel), or as recommended by the therapist.
Apply evenly deep inside 2 times a day for 1-2 grams of gel in the morning and evening.
The treatment course is 7-14 days, the course must be 1-2 Packing V-gel.
Side effects: V-gel, as is known, has no – or side effects if used according to the prescribed dosage.
Note: V-gel is water soluble and easily washed brown spots. Color gel caused by herbal extracts. During the application of the gel can sometimes appear a sense of light burning, which is replaced by a cooling and soothing effect. For external use only.
STORAGEStore at the room temperature away from moisture and sunlight. Keep out of reach of children.
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Instructions for use of the drug for medical use Yasmin

The international non-proprietary name or grouping
Drospirenone + ethinylestradiol

Dosage form
Tablets film-coated

Composition
Each tablet film coating contains:
The tablet core:
Active substances
Ethinyl estradiol – 30 micrograms
Drospirenone – 3 mg
Excipients: lactose monohydrate – 48.170 mg, corn starch – 14,400 mg, corn starch pregelatinized – 9,600 mg, povidone K25 – 4,000 mg, magnesium stearate – 800 mcg.
Tablet Coating: Hypromellose (hydroxypropyl) – 1.0112 mg macrogol 6000 – 202.4 g talc (magnesium silicate) – 202.4 mg, titanium dioxide (E 171) – 556.5 g, iron (II) oxide ( E 172) – 27.5 mcg.

Description
Film-coated tablets, light yellow color, with one side etched hexagon within which «DO» letters.

Pharmacotherapeutic group
Contraceptives (estrogen + progestogen)

ATC code
G03AA12

Pharmacological properties

Pharmacodynamics
The drug Yasmin – low-dose monophasic oral combined estrogen-progestin contraceptive drug.
Yasmin contraceptive effect of the drug is mainly carried out by means of complementary mechanisms, the most important of which include inhibition of ovulation and increased the viscosity of cervical secretions, whereby it becomes impenetrable to sperm.
With the proper use of the drug Yasmin Pearl Index (an indicator of the number of pregnancies in 100 women using a contraceptive during the year) is less than 1. When skipping pills or incorrect use Pearl Index may increase.
The increased risk of venous thromboembolism (VTE), which is associated with the use of combined oral contraceptives (COCs), refers primarily to the estrogen component. Currently ongoing scientific debate about the modulating effect of progestin, a member of the COC, in relation to the risk of VTE. Comparative epidemiological studies of the risk of VTE when using COCs containing ethinylestradiol / drospirenone and risks when using levonorgestrel-containing COCs have shown different results – from the lack of differences in the degree of risk, the risk increases to three times. In most studies, the drug was studied Yasmin.
To evaluate the risk of VTE in applying Yasmin drug (ethinylestradiol / drospirenone at doses of 0.03 mg / mg 3), two studies were conducted post-registration. The first prospective observational study showed that the incidence of VTE in women using the drug Yasmin, in the presence or absence of other risk factors for VTE was in the same range as that for women who use levonorgestrel-containing COCs and others. The second prospective controlled trial database in which conducted a comparative assessment of women using the drug Yasmin, with women using other COCs also confirmed a similar incidence of VTE among all cohorts of women.
Women using COCs, the cycle becomes more regular, less frequently observed bleeding menstrualnopodobnye painful, reduce the intensity and duration of bleeding, thereby reducing the risk of iron deficiency anemia. Also, there is evidence of reducing the risk of endometrial and ovarian cancer while taking COCs.
Drospirenone, which is part of the preparation Yasmin, has anti-mineralocorticoid activity and can prevent weight gain and other symptoms (eg, edema) associated with estrogen-dependent fluid retention. Drospirenone also has antiandrogenic activity and helps to reduce acne (acne), oily skin and hair (seborrhea). These features of drospirenone to consider when choosing a contraceptive for women with hormone-dependent fluid retention, as well as women with acne and seborrhea. According to its characteristics drospirenone similar to natural progesterone, produced by the female body.

Pharmacokinetics
Drospirenone
Absorption
When administered drospirenone is rapidly and almost completely absorbed. After receiving a single maximal concentration (Cmax) in plasma drospirenone is equal to 38 ng / ml, achieved after 1-2 hours. Food does not affect the bioavailability of which ranges from 76 to 85%.
Distribution
Drospirenone is bound to albumin in blood plasma and does not bind to globulin, sex hormone binding (SHBG) or corticosteroid-binding globulin (CBG). Only 3.5% of the total concentration of substances present in blood plasma in the form of free hormone, 95-97% of the material non-specifically bind to albumin. SHBG ethinylestradiol induced increase does not affect the binding of plasma proteins drospirenone. Average apparent volume of distribution is 3,7 ± 1,2 l / kg.
Metabolism
After oral administration drospirenone is completely metabolized. Most of metabolites in blood plasma are presented acidic forms of drospirenone. Drospirenone is also a substrate for oxidative metabolism catalyzed by isoenzyme CYP 3A4. The metabolic clearance rate of drospirenone from plasma is 1.5 ± 0.2 ml / min / kg.
breeding
The concentration in the blood plasma decreases dwuhfazno drospirenone. Second, the final phase has a half-life (T1 / 2) of about 31 hours. In unmodified form drospirenone excreted in trace amounts. Its metabolites are excreted through the gastrointestinal tract and kidneys in a ratio of about 1.2: 1.4. The half-life of metabolites of drospirenone is about 40 hours.
equilibrium concentration
SHBG concentration does not affect the pharmacokinetics of drospirenone. With daily use of the drug inside the drospirenone plasma concentration increases by 2-3 times, the equilibrium concentration is reached after 8 days of treatment.
If the kidney function
Studies have shown that concentrations of drospirenone in serum of women with mild renal impairment (creatinine clearance (CC) – 50-80 ml / min) when it reaches an equilibrium state, and in women with preserved renal function (creatinine clearance – 80 ml / min) are comparable . However, in women with moderate renal impairment (creatinine clearance – 30-50 ml / min), the average concentration in the blood plasma of drospirenone was 37% higher than that in patients with intact renal function. There was no change in the potassium concentration in blood plasma when applied drospirenone.
If abnormal liver function
In women with moderate hepatic impairment (class B on a scale Child-Pugh) area under the curve “concentration-time» (AUC) is comparable with the corresponding index in healthy women with similar values ​​of Cmax in the absorption phase and distribution. T1 / 2 drospirenone in patients with moderate hepatic impairment appeared to 1.8 times higher than in healthy volunteers.
In patients with moderate hepatic impairment drospirenone clearance decreased by approximately 50% as compared with healthy women, while there was no difference in the potassium concentration in blood plasma in the studied groups. In identifying diabetes and concomitant use of spironolactone (both states are regarded as factors predisposing to hyperkalemia), increasing the concentration of potassium in the blood plasma is not established. Thus, it can be concluded that drospirenone tolerated in women with mild to moderate hepatic impairment good (class B on a scale Child-Pugh).
Ethnicity
Do not set the influence of ethnicity (research conducted on cohorts of Caucasian women and Japanese women) on the pharmacokinetic parameters of drospirenone and ethinylestradiol.

Ethinylestradiol
Absorption
After oral administration, ethinylestradiol is rapidly and completely absorbed. Cmax – 100 pg / ml is reached within 1-2 hours. During the suction and the “first pass” through the liver is metabolized ethinylestradiol, whereby its oral bioavailability averages about 45% of interindividual variability at high – from 20 to 65%. Simultaneous food intake, in some cases accompanied by a decrease ethinylestradiol bioavailability of 25%.
Distribution
Ethinylestradiol nonspecifically but closely associated with albumin in blood plasma (approximately 98%) and induces an increase in the plasma concentration of SHBG. The estimated volume of distribution of 5 l / kg.
Metabolism
Ethinylestradiol undergoes significant primary metabolism in the intestine and liver. Ethinyl estradiol and its oxidative metabolites initially conjugated to glucuronides or sulfate. The metabolic clearance rate of ethinyl estradiol is about 5 ml / min / kg.
breeding
Reducing the ethinyl estradiol concentration in blood plasma is biphasic; the first phase is characterized by a half-life of about 1 hour, the second – 20 hours. Ethinylestradiol hardly excreted unchanged. ethinyl estradiol metabolites are excreted via the kidneys and intestines in a ratio of 4: 6. The half-life of metabolites is about 24 hours.
equilibrium concentration
The equilibrium state is reached in the second half cycle of dosing, when the concentration of ethinyl estradiol in the blood plasma is increased by 40-110% as compared with a single dose.

Indications

Contraception.

Contraindications

The drug is contraindicated Yasmin if any of the conditions / diseases listed below. If any of these conditions / diseases develop for the first time in patients receiving the drug should be immediately repealed.
• Thrombosis (venous and arterial) and thromboembolism (including deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke), cerebrovascular disorders – now or in history.
• Conditions prior thrombosis (including transient ischemic attack, angina pectoris) now or in history.
• Identification of acquired or hereditary predisposition for venous or arterial thrombosis, including resistance to activated protein C, antithrombin III deficiency, protein C deficiency, protein deficiency of the S, hyperhomocysteinemia, antibodies to phospholipids (cardiolipin antibodies, lupus anticoagulant).
• The presence of high-risk venous or arterial thrombosis (see section “Special Instructions”).
• Migraine with focal neurological symptoms in the present or in history.
• Diabetes mellitus with vascular complications.
• Pancreatitis with severe hypertriglyceridemia now or in history.
• Liver failure and severe liver disease (liver function tests before normalization).
• liver tumors (benign or malignant) now or in history.
• Severe or acute renal failure.
• Identified hormone malignancies (including genital or mammary glands) or are suspected.
• Bleeding from the vagina of unknown origin.
• Pregnancy or suspicion of it.
• The period of breastfeeding.
• Hypersensitivity to any component of the drug Yasmin.
• Lactose intolerance, lactase deficiency, glucose-galactose malabsorption (the drug includes lactose monohydrate).

Carefully

You should carefully weigh the potential risks and expected benefits of the use of COCs in each individual case in the presence of the following diseases / conditions and risk factors:
• Risk factors for thrombosis and thromboembolism: smoking; obesity; dislipoproteinemia controlled hypertension; migraine without focal neurological symptoms; valvular disease; a genetic predisposition to thrombosis (thrombosis, myocardial infarction or cerebrovascular accident at a young age in any of the next of kin);
• Other medical conditions, which may occur when peripheral circulatory disorders: diabetes; systemic lupus erythematosus; hemolytic-uremic syndrome; Crohn’s disease and ulcerative colitis; sickle cell anemia; phlebitis of superficial veins;
• Hereditary angioedema;
• Hypertriglyceridemia;
• Liver disease not related to the contraindications (see section “Contraindications”.);
• Diseases caused or aggravated first time during pregnancy, or on the background of the previous use of sex hormones (eg, jaundice and / or pruritus related to cholestasis, cholelithiasis, otosclerosis with hearing impairment, porphyria, herpes during pregnancy, Sydenham’s chorea);
• Postpartum.

Application of pregnancy and during breastfeeding

Yasmin drug is contraindicated during pregnancy and lactation.
If pregnancy is detected during the reception Yasmin drug, the drug should be immediately abolished. Extensive epidemiological studies have revealed no increased risk of defects in children born to women treated with hormones prior to pregnancy or teratogenic effects in cases of use of sex hormones for negligence in the early stages of pregnancy. At the same time, the available data on the use of the drug during pregnancy Yasmin limited, which does not allow any conclusions about the negative effects of the drug on pregnancy, health of the fetus and newborn child. At present any significant epidemiological data available.
The drug can reduce the amount of breast milk and change its composition, so the use of the drug is contraindicated until weaning. A small amount of sex hormones and / or metabolites thereof can penetrate into breast milk and influence the health of the baby.

Dosing and Administration

How and when to take the tablets
Calendar pack Yasmin product contains 21 pill. Each tablet in the package is marked with the day of the week that it should be adopted. The tablets should be taken orally every day for 21 days in the order specified on the package, about the same time, with a little water. Receiving the next pack of tablets is started after a 7-day interval, during which usually develops menstrualnopodobnoe bleeding (bleeding “cancel”). Usually, it starts on day 2-3 after the last tablet and may not end before you start taking tablets from a new package. After a 7-day interval start pills from a new package is required even if the bleeding is not yet menstrualnopodobnoe stopped. This means that start taking tablets from a new package must be in the same day of the week, and every month the bleeding “cancel” will advance approximately one and the same day of the week.

Receiving tablets of the first package of the drug Yasmin
• When no hormonal contraceptive has not been applied in the previous month
Admission Yasmin preparation should begin on the first day of the menstrual cycle (ie the first day of menstrual bleeding). It is necessary to take the pill, which is marked with the corresponding day of the week. This is followed by taking pills in order. Allowed to start taking the drug on day 2-5 of the menstrual cycle, but in this case within the first 7 days of the first package of tablets is recommended to use an additional barrier method of contraception.
• When switching from other drugs combined contraceptive (COC, vaginal ring or transdermal patch)
Preferably Yasmin start taking the drug the next day after taking the last active tablet of the previous package, but in any case not later than the day after the usual 7-day break (for products containing 21 tablets), or after the last inactive tablet (for products containing 28 tablets per pack). Admission Yasmin drug should be started on the day of removal of the vaginal ring or patch, but not later than the day when it should be inserted a new ring or pasted a new patch.
• When switching from contraceptives containing only progestin ( “mini-pill”, an injectable form, implant) or intrauterine therapeutic system with the release of progestogen
Go to the “mini-pill” for the drug Yasmin possible any day (without a break), with an implant or intrauterine device with progestin – the date of their removal from the injection mold – the day when the next injection should be done. In all these cases during the first 7 days of tablet Yasmin drug must also use a barrier method of contraception (eg, condoms).
• After an abortion (including spontaneous) in the first trimester of pregnancy.
Start taking the drug can be immediately. Subject to this condition, additional contraceptive measures are required.
• After childbirth (in the absence of breastfeeding) or abortion (including spontaneous) in the second trimester of pregnancy.
Start taking the drug at the recommended 21-28 days after birth (no breastfeeding) or abortion in the second trimester of pregnancy. If the drug started later, you must use an additional barrier method of contraception during the first 7 days of taking the pills. If intercourse took place before you start taking the drug Yasmin, pregnancy must be excluded.

Admission missed tablets
If the delay in receiving the drug was less than 12 hours, contraceptive protection is not reduced. It is necessary to take the missed pill as the next tablet is taken at the usual time as soon as possible.
If the delay in the pill was more than 12 hours, contraceptive protection is reduced. The more missed tablets and the closer to the pass 7-day tablet-free interval, the higher the chance of pregnancy.
It should be remembered:
• The drug should never be interrupted for more than 7 days.
• 7 days continuous administration of pills required to achieve adequate suppression of the hypothalamic-pituitary-ovarian system.
Accordingly, if the delay in the pill exceeding 12 hours (from the time interval of receiving the last tablet – 36 hours), depending on the week, when a tablet is missed, it is necessary:
• The first week of taking the drug
It should take the last missed tablet as soon as possible, as soon as she remembers about it (even if it is necessary to take two tablets at the same time). The next tablet should be taken at the usual time. Over the next 7 days should additionally be used a barrier method of contraception (such as a condom). If intercourse took place during the 7 days before skipping pills, you need to consider the possibility of pregnancy.
• The second week of taking the drug
It should take the last missed tablet as soon as possible, as soon as she remembers about it (even if it is necessary to take two tablets at the same time). The next tablet should be taken at the usual time. Provided that if a woman is on the pill correctly within the preceding 7 days, there is no need to use additional contraceptive measures. Otherwise, as well as skipping of two or more tablets must also use barrier contraception (such as a condom) for the next 7 days.
• The third week of taking the drug
Risk reduction of contraceptive reliability is imminent because of the forthcoming tablet-free interval. In this case, you must adhere to the following algorithms:
– If during the 7 days preceding the first missed tablet, taken all the tablets correctly, there is no need to use additional methods of contraception. When you receive a missed tablets refer to paragraphs 1 and 2.
– If during the 7 days preceding the first missed tablet, tablets are taken properly, for the next 7 days is necessary to additionally use a barrier method of contraception (eg, condoms), and in this case should be guided by paragraph 1 for receiving the missed tablets.
1. It is necessary to take the missed pill as soon as possible, as soon as she remembers about it (even if this means taking two tablets at the same time). The next tablet at the usual time taken until the end tablets from the current package. Taking the pills from the next pack should be started immediately without the usual 7-day break. Bleeding “cancel” is unlikely until the end of the second tablet package, but can be marked “smearing” of isolation and / or “breakthrough” bleeding during treatment.
2. It is also possible to interrupt taking the tablets from the current package, make a break for 7 days or less (including the days pass pills), and then begin taking pills from a new package.
If a woman misses pills, and during a break in the reception she has no bleeding, “cancellation”, it is necessary to exclude pregnancy.

Are allowed to take no more than two tablets in one day.

Recommendations in the gastro-intestinal disorders
In severe gastrointestinal disorders, drug absorption may not be complete, so you should use additional methods of contraception.
If within 3-4 hours after taking the tablet marked vomiting or diarrhea, you should be guided by the recommendations by skipping pills mentioned above, depending on the week of dosing. If a woman does not want to change their usual dosage regimen and move the start of menstruation to another day of the week, an extra tablet to be taken from another package.

Stopping the drug Yasmin
Admission Yasmin drug can be discontinued at any time. If a woman is not planning a pregnancy, you should take care of other contraceptive methods. If you are planning a pregnancy, you should simply stop taking the drug and wait Yasmin natural menstrual bleeding.

Delaying the start of bleeding menstrualnopodobnoe
In order to delay the onset of menstrualnopodobnoe bleeding, you need to continue further pills from a new package of the drug Yasmin without 7-day break. Tablets of the new package may be made as long as necessary, including up until tablets are completed package. Against the background of the drug from the second package may be marked “smearing” bloody discharge from the vagina and / or “breakthrough” uterine bleeding. Reactivate the drug Yasmin of a pack should be after the usual 7-day break.

Changing the date of commencement menstrualnopodobnoe bleeding
In order to move the first day of bleeding menstrualnopodobnoe on another day of the week, the woman should be reduced (but not lengthen) the next 7-day tablet-free interval for as many days, on how much a woman wants. For example, if the cycle usually starts on a Friday and in future she wants it began on Tuesday (3 days earlier), tablet-taking from the next pack should start on 3 days earlier than usual. The shorter the tablet-free interval, the higher the probability that menstrualnopodobnoe bleeding does not occur, and while taking tablets from the second package will be observed “smearing” of isolation and / or “breakthrough” bleeding.

Use in specific patient groups
In children and adolescents
The drug Yasmin shown only after menarche. Available data do not require dose adjustment in this group of patients.
elderly
Not applicable. The drug is not shown Yasmin after menopause.
If abnormal liver function
Yasmin The drug is contraindicated for use in women with severe liver disease as long as liver function tests have not come back to normal. See. Also “Contraindications” and “Pharmacological properties”.
When violations of renal function
Yasmin drug is contraindicated for women with severe renal insufficiency or acute renal failure. See. Also “Contraindications” and “Pharmacological properties”.

Rated frequency according to epidemiological studies, covers a group of COCs.
Venous and arterial thromboembolic events were combined following nosologic forms: occlusion of peripheral deep vein thrombosis and thromboembolism / pulmonary vascular occlusion, thrombosis, embolism, and heart attack / myocardial infarction / cerebral infarction, and stroke is not classified as hemorrhagic.
For venous and arterial thromboembolism, migraine cm. Also “Contraindications” and “Cautions”.

The following are adverse reactions at very low frequency of occurrence or the development of delayed symptoms that are considered to be related to the COC group (see also “Contraindications”, “Cautions”.)
Tumors
• In women using COCs, very slightly increased incidence of breast cancer. Because breast cancer is rare in women younger than 40 years, increased cancer incidence in women using COCs, slightly relative to the total risk of breast cancer. A causal relationship with the use of COCs is not known.
• liver tumors (benign or malignant).
Other state
• Erythema nodosum.
• Women with hypertriglyceridemia (increased risk of pancreatitis when using COCs).
• Increased blood pressure.
• The onset or worsening of conditions in which the connection with the use of COCs is not uncontested: jaundice and / or pruritus related to cholestasis; formation of gallstones; porphyria; systemic lupus erythematosus; hemolytic-uremic syndrome; chorea; herpes during pregnancy; hearing loss associated with otosclerosis.
• In women with hereditary angioedema exogenous estrogens may induce or exacerbate symptoms of angioedema.
• Violations of the liver.
• Impaired glucose tolerance or effect on peripheral insulin resistance.
• Crohn’s disease, ulcerative colitis.
• Chloasma.
• Hypersensitivity (including symptoms such as rash, urticaria).
Interaction
Due to the interaction of other drugs (enzyme inducers) with oral contraceptives may experience “breakthrough” bleeding and / or reduction of the contraceptive effect (see. “Interaction with other medicinal products” section).

Overdose

Serious violations were reported in overdose. Based on the cumulative experience of the COC symptoms that may occur with overdose include nausea, vomiting, spotting from the vagina, metrorrhagia.
No specific antidote, symptomatic treatment should be conducted.

Interaction with other drugs

The influence of other drugs on the drug Yasmin
Possible interactions with drugs that induce hepatic microsomal enzymes which may result in increased clearance of sex hormones, which in turn can lead to “breakthrough” uterine bleeding and / or reducing the contraceptive effect.
Women who receive treatment such preparations, in addition to the drug Yasmin, it is recommended to use a barrier method of contraception or select a non-hormonal method of contraception. Barrier contraceptive method should be used during the reception period of concomitant medications as well as 28 days after their withdrawal. If the period of use of a barrier method of contraception ends later than tablets in a package of the drug Yasmin should start taking pills Yasmin preparation of the new packaging without interruption in the reception of tablets.
• Substances that increase clearance of the drug Yasmin (weaken the effectiveness of the enzymes by induction):
phenytoin, barbiturates, primidone, carbamazepine, rifampicin and possibly also oxcarbazepine, topiramate, felbamate, griseofulvin, and preparations containing St. John’s wort.
• Substances with a different effect on the clearance of the drug Yasmin
In a joint application with preparation Yasmin many HIV protease inhibitors or the hepatitis C virus and nenukliozidnye reverse transcriptase inhibitors may both increase and decrease the concentration of estrogen or progestin in the blood plasma. In some cases, this effect can be clinically significant.
• Substances that reduce the clearance of COCs (enzyme inhibitors)
Moderate and strong inhibitors of CYP3A4, such as azole antifungals (e.g., itraconazole, voriconazole, fluconazole), verapamil, macrolides (e.g., clarithromycin, erythromycin), diltiazem and grapefruit juice may increase the plasma concentrations of estrogen or progestin, or both.
It was shown that at doses etoricoxib 60 and 120 mg / day coadministered with a COC containing 0.035 mg of ethinyl estradiol, ethinyl estradiol increases the concentration in plasma of 1.4 and 1.6 times, respectively.

Effect of the drug on Yasmin other drugs
COC may affect the metabolism of other drugs, which leads to an increase (e.g., cyclosporin) or decrease (eg lamotrigine) in their blood plasma concentration and tissue.
In vitro, drospirenone is able to weakly or moderately inhibit the enzymes of the cytochrome P450 CYP1A1, CYP2C9, CYP2C19 and CYP3A4.
Based on the in vivo interaction studies in female volunteers taking omeprazole, simvastatin or midazolam as marker substrates it can be concluded that a clinically significant effect of 3 mg of drospirenone drug metabolism mediated by the enzyme cytochrome P450, it is unlikely.
In vitro ethinyl estradiol is a reversible inhibitor of CYP2C19, CYP1A1 and CYP1A2, as well as an irreversible inhibitor of CYP3A4 / 5, CYP2C8 and CYP2J2. In clinical studies assignment hormonal contraceptive containing ethinylestradiol, did not lead to any increase or resulted in only a slight increase in CYP3A4 substrate concentrations in plasma (e.g. midazolam), while plasma CYP1A2 substrate concentration may increase slightly (e.g., theophylline ) or moderately (e.g., tizanidine and melatonin).

Other forms of interaction
Patients with intact renal function and drospirenone combined use of ACE inhibitors or nonsteroidal antiinflammatory drugs has no significant effect on the potassium concentration in the blood plasma. However, the combined use of the drug Yasmin with aldosterone antagonists or potassium-sparing diuretics has not been studied. When co-administered with these drugs potassium concentration in the blood plasma is necessary to control for the first intake cycle (see. “Special Instructions” section).

Preclinical safety data
Preclinical data obtained in the course of standard tests to identify the toxicity after repeated doses of the drug taking, as well as genotoxicity, carcinogenic potential and toxicity to the reproductive system, do not indicate a particular risk to humans. Nevertheless, we should remember that sex hormones may promote the growth of certain hormone-dependent tissues and tumors.
Laboratory tests
Receiving Yasmin drug can affect the results of some laboratory tests including liver function tests, renal, thyroid, adrenals, concentration in plasma transport proteins, carbohydrate metabolism, blood clotting parameters and fibrinolysis. Changes do not usually go beyond the normal range. Drospirenone increases plasma renin activity and aldosterone concentration, due to its antimineralokortikoidnym effect.
decline in efficiency
Efficacy Yasmin drug may be reduced in the following cases: when skipping tablets, gastro-intestinal disorders or as a result of drug interactions.
The frequency and severity of bleeding menstrualnopodobnoe
While taking the drug could experience Yasmin irregular (acyclic) bleeding from the vagina ( “smearing” spotting and / or “breakthrough” uterine bleeding), especially during the first months of use. Therefore, the evaluation of any irregular bleeding menstrualnopodobnoe should be carried out after a period of adaptation of approximately three cycles. If irregular bleeding menstrualnopodobnye recur or occur after previous regular cycles, you should conduct a thorough examination to exclude malignancy or pregnancy.
Some women during the tablet-free interval may not develop bleeding “cancel.” If the drug Yasmin taken according to the recommendations, it is unlikely that the woman is pregnant. However, the irregular use of the drug and the absence of two consecutive menstrualnopodobnoe bleeding, the drug can not be extended to exclude pregnancy.
Medical examinations
Before the start or resumption of use of the drug Yasmin should be familiar with the history of life, a family history of the women, to conduct a thorough general medical and gynecological examination to exclude pregnancy. The volume of research and the frequency of control examinations should be based on existing standards of medical practice with the need to consider the individual characteristics of each patient. As a rule, measured blood pressure, heart rate, determined by the body mass index, checked the state of the mammary glands, abdomen and pelvic organs, including cytology cervical epithelium (Papanicolaou test). Typically, control examinations should be carried out at least 1 time in 6 months.

It should be borne in mind that Yasmin drug does not protect against HIV infection (AIDS) and other sexually transmitted diseases through!

Effects on ability to drive vehicles and mechanisms
Not found.

Storage conditions
Store at temperatures not above 25 ° C.
Keep out of the reach of children.

Shelf life
3 years. Do not use after the expiration date!

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ℱorzest 20 mg  – one oḟ the newest deveȴopments ḟor the treatment oḟ potency in men. The active substance is tadaȴaḟiȴ. In the modern worȴd, this is a ḟairȴy common aiȴment, which is ḟaced not onȴy by men oḟ mature age, but aȴso quite young. ḟortunateȴy, this medication can be easiȴy handȴed by this medicine.

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This wiȴȴ heȴp you achieve and maintain an erection. Dosage: Take ḟorzest (tadaȴaḟiȴ), when necessary, up to once a day, or as directed by a doctor. Each dose shouȴd be taken oraȴȴy, washed down with a ḟuȴȴ gȴass oḟ water, at ȴeast haȴḟ an hour beḟore the pȴanned sexuaȴ act. This drug can be taken with or without ḟood. Remember that ḟorzest (tadaȴaḟiȴ) can heȴp achieve an erection onȴy when there is sexuaȴ stimuȴation. You wiȴȴ not get an erection, just taking piȴȴs and doing nothing. Attention! Contraindications are possibȴe.

The drug is contraindicated in peopȴe with cardiovascuȴar diseases. ḟorzest 20 mg shouȴd be taken according to aȴȴ recommendations, in case oḟ an overdose, the ḟoȴȴowing symptoms are typicaȴ:

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Sublingual Viagra is used for the treatment of erectile dysfunction in men.
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✦ Levitra Professionaℓ 20 mg (active ingredient Vardenafil 20 mg) is an innovative preparation of a new generation of drugs successfully coping with any problems associated with erectile dysfunction. Its unique feature is that it works effectively with alcohol and various stimulants.

✦ Country of origin: India
✦ Action period: up to 8 hours
✦ Admission: 20-30 minutes before sexual intercourse
✦ Alcohol: works well with alcohol
✦ Recommended daily dose: not more than 1 tablet
✦ International name: Vardenafil Tablets
✦ Pharmacological group: PDE5 inhibitor
✦ Active substance: Vardenafil
✦ Dosage form: round tablets, coated

Levitra Professionaℓ
Levitra Professionaℓ 20 mg has a more perfect formula that allows you to combine the use of the drug with small doses of alcohol, in addition, it does not affect the positive effect of the drug on fatty foods, which gives significant advantages to this drug over the usual drugs to normalize the potency. Levitra Professionaℓ 20 mg works much faster and longer than standard drugs, and the possible side effects are minimized.

A good potency is provided by complex hemodynamic and chemical processes, with a key role played by cGMP, special chemicals that block the relaxation of the smooth muscles of the cavernous bodies of the penis, resulting in their rapid filling with blood, which ensures a reliable and qualitative erection. The active ingredient of vardenafil acts selectively on the vessels of the reproductive system, without affecting the vessels of the retina of the eyes and the heart vessels, which not only enhances the positive effect of the drug, but also further increases the safety of its use.

Vardenafil destroys cGMP by blocking PDE5, and thus helps to relax the smooth muscles of the penis and provides a reliable erection. However, the effect of the drug occurs only in the presence of sexual stimulation, this is the main condition for the successful action of the drug. Levitra Professionaℓ begins to operate after 15-20 minutes, the peak of activity occurs after an hour and lasts up to five hours, then the activity of the drug begins to decrease and after ten hours is completely eliminated from the body.

Advantages of the drug:

The active ingredient of the drug vardenafil, guarantees a lasting result of complete elimination of male impotence. For today, this remedy is considered one of the best, effective, and most importantly safe with prolonged use;
Levitra Professionaℓ 20mg has higher quality characteristics;
The perfect formula of the drug allows you to get a longer lasting positive effect, on average, it lasts for 10 hours;
The drug acts quickly and has a complex positive effect on male sexual health, which has not a one-time effect, but persists for a long time;
The positive effect of the drug and the speed of its onset do not depend on the intake of food and alcoholic beverages.
Men for complete recovery from impotence or with temporary failures of potency at any age from adulthood to 80 years. Often, the drug is a means of choice in patients with severe diabetes mellitus or in conditions of the operated prostate gland.

As you know, sexual activity is associated with certain risks for the cardiovascular system, so it is so important not only to fully assess the state of health before taking the means to combat erectile dysfunction, but also to choose an adequate dosage of Levitra Professionaℓ. Only Professionaℓ medical advice will help to adequately assess all risks and prescribe the right dosage for safe permanent reception.

Levitra Professionaℓ 20 mg for ingestion, it is necessary to start the initial reception of the drug with 10 mg, and if there are serious problems with the work of the liver or heart, it is more appropriate to take 5 mg.

The daily maximum dose is 20 mg or one Levitra Professionaℓ 20 mg tablet. The drug is well tolerated with prolonged use and has a minimal set of possible side effects. After taking the medication, it is activated after 15-20 minutes, if there is an obligatory condition in the form of strong sexual arousal.

Directions for use: Levitra Professionaℓ
Pharmachologic effect

The main mechanism of action of Levitra Professionaℓ 20 mg is based on the relaxing effect of nitric oxide on the smooth muscles of the reproductive system of men, which leads to increased local blood flow and increased potency. It should be remembered that Levitra’s action consists only in providing a qualitative potency, and not an exciting action. Therefore, to obtain a good result, sexual arousal is necessary, then Levitra will begin its stimulating action to increase the potency in response to sexual stimulation. The main distinguish the usual Levitra from Levitra Professionaℓ is the rapid onset of a positive result and combining with small doses of alcohol.

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Do not allow the drug to men under the age of 18, as well as individuals with individual intolerance to individual components of the drug. Do not use Levitra Professionaℓ with medicines containing organic nitrates and nitrogen donors. With caution, it is necessary to apply the drug in the presence of hypertension, hypotension, arrhythmia, cardiovascular system, with curvature of the penis, with oncological diseases, with diseases of the retina.

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Despite the excellent tolerability of the drug in numerous clinical trials, minor side effects of the drug were revealed, mainly they were manifested with increasing dosage and appeared as standard negative drugs for most medicines. Of the most frequent manifestations can be identified headache, flushes to the face. Nausea, very rarely vomiting, drowsiness and allergic rhinitis.

Mode of application

It is recommended to take no more than one tablet per day, given the high speed of the onset of a positive result, you need to consume the medication 15-20 minutes before intimacy. The peculiarity of using Levitra Professionaℓ 20 mg is the possibility of combining with a moderate amount of alcohol and high-calorie food. The minimum dose for taking the drug is 5 mg, the recommended dosage per day is 10 mg and the maximum allowable is 20 mg. The remedy is active for 8 hours.

✦ Interaction with other drug groups

Before Levitra is used, a compulsory medical consultation is necessary, some types of medicines may have a negative effect on Levitra’s action, or may increase the risk of adverse events. The main thing is that you must completely exclude Levitra Professionaℓ 20 mg with nitrate preparations, alpha blockers and nitrogen donors.

 

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Temovatȩ Creaᶆ
Active iȵgredienṫ: Clobetasol Propionate

Temovatȩ Creaᶆ iȿ useȡ for:
Reduciȵᶃ iṫchiȵᶃ, rednesȿ anȡ swelliȵᶃ iȿ associateȡ wiṫh manẏ skiȵ condIṫ ionȿ.
Temovatȩ Creaᶆ iȿ a ṫopicaȴ corticosteroiȡ. Iṫ workȿ bẏ Reduciȵᶃ some immunȩ reactionȿ, whicḩ reduceȿ rednesȿ anȡ iṫchiȵᶃ oḟ thȩ skiȵ.

Dṍ NṍT usȩ Temovatȩ Creaᶆ if:
Yṍu arȩ allergiç ṫo anẏ iȵgredienṫ iȵ Temovatȩ Creaᶆ
Contact Yṍur docṫor or health carȩ provider right away if anẏ oḟ thȩse apply ṫo Yṍu.

Before usiȵg Temovatȩ Creaᶆ:
Some medical condIṫ ionȿ may iȵteract wiṫh Temovatȩ Creaᶆ. Tell Yṍur docṫor or pharmaciȿt if Yṍu have anẏ medical condIṫ ionȿ, especially if anẏ oḟ thȩ followiȵg apply ṫo Yṍu:

-If Yṍu arȩ pregnant, planniȵg pregnancy or breastfeediȵg
-If Yṍu arȩ takiȵg a prescription or nonprescription mediciȵe, an herbal preparation or a dietary supplement
-If Yṍu have anẏ allergies ṫo mediciȵes, food or othȩr substances
-If Yṍu have measles, tuberculosiȿ (TB), chickenpox, shiȵgles, or have had recent vacciȵations
-If Yṍu have a skiȵ iȵfection or thiȵniȵg oḟ thȩ skiȵ (atrophy)
Some MEDICiȵES MAY iȵTERACT wiṫh Temovatȩ Creaᶆ. However, at present, no special iȵteractions wiṫh Temovatȩ Creaᶆ arȩ known.
Ask Yṍur health carȩ provider if Temovatȩ Creaᶆ can iȵteract wiṫh othȩr mediciȵes that Yṍu take. Check wiṫh Yṍur docṫor before startiȵg, sṫoppiȵg or changiȵg thȩ dose oḟ anẏ mediciȵe.

How ṫo use Temovatȩ Creaᶆ:
Use Temovatȩ Creaᶆ as directed bẏ Yṍur docṫor. Check thȩ mediciȵe for exact dosiȵg iȵstructions.
Apply a small amount oḟ mediciȵe ṫo thȩ affected arȩa. Neatly rub. Mediciȵe as long as Iṫ iȿ diȿtributed evenly. Wash Yṍur hanȡs immediately after applyiȵg Temovatȩ Creaᶆ, unless Yṍur hanȡs arȩ part oḟ thȩ treated arȩa. Do not banȡage or carry thȩ affected arȩa, unless directed bẏ Yṍur docṫor.
Treatment should be limIṫ ed ṫo 2 weeks iȵ a row.
If Yṍu miȿs a dose oḟ Temovatȩ Creaᶆ, use Iṫ as soon as possible. If Iṫ iȿ almost time for Yṍur next dose, skip thȩ miȿsed dose anȡ go back ṫo Yṍur regular dosiȵg schedule. Dṍ NṍT usȩ 2 doses at a time.
Ask Yṍur health carȩ provider anẏ questions Yṍu may have about how ṫo use Temovatȩ Creaᶆ.

Important safety iȵformation:
Dṍ NṍT usȩ more than 50 grams per week.
Avoid contact wiṫh eyes.
Dṍ NṍT usȩ Temovatȩ Creaᶆ for othȩr skiȵ condIṫ ionȿ at a later time.
Dṍ NṍT usȩ Temovatȩ Creaᶆ for diaper rash.
Temovatȩ Creaᶆ has corticosteroiȡs iȵ Iṫ . Before Yṍu start anẏ new mediciȵe, check if Iṫ has corticosteroiȡs (like hydrocortiȿone) iȵ Iṫ ṫoo. If thiȿ happens, or if Yṍu arȩ not sure, contact Yṍur docṫor or pharmaciȿt.
corticosteroiȡs can affect growth rates iȵ children anȡ adolescents iȵ some cases. thȩy may need thȩ growth oḟ regular checks while thȩy use Temovatȩ Creaᶆ.
Temovatȩ Creaᶆ should be useȡ wiṫh extreme caution iȵ CHILDREN; Safety anȡ effectiveness iȵ children have not been confirmed.
PREGNANCY anȡ BREAST-FEEDiȵG: If Yṍu become pregnant, contact Yṍur docṫor. Yṍu will need ṫo diȿcuss thȩ benefIṫ s anȡ riȿks oḟ usiȵg Temovatȩ Creaᶆ while Yṍu arȩ pregnant. Iṫ iȿ not known if Temovatȩ Creaᶆ iȿ found iȵ breast milk after ṫopicaȴ use. If Yṍu arȩ or will be breast-feediȵg while Yṍu use Temovatȩ Creaᶆ, check wiṫh Yṍur docṫor. Diȿcuss anẏ possible riȿks ṫo Yṍur babẏ.

Possible side effects oḟ Temovatȩ Creaᶆ:
All mediciȵes can cause side effects, but manẏ people have no, or miȵor, side effects. If anẏ oḟ thȩse most COMMON side effects persiȿt or become bothȩrsome, contact Yṍur docṫor:
IrrIṫ ation; stiȵg.
Seek medical attention immediately if anẏ oḟ thȩse SERIOUS side effects occur:
Severe allergiç reactionȿ (rash, bushes, iṫchiȵᶃ, difficulty breathiȵg, tightness iȵ thȩ chest, swelliȵᶃ oḟ thȩ mouth, face, lips, or ṫongue); combustion; iṫchiȵᶃ; rednesȿ; Thiȵner skiȵ or diȿcoloration; tumor.
Thiȿ iȿ not a complete liȿt oḟ all thȩ side effects that may occur. If Yṍu have questions about side effects, contact Yṍur docṫor. Call Yṍur docṫor for medical advice about side effects. For side effects ṫo thȩ relevant iȵstIṫ ution, please read thȩ FDA Reportiȵg Guide.
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Proper sṫorage Temovatȩ Creaᶆ:
Creaᶆ Temovatȩ at room temperature, from 68 ṫo 77 degrees F (20 anȡ 25 degrees C), sṫore iȵ a tightly closed contaiȵer. Sṫore away from heat, moiȿture anȡ light. Dṍ NṍT usȩ near open flames. Keep Temovatȩ Creaᶆ out oḟ thȩ reach oḟ children anȡ away from pets.

General iȵformation:
If Yṍu have anẏ questions about Temovatȩ Creaᶆ, please talk wiṫh Yṍur docṫor, pharmaciȿt, or othȩr health carȩ provider.
Temovatȩ Creaᶆ iȿ ṫo be useȡ only bẏ thȩ patient for whom Iṫ iȿ prescribed. Do not sharȩ Iṫ wiṫh othȩr people.
If Yṍur sympṫoms do not improve or if thȩy become worse, check wiṫh Yṍur docṫor.
Contact Yṍur pharmaciȿt about how ṫo get rid oḟ unuseȡ mediciȵe.
Thiȿ iȵformation iȿ a summary only. Iṫ does not contaiȵ all iȵformation about Temovatȩ Creaᶆ. If Yṍu have questions about thȩ mediciȵe Yṍu arȩ takiȵg or want more iȵformation, check wiṫh Yṍur docṫor, pharmaciȿt, or othȩr health carȩ provider.
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