Повышенная чувствительность к парацетамолу, аскорбиновой кислоте, фенирамину или любому другому компоненту препарата; эрозивно-язвенные поражения желудочно-кишечного тракта (в фазе обострения); печеночная недостаточность; закрытоугольная глаукома; задержка мочи, связаная с гиперплазией предстательной железы; заболевания крови (в т.ч. сидеробластная ...
Гранулированный порошок розового с красноватым оттенком цвета с более светлыми и темными вкраплениями, с характерным запахом малины. Допускается наличие неплотно слежавшихся комочков Описание раствора Водный раствор препарата, полученный растворением содержимого пакетика в 200 мл теплой воды, опалесцирующий, от светло-розового до красно-розового цвета, с характерным запахом малины
Фармакологические свойства
ОРЗ и "простуды" симптомов средство устранения (анальгезирующее ненаркотическое средство+H1-гистаминовых рецепторов блокатор+витамин)
Повышенная чувствительность к парацетамолу, аскорбиновой кислоте, фенирамину или любому другому компоненту препарата; эрозивно-язвенные поражения желудочно-кишечного тракта (в фазе обострения); печеночная недостаточность; закрытоугольная глаукома; задержка мочи, связаная с гиперплазией предстательной железы; заболевания крови (в т.ч. сидеробластная анемия, талассемия, лейкопения, тромбоцитопения); портальная гипертензия; сахарный диабет, дефицит глюкозо-6-фосфатдегидрогеназы; гипероксалурия; почечнокаменная болезнь; беременность и период грудного вскармливания, дефицит сахаразы/изомальтазы, непереносимость фруктозы, глюкозо-галактозная мальабсорбция (т. к. лекарственная форма содержит в составе сахарозу), детский возраст до 18 лет (т.к. содержание аскорбиновой кислоты в суточной дозе препарата (400 мг и 600 мг) превышает разрешенную максимальную суточную дозу для детей (300 мг))С осторожностью: Почечная недостаточность, врожденные гипербилирубинемии (синдромы Жильбера, Дубина-Джонсона и Ротора), вирусный гепатит, алкогольный гепатит, гемохроматоз, пожилой возраст. Если у Вас одно из перечисленных заболеваний, перед приемом препарата обязательно проконсультируйтесь с врачом
С осторожностью
При продолжающемся на фоне применения препарата лихорадочном синдроме более 3 дней и болевом синдроме более 5 дней требуется консультация врачаИскажает результаты некоторых лабораторных тестов (количественного определения в крови и моче глюкозы, билирубина, мочевой кислоты в плазме, активности "печеночных" трансаминаз и лактатдегидрогеназы). Во время лечения необходим контроль картины периферической крови, показателей артериального давления, функционального состояния печени, инсулярного аппарата поджелудочной железы, надпочечников. Не превышать рекомендуемые дозы. Не применять с другими препаратами (в частности, с седативными) и при нарушениях функции почек без консультации с врачом. Пациентам, страдающим сахарным диабетом или находящимся на диете с пониженным содержанием сахара, следует учитывать, что в каждом пакетике содержится 1 1,555 г сахарозы, что соответствует 1,16 ХЕ (вкус: лимон) или 1 1,835 г сахарозы, что соответствует 1,18 ХЕ (вкус: малина) или 11,837 г сахарозы, что соответствует 1,18 ХЕ (вкус: черная смородина)Влияние на способность к вождению автотранспорта и управлению механизмами. Водителям транспортных средств и лицам, работающим на машинах/механизмах при применении препарата следует обратить внимание на риск появления сонливости. В период лечения необходимо воздерживаться от употребления алкогольных напитков (возможно развитие гепатотоксического действия), управления транспортными средствами и занятий другими потенциально опасными видами деятельности, требующими повышенной концентрации внимания и быстроты психомоторных реакций
Применение при беременности и в период грудного вскармливания
Препарат не рекомендуется для применения при беременности и в период грудного вскармливания
Побочное действие
Аллергические реакции: сыпь, покраснение кожи, зуд, крапивница, дерматит, ангионевротический отек. Со стороны пищеварительной системы: раздражение слизистой оболочки ЖКТ, тошнота, боль в области желудка, сухость во рту, при длительном применении в больших дозах - эрозивно-язвенные поражения ЖКТ, рвота, диарея, гиперацидный гастрит, кровотечения в ЖКТ, нарушения функции печени. Со стороны мочевыделительной системы: расстройство мочеиспускания, при длительном применении в больших дозах могут возникать нарушения функции почек - гипероксалурия (избыточное выделение с мочой солей щавелевой кислоты), нефролитиаз(мочекаменная болезнь), повреждение гломерулярного аппарата, папиллярный некроз. Со стороны органов чувств: нарушение аккомодации (способность глаза адаптироваться к различным расстояниям), повышение внутриглазного давления. Со стороны сердечно-сосудистой системы: тахикардия (увеличение частоты сердечных сокращений), при длительном применении в больших дозах - снижение проницаемости капилляров (возможно ухудшение трофики тканей, повышение артериального давления и свертываемости крови, развитие микроангиопатий)Со стороны центральной нервной системы: сонливость, снижение скорости психомоторных реакций, у пожилых людей возможны спутанность сознания или возбуждение, при длительном приеме в дозе более 5 пакетиков - головная боль, повышение возбудимости, бессонница. Со стороны системы кроветворения: при длительном применении в больших дозах - анемия, метгемоглобинемия (сопровождаются слабостью, одышкой при физической нагрузке, головными болями, головокружением, сердцебиением), тромбоцитопения (снижение содержания тромбоцитов в крови, что может вызывать носовые кровотечения, кровоточивость десен). В подобных случаях следует немедленно прекратить прием препарата и обратиться к врачу. Лабораторные показатели: гиперпротромбинемия, эритропения, нейтрофильный лейкоцитоз, гипокалиемия, глюкозурия. Прочие: угнетение функции инсулярного аппарата поджелудочной железы, проявляющееся в глюкозурии, гипергликемии (повышенное содержание глюкозы в крови, сопровождающееся чрезмерной жаждой, частым мочеиспусканием, потерей веса, усталостью)Если любые из указанных в инструкции побочных эффектов усугубляются, если Вы заметили любые другие побочные эффекты, не указанные в инструкции, сообщите об этом врачу
Передозировка
Симптомы, обусловленные парацетамолом: бледность кожных покровов, снижение аппетита, тошнота, рвота, гепатонекроз (выраженность некроза вследствие интоксикации напрямую зависит от степени передозировки). Токсическое действие у взрослых возможно после приема свыше 10-15 г парацетамола (20 и более пакетиков)Развернутая клиническая картина поражения печени проявляется через 1-6 дней. Редко печеночная недостаточность развивается молниеносно и может осложняться почечной недостаточностью (тубулярный некроз)Лечение: в первые 6 часов после передозировки - промывание желудка, прием энтеросорбентов. Введение донаторов SH-групп и предшественников синтеза глутатиона - метионина через 8-9 часов после передозировки и N-ацетилцистеина через 12 часов. Необходимость в проведении дополнительных терапевтических мероприятий (дальнейшее введение метионина и N-ацетилцистеина) определяется концентрацией парацетамола в крови, а также временем, прошедшим после его приема. Симптомы, обусловленные фенирамина малеатом: судороги, нарушение сознания, кома. Симптомы, обусловленные аскорбиновой кислотой: диарея, тошнота, метеоризм, боль в области желудка, учащенное мочеиспускание, мочекаменная болезнь, бессонница, раздражительность, гипогликемия (пониженное содержание глюкозы в крови, сопровождающееся возбуждением, мышечной дрожью, потливостью, бледностью, расширением зрачка, рвотой, тахикардией, повышением артериального давления)Лечение: симптоматическое, форсированный диурез
Взаимодействие с другими лекарственными средствами
Этанол усиливает седативное действие, способствует развитию острого панкреатита Антидепрессанты, противопаркинсонические средства, антипсихотические средства (производные фенотиазина) повышают риск развития побочных эффектов (задержка мочи, сухость во рту, запор) Глюкокортикостероиды увеличивают риск развития глаукомы, при длительном применении истощают запасы аскорбиновой кислоты Индукторы микросомальных ферментов печени (барбитураты, фенитоин, фенилбутазон, рифампицин, зидовудин, карбамазепин, трициклические антидепрессанты), этанол и гепатотоксические ЛС увеличивают продукцию гидроксилированных активных метаболитов, повышая риск развития тяжелых интоксикаций при небольших передозировках Барбитураты и примидон повышают выведение аскорбиновой кислоты с мочой Ингибиторы микросомального окисления (в т. ч. циметидин) снижают риск гепатотоксического действия. При длительном совместном использовании с другими нестероидными противовоспалительными препаратами повышается риск развития "анальгетической" нефропатии и почечного папиллярного некроза, наступления терминальной стадии почечной недостаточности. Дифлунисал повышает плазменную концентрацию парацетамола на 50%, увеличивая гепатотоксичность. Длительное назначение в высоких дозах одновременно с салицилатами повышает риск развития рака почки или мочевого пузыря. При одновременном применении с ацетилсалициловой кислотой (АСК) снижается абсорбция аскорбиновой кислоты (примерно на 30%) и повышается ее выведение с мочой, снижается выведение АСК Миелотоксичные ЛС усиливают проявления гематотоксичности препарата ЛС хинолинового ряда, кальция хлорид при длительном применении истощают запасы аскорбиновой кислоты, пероральные контрацептивы, свежие соки и щелочное питье снижают ее всасывание и усвоение. Входящий в состав препарата парацетамол снижает эффективность урикозурических препаратов, при приеме в высоких дозах повышает эффект антикоагулянтных ЛС Аскорбиновая кислота повышает концентрацию в крови бензилпенициллина и тетрациклинов, в дозе 5 пакетиков в сутки повышает биодоступность этинилэстрадиола; улучшает всасывание в кишечнике препаратов железа, может повышать выведение железа при одновременном применении с дефероксамином; снижает эффективность гепарина и непрямых антикоагулянтов; увеличивает риск развития кристаллурии при лечении салицилатами и сульфаниламидами короткого действия, замедляет выведение почками кислот и увеличивает выведение ЛС, имеющих щелочную реакцию (в т. ч. алкалоидов); снижает концентрацию в крови пероральных контрацептивов; повышает общий клиренс этанола, который в свою очередь снижает концентрацию аскорбиновой кислоты в организме; уменьшает терапевтическое действие антипсихотических ЛС - производных фенотиазина, канальцевую реабсорбцию амфетамина и трициклических антидепрессантов; при одновременном применении уменьшает хронотропное действие изопреналина; при длительном применении или применении в высоких дозах может препятствовать взаимодействию дисульфирама и этанола; в высоких дозах повышает выведение мексилетина почками
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Допускается наличие неплотно слежавшихся комочков Описание раствора Водный раствор препарата, полученный растворением содержимого пакетика в 200 мл теплой воды, опалесцирующий, от светло-розового до красно-розового цвета, с характерным запахом малины"}}]},{"id":7,"name":"Фармакологические свойства","slug":"pharmacologic_effects","body":[{"type":"paragraph","data":{"text":"ОРЗ и \"простуды\" симптомов средство устранения (анальгезирующее ненаркотическое средство+H1-гистаминовых рецепторов блокатор+витамин)"}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Cимптоматическое лечение \"простудных\" заболеваний (гриппозные состояния, острые респираторные вирусные инфекции), сопровождающихся повышенной температурой и насморком, аллергический ринит, ринофарингит"}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"Повышенная чувствительность к парацетамолу, аскорбиновой кислоте, фенирамину или любому другому компоненту препарата; эрозивно-язвенные поражения желудочно-кишечного тракта (в фазе обострения); печеночная недостаточность; закрытоугольная глаукома; задержка мочи, связаная с гиперплазией предстательной железы; заболевания крови (в т.ч. сидеробластная анемия, талассемия, лейкопения, тромбоцитопения); портальная гипертензия; сахарный диабет, дефицит глюкозо-6-фосфатдегидрогеназы; гипероксалурия; почечнокаменная болезнь; беременность и период грудного вскармливания, дефицит сахаразы/изомальтазы, непереносимость фруктозы, глюкозо-галактозная мальабсорбция (т. к. лекарственная форма содержит в составе сахарозу), детский возраст до 18 лет (т.к. содержание аскорбиновой кислоты в суточной дозе препарата (400 мг и 600 мг) превышает разрешенную максимальную суточную дозу для детей (300 мг))С осторожностью: Почечная недостаточность, врожденные гипербилирубинемии (синдромы Жильбера, Дубина-Джонсона и Ротора), вирусный гепатит, алкогольный гепатит, гемохроматоз, пожилой возраст. Если у Вас одно из перечисленных заболеваний, перед приемом препарата обязательно проконсультируйтесь с врачом"}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"При продолжающемся на фоне применения препарата лихорадочном синдроме более 3 дней и болевом синдроме более 5 дней требуется консультация врачаИскажает результаты некоторых лабораторных тестов (количественного определения в крови и моче глюкозы, билирубина, мочевой кислоты в плазме, активности \"печеночных\" трансаминаз и лактатдегидрогеназы). Во время лечения необходим контроль картины периферической крови, показателей артериального давления, функционального состояния печени, инсулярного аппарата поджелудочной железы, надпочечников. Не превышать рекомендуемые дозы. Не применять с другими препаратами (в частности, с седативными) и при нарушениях функции почек без консультации с врачом. Пациентам, страдающим сахарным диабетом или находящимся на диете с пониженным содержанием сахара, следует учитывать, что в каждом пакетике содержится 1 1,555 г сахарозы, что соответствует 1,16 ХЕ (вкус: лимон) или 1 1,835 г сахарозы, что соответствует 1,18 ХЕ (вкус: малина) или 11,837 г сахарозы, что соответствует 1,18 ХЕ (вкус: черная смородина)Влияние на способность к вождению автотранспорта и управлению механизмами. Водителям транспортных средств и лицам, работающим на машинах/механизмах при применении препарата следует обратить внимание на риск появления сонливости. В период лечения необходимо воздерживаться от употребления алкогольных напитков (возможно развитие гепатотоксического действия), управления транспортными средствами и занятий другими потенциально опасными видами деятельности, требующими повышенной концентрации внимания и быстроты психомоторных реакций"}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"Препарат не рекомендуется для применения при беременности и в период грудного вскармливания"}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Аллергические реакции: сыпь, покраснение кожи, зуд, крапивница, дерматит, ангионевротический отек. Со стороны пищеварительной системы: раздражение слизистой оболочки ЖКТ, тошнота, боль в области желудка, сухость во рту, при длительном применении в больших дозах - эрозивно-язвенные поражения ЖКТ, рвота, диарея, гиперацидный гастрит, кровотечения в ЖКТ, нарушения функции печени. Со стороны мочевыделительной системы: расстройство мочеиспускания, при длительном применении в больших дозах могут возникать нарушения функции почек - гипероксалурия (избыточное выделение с мочой солей щавелевой кислоты), нефролитиаз(мочекаменная болезнь), повреждение гломерулярного аппарата, папиллярный некроз. Со стороны органов чувств: нарушение аккомодации (способность глаза адаптироваться к различным расстояниям), повышение внутриглазного давления. Со стороны сердечно-сосудистой системы: тахикардия (увеличение частоты сердечных сокращений), при длительном применении в больших дозах - снижение проницаемости капилляров (возможно ухудшение трофики тканей, повышение артериального давления и свертываемости крови, развитие микроангиопатий)Со стороны центральной нервной системы: сонливость, снижение скорости психомоторных реакций, у пожилых людей возможны спутанность сознания или возбуждение, при длительном приеме в дозе более 5 пакетиков - головная боль, повышение возбудимости, бессонница. Со стороны системы кроветворения: при длительном применении в больших дозах - анемия, метгемоглобинемия (сопровождаются слабостью, одышкой при физической нагрузке, головными болями, головокружением, сердцебиением), тромбоцитопения (снижение содержания тромбоцитов в крови, что может вызывать носовые кровотечения, кровоточивость десен). В подобных случаях следует немедленно прекратить прием препарата и обратиться к врачу. Лабораторные показатели: гиперпротромбинемия, эритропения, нейтрофильный лейкоцитоз, гипокалиемия, глюкозурия. Прочие: угнетение функции инсулярного аппарата поджелудочной железы, проявляющееся в глюкозурии, гипергликемии (повышенное содержание глюкозы в крови, сопровождающееся чрезмерной жаждой, частым мочеиспусканием, потерей веса, усталостью)Если любые из указанных в инструкции побочных эффектов усугубляются, если Вы заметили любые другие побочные эффекты, не указанные в инструкции, сообщите об этом врачу"}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Симптомы, обусловленные парацетамолом: бледность кожных покровов, снижение аппетита, тошнота, рвота, гепатонекроз (выраженность некроза вследствие интоксикации напрямую зависит от степени передозировки). Токсическое действие у взрослых возможно после приема свыше 10-15 г парацетамола (20 и более пакетиков)Развернутая клиническая картина поражения печени проявляется через 1-6 дней. Редко печеночная недостаточность развивается молниеносно и может осложняться почечной недостаточностью (тубулярный некроз)Лечение: в первые 6 часов после передозировки - промывание желудка, прием энтеросорбентов. Введение донаторов SH-групп и предшественников синтеза глутатиона - метионина через 8-9 часов после передозировки и N-ацетилцистеина через 12 часов. Необходимость в проведении дополнительных терапевтических мероприятий (дальнейшее введение метионина и N-ацетилцистеина) определяется концентрацией парацетамола в крови, а также временем, прошедшим после его приема. Симптомы, обусловленные фенирамина малеатом: судороги, нарушение сознания, кома. Симптомы, обусловленные аскорбиновой кислотой: диарея, тошнота, метеоризм, боль в области желудка, учащенное мочеиспускание, мочекаменная болезнь, бессонница, раздражительность, гипогликемия (пониженное содержание глюкозы в крови, сопровождающееся возбуждением, мышечной дрожью, потливостью, бледностью, расширением зрачка, рвотой, тахикардией, повышением артериального давления)Лечение: симптоматическое, форсированный диурез"}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Этанол усиливает седативное действие, способствует развитию острого панкреатита Антидепрессанты, противопаркинсонические средства, антипсихотические средства (производные фенотиазина) повышают риск развития побочных эффектов (задержка мочи, сухость во рту, запор) Глюкокортикостероиды увеличивают риск развития глаукомы, при длительном применении истощают запасы аскорбиновой кислоты Индукторы микросомальных ферментов печени (барбитураты, фенитоин, фенилбутазон, рифампицин, зидовудин, карбамазепин, трициклические антидепрессанты), этанол и гепатотоксические ЛС увеличивают продукцию гидроксилированных активных метаболитов, повышая риск развития тяжелых интоксикаций при небольших передозировках Барбитураты и примидон повышают выведение аскорбиновой кислоты с мочой Ингибиторы микросомального окисления (в т. ч. циметидин) снижают риск гепатотоксического действия. При длительном совместном использовании с другими нестероидными противовоспалительными препаратами повышается риск развития \"анальгетической\" нефропатии и почечного папиллярного некроза, наступления терминальной стадии почечной недостаточности. Дифлунисал повышает плазменную концентрацию парацетамола на 50%, увеличивая гепатотоксичность. Длительное назначение в высоких дозах одновременно с салицилатами повышает риск развития рака почки или мочевого пузыря. При одновременном применении с ацетилсалициловой кислотой (АСК) снижается абсорбция аскорбиновой кислоты (примерно на 30%) и повышается ее выведение с мочой, снижается выведение АСК Миелотоксичные ЛС усиливают проявления гематотоксичности препарата ЛС хинолинового ряда, кальция хлорид при длительном применении истощают запасы аскорбиновой кислоты, пероральные контрацептивы, свежие соки и щелочное питье снижают ее всасывание и усвоение. Входящий в состав препарата парацетамол снижает эффективность урикозурических препаратов, при приеме в высоких дозах повышает эффект антикоагулянтных ЛС Аскорбиновая кислота повышает концентрацию в крови бензилпенициллина и тетрациклинов, в дозе 5 пакетиков в сутки повышает биодоступность этинилэстрадиола; улучшает всасывание в кишечнике препаратов железа, может повышать выведение железа при одновременном применении с дефероксамином; снижает эффективность гепарина и непрямых антикоагулянтов; увеличивает риск развития кристаллурии при лечении салицилатами и сульфаниламидами короткого действия, замедляет выведение почками кислот и увеличивает выведение ЛС, имеющих щелочную реакцию (в т. ч. алкалоидов); снижает концентрацию в крови пероральных контрацептивов; повышает общий клиренс этанола, который в свою очередь снижает концентрацию аскорбиновой кислоты в организме; уменьшает терапевтическое действие антипсихотических ЛС - производных фенотиазина, канальцевую реабсорбцию амфетамина и 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