equipoise dosage

When administered intravitreally ranibizumab (1 per month) in patients with neovascular AMD maximum drug concentration (Cmax) in plasma was low and insufficient to inhibit the biological activity of VEGF-A by 50% (11 -27 ng / ml as studies of cell equipoise dosage proliferation in vitro). When administered drug in the vitreous humor in a dose range from 0.05 to 1.0 mg Cmax ranibizumab plasma was proportional to the dosage.
Based on the results of pharmacokinetic analysis and considering excretion ranibizumab from blood plasma, the average half-life of the drug (dose 0.5 mg) of vitreous average It was about 9 days.
When administered intravitreally Lucentis (1 per month) ranibizumab plasma concentration reaches the maximum value within one day after injection, and is in the range 0.79-2.90 ng / ml. Ranibizumab minimum concentration in plasma is in the range of 0.07-0.49 ng / mL. The concentration of serum ranibizumab approximately 90,000 times lower than that of the vitreous body. Patients with impaired renal function In patients with impaired renal function specific pharmacokinetic studies on the use of the drug have not been conducted. In 68% (136 of 200) of patients included in the pharmacokinetic analysis had renal impairment (46.5% – mild, 20% – moderate and 1.5% -Heavy degree). In patients with impaired renal function on the background of treatment with minimal observed decrease in clearance of ranibizumab, has no clinical significance. Patients with hepatic impairment In patients with impaired hepatic function on the application of specific pharmacokinetic studies have not been conducted ranibizumab.

INDICATIONS
Neovascular (wet) form of age-related macular degeneration in adults.

CONTRAINDICATIONS

  • Hypersensitivity to ranibizumab or any other component of the formulation.
  • Confirmed or suspected infection of the eye or periocular infections processes of localization.
  • Intraocular inflammation.
  • Children under 18 years of age (efficacy and safety of the drug in these patients has not been studied).
  • Pregnancy and lactation.

WITH CARE
Patients with a known history of hypersensitivity, the presence of stroke risk factors, the drug should be administered only after a careful assessment of risk / benefit ratio.

DOSAGE AND ADMINISTRATION
Lucentis is used only as an injection into the vitreous body.
The recommended dose of Lucentis is 0.5 mg (0.05 mL) 1 time a month as an injection into the vitreous body.
The first three Lucentis injections performed at a frequency of 1 time per month consistently for 3 -x months after drug treatment is stopped (stabilization phase) and regularly (at least 1 time per month) check visual acuity. By reducing the visual acuity of more than 5 letters on the ETDRS cupboard (1 line on the Snellen chart) treatment Lucentis resume.
Between the introduction of two doses of the drug should be observed interval of at least 1 month.
Before the introduction of Lucentis should monitor the quality of solution and the solution color. The drug should not be used when the color of the solution change and the emergence of insoluble visible particles.
The injection of the drug into the vitreous body should be carried out under aseptic conditions, including treatment of the hands of health professionals, the use of sterile gloves, napkins, blepharostat (or its equivalent) and, if necessary tools for paracentesis.
Before the introduction of the drug necessary to carry out proper disinfection of the skin of eyelids and around the eyes, anesthesia of the conjunctiva and therapy antimicrobials wide spectrum.
antimicrobial drugs should be instilled into the conjunctival sac 3 times a day for 3 days before and after drug administration.
Lucentis should be administered into the vitreous body at 3.5-4 mm posterior to the limbus, avoiding the horizontal meridian and directing the needle toward the center of the eyeball. The volume of drug administered is 0.05 ml.
Next injection of a drug into the other half of the sclera.
As for 60 min after injection Lucentis may increase intraocular pressure (IOP), must be controlled IOP perfusion of the optic nerve n apply appropriate treatment, if necessary.
One session administering Lucentis is performed only in one eye. patients with hepatic impairment Use of the drug in patients with hepatic impairment has not been studied. Given the small concentration of Lucentis in plasma, does not require changes in drug dosing regimen. Patients with impaired renal function, patients with impaired renal function does not require dose adjustment. Patients aged 65 years and older patients aged 65 years and older did not require dose adjustment .

SIDE EFFECTS
safety study of the drug was carried out in the course of clinical trials in 1315 patients within 2 years. Serious adverse events related to the procedure of administration included endophthalmitis, rhegmatogenous retinal detachment and cataract due to iatrogenic injury.
Other serious adverse events from the eyes, seen with Lucentis included intraocular inflammation and increased intraocular pressure.
The following adverse events (possibly related with the use of the drug) were observed in the frequency of at least 2% of patients treated with Lucentis 0.5 mg, compared with the equipoise dosage control group (simulated injection or photodynamic therapy).
The incidence of adverse events was estimated as follows: emerging “very often” ( > 1 / 10), “often” ( > 1/100, <1/10), “sometimes” ( > 1/1000, <1/100), “rare”; ( > 1/10000, <1/1000), “very rare”; . (<1/10000)Infections and infestations : very often -nazofaringit; often – flu. From the hematopoietic system : often – anemia. Psychiatric disorders : often – anxiety. From the nervous system : very often – headache, sometimes – a stroke. From a sight organ : very often -intraokulyarnoe inflammation, inflammation of the vitreous, vitreous detachment, retinal haemorrhage, visual disturbances, eye pain, turbidity in the vitreous body, increased intraocular pressure, conjunctival hemorrhage, eye irritation, a feeling of “foreign body” in the eyes, lacrimation, blepharitis, a syndrome of “dry” eyes, eye redness, itching sensation in the eyes, often degenerative changes in the retina, retinal damage, retinal detachment, retinal tears, detachment of the retinal pigment epithelium, RPE tear, reduced visual acuity, vitreous hemorrhage, vitreous loss, uveitis, iritis, iridocyclitis, cataract, subcapsular cataracts, clouding of the posterior lens capsule, punctate keratitis, corneal erosion, cell opalescence in the anterior chamber of the eye, blurred vision, bleeding at the injection site, eye haemorrhage, conjunctivitis, allergic conjunctivitis, eye discharge, photopsia, photophobia, discomfort in the eyes, swelling of the age, tenderness eyelids, conjunctival hyperemia, sometimes – blindness, endophthalmitis, hypopyon, hyphema, keratopathy, adhesions of the iris, the deposits in the cornea, corneal edema, striae cornea, pain or irritation at the site of injection, abnormal sensation in the eye and irritation century. From the respiratory system : often – cough. From the digestive system : often – nausea. Dermatological disorders : often -allergicheskie reactions (rash, hives, itching. On the part of the musculoskeletal system : very often -artralgii.

 

INTERACTION WITH OTHER DRUGS
Lucentis interaction with other drugs has not been studied.
Lucentis should not be mixed with any other drugs or solvents.

Overdose In clinical trials and use of the drug in clinical practice, there were cases of unintentional overdose. In these cases, an overdose of Lucentis most frequently observed increased intraocular pressure and pain in the eye . In case of overdose should be sure to monitor the intraocular pressure; if necessary, the patient must remain under medical supervision.

Cautions
provide treatment Lucentis should only ophthalmologist who has experience performing intravitreal injection.
The introduction of Lucentis must always be carried out under aseptic conditions. In addition, within I week after injection of the drug should be monitored in patients with a view to identifying possible local infection and of timely treatment. It is necessary to inform patients about the need to immediately tell your doctor about all of the symptoms that may indicate the development of endophthalmitis.
When intravitreal injection of inhibitors of endothelial growth factor A (VEGF-A) may develop arterial thromboembolic events.
When intravitreal injection of VEGF inhibitors A (VEGF-A) may develop arterial thromboembolic events. The risk of stroke can be higher in the presence of risk factors in patients, including equipoise dosage previous myocardial stroke or transient cerebrovascular accidents in history. during the therapy with women of childbearing age should use reliable methods of contraception.

Effects on ability to drive vehicles and use machines
On the background of Lucentis may develop temporary visual impairment, adversely affecting the ability to drive vehicles and use machines. If you have these symptoms, patients should not drive vehicles or operate machinery to reduce the severity of temporary visual impairment. online anabolic steroids pharmacy

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equipoise

It affects the bacterial enzyme DNA gyrase, which provides supercoiling forms a complex with its tetramer (subunit of gyrase A2B2) and disrupts the transcription and DNA replication, equipoise leading to bacterial cell death. Beta-lactamases produced by pathogens, have no effect on the activity of lomefloxacin. Highly active against gram-negative aerobic organisms: Neisseria gonorrhoeae, Neisseria meningitidis, Escherichia coli, Citrobacter diversus, Klebsiella pneumoniae, Enterobacter cloacae, Proteus vulgaris, Salmonella spp, Shigella spp, Moraxella catarrhalis, Morganella morganii, Haemophilus influenzae and Haemophilus parainfluenzae, Legionella pneumophila…Moderate sensitive to the drug Staphylococcus aureus, Staphylococcus epidermidis, Serratia liquifaciens and Serratia marcescens, Pseudomonas aeruginosa, Mycobacterium tuberculosis , Chlamydia trachomatis, Hafnia alvei, Citrobacter freundii, Aeromonas hydrophila, Proteus mirabilis and Proteus stuartii, Providencia rettgeri and Providencia alcalifaciens, Klebsiella oxytoca, Klebsiella ozaenae , Enterobacter aerogenes, Enterobacter agglomerans. drug resistance Streptococcus spp., Pseudomonas cepacia, Ureaplasma urealyticum, Treponema pallidum, Mycoplasma hominis and anaerobic bacteria.

Indications for use
of the anterior eye bacterial infections (conjunctivitis, blepharitis, bluff-rokonyunktivit, including chlamydial infection). Contraindications:
Hypersensitivity to the drug, pregnancy, lactation, childhood and adolescence (18).

Use in pregnancy and breast-feeding
is not recommended during pregnancy. In the appointment during lactation should stop breastfeeding.

Dosage and administration:
Adults: 1 drop 2-3 times a day equipoise in the lower conjunctival sac for 7-9 days. Early treatment requires more frequent administration of 5 drops within 20 min (1 drop at intervals of 5 minutes) or 1 hour dropwise for 6-10 hours.
For the treatment of chlamydial conjunctivitis 1 drop formulation was instilled into the conjunctival sac of the affected eye 2 -4 times daily for 1-2 months.

Side effects
Burning sensation; long-term use -. the development of secondary fungal infections
If any of these instructions side effects are compounded, or if you notice any other side effects not mentioned equipoise in the instructions, inform your doctor. Overdose We have no data.

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equipoise for horses

Losartan inhibits not kininase II, an enzyme which is involved in the metabolism of bradykinin.

Reduces the total equipoise for horses peripheral vascular resistance (SVR), the pressure in the “small” circle of blood circulation; reduces afterload, it has a diuretic effect.

It prevents the development of myocardial hypertrophy, improves exercise tolerance in patients with chronic heart failure (CHF). Losartan once daily resulted in a statistically significant reduction in systolic and diastolic blood pressure (BP). Losartan uniformly controls the pressure throughout the day, with the antihypertensive effect corresponds to the natural circadian rhythm. Lowering blood pressure (BP) at the end of the action of the drug dose was approximately 70-80% at the peak of the effect of the drug, 5-6 hours after administration. The syndrome of “cancellation” is not observed; as losartan has no clinically significant effects on heart rate (HR). Losartan is effective in men and women, and the elderly (> 65 years) and younger patients (<65 years).

. Hydrochlorothiazide is a thiazide diuretic, diuretic effect which is associated with impaired reabsorption of sodium, chlorine, potassium, magnesium, water in the distal nephron; delayed excretion of calcium, uric acid. It has antihypertensive properties; hypotensive action develops due to the expansion of the arterioles. Almost no effect on normal blood pressure (BP). The diuretic effect occurs within 1-2 hours, reaches a peak after 4 hours and lasts 6-12 hours. The antihypertensive effect occurs within 3-4 days, but may need 3-4 weeks to achieve the optimal therapeutic effect.

Pharmacokinetics
The pharmacokinetics of losartan and hydrochlorothiazide while receiving no different from that in their separate appointment.

Losartan.
Losartan is well absorbed from the gastrointestinal tract. Subject to significant metabolism in the “first pass” through the liver to form the active metabolite (EHR- 3174) with a carboxylic acid and other inactive metabolites. The bioavailability is approximately 33%. The drug with food has no clinically significant impact on its serum concentrations. TStah 1 hour after ingestion, and its active metabolite (EXP-3174) – 3.4 hours.

More than 99% and losartan, EXP-3174 binds to plasma proteins, mainly albumin. The volume of distribution of losartan is 34 liters. Very poorly crosses the blood-brain barrier.

Losartan is metabolized to produce an active (EXP-3174), a metabolite (14%) and inactive, including two major metabolite produced by hydroxylation chain butyl group and less significant metabolite, N-2-tetrazol-glucuronide.

Plasma clearance of losartan and its active metabolite is about 10 ml / sec. (600 ml / min.) And 0.83 ml / sec. (50 ml / min.), Respectively. Renal clearance of losartan and its active metabolite is about 1.23 ml / sec. (74 ml / min.) And 0.43 ml / sec. (26 ml / min.). The half-life of the active metabolite of losartan, and is 2 hours or 9.6 hours, respectively. Write mainly in the bile -58%, the kidneys – 35%.

Hydrochlorothiazide
After oral administration absorption of hydrochlorothiazide is 60-80%. The maximum concentration of hydrochlorothiazide in the blood is achieved in 1-5 hours after ingestion.

Communicating with hydrochlorothiazide blood plasma proteins – 64%. Hydrochlorothiazide is not metabolized and is rapidly excreted by the kidneys. The half-life is 5-15 hours.

Indications

  • Hypertension (in patients who have shown combination therapy).
  • Reducing the risk of cardiovascular morbidity and mortality in patients with hypertension and left ventricular hypertrophy.

Contraindications
: Hypersensitivity to losartan, to the media, is a derivative of sulfonamides and other components of the drug, anuria, marked renal impairment (creatinine clearance (CC) of less than 30 ml / min.), Hyperkalemia, dehydration (including in patients receiving high doses of diuretics ), expressed human liver, refractory hypokalemia, pregnancy, lactation, hypotension, up to age 18 years (effectiveness and safety have not been established), lactase deficiency, galactosemia or malabsorption syndrome glucose / galactose.

Precautions: violations of water-electrolyte balance of blood (hyponatremia, gipohloremichesky alkalosis, hypomagnesemia, hypokalemia), a bilateral renal artery stenosis or stenosis of the artery to a solitary kidney, diabetes, hypercalcemia, hyperuricemia and / or gout, allergic history (in some patients, angioedema previously developed while taking other drugs, including ACE inhibitors) and asthma, systemic blood diseases (including systemic lupus erythematosus), co-administration of nonsteroidal anti-inflammatory drugs (NSAIDs), including cyclooxygenase-II (COX 2 inhibitors).

Application of pregnancy and lactation
on the use of losartan during pregnancy No Data. Fetal renal perfusion, which is dependent on the development of the renin-angiotensin system, begins to operate in the third trimester of pregnancy. The risk to the fetus increases if losartan in the second and third trimesters. In establishing pregnancy Loristoy H therapy should be discontinued immediately. If necessary, the appointment during lactation should stop breastfeeding.

Dosing and Administration
Inside, regardless of meals. Loristu H can be combined with other antihypertensive agents.

Hypertension
The starting and maintenance dose is 1 tablet Loristy H (50 / 12.5 mg), 1 per day. The maximum antihypertensive effect is reached within three weeks of therapy. To achieve a more pronounced effect may increase the dose to 2 tablets Loristy H (50 / 12.5 mg), 1 per day. The maximum daily dose – 2 tablets of the drug Lorista N.

In patients with a decreased volume of circulating blood (for example, in patients receiving large doses of diuretics), the recommended initial dose of losartan in patients with hypovolemia is 25 mg once daily.In connection with this therapy Loristoy H should begin after the cancellation of diuretics and correction of hypovolemia.

Older patients and patients with mild renal insufficiency, including dialysis, the initial dose is not required correction.

Reducing the risk of cardiovascular morbidity and mortality in patients with hypertension and left ventricular hypertrophy

The standard initial dose of losartan is 50 mg 1 time per day. Patients who did not achieve target levels of blood pressure in patients receiving losartan 50 mg / day, requires selection by the combination therapy with low doses of losartan hydrochlorothiazide (12.5 mg), and, if necessary, it is necessary to increase the dose up to 100 mg of losartan in combination with hydrochlorothiazide in a dose of 12.5 mg / day, further – to increase up to 2 tablets Loristy H 50 / 12.5 mg total (100 mg losartan and hydrochlorothiazide 25 mg once a day).

Side effect On the part of the blood and lymphatic system: rare: anemia, Henoch-Schönlein purpura.

Immune system:
Rare: anaphylaxis, angioedema (including swelling of the larynx and tongue,
causing airway obstruction and / or swelling of the face, lips, throat).

From the central and peripheral nervous systems:
common: headache, systemic equipoise for horses and non-systemic dizziness, insomnia, fatigue;
rare: migraine.

Cardio-vascular system:
common: orthostatic hypotension (dose-dependent), palpitations, tachycardia;
rare: vasculitis.

The respiratory system:
frequent: cough, infections of the upper respiratory tract, pharyngitis, swelling of the nasal mucosa.

From the gastrointestinal tract:
common: diarrhea, dyspepsia, nausea, vomiting, abdominal pain.

On the part of the hepatobiliary system:
rare: hepatitis, abnormal liver function.

For the skin and subcutaneous fat:
Uncommon: rash, pruritus.

On the part of the musculoskeletal system and connective tissue disorders:
common: myalgia, back pain;
rare: arthralgia.

Other:
Common: asthenia, fatigue, peripheral edema, pain in the chest.

Laboratory findings:
common: hyperkalemia, increasing the concentration of hemoglobin and hematocrit (not clinically significant);
rare: a moderate increase in levels of urea and creatinine in blood serum;
very rare: increase in liver enzymes and bilirubin.

Overdose

Losartan Symptoms: marked reduction of blood pressure, tachycardia; bradycardia caused by parasympathetic (vagal) stimulation. Treatment: forced diuresis, symptomatic therapy, hemodialysis is ineffective.

Hydrochlorothiazide Symptoms: The most common symptoms are a consequence of electrolyte deficiency (hypokalemia, hyposalemia, hyponatremia) and dehydration due to excessive diuresis. At the same time taking cardiac glycosides may aggravate hypokalemia during arrhythmias. Treatment: symptomatic.

Interactions with other drugs

Losartan
In clinical studies, pharmacokinetic interactions are not clinically significant drug interactions with hydrochlorothiazide, digoxin, warfarin, cimetidine, phenobarbital, ketoconazole and erythromycin. Rifampicin and fluconazole reduced the level of the active metabolite (not clinically studied this interaction).

The combination of losartan with potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium-sparing additives or salts of potassium can lead to hyperkalemia.

NSAIDs, including selective cyclooxygenase-2 inhibitors can reduce the effects of diuretics and other hypotensive drugs, including losartan. In patients with impaired renal function receiving NSAID therapy (including cyclooxygenase-2 inhibitors), angiotensin II receptor antagonist therapy may result in further deterioration of renal function, including acute renal failure, which is usually reversible.

The hypotensive effect of losartan, like other antihypertensive agents can be reduced when receiving indomethacin.

Hydrochlorothiazide
with thiazide diuretics drugs such as ethanol, barbiturates and narcotics, may potentiate the risk of orthostatic hypotension.

Hypoglycaemic agents (oral and insulin) – may be necessary to adjust the dose of hypoglycemic agents.
Other antihypertensive drugs – additive effect.
Cholestyramine and colestipol – in the presence of anionic exchange resins absorption of hydrochlorothiazide is violated.

Corticosteroids, ACTH (adrenocorticotropic hormone) – marked reduction in the levels of electrolytes, particularly hypokalaemia.

Pressor amines (e.g., epinephrine, norepinephrine) – reduction of expression of pressor response to receiving amines.

Muscle relaxants nondepolarizing type of action (eg, tubocurarine) – strengthening the muscle relaxant effect.

Lithium – diuretics reduce the renal clearance of lithium and increase the risk of toxic action of lithium; concurrent use is not recommended.

NSAIDs (including COX-2 inhibitors) – may reduce the diuretic, natriuretic and antihypertensive effects of diuretics.

In connection with the effect on calcium metabolism taking them may distort the results of the research function of the parathyroid glands.

Cautions
You can assign along with other antihypertensive agents.

No need for special selection of the initial dose of elderly patients. The drug may increase plasma concentrations of urea and creatinine in patients with bilateral renal artery stenosis or stenosis of the renal artery to a solitary kidney.

Hydrochlorothiazide may enhance hypotension and fluid and electrolyte balance (reduction of circulating blood volume, hyponatremia, gipohloremichesky alkalosis, hypomagnesemia, hypokalemia), disrupt glucose tolerance, reduce calcium excretion in the urine and cause a transient, minor increase in the calcium concentration in blood plasma, to improve the concentration of cholesterol and triglycerides, the occurrence provoke hyperuricaemia and / or gout. Receiving drugs directly acting on the renin-angiotensin system during the II and III trimester of pregnancy can lead to fetal death. In the event of pregnancy shows removal of the drug.

Pregnant women diuretic use is generally not recommended due to the risk of jaundice in the fetus and newborn thrombocytopenia in mothers. Diuretic therapy does not prevent development of toxemia of pregnancy.

Special warnings regarding the excipients:
Lorista H contains lactose, therefore, can not be appointed under the following conditions: lactase deficiency, equipoise for horses galactosemia or malabsorption syndrome glucose / galactose.

Effects on ability to drive and use other mechanisms
Almost all patients during therapy Loristoy H can perform tasks that require special attention (eg, driving). In individuals at the beginning of drug treatment may cause a decrease in blood pressure and dizziness, thus indirectly affect their psycho-emotional state. For safety reasons, before activities requiring increased attention, patients should first assess their response to treatment. stanazolin 10mg

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It prevents the development of myocardial hypertrophy, improves exercise tolerance in patients with chronic heart failure (CHF). Admission lozartana once daily resulted in a statistically significant reduction in systolic and diastolic blood pressure (BP).equipoise side effects uniformly controls the pressure throughout the day, with the antihypertensive effect corresponds to the natural circadian rhythm. Lowering blood pressure (BP) at the end of the action of the drug dose was approximately 70-80% at the peak of the effect of the drug, 5-6 hours after administration. .

Pharmacokinetics.
Lozartan well absorbed from the gastrointestinal tract. Subject to significant metabolism in the “first pass” through the liver to form the active metabolite (EXP-3174) with a carboxylic acid and other inactive metabolites. The bioavailability is approximately 33%. The drug with food has no clinically significant impact on its serum concentrations. T Cmax – 1 hour after ingestion, and its active metabolite (EXP-3174.) – 3-4 hours
More than 99% lozartana and EXP-3174 binds to plasma proteins, mainly to albumin. Lozartana volume of distribution is 34 liters. Very poorly penetrates the blood-brain barrier.
Lozartan metabolized to form an active (EXP-3174), a metabolite (14%) and inactive, including two major metabolite produced by hydroxylation butyl group chain and less significant metabolite, N-2-tetrazol-glucuronide.
Plasma clearance lozartana and its active metabolite is about 10 ml / sec. (600 ml / min.) And 0.83 ml / sec. (50 ml / min.), Respectively. Renal clearance lozartana and its active metabolite is about 1.23 ml / sec. (74 ml / min.) And 0.43 ml / sec. (26 ml / min.). Lozartana and half-life of the active metabolite of 2 hours or 9.6 hours, respectively. Write mainly in the bile -58% -35% by the kidneys.

Indications

  • Arterial hypertension.
  • Reducing the risk of stroke in patients with hypertension and left ventricular hypertrophy.
  • Chronic heart failure (in a combination therapy, in case of intolerance or failure of therapy with ACE inhibitors).
  • Protection of renal function in patients with type 2 diabetes mellitus with proteinuria to reduce proteinuria, reduce the progression of renal disease, end-stage reduction of the risk (to prevent the need for dialysis, the probability of increasing the level of serum creatinine) or death.

Contraindications
: Hypersensitivity to lozartanu or to other components of the drug, hypotension, hyperkalemia, dehydration, pregnancy and lactation, age 18 years (effectiveness and safety have not been established), lactose intolerance, galactosemia or malabsorption syndrome glucose / galactose.

Precautions: hepatic and / or renal failure, decreased blood volume, fluid and electrolyte balance, bilateral renal artery stenosis or stenosis of the artery to a solitary kidney.

Pregnancy and lactation
Data on the use during pregnancy lozartana not. Fetal renal perfusion, which is dependent on the development of the renin-angiotensin system, begins to operate in the third trimester of pregnancy. The risk to the fetus increases when taking lozartana in the second and third trimesters. In establishing pregnancy lozartanom therapy should be discontinued immediately. No data on the allocation of lozartana in mother’s milk. Therefore, you should resolve the issue of termination of breastfeeding or cancellation lozartanom therapy, given its importance to the mother.

Dosing and Administration
Inside, regardless of the meal, the multiplicity of reception -1 once a day.

Arterial gipertetiya: the average daily dose is 50 mg. The maximum antihypertensive effects achieved within 3-6 weeks of therapy. Some patients may be more pronounced effect achieved by increasing the dose up to 100 mg per day in two steps or in one step.
In patients receiving high doses of diuretics Loristoy therapy is recommended to start with 25 mg per day in one portion. Elderly patients and patients with impaired renal function, including patients on hemodialysis, does not require correction of the initial dose.
No need to adjust the dose in patients of advanced age or patients with impaired renal function, including patients on hemodialysis.
Patients with impaired function liver should be prescribed lower doses of the drug.

Chronic heart failure: initial dose of 12.5 mg per day in one portion. In order to achieve the usual maintenance dose is 50 mg daily dose should be gradually increased at intervals of one week (for example, 12.5 mg, 25 mg, 50 mg for single dose per day). Lorista usually given in combination with diuretics and cardiac glycosides.

Dose should be increased as follows:
Week 1:. 1 to 7 day – 1 tablet of 12.5 mg once daily
2 weeks from 8 to 14 day – 1 tablet of 25 mg once a day.
3 Week .: from 15 to 21 days – 1 tablet of 50 mg once a day
4 weeks; 22 to 28 day – 1 tablet of 50 mg once a day.

Reducing the risk of stroke in patients with hypertension and left ventricular hypertrophy: the standard initial dose Loristy is 50 mg per day in one step. Further hydrochlorothiazide may be added in low doses and / or dose Loristy increased to 100 mg per day.

Renal protection in patients with type 2 diabetes mellitus with proteinuria: the standard initial dose Loristy is 50 mg per day in one step. The dose may be increased to 100 mg per day in terms of reduction in blood pressure.

Paediatric use
Safety and efficacy have not been established in children.

Side effects:
In most cases, Lorista well tolerated, side effects are mild and transient and did not require discontinuation of therapy.

Blood system: rare anemia, purpura Shenlyayna-Henoch. Allergic reaction: less than 1% – hives, skin rash, itching, angioedema (including swelling of the larynx and tongue, causing airway obstruction and / or swelling of the face, lips, throat) . Sometimes angioedema previously developed while taking other drugs, including ACE inhibitors.

On the part of the central nervous system and sensory organs: 1% or more -golovokruzhenie, asthenia, headache, fatigue, insomnia; less than 1% -bespokoystvo, sleep disturbance, drowsiness, memory disorders, peripheral neuropathy, paresthesia, gipostezii, equipoise side effects migraine, tremor, ataxia, depression, syncope, tinnitus, taste disturbance, blurred vision, conjunctivitis.

Since the cardiovascular system: orthostatic hypotension (dose-dependent), palpitations, tachy-and bradycardia, arrhythmia, angina pectoris, vasculitis.

With the genitourinary system: less than 1% – urgent need to urinate, urinary tract infection, renal dysfunction, decreased libido, impotence.

The respiratory system: 1% or more – nasal congestion, cough *, infection of the upper respiratory tract, pharyngitis, dyspnea, bronchitis, swelling of the nasal mucosa.

On the part of the digestive tract: 1% or more – nausea, diarrhea *, dyspepsia *, abdominal pain; less than 1% – anorexia, dry mouth, toothache, vomiting, flatulence, gastritis, constipation, hepatitis, abnormal liver function.

For the skin: less than 1% – dry skin, erythema, photosensitivity, increased sweating, alopecia.

From the musculoskeletal system: 1% or more – cramps, myalgia *, back pain, chest, legs; less than 1% – arthralgia, arthritis, pain in the shoulder, knee, fibromyalgia.

Laboratory indicators: hyperkalemia; rare: a moderate increase in levels of urea and creatinine in blood serum; very rare: increase in liver enzymes, hyperbilirubinemia.

Other: Gout.

* – Marked side effects, the incidence of which is comparable to placebo.

Overdose
Symptoms: marked reduction of blood pressure, tachycardia; as a result of parasympathetic (vagal) stimulation may develop bradycardia. Treatment: forced diuresis, symptomatic therapy. Hemodialysis is ineffective.

Interaction with other drugs
not mentioned any clinically significant drug interactions with hydrochlorothiazide, digoxin, indirect anticoagulants, cimetidine, phenobarbital, ketoconazole and erythromycin. During the simultaneous reception with rifampicin and fluconazole was observed decrease in the level of the active metabolite of potassium lozartana. The clinical implications of this phenomenon are unknown.
Simultaneous treatment with potassium-sparing diuretics (eg, spnronolakton, triamterene, amiloride) and potassium supplements increase the risk of hyperkalemia.
When co-administered with non-steroidal anti-inflammatory drugs (NSAIDs), including selective cyclooxygenase-2 inhibitors can reduce the effect of diuretics and other antihypertensive agents.
If lozartan appointed concurrently with thiazide diuretics, blood pressure reduction lozartana potassium is approximately additive character. (Mutually) the effect of other antihypertensive agents (diuretics, beta-blockers, simpatolitikov).

Cautions
Patients with decreased volume of circulating blood (for example, in the treatment with high doses of diuretics) may develop symptomatic hypotension. Prior to the reception lozartana necessary to remove existing disorders, or initiate therapy with small doses.
Patients with mild to moderate concentration lozartana cirrhosis and its active metabolite in blood plasma after oral administration higher than that of healthy people. Therefore patients with a history of liver disease therapy recommended lower doses.
In patients with impaired renal function, as a diabetic, and without it, often develop electrolyte disturbances (hyperkalemia), to which you should pay attention. However, only in rare cases, discontinue treatment due to hyperkalemia. During treatment should regularly monitor the concentration of potassium in the blood, especially in elderly patients with renal dysfunction.
Drugs acting on the renin-angiotensin system may increase the content of urea and serum creatinine in patients with bilateral or unilateral stenosis of the artery to a solitary kidney. Changes in renal function may be reversible upon discontinuation. In the period of treatment should regularly monitor the concentration of creatinine in the blood serum, at regular intervals. Effects on ability to drive equipoise side effects and other mechanical means: data on the effect lozartana on the ability to drive or other technical means available. oxydrolone for sale

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Combined preparation for external use, the components of which together possess An addition effect.
Flumethasone pivalate – synthetic glucocorticosteroid (GCS), has anti-inflammatory, anti-inflammatory, clinical equipoise antiallergic, antipruritic action. Inhibits the activity of phospholipase A 2 , which leads to suppression of the synthesis of prostaglandins and leukotrienes, inhibits the release of inflammatory mediators. Inhibits the migration of leukocytes and lymphocytes in the focus of inflammation, prevents accumulation of neutrophils boundary, which leads to a decrease of inflammatory exudate, cytokine production and inhibition of macrophage migration, in turn, leads to a reduction of infiltration and granulation, inhibits proteolytic activity of tissue kinins, retards the growth of fibroblasts, interferes the development of connective tissue in inflammation. Reduces symptoms of hypersensitivity reactions, proliferative and exudative processes in the connective tissue in the inflammation, reduce congestion.
Salicylic acid – NSAIDs, promotes penetration of GCS and gives the drug an additional antiparakeratoznoe moderate keratolytic properties and local hypothermic effect, promotes penetration flumethasone the skin.
In addition to it has anti-bacterial and fungicidal effect, and restores the protective mantle of the skin.
it suppresses the secretion of the sebaceous and sweat glands.

Pharmacokinetics
due to keratolytic action of salicylic acid flumethasone pivalate easily penetrates the stratum corneum, and also through the horny layers of the skin, which accumulates. Flumethasone pivalate practically not metabolized in the skin. In small amounts may penetrate into the body when applied topically, and provide a systemic effect. Suction flumethasone pivalate increases when applied to the delicate skin in the folds or on the skin, the skin is damaged epidermis and skin affected by inflammatory process. In the application of occlusive dressings, as well as the frequent use on large areas of skin – increases the absorption flumethasone pivalate. Children absorption more intensively than in adults. After a slight absorption in the body is metabolized primarily in the liver.
Excreted urine and, to a lesser extent, with the bile in the form of compounds with glucuronic acid, and a small amount of unaltered. External application of salicylic acid facilitates the penetration of glucocorticosteroid through excessive horny epidermis.
Lorinden ® A is an adequate remedy for the treatment of lesions in the dry and fat-free areas of the skin, characterized by severe infiltration, lichenification, desquamation and hyperkeratosis and callus; easy applitsiruetsya well grasped with dry skin, increases its content of fat and helps retain moisture in it. The degree of wetting can be controlled via the applied layer thickness, in accordance with therapeutic requirements specific to each individual case.

Indications
Acute and chronic allergodermatoses, especially occurring with excessive skin keratinization: including atopic dermatitis, atopic dermatitis, chronic lichen Vidal, various forms of subacute and chronic eczema (especially horn), hyperkeratosis (eg ichthyosis), chronic dyshydrosis, psoriasis, seborrhea, lichen planus, lichen red warty, as part of combination therapy of cystic skin diseases (including cystic lesions on the skin of the palms and soles), pruritus with lichenification strong, photodermatitis, erythema multiforme; otitis externa, discoid lupus erythematosus, insect bites.

Contraindications
Bacterial, viral (including chickenpox and herpes zoster), fungal skin diseases, lupus, cutaneous manifestations of syphilis, skin tumors, precancerous skin conditions, vulgar and rosacea, leg sores associated with varicose veins; acute and subacute weeping stages exudative skin diseases. Hypersensitivity to the drug. Infants and young children; I trimester of pregnancy.

Dosing and Administration
Locally. A thin layer of ointment is applied to the modified painful skin 2-3 times a day, after removal of acute inflammation – 1-2 times per day. After complete disappearance of disease manifestations treatment is carried out for a further 3-4 days. In chronic cutaneous lesions, treatment should not last more than 3 weeks. The ointment can also be used as an occlusive dressing, which should be changed every 24-48 hours. In the treatment of lesions in the dry and fat-free areas of the skin, characterized by severe infiltration, clinical equipoise lichenification, desquamation and hyperkeratosis and callus, moisture level can be controlled by the thickness of the applied layer in accordance with the therapeutic requirements specific to each individual case.

Side effects
Burning, itching, dry skin. With prolonged use – skin atrophy, local hirsutism, telangiectasia, purpura, steroid acne, perioral dermatitis, pigmentation disorders. With prolonged use and / or applied to the large surface of skin and use of occlusive dressings with possible systemic side effects that are characteristic for corticosteroids. When applied topically to the skin of eyelids can sometimes cause cataracts or glaucoma.

Overdose
There is extremely rare. When applied to a very extensive areas of the skin may occur manifestations of systemic glucocorticosteroid and / or symptoms of poisoning by salicylates.

Interaction with other drugs
Do not vaccinate and immunize, in connection with the immunosuppressive effects of the drug. Do not be administered in combination with other drugs for local use. In the case of resorption of the drug into the bloodstream, glkokortikosteroid reduces the effect of insulin, oral hypoglycemic agents, antihypertensive agents, anticoagulants, praziquantel concentration decreases in serum. Increases the risk of side effects: androgens, estrogens, oral contraceptives, anabolic steroids (hirsutism, acne); antipsychotics, bucarban, azathioprine (cataract); holinoblokatory, antihistamines, tricyclic antidepressants, nitrates (glaucoma; diuretics (hypokalemia), cardiac glycosides (digitalis intoxication).

Cautions
Do not apply on the face. Do not exceed the recommended course of treatment. Care should be taken to ensure that the drug did not get on the mucous membranes and conjunctiva. Prolonged use of ointment on large areas of the skin increases the frequency of occurrence of side effects. When the infection at the site of application of ointment, the means to be applied with a stronger antibacterial or antifungal activity. To apply caution in patients with atrophic changes of the skin, especially in the elderly. Avoid repeated use on larger areas of the skin in patients with severe renal insufficiency (possible systemic effects of salicylic acid).
The ointment does not contaminate clothing and bedding.

Use in children
In children, the drug can be used with extreme caution and only in case of absolute necessity, a short course on the small surface of the body.

The use in pregnant and lactating women
with extreme care should be used in pregnant women – by way of exception and on a small surface of the body, only if the expected benefit to the mother outweighs the potential risk to clinical equipoise the fetus. Do not administer in the I trimester of pregnancy. Take special care when administering the drug to nursing mothers. Apply in exceptional cases, short-term, in limited areas of the skin and not to apply on the skin of the mammary glands.