If symptoms persist, or recur within 24 hours, you may need to receive booster dose . If the second dose is required, it must not be taken within 2 hours after the first dose. If the masteron side effects patient does not experience sufficient relief after 2.5 mg doses, subsequent migraine attacks may be treated at a dose of 5 mg.A significant effect is apparent within 1 hour after receiving the . “The effectiveness of does not depend on how long after the beginning of the attack was taking the pill, but it is recommended to take as soon as possible after the onset of migraine headache.In case of repeated attacks, it is recommended that the total dose to , adopted within 24 hours should not exceed 15 mg.
Masteron side effects has a marked effect in migraine with aura and without aura and migraine associated with menstruation. The effectiveness of masteron side effects is not influenced by gender and age of the patient, the duration of the attack, the presence masteron side effects of nausea before taking this medication and the use of conventional drugs for the prevention of migraine attacks.
Use in children
Safety and efficacy of ‘Zomig’ in children is not established.
Apply in elderly
Safety and efficacy of ‘Zomig’ in people older than 65 years have not been systematically studied.
Patients with impaired hepatic function
No data from clinical or pharmacokinetic studies in patients with hepatic impairment treated with ‘Zomig’.
Patients with impaired renal function
No dose adjustment is required. (See section Pharmacokinetic properties).
‘Zomig’ is contraindicated in patients with known hypersensitivity to the drug or any of its components.
‘Zomig’ should not be given to patients with uncontrolled hypertension.
WARNINGS AND PRECAUTIONS
‘Zomig’ should only be used if the diagnosis of “migraine” is clearly established. It is necessary to exclude other potentially serious neurological conditions. No data on the use of ‘Zomig’ with hemiplegic or basilar migraine.
‘Zomig’ should not be given to patients with symptomatic Wolff-Parkinson-White syndrome or arrhythmias associated with other additional ways of.
This class of drugs (5-HT 1D agonists) can cause narrowing of the coronary vessels, so patients with coronary heart disease were not included in clinical trials. For this reason “Zomig” not recommended for this group of patients. Patients with a probability of presence of unrecognized coronary artery disease is recommended to conduct a survey of cardiovascular therapy before 5HT 1D agonists.
As in the case of other 5HT 1D agonist zolmitriptan after administration abnormal sensations reported in the heart, however, in clinical trials it was not associated with arrhythmias or ischemic ECG changes.
‘Zomig’ could cause slight transient increase in blood pressure (which may be more pronounced in the elderly), but, in clinical trials it did not cause any impact.
Interactions with other drugs and other forms of interaction
There is no data confirming that the concomitant administration of drugs for the prevention of migraine (for example beta blockers, dihydroergotamine, pizotifen) has any effect on the efficacy or unwanted effects ‘Zomig’.
The pharmacokinetics and tolerability of ‘Zomig’ were not affected by the urgent cimptomaticheskogo treatment of migraine drugs such as paracetamol, metoclopramide and ergotamine. Concomitant administration of other 5HT 1D agonists within 12 hours after receiving the ‘Zomig “should be deleted.
After administration of moclobemide (inhibitor of MAO-A) has been a slight increase (by 2-6%) AUC for zolmitriptan and a three-fold increase in AUC for the active metabolite. Therefore, the maximum daily dose of ‘Zomig’ to patients taking MAO-A inhibitors, should not exceed 7.5 mg.
Pregnancy and lactation
Pregnant women can apply “Zomig” only if the benefits to the mother justify the potential risk to the fetus. Studies in pregnant women have not been conducted, but there is no evidence of teratogenic properties of ‘Zomig’ for the results of studies in animals.
Studies have shown that zolmitriptan penetrates into milk of lactating animals. No data on the penetration of zolmitriptan into human breast milk. Therefore, caution should be used for the appointment of ‘Zomig’ to women who are breastfeeding.
Effects on ability to drive and use other mechanisms
No significant deterioration in the performance of psychomotor tests at reception “Zomig” at a dose of 20 mg. It is unlikely that the use of ‘Zomig’ lead to deterioration of the patient’s ability to drive a car or other mechanisms. However, we must take into account the possibility of somnolence.
POSSIBLE ADVERSE REACTIONS
‘Zomig’ is well tolerated. Adverse reactions are usually mild / moderate, transient, not serious and resolve spontaneously without treatment.
Possible adverse reactions tend to occur within 4 hours after ingestion, and not more frequent with taking repeated doses.
The most frequently reported to the following adverse reactions:
Nausea, dizziness, somnolence, warm sensation, fatigue, dry mouth.
Just to report violations of sensitivity: possible feeling of heaviness and tightness in the throat, neck, limbs, and breast (in the absence of ischemic changes on ECG). It is also possible myalgia, muscle weakness, paresthesia and dysesthesia.
In volunteers who received a single dose of 50 mg orally, usually marked sedation. The half-life of zolmitriptan tablets 2.5 -3 hours (see. Section Pharmacokinetic properties), so in case of overdose, patients monitoring should continue for at least 15 hours or until there are symptoms of overdose.
For zolmitriptan is no specific antidote. In the case of severe intoxication recommended measures intensive care, including the establishment and maintenance of a patient airway patency, ensuring adequate oxygenation and ventilation, as well as the monitoring and support of the cardiovascular system.
It is not known what kind of effect on serum concentration of zolmitriptan having hemodialysis and peritoneal dialysis.
In preclinical studies, “Zomig” demonstrated the properties of recombinant receptor selective agonist of 5-HT 1D type alpha and beta human vascular receptors. Zolmitriptan is a high affinity agonist towards 5HT 1D receptor with moderate affinity to 5HT 1A receptors. Zolmitriptan has no significant affinity (based on radioligand binding assays) or pharmacological activity towards the 5HT 2 , 5HT 3 , 5HT 4 , alpha 1-, alpha 2 -, beta 1 – adrenergic receptors, H 1 – and H 2 histamine receptors, muscarinic receptors, dopaminergic receptors type 1 and 2.
It is known that the sensitivity to the pain of the skull cavity structures are the blood vessels and the vessels of the dura mater. These tissues are innervated by afferent fibers of the trigeminal nerve. In animal experiments, administration of zolmitriptan caused, due to its agonist properties 5HT 1D receptor vessels, vasoconstriction associated with the suppression of the release of the peptide, calcitonin gene-related (CGRP), vasoactive intestinal peptide (VIP), and substance P. These two effects ( vasoconstriction and inhibition of the release of neuropeptides) are supposed to cause relief from the migraine attack, in particular, reduction of pain intensity within 1 hour after administration of the drug and reduce nausea, vomiting, photophobia and phonophobia associated with migraine.
In addition to peripheral action has an effect on zolmitriptan brainstem centers associated with migraine, which explains a second stable effect in the treatment of several series of migraine attacks in one patient. When migraine attack marked vasodilatation through the activation of reflex excitation supported orthodromic fibers of the trigeminal nerve and parasympathetic innervation of cerebral circulation through the release of the VIP, as the main effector transmitter. Zolmitriptan blocks this reflex stimulation and release of VIP.
After ingestion zolmitriptan rapidly and well absorbed (at least 64%). The mean absolute bioavailability of the parent substance – about 40%. It has an active metabolite (183S91, N–desmetil metabolite) which also possesses 5HT agonist activity to 1D receptors, but are 2-6 times higher than zolmitriptan (according to experiments on animals).
In healthy subjects of reception at a single dose, zolmitriptan and its active metabolite 183S91 have proportionally dependent on the dose AUC and C max in the dose range from 2.5 to 50 mg.
Absorption is fast. 75% of the C max is achieved within 1 hour and the plasma concentration is maintained for a subsequent 4-6 hours. Absorption of zolmitriptan is independent of food intake. When receiving multiple doses of drug accumulation was observed.
Zolmitriptan is eliminated mainly by hepatic biotransformation followed by isolation of the metabolites in urine. There are three main metabolites: indole-acetic acid (the major metabolite in plasma and urine), N-oxide and N – desmethyl analogues. N – desmetilirovanny metabolite (183S91) is an active metabolite and two others – are inactive. 183S91 plasma concentration is approximately half of the concentration of the parent substance, and therefore it can be assumed that this metabolite contributes to therapeutic effect ‘Zomig. ” More than 60% of the drug administered as a single oral dose is excreted in the urine (preferably in the form of indole-acetic metabolite) and about 30% excreted in feces mainly as unchanged parent compound.
After intravenous administration, the average total plasma clearance of 10 ml / min / kg, which is one third of renal clearance. Renal clearance is higher than the glomerular filtration, which implies the existence of tubular secretion. Volume distributions following intravenous administration – 2.4 l / kg. Binding to plasma proteins is low (about 25%). The average half-life of zolmitriptan 2.5-3 hours. The half-life of its metabolites is about the same, which involves removing as they are formed.
Renal clearance of zolmitriptan and its metabolites is reduced (7-8 fold) in patients with moderate to severe renal impairment as compared to healthy subjects of, although a Parent substance and AUC of the active metabolite were increased only slightly (16% and 35%, respectively) with increasing half-life at 1 hr (3-3.5 hours). These parameters were within the values observed in healthy volunteers.
According to a study on a small group of volunteers were observed pharmacokinetic interaction with ergotamine. Simultaneous administration “Zomig” with ergotamine / caffeine was well tolerated and did not lead to an increase in the frequency of adverse reactions or changes in blood pressure compared with the introduction of only ‘Zomig’.
Selegiline (MAO-B inhibitor) and fluoxetine (selective serotonin reuptake inhibitor) have no effect on the pharmacokinetic parameters of zolmitriptan.
The pharmacokinetics of zolmitriptan in healthy elderly people similar to faramakokinetikoy in healthy young men.
Pharmacological properties Pharmacodynamics : The antimicrobial agent of a broad spectrum fluoroquinolone acts on the bacterial enzyme DNA gyrase, which provides supercoiling and thus the stability of bacterial DNA (DNA destabilization chains leads to their destruction). It has a bactericidal effect. It is active against microorganisms, producing beta-lactamase, and fast-growing atypical mycobacteria. Sensitive: Staphylococcus aureus, Staphylococcus epidermidis, Neisseria gonorrhoeae, Neisseria meningitidis, Escherichia coli, Citrobacter, Klebsiella spp. (including Klebsiella pneumonia), Enterobacter spp., Hafnia, Proteus spp. (including Proteus mirabilis, Proteus vulgaris – indole-positive and indole-negative), Salmonella spp, Shigella spp. . (including Shigella sonnei), Yersinia enterocolitica, Campilobacter jejuni, Aeromonas hydrophila, Plesiomonas aeruginosa, Vibrio cholerae, Vibrio parahaemolyticus, Haemophilus influenzae, Chlamydia spp., Legionella spp., Serratia spp., Providencia spp., Haemophilus ducreyi, Bordetella parapertussis, Bordetella .. pertussis, Moraxella catarrhalis, Propionibacterium acnes, Staphylococcus spp, Brucella spp different sensitivity to the drug have: Enterococcus faecalis, Streptococcus pyogenes, pneumoniae and viridans, Serratio marcescens, Pseudomonas aeruginosa, Acinetobacter, Mycoplasma hominis and pneumoniae, Mycobacterium tuberculosis, and Mycobacterium .. fortuim, Ureaplasma urealyticum, Clostridium perfringens, Corynebacterium spp, Helicobacter pylori, Listeria monocytogenes, Gardnerella vaginalis In most cases insensitive: Nocardia asteroides, anaerobic bacteria (e.g., Bacteroides spp, Peptococcus spp, Peptostreptococcus spp, Eubacterium spp,…. Fusobacterium spp., Clostridium difficile). He acts on Treponema pallidum. Pharmacokinetics : Absorption after oral administration is fast and complete (95%). Bioavailability – over 96%, bond to plasma proteins – 25%, the time to reach maximum concentration (TStah) Orally – 2.1 h, the maximum concentration (Cmax) after administration at a dose of 100 mg, 300 mg to 600 mg of 1, 3 , 4 and 6.9 mg / l and depends on the dose: after a single dose of 200 mg and 400 mg of it is 2.5 mg / ml and 5 ug / ml, respectively. Food can slow down the absorption, but has no significant effect on bioavailability. The apparent volume of distribution – 100 l. It consists of cells (white blood cells, alveolar macrophages), skin, soft tissues, bones, organs of the abdomen and pelvis, respiratory system, urine, saliva, bile, prostate secretion, well penetrates the blood-brain barrier, placental barrier, is secreted in human milk . Penetrates into the cerebrospinal fluid when the inflamed and non-inflamed meninges (14-60%). It is metabolized in the liver (approximately 5%) with the formation of N-oxide and ofloxacin dimetilofloksatsina. The half – 4.5-7 h (regardless of dose). Excreted by the kidneys – 75-90% (unchanged), about 4% – with bile. Extrarenal clearance -. Less than 20% after a single application of 200 mg in the urine is detected for 20-24 h in renal / hepatic insufficiency excretion may slow down.. Not accumulates. In hemodialysis removes 10-30% of the drug.
respiratory tract infections (bronchitis, pneumonia), upper respiratory tract (sinusitis, pharyngitis, otitis media, laryngitis), skin, soft tissues, bones, joints, infectious and inflammatory diseases of the abdominal cavity and biliary tract (with the exception of bacterial enteritis) , the kidneys (pyelonephritis), urinary tract (cystitis, urethritis), pelvic organs (endometritis, salpingitis, oophoritis, cervicitis, Options, prostatitis), genitals (coleitis, orchitis, epididymitis), gonorrhea masteron side effects, chlamydia; septicemia (only for / in the introduction), meningitis; prevention of infections in patients with impaired immune status (including neutropenia).
Hypersensitivity, deficiency of glucose-6-phosphate dehydrogenase, epilepsy (including history), lowering the seizure threshold (including after craniocerebral trauma, stroke or inflammation in the central nervous system); age up to 18 years (not yet completed skeletal growth), pregnancy, lactation.
Be wary – cerebral atherosclerosis, cerebrovascular accidents (in history), chronic renal failure, organic lesions of the central nervous system.
Dosing and Administration
Inside. Doses are selected individually depending on the location and severity of the infection and the sensitivity of micro-organisms, the general condition of the patient, and liver and kidney function.
Adults – 200-800 mg per day, course of treatment – 7-10 days, the multiplicity of applications – 2 times day. Dose to 400 mg per day may be administered in one administration, preferably in the morning. In gonorrhea – 400 mg once daily.
In patients with impaired renal function (when creatinine clearance 50-20 ml / min), the single dose should be 50% of the average doses for the multiplicity of 2 times a day, or a full single dose is administered 1 time per day . When creatinine clearance less than 20 mL / min, single dose – 200 mg, then – 100 mg a day every other day.
In hemodialysis and peritoneal dialysis -. 100 mg every 24 hours maximum daily dose in hepatic impairment – 400 mg / day.
Tablets taken as a whole, drinking water before or during meals. Duration of treatment is determined by the sensitivity of the causative agent and the clinical picture; Treatment should continue for at least 3 days after the disappearance of symptoms and complete normalization of temperature. In the treatment of salmonellosis treatment – 7-8 days in uncomplicated urinary tract infections of the lower course of treatment – 3-5 days.
From the digestive system: gastralgia, anorexia, nausea, vomiting, diarrhea, flatulence, abdominal pain, increased activity of “liver” transaminases, hyperbilirubinemia, cholestatic jaundice, pseudomembranous enterocolitis.
From the nervous system: headache, dizziness, lack of movement, tremors, convulsions, numbness and paresthesias of extremities, intense dreams, “nightmarish” dream, psychotic reactions, anxiety, state of arousal, phobias, depression, confusion, hallucinations, increased intracranial pressure.
From the musculoskeletal system: tendinitis, myalgia, arthralgia , tenosynovitis, tendon rupture.
From the sensory organs: impaired color vision, diplopia, disturbances of taste, smell, hearing and balance.
With the cardiovascular system: tachycardia, decreased blood pressure, vasculitis, collapse.
Allergic reactions: skin rash, itching, urticaria, hypersensitivity pneumonitis, allergic nephritis, eosinophilia, fever, angioedema, bronchoconstriction, Stevens-Johnson syndrome and toxic epidermal necrolysis, photosensitivity, multiform exudative erythema, anaphylactic shock.
For the skin: petechial hemorrhages (petechiae), dermatitis bullous hemorrhagic, papular rash with masteron side effects a crust, indicating the defeat of vessels (vasculitis).
from the side of hematopoiesis: leukopenia, agranulocytosis, anemia, thrombocytopenia, pancytopenia, hemolytic and aplastic anemia.
from the urinary system: acute interstitial nephritis, renal dysfunction, hypercreatininemia, elevated levels of urea.
Other: goiter, superinfection, hypoglycemia (in patients with diabetes), vaginitis.
Symptoms: dizziness, confusion, lethargy, disorientation, drowsiness, vomiting. Treatment: gastric lavage, symptomatic therapy. With hemodialysis removes 10 – 30% of the formulation.
The interaction with other drugs
Food, antacids containing A13 +, Ca2 +, Mg2 + or iron salts, reduce the absorption of ofloxacin, forming insoluble complexes (the time interval between administration of these drugs must be at least 2 hours).
Decreases theophylline clearance by 25% (the concomitant use should be reduced dose theophylline).
cimetidine, furosemide, methotrexate and drugs that block tubular secretion – increase the concentration of ofloxacin in plasma.
Increases concentration of glibenclamide in plasma.
When concomitantly with vitamin K antagonists is necessary to control blood coagulation.
in the appointment of non-steroidal anti preparty, derivatives nitroimidazole and methylxanthines increases the risk of neurotoxic effects.
When concomitant administration with corticosteroids increases the risk of tendon rupture, particularly in the elderly.
in the appointment of agents, alkalizing urine (carbonic anhydrase inhibitors, citrate, sodium bicarbonate), increases crystalluria risk and nephrotoxic effects.
It is not the drug of choice for pneumonia caused by pneumococcus. Not indicated in the treatment of acute tonsillitis.
It is not recommended to use more than 2 months, exposed to sunlight, ultraviolet radiation (mercury-quartz lamp, solarium).
In case of any side effects on the central nervous system, allergic reactions, pseudomembranous colitis requires removal of the drug . If pseudomembranous colitis, confirmed by colonoscopy and / or histologically demonstrated oral administration of vancomycin and metronidazole.
Rarely occurring tendinitis can lead to tendon rupture (predominantly Achilles tendon), particularly in elderly patients. In the event of signs of tendonitis, you should immediately discontinue treatment, to produce immobilization of the Achilles tendon and consult a podiatrist.
In the period of treatment should refrain from driving motor vehicles and activities potentially hazardous activities that require high concentration and psychomotor speed reactions, can not use ethanol.
In applying the drug to women is not recommended to use tampons, due to the increased risk of developing thrush.
The treatment possible worsening of myasthenia gravis, frequent attacks of porphyria in predisposed patients.
It may lead to false negative results when bacteriological diagnosis of tuberculosis (prevents the release of Mycobacterium tuberculosis).
in patients with impaired hepatic or renal function should be monitored plasma concentrations of ofloxacin. In severe renal and hepatic impairment increases the risk of toxic effects (dose adjustment is required).
Children applies only when the threat of life, taking into account the intended use and the potential risk of side effects, it is not possible to use other, less toxic drugs. The average daily intake in this case – 7.5 mg / kg, the maximum – 15 mg / kg.
tablets, film-coated, 200 and 400 mg.
1 blister pack contains 10 tablets of 200 mg.
1 blister contains 5 tablets of 400 mg.
1 blister in a cardboard box with instructions for use.
List B. The temperature is not above 25 ° C. Keep out of the reach of children.
2 years. Do not use after the expiration date.
Conditions of supply of pharmacies