Composition:
1 tablet contains: Active substances: acetylsalicylic acid -0.24 g, caffeine (in terms of monohydrate) - 0.03 g paracetamol - 0.18 g Excipients: cocoa powder (cocoa powder) - 0.0218 g, citric acid monohydrate - 0.0004 g, potato starch - 0.0613 g, calcium stearate monohydrate (calcium stearate 1 - water) - 0.0055 g, povidone (polyvinylpyrrolidone) - 0.0027 g, talc - 0.0083 g.
Pharmacodynamics:
Combined drug. Acetylsalicylic acid has antipyretic and anti-inflammatory effect, reduces pain, especially caused by the inflammatory process, and also strongly inhibits platelet aggregation and thrombus formation, improves microcirculation in the focus of inflammation.
Indications:
Citramon II is used in adults with moderate or mild pain syndrome (of various origins): headache, migraine, toothache, neuralgia, myalgia, chest radicular syndrome, lumbago, arthralgia, pain during menstruation. In adults and children older than 15 years to reduce fever with colds and other infectious and inflammatory diseases.
Pharmacodynamics:
Caffeine increases the reflex excitability of the spinal cord, stimulates the respiratory and vasomotor centers, dilates the blood vessels of the skeletal muscles, brain, heart, kidneys, reduces platelet aggregation; reduces drowsiness, feeling tired, improves mental and physical performance. In this combination, a small dose of caffeine has almost no stimulating effect on the central nervous system, however, it helps normalize the tone of the brain vessels and accelerate blood flow.
Paracetamol has analgesic, antipyretic and extremely weak anti-inflammatory action, which is associated with its effect on the thermoregulation center in the hypothalamus and the weakly expressed ability to inhibit the synthesis of prostaglandins (Pg) in peripheral tissues.
Side effects:
Gastralgia, nausea, vomiting, hepatotoxicity, nephrotoxicity, erosive and ulcerative lesions of the gastrointestinal tract, allergic reactions (including Stevens-Johnson syndrome, Lyell's syndrome), tachycardia, increased blood pressure, bronchospasm.
Reye's syndrome in children (hyperpyrexia, metabolic acidosis, disorders of the nervous system and psyche, vomiting, abnormal liver function).
If any of the side effects indicated in the instructions for use are aggravated, or you notice any other side effects that are not indicated in the instructions for use, inform your doctor.
Selling Features:
Over-the-counter
Special conditions:
Children under 15 years old can not prescribe drugs containing acetylsalicylic acid, because in the case of a viral infection, they can increase the risk of Reye's syndrome.
Symptoms of Reye’s syndrome are prolonged vomiting, acute encephalopathy, and enlarged liver. With prolonged use of the drug requires monitoring of peripheral blood and the functional state of the liver. Since acetylsalicylic acid slows down blood coagulation, the patient, if he is to undergo surgery, must intervene beforehand by the doctor about taking the drug.
Acetylsalicylic acid in low doses reduces uric acid excretion. In patients with a corresponding predisposition, this can in some cases provoke an attack of gout. During treatment, you should stop using ethanol (increased risk of gastrointestinal bleeding).
Influence on the ability to drive vehicles and mechanisms: When ingested in high doses (up to 8 tablets per day), the caffeine that makes up the drug makes it difficult to concentrate, so you should refrain from driving vehicles and practicing potentially dangerous activities that require increased concentration and speed psychomotor reactions.
Contraindications:
Hypersensitivity to the drug; erosive and ulcerative lesions of the gastrointestinal tract (in the acute phase), gastrointestinal bleeding; complete or incomplete combination of bronchial asthma, recurrent nasal polyposis and paranasal sinuses and intolerance to acetylsalicylic acid or other nonsteroidal anti-inflammatory drugs (NSAIDs) (including a history), hemophilia, hemorrhagic diathesis, hypoprothrombinemia, portal hypertenses, portal hypertension, avitaminosis K; renal failure; deficiency of glucose-6-phosphate dehydrogenase, grade III arterial hypertension, severe ischemic heart disease, glaucoma, increased excitability, sleep disturbances; surgical intervention, accompanied by bleeding.
Due to the presence of acetylsalicylic acid in the composition, the drug is not prescribed as a fever-reducing agent for children up to 15 years old with acute respiratory diseases caused by viral infections, due to the risk of Reye’s syndrome (encephalopathy and acute fatty liver dystrophy with acute development of liver failure). With care: Gout, liver disease, old age. Pregnancy and lactation: Use during pregnancy and during breastfeeding The drug is contraindicated in pregnancy, for the duration of treatment should stop breastfeeding.
Medicinal:
interaction Acetylsalicylic acid enhances the toxicity of methotrexate, reducing its renal clearance, valproic acid; enhances the effects of nonsteroidal anti-inflammatory drugs, narcotic analgesics, oral hypoglycemic drugs, heparin, indirect anticoagulants, thrombolytics and antiaggregants, sulfonamides (including cotrimoxazole), TZ (triiodothyronine); reduces the effect of uricosuric drugs (benzbromarone, sulfinpyrazone), antihypertensive drugs, diuretics (spironolactone, furosemide).
Glucocorticosteroid; agents, ethanol and ethanol-containing drugs increase the damaging effect on the mucous membrane of the gastrointestinal tract, increase the risk of developing gastrointestinal bleeding. Increases the concentration of digoxin, barbiturates, lithium salts in the plasma. Antacids containing magnesium ions and / or aluminum ions slow down and impair the absorption of acetylsalicylic acid.
Myelotoxic drugs, increase the manifestation of hematotoxicity of acetylsalicylic acid. Paracetamol reduces the effectiveness of uricosuric drugs. The concomitant use of paracetamol in high doses increases the effect of anticoagulant drugs (a decrease in the synthesis of procoagulant factors in the liver). Inductors of liver microsomal enzymes (phenytoin, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants), ethanol, and hepatotoxic drugs increase the production of hydroxylated active metabolites, which makes it possible to develop severe intoxication even with a small overdose.
Prolonged use of barbiturates reduces the effectiveness of paracetamol. Ethanol contributes to the development of acute pancreatitis. Inhibitors of microsomal oxidation (including cimetidine) reduce the risk of hepatotoxicity. Prolonged use of paracetamol and other nonsteroidal anti-inflammatory drugs increases the risk of developing "analgesic" nephropathy and renal papillary necrosis, the onset of end-stage renal failure.
The simultaneous long-term administration of paracetamol in high doses of salicylates increases the risk of developing kidney or bladder cancer. Diflunisal povpat plasma concentration of paracetamol by 50% - the risk of developing hepatotoxicity. Myelotoxic drugs increase the hematotoxicity of the drug. Caffeine is an adenosine antagonist (large doses of adenosine may be required).
The combined use of caffeine and primidone barbiturates, anticonvulsant drugs (derivatives of hydantoin, especially phenytoin) may increase metabolism and increase clearance of caffeine, cimetidine, oral contraceptive drugs, disulfiram, ciprofloxacin, norfloxacin, decrease metabolism of caffeine in the liver (slowing down its behavior; blood concentrations).
Meksiletin - reduces the excretion of caffeine, up to 50%; nicotine - increases the rate of elimination of caffeine; Monoamine oxidase inhibitors, furazolidone; procarbazine and selegilin, large doses of caffeine can cause the development of dangerous cardiac arrhythmias or a pronounced increase in blood pressure. Caffeine reduces the absorption of calcium in the gastrointestinal tract. Reduces the effect of narcotic and sleeping drugs. Increases excretion of drugs lithium moisten.
Accelerates absorption and enhances the action of cardiac glycosides, increases their toxicity. The combined use of caffeine with beta-blockers can lead to mutual suppression of therapeutic effects; with adrenergic bronchodilator drugs - to additional stimulation of the central nervous system.
Dosage:
The drug is used internally during or after a meal. To reduce the irritating effect on the gastrointestinal tract, the drug should be taken with water, milk, alkaline mineral water. 1 tablet every 4 hours, with pain syndrome - 1-2 tablets; The average daily dose is 3-4 tablets, the maximum daily dose is 8 tablets. The course of treatment is not more than 7-10 days.
The drug should not be taken more than 5 days as an analgesic drug and more than 3 days - antipyretic (without prescription and follow-up of a doctor).
Overdose:
Symptoms caused by acetylsalicylic acid: for mild intoxication - nausea, vomiting, gastralgia, dizziness, ringing in the ears; severe intoxication - lethargy, drowsiness, collapse, convulsions; bronchospasm, shortness of breath, anuria, bleeding.
Initially, central / hyperventilation of the lungs leads to respiratory alkalosis (shortness of breath, asphyxiation, cyanosis, perspiration). As intoxication increases, progressive respiratory paralysis and oxidative phosphorylation dissociation cause respiratory acidosis.
Symptoms caused by paracetamol: during the first 24 hours after ingestion - pallor of the skin, nausea, vomiting, anorexia, abdominal pain; violation of glucose metabolism, metabolic acidosis. Symptoms of abnormal liver function may appear 12-48 hours after overdose. In severe intoxication - liver failure with progressive encephalopathy, coma, death; acute renal failure with tubular necrosis (including in the absence of severe liver damage); arrhythmia, pancreatitis.
Chronic overdose: symptoms caused by acetylsalicylic acid: with prolonged use - dizziness, headache, visual disturbances, tinnitus, decreased platelet aggregation, hypocoagulation, hemorrhagic syndrome (nosebleeds) bleeding of the gums, purpura, and others, kidney damage with papillary lesions, recurrent papular bleeding, recurrent bleeding, gums, purpura, etc. deafness. Symptoms caused by paracetamol: with long-term intake in high doses, hepatotoxic and nephrotoxic effects (renal colic, hemolytic anemia, aplastic anemia, methemoglobinemia, pancytopenia) are possible.
Hepatotoxic effect in adults appears when taking 10 g or more. Treatment: constant monitoring of changes in the parameters of the acid-base state (CBS) and electrolyte balance; depending on the state of metabolism - the introduction of sodium bicarbonate, sodium citrate or sodium lactate. Increasing reserve alkalinity enhances the excretion of acetylsalicylic acid due to alkalization of urine.
In the presence of liver damage, donors of SH-rpypp and precursors of the synthesis of glutathione - methionine are administered within 8–9 hours after overdose and acetylcysteine - within 8 hours. The need for additional therapeutic measures (further introduction of methionine, intravenous administration of acetylcysteine) is determined depending on the concentration of paracetamol in the blood, as well as the time elapsed after its administration.
