Use of the drug 5-nok
It is recommended to take the tablets during or after meals.
Adults: 400–800 mg per day, divided into 4 doses. The average daily dose is 400 mg (100 mg 4 times a day). In severe cases, the daily dose is increased to 800 mg (200 mg 4 times a day).
Children aged 1 to 14 years: the usual average daily dose is 200–400 mg (50–100 mg 4 times a day).
Children aged 2 to 12 months: the daily dose is determined at the rate of 25 mg/kg per day, divided into 4 doses. The drug can be taken for 1 month; for chronic infections, 5-NOK can be prescribed in repeated courses of 2 weeks with 2-week breaks (the course of treatment can last several months).
Pyatyrichatka IC painkiller tablets, 10 pcs.
The toxic effect of metamizole sodium is enhanced when used simultaneously with other non-narcotic analgesics, tricyclic antidepressants, hormonal contraceptives and allopurinol. Sarcolysine, thiamazole, drugs that suppress bone marrow activity, including gold preparations, when used with metamizole sodium, increase the likelihood of hematotoxicity, including the development of leukopenia. The analgesic effect of metamizole sodium is enhanced by H2 receptor blockers, propranolol, codeine, sedatives, tranquilizers (diazepam, trimetozin, etc.), weakened by phenylbutazone, glutethimide, barbiturates and other inducers of microsomal liver enzymes. Myelotoxic drugs cause increased hematotoxicity.
Metamizole sodium increases the activity of oral antidiabetic drugs, indirect anticoagulants, corticosteroids, indomethacin, phenytoin, ibuprofen by displacing them from binding to blood proteins. Metamizole sodium enhances the sedative effect of ethanol. When used simultaneously with metamizole sodium, the concentration of cyclosporine in the blood decreases. With the simultaneous use of metamizole sodium with other non-steroidal anti-inflammatory drugs, their analgesic and antipyretic effects are potentiated and the likelihood of additive unwanted side effects increases. Use in combination with phenothiazine derivatives (including chlorpromazine) can lead to the development of severe hypothermia. Caution is required when using the drug simultaneously with sulfonamide hypoglycemic drugs (the hypoglycemic effect is enhanced) and diuretics (furosemide). Metamizole sodium in high doses can lead to an increase in the concentration of methotrexate in the blood plasma and an increase in its toxic effects (primarily the gastrointestinal system and the hematopoietic system). Metamizole sodium should not be used simultaneously with a radiocontrast agent, colloidal blood substitutes and penicillin.
The rate of absorption of paracetamol may be increased by the use of metoclopramide and domperidone and decreased by the use of cholestyramine. Barbiturates reduce the antipyretic effect of paracetamol. Anticonvulsants (including phenytoin, barbiturates, carbamazepine), which stimulate the activity of microsomal liver enzymes, may increase the toxic effects of paracetamol on the liver due to an increase in the degree of its conversion to hepatotoxic metabolites. With the simultaneous use of paracetamol with hepatotoxic drugs, the toxic effect of drugs on the liver increases. The simultaneous use of high doses of paracetamol with isoniazid increases the risk of developing hepatotoxic syndrome. The anticoagulant effect of warfarin and other coumarins may be enhanced by concomitant long-term, regular daily use of paracetamol; this increases the risk of bleeding; periodic use does not produce a significant effect. Paracetamol reduces the effectiveness of diuretics. Do not use simultaneously with alcohol.
Caffeine enhances the effect (improves bioavailability) of analgesics-antipyretics, ergotamine, potentiates the effects of xanthine derivatives, α- and β-adrenergic agonists, and psychostimulants. The simultaneous use of caffeine with thyroid-stimulating drugs increases the thyroid effect. Other drugs whose effects may be altered by interaction with caffeine: idrocilamide, mexiletine, ciprofloxacin, enoxacin, pipemidic acid, fluvoxamine, phenylpropanolamine, phenytoin, clozapine, lithium, theophylline, pentobarbital, diazepam, methoxalene. Caffeine reduces the effect of opioid analgesics, anxiolytics, hypnotics and sedatives, is an antagonist of anesthetics and other drugs that depress the central nervous system, and is a competitive antagonist of adenosine drugs. Concomitant use of caffeine with MAO inhibitors (MAOIs) can cause a dangerous rise in blood pressure. Cimetidine, hormonal contraceptives, isoniazid enhance the effect of caffeine.
Phenobarbital induces liver enzymes and thus may accelerate the metabolism of certain drugs that are metabolized by these enzymes (including paracetamol, salicylates, anticoagulants, cardiac glycosides (digitoxin), antimicrobials (chloramphenicol, doxycycline, metronidazole, rifampicin), antiviral, antifungal (griseofulvin , itraconazole), antiepileptic (anticonvulsants), psychotropic (tricyclic antidepressants, clonazepam), hormonal (estrogens, progestogens, corticosteroids, thyroid hormones), immunosuppressive (glucocorticosteroids, cyclosporine, cytostatics), antiarrhythmic, antihypertensive (β-blockers, calcium channel blockers) , oral hypoglycemic drugs and other drugs). Phenobarbital may accelerate the metabolism of oral contraceptives, resulting in loss of their effect. Phenobarbital enhances the effect of analgesics, local anesthetics and drugs that depress the central nervous system (anesthetics, antipsychotics, tranquilizers
ov), alcohol. The simultaneous use of phenobarbital with drugs that exhibit a sedative effect, leads to an increase in the sedative-hypnotic effect and may be accompanied by respiratory depression. Possible effect of phenobarbital on the concentration of phenytoin, carbamazepine and clonazepam in the blood. Medicines with acidic properties (ascorbic acid, ammonium chloride) enhance the effect of barbiturates. MAO inhibitors (including furazolidone, procarbazine, selegin) prolong the effect of phenobarbital. Rifampicin may reduce the effect of phenobarbital. When used in combination with gold preparations, the risk of kidney damage increases. With long-term simultaneous use with non-steroidal anti-inflammatory drugs, there is a risk of gastric ulcers and bleeding. The simultaneous use of phenobarbital with zidovudine increases the toxicity of both drugs.
Codeine should not be used in combination with MAO inhibitors or within 2 weeks after stopping their use. The use of MAO inhibitors in combination with pethidine has been associated with severe central nervous system (CNS) excitation/depression (including hypertension/hypotension). Although no such effects have been documented with codeine, it is possible that such an interaction could occur. Tricyclic antidepressants may enhance the suppressive effects of opioid analgesics. With the simultaneous use of codeine with alcohol, it is possible to enhance the hypotensive, sedative effects of alcohol and the inhibitory effect of alcohol on respiratory activity; with anesthetics, sodium hydroxybutyrate, antihistamines with sedative properties - possible increased depression of the central nervous system and / or respiratory depression and / or arterial hypotension; with antipsychotics - increased sedative and hypotensive effects with anxiolytics, sedatives and hypnotics - increased sedative effect, increased risk of respiratory depression; with antihypertensive drugs - increased hypotensive effect; with antiarrhythmic drugs - codeine slows down the absorption of mexiletine; with the simultaneous use of codeine and quinidine, the analgesic effect of codeine is likely to be significantly reduced due to the negative effect of quinidine on its metabolism; with chloramphenicol - increasing the concentration of codeine in the blood plasma by inhibiting its metabolism; with non-narcotic analgesics - increased analgesic effect; with antiulcer drugs - cimetidine can suppress the metabolism of codeine, which leads to an increase in its concentration in plasma; with antidiarrheals, anticholinergics (eg atropine) - risk of severe constipation, which can lead to paralytic ileus and/or urinary retention.
Codeine antagonizes the effects of cisapride, metoclopramide and domperidone on gastrointestinal activity. The use of codeine in combination with opioid antagonists (eg, buprenorphine, naloxone, naltrexone) may accelerate the development of withdrawal symptoms. Premedication with opioids should be avoided as they reduce the plasma concentration of ciprofloxacin. When used with ritonavir, it is possible to increase the level of opioid analgesics (in particular codeine) in the blood plasma. When using codeine in large doses, the effect of cardiac glycosides (digoxin and others) may be enhanced. The use of opioids may interfere with gastric emptying studies, as opioids delay gastric emptying, and hepatobiliary imaging with Technetium Tc 99m Disofenin, as opioid therapy may cause constriction of the sphincter of Oddi and increased biliary pressure.
Special instructions for the use of the drug 5-nok
in case of moderate renal failure (creatinine clearance above 20 ml/min), half the usual daily dose should be prescribed. In severe renal failure (creatinine clearance below 20 ml/min), treatment with 5-NOC is contraindicated.
For liver failure, half the usual daily dose is prescribed. The safety of the drug during pregnancy and lactation has not been established; Despite the lack of data, prescribing the drug is not recommended.
The effect on the ability to drive vehicles and machinery has not been established.
Pyatirichatka
Name: Pyatirchatka Pharmacological action: Pyatirchatka is a combined drug with analgesic, antipyretic, anti-inflammatory and sedative effects. Metamizole sodium has an analgesic, antipyretic effect and a moderate anti-inflammatory effect. It acts as an antispasmodic, affecting the smooth muscle cells of the urinary, biliary tract and the uterus. Paracetamol inhibits the activity of COX, affecting pain centers and providing antipyretic effects. Metamizole and paracetamol exhibit mutual potentiation of pharmacological effects. Caffeine is a competitive inhibitor of PDE (phosphodiesterase) and an antagonist of adenosine receptors; it is not an analgesic, but can enhance the effect of paracetamol, suppressing the sedative effects of phenobarbital.
Phenobarbital causes mild sedative and hypnotic effects, acts as a muscle relaxant and antispasmodic, enhancing the pharmacological effectiveness of analgesics. Codeine phosphate is a drug from the group of analgesics with a central mechanism of action. Suppresses the excitability of the cough center, potentiates the activity of analgesics and hypnotics. In minimal doses it does not affect bronchial secretion and ciliated epithelium. The effect of metamizole sodium occurs after 20 minutes. Reduction is observed after 120 minutes. Binds to albumin by 60%. Metabolized in the liver. Eliminated in urine. Paracetamol is quickly absorbed from the gastrointestinal tract. Binds to proteins. Period T ½ - 1-4 hours. Metabolized by the liver. Eliminated in urine.
Caffeine is well absorbed and metabolized in the liver. Up to 10% is eliminated unchanged in urine. Phenobarbital is slowly absorbed from the gastrointestinal tract. Period T ½ - up to 3 days. Eliminated by the kidneys and up to 50% unchanged. Penetrates the uteroplacental barrier. Codeine penetrates well through the BBB. Codeine metabolites exhibit analgesic effects. Eliminated in urine and minimally in bile.
Indications for use: As a symptomatic remedy for inflammatory diseases, colds and for the relief of febrile conditions. For symptomatic treatment of pain syndrome.
Directions for use: As a symptomatic remedy for inflammatory diseases, colds and for the relief of feverish conditions. For symptomatic treatment of pain syndrome.
Side effects: Possible negative effects are transitory in nature, which are leveled off after discontinuation of therapy. During treatment, individuals with individual sensitivity develop allergic reactions up to anaphylaxis, and bronchospasm and dyspnea are often provoked. Dyspeptic manifestations, stool disturbances, and lack of appetite are often observed; changes in the level of liver enzymes are less common. There is information about the effect of the drug on the hematopoietic system: an inhibitory effect on blood cells, especially with long-term use. The drug can cause sleep disturbances, asthenic phenomena, emotional lability, tremors and coordination problems.
Rhythm disturbances and decreased blood pressure were noted in the vascular system. Nephrotoxic negative effects have rarely been observed with long-term use of Pyatyrichatka. In the case of prolonged use of increased doses of the drug, drug addiction and dependence develop.
Contraindications: The drug is not used in persons with hypersensitivity to the components of the drug. It is not recommended to prescribe Pyatirchatka in patients with liver and kidney dysfunction, ulcerative processes in the gastrointestinal tract, with a tendency to bronchospasm, diseases of the blood system, during the rehabilitation period after TBI and acute myocardial infarction, with cardiac arrhythmias and increased blood pressure, with glaucoma, G6PD deficiency. Not for use in children under 12 years of age.
Pregnancy: It is recommended to avoid prescribing Pentaria in pregnant and lactating women due to the high risk of negative effects on the fetus and newborn child.
Interaction with other drugs: Analgesics increase the likelihood of toxic reactions when combined with Pyatyrichatka. Paracetamol potentiates the effect of coumarin anticoagulants. Rifampicin inhibits the effectiveness of paracetamol, while cimetidine, on the contrary, can enhance its analgesic effects. Paracetamol suppresses the effects of drugs that are actively metabolized in the liver. COCs, allopurinol, tricyclic antidepressants enhance the negative effect of metamizole, barbiturates, phenylbutazone inhibit the effect of analgin.
Analgin is able to reduce the blood level of cyclosporines. Codeine potentiates the depressant effects on the central nervous system of alcohol, barbiturates, sedatives and hypnotics, and benzodiazepines. Tricyclic antidepressants and MAO inhibitors interact according to the type of mutual synergism. Caffeine increases the pharmacological activity of steroid drugs and hypnotics. Phenobarbital increases the metabolism of griseofulvin, doxycycline, quinidine, estrogens, carbamazepine, phenytoin. Inhibition of the activity of phenobarbital is observed when it interacts with sodium valproate and valproic acid.
The pharmacological activity of phenobarbital is observed when it is combined with analgesics (narcotics), alcohol, phenothiazines, and tricyclic antidepressants. Sedatives and tranquilizers increase the analgesic effect of the drug. Alcohol significantly increases the likelihood of hepatotoxic and nephrotoxic effects of Pentaria.
Overdose: When using high doses of the drug, the development of dyspeptic symptoms, heart rhythm disturbances, decreased blood pressure, depression of the respiratory center and central nervous system, and weakness is possible. To level the symptoms, it is recommended to perform gastric lavage, taking sorbents, and symptomatic therapy.
Release form: Tablets in blisters No. 10.
Storage conditions: Temperature 15-25 degrees Celsius. Stored in a dry, dark place.
Synonyms: Pentalgin.
Composition: Active ingredient: Metamizole sodium, Paracetamol, Coneinum natrii-benzoas, Phenobarbital, Codeini phosphas; 1 tablet contains Metamizole sodium 300 mg, Paracetamol 200 mg, Coneinum natrii-benzoas 50 mg (equivalent to caffeine 20 mg), Phenobarbital 10 mg, Codeini phosphas 9.5 mg (equivalent to codeine 7 mg); Excipients: calcium stearate, gelatine, potato starch.
Additionally: In patients using the drug for longer than seven days, it is recommended to monitor the parameters of the hematopoietic system and the activity of liver transaminases. In persons with allergic diseases, the risk of developing individual intolerance to the drug increases significantly. The drug changes the results of doping control in athletes.
Caution: Pyatirchatka is used in persons in remission of ulcerative processes in the gastrointestinal tract, in cases of impaired functional state of the kidneys and liver, and in elderly patients. Considering the possible effect of the drug on the central nervous system, it is recommended to avoid driving vehicles during the treatment period. The drug is not used in patients under 12 years of age.
Attention! The description of the drug “ Pyatirichatka ” on this page is a simplified and expanded version of the official instructions for use. Before purchasing or using the drug, you should consult your doctor and read the instructions approved by the manufacturer. Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide to prescribe the drug, as well as determine the dose and methods of its use.
