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Hydrocortisone-Richter

From the nervous system:

insomnia, irritability, anxiety, agitation, euphoria, epileptiform convulsions; mental disorders; delirium; disorientation; hallucinations; exacerbation of manic-depressive psychosis while taking the drug; depression; paranoia; increased intracranial pressure with swelling of the optic nerve nipple, dizziness; pseudotumor of the cerebellum; headache.

From the side of metabolism:

weight gain, negative nitrogen balance, increased sweating.

From the side of the organ of vision:

corneal ulceration; posterior capsular cataract (more likely in children); increased intraocular pressure with possible damage to the optic nerve; secondary bacterial, fungal, viral eye infections; trophic changes in the cornea; exophthalmos, glaucoma.

From the musculoskeletal system:

slower growth and ossification processes in children (premature closure of epiphyseal growth zones); osteoporosis; very rarely - pathological bone fractures; aseptic necrosis of the head of the humerus and femur; muscle tendon rupture; steroid myopathy; decreased muscle mass; arthralgia.

Effects due to the mineralocorticoid activity of the drug:

fluid and sodium retention with the formation of peripheral edema; hypernatremia; hypokalemia, arrhythmia, myalgia, muscle spasm, increased weakness, fatigue.

From the immune system:

opportunistic infections, exacerbation of latent tuberculosis, hypersensitivity reactions; local and generalized: skin rash, itching; anaphylactic shock; delayed wound healing; tendency to develop pyoderma and candidiasis, exacerbation of infections, especially with vaccination and simultaneous treatment with immunosuppressive drugs.

From the skin and mucous membranes:

petechiae; ecchymoses; hyper- or hypopigmentation; steroid acne; striae; folliculitis, hirsutism, telangiectasia.

Local reactions:

tissue swelling and pain at the injection site, which spontaneously disappear after a few hours, increased pain in the joint when the drug is injected into the joint, burning, numbness, paresthesia at the injection site, atrophy of the skin and subcutaneous tissue at the injection site (if accidentally administered into the deltoid muscle ), rarely - necrosis of surrounding tissues, scar formation at the injection site.

Directions for use and doses

IM (deep) into the gluteal muscle at a dose of 50–300 mg to 1000–1500 mg/day. Before use, the contents of the ampoules must be shaken until a homogeneous suspension is formed.

For acute, life-threatening conditions, 100–150 mg is administered every 4 hours for 48 hours; then - every 8-12 hours. Children - every 4 hours 1-2 mg/kg, the optimal daily dose is 6-9 mg/kg.

5–25 mg (0.1–1 ml (depending on the size of the joint)) is injected into the joint cavity once a week. 3–5 injections per course. The effect of the drug begins 6–25 hours after administration and lasts several days or weeks

Hydrocortisone - Richter suspension in/joint, periarticular. administration 25mg+5mg/ml 5ml bottle No. 1

pharmachologic effect

Hydrocortisone has anti-inflammatory, desensitizing (preventing or inhibiting allergic reactions) and antiallergic effects, and has immunosuppressive (suppressing the body's defenses) activity.
GKS. Suppresses the functions of leukocytes and tissue macrophages. Limits the migration of leukocytes to the area of inflammation. It disrupts the ability of macrophages to phagocytose, as well as to form interleukin-1. Helps stabilize lysosomal membranes, thereby reducing the concentration of proteolytic enzymes in the area of inflammation. Reduces capillary permeability due to the release of histamine. Suppresses fibroblast activity and collagen formation.

Inhibits the activity of phospholipase A2, which leads to suppression of the synthesis of prostaglandins and leukotrienes. Suppresses the release of COX (mainly COX-2), which also helps to reduce the production of prostaglandins.

Reduces the number of circulating lymphocytes (T- and B-cells), monocytes, eosinophils and basophils due to their movement from the vascular bed into the lymphoid tissue; suppresses the formation of antibodies.

Hydrocortisone suppresses the release of ACTH and β-lipotropin by the pituitary gland, but does not reduce the level of circulating β-endorphin. Inhibits the secretion of TSH and FSH.

When directly applied to blood vessels, it has a vasoconstrictor effect.

Hydrocortisone has a pronounced dose-dependent effect on the metabolism of carbohydrates, proteins and fats. Stimulates gluconeogenesis, promotes the uptake of amino acids by the liver and kidneys and increases the activity of gluconeogenesis enzymes. In the liver, hydrocortisone enhances the deposition of glycogen, stimulating the activity of glycogen synthetase and the synthesis of glucose from protein metabolism products. An increase in blood glucose levels activates the release of insulin.

Hydrocortisone inhibits the uptake of glucose into fat cells, which leads to activation of lipolysis. However, due to increased insulin secretion, lipogenesis is stimulated, which leads to fat accumulation.

It has a catabolic effect in lymphoid and connective tissue, muscles, adipose tissue, skin, bone tissue. To a lesser extent than mineralocorticoids, it affects the processes of water-electrolyte metabolism: it promotes the excretion of potassium and calcium ions, the retention of sodium and water ions in the body. Osteoporosis and Itsenko-Cushing syndrome are the main factors limiting long-term GCS therapy. As a result of the catabolic effect, growth suppression in children is possible.

In high doses, hydrocortisone can increase the excitability of brain tissue and help lower the seizure threshold. Stimulates excess production of hydrochloric acid and pepsin in the stomach, which contributes to the development of peptic ulcers.

When used systemically, the therapeutic activity of hydrocortisone is due to its anti-inflammatory, antiallergic, immunosuppressive and antiproliferative effects.

When applied externally and locally, the therapeutic activity of hydrocortisone is due to its anti-inflammatory, antiallergic and antiexudative (due to the vasoconstrictor effect) effect.

Its anti-inflammatory activity is 4 times weaker than prednisolone, and its mineralocorticoid activity is superior to other corticosteroids.

Plasma protein binding - 40-90%. Metabolized primarily in the liver. T1/2 - 80-120 min. It is excreted by the kidneys mainly in the form of metabolites.

Indications

Allergic skin diseases, inflammatory joint diseases, rheumatism, arthritis, bursitis, bronchial asthma, acute adrenal insufficiency, thyroiditis, thyrotoxic crisis.

Contraindications

Severe forms of diabetes mellitus, hypertension, circulatory failure of the third degree, Itsenko-Cushing's disease, psychosis, nephritis, osteoporosis, gastric and duodenal ulcers, syphilis, active form of tuberculosis.

Use during pregnancy and breastfeeding

Studies of the safety and effectiveness of hydrocortisone in pregnant and lactating women have not been conducted. There is no precise data on the penetration of glucocortisteroids into breast milk when applied topically. However, the risk cannot be completely eliminated. The use of hydrocortisone in pregnant and lactating women is allowed only as prescribed by the attending physician, when the expected therapeutic effect for the mother exceeds the potential risk for the fetus and child.

special instructions

For tuberculosis, it can only be used in conjunction with tuberculostatic drugs.

In patients with diabetes mellitus, use only when absolutely indicated or to prevent possible insulin resistance. For infectious diseases it can be used with caution and only in conjunction with specific antibacterial therapy. With prolonged use, it is necessary to prescribe potassium supplements to prevent possible hypokalemia. During treatment, it is advisable to regularly measure blood pressure and test urine and feces for occult blood. Treatment should be completed by gradually reducing the dose of the drug and deciding on the need to use ACTH (skin test).

During treatment with hydrocortisone, it is advisable to re-evaluate the doses of oral antidiabetic agents and anticoagulants.

When combined with diuretics, it is necessary to control electrolyte metabolism in the body. In the case of combined use with salicylates, when reducing the dose of GCS, it is necessary to simultaneously reduce the dose of salicylate. If there is a history of psychosis, the drug should be used with caution.

Before use, the contents of the bottle must be shaken thoroughly.

Compound

1 ml of suspension contains:

Active substance: hydrocortisone acetate 25 mg;

Excipients: propylene glycol - 0.2 ml; sorbitol - 20 mg; povidone - 10 mg; sodium chloride - 1.4 mg; benzyl alcohol - 0.015 ml; water for injection - up to 1 ml.

Directions for use and doses

Intramuscularly (deeply) into the gluteal muscle at a dose of 50–300 mg to 1000–1500 mg/day. Before use, the contents of the ampoules must be shaken until a homogeneous suspension is formed.

For acute, life-threatening conditions, 100–150 mg is administered every 4 hours for 48 hours; then - every 8-12 hours. Children - every 4 hours 1-2 mg/kg, the optimal daily dose is 6-9 mg/kg.

Side effects

Virilization, obesity, hirsutism, menstrual irregularities, osteoporosis, mental disorders, Itsenko-Cushing symptom complex.

Drug interactions

The effect is weakened by barbiturates, and hypokalemia is enhanced by diuretics. Reduces the effect of hypoglycemic drugs.

Overdose

Exceeding the dose or prolonged administration of the drug can lead to inhibition of the body's own production of glucocorticoids, increased blood pressure, ulcerative bleeding of the gastrointestinal tract, exacerbation of chronic infections, and the development of Cushing's syndrome.

Treatment: symptomatic.

Storage conditions

The drug should be stored out of the reach of children at a temperature not exceeding 15°C.

Best before date

3 years

Active substance

Hydrocortisone, Lidocaine

Conditions for dispensing from pharmacies

On prescription

Contraindications to the use of the drug Hydrocortisone-Richter

Vaccination period, peptic ulcer of the stomach and duodenum, Itsenko-Cushing disease, osteoporosis, tendency to thromboembolism, renal failure, severe hypertension (arterial hypertension), herpes simplex, chicken pox, active tuberculosis, hypersensitivity to the components of the drug. Relative contraindications: pregnancy, especially the first trimester (possibly damaging to the fetus), therefore, before prescribing, it is necessary to evaluate the expected benefits and possible negative consequences of treatment.