Losec MAPS, 14 pcs., 20 mg, film-coated tablets
Inside, in the morning, the tablet should be swallowed whole, without chewing, with liquid (you can dissolve the tablet in water or a slightly acidified liquid, such as fruit juice; the resulting solution should be used within 30 minutes).
Duodenal ulcer: in the acute phase - 20 mg 1 time per day daily for 2 weeks; if there is no effect within 2 weeks, a repeat 2-week course is prescribed. For duodenal ulcer resistant to therapy - 40 mg once a day for 4 weeks. To prevent relapses of duodenal ulcer - 10 mg (if necessary - up to 20-40 mg/day) 1 time per day.
Gastric ulcer: 20 mg 1 time per day daily for 4 weeks; if there is no effect, repeat the 4-week course. For gastric ulcers resistant to therapy - 40 mg once a day for 8 weeks. To prevent relapses of gastric ulcer - 20 mg (if necessary - up to 40 mg) 1 time per day.
NSAID-associated gastric ulcers or duodenal erosions: 20 mg once a day for 4 weeks. If there is no effect, a repeat 4-week course of treatment is prescribed.
Helicobacter pylori eradication regimens for gastric ulcers.
Three-component treatment regimen:
Losec MAPS 20 mg, amoxicillin 1 g and clarithromycin 500 mg (take all drugs 2 times a day for 1 week) or Losec MAPS 20 mg, metronidazole 400 mg (or tinidazole 500 mg) and clarithromycin 250 mg (take all drugs 2 times per day for 1 week), or Losek MAPS 40 mg 1 time per day, amoxicillin 500 mg and metronidazole 400 mg 3 times per day for 1 week.
Two-component treatment regimen: Losec MAPS 40–80 mg and amoxicillin 1.5 g daily (the dose should be divided into parts) for 2 weeks. During clinical trials, Losec MAPS 40 mg was used once a day, amoxicillin in a daily dose of 1.5–3 g and clarithromycin 500 mg 3 times a day for 2 weeks. If after treatment the test for Helicobacter pylori remains positive, the course can be repeated.
Reflux esophagitis: 20 mg once a day for 4 weeks. If there is no effect, repeat the 4-week course. For patients with severe reflux esophagitis - 40 mg once a day for 8 weeks. For reflux esophagitis in remission - 10 mg once a day (if necessary - up to 20-40 mg/day) for a long time.
Symptomatic gastroesophageal reflux disease, dyspepsia associated with increased production of hydrochloric acid: 10–20 mg/day daily for 4 weeks. If symptoms do not disappear at the end of therapy, additional examination of the patient is recommended.
Zollinger-Ellison syndrome: the dosage regimen is determined individually. The recommended starting dose is 60 mg/day. In all patients with severe disease, as well as in cases where other therapeutic methods did not lead to the desired result, the drug was effective in more than 90% of patients when taking 20-120 mg of Losec MAPS daily. If the daily dose exceeds 80 mg, it should be divided into 2 hours and taken 2 times a day.
In elderly patients, as well as in patients with impaired renal function, no dose adjustment is required.
If liver function is impaired, the bioavailability of omeprazole and T1/2 from plasma increases; therefore, a dose of 10–20 mg is sufficient.
Losec®
The effect of omeprazole on the pharmacokinetics of other drugs.
A decrease in the secretion of hydrochloric acid in the stomach during treatment with omeprazole and other proton pump inhibitors can lead to a decrease or increase in the absorption of other drugs, the absorption of which depends on the acidity of the environment. Like other drugs that reduce gastric acidity, treatment with omeprazole may result in decreased absorption of ketoconazole, itraconazole and erlotinib, and increased absorption of drugs such as digoxin. Co-administration of omeprazole 20 mg once daily and digoxin increases the bioavailability of digoxin by 10% (bioavailability of digoxin increased by up to 30% in 20% of patients).
Omeprazole has been shown to interact with some antiretroviral drugs. The mechanisms and clinical significance of these interactions are not always known. An increase in pH during omeprazole therapy may affect the absorption of antiretroviral drugs. Interaction at the level of the CYP2C19 isoenzyme is also possible. When omeprazole is co-administered with certain antiretroviral drugs, such as atazanavir and nelfinavir, during omeprazole therapy, a decrease in their serum concentrations is observed. In this regard, the combined use of omeprazole with antiretroviral drugs such as atazanavir and nelfinavir is not recommended.
With the simultaneous use of omeprazole and saquinavir, an increase in the concentration of saquinavir in the serum was noted; when used with some other antiretroviral drugs, their concentration did not change.
Omeprazole inhibits CYP2C19, the main isoenzyme involved in its metabolism. Concomitant use of omeprazole with other drugs that are metabolized by the CYP2C19 isoenzyme, such as diazepam, phenytoin, warfarin, other vitamin K antagonists and cilostazol, may lead to a decrease in the metabolism of these drugs.
It is recommended to monitor plasma phenytoin concentrations when taking phenytoin and omeprazole together; in some cases it may be necessary to reduce the dose of phenytoin. At the same time, in patients taking phenytoin for a long time, co-administration of omeprazole at a dose of 20 mg once daily did not cause changes in the concentration of phenytoin in the blood plasma.
When using omeprazole in patients receiving warfarin or other vitamin K antagonists, monitoring of the INR (international normalized ratio) is necessary; in some cases, it may be necessary to reduce the dose of warfarin or another vitamin K antagonist. At the same time, in patients taking warfarin for a long time, co-administration of omeprazole at a dose of 20 mg once a day did not cause a change in coagulation time.
The use of omeprazole at a dose of 40 mg once daily led to an increase in Cmax and the area under the concentration-time curve of cilostazol by 18% and 26%, respectively; for one of the active metabolites of cilostazol, the increase was 29% and 69%, respectively.
According to the results of the studies, a pharmacokinetic/pharmacodynamic interaction was noted between clopidogrel (loading dose of 300 mg and maintenance dose of 75 mg/day) and omeprazole (80 mg/day orally), which leads to a decrease in exposure to the active metabolite of clopidogrel, on average, by 46% and a decrease in maximum inhibition of ADP-induced platelet aggregation by an average of 16%.
The clinical significance of this interaction is unclear. In a prospective study in patients receiving placebo or omeprazole 20 mg/day. simultaneously with therapy with clopidogrel and acetylsalicylic acid (ASA), and when analyzing the clinical outcomes of large-scale randomized trials, there was no increase in the risk of cardiovascular complications with the combined use of clopidogrel and proton pump inhibitors, including omeprazole.
The results of a number of observational studies are contradictory and do not provide a clear answer about the presence or absence of an increased risk of thromboembolic cardiovascular complications during the combined use of clopidogrel and proton pump inhibitors.
When clopidogrel was used together with a fixed combination of 20 mg esomeprazole and 81 mg ASA, exposure to the active metabolite of clopidogrel decreased by almost 40% compared with clopidogrel monotherapy, while the maximum levels of inhibition of ADP-induced platelet aggregation were the same, which is likely due to simultaneous administration ASA in low dose.
Omeprazole does not affect the metabolism of drugs that are metabolized by the CYP3A4 isoenzyme, such as cyclosporine, lidocaine, quinidine, estradiol, erythromycin and budesonide.
There was no effect of omeprazole on the following drugs: caffeine, theophylline, quinidine, piroxicam, diclofenac, naproxen, metoprolol, propranolol and ethanol.
With the simultaneous use of omeprazole and tacrolimus, an increase in the concentration of tacrolimus in the blood serum was noted.
In some patients, an increase in the concentration of methotrexate was observed during combined use with proton pump inhibitors. When using high doses of methotrexate, the possibility of temporary withdrawal of omeprazole should be considered.
The effect of drugs on the pharmacokinetics of omeprazole.
The isoenzymes CYP2C19 and CYP3A4 are involved in the metabolism of omeprazole. The combined use of omeprazole and inhibitors of the CYP2C19 and CYP3A4 isoenzymes, such as clarithromycin and voriconazole, may lead to an increase in the concentration of omeprazole in the blood plasma by slowing down the metabolism of omeprazole. Concomitant use of voriconazole and omeprazole results in a more than twofold increase in the AUC value for omeprazole. Due to the good tolerance of high doses of omeprazole, short-term joint use of these drugs does not require dose adjustment of omeprazole. Drugs that induce CYP2C19 and CYP3A4 isoenzymes, such as rifampicin and St. John's wort preparations, when used together with omeprazole, may lead to a decrease in the concentration of omeprazole in the blood plasma by accelerating the metabolism of omeprazole.
Pharmacodynamics and pharmacokinetics
The medicine is an antiulcer agent. It inhibits the action of H + -K + -ATPase in gastric parietal cells . Thus, the last stage of hydrochloric acid formation is blocked. The effect of the medicine depends on the dose. It effectively inhibits basal and stimulated secretions when used daily.
The drug reaches maximum effectiveness within 4 days. Its action in combination with antibacterial agents causes eradication of Helicobacter pylori . Due to this, the manifestations of the disease are stopped, stable remission is achieved, damage to the gastric mucosa is healed, and the risk of bleeding from the gastrointestinal tract is reduced. When using Losek Maps there is no need for long-term antiulcer therapy.
The tablets are absorbed in the small intestine. Absorption is completed 3-6 hours after consumption. When taking the product again, bioavailability increases to 60%. Eating has no effect on it. Plasma protein binding is approximately 95%.
The half-life from blood plasma is less than an hour. The active substance of the drug is completely broken down by the cytochrome , mainly in the liver. 80% of the drug is excreted in the form of metabolites in the urine, and another 20% in the feces.
Losek Maps price, where to buy
The price of tablets depends on the form of release. The cost of 10 mg (14 pieces in a package) is about 200 rubles. And the price of Losek Maps 20 mg is approximately 230 rubles.
- Online pharmacies in RussiaRussia
ZdravCity
- Losek Maps tablets p.p.o.
20 mg 28 pcs. AstraZeneca 440 rub. order - Losek Maps tablets p.p.o. 20 mg 14 pcs AstraZeneca AB
RUB 227 order
Side effects
As a rule, the medicine is well tolerated by patients. Undesirable side reactions are usually mild and pass quickly. Among them are:
- skin – rash, itching , photosensitivity, alopecia , erythema multiforme ;
- CNS – drowsiness , headache , vertigo , dizziness , paresthesia , insomnia , confusion , depression , agitation, hallucinations ;
- liver - liver dysfunction, increased levels of enzymes , encephalopathy (in liver diseases with complications), hepatitis ;
- circulatory system – leukopenia , agranulocytosis , thrombocytopenia , pancytopenia ;
- musculoskeletal system - muscle weakness , pain in joints and muscles;
- Gastrointestinal tract - diarrhea , pain in the abdominal area, vomiting, constipation , flatulence , dry mouth, candidiasis , stomatitis ;
- endocrine system – gynecomastia ;
- others - urticaria , fever , interstitial nephritis , angioedema , bronchospasm , anaphylactic shock , severe sweating , blurred vision, decreased sodium levels in the blood, peripheral edema , impaired taste, malaise .
Analogues of Losek Maps
Level 4 ATC code matches:
Khairabesol
Noflux
Lancid
Barol
Beret
Ontime
Gastrozol
Omeprazole
Pantoprazole
Proxium
Lansoprazole
Zulbex
Ultop
Epicurus
Pariet
Losek
Sanpraz
Emanera
Omez Insta
Omez
The most common analogues of Losek Maps:
- Ultop;
- Losek;
- Helicid;
- Omeprazole;
- Omitox.
Each of these medications has its own nuances of use, so you should not take them on your own, without a doctor’s prescription.
Indications for use
The medicine is prescribed for:
- acid-dependent dyspepsia;
- gastric ulcer caused by Helicobacter pylori;
- Zollinger-Ellison syndrome;
- peptic ulcer of the stomach and duodenum (including if the disease is caused by NSAIDs );
- gastroesophageal reflux.
Instructions for use LOSEC
The effect of omeprazole on the pharmacokinetics of other drugs
Reduced acidity in the stomach during treatment with omeprazole can lead to a decrease or increase in the absorption of other drugs, the mechanism of absorption of which depends on the acidity of the environment. As with other drugs that suppress the secretion of hydrochloric acid or antacids, treatment with omeprazole may lead to decreased absorption of ketoconazole or itraconazole, as well as increased absorption of digoxin. Combined use of omeprazole at a dose of 20 mg once a day. and digoxin increases the bioavailability of digoxin by 10% (bioavailability of digoxin increased by up to 30% in 20% of patients).
Omeprazole has been shown to interact with some antiretroviral drugs. The mechanisms and clinical significance of these interactions are not always known. An increase in pH during omeprazole therapy may affect the absorption of antiretroviral drugs. Interaction at the level of the CYP2C19 isoenzyme is also possible. When omeprazole is co-administered with certain antiretroviral drugs, such as atazanavir and nelfinavir, during therapy with omeprazole, a decrease in their serum concentrations is observed. In this regard, the combined use of omeprazole with antiretroviral drugs such as atazanavir and nelfinavir is not recommended.
With the simultaneous use of omeprazole and saquinavir, an increase in the concentration of saquinavir in the serum was noted; when used with some other antiretroviral drugs, their concentration did not change.
Omeprazole inhibits CYP2C19, the main isoenzyme involved in its metabolism. Concomitant use of omeprazole with other drugs that are metabolized by the CYP2C19 isoenzyme, such as diazepam, phenytoin, warfarin, other vitamin K antagonists and cilostazol, may lead to a decrease in the metabolism of these drugs.
It is recommended to monitor plasma phenytoin concentrations when taking phenytoin and omeprazole together; in some cases it may be necessary to reduce the dose of phenytoin. At the same time, in patients taking phenytoin for a long time, co-administration of omeprazole at a dose of 20 mg 1 time / day did not cause changes in the concentration of phenytoin in the blood plasma.
When using omeprazole in patients receiving warfarin or other vitamin K antagonists, monitoring of the MHO index (international normalized ratio) is necessary; in some cases, it may be necessary to reduce the dose of warfarin or another vitamin K antagonist. At the same time, in patients taking warfarin for a long time. joint use of omeprazole at a dose of 20 mg 1 time/day did not cause a change in coagulation time.
The use of omeprazole at a dose of 40 mg 1 time / day led to an increase in Cmax and AUC of cilosgazole by 18% and 26%, respectively; for one of the active metabolites of cilostazol, the increase was 29% and 69%, respectively.
Omeprazole does not affect the metabolism of drugs that are metabolized by the CYP3A4 isoenzyme, such as cyclosporine, lidocaine, hipidine, estradiol, erythromycin and budesonide.
There was no effect of omeprazole on the following drugs:
- caffeine, theofidline, quinidine, piroxicam, diclofenac, naproxen, metoprolol, propranolol and ethanol.
With the simultaneous use of omeprazole and tacrolimus, an increase in the concentration of tacrolimus in the blood serum was noted.
Effect of drugs on the pharmacokinetics of omeprazole
The isoenzymes CYP2C19 and CYP3A4 are involved in the metabolism of omeprazole. The combined use of omeprazole and inhibitors of the CYP2C19 and CYP3A4 isoenzymes, such as clarithromycin and voriconazole, may lead to an increase in the concentration of omeprazole in the blood plasma by slowing down the metabolism of omeprazole. Concomitant use of voriconazole and omeprazole results in a more than twofold increase in the AUC value for omeprazole. Due to the good tolerance of high doses of omeprazole, short-term co-administration of these drugs does not require dose adjustment of omeprazole.
Drugs that induce CYP2C19 and CYP3A4 isoenzymes, such as rifampicin and St. John's wort preparations, when used together with omeprazole, may lead to a decrease in the concentration of omeprazole in the blood plasma by accelerating the metabolism of omeprazole.
Effect on clopidogrel therapy
During therapy with omeprazole, the antithrombotic effect of clopidogrel may be reduced. The mechanism of this interaction has not yet been fully studied, so it is recommended to use these drugs together with caution.
