Milistan tablets: instructions for use, price and reviews

Release form: Caplets, p/o, No. 12.

A combination of four active ingredients for maximum effectiveness. The proven formula quickly and permanently relieves fever, headache, cough, sore throat and poor health.

Manufacturer: Unimax Laboratories, India; Windlace Healthcare Pvt. Ltd., India; Mepro Pharmaceuticals PVT LTD, India.

Registration Certificate: No.UA/6458/01/01 Order of the Ministry of Health of Ukraine No. 429 dated 06/08/2012

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Compound

1 tablet (caplet) of the drug Milistan Multisymptom includes 325 mg of paracetamol ; 15 mg dextromethorphan hydrobromide ; 10 mg cetirizine hydrochloride ; 2 mg chlorpheniramine maleate .
Additionally: corn starch, methylparaben, microcrystalline cellulose, propylparaben, magnesium stearate, sodium lauryl sulfate, talc, propylene glycol, colloidal silica, sodium starch glycolate (type A), polyethylene glycol 4000, hypromellose, titanium dioxide.

Pharmacodynamics and pharmacokinetics

Milistan Multisymptom tablets are a combined medicinal product belonging to the group of analgesics and antipyretics , exhibiting the effects of all active ingredients included in its composition.

Paracetamol is known for its pronounced antipyretic, analgesic and anti-inflammatory effectiveness. The analgesic effect of paracetamol occurs due to the suppression of prostaglandin biosynthesis . Being a cyclogenase , the drug blocks the production of E2 and F2 prostaglandins , which play an important role in the transmission of pain stimuli by nociceptors impulses to the central nervous system . The peculiarity of the inhibitory effect of paracetamol on cyclooxygenase is that in the cells of the central nervous system it occurs much stronger than in peripheral tissues, leading to a virtual absence of negative effects on the processes of prostaglandin , thereby ensuring normal water-salt metabolism and proper functioning of the gastrointestinal mucosa. The antipyretic (antipyretic) activity of paracetamol becomes possible due to the inhibition of the biosynthesis of prostaglandins , which are mediators of the thermoregulation center , directly in the hypothalamus.

Cetirizine is a metabolic of hydroxyzine and is a selective peripheral H1 receptor . The main effect of this drug is aimed at preventing the formation and alleviating the course of existing allergic manifestations . Cetirizine also has antiexudative and antipruritic effectiveness. The antiallergic activity of the drug is achieved due to its ability to suppress the late stage of cell migration (mainly eosinophils ) that take part in inflammatory processes, as well as due to a decrease in the expression of adhesion molecules (VCAM-1, ICAM-1), which are allergic markers . Cetirizine inhibits the effects of other mediators and inducers of histamine secretion , such as substance P and PAF, and does not actually have an antiserotonin or anticholinergic effect. Reduces capillary permeability , prevents the formation of edema , and helps relieve spasm of smooth muscles . In therapeutic dosages it does not lead to a sedative effect .

Dextromethorphan is an antitussive drug that is particularly effective in the treatment of nonproductive (non-sputum-producing) bronchial cough . The effectiveness of this drug is associated with its inhibition of afferent impulses sent by the mucous membrane of the respiratory tract and an increase in the sensitive threshold of the cough center located in the medulla oblongata. When taking therapeutic dosages of dextromethorphan, there is no addiction , sedative and analgesic effects of the drug, as well as suppression of the work of the ciliated epithelium and respiration.

Chlorphenamine is an antiallergic drug from the group of H1 receptor blockers , which is characterized by antiallergic effectiveness manifested by vasoconstriction , decreased capillary permeability , elimination of hyperemia and swelling of the mucous membrane of the nasopharynx, nose and paranasal sinuses. Chlorphenamine reduces local exudative allergic rhinitis ( rhinorrhea , sneezing , itching of the nose, eyes, throat), and also has a moderate sedative effect .

In the digestive tract, the absorption of all active ingredients of Milistan tablets after oral administration occurs quite quickly and almost completely.

T1/2 of paracetamol varies between 1-3 hours. In patients suffering from liver cirrhosis , this parameter is slightly longer. The renal clearance of the drug is 5%. Excretion is carried out by the kidneys mainly in the form of sulfate and glucuronide conjugates.

T1/2 of cetirizine is approximately 10 hours. Excretion occurs through the kidneys (2/3 in unchanged form) and intestines (about 10% of the drug). Systemic clearance indicators are at the level of 53 ml/min.

T1/2 of dextromethorphan is approximately 4 hours. Excretion occurs in the urine in unchanged form and in the form of demethylated metabolic products (including dextrorphan).

The active ingredients of Milistan are able to cross the placenta and are found in breast milk .

Mode of application

The price of the medicine in this form is approximately 120-150 rubles.

Caplets. When taken by adults and children over 12 years of age, it is prescribed in the amount of 1 caplet up to 4 times a day. If necessary, relieve severe pain syndromes, you can take up to 2 tablets at a time. The maximum permissible daily dose is 8 pieces. The duration of the course is no more than a week.

If you have kidney problems, it is recommended to reduce the indicated doses by 2 times.

Suspension. The dosage in this case is determined by age categories:

Children 1-3 years old should be given 1 spoon (5 ml) of the drug three times a day
Children 3-6 years old should drink 1 spoon four times a day
Children from 6 years old: 2 spoons 3-4 times a day.

The break between doses should be more than 4 hours. Do not use more than 4 times a day.

The maximum period of taking the drug is one week.

Indications for use

Prescription of Milistan Multisymptomatic is indicated for the purpose of symptomatic treatment of influenza and other acute respiratory viral infections , accompanied by high fever , irritating dry cough lacrimation , headaches , runny nose , muscle and joint pain, nasal congestion , including painful conditions with accompanying allergic manifestations .

Contraindications

The use of the drug is prohibited when:

congenital hyperbilirubinemia ;
pregnancy;
glucose-6-phosphate dehydrogenase deficiency;
personal hypersensitivity to any of the ingredients of the drug;
severe pathologies of the liver / kidneys ;
breastfeeding;
blood diseases ;
alcoholism;
severe anemia ;
intestinal obstruction;
leukopenia;
pyloroduodenal stenosis;
hypocoagulation;
arrhythmias;
angle-closure glaucoma;
epilepsy;
hyperthyroidism;
risk of urinary retention (due to diseases of the prostate and urethra);
severe hypertension ;
bladder outlet obstruction;
pathologies of the cardiac coronary arteries;
diabetes mellitus;
risk of respiratory failure ;
concurrent use of SSRIs and MAO inhibitors;
up to 12 years old.

Side effects

Skin and mucous membranes:

skin rashes (maculopapular, generalized, erythematous);
rash on mucous membranes;
angioedema;
Stevens-Johnson syndrome;
hives;
erythema (multiform, drug-resistant);
hyperemia;
epidermal toxic necrolysis;
itchy skin;
vascular edema.

Gastrointestinal organs:

heartburn;
dyspeptic disorders;
impaired liver function;
nausea, vomiting;
gastritis;
abdominal pain;
flatulence;
dry mouth;
increased levels enzymes ;
diarrhea;
hyperbilirubinemia;
constipation;
hepatotoxic effect (with prolonged use of high doses).

The immune system:

reactions associated with personal hypersensitivity (including anaphylactic shock and anaphylaxis ).

Endocrine system:

hypoglycemia (possible development of hypoglycemic coma).

Respiratory system:

rhinitis;
pharyngitis;
nasal congestion;
bronchospasm (with sensitivity to NSAIDs).

Hematopoietic system:

anemia (including hemolytic and aplastic);
thrombocytopenia;
methemoglobinemia and sulfhemoglobinemia (shortness of breath, cyanosis, heart pain);
agranulocytosis;
leukopenia.

Nervous system:

paradoxical stimulation of the central nervous system;
dizziness;
dysgeusia;
headache;
euphoria;
convulsions;
excitation;
vertigo;
sedative effect;
paresthesia;
movement disorders;
nervousness;
noise in ears;
fainting;
neurosis;
drowsiness / insomnia ;
dystonia;
depression;
neuritis;
dyskinesia;
aggression;
lack of coordination;
acute labyrinthitis;
irritability;
increased fatigue;
nervous tic;
coma;
confusion;
behavior changes;
anxiety;
tremor;
hallucinations.

Urinary system:

urinary retention;
dysuria;
difficulty urinating;
enuresis.

Organs of vision:

double vision;
mydriasis;
disturbance of accommodation;
photophobia;
blurred vision;
increased intraocular pressure ;
decreased visual acuity;
fogging;
involuntary eye movements.

The cardiovascular system:

cardiopalmus ; _
tachycardia;
blood pressure fluctuations ;
arrhythmia.

Reproductive system:

impotence;
menstruation disorders.

Are common:

increased fatigue;
asthenia;
malaise;
swelling.

Other:

dry mucous membranes;
weight gain;
hyperhidrosis.

Milistan, instructions for use

Patients over 12 years of age are recommended to take Milistan Multisymptomatic orally (inside), 1 caplet (tablet) once every 24 hours. The duration of the therapeutic course for adult patients should be limited to 7 days; at the age of 12-18 years – 3 days.

For moderately severe renal pathologies, tablets are taken in half the dose.

In old age there is no need to adjust the dosage regimen.

Release forms

The cost of packaging varies between 120-150 rubles.

Milistan Multisymptom is available in two forms:

Milistan tablets
Suspension.

The caplets are covered with a membrane. Sold in 12 pieces, packed in a box along with instructions for use. The tablets are white and oblong in shape. Intended for use by adults and children over 12 years of age.

The suspension is available in 100 ml bottles. After Milistan is packaged together with instructions for use and a measuring spoon in a box. The liquid has a pinkish tint. This form of the drug is intended for use by children aged 1 to 12 years.

Overdose

Due to possible liver damage , if you take excessive doses of the drug, you should contact your doctor.

The dosage of paracetamol that can potentially cause liver damage in an adult patient is considered to be a dose of 10 grams or more; in children – 150 mg per kilogram of weight. This dosage is halved (to 5 grams) for adult patients with any risk factors (including alcohol abuse , cachexia, cystic fibrosis , hunger strike, HIV infection , digestive disorders, long-term therapy with Phenobarbital , Carbamazepine , Phenytoin , Rifampicin , Primidone , drugs St. John's wort or other drugs that induce liver enzymes).

In the first 24 hours, the following symptoms of overdose were observed: loss of appetite , pallor , nausea / vomiting , abdominal pain. Liver damage itself appears within 12-48 hours after the first symptoms of overdose. It is also possible to develop metabolic acidosis and glucose metabolism .

In case of intoxication , liver failure can develop into hemorrhage, encephalopathy , hypoglycemia , coma , cerebral edema and result in death .

In acute renal failure with tubular necrosis, which can develop even without symptoms of liver damage , severe pain in the lumbar region, proteinuria and hematuria .

Other manifestations of an overdose can be expressed: renal colic , cardiac arrhythmia , papillary necrosis , tachycardia , interstitial nephritis , sleep impairment, urination delay , tachypnoe , dizziness , pancreatitis , headaches , drowsiness , psychomotor excitation , orientation , rash/imperial impaired, increased rash , increased fatigue, confusion malaise , anxiety, mydriasis , stupor , respiratory depression, ataxia , diplopia , hepatonecrosis, convulsions .

With prolonged use of high dosages of the drug, the hematopoietic system may cause leukopenia , aplastic anemia, agranulocytosis , pancytopenia , neutropenia, thrombocytopenia .

In case of reasonable suspicion of overdose, all measures should be taken to provide emergency medical assistance. The patient must be immediately taken to a specialized medical facility even in the absence of early severe symptoms, since sometimes the external manifestations of this condition may be limited to nausea / vomiting or may not reflect the full severity of negative internal pathological processes.

If an overdose of the drug is observed within 60 minutes, Activated Charcoal .

Plasma concentrations of paracetamol should be monitored 4 hours after an overdose or later, since early indicators of its level may be unreliable.

Taking the antidote - Acetylcysteine - is advisable throughout the day after an overdose of paracetamol (maximum effectiveness is observed within 8 hours).

In the absence of vomiting, Methionine can be prescribed orally (alternative help if a medical facility is not available).

Subsequently, treatment is carried out according to the observed symptoms.

Interaction

The absorption of paracetamol is enhanced by the concomitant use of Domperidone and Metoclopramide and reduced by the concomitant use of Cholestyramine .

In the case of long-term combined use of paracetamol with Warfarin and other coumarins , an increase in their anticoagulant effect was observed with an increase in the possibility of bleeding .

The combined use of barbiturates with paracetamol may adversely affect its antipyretic effectiveness.

Anticonvulsants ( Phenytoin , Carbamazepine ), barbiturates, Isoniazid , Rifampicin and ethanol can increase the toxic effect of paracetamol on the liver.

The effectiveness of diuretics is reduced when taking paracetamol .

Taking the drug with food reduces the rate of absorption of Cetirizine , but does not affect its extent.

Ethanol and drugs that depress the central nervous system can enhance the inhibitory effect of Chlorpheniramine , which increases the possibility of overdose.

Maprotiline , tricyclic antidepressants and other anticholinergic medications may increase the anticholinergic effectiveness of chlorpheniramine . With this combination of drugs and the discovery of negative gastrointestinal side effects in the patient, the formation of paralytic intestinal obstruction .

Caffeine increases the analgesic effects of paracetamol .

Photosensitizing drugs may cause an additional risk of photosensitizing effects.

Taking ototoxic medications may mask possible symptoms of ototoxicity, including dizziness , tinnitus , and fainting .

Milistan should not be used in conjunction with antitussives that suppress the cough reflex ( Codeine ), as this complicates the expectoration .

Cross-drug interactions

As a result of taking rifampicin, barbiturates, anticonvulsants and alcoholic beverages, the hepatotoxic effect of the drug may be enhanced.

Drinking coffee and other caffeine-containing drinks during the course of treatment with the drug may enhance the analgesic effect of paracetamol. And metolclopramide, in turn, leads to an increase in the absorption of the component.

When taking coumarin derivatives simultaneously, slight hypoprothrombinemia may occur.

Chlorpheniramine leads to disruption of the metabolism of diphenine in the liver.

special instructions

If a patient is diagnosed with pathologies of liver or kidney function , before taking Milistan it is necessary to consult with the appropriate doctors.

In patients with cachexia taking paracetamol , the risk of developing metabolic acidosis . Symptoms of this painful condition are expressed by loss of appetite , rapid, deep difficulty breathing , nausea/vomiting. Before starting to take Milistan caplets, patients with severe infections that increase the risk of metabolic acidosis should consult a doctor.

Patients with alcoholic liver damage are more susceptible to the hepatotoxic effects of paracetamol .

Milistan may alter laboratory results, particularly with regard to plasma uric acid and glucose .

Elderly patients at risk of developing convulsive seizures , patients with bronchial asthma and with chronic or persistent cough caused by asthma , smoking , emphysema , accompanied by excessive secretion, Milistan should be prescribed with extreme caution.

Concomitant use of drugs including paracetamol .

In case of persistent headaches , you should consult your doctor.

With prolonged use of Milistan, it is necessary to monitor the functionality of the liver / kidneys , as well as monitor the hematopoietic function .

During therapy you should not take sedatives .

When treating a painful condition caused by a bacterial infection antibiotic therapy should be considered .

If, when taking Milistan Multisymptomatic, the formation of skin rashes is observed, as well as the development of hemolytic drug-induced anemia or hemolysis of red blood cells , treatment is stopped.

You should not take the drug if you have previous respiratory problems while taking NSAIDs.

Appropriate safety precautions for use.

It should be taken into account that in patients with alcoholic non-cirotic liver damage, the risk of hepatotoxic action of paracetamol increases; the drug may affect the results of laboratory tests on the levels of glucose and uric acid in the blood.

Prescribe the drug with caution to elderly patients, patients at risk of seizures, patients with bronchial asthma, persistent or chronic cough that occurs as a result of smoking, asthma or emphysema, when the cough is accompanied by excess secretion. Do not exceed the indicated doses. Do not take the drug simultaneously with other products containing paracetamol. If the headache becomes persistent, you should consult a doctor. With long-term use, it is necessary to monitor the function of the liver, kidneys, and the state of the hematopoietic system. If symptoms do not go away, you should consult a doctor.

During treatment, do not use sedatives (especially barbiturates), which increase the sedative effect of antihistamines (chlorpheniramine maleate).

If the disease is caused by a bacterial infection, concurrent treatment with antibiotics is recommended.

If hemolysis of red blood cells or drug-induced hemolytic anemia occurs during the use of the drug Milistan multisymptomatic, the drug should be discontinued immediately. If skin rashes occur, use of the drug should be discontinued.

Do not drink alcohol while using the drug!

Analogs

Level 4 ATC code matches:
Phenacetin

Combiflu

Chlorphenamine

Coldflu

Calpol

Fervex

Panadol Extra

Panadol for children

Panadol

Solpadeine

Efferalgan

Coldrex Maxgripp

Coldrex Hotrem

Coldrex

AntiGrippin

Unispaz

Pentalgin Plus

Rapidol

Maxicold

Perfalgan

Medicinal products with a similar main effect are:

Adzhikold;
Gripout;
Glycodin;
Coldrin;
Neogrip;
Lorcold;
Maxicold;
Amicitron;
Flukold;
Vicks Active;
Teraflu;
Antigrippin;
Pharmacitron , etc.

Medicines from its product line are also considered analogues of the drug: Milistan for cough ; Milistan syrup ; Milistan sine ; Milistan hot drink .

Medicinal properties

The broad effect of the drug is determined by the content of both an analgesic, antitussive and antihistamine. The therapeutic effect of paracetamol is achieved by blocking cyclooxygenase in the central nervous system. As a result, the patient experiences a decrease in pain and a decrease in temperature. In this case, the substance in question does not have a strong anti-inflammatory property. It is absorbed in the small intestine. Its main share undergoes conjugation in the liver. After which the conjugates and a small part of paracetamol are excreted by the kidneys.

Cetirizine has an antiallergic effect. Absorption inside the body occurs in a short time. Some of the component is dealkylated in the liver, resulting in the formation of an inactive metabolite. Most are excreted in urine, and only about 10% in feces.

The contained chlorpheniramine leads to a weakening of the manifestations of allergies, a reduction in local swelling and exudation. In addition, the component has a sedative, antiserotonin and anticholinergic effect. Once inside, it is absorbed over a long period of time. The bulk of chlorpheniramine undergoes methylation in the liver. The substance is mostly excreted by the kidneys.

Dextromethorphan in the composition allows Milistan to be used for coughs by suppressing the neurons of the cough center. We can say that it does not have analgesic or hypnotic properties. The medication does not cause addiction. Inside the body, this component is absorbed very quickly and completely. Some of it is excreted by the kidneys, the other is biotransformed in the liver.

Reviews

Provided the dosage regimen is followed and there are no contraindications, reviews of Milistan Multisymptom in the vast majority of cases are positive. The combination of active ingredients of this drug really leads to quick and lasting relief from the negative symptoms of influenza and ARVI and most often does not cause any side effects. Naturally, Milistan should not be abused, nor should it be taken in increased dosages, as this could potentially lead to serious adverse consequences.

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** The Drug Directory is intended for informational purposes only. For more complete information, please refer to the manufacturer's instructions. Do not self-medicate; Before starting to use the drug Milistan, you should consult a doctor. EUROLAB is not responsible for the consequences caused by the use of information posted on the portal. Any information on the site does not replace medical advice and cannot serve as a guarantee of the positive effect of the drug.

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** Attention! The information presented in this medication guide is intended for medical professionals and should not be used as a basis for self-medication. The description of the drug Milistan is provided for informational purposes and is not intended for prescribing treatment without the participation of a doctor. Patients need to consult a specialist!

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Price, where to buy

The price of Milistan Multisymptom fluctuates around 70-90 hryvnia.

Online pharmacies in RussiaRussia
Online pharmacies in UkraineUkraine

LuxPharma* special offer

Milistan multisymptomatic caplets N12
RUB 1,480 order

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