Tradename
Ripronate
International nonproprietary name
Meldonium
Dosage form
Capsules 250 mg, 500 mg
Compound
1 capsule contains
active substance - meldonium 250 mg or 500 mg,
excipients: modified corn starch, anhydrous colloidal silicon, calcium stearate,
shell composition: titanium dioxide E171, iron (III) yellow oxide E172, yellow quinoline E104, azorubine E122, crimson 4 RE124, gelatin.
Description
Ripronate 250 m - shiny cream-colored capsules.
Ripronate 500 mg - shiny capsules with a red cap and a cream-colored body.
Contents of the capsule
White or almost white powder.
Pharmacotherapeutic group
Other drugs for the treatment of heart diseases.
Pharmacological properties
Pharmacokinetics
After oral administration, the drug is rapidly absorbed from the gastrointestinal tract. its bioavailability is about 78%. The maximum concentration in blood plasma is achieved 1 to 2 hours after administration. The half-life is 3 – 6 hours.
Pharmacodynamics
Ripronate is a structural analogue of gamma-butyrobetaine, a precursor of carnitine. Performing the functions of gamma-butyrobetaine, it is able to accelerate the transmission of nerve impulses in the body, as a result, all responses are accelerated, overall metabolism improves, a tonic effect is observed - memory improves, thinking processes accelerate, dexterity of movements increases, the body's resistance to adverse circumstances increases, mental and physical stress is weakened .
The drug, by inhibiting γ-butyrobetaine hydroxylase, reduces the biosynthesis of carnitine and the transport of long-chain fatty acids through cell membranes, prevents the accumulation in cells of activated forms of unoxidized fatty acids - derivatives of acylcarnitine and acyl coenzyme A, thus preventing their harmful effects. In conditions of ischemia, it restores the balance between the delivery and the need of cells for oxygen. As a result of a decrease in carnitine concentration, u-butyrobetaine, which has vasodilating properties, is intensively synthesized.
In acute myocardial infarction, it slows down tissue necrosis and shortens the rehabilitation period. In case of heart failure, it improves myocardial contractility and increases exercise tolerance.
The drug is able to eliminate functional disorders of the somatic and autonomic nervous system in patients with chronic alcoholism during the abstinence period.
Indications for use
IHD (angina pectoris, myocardial infarction), chronic heart failure, cardialgia against the background of dishormonal myocardial dystrophy and dishormonal cardiomyopathy as part of complex therapy
acute and chronic cerebrovascular accidents (cerebral strokes and cerebrovascular insufficiency) as part of complex therapy
decreased performance, physical stress (including among athletes)
withdrawal syndrome in chronic alcoholism (in combination with specific therapy for alcoholism)
Directions for use and doses
Due to the possible development of an exciting effect, it is recommended to use it in the first half of the day.
For adults:
For cardiovascular diseases, as part of complex therapy, the drug is prescribed at 500–1000 mg/day in 1 or 2 doses. Course of treatment: 4 – 6 weeks.
For cardialgia against the background of dyshormonal myocardial dystrophy, Ripronate is prescribed 250 mg 2 times a day. Course of treatment: 12 days.
In case of acute cerebrovascular accident, take the drug orally at 500–1000 mg/day. General course of therapy: 4 – 6 weeks.
For chronic cerebrovascular accidents, the drug is taken at a dose of 500 mg/day. General course of therapy: 4 – 6 weeks. Repeated courses are prescribed individually 2–3 times a year.
For mental and physical stress, 250 mg is prescribed orally 4 times a day. Course of treatment: 10 – 14 days. If necessary, therapy is repeated after 2–3 weeks.
Athletes are recommended to use 500–1000 mg 2 times/day before training. The duration of the course during the preparatory period is 14–21 days, during the competition period – 10–14 days.
For chronic alcoholism, the drug is prescribed 500 mg 4 times a day. Course of treatment: 7 – 10 days.
Children over 12 years old:
For functional disorders of the cardiovascular system, Ripronate is prescribed at a rate of 12.5 - 25 mg/kg body weight, but not more than 1 g per day. The daily dose must be divided into 2 doses.
For mental and physical stress, the drug is prescribed 250 mg 4 times a day.
The course of treatment is determined by the doctor.
Side effects
Rarely
– tachycardia, changes in blood pressure
psychomotor agitation
dyspeptic symptoms
skin itching, redness, rash, swelling
Contraindications
hypersensitivity to the drug
increased intracranial pressure (due to impaired venous outflow, intracranial tumors)
pregnancy and lactation
children's age up to 12 years
Drug interactions
Enhances the effect of coronary dilating drugs, some antihypertensive drugs, cardiac glycosides. Due to the possible development of moderate tachycardia and arterial hypotension, caution should be exercised when combined with nitroglycerin, nifedepine, alpha-blockers, antihypertensive agents and peripheral vasodilators.
Can be combined with antianginal drugs, anticoagulants, antiplatelet agents, antiarrhythmic drugs, diuretics, bronchodilators.
special instructions
Ripronate is not a first-line drug for acute coronary syndrome.
Patients with chronic liver and kidney diseases should be careful with long-term use of the drug.
Features of the effect of the drug on the ability to drive a vehicle or potentially dangerous mechanisms
Considering the side effects of the drug, care should be taken when driving a vehicle or potentially dangerous mechanisms.
Overdose
Symptoms: sudden changes in blood pressure are possible, mainly towards hypotension.
Treatment is symptomatic and drug withdrawal.
Release form and packaging
Hard gelatin capsules 250 mg
10 capsules in a blister pack, 4 or 6 packs along with instructions for medical use in a cardboard box.
Hard gelatin capsules 500 mg
15 capsules in a blister pack, 4 packs along with instructions for medical use in a cardboard box.
Storage conditions
Store at a temperature not exceeding 25°C in a dry place.
Keep out of the reach of children!
Shelf life
3 years
Do not use after the expiration date.
Attention! The description of the drug on this page is simplified. Before purchasing and using the drug, consult your doctor or pharmacist, and also 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. ATTENTION! This section is provided for informational purposes only and is not a catalog or price list of our company. To obtain information about the availability of drugs, call + 99871 202 0999 Pharmacy Network Helpline 999.
Ripronate 10%/5 ml No. 10 solution d/in.amp.
Instructions for medical use of the drug RIPRONAT Trade name Ripronate International nonproprietary name Meldonium Dosage form Solution for injection 10% Composition 1 ml of solution contains the active substance - Meldonium (3-(2,2,2-trimethylhydrazinium) propionate dihydrate) (meldonium) 100 mg , excipient - water for injection up to 1 ml. Description Transparent colorless liquid Pharmacotherapeutic group Other drugs for the treatment of heart diseases. Meldonium ATC code C01EB22 Pharmacological properties Pharmacokinetics Metabolized in the body to form two main metabolites, which are excreted by the kidneys. The half-life is 3-6 hours. The bioavailability of the drug after intravenous administration is 100%. The maximum concentration in blood plasma is achieved immediately after its administration. Pharmacodynamics Ripronate is a structural analogue of γ-butyrobetaine, a precursor of carnitine. As a result of a decrease in carnitine concentration, γ-butyrobetaine, which has vasodilating properties, is intensively synthesized. In the case of acute ischemic damage to the myocardium, the use of the drug slows down the formation of the necrotic zone, shortens the rehabilitation period, improves blood circulation in the ischemic area, and promotes the redistribution of blood in favor of the ischemic area. In heart failure, Ripronate increases myocardial contractility, increases exercise tolerance, and reduces the frequency of angina attacks. Under conditions of increased stress, the drug restores the balance between the delivery and the need of cells for oxygen, eliminates the accumulation of toxic metabolic products in cells, protecting them from damage. As a result of use, the body acquires the ability to withstand stress and quickly restore energy reserves. Ripronate has a tonic effect. The drug is able to eliminate functional disorders of the somatic and autonomic nervous system in patients with chronic alcoholism during the period of abstinence. Indications for use: coronary heart disease (angina pectoris, myocardial infarction), chronic heart failure and dyshormonal cardiomyopathy (as part of complex therapy) - acute and chronic cerebrovascular accidents (cerebral strokes and cerebrovascular insufficiency) (as part of complex therapy). Method of administration and dosage Due to the possible development of an stimulating effect, it is recommended to use it in the first half of the day. Recommended doses of ripronate for adults. As part of complex therapy for coronary artery disease, chronic heart failure, dishormonal cardiopathy, 500 mg-1 g/day is prescribed intravenously (iv), administering the entire dose at once or dividing it by 2 times for 10 days, then switching to taking the tablet form of the drug. In case of acute cerebrovascular accident, the drug is prescribed intravenously at 500 mg/day for 10 days, then switched to taking the drug in tablet form. For chronic cerebrovascular accidents - intramuscularly (IM) 500 mg x 1 time / day, then switch to taking the drug in tablet form. The total duration of treatment is determined by the attending physician. Repeated courses are prescribed individually 2-3 times a year. Elderly patients: Elderly patients with liver and/or kidney disease should have their dose of meldonium reduced. Patients with Renal Impairment Since the drug is eliminated from the body through the kidneys, patients with mild to moderate renal impairment should use a lower dose of meldonium. Patients with hepatic impairment Patients with mild to moderate hepatic impairment should use a lower dose of meldonium. Pediatric population There is no data on the safety and effectiveness of meldonium in children and adolescents under the age of 18 years, therefore the use of this drug in children and adolescents is contraindicated. Side effects Often - allergic reactions (hypersensitivity, allergic dermatitis, urticaria, angioedema, anaphylactic reaction) - headaches - dyspepsia (feeling of heaviness, bloating, fullness, pain and discomfort in the epigastrium, nausea) Rarely - agitation, feeling of fear, obsessiveness thoughts, sleep disturbance - paresthesia, tremor, hypoesthesia, tinnitus, vertigo, dizziness, gait disturbance, lightheadedness, loss of consciousness - tachycardia/sinus tachycardia, atrial fibrillation, arrhythmia, chest discomfort/chest pain - blood pressure fluctuations , hypertensive crisis, hyperemia, pallor of the skin - sore throat, cough, dyspnea, apnea - dysgeusia (metallic taste in the mouth), loss of appetite, nausea, vomiting, gas accumulation, diarrhea, abdominal pain - rashes (general / macular / papular), itching - back pain, muscle weakness, muscle spasms - pollakiuria - general weakness, tremor, asthenia, general swelling, swelling of the face, swelling of the legs, feeling hot, feeling cold, cold sweat - abnormalities in the electrocardiogram (ECG), acceleration heart function, eosinophilia Contraindications - hypersensitivity to meldonium dihydrate - severe liver and/or renal failure, due to the lack of data on the safety of use - pregnancy and lactation - children under 18 years of age, due to the lack of data on clinical use during this period Drug interactions Strengthens the effect of coronary dilatants, some antihypertensive drugs, cardiac glycosides. Due to the possible development of moderate tachycardia and arterial hypotension, caution should be exercised when combined with nitroglycerin, nifedipine, alpha-blockers, antihypertensive agents and peripheral vasodilators. Can be combined with antianginal drugs, anticoagulants, antiplatelet agents, antiarrhythmic drugs, diuretics, bronchodilators. Special instructions Ripronate is not a first-line drug for acute coronary syndrome. Patients with chronic liver and kidney diseases should be careful with long-term use of the drug. Features of the effect of the drug on the ability to drive a vehicle or potentially dangerous mechanisms Care should be taken when driving vehicles or potentially dangerous mechanisms. Overdose Symptoms: increased severity of side effects. In particular, there is excitement and a decrease in blood pressure. Treatment is symptomatic. Release form and packaging 5 ml of the drug in colorless glass ampoules. A self-adhesive label is placed on the ampoule or the text is applied with quick-fixing paint for glass products. 5 ampoules are placed together in a blister pack. 2 contour packages together with instructions for medical use in the state and Russian languages are placed in a cardboard box. Storage conditions Store at a temperature not exceeding 25ºС. Do not freeze. Keep out of the reach of children! Shelf life: 3 years Do not use after expiration date. Conditions for dispensing from pharmacies By prescription, Otopeni, st. Eroilor 1A, Romania (“Rompharm Company SRL”, Otopeni, Eroilor Street 1A, Romania) for ROTAPHARM, UK Registration certificate holder Rotapharm, London/UK. Address of the organization that accepts claims from consumers on the quality of products (goods) of the Republic of Kazakhstan on the territory of the Republic of Kazakhstan, Almaty, st. Suyunbaya 222 B Tel/fax: 8(7272)529090
Instructions for use CIPRONEX
Ciprofloxacin should be used with caution in patients with diseases of the central nervous system (for example, atherosclerosis of the cerebral arteries, epilepsy or a history of other diseases that can cause seizures).
During treatment with ciprofloxacin, crystalluria may develop, especially if the urine is alkaline or neutral, and therefore patients should be given sufficient fluids.
If skin rash or other symptoms indicating hypersensitivity to the drug appear, you should stop taking the drug. Very rarely, after taking the first dose of the drug, an anaphylactic reaction and shock may develop (decreased blood pressure, cardiac and respiratory rhythm disturbances).
During treatment with Cipronex, as in the case of treatment with other quinolones, tenosynovitis and even tendon rupture (for example, Achilles tendon) may develop. The patient should be informed that they should stop taking the drug and consult a doctor if pain or inflammatory changes occur in the tendon area.
Ciprofloxacin, as well as other fluoroquinolones, can cause phototoxic reactions, therefore the patient should avoid UV radiation during treatment with Cipronex. Treatment with the drug should be discontinued if phototoxic reactions occur.
During therapy with ciprofloxacin, pseudomembranous enterocolitis of varying severity may develop. Symptoms of this disease may include severe and prolonged diarrhea. You should not use drugs that inhibit intestinal motility.
Caution should be exercised when using fluoroquinolones in patients with glucose-6-phosphate dehydrogenase deficiency due to the possibility of hemolysis.
Caution should be exercised when prescribing the drug to patients with hepatic or renal insufficiency.
In experimental studies
It has been established that ciprofloxacin does not have a teratogenic effect. Mutagenicity tests revealed 7 negative tests and 1 positive test.
Impact on the ability to drive vehicles and operate machinery
Ciprofloxacin may cause headache and dizziness, a feeling of weakness, which may affect driving a vehicle and operating moving machinery, as well as activities associated with high psychophysical activity
Ripronate 250 mg No. 40 caps.
Instructions for medical use of the drug RIPRONAT Trade name Ripronate International nonproprietary name Meldonium Dosage form Capsules 250 mg, 500 mg Composition 1 capsule contains the active substance - meldonium 250 mg or 500 mg, excipients: modified corn starch, colloidal anhydrous silicon, calcium stearate, shell composition: titanium dioxide E171, iron (III) yellow oxide E172, yellow quinoline E104, azorubine E122, crimson 4 RE 124, gelatin. Description Hard shiny gelatin capsules No. 1 with a cream-colored body and cap (for a dosage of 250 mg) or capsules No. 0 with a cream body and a red cap (for a dosage of 500 mg). The contents of the capsule are white or almost white powder. Pharmacotherapeutic group Other drugs for the treatment of heart diseases. ATC code C01E Pharmacological properties Pharmacokinetics After oral administration, the drug is rapidly absorbed from the gastrointestinal tract, its bioavailability is about 78%. The maximum concentration in blood plasma is achieved 1 to 2 hours after administration. The half-life is 3 – 6 hours. Pharmacodynamics Ripronate is a structural analogue of the carnitine precursor gamma butyrobetaine (hereinafter GBB), in which one hydrogen atom is replaced by a nitrogen atom. Its effect on the body can be explained in two ways. Effect on carnitine synthesis As a result of inhibition of the activity of butyrobetaine hydroxylase, meldonium reduces the biosynthesis of carnitine and thus inhibits the transport of long-chain fatty acids through the cell membrane, preventing the accumulation in cells of activated derivatives of non-oxidized fatty acids - acylcarnitine and acyl coenzyme A, which have pronounced detergent properties. Under conditions of ischemia, Ripronate restores the balance between the delivery and consumption of oxygen in cells, eliminates disturbances in ATP transport, while simultaneously activating an alternative source of energy - glycolysis, which occurs without additional oxygen consumption. With increased load, as a result of intensive energy consumption, a temporary decrease in the content of fatty acids occurs in the cells of a healthy body. This, in turn, stimulates the process of fatty acid metabolism, mainly the synthesis of carnitine. Carnitine biosynthesis is regulated by its level in the blood plasma and stress, but does not depend on the concentration of carnitine precursors in the cell. Since meldonium inhibits the conversion of GBB to carnitine, this leads to a decrease in the level of carnitine in the blood, which in turn activates the process of synthesis of the precursor of carnitine, that is, GBB. When the concentration of meldonium decreases, the process of carnitine biosynthesis is restored and the concentration of fatty acids in the cell is normalized. Thus, the cells undergo regular training, which contributes to their survival under conditions of increased load, in which the content of fatty acids in them regularly decreases, and when the load decreases, the fatty acid content is quickly restored. Under conditions of real overload, cells “trained” with the help of the drug Ripronate survive in those conditions when “untrained” cells die. Function of the mediator of the hypothetical GBB-ergic system It is hypothesized that in the body there is a previously undescribed system for the transmission of nerve impulses - the GBB-ergic system, which ensures the transmission of nerve impulses to somatic cells. The mediator of this system is the immediate precursor of carnitine, the GBB ester. As a result of the action of esterase, this transmitter gives the cell an electron, thus transferring an electrical impulse, and itself turns into GBB. GBB synthesis is possible in any somatic cell of the body. Its speed is regulated by the intensity of the stimulus and energy expenditure, which in turn depend on the concentration of carnitine. Therefore, when carnitine concentration decreases, GBB synthesis is stimulated. Thus, the body has an economical chain of reactions that provides an adequate response to irritation or stress: it begins with the receipt of a signal from nerve fibers (in the form of an electron), followed by the synthesis of GBB and its ester, which in turn carries the signal on the membranes of somatic cells. Somatic cells, in response to irritation, synthesize new molecules, ensuring the propagation of the signal. After this, the hydrolyzed form of GBB, with the participation of active transport, enters the liver, kidneys and testes, where it is converted into carnitine. As stated earlier, meldonium is a structural analogue of HBB, in which one hydrogen atom is replaced by a nitrogen atom. Since meldonium can be exposed to GBB esterase, it may function as a hypothetical “transmitter”. However, GBB hydroxylase does not act on meldonium and therefore, when it is introduced into the body, the concentration of carnitine does not increase, but decreases. Due to the fact that meldonium itself acts as a “mediator” of stress and also increases the content of GBB, it contributes to the development of the body’s response. As a result, overall metabolic activity in other systems, such as the central nervous system (CNS), increases. Indications for use: angina pectoris and myocardial infarction (as part of complex therapy) - chronic heart failure (in complex treatment) - cardiomyopathy - acute cerebrovascular accident (in complex therapy) - hemophthalmos and retinal hemorrhages of various etiologies, thrombosis of the central retinal vein and its branches, retinopathy of various etiologies (diabetic, hypertensive) - mental and physical overload, including in athletes - withdrawal syndrome in chronic alcoholism (in combination with specific therapy for alcoholism) Method of administration and dosage Due to the possible development of an stimulating effect, it is recommended to use in the first half of the day . Adults: For cardiovascular diseases, as part of complex therapy, the drug is prescribed at 500–1000 mg/day in 1 or 2 doses. Course of treatment: 4 – 6 weeks. For cardialgia against the background of dishormonal myocardial dystrophy, Ripronate is prescribed 250 mg 2 times a day. Course of treatment: 12 days. In case of acute cerebrovascular accident, take the drug orally at 500–1000 mg/day. General course of therapy: 4 – 6 weeks. For chronic cerebrovascular accidents, the drug is taken at a dose of 500 mg/day. General course of therapy: 4 – 6 weeks. Repeated courses are prescribed individually 2–3 times a year. For mental and physical stress, 250 mg is prescribed orally 4 times a day. Course of treatment: 10 – 14 days. If necessary, therapy is repeated after 2–3 weeks. Athletes are recommended to use 500–1000 mg 2 times/day before training. The duration of the course during the preparatory period is 14–21 days, during the competition period – 10–14 days. For chronic alcoholism, the drug is prescribed at a dose of 500 mg 4 times a day. Course of treatment: 7 – 10 days. Side effects Rarely - tachycardia, changes in blood pressure - psychomotor agitation - dyspeptic symptoms - skin itching, redness, rash, swelling Contraindications - hypersensitivity to the drug - increased intracranial pressure (in case of impaired venous outflow, intracranial tumors) - pregnancy and lactation - children and adolescents age up to 18 years Drug interactions Enhances the effect of coronary dilation drugs, some antihypertensive drugs, cardiac glycosides. Due to the possible development of moderate tachycardia and arterial hypotension, caution should be exercised when combined with nitroglycerin, nifedepine, alpha-blockers, antihypertensive agents and peripheral vasodilators. Can be combined with antianginal drugs, anticoagulants, antiplatelet agents, antiarrhythmic drugs, diuretics, bronchodilators. Special instructions Ripronate is not a first-line drug for acute coronary syndrome. Patients with chronic liver and kidney diseases should be careful with long-term use of the drug. Features of the effect of the drug on the ability to drive a vehicle or potentially dangerous mechanisms Considering the side effects of the drug, care should be taken when driving a vehicle or potentially dangerous mechanisms. Overdose Symptoms: sudden changes in blood pressure are possible, mainly towards hypotension. Treatment is symptomatic and drug withdrawal. Release form and packaging 10 (for a dosage of 250 mg) or 15 (for a dosage of 500 mg) capsules in a blister pack made of polyvinyl chloride and aluminum foil. 4 or 6 (for a dosage of 250 mg) or 4 (for a dosage of 500 mg) contour packages along with instructions for use in the state and Russian languages are placed in a cardboard pack. Storage conditions Store at a temperature not exceeding 25°C in a dry place. Keep out of the reach of children! Shelf life: 3 years Do not use after expiration date. Dispensing conditions By prescription Manufacturer and country of origin “Rompharm Company S.R.L.”, Romania, Otopeni, Eroilor St., 1A for “Rotapharm”, Great Britain Registration certificate holder “ROTAPHARM”, Great Britain Ripronate is a product and a trademark company “ROTAPHARM”, Great Britain Manufactured by “Rompharm Company S.R.L.”, Romania, Otopeni, Eroilor St., 1A Address of the organization that accepts claims from consumers on the quality of products (products) in the territory of the Republic of Kazakhstan Troka-S Pharma RK LLP , Almaty, st. Suyunbaya 222 B Tel/fax: 8(7272)529090
Diprometa
Severe nervous system complications (including death) have been reported with epidural and intrathecal administration of corticosteroids (with or without fluoroscopic guidance), including, but not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke. Since the safety and effectiveness of epidural administration of GCS have not been established, this route of administration is not indicated for this group of drugs.
Recommended routes of administration are listed in the "Method of administration and dosage" section.
Intravascular administration of the drug must be avoided.
Due to the lack of data regarding the risk of calcification, injection of the drug into the intervertebral space is contraindicated.
Rare cases of anaphylactoid/anaphylactic reactions (up to the development of anaphylactic shock) have been reported with parenteral administration of GCS. The necessary precautions should be taken before administering the drug, especially if the patient has a history of allergic reactions to GCS.
The dosage regimen and route of administration are determined individually, depending on the indications, severity of the disease and patient response.
The dose should be as small as possible and the period of use as short as possible. The initial dose is adjusted until the desired therapeutic effect is achieved. Then gradually reduce the dose of Dipromet to the minimum effective maintenance dose. If there is no effect from the therapy or if it is used for a long time, the drug is discontinued in the same way, gradually reducing the dose.
If a stressful situation (not related to the disease) occurs or threatens to occur, it may be necessary to increase the dose of Dipromet.
The patient's condition is monitored for at least one year after completion of long-term therapy or use in high doses.
Administration of the drug into soft tissues, into the lesion and intra-articularly can, with a pronounced local effect, simultaneously lead to a systemic effect.
The drug Dipromet contains two active substances - betamethasone derivatives, one of which - betamethasone sodium phosphate - quickly penetrates into the systemic circulation, and therefore its possible systemic effect should be taken into account.
The use of Dipromet may increase the patient's emotional instability or tendency to psychosis.
When using Dipromet in patients with diabetes mellitus, adjustment of hypoglycemic therapy may be required.
Patients receiving corticosteroids should not be vaccinated against smallpox. Other immunizations should not be carried out in patients receiving GCS (especially in high doses), due to the possibility of developing neurological complications and a low immune response (lack of antibody formation). However, immunization is possible during replacement therapy (for example, with primary adrenal insufficiency). Patients receiving Dipromet in doses that suppress the immune system should be warned to avoid contact with patients with chickenpox and measles (especially important when using the drug in children).
It is possible to suppress the reaction when performing skin tests during the use of GCS.
When using the drug Dipromet, it should be taken into account that GCS can mask the signs of an infectious disease, as well as reduce the body's resistance to infections.
It is necessary to carefully observe the rules of asepsis and antisepsis when administering the drug.
Caution must be exercised when using the drug in patients at high risk of infection (on hemodialysis or with dentures).
The use of Dipromet for active tuberculosis is possible only in cases of fulminant or disseminated tuberculosis in combination with adequate anti-tuberculosis therapy. When using Dipromet in patients with latent tuberculosis or a positive reaction to tuberculin, careful medical supervision is necessary due to the danger of reactivation of tuberculosis. With long-term use of GCS, such patients should receive specific chemotherapy. When using rifampicin prophylactically, acceleration of the hepatic clearance of betamethasone should be taken into account (dosage adjustment may be required).
If there is fluid in the joint cavity, a septic process should be excluded. A noticeable increase in pain, swelling, increased temperature of the surrounding tissues and further limitation of joint mobility indicate septic arthritis. It is necessary to conduct a study of aspirated joint fluid. Once the diagnosis is confirmed, appropriate antibacterial therapy must be prescribed. The use of Dipromet in septic arthritis is contraindicated.
Repeated injections into a joint for osteoarthritis may increase the risk of joint destruction. The introduction of GCS into the tendon tissue gradually leads to tendon rupture.
After successful intra-articular therapy, the patient should avoid overloading the joint.
Long-term use of corticosteroids can lead to posterior subcapsular cataracts (especially in children), glaucoma with possible damage to the optic nerve, and may contribute to the development of secondary eye infections (fungal or viral). It is necessary to periodically conduct an ophthalmological examination, especially in patients receiving Dipromet for more than 6 months.
The use of medium and high doses of corticosteroids can lead to increased blood pressure, sodium and fluid retention in the body, and increased excretion of potassium from the body (these phenomena are less likely when taking synthetic corticosteroids, unless they are used in high doses). In this case, the need to prescribe potassium-containing drugs and a diet with limited salt should be considered. All corticosteroids enhance calcium excretion.
With the simultaneous use of Dipromet and cardiac glycosides or drugs that affect the electrolyte composition of plasma, monitoring of the water-electrolyte balance is required.
Use acetylsalicylic acid with caution in combination with betamethasone for hypoprothrombinemia.
The effect of GCS is enhanced in patients with hypothyroidism and liver cirrhosis.
The development of secondary adrenal insufficiency due to too rapid withdrawal of GCS is possible within several months after the end of therapy. If a stressful situation occurs or is threatened during this period, therapy with Dipromet should be resumed and a mineralocorticoid should be prescribed at the same time (due to a possible disruption of mineralocorticoid secretion). Gradual withdrawal of GCS can reduce the risk of developing secondary adrenal insufficiency.
With the use of GCS, changes in sperm motility and number are possible.
During long-term therapy with GCS, it is advisable to consider the possibility of switching from parenteral to oral use of GCS, taking into account the assessment of the benefit/risk ratio.
Caution must be exercised when using GCS in elderly patients; in patients with ulcerative colitis with a threat of perforation, with an abscess or other purulent infections, diverticulitis, with the presence of recently created intestinal anastomoses, active or latent peptic ulcer of the stomach and/or intestines, renal or hepatic failure, arterial hypertension, osteoporosis, myasthenia, confirmed or suspected parasitic infections (eg, strongyloidiasis).
With systemic and local (including intranasal, inhalation and intraocular) use of GCS, visual impairment may occur. If a patient experiences symptoms such as blurred vision or other visual disturbances, consideration should be given to referring the patient to an ophthalmologist to evaluate possible causes, including cataracts, glaucoma, or rare diseases such as central serous chorioretinopathy (CSC), which has been observed in a number of cases. cases with systemic or local use of GCS.
Use in pediatrics
Children undergoing therapy with Dipromet (especially long-term therapy) should be under close medical supervision for possible growth retardation and the development of secondary adrenal insufficiency.
Use in athletes
Patients participating in competitions under the control of the World Anti-Doping Agency (WADA) should familiarize themselves with the WADA rules before starting treatment with the drug, since the use of betamethasone may affect the results of doping control.
