Pharmacological properties
Pharmacodynamics.
Paracetamol has analgesic and antipyretic effects, which are thought to be primarily due to inhibition of prostaglandin synthesis in the central nervous system. Guaifenesin is an expectorant. It acts by increasing the volume and reducing the viscosity of secretions in the trachea and bronchi, which facilitates the release of sputum when coughing.
Phenylephrine hydrochloride is a sympathomimetic that primarily stimulates α-adrenergic receptors. It is a decongestant and acts by constricting blood vessels, reducing swelling, including swelling of the nasal mucosa and paranasal sinuses.
The active ingredients do not cause a sedative effect.
Pharmacokinetics. Paracetamol is quickly and almost completely absorbed from the gastrointestinal tract, passes through the placental barrier, and a small portion passes into breast milk. 95% of acetaminophen is metabolized in the liver by sulfo- and glucuronoconjugation, as well as oxidation by the cytochrome P450 system. T½ is from 1 to 4 hours. Duration of action is 3–4 hours. It is excreted by the kidneys, mainly in the form of metabolites, 3% of the substance is excreted unchanged.
Guaifenesin is rapidly absorbed from the gastrointestinal tract and metabolized to β-(2-methoxyphenoxy) lactic acid, an inactive metabolite that is excreted in the urine. T½ of guaifenesin is short - approximately 1 hour.
Phenylephrine hydrochloride is absorbed unevenly from the gastrointestinal tract and is subject to first-pass metabolism by MAO in the intestine and liver. Thus, orally administered phenylephrine has reduced bioavailability.
It is excreted almost entirely in the urine as a sulfate conjugate.
Application
For internal use.
Dissolve the contents of 1 sachet in a standard cup (250 ml) of hot but not boiling water. Take warm.
Adults, elderly people and children over 12 years of age: 1 sachet.
Repeat, if necessary, every 4–6 hours, but not more than 4 doses (4 sachets) per day; the interval between doses is at least 4 hours. Do not exceed the recommended doses, especially in persons with increased blood clotting.
The duration of treatment is determined by the doctor. Do not use the drug for more than 3 days without consulting a doctor. If the symptoms of the disease do not disappear, you should consult a doctor.
Children. Contraindicated for children under 12 years of age. For children over 12 years of age, use under medical supervision.
Contraindications
Hypersensitivity to paracetamol or any other component of the drug. cardiovascular diseases, hypertension, diabetes mellitus, angle-closure glaucoma, hyperthyroidism, urinary retention due to prostatic hyperplasia, pheochromocytoma.
Severe liver dysfunction, acute hepatitis, pancreatitis, renal dysfunction. Alcoholism.
Patients using MAO inhibitors (or within 2 weeks after stopping such treatment), tricyclic antidepressants, beta-adrenergic blockers and other vasodilators or sympathomimetics.
Congenital hyperbilirubinemia, glucose-6-phosphate dehydrogenase deficiency, blood diseases, severe anemia, leukopenia.
Phenylketonuria.
Side effects
From the immune system: anaphylaxis; hypersensitivity reactions, including skin itching, rash, urticaria, angioedema, erythema multiforme (including Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell's syndrome).
From the circulatory and lymphatic systems: anemia, sulfhemoglobinemia and methemoglobinemia (cyanosis, shortness of breath, heart pain), hemolytic anemia, aplastic anemia, pancytopenia, thrombocytopenia, which can cause nosebleeds and/or bleeding gums, bruising or bleeding, leukopenia, neutropenia , agranulocytosis.
From the nervous system (usually develop when taken in high doses): dizziness, headache, psychomotor agitation, disorientation, impaired consciousness, insomnia, restlessness, nervousness, tremor, irritability, anxiety.
From the organ of vision: acute angle-closure glaucoma.
From the cardiovascular system: tachycardia, increased blood pressure, palpitations.
From the digestive system: a feeling of discomfort in the gastrointestinal tract, nausea, vomiting, diarrhea, loss of appetite, epigastric pain, impaired liver function, increased activity of liver enzymes in the blood plasma, usually without the development of jaundice, hepatonecrosis (dose-dependent effect).
From the urinary system: urinary retention or difficulty urinating (with an enlarged prostate gland), renal colic. There have been rare reports of bladder or kidney stones in patients who have taken high doses of guaifenesin for a long time.
From the endocrine system: hypoglycemia, up to hypoglycemic coma.
From the respiratory system: bronchospasm in patients sensitive to acetylsalicylic acid and other NSAIDs.
Vicks AntiGrip Complex powder d/d/internally 4.36g No. 5 lemon
Compound
Active ingredients: paracetamol 500 mg, guaifenesin 200 mg, phenylephrine hydrochloride 10 mg. Excipients: sucrose - 2000 mg, citric acid - 330 mg, tartaric acid - 330 mg, sodium cyclamate - 200 mg, sodium citrate - 500 mg, aspartame - 6 mg, ascorbic acid - 100 mg, acesulfame potassium - 17 mg, flavoring lemon 8476 - 50 mg, lemon juice flavor - 120 mg, menthol flavor - 100 mg, quinoline yellow dye - 1 mg.
Indications for use
Symptoms of colds and flu:
- Headache.
- A sore throat.
- Pain in the body and limbs.
- Nasal congestion.
- Cough with difficult discharge of viscous sputum.
- Increased body temperature.
Contraindications
- Hypersensitivity to guaifenesin, paracetamol, phenylephrine or other components of the drug.
- Impaired liver function and severe chronic renal failure.
- Arterial hypertension.
- Hyperthyroidism.
- Diabetes.
- Phenylketonuria (because the drug contains aspartame).
- Coronary heart disease (acute myocardial infarction, atherosclerosis of the coronary arteries).
- Aortic stenosis.
- Tachyarrhythmia.
- Simultaneous use of beta-blockers, tricyclic antidepressants, monoamine oxidase inhibitors MAO (including within 14 days after their withdrawal).
- Concomitant use of other sympathomimetic drugs.
- Simultaneous use of other drugs containing paracetamol.
- Peptic ulcer of the stomach and duodenum in the acute stage.
- Prostatic hyperplasia.
- Angle-closure glaucoma.
- Age up to 12 years.
- Pregnancy and breastfeeding period.
- Sucrase/isomaltase deficiency.
- Fructose intolerance.
- Glucose-galactose malabsorption.
- Porphyria.
- Pheochromocytoma.
With caution: Glucose-6-phosphate dehydrogenase deficiency, blood diseases, congenital hyperbilirubinemia (Gilbert, Dubin-Johnson, Rotor syndromes), hyperoxaluria, bronchial asthma, COPD (chronic obstructive pulmonary disease); mild to moderate renal failure, dehydration, hypovolemia, anorexia, bulimia and cachexia (insufficient supply of glutathione in the liver), viral hepatitis, alcoholic liver damage, alcoholism, old age; Raynaud's syndrome; patients taking cardiac glycosides, beta-blockers, methyldopa and other antihypertensive drugs.
Directions for use and doses
Adults and children over 12 years of age are prescribed 1 sachet every 4-6 hours, but not more than 4 doses (sachets)/day. The maximum daily dose is 4 sachets.
The maximum duration of use of the drug without consulting a doctor is no more than 5 days. If after 5 days of treatment there is no improvement or symptoms worsen, or new symptoms appear, the patient should consult a doctor.
Storage conditions
Store at a temperature not exceeding 25°C. Keep out of the reach of children.
Best before date
3 years. Do not use after expiration date.
special instructions
It is recommended to take the drug for the shortest possible course and in the minimum effective dose necessary to eliminate symptoms.
The drug should not be used simultaneously with other cough, cold, or decongestant medications.
The simultaneous use of the drug with other paracetamol-containing drugs should be avoided, as this may cause an overdose of paracetamol.
In patients with alcoholic liver disease, the negative consequences of overdose are more pronounced.
When using the drug for more than 5 days, peripheral blood counts and the functional state of the liver should be monitored.
The drug distorts the results of laboratory tests of glucose and uric acid in the blood plasma.
During treatment, it is recommended to take enough fluids.
The urine may turn pink.
Guaifenesin, which is part of the drug, may give false-positive results when determining 5-hydroxyindoleacetic and vanillinmandelic acids in urine due to the effect of guaifenesin metabolites on color (guaifenesin should be discontinued 48 hours before collecting urine for these tests).
The drug contains sodium, which must be taken into account in patients on a diet with reduced sodium intake.
The drug contains aspartame, which is a source of phenylalanine, which can be toxic to patients with phenylketonuria.
While using the drug, you must refrain from drinking alcohol and medications containing ethanol.
Description
Acute respiratory infections and “cold” symptoms are a remedy (non-narcotic analgesic + expectorant + alpha-adrenergic agonist).
Use in children
The use of the drug is contraindicated for children under 12 years of age.
Pharmacodynamics
A combined drug whose effect is determined by the composition of its constituent components.
Paracetamol has analgesic and antipyretic effects.
Guaifenesin has a mucolytic effect, facilitates the removal of sputum from the bronchi and promotes the transition of a non-productive cough to a productive one.
Phenylephrine is a sympathomimetic, has pronounced alpha-adrenergic activity, constricts the vessels of the nasal mucosa, eliminates swelling and hyperemia of the nasal mucosa.
Side effects
The incidence of adverse reactions is assessed as follows: very often (≥1/10), often (from ≥1/100 to <1/10), infrequently (from ≥1/1000 to <1/100), rarely (from ≥1 /10,000 to <1/1000), very rare (<1/10,000), frequency unknown (cannot be estimated from available data).
Paracetamol
Allergic reactions: rarely - urticaria, anaphylaxis, bronchospasm, angioedema.
From the skin and subcutaneous tissue: rarely - skin rash, frequency unknown - Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome), acute generalized exanthematous pustulosis.
From the nervous system: rarely - dizziness.
From the organ of vision: rarely - paresis of accommodation, increased intraocular pressure, mydriasis.
From the hematopoietic system: rarely - aplastic anemia, methemoglobinemia; very rarely - pathological changes in the blood, such as thrombocytopenia, agranulocytosis, hemolytic anemia, neutropenia, leukopenia, pancytopenia.
From the cardiovascular system: rarely - increased blood pressure.
From the digestive system: rarely - nausea, vomiting, dry mouth, hepatotoxic effect.
From the urinary system: rarely - urinary retention, nephrotoxicity (papillary necrosis); frequency unknown - interstitial nephritis.
Phenylephrine
From the cardiovascular system: rarely - tachycardia, arterial hypertension, accompanied by headache, vomiting and rapid heartbeat.
From the nervous system: rarely - insomnia, nervousness, tremor, anxiety, agitation, confusion, irritability and headache.
From the digestive system: often - anorexia, nausea and vomiting.
Allergic reactions: rarely - skin rash, urticaria, anaphylaxis and bronchospasm.
Guaifenesin
From the nervous system: rarely - headache, dizziness and drowsiness.
From the digestive system: rarely - discomfort in the gastrointestinal tract, nausea, vomiting and diarrhea.
Use during pregnancy and breastfeeding
The drug should not be used during pregnancy and breastfeeding.
Interaction
Paracetamol
Inducers of microsomal oxidation in the liver (phenytoin, ethanol, barbiturates, flumecinol, rifampicin, phenylbutazone, tricyclic antidepressants) increase the production of hydroxylated active metabolites, which makes it possible to develop severe intoxication with a slight overdose.
Long-term use of barbiturates reduces the effectiveness of paracetamol.
Concomitant use with ethanol increases the risk of acute pancreatitis.
Inhibitors of microsomal oxidation (including cimetidine) reduce the risk of hepatotoxicity.
When used together with NSAIDs, incl. salicylates, the nephrotoxic effect of paracetamol increases.
Diflunisal increases the plasma concentration of paracetamol by 50%, which increases the risk of hepatotoxicity.
Metoclopramide and domperidone may increase the rate of absorption of paracetamol.
Cholestyramine may reduce the rate of absorption of paracetamol.
Isoniazid reduces the clearance of paracetamol by suppressing its metabolic transformation in the liver, which may lead to an increase in the pharmacological effects of paracetamol and/or its toxicity.
Probenecid causes a decrease in the clearance of paracetamol by almost 2 times due to inhibition of the conjugation of paracetamol with glucuronic acid. When used concomitantly with probenecid, a reduction in the dose of paracetamol should be considered.
Regular use of paracetamol may lead to a possible decrease in the metabolism of zidovudine (increased risk of neutropenia).
Paracetamol may reduce the bioavailability of lamotrigine with a possible decrease in the severity of its effect due to the possible induction of the metabolic transformation of lamotrigine in the liver.
Paracetamol enhances the effect of indirect anticoagulants, which increases the risk of bleeding and reduces the activity of uricosuric drugs.
Phenylephrine
Reduces the hypotensive effect of diuretics and antihypertensive drugs (including methyldopa, mecamylamine, guanadrel, guanethidine).
Phenothiazines, alpha-blockers (phentolamine), furosemide and other diuretics reduce the hypertensive effect.
MAO inhibitors (including furazolidone, procarbazine, selegiline), oxytocin, ergot alkaloids, tricyclic antidepressants, methylphenidate, adrenergic stimulants enhance the pressor effect and arrhythmogenicity of phenylephrine.
Beta-blockers reduce cardiac stimulating activity; in the presence of reserpine, arterial hypertension is possible (due to depletion of catecholamine reserves in adrenergic endings, sensitivity to adrenergic agonists increases).
Inhalation anesthetics (including chloroform, enflurane, halothane, isoflurane, methoxyflurane) increase the risk of severe atrial and ventricular arrhythmias because they sharply increase the sensitivity of the myocardium to sympathomimetics.
Ergometrine, ergotamine, methylergometrine, oxytocin, doxapram increase the severity of the vasoconstrictor effect.
Reduces the antianginal effect of nitrates, which in turn can reduce the pressor effect of sympathomimetics and the risk of arterial hypotension (simultaneous use is allowed depending on the achievement of the required therapeutic effect).
Thyroid hormones increase (mutually) the effect and the associated risk of coronary insufficiency (especially with coronary atherosclerosis).
Concomitant use of phenylephrine and other sympathomimetic amines may lead to increased blood pressure and other cardiovascular side effects.
Concomitant use of cardiac glycosides (eg, digoxin) and phenylephrine may increase the risk of arrhythmia and myocardial infarction.
Guaifenesin
Codeine makes it difficult to clear liquefied mucus.
Compatible with bronchodilators, antimicrobial drugs, cardiac glycosides.
Overdose
Paracetamol
Liver damage is possible in adults who have taken 10 g or more of paracetamol. Taking 5 grams or more of paracetamol can cause liver damage if the following risk factors are present: long-term treatment with carbamazepine, phenobarbitone, phenytoin, primidone, rifampicin, St. John's wort or other drugs that activate liver enzymes, alcohol abuse, glutanione deficiency (for example, poor diet ), cystic fibrosis, HIV infection, starvation, cachexia.
Symptoms of paracetamol overdose in the first 24 hours: pale skin, nausea, vomiting, anorexia and abdominal pain.
Increased activity of “liver” transaminases, increase in prothrombin time.
Liver damage may appear 12-48 hours after ingestion, so you should consult a doctor even if you have no symptoms. Impaired glucose metabolism and metabolic acidosis are possible. In severe poisoning, liver failure can progress with complications such as encephalopathy, hemorrhage, hypoglycemia, cerebral edema and death. Acute renal failure with acute tubular necrosis (defined by low back pain, hematuria, and proteinuria) can develop even in the absence of severe liver damage. There have been reports of cardiac arrhythmias and pancreatitis.
Phenylephrine
Symptoms of phenylephrine overdose include irritability, headache, increased blood pressure and associated reflex bradycardia and cardiac arrhythmias.
If the above symptoms of overdose occur, you should consult a doctor.
Guaifenesin
Small to moderate overdose may cause dizziness, gastrointestinal upset (nausea, vomiting and diarrhea). Very high overdoses may cause restlessness, confusion and respiratory depression.
Treatment
Gastric lavage, activated charcoal, acetylcysteine (paracetamol antidote), symptomatic therapy.
Immediate treatment is required in case of paracetamol overdose. Despite the lack of significant early symptoms, patients should be rushed to hospital for immediate medical examination. Symptoms may be limited to nausea or vomiting and may not be consistent with the severity of the overdose or the risk of organ damage. Liver damage can occur 12-48 hours after ingesting paracetamol, so you should consult a doctor even if you have no symptoms. Treatment with activated charcoal and gastric lavage should be considered if the excessive dose was taken less than 1 hour ago. Plasma concentrations of paracetamol should be measured 4 hours or more after administration (earlier concentrations are unreliable).
Treatment with N-acetylcysteine can be carried out up to 2 hours after taking paracetamol, but the maximum protective effect is achieved about 8 hours after taking the drug. The effectiveness of the antidote gradually decreases after this time. If necessary, N-acetylcysteine is administered intravenously in accordance with the established dosage regimen.
Outside the hospital, if there is no vomiting, methionine can be used orally.
Patients presenting with severe hepatic dysfunction within 24 hours of taking the drug should be referred to a poisoning specialist.
For the hypertensive effects of phenylephrine overdose, intravenous alpha-adrenergic blockers such as phentolamine can be used. A decrease in blood pressure will be reflexively accompanied by an increase in heart rate, but if necessary, this effect can be enhanced by the administration of atropine.
Impact on the ability to drive vehicles and operate machinery
When driving or engaging in other potentially hazardous activities, be aware that the drug may cause side effects such as dizziness and confusion.
special instructions
Long-term use of the drug is not recommended.
If the headache becomes persistent, you should consult a doctor.
Patients using analgesics daily for mild arthritis should consult a physician.
Avoid simultaneous use of other anti-cold, decongestant and paracetamol-containing medications. Before starting treatment, you should make sure that drugs that contain sympathomimetics are not used simultaneously in several ways, that is, orally and topically (drugs for the nose, ears and eyes).
Do not take with alcohol. The risk of overdose is greater in patients with non-cirotic alcoholic liver disease.
It is necessary to consult a doctor regarding the possibility of using the drug in patients with mild to moderate renal and liver dysfunction in the presence of persistent or chronic cough (due to smoking, asthma, chronic bronchitis or emphysema).
Paracetamol should be used with caution in patients using hepatotoxic drugs, digitalis, methyldopa or other antihypertensive drugs; persons with chronic malnutrition (low glutathione levels), Raynaud's phenomenon, asthma, granulocytopenia, arrhythmia, chronic lung diseases.
The drug should be used with caution in patients with myasthenia gravis and acute gastrointestinal disorders.
The drug contains sucrose. Persons with rare hereditary fructose intolerance, glucose-galactose malabsorption syndrome, or sucrase-isomaltase deficiency should not take this drug.
The drug contains 140 mg of sodium per dose. This must be taken into account in patients on a sodium controlled diet.
The drug contains aspartame (E951), a source of phenylalanine. May be harmful to people with phenylketonuria.
Use during pregnancy or breastfeeding. Paracetamol passes into breast milk, but in clinically insignificant quantities. Available published data do not contain any contraindications for breastfeeding.
Given the limited data on the use of the drug during pregnancy and lactation, it should be used only after consultation with a doctor.
The ability to influence reaction speed when driving vehicles or working with other mechanisms. The drug has a slight effect on the reaction rate, which should be taken into account when driving vehicles and working with other mechanisms.
Vicks Anti-Flu Complex dosage solution for oral administration Lemon No. 10
Indications
Symptoms of colds and flu (headache, sore throat, pain in the body and limbs, nasal congestion, cough with difficulty clearing viscous sputum, fever).
pharmachologic effect
A combined drug whose effect is determined by the composition of its constituent components.
Paracetamol
has analgesic and antipyretic effects.
Guaifenesin
has a mucolytic effect, facilitates the removal of sputum from the bronchi and promotes the transition of a non-productive cough to a productive one.
Phenylephrine
- a sympathomimetic, has pronounced alpha-adrenergic activity, constricts the vessels of the nasal mucosa, eliminates swelling and hyperemia of the nasal mucosa.
Drug interactions
Paracetamol
Inducers of microsomal oxidation in the liver (phenytoin, ethanol, barbiturates, flumecinol, rifampicin, phenylbutazone, tricyclic antidepressants) increase the production of hydroxylated active metabolites, which makes it possible to develop severe intoxication with a slight overdose.
Long-term use of barbiturates
reduces the effectiveness of paracetamol.
Simultaneous use with ethanol
increases the risk of acute pancreatitis.
Microsomal oxidation inhibitors (including cimetidine)
reduce the risk of hepatotoxicity.
When used together with NSAIDs, incl. salicylates,
the nephrotoxic effect of paracetamol increases.
Diflunisal
increases the plasma concentration of paracetamol by 50%, which increases the risk of hepatotoxicity.
Metoclopramide and domperidone
may increase the rate of absorption of paracetamol.
Cholestyramine
may reduce the rate of absorption of paracetamol.
Isoniazid
reduces the clearance of paracetamol by suppressing its metabolic transformation in the liver, which may lead to an increase in the pharmacological effects of paracetamol and/or its toxicity.
Probenecid
causes a decrease in the clearance of paracetamol by almost 2 times due to inhibition of the conjugation of paracetamol with glucuronic acid. When used concomitantly with probenecid, a reduction in the dose of paracetamol should be considered.
Regular use of paracetamol may lead to a possible decrease in the metabolism of zidovudine
(increased risk of neutropenia).
Paracetamol may reduce the bioavailability of lamotrigine
with a possible decrease in the severity of its effect due to the possible induction of the metabolic transformation of lamotrigine in the liver.
Paracetamol enhances the effect of indirect anticoagulants,
which increases the risk of bleeding and reduces the activity of uricosuric drugs.
Phenylephrine
Reduces the hypotensive effect of diuretics and antihypertensive drugs (including methyldopa, mecamylamine, guanadrel, guanethidine
).
Phenothiazines, alpha-blockers (phentolamine), furosemide
and other diuretics reduce the hypertensive effect.
MAO inhibitors (including furazolidone, procarbazine, selegiline), oxytocin, ergot alkaloids, tricyclic antidepressants, methylphenidate, adrenergic stimulants
enhance the pressor effect and arrhythmogenicity of phenylephrine.
Beta blockers
reduce cardiac stimulating activity; against the background of reserpine, arterial hypertension is possible (due to depletion of catecholamine reserves in adrenergic endings, sensitivity to adrenergic agonists increases).
Inhalational anesthetics (including chloroform, enflurane, halothane, isoflurane, methoxyflurane)
increase the risk of severe atrial and ventricular arrhythmias, since they sharply increase the sensitivity of the myocardium to sympathomimetics.
Ergometrine, ergotamine, methylergometrine, oxytocin, doxapram
increase the severity of the vasoconstrictor effect.
Reduces the antianginal effect of nitrates
, which in turn can reduce the pressor effect of sympathomimetics and the risk of arterial hypotension (simultaneous use is allowed depending on the achievement of the required therapeutic effect).
Thyroid hormones
increase (mutually) the effect and the associated risk of coronary insufficiency (especially with coronary atherosclerosis).
Concomitant use of phenylephrine and other sympathomimetic amines
may lead to increased blood pressure and other side effects from the cardiovascular system.
Concomitant use of cardiac glycosides (eg, digoxin)
and phenylephrine may increase the risk of arrhythmia and myocardial infarction.
Guaifenesin
Codeine
makes it difficult to clear liquefied sputum.
Compatible with bronchodilators, antimicrobial drugs, cardiac glycosides
.
Dosage regimen
Adults and children over 12 years old
— prescribe 1 sachet every 4-6 hours, but not more than 4 doses (sachets)/day. The maximum daily dose is 4 sachets.
The maximum duration of use of the drug without consulting a doctor is no more than 5 days. If after 5 days of treatment there is no improvement or symptoms worsen, or new symptoms appear, the patient should consult a doctor.
Contraindications for use
Liver dysfunction; severe chronic renal failure; arterial hypertension; hyperthyroidism; diabetes; phenylketonuria; IHD (acute myocardial infarction, atherosclerosis of the coronary arteries); aortic stenosis; tachyarrhythmia; peptic ulcer of the stomach and duodenum in the acute stage; prostatic hyperplasia; angle-closure glaucoma; porphyria; pheochromocytoma; age up to 12 years; pregnancy, lactation period; simultaneous use of beta-blockers, tricyclic antidepressants, MAO inhibitors (including within 14 days after their discontinuation); simultaneous use of other sympathomimetic drugs; simultaneous use of other drugs containing paracetamol; sucrase/isomaltase deficiency, fructose intolerance, glucose-galactose malabsorption syndrome; hypersensitivity to guaifenesin, paracetamol, phenylephrine or other components of the drug.
Carefully:
deficiency of glucose-6-phosphate dehydrogenase, blood diseases, congenital hyperbilirubinemia (Gilbert, Dubin-Johnson, Rotor syndromes), hyperoxaluria, bronchial asthma, COPD, mild to moderate renal failure, dehydration, hypovolemia, anorexia, bulimia and cachexia (insufficient supply glutathione in the liver), viral hepatitis, alcoholic liver damage, alcoholism, Raynaud's syndrome; simultaneous use of cardiac glycosides, beta-blockers, methyldopa and other antihypertensive drugs, old age.
Use in children
The use of the drug is contraindicated for children under 12 years of age.
Restrictions for children
Use with caution
Use in elderly patients
Elderly patients should take the drug with caution.
Restrictions for elderly patients
Use with caution
Use for liver dysfunction
The use of the drug is contraindicated in case of liver dysfunction.
Restrictions for liver dysfunction
Contraindicated
Use during pregnancy and breastfeeding
The drug should not be used during pregnancy and breastfeeding.
Restrictions when breastfeeding
Contraindicated
Restrictions during pregnancy
Contraindicated
Use for renal impairment
Contraindicated in severe chronic renal failure.
With caution: mild to moderate renal failure.
Restrictions for impaired renal function
Use with caution
special instructions
It is recommended to take the drug for the shortest possible course and in the minimum effective dose necessary to eliminate symptoms.
The drug should not be used simultaneously with other cough, cold, or decongestant medications.
The simultaneous use of the drug with other paracetamol-containing drugs should be avoided, as this may cause an overdose of paracetamol.
In patients with alcoholic liver disease, the negative consequences of overdose are more pronounced.
When using the drug for more than 5 days, peripheral blood counts and the functional state of the liver should be monitored.
The drug distorts the results of laboratory tests of glucose and uric acid in the blood plasma.
During treatment, it is recommended to take enough fluids.
The urine may turn pink.
Guaifenesin, which is part of the drug, may give false-positive results when determining 5-hydroxyindoleacetic and vanillinmandelic acids in urine due to the effect of guaifenesin metabolites on color (guaifenesin should be discontinued 48 hours before collecting urine for these tests).
The drug contains sodium, which must be taken into account in patients on a diet with reduced sodium intake.
The drug contains aspartame, which is a source of phenylalanine, which can be toxic to patients with phenylketonuria.
While using the drug, you must refrain from drinking alcohol and medications containing ethanol.
Impact on the ability to drive vehicles and machinery
When driving or engaging in other potentially hazardous activities, be aware that the drug may cause side effects such as dizziness and confusion.
Side effect
The incidence of adverse reactions is assessed as follows: very often (≥1/10), often (from ≥1/100 to <1/10), infrequently (from ≥1/1000 to <1/100), rarely (from ≥1 /10,000 to <1/1000), very rare (<1/10,000), frequency unknown (cannot be estimated from available data).
Paracetamol
Allergic reactions:
rarely - urticaria, anaphylaxis, bronchospasm, angioedema.
From the skin and subcutaneous tissue:
rarely - skin rash, frequency unknown - Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome), acute generalized exanthematous pustulosis.
From the nervous system:
rarely - dizziness.
From the side of the organ of vision:
rarely - accommodation paresis, increased intraocular pressure, mydriasis.
From the hematopoietic system:
rarely - aplastic anemia, methemoglobinemia; very rarely - pathological changes in the blood, such as thrombocytopenia, agranulocytosis, hemolytic anemia, neutropenia, leukopenia, pancytopenia.
From the cardiovascular system:
rarely - increased blood pressure.
From the digestive system:
rarely - nausea, vomiting, dry mouth, hepatotoxicity.
From the urinary system:
rarely - urinary retention, nephrotoxicity (papillary necrosis); frequency unknown - interstitial nephritis.
Phenylephrine
From the cardiovascular system:
rarely - tachycardia, arterial hypertension, accompanied by headache, vomiting and rapid heartbeat.
From the nervous system:
rarely - insomnia, nervousness, tremor, anxiety, agitation, confusion, irritability and headache.
From the digestive system:
often - anorexia, nausea and vomiting.
Allergic reactions:
rarely - skin rash, urticaria, anaphylaxis and bronchospasm.
Guaifenesin
From the nervous system:
rarely - headache, dizziness and drowsiness.
From the digestive system:
rarely - discomfort in the gastrointestinal tract, nausea, vomiting and diarrhea.
Interactions
With long-term regular use of paracetamol, the anticoagulant effect of warfarin and other coumarins may increase, increasing the risk of bleeding; Rare use does not cause such an effect.
Before using the drug, you should consult your doctor if the patient is using warfarin or similar drugs with an anticoagulant effect.
The hepatotoxicity of paracetamol may be enhanced by excessive alcohol consumption.
Metoclopramide or domperidone can increase the rate of absorption of paracetamol, and cholestyramine reduces the absorption of paracetamol. Pharmacological interactions between paracetamol and a number of other drugs have been reported. These interactions are considered unlikely to be clinically significant when used at the recommended dosage regimen.
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 conversion of paracetamol into hepatotoxic metabolites. When paracetamol is used in combination with hepatotoxic drugs, the toxic effect of the drugs on the liver increases.
The simultaneous use of paracetamol in high doses with isoniazid increases the risk of developing hepatotoxic syndrome.
Paracetamol reduces the effectiveness of diuretics.
Probenecid inhibits the binding of paracetamol to gloyuronic acid and thus leads to a decrease in the clearance of paracetamol by almost half. When using probenecid simultaneously, the dose of paracetamol should be reduced.
The combined use of paracetamol and zidovudine increases the risk of neutropenia. Thus, the simultaneous use of paracetamol and zidovudine must be carried out under medical supervision.
Existing hypertensive interactions with sympathomimetic amines such as phenylephrine and MAO inhibitors. Phenylephrine may reduce the effectiveness of beta-blocking drugs and antihypertensive drugs. This drug may increase the likelihood of arrhythmia in patients taking digitalis medications. Conditions when these drugs are used are a contraindication for this drug.
Phenylephrine may enhance the cardiovascular effects of other sympathomimetic amines (decongestants).
Concomitant use with halogenated anesthetics such as chloroform, cyclopropane, haloman, enflurane or isoflurane may cause or worsen ventricular arrhythmia.
The drug may affect laboratory test results for blood glucose and uric acid levels.
Vicks AntiGrip COMPLEX
Paracetamol
Inducers of microsomal oxidation in the liver (phenytoin, ethanol, barbiturates, flumecinol, rifampicin, phenylbutazone, tricyclic antidepressants) increase the production of hydroxylated active metabolites, which makes it possible to develop severe intoxication with small overdoses.
Long-term use of barbiturates reduces the effectiveness of paracetamol. Concomitant use with ethanol increases the risk of acute pancreatitis.
Inhibitors of microsomal oxidation (including cimetidine) reduce the risk of hepatotoxicity.
When taken together with non-steroidal anti-inflammatory drugs, including salicylates, the nephrotoxic effect of paracetamol increases.
Diflunisal increases the plasma concentration of paracetamol by 50%, which increases the risk of hepatotoxicity.
Metoclopramide and domperidone may increase the rate of absorption of paracetamol. Cholestyramine may reduce the rate of absorption of paracetamol.
Isoniazid reduces the clearance of paracetamol by suppressing its metabolic transformation in the liver, which may lead to an increase in the pharmacological effects of paracetamol and/or its toxicity.
Probenecid causes a decrease in the clearance of paracetamol by almost 2 times due to inhibition of the conjugation of paracetamol with glucuronic acid. When used concomitantly with probenecid, a reduction in the dose of paracetamol should be considered.
Regular use of paracetamol may lead to a possible decrease in the metabolism of zidovudine (increased risk of neutropenia).
Paracetamol may reduce the bioavailability of lamotrigine with a possible decrease in the severity of its effect due to the possible induction of the metabolic transformation of lamotrigine in the liver.
Paracetamol enhances the effect of indirect anticoagulants, which increases the risk of bleeding and reduces the activity of uricosuric drugs.
Phenylephrine
Reduces the hypotensive effect of diuretics and antihypertensive drugs (including methyldopa, mecamylamine, guanadrel, guanethidine).
Phenothiazines, alpha-blockers (phentolamine), furosemide and other diuretics reduce the hypertensive effect.
MAO inhibitors (including furazolidone, procarbazine, selegiline), oxytocin, ergot alkaloids, tricyclic antidepressants, methylphenidate, and adrenergic stimulants enhance the pressor effect and arrhythmogenicity of phenylephrine.
Beta-blockers reduce cardiac stimulating activity; in the presence of reserpine, arterial hypertension is possible (due to depletion of catecholamine reserves in adrenergic endings, sensitivity to adrenergic agonists increases).
Inhalation anesthetics (including chloroform, enflurane, halothane, isoflurane, methoxyflurane) increase the risk of severe atrial and ventricular arrhythmias because they sharply increase the sensitivity of the myocardium to sympathomimetics.
Ergometrine, ergotamine, methylergometrine, oxytocin, doxapram increase the severity of the vasoconstrictor effect.
Reduces the antianginal effect of nitrates, which in turn can reduce the pressor effect of sympathomimetics and the risk of arterial hypotension (simultaneous use is allowed depending on the achievement of the required therapeutic effect).
Thyroid hormones increase (mutually) the effect and the associated risk of coronary insufficiency (especially with coronary atherosclerosis).
Concomitant use of phenylephrine and other sympathomimetic amines may result in increased blood pressure and other cardiovascular side effects.
Concomitant use of cardiac glycosides (eg, digoxin) and phenylephrine may increase the risk of arrhythmia and myocardial infarction.
Guaifenesin
Codeine makes it difficult to clear liquefied mucus.
Compatible with bronchodilators, antimicrobial drugs, cardiac glycosides.
If you are using the above or other medications (including over-the-counter medications), consult your doctor before using Vicks AntiGrip COMPLEX.
Overdose
Paracetamol. Liver damage is possible in adults who took ≥10 g of paracetamol and in children who took 150 mg/kg body weight. Also, taking ≥5 g of paracetamol can lead to liver damage if the patient: is undergoing long-term treatment with carbamazepine, phenobarbital, phenytoin, primidone, rifampicin, St. John's wort or other drugs that induce liver enzymes; constantly drinks alcohol or there is a suspicion of glutathione depletion, for example, due to poor diet, cystic fibrosis, HIV infection, fasting, cachexia.
Symptoms. Symptoms of overdose when using paracetamol in the first 24 hours are pallor, nausea, vomiting, anorexia and abdominal pain. Liver damage may occur 12–48 hours after ingestion. Abnormal glucose metabolism and metabolic acidosis may occur. In severe poisoning, liver failure may progress to encephalopathy, hemorrhage, hypoglycemia, cerebral edema and death. AKI with acute tubular necrosis, indicated by low back pain, hematuria, and proteinuria, can occur even in the absence of severe liver damage. There have been reports of cardiac arrhythmia and pancreatitis.
With prolonged use of the drug in high doses, aplastic anemia, pancytopenia, agranulocytosis, neutropenia, leukopenia, thrombocytopenia may develop on the part of the hematopoietic organs. When taking the drug in high doses, the central nervous system may experience dizziness, psychomotor agitation and disorientation; from the urinary system - nephrotoxicity (renal colic, interstitial nephritis, capillary necrosis).
Treatment. When treating conditions following an overdose of paracetamol, despite the absence of severe early symptoms, patients should be immediately hospitalized for emergency medical care. Symptoms may be limited to nausea and vomiting and may not reflect the severity of the overdose or the danger of organ damage.
Treatment with activated charcoal should be considered if an excessive dose of paracetamol has been taken within 1 hour. Plasma concentrations of paracetamol should be measured ≥4 hours after administration (earlier concentrations are unreliable).
It is recommended to administer SH-group donors and precursors of glutathione synthesis (such as methionine, N-acetylcysteine) intravenously in doses that are determined depending on the concentration of paracetamol in the blood, as well as the time elapsed after its administration.
Treatment with N-acetylcysteine can be applied within 24 hours after taking paracetamol, but the maximum protective effect occurs when it is used within 8 hours after administration.
The effectiveness of the antidote decreases sharply after this time. If necessary, the patient should be administered N-acetylcysteine intravenously, according to the established list of doses. In the absence of vomiting, oral methionine can be used as an appropriate alternative in remote areas outside the hospital.
Phenylephrine hydrochloride. Signs of severe phenylephrine overdose include irritability, headache, convulsions, palpitations, paresthesia, vomiting, hyperpyrexia, cardiac pain, increased blood pressure, and associated reflex bradycardia and arrhythmia. Symptoms of severe overdose include severe peripheral and visceral vasoconstriction with cardiovascular collapse.
Therapy includes early gastric lavage, as well as symptomatic and supportive measures.
Guaifenesin. An overdose of low or moderate doses can cause dizziness or vertigo, gastrointestinal diseases. Overdose with very high doses may cause symptoms such as agitation, confusion and respiratory depression.
Vicks AntiFlu Complex powder in sachet for oral solution, 10 pcs.
Paracetamol.
Liver damage is possible in adults who took 10 g or more of paracetamol, and in children who took more than 150 mg/kg body weight. Also, taking 5 g or more of paracetamol can lead to liver damage if the patient: is undergoing long-term treatment with carbamazepine, phenobarbital, phenytoin, primidone, rifampicin, St. John's wort or other drugs that induce liver enzymes; constantly drinks alcohol or there is a suspicion of glutathione depletion, for example, due to poor diet, cystic fibrosis, HIV infection, fasting, cachexia.
Symptoms.
Symptoms of overdose when using paracetamol in the first 24 hours are pallor, nausea, vomiting, anorexia and abdominal pain. Liver damage may occur 12-48 hours after ingestion. Abnormal glucose metabolism and metabolic acidosis may occur. In severe poisoning, liver failure may progress to encephalopathy, hemorrhage, hypoglycemia, cerebral edema and death. Acute renal failure with acute tubular necrosis, indicated by low back pain, hematuria, and proteinuria, can occur even in the absence of severe liver damage. There have been reports of arrhythmia and pancreatitis.
With long-term use of the drug in large doses, the hematopoietic organs may develop aplastic anemia, pancytopenia, agranulocytosis, neutropenia, leukopenia, thrombocytopenia. When taking large doses, the central nervous system causes dizziness, psychomotor agitation and disorientation; from the urinary system - nephrotoxicity (renal colic, interstitial nephritis, capillary necrosis).
Treatment.
When treating paracetamol overdose conditions, despite the absence of severe early symptoms, patients should be immediately admitted to hospital for emergency medical treatment. Symptoms may be limited to nausea or vomiting and may not reflect the severity of overdose or the danger of organ damage.
Treatment with activated charcoal should be considered if an excessive dose of paracetamol has been taken within 1 hour. Plasma concentrations of paracetamol should be measured 4 hours or later after administration (earlier concentrations are not reliable). It is recommended to administer SH-group donors and precursors of glutathione synthesis (such as methionine, N-acetylcysteine) intravenously, in doses that are determined depending on the concentration of paracetamol in the blood, as well as the time elapsed after its administration. Treatment with N-acetylcysteine can be applied within 24 hours after taking paracetamol, but the maximum protective effect occurs when it is used within 8 hours after administration. The effectiveness of the antidote decreases sharply after this time. If necessary, the patient should be administered N-acetylcysteine intravenously, according to the established list of doses. In the absence of vomiting, oral methionine can be used as an appropriate alternative in remote areas outside the hospital.
Phenylephrine hydrochloride.
Signs of severe phenylephrine overdose include irritability, headache, seizures, palpitations, paresthesia, vomiting, hyperpyrexia, cardiac pain, increased blood pressure, and associated reflex bradycardia and arrhythmia. Symptoms of severe overdose include severe peripheral and visceral vasoconstriction with cardiovascular collapse.
Therapy includes early gastric lavage, as well as symptomatic and supportive measures.
Guaifenesin.
An overdose of small or moderate doses can cause dizziness or vertigo, gastrointestinal disorders. Very high doses may cause symptoms such as agitation, confusion and respiratory depression.
Note!
Description of the drug Vicks AntiGrip Pore Complex. d/oral. solution No. 10 on this page is a simplified author’s version of the apteka911 website, created on the basis of the instructions for use.
Before purchasing or using the drug, you should consult your doctor and read the manufacturer's original instructions (attached to each package of the drug). 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.
