Indicated for removing rheumatoid arthritis forms (also juvenile type), SLE and DHQ, and besides dermatitis that developed under the action of sunlight (or the deterioration manifestations of the disease).
By suppressing or treating acute malaria attacks provoked plazmodium wiwaxia, Plasmodium oval and P.malariae, and moreover susceptible strains of bacteria plazmodium falciparum. Also, when a radical treatment of malaria, which is triggered by susceptible strains of bacteria plazmodium falciparum.
Produced in tablets - 10 pieces on a blister plate. In one bundle - 3 blisters.
Antimalarial components (chloroquine, as well as hydroxychloroquine) have several pharmacological effects that cause their medicinal effect in the process of elimination of rheumatic pathologies (but the role of these mechanisms remains unclear).
Among the effects are interaction with thiol groups, changes in the activity of enzymes (among such phospholipase, protease, NADH-hemoprotein C-reductase, and addition of hydrolase with cholinesterases), DNA synthesis. In addition, the normalization of lysosome membranes, the slowing down of the formation of PG, and in addition phagocytosis with the chemotaxis of polymorphonuclear cells. At the same time, they are able to interfere with the binding of IL-1 monocytes and slowing down the release of superoxide by neutrophils.
Pharmacokinetic properties, the mechanism of action, as well as the process of metabolism of hydroxychloroquine are similar to those of chloroquine. After consuming drugs, hydroxychloroquine is quickly and almost completely absorbed. During the testing on volunteers who took a single dose of the drug (400 mg), it was found that the peak level of the substance is in the range of 53-208 ng / ml, and the average value is 105 ng / ml. The average time period necessary to obtain the maximum plasma index is 1.83 hours.
The half-life varies depending on the time elapsed from the time of consumption, respectively: 5.9 hours (peak 10 hours), 26.1 hours (peak 10-48 hours), and 299 hours (peak 48- 504 hours).
Related compounds with the products of decay are distributed within all tissues of the body, and excreted mainly in the urine. There is a test, which showed that after 24 hours from the time of drug administration only 3% of the dosage was withdrawn.
Use of immarda during pregnancy
It is forbidden to appoint pregnant and lactating women.
Among the contraindications:
intolerance to 4-aminoquinoline derivatives;
presence in the anamnesis of retinopathy, hepatic or renal pathologies, maculopathy, blood diseases or CNS, and in addition porphyria;
people with rare congenital disorders (among them sensitivity to galactose, lactase deficiency or impaired absorption of glucose-galactose);
children weighing less than 31 kg;
prolonged use in children;
with the patient's porphyria at the time of treatment.
Side effects of immarda
Admission tablets can cause the development of these side effects:
visual organs: the development of nystagmus. Sometimes there is the appearance of retinopathy with the development of defects in the visual field, and in addition to changes in pigmentation, but if the required dosages such symptoms are rare. At an early stage of retinopathy of its development process is reversible after drug discontinuation. But if this is not done in time, there is a risk that the disease will progress after the late cancellation. There may be changes in the retina, which initially are asymptomatic or manifested as color perception disorder or temporal, or pericentral paracentral forms cattle. May develop problems with the cornea (such as clouding or swelling). These disorders are sometimes asymptomatic, but sometimes contribute to the development of blurred vision, and besides the appearance of halos or photophobia. Such disorders may be transient and reversible, if you discontinue therapy. The loss of visual clarity arises from the accommodation disorders and is dependent on the dosage. This disorder is reversible;
skin: sometimes itching, and in addition, skin rash, skin pigmentation changes with pigmentation of mucous membranes occurs alopecia, discolored hair, developing porphyria. These disorders often disappear with the abolition of drugs. Bullous rash can appear with a single observation type of erythema multiforme and malignant exudative erythema, and in addition photophobia. In the cases described separately appeared dermatitis Ritter. Occasionally pustular rash (generalized exanthematous form) acute type - it has to be distinguished from psoriasis, although the current drug substance is able to induce an exacerbation, and this pathology. It is possible that this is due to leukocytosis, and an increase in temperature. If you cancel the medicine disorders are often reversible;
digestive organs: diarrhea, severe nausea, and furthermore abdominal pain, and anorexia; occasionally vomiting occurs. These symptoms disappear after dosage reduction or abolition of drugs;
NA bodies: the appearance of noise in the ears, severe dizziness, sudden headaches, feelings of nervousness, emotional instability. Furthermore, hearing loss, convulsions, ataxia, toxic psychoses, the occurrence of nightmares, and suicidal behavior;
muscles and skeleton: the emergence of progressive muscular dystrophy or neyromiopatii that cause the development of weakness and subsequent atrophy of the proximal muscles. This pathology is reversible drug cases, but full recovery can occur only after a few months. May develop mild sensory disturbances, pain in the legs, the suppression of tendon reflexes, and in addition to this type of abnormal nerve conduction;
authorities CCC: cardiomyopathy occurs sporadically. If you have any problems with conductivity (so-called bundle branch block blockade) or started ventricular hypertrophy each, it is possible that the onset of chronic poisoning. In case of cancellation PM conductivity can be restored;
bodies of the hematopoietic system: rarely is suppressed bone marrow function; singly anemia (aplastic or its form), trombotsito- or leukopenia, and in addition haemolysis in people with G6PD disadvantage. Active drug component can exacerbate deterioration porphyria or percolation of the disease;
hepatobiliary disorders: changes in the values of liver function tests; there is information about the development of fulminant forms of liver failure;
intolerance reactions: allergic reactions, including angioedema, urticaria, bronchospasm. Besides itching and redness;
Other: weight reduction.
Dosing and administration
The medicine should be consumed orally. Adults, and together with this elderly people, need a minimum dosage, which gives a medicinal effect (it is not allowed to be above 6.5 mg / kg (the calculation is based on the ideal and not actually available weight) per day and is usually 200 or 400 mg).
People who are allowed to consume 400 mg of medicine per day - at the initial stage this dosage should be divided into 2 separate receptions. If there are no noticeable signs of improvement, it is allowed to reduce it to 200 mg. If the drug works effectively, you can increase the daily maintenance dosage to a value of 400 mg.
Children are prescribed a minimally effective daily dosage (no more than 6.5 mg / kg of ideal weight value). It is because of this that it is forbidden to prescribe medication in 200 mg tablets to children whose ideal weight is less than 31 kg.
During elimination of attacks of malaria - for adults the dosage is equal to 400 mg on the same days of the week. In childhood (children weighing 31+ kg), a weekly dosage for an attack is 6.5 mg / kg, but it can not exceed the recommended adult dosage, regardless of weight.
If circumstances permit, overwhelming treatment should be started 2 weeks before the trip to the area of endemia distribution. In the absence of such an opportunity for adults, a double loading dose is prescribed (800 mg), and for children - 12.9 mg / kg weight (but not more than 800 mg), which is divided into 2 separate doses with an interval of 6 hours. Suppressive therapy should be continued 8 weeks after the person has left the endemic area.
Treatment in case of acute malarial attacks. The size of the initial adult dosage is 800 mg, followed by 400 mg every 6-8 hours for the next 2 days (on the whole, 2 g of the active ingredient of the drug is obtained). As an effective alternative, you can use a single dose of LS at a dosage of 800 mg. You can count on it, given the weight (as for the child).
Children with an ideal weight of 31+ kg - the total dosage is 32 mg / kg (but maximum 2 g), it should be taken for 3 days, taking into account the additions described below:
initial - 12.9 mg / kg (but with a single dose of no more than 800 mg);
2 nd - 6.5 mg / kg (but with a maximum of 400 mg) 6 hours after the use of the initial dosage;
3rd - 6.5 mg / kg (maximum 400 mg) 18 hours after the use of the 2nd dosage;
4th - 6.5 mg / kg (maximum size 400 mg) 24 hours after the use of the 3rd dosage.
All tablets should be consumed with food or by washing them with milk (1 glass).
Hydroxychloroquine is able to accumulate in the body, so several weeks are needed to get the drug, but weak negative reactions can appear quite early. In the case when in the treatment of rheumatic pathologies for six months there is no improvement in the patient's condition, it is recommended to stop the course.
In the treatment of pathologies associated with intolerance to light, it is required to limit therapeutic courses exclusively to periods of constant exposure to light.
Overdose of 4-aminoquinolines is very dangerous for babies, because for them the use of this substance even in the amount of 1-2 g can lead to death.
Among the manifestations are: visual disturbance, severe headaches, seizures, cardiac conduction disorder, and at the same time rhythm (including QT interval prolongation), cardiovascular collapse, development of hypokalemia, ventricular fibrillation and ventricular tachycardia. A sudden (sometimes fatal) cardiac arrest with breathing may also occur.
Since such a reaction may appear immediately after the use of a large dose of drugs, it is required to immediately perform therapy aimed at eliminating the signs of the disorder. It will require gastric lavage and induction of vomiting. The intake of activated carbon in a size that is not less than 5 times the amount of medicines consumed can prevent its subsequent absorption (when activated carbon is injected into the stomach via a probe immediately after the rinsing procedure, no later than half an hour after the drug is consumed).
In case of an overdose, the variant of administering a diazepam substance by the parenteral method may be considered. There is evidence that this drug can weaken the symptoms of cardiotoxicity, provoked by chloroquine.
If necessary, procedures are performed to maintain respiratory function, and anti-shock treatment is also performed.
Interactions with other drugs
Hydroxychloroquine sulphate is able to increase the digoxin plasma index, which means that people taking these drugs simultaneously need to monitor the serum level of digoxin.
Hydroxychloroquine sulphate is also capable of interacting with chloroquine. When combined, the following effects are possible: increased blocking properties of aminoglycosides with respect to the myoneural synapse; the slowing down of the metabolism of the substance under the action of cimetidine, which increases the level of antimalarial drugs inside the plasma; antagonism with respect to the properties of pyridostigmine with neostigmine; decrease in the number of antibodies formed (as a reaction to the performance of immunization of the primary type - intradermal human vaccine (diploid cell) against rabies).
Similar to chloroquine, antacids also have an effect - they weaken the absorption of hydroxychloroquine. Because of this, when combining such drugs it is necessary to observe a minimum 4-hour interval between their methods.
Since hydroxychloroquine is capable of increasing the properties of antidiabetic drugs, a combination of them may require a decrease in the dosage of insulin or hypoglycemic drugs.
Halofantrine prolongs the QT-interval, so it can not be combined with other drugs that can provoke cardiac arrhythmia (this list includes hydroxychloroquine). In addition, the likelihood of developing ventricular arrhythmias increases - with combined use of the drug with other arrhythmogenic drugs (among them moxifloxacin with amiodarone).
The combination of Immard with cyclosporine causes an increase in its plasma indices.
Hydroxychloroquine is able to lower the border of the convulsive threshold. When combined with other antimalarial drugs, which also reduce the convulsive threshold (such as mefloquine), the likelihood of seizures increases.
Combination with anticonvulsants can lead to a decrease in their effectiveness.
Studies conducted to study the interaction of once-combined chloroquine and praziquanthal, showed a decrease in the bioavailability of the latter. There is no information as to whether it is possible to develop the same effect in the case of combination with hydroxychloroquine with praziquanthal. If we extrapolate this information, given that the pharmacokinetics and structure of chloroquine with hydroxychloroquine are very similar, we can conclude that the development of such an impact should be expected.
Combined therapy with agalicidase can theoretically provoke a slowdown in the activity of α-galactosidase within cells.
The medicine is stored in standard conditions for medicines, inaccessible to children. Temperature values - no more than 25 ° С.
Immard permitted within 2 years since the release of the drug.
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To simplify the perception of information, this instruction for use of the drug "Immard" translated and presented in a special form on the basis of the official instructions for medical use of the drug. Before use read the annotation that came directly to medicines.
Description provided for informational purposes and is not a guide to self-healing. The need for this drug, the purpose of the treatment regimen, methods and dose of the drug is determined solely by the attending physician. Self-medication is dangerous for your health.
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