Journalist

The journalist refers to strong analgesic drugs, natural opium alkaloids. Its active ingredient is hydromorphone, a derivative of the well-known analgesic drug morphine hydrochloride. A journalist is considered a narcotic drug, is released strictly according to the prescription of the doctor and is taken under his strict control.

Indications Journalist

The drug is used in severe pain syndrome of different etiology:

• severe pain caused by traumatic or other pathological lesions (except for skull injuries and stroke status);
• state of myocardial infarction;
• extensive burn injuries;
• a state of painful shock;
• pain in acute inflammatory processes of internal organs;
• intestinal, hepatic and renal colic;
• inoperable cases of oncological diseases;
• before and after surgery;
• cardiac asthma.

Release form

The drug is manufactured in tablets, 7 pieces in synthetic blister plates. Carton boxes with an annotation can contain one or four blisters.

The active component is hydromorphone.

• Tablets of 8 mg include 7.12 mg of the active ingredient.
• Tablets of 16 mg each include 14.24 mg of the active ingredient.
• Tablets of 32 mg include 28.48 mg of the active ingredient.
• Tablets of 64 mg include 59.96 mg of active ingredient.

Among the additional substances in the preparation are lactose, polyethylene oxide, macrogol, butylhydroxytoluene, cellulose acetate, povidone, sodium chloride, titanium dioxide, magnesium stearate, iron oxide, etc.

Tablets have a prolonged effect, have a rounded shape, convexity on both sides, a logo indicating the dosage of the drug.

Tablets can also have a different color depending on the dosage:

• 8 mg - red;
• 16 mg - yellow;
• 32 mg is white;
• 64 mg are blue.

Pharmacodynamics

The active ingredient of the drug is a synthetic derivative of morphine, an alkaloid opium. A strong analgesic effect is due to the oppressive effect on the opioid receptors, which are located in the subcortical structure of the brain, as well as blocking the passage of a pain pulse to the cerebral cortex. The drug directly affects the central nervous system and smooth muscles, including in the digestive system.

The journalist can cause depression of respiratory functions, secretory and motor ability of the gastrointestinal tract, as well as an increase in the tone of the valvular system of the bladder and smooth muscles of the system of bronchi, gall bladder and internal female genital organs. The drug can slow down metabolic processes and lower body temperature.

[1], [2], [3], [4],

Pharmacokinetics

One-time administration of the prolonged journalist means a slow increase in the concentration of the active ingredient for seven hours, after which its content in the blood remains unchanged about 20-24 hours. The maximum amount of substance is detected, after 12-14 hours after administration. Such indicators indicate that the Journalist is sufficient to use only once a day.

The drug becomes bioavailable by 23-25%, and a large amount of fats in food does not affect the absorption of the active substance.

Multiple administration of the drug (more than 4 times) allows to achieve the stability of the active ingredient in the blood serum, while the pharmacokinetic parameters of the Journalist do not change.

Reception of the Journalist with prolonged exposure once every 24 hours determines in the blood serum the same concentration as the intake of hydromorphone of usual use in the amount of 4 times a day. Binding to plasma proteins is <30%.

Metabolites are excreted through the urinary system, the rest through the bile ducts.

[5], [6], [7], [8]

Dosing and administration

To determine the effective and at the same time safe dosage of the drug, it is necessary to assess the patient's condition, taking into account the nature of the pain and accompanying pathologies. Opioid preparations can have a different effect on patients; therefore, experts recommend starting therapy using the minimum therapeutic dosage. The initial dosage rises gradually until the optimal level of anesthesia is achieved with the minimum number of side effects.

The Journalist's Tablet should be swallowed without chewing and grinding, at least 200 ml of liquid. Reception is desirable to be carried out every time at the same time of day, exactly after 24 hours. If the patient forgot to take the dosage on time, it should be taken as soon as possible. The next step is now counted from the newest last time of tablet use.

The initial dosage should not be more than 8 mg per day. Further increase in dosage, if necessary, is performed once in two to three days, increasing the dose by 25-100% of the previous dose.

Sometimes, along with the use of the Journalist, patients with persistent pain symptoms may be prescribed other opioid preparations that are normal (not prolonged). The proportion of such drugs compared with the Journalist should not exceed 10-25% of his daily dosage.

The course of treatment is stopped gradually, lowering the dosage by 50% every two days before returning to the minimum dosage, after which the therapy can be completed. A sharp cessation of treatment can trigger the development of withdrawal symptoms. If pain relief was resumed during the period of dose reduction, the dose is briefly raised again by 25%, using longer intervals.

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Use Journalist during pregnancy

There were no full-scale clinical trials regarding the use of the Journalist during pregnancy. It is well known that the active component of the drug in small amounts, but still found in breast milk, therefore it is forbidden to use the Journalist during lactation.

The risk of teratogenic effects in the use of the drug is not currently known, but experts do not recommend using the Journalist during pregnancy. This is due to the fact that hydromorphone is able to influence the smooth muscle fibers of the uterus and inhibit the respiratory function of the newly born baby.

There are cases when children whose mothers have been treated with opioids subsequently had abstinence (somatoneurological or psychiatric disorders).

Contraindications

The reception of an anesthetic preparation of the Journalist has a number of contraindications:

• allergic reactions to the components of the drug;
• narrowing of any parts of the digestive tract (condition after some operations or pathologies), gastrointestinal obstruction, blind loop syndrome in the intestine;
• disorders of the functionality of the liver;
• respiratory function disorders;
• acute pain with an unexplained diagnosis;
• active stage of bronchial asthma;
• treatment with MAO inhibitors, as well as the first two weeks after the withdrawal of these drugs;
• treatment with other opiates;
• children's age (up to 2 years);
• trauma to the skull, stroke status;
• febrile and convulsive conditions;
• pregnancy and lactation.

The journalist has a pronounced effect on the ability to drive a vehicle or other complex mechanisms. Especially, this effect is manifested in the first day of therapy, with increasing dosage or when the drug is withdrawn.

[9], [10], [11], [12], [13], [14]

Side effects Journalist

Mediapreparat Journalist has a fairly large number of adverse events:

• Dyspeptic phenomena (delayed defecation, attacks of nausea);
• increased appetite, stool disorders, thirst, epigastric pain, bloating and rumbling in the abdomen, development of gastroenteritis;
• inadequate secretion of androgens;
• sleep disorders, depressive state, irritability, impaired consciousness, psychoemotional disorders;
• pain in the head, dizziness, impaired sensation, change in taste, emotional instability;
• deterioration of visual functions, double vision;
• disorders of the heart rhythm, destabilization of blood pressure, redness of the skin;
• the appearance of shortness of breath, a sense of lack of air;
• increased sweating, itching of the skin;
• soreness of muscles, joints, limbs;
• disturbances of urination;
• decreased libido, erectile dysfunction;
• lethargy, swelling, fever, withdrawal syndrome;
• violation of electrolyte and water balance, increase in the number of liver enzymes, a decrease in the amount of testosterone in the bloodstream.

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Overdose

Signs of a journalist overdose:

• depression of the respiratory center;
• drowsiness, until the development of stupor and coma;
• apathy, lowering of pressure and temperature;
• narrowing of the pupils;
• disorders of cardiac activity;
• severe overdose - stopping breathing, cardiac activity, circulatory hypoxia and collapse, even to death.

Urgent measures with an overdose should be aimed at restoring respiratory function, it is possible to use artificial ventilation. If the use of a large amount of the drug has just happened, it is necessary to rinse the stomach immediately.

Shock and beginning pulmonary edema require additional oxygen supply and the appointment of vasoconstrictors.

Cardiac arrest, as a rule, requires a closed massage or defibrillation of the heart.

It is possible to use specific antidotes (naloxone and nalmefene) in order to restore respiratory function. Antidotes have a short-term effect, so careful monitoring of the patient is necessary before resuming stable independent breathing. Antidotes can not be used without the presence of reliable signs of opioid exposure to the body, and should be used very carefully when the patient is physically dependent on opium preparations: a sudden discontinuation of the hydromorphone can trigger a withdrawal syndrome.

Interactions with other drugs

Combined use of the Journalist and MAO inhibitors can provoke an excited or depressed CNS state, destabilization of blood pressure.

Using a Journalist with agonistic and antagonistic drugs of morphine (pentazocine, buprenorphine, nalbuphine) can lead to a decrease in the analgesic effect and the danger of the emergence of an abstinence syndrome. The combination of such drugs can not be categorically allowed.

Using a Journalist with barbiturates, sedatives and antipsychotics, alcoholic beverages can provoke an addictive depressant effect, in particular, on respiratory centers. May develop hypotension, coma.

The journalist is able to strengthen the action of myorelaxing drugs and cause respiratory depression.

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Storage conditions

The drug should be stored in a dark, dry place, out of the reach of children. The temperature optimal for storing the drug is from 15 to 30 ° C.

Shelf life

Maximum shelf life - up to 2 years.

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