Ranferon

Ranferon is an anti-anemic drug, an iron medicine. It contains various minerals with polyvitamins, as well as iron.

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Indications of the ranferone

Used to eliminate anemia, which is provoked by a deficiency in the body of folic acid and iron.

Release form

Release is carried out in capsules, 10 pieces in the first blister. Inside a separate pack contains 3 blister plates.

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Pharmacodynamics

Ranferon is a balanced drug complex that includes zinc sulfate, iron fumarate, ascorbic and folic acid, and cyanocobalamin. All these substances are required by the body for a stable hematopoietic process inside the bone marrow.

Iron is an integral part of myoglobin with hemoglobin, as well as a variety of enzymes. It reversibly synthesizes oxygen, and besides it promotes its movement inside tissues, provokes erythropoiesis and is a participant in several oxidation-reduction processes. The body needs iron in pregnancy, lactation, in adolescents with active growth, as well as during menstruation and other bleeding.

Folic acid in combination with cyanocobalamin causes erythropoiesis, is a participant in the binding of nucleotides to amino acids and nucleic acids, as well as the process of choline metabolism. In pregnancy, vitamin B9 is required for healthy development in the fetus of nerve endings, and in addition, it protects the child from teratogenic effects and is an important element in the reactions of the cellular immune system.

Cyanocobalamin - a participant in the binding of nucleotides. It is very important for the stable development and growth of epithelial cells, as well as the processes of ripening of erythrocytes and hematopoiesis. The component is necessary for the metabolism of vitamin B9 and the synthesis of myelin. Vitamins B12 and B9 prevent the appearance of a megaloblastic form of anemia, as well as neurological disorders.

Ascorbic acid has a powerful restoring effect. Included in the category of water-soluble vitamins. Is a participant in oxidation-reduction processes, regulates the metabolism of carbohydrates. In addition, it affects the metabolism of amino acids (included in the category of aromatic) and thyroxine, the processes of biosynthesis of steroid hormones, as well as catecholamines and insulin (necessary for blood clotting). It also affects the binding of procollagen to collagen and helps the healing of bone and connective tissues. Together with this, it improves the capillary permeability, helps the absorption of iron inside the intestine, and promotes the binding of hemoglobin. Strengthens the nonspecific resistance of the body and acts as an antidote. When there is a lack of vitamin C in food, avitaminosis or hypovitaminosis of type C develops, because this substance is not synthesized inside the organism.

Zinc has structural, catalytic and regulating properties when exposed to 200+ zinc-metal containing enzymes found within biosystems. These enzymes help the metabolism of proteins with nucleic acids, as well as in the production of energy. In addition, zinc helps in the formation of "zinc fingers" (they are used by transcription factors - to get interaction with DNA while regulating gene activity).

Another structural property of zinc is the support of the integrity of the membranes of biological membranes, thereby helping to protect them from acid damage. Zinc is very important in the processes of protein synthesis, as well as cell division. With a deficiency of this element, low growth, anemia, and also geophagia and hypogonadism are observed. In addition, there are also problems with wound healing, erythrocyte fragility increases and the fluidity of their membranes changes.

Dosing and administration

The duration of the course and the size of the doses are prescribed by the treating doctor.

The standard adult dosage is 1 capsule 1-2 times per day. It is recommended to take the medicine before meals (for 30-40 minutes), washing down with water or juice.

The duration of the therapeutic course is often 1-3 months.

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Use of the ranferone during pregnancy

Pregnant or lactating women can use the medicine exclusively with the appointment of a doctor and only in cases where the likelihood of benefit to the mother will be higher than the risk of complications in the fetus / child.

Contraindications

Among the contraindications of the medicine:

• presence of folate dependent tumors, as well as intolerance of elements of the drug;
• malignant pathologies (excluding the megaloblastic form of anemia), provoked by a deficiency of vitamin B9, and in addition the disease of Marciyafawa-Micheli;
• an excess of stored iron inside the body (presence of hematochromatosis or hemosiderosis) or a tendency to such a disease;
• other types of anemia, and in addition to the condition that develops not because of a lack of iron (such as hemolytic, hypo- or aplastic form of anemia, iron-saturated and B12-deficient anemia, as well as anemia due to lead intoxication, hemoglobinopathy and thalassemia) ;
• Vakeza-Osler disease or erythrocytosis;
• acute form of thromboembolism, as well as tumors, except accompanied by a megaloblastic form of anemia;
• late stage of cutaneous porphyria and hepatic cirrhosis;
• acute forms of inflammatory processes inside the intestine;
• exacerbated ulcerative pathology in the stomach or the duodenum gut;
• intestinal diverticulum;
• intestinal obstruction;
• frequent blood transfusions;
• use in combination with parenteral administration of iron, thrombosis, as well as abdominal pain and vomiting with nausea of unknown origin;
• propensity to develop thrombosis;
• presence of thrombophlebitis;
• severe kidney pathologies, diabetes, urolithiasis (in case of daily doses exceeding 1 g of vitamin C).

Side effects of the ranferone

Taking capsules can cause such adverse reactions:

• the area of the digestive tract: the appearance of gastric pain, vomiting, constipation or diarrhea, as well as nausea and bloating. Fecal staining can be observed in black, a feeling of overfilling of the stomach, a taste of metal, loss of appetite, darkening of tooth enamel, heartburn, and irritation of mucous membranes inside the digestive tract;
• areas of the skin and subcutaneous layer: rashes, redness, acne, pruritus, bullous type rash and urticaria;
• immune reactions: manifestations of hypersensitivity (the development of anaphylaxis or anaphylactic shock with the existing sensitization, as well as bronchial spasms) and angioedema;
• area of NS: dizziness with headaches, sleep disorders and increased excitability;
• organs of the hematopoiesis system: the development of erythrocytopenia or hyperprotrombinemia, thrombocytosis, and neutrophilic leukocytosis. In individuals with G6FD deficiency and erythrocytes, the development of erythrocytolysis is possible;
• Other: a feeling of general weakness, increased sweating, the appearance of hot flashes, the development of hyperthermia.

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Overdose

In case of excess of the required dose, an overdose may develop. A dose of 180-300 mg / kg is considered fatal. But for individuals, even a dose of 30 mg / kg of elemental iron can be poisonous. In young children, the likelihood of acute intoxication is especially high - even 1 g of iron fumarate is enough to develop a life-threatening poisoning.

Signs of acute intoxication with iron manifest after 10-60 minutes or several hours after the use of drugs.

Among the manifestations: epigastric and abdominal pain, vomiting (sometimes with blood) and nausea, as well as diarrhea with green excrements (further they become tarry) and melena. These symptoms can be supplemented by a feeling of weakness, drowsiness, cyanosis and acrocyanosis, pallor of the skin and the release of sticky cold sweat. Also, the level of blood pressure may decrease, heartbeat, heartbeat, hyperthermia, confusion develop, as well as convulsions, paresthesia and necrosis of the mucosa inside the digestive tract. In the absence of medicinal measures after 12-48 hours, the development of coma and shock, in which there is a toxic form of liver failure, oliguria, as well as coagulopathy and a spiropram of the Cheyne-Stokes type.

Medicinal methods: in cases of severe overdosage, it is required to immediately render assistance to the victim: perform gastric lavage (use water or phosphate-buffered or soda solution). It is also necessary that the patient use more milk and raw eggs - this will help the formation of insoluble iron compounds inside the digestive tract and contribute to the elimination of iron from the body.

If necessary, the treatment of acidosis and a shock condition is performed. Individuals who developed anuria / oliguria require hemodialysis or peritoneal dialysis.

The most suitable way to determine the severity of the condition is to analyze the iron level inside the serum, and at the same time evaluate its iron binding ability. If the maximum iron limit is exceeded, suitable for normal serum iron binding, systemic intoxication may develop.

Special therapy methods:

It is required to check up vomitive masses for presence in them of medical capsules. If you can not remove the required amount, you should wash the stomach with an aqueous solution of sodium carbonate (1%) or a solution of sodium chloride (0.9%), and then give the patient a laxative.

People who have acute intoxication, you need to take the antidote of iron - deferoxamine substance. Chelation treatment with its use is carried out in such situations:

• the use of a potentially lethal dose of 180-300 mg / kg or higher;
• with serum iron values exceeding 400-500 μg / dL;
• the level of iron inside the serum is greater than its iron-binding ability, or the person has signs of severe iron poisoning: shock or coma.

In acute overdose, to bind iron that is not absorbed, it is required to take orally deferoxamine in the amount of 5-10 g (dissolve in the usual water contents of 10-20 ampoules). When the absorbed iron is eliminated, the drug substance is injected in the / m way every 3-12 hours in the amount of 1-2 g. If the patient develops a shock condition, a drip injection of the 1st dL of the IV method is performed, and a symptomatic treatment.

Manifestations of intoxication with vitamin C: in the case of a single dose of LS in a large dose, vomiting, abdominal pain, nausea, itching, flatulence, skin rash and increased excitability are observed.

Long-term administration of large doses of Ranferon can lead to suppression of the function of the insular apparatus in the pancreas (it is required to monitor its work) and the appearance of cystitis, and in addition to accelerate the formation of concrements (oxalates with urates). In addition, pain in the heart may occur, the level of blood pressure may rise, myocardial dystrophy or tachycardia develop. Damages may occur in the glomerular renal area, the formation of cystine, urate or oxalate stones inside the kidneys and urinary ducts, the development of crystalluria, glucosuria or hyperglycemia, and in addition the disorder of the glycogen synthesis process (up to the development of diabetes mellitus), and the violation of the metabolism of copper and zinc . An unjustified prolonged use of drugs can provoke hemosiderosis.

To eliminate the disorders, it is necessary to cancel the intake of the medicine, do gastric lavage, take activated charcoal (or other sorbents), perform alkaline drinking and treat the symptoms.

Interactions with other drugs

As a result of the combination of the drug with antacids, which contain aluminum, bismuth, and calcium with magnesium, and with it, when combined with cimetidine or colestyramine, the absorption of Ranferon from the digestive tract decreases.

Absorption of iron decreases when combined with coffee, black tea, bread, eggs and dairy products, as well as raw cereals and solid foods.

Tetracyclines and penicillamine in combination with Ranferon form complex compounds, which reduce the absorption of iron and weaken the effectiveness of drugs.

GKS are able to increase the stimulation of erythropoiesis, carried out by Ranferon.

Vitamin C increases the level of bioavailability of iron after internal use. The combination with tocopherol can weaken the medicinal effect of iron on the body.

Iron salts lower the bioavailability of methyldopa with levodopa, and in addition, weaken the absorption of thyroxine with zinc and sulfasalazine with DNA-gyrase inhibitors (such as levofloxacin with ofloxacin, and ciprofloxacin with norfloxacin).

The combination of iron and NSAID drugs increases the irritating effect of iron on the mucosa inside the digestive tract.

Absorption of vitamin B9 decreases in the case of combination with anticonvulsants, analgesics, cytostatics (methotrexate) and sulfonamides, and also with neomycin, trimethoprim and triamterene.

The use of folic acid weakens the effectiveness of PASC, chloramphenicol, primidone with phenytoin, and oral hormonal contraception and sulfasalazine, as it increases the metabolism of these drugs.

Combination with chloramphenicol inhibits the absorption of iron, and in addition reduces the hematopoietic properties of cyanocobalamin.

Absorption of cobalamin decreases in the case of combination with PASC, tetracyclines, hormonal contraception and anticonvulsants. In addition, a similar effect has a combination with neomycin, ranitidine, kanamycin, as well as colchicine, polymyxins and potassium drugs.

It is forbidden to take Ranferon simultaneously with allopurinol and methotrexate, as well as pyrimethamine and disulfiram.

Absorption of vitamin C is weakened in combination with OK, alkaline drink, as well as vegetable or fruit juices.

The internal intake of ascorbic acid enhances the absorption of tetracyclines with penicillins, as well as iron. Together with this, it weakens the effect of indirect anticoagulants with heparin and increases the likelihood of the appearance of crystalluria in the case of salicylates.

Combination of ascorbic acid with deferoxamine increases the toxic properties of iron inside tissues (it particularly affects the heart muscle), which can lead to the development of systemic blood flow decompensation. Therefore, vitamin C should be consumed at least 2 hours after the administration of deferoxamine.

The medicine in high doses weakens the effect of tricyclics and neuroleptics (phenothiazine derivatives) and reabsorption of amphetamine inside the tubules, and also prevents the excretion of mexiletine through the kidneys.

Vitamin C increases the total ethanol clearance. Medications from the category of quinolines, salicylates, calcium chloride and corticosteroids reduce the vitamin supply in the body in the case of prolonged intake of these drugs.

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Storage conditions

The medicine must be kept in a place where moisture does not penetrate, and also inaccessible children. Temperature values are a maximum of 25 ° C.

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Shelf life

Ranferon is allowed to be used during the 2 years since the release of the medicine.