Zomax

Zomax is an azalide macrolide that has a large range of antimicrobial activity.

Indications Zomax

It is used in inflammatory and infectious processes, triggered by the influence of pathogens that are sensitive to azithromycin:

• diseases affecting the lungs with bronchi and ENT organs;
• pathologies affecting the subcutaneous tissue and epidermis;
• diseases associated with the urogenital system and having no complications;
• as a complex element in the destruction of the Helicobacter bacterium.

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

Release form

The release of the substance is realized in tablets with a volume of 0.5 g, 2-3 pieces inside the pack, and in addition, in capsules with a volume of 0.25 g, 6 pieces each inside the cell plates. In the box - 1 record.

[4]

Pharmacodynamics

Minimum portions of azithromycin have bacteriostatic activity, and higher dosages lead to the development of bactericidal effect. The drug irreversibly inhibits the protein binding inside the ribosomes of the bacteria, which destroys the binding of functional proteins, with inhibition of their reproduction and growth.

Zomax , as well as chlamydia and gonococci.

Also, the drug affects chlamydia pneumonia, mycoplasma pneumonia and legionella pneumonia. The bactericidal effect develops against pathogens of ureaplasma with toxoplasmosis and Helicobacter.

At the same time, azithromycin exhibits anti-inflammatory activity by suppressing the formation of pro-inflammatory cytokines, as a result of which oxidative stress is inhibited and production of PG and thromboxane is reduced.

Anti-inflammatory properties of drugs are comparable with the effect of NSAIDs. 

The drug quickly passes inside the leukocytes, after which it is released at a low speed inside the infectious area, which creates prerequisites for local influence on the inflammatory-infectious area.

Azithromycin can stimulate immune activity, as well as activate neutrophilic apoptosis after the process of rehabilitation of the affected area, thereby slowing local damage and reducing the risk of possible involvement of host cells in the immune activity.

[5], [6]

Pharmacokinetics

The drug continues to maintain its activity inside the acidic gastric environment, thereby developing its therapeutic effect.

When used inside the blood indicators of drugs are recorded after 2-3 hours. Intracellular cumulation of large azithromycin values in the affected tissues occurs with the participation of macrophages with leukocytes, which transfer the drug to the affected area, releasing it there. At the same time, high indices are formed inside the tissues, significantly exceeding the serum values of drugs.

Half-life is 54 hours. Cmax level is determined after 2.5-2.96 hours after application of 0.5 g of azithromycin (the indicator of the substance inside the blood plasma is 0.4 mg / l).

Bioavailability values are 37%. Metabolic processes develop inside the hepatobiliary organs. The drug is 50% excreted in the bile (unchanged substance), and another 6% is eliminated with urine.

Dosing and administration

Zomax is administered orally. Assign it to short courses, components of 3-5 days, with 1-time use per day. The use of drugs is prohibited to combine with the use of food, because it violates its absorption inside the gastrointestinal tract. Reception should occur 1 hour before meals or after 2 hours after.

Children whose weight exceeds 45 kg, as well as adults, the drug is used according to the following schemes:

• diseases affecting the upper respiratory tract and lungs with bronchi, as well as epidermal infections: 1 time per day 0.5 g of the substance. The cycle lasts 3 days;
• chronic form of migratory erythema in nature: on the first day - 1000 mg of azithromycin, in the period of 2-5 days - 0.5 g;
• lesions of the urogenital system (without complications): take 1000 mg of the drug once a day;
• destruction of helicobacter: 1000 mg of the drug over a 3-day cycle, combining with combined substances;
• other inflammations and infections: use of 0.5 g of the drug 1 time per day. The cycle is 3 days.

If the drug was missed, therapy should be resumed over the next 24 hours. Further portions are used with a 24-hour gap.

With CRF (GFR values are within 10-80 ml / minute), dosage change is not required.

If the GFR values are below 10 ml / minute, the medication should be used very carefully.

[11], [12],

Use Zomax during pregnancy

Azithromycin is used in lactating or pregnant only if there is a high probability of mother help.

Contraindications

Main contraindications:

• the appointment of people with intolerance against azithromycin, macrolides, or the constituent elements of the drug;
• use in patients with a weight of less than 45 kg.

[7], [8]

Side effects Zomax

It is believed that azithromycin is one of the safest antibacterial substances, because its use only rarely leads to the emergence of life-threatening negative medical manifestations.

Epidermal lesions in the form of dermatitis may occur. Occasionally, symptoms of Quincke's edema, urticaria, photophobia, and also TEN and Stevens-Johnson syndrome were recorded.

Occasionally, there are disorders associated with the work of NA: a feeling of anxiety, drowsiness or nervousness, dizziness or headaches, taste or olfactory disorders, signs of seizures, paresthesia and sleep disorders.

Single macrolides provoke hearing impairment or ear ringing, especially in the case of prolonged use of large dosages of drugs. After discontinuation of azithromycin, these symptoms can be reversed.

Macrolides can prolong the QT-interval, which increases the likelihood of heartbeat or rhythm disorders, the development of ventricular tachycardia, and a decrease in blood pressure.

The use of azithromycin is much less likely to cause signs of dyspepsia than the use of other antibacterial drugs. Occasionally, stool disorders, intestinal flatulence, glossitis, hepatitis, and intrahepatic cholestasis appear. Pancreatitis, oral candidiasis, pseudomembranous colitis and loss of appetite were reported sporadically.

Symptoms may occur in the form of asthenia, vaginitis, tubulointerstitial nephritis, and besides arthralgia and candidiasis.

Occasionally, changes in test results are recorded: a single decrease in leukocyte and platelet counts with neutrophils. More often, symptoms of a decrease in blood bicarbonates and lymphocytes, an increase in blood urea, eosinophils, bilirubin, AST with ALT and creatinine appear. Occasionally, hyperglycemia develops.

[9], [10]

Overdose

The introduction of large portions of Zomax can provoke nausea with vomiting, upset stools and impaired hearing, which has a treatable character.

With the development of such disorders, gastric lavage is first performed, and then symptomatic measures are carried out.

[13], [14], [15], [16]

Interactions with other drugs

It is necessary to very carefully combine the drug with ketoconazole, haloperidol and quinidine, and in addition with lithium, haloperidol and terfenadine, because these substances prolong QT values, because of which myocardial repolarization symptoms are potentiated.

Antacids do not affect the absorption parameters of Zomax.

The combination of cetirizine with the drug slightly potentiates the repolarization occurring inside the myocardium.

The drug does not affect the substances inactivated by the hemoprotein system.

The use of ergot alkaloids leads to symptoms of ergotism.

The therapeutic effect of digoxin may be enhanced when used in combination with azithromycin, because the latter increases the level of Cmax of digoxin.

Coumarin anticoagulant activity for ingestion is potentiated when used with medication.

Combined with the drug zidovudine may increase the values of the active metabolic product within mononuclear cells, although this does not have any clinical consequences.

The maximum absorption of cyclosporine increases with the introduction of azithromycin, due to which the medicinal properties of the first may change. Therefore, the dosage of this substance must be adjusted.

Fluconazole reduces the Cmax value of azithromycin by 18%, but this does not affect the clinical picture.

Nelfinavir significantly increases the plasma values of azithromycin, because of which the negative signs of the latter are amplified.

The combination of Zomax with rifabutin rarely leads to neutropenia, which must be taken into account when monitoring the patient.

[17], [18], [19], [20], [21], [22]

Storage conditions

Zomax is required to be maintained at temperature elevations in the range of 15-25 ° C.

[23]

Shelf life

Zomax can be used for a period of 36 months from the date of release of the pharmaceutical preparation.

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Analogs

Analogues of the medication are the drugs Azithromycin, Azitrus, Azitral and Sumamed with Zitrox and Azaks, and in addition Zitrolid, Azitrox, AzitroSandoz, Hemomitsin with Azitsin and Zetamax with Zi-factor.

[25], [26], [27]