Декадрон®

General characteristics. Structure:

Active ingredient: 0,5 mg of dexamethasone in 1 tablet.

Pharmacological properties:

Pharmacodynamics. GKS - metilirovanny derivative a ftorprednizolona, slows down release interleykina1 and interleykina2, interferon scale from lymphocytes and macrophages. Renders the antiinflammatory, antiallergic, desensibilizing, antishock, anti-toxic and immunodepressive effect. Suppresses release by a hypophysis of AKTG and beta липотропина, but does not reduce the level of the circulating beta endorphine. Oppresses secretion of TTG and FSG. Increases excitability of TsNS, reduces quantity of lymphocytes and eosinophils, increases - erythrocytes (stimulates production of erythropoetins).

Interacts with specific cytoplasmatic receptors and forms the complex getting into a kernel of a cell and stimulates synthesis of MRNK; the last induces formation of proteins, including the lipokortin mediating cellular effects. Lipokortin oppresses A2 phospholipase, suppresses release of arachidonic acid and suppresses synthesis of endoperoxides, Pg, the leukotrienes promoting processes of an inflammation, an allergy, etc. Protein metabolism: reduces amount of protein in plasma (at the expense of globulins) with increase in coefficient albumine/globulin, increases synthesis of albumine in a liver and kidneys; strengthens a protein catabolism in muscular tissue. Lipidic exchange: increases synthesis of higher fatty acids and TG, redistributes fat (accumulation of fat is preferential in the field of a shoulder girdle, the person, a stomach), leads to development of a hypercholesterolemia.

Carbohydrate metabolism: increases absorption of carbohydrates from a GIT; increases activity of the glyukozo-6-phosphatase leading to increase in intake of glucose from a liver in blood; increases activity of a fosfoenolpiruvatkarboksilaza and synthesis of the aminotransferases leading to activation of a gluconeogenesis. Water and electrolytic exchange: Na + and water in an organism detains, stimulates removal of K+ (the ISS activity), reduces absorption of Ca2 + from a GIT, "washes away" Ca2 + from bones, increases removal of Ca2 + kidneys.

The antiinflammatory effect is connected with release oppression by eosinophils of mediators of an inflammation; induction of formation of a lipokortin and reduction of quantity of the mast cells producing hyaluronic acid; with reduction of permeability of capillaries; stabilization of cellular membranes and membranes of organellas (especially lizosomalny). The antiallergic effect develops as a result of suppression of synthesis and secretion of mediators of an allergy, braking of release from sensitized mast cells and basophiles of a histamine, etc. biologically active agents, reduction of number of the circulating basophiles, suppression of development of adenoid and connecting tissue, decrease in quantity of T-and B-lymphocytes, mast cells, decrease in sensitivity of effector cells to mediators of an allergy, oppression of antibodyformation, change of an immune response of an organism.

At HOBL action is based mainly on braking of inflammatory processes, oppression of development or the prevention of hypostasis of mucous membranes, braking of eosinophilic infiltration of a submucosal layer of an epithelium of bronchial tubes, adjournment in a mucous membrane of bronchial tubes of the circulating cell-bound immune complexes, and also braking of an erozirovaniye and desquamation of a mucous membrane. Increases sensitivity of beta adrenoceptors of bronchial tubes of small and average caliber to endogenous catecholamines and exogenous sympathomimetics, reduces viscosity of slime due to oppression or reduction of its products. Antishock and anti-toxic action is connected with increase in the ABP (due to increase in concentration of the circulating catecholamines and recovery of sensitivity to them of adrenoceptors, and also vasoconstriction), decrease in permeability of a vascular wall, membranoprotektorny properties, activation of the enzymes of a liver participating in metabolism endo-and xenobiotics. The immunodepressive effect is caused by braking of release of cytokines (interleykina1, interleykina2; interferon scale) from lymphocytes and macrophages.

Suppresses synthesis and secretion of AKTG and for the second time - synthesis of endogenous GKS. Slows down connective tissue reactions during inflammatory process and reduces a possibility of formation of cicatricial fabric. Feature of action - considerable inhibition of function of a hypophysis and almost total absence of the ISS of activity. Doses of 1-1.5 mg/days oppress bark of adrenal glands; biological T1/2 - 32-72 h (duration of oppression of system a hypothalamus-hypophysis-bast layer of adrenal glands). On GKS force of activity of 0.5 mg of dexamethasone there correspond about 3.5 mg of Prednisonum (or Prednisolonum), 15 mg of a hydrocortisone or 17.5 mg of a cortisone.

Indications to use:

The inflammatory and allergic diseases, nausea and vomiting caused by chemotherapeutic means, shock and wet brain (injections).

Route of administration and doses:

Inside, in/in, in oil, vnutrisustavno or vnutribursalno. The dosage and a course of treatment are established individually according to disease severity and reaction of the patient. At acute states use of high doses is also in case of emergency admissible (to 20 mg). Further the dosage should be supported at the minimum therapeutic level.

Features of use:

Prior to the beginning of and during GKS of therapy it is necessary to control the general blood test, level of a glycemia and content of electrolytes in plasma. Appointing dexamethasone at intercurrent infections, septic states and tuberculosis, it is necessary to carry out treatment by bactericidal antibiotics at the same time.

At daily use by 5 months of treatment the atrophy of bark of adrenal glands develops. Can mask some symptoms of infections; during treatment it is useless to carry out immunization.

At sudden cancellation, especially in case of the previous use of high doses, there is a syndrome of "cancellation" of GKS (it is not caused by a hypocorticoidism): loss of appetite, nausea, block, generalized musculoskeletal pains, adynamy. After cancellation within several months relative insufficiency of bark of adrenal glands remains. If during this period there are stressful situations, appoint (according to indications) for the period of GKS, in need of a combination to the ISS.

At children during prolonged treatment careful observation of dynamics of growth and development is necessary. To children who during treatment were in contact with patients with measles or chicken pox preventively appoint specific Ig. In the I trimester, in the period of a lactation appoint only according to "vital" indications, taking into account the expected medical effect and negative influence on a fruit.

At long therapy during pregnancy - a fruit growth disorder. In the III trimester of pregnancy - danger of emergence of an atrophy of bark of adrenal glands at a fruit that can demand performing replacement therapy from the newborn. During treatment by dexamethasone (especially long) observation of the oculist, control of the ABP and water and electrolytic balance, and also a picture of peripheral blood and level of a glycemia is necessary.

For the purpose of reduction of by-effects it is possible to appoint anabolic steroids, antacids, and also to increase receipt of K+ in an organism (a diet, the drugs K+). Food has to be rich K+, proteins, vitamins, with the maintenance of a small amount of fats, carbohydrates and salts. At children in a growth period of GKS have to be applied only according to absolute indications and under especially careful observation of the attending physician.

Side effects:

Frequency of development and expressiveness of side effects depend on duration of use, size of the used dose and a possibility of observance of a circadian rhythm of appointment.

From endocrine system: decrease in tolerance to glucose, a "steroid" diabetes mellitus or manifestation of a latent diabetes mellitus, oppression of function of adrenal glands, an Icenco-Cushing syndrome (a crescent-shaped face, obesity of pituitary type, a hirsutism, increase in the ABP, a dysmenorrhea, an amenorrhea, a myasthenia, striya), a delay of sexual development at children.

From the alimentary system: nausea, vomiting, pancreatitis, "steroid" stomach ulcer and 12-perstny gut, erosive esophagitis, bleedings and perforation of a GIT, increase or loss of appetite, meteorism, hiccups. In rare instances - increase in activity of "hepatic" transaminases and ShchF.

From CCC: arrhythmias, bradycardia (up to a cardiac standstill); development (at predisposed patients) or strengthening of expressiveness of HSN, ECG change characteristic of a hypopotassemia, increase in the ABP, hypercoagulation, fibrinferments. Patients with an acute and subacute myocardial infarction have a distribution of the center of a necrosis, delay of formation of cicatricial fabric that can lead to a rupture of a cardiac muscle.

From a nervous system: delirium, disorientation, euphoria, hallucinations, maniac-depressive psychosis, depression, paranoia, increase in intracranial pressure, nervousness or concern, sleeplessness, dizziness, вертиго, cerebellum pseudoneoplasm, headache, spasms.

From sense bodys: a back subkapsulyarny cataract, increase in intraocular pressure with possible injury of an optic nerve, tendency to development of consecutive bacterial, fungal or viral infections of eyes, trophic changes of a cornea, an exophthalmos. From a metabolism: the increased removal of Ca2+, a hypocalcemia, increase in body weight, negative nitrogenous balance (the increased disintegration of proteins), the increased sweating. The caused ISS activity - a delay of liquid and Na + (peripheral hypostases), a hypernatremia, a gipokaliyemichesky syndrome (a hypopotassemia, arrhythmia, a mialgiya or a spasm of muscles, unusual weakness and fatigue).

From a musculoskeletal system: delay of growth and processes of ossification at children (premature closing of epiphyseal regions of growth), osteoporosis (it is very rare - pathological fractures of bones, an aseptic necrosis of a head humeral and a femur), a rupture of sinews of muscles, a "steroid" myopathy, decrease in muscle bulk (atrophy).

From integuments and mucous membranes: the slowed-down healing of wounds, petechias, ecchymomas, thinning of skin, an atrophy of skin and hypodermic cellulose, hyper - or hypopigmentation, steroid eels, striya, tendency to development of a pyoderma and candidiases.

Allergic reactions: generalized (skin rash, skin itch, acute anaphylaxis), local allergic reactions. Other: development or an exacerbation of infections (emergence of this side effect is promoted jointly by the applied immunodepressants and vaccination), a leukocyturia, a syndrome of "cancellation". Overdose.

Symptoms: strengthening of the described side effects is possible. In this case the dose of drug should be reduced. Treatment: symptomatic.

Interaction with other medicines:

Pharmaceutical it is incompatible with other. Hp (can form insoluble compounds). Dexamethasone increases toxicity of cardiac glycosides (because of the arising hypopotassemia the risk of development of arrhythmias increases). Accelerates removal of ASK, reduces its level in blood (at dexamethasone cancellation concentration of salicylates in blood increases and the risk of development of by-effects increases).

At simultaneous use with live antiviral vaccines and against the background of other types of immunizations increases risk of activation of viruses and development of infections. Increases metabolism of an isoniazid, meksiletin (especially at "bystry acetylizers") that leads to decrease in their plasma concentration.

Increases risk of development of a hepatotoxic action of paracetamol (induction of "hepatic" enzymes and formation of a toxic metabolite of paracetamol). Increases (at long therapy) the content of folic acid. The hypopotassemia caused by GKS can increase expressiveness and duration of muscular blockade against the background of muscle relaxants.

In high doses reduces effect of a somatropin.

Antacids reduce absorption of GKS.

Dexamethasone reduces action of hypoglycemic HP; strengthens anticoagulating action of derivatives of coumarin. Weakens influence of vitamin D on absorption of Ca2 + in an intestines gleam.

Ergocalciferol and parathormone interfere with development of the osteopathy caused by GKS. Reduces concentration of a prazikvantel in blood.

Cyclosporine (metabolism oppresses) and кетоконазол (reduces clearance) increase toxicity.

Thiazide diuretics, inhibitors of a karboangidraza, other GKS and Amphotericinum In increase risk of development of a hypopotassemia, the Na+-containing HP - hypostases and increase in the ABP.

NPVP and ethanol increase danger of development of an ulceration of a mucous membrane of a GIT of bleeding, in a combination with NPVP for treatment of arthritis GKS dose decline because of summation of therapeutic effect is possible.

Indometacin, forcing out dexamethasone from communication with albumine, increases risk of development of its side effects.

Amphotericinum In and inhibitors of a karboangidraza increase risk of development of osteoporosis.

Therapeutic action of GKS decreases under the influence of Phenytoinum, barbiturates, ephedrine, theophylline, rifampicin, etc. inductors of "hepatic" microsomal enzymes (increase in speed of metabolism).

Mitotanum, etc. inhibitors of function of bark of adrenal glands can cause need of increase in a dose of GKS. The clearance of GKS increases against the background of hormones of a thyroid gland.

Immunodepressants increase risk of development of infections and a lymphoma or other limfoproliferativny disturbances connected with Epstein's virus - Barrel.

Estrogen (including oral estrogensoderzhashchy contraceptives) reduces clearance of GKS, extends T1/2 and their therapeutic and toxic effects.

Emergence of a hirsutism and eels is promoted by simultaneous use of other steroid hormonal HP - androgens, estrogen, anabolic steroids, oral contraceptives.

Tricyclic antidepressants can increase expressiveness of the depression caused by reception of GKS (are not shown for therapy of these side effects).

The risk of development of a cataract increases at use against the background of other.

GKS, antipsychotic HP (neuroleptics), Carbutamidum and Azathioprinum.

Co-administration with m-holinoblokatorami (including antihistaminic HP, tricyclic antidepressants), nitrates promotes development of increase in intraocular pressure.

Contraindications:

For short-term use according to "vital" indications the only contraindication is giperchuvstvitelnost.s care.

Parasitic and infectious diseases of the virus, fungal or bacterial nature (now or recently postponed, including recent contact with the patient) - the herpes simplex surrounding herpes (a viremichesky phase), chicken pox, measles; the amebiasis, a strongyloidosis (established or suspected); system mycosis; active and latent tuberculosis.

Use at serious infectious diseases is admissible only against the background of specific therapy. Pre-and the postvaccinal period (8 weeks to and 2 weeks after vaccination), lymphadenitis after BTsZh inoculation. Immunodeficiency (including AIDS or HIV infection).

Gastrointestinal diseases - a peptic ulcer of a stomach and a 12-perstny gut, an esophagitis, gastritis, an acute or latent round ulcer, recently created intestines anastomosis, nonspecific ulcer colitis with threat of perforation or abscessing, a diverticulitis.

Diseases of CCC, including recently postponed myocardial infarction (at patients with an acute and subacute myocardial infarction distribution of the center of a necrosis, delay of formation of cicatricial fabric and thereof - a rupture of a cardiac muscle is possible), dekompensirovanny HSN, arterial hypertension, lipidemia.

Endocrine diseases - a diabetes mellitus (including disturbance of tolerance to carbohydrates), a thyrotoxicosis, a hypothyroidism, Itsenko-Cushing's disease.

Heavy chronic renal and/or liver failure, нефроуролитиаз. The hypoalbuminemia and states contributing to its emergence.

System osteoporosis, gravis myasthenia, acute psychosis, obesity (the III-IV Art.), poliomyelitis (except for a form of bulbar encephalitis), open and closed-angle glaucoma, the lactation period.

Storage conditions:

In the place protected from light. List B. To store in the place, unavailable to children.

Issue conditions:

According to the recipe

Packaging:

On 100 tablets in packaging.