Amosin

General characteristics. Structure:

Active agent: amoxicillin trihydrate (in terms of amoxicillin) - 250 mg, 500 mg. Excipients: potato starch, magnesium stearate, calcium stearate, magnesium гидроксиликат (talc), povidone (коллидон 90F).

Pharmacological properties:

Pharmacodynamics. Derivative dihydropyridine – the blocker of "slow" calcium channels, has anti-hypertensive and anti-anginal effect. Blocks calcium channels, reduces transmembrane transition of calcium ions to a cell (more in smooth muscle cells of vessels, than in cardiomyocytes).
Anti-hypertensive action is caused by direct vazodilatiruyushchy action on unstriated muscles of vessels. Has long dozozavisimy anti-hypertensive effect.
Amlodipin reduces myocardium ischemia (has anti-anginal effect) in two ways:
1) expands peripheral arterioles and thus reduces the general peripheric resistance of vessels, reduces an afterload by heart, at the same time heart rate practically does not change that leads to decrease in consumption of energy and need of a myocardium for oxygen;
2) expands coronary and peripheral arteries and arterioles in not changed and in ischemic zones of a myocardium that increases intake of oxygen in a myocardium (especially at vasospastic stenocardia), reduces expressiveness of ischemia of a myocardium and prevents development of a spasm of coronary arteries (including caused by smoking).
At arterial hypertension the single dose provides clinically significant lowering of arterial pressure for 24 h (in position of the patient "lying" and "standing"). Thanks to the slow beginning of action амлодипин does not cause a sharp lowering of arterial pressure. Does not reduce tolerance to an exercise stress and fraction of emission of a left ventricle.
At patients with stenocardia the single daily dose of an amlodipin increases time of performance of an exercise stress, slows down development of stenocardia and "ischemic" depression of a segment of ST (on 1 mm), reduces the frequency of attacks of stenocardia and consumption of nitroglycerine and other nitrates.
Reduces degree of a hypertrophy of a myocardium of a left ventricle, has anti-atherosclerotic and cardiotyre-tread effect at the coronary heart disease (CHD).
At patients from the ischemic heart diseases (including coronary atherosclerosis with defeat of one vessel and to a stenosis of three and more arteries and atherosclerosis of carotid arteries) which transferred a myocardial infarction, a transdermal transluminal angioplastinka of coronary arteries (TLAP) or having stenocardia, use of an amlodipin prevents development of a thickening erotic-medii of carotid arteries, considerably reduces a lethality from the cardiovascular reasons, a myocardial infarction, stroke, TLAP, aortocoronary shunting, leads to decrease in number of hospitalization concerning unstable stenocardia and progressing of chronic heart failure, reduces the frequency of the interventions directed to recovery of a coronary blood-groove.
Amlodipin does not increase risk of death or development of the complications leading to deaths at patients with chronic heart failure (the III-IV functional class on classification of the New York Association of cardiologists (NYHA)) against the background of therapy by digoxin, diuretics and inhibitors of an angiotensin-converting enzyme (APF).
Patients with chronic heart failure (the III-IV functional class on NYHA classification) not ischemic etiology at use of an amlodipin have a probability of emergence of a fluid lungs.
Does not exert impact on contractility and conductivity of a myocardium, does not cause reflex increase in the heart rate (HR), slows down aggregation of thrombocytes, raises a glomerular filtration rate, possesses a weak natriuretic effect. At a diabetic nephropathy does not increase expressiveness of a microalbuminuria. Does not exert adverse impacts on a metabolism and concentration of lipids in a blood plasma and it can be applied at treatment of patients with bronchial asthma, a diabetes mellitus and gout.
Time of approach of effect of drug - 2-4 hours, effect duration - 24 hours. At long therapy the maximum lowering of arterial pressure comes in 6-12 hours after reception of an amlodipin inside. If after long treatment амлодипин to cancel, the effective lowering of arterial pressure remains during 48 h after reception of the last dose. Then indicators of arterial pressure gradually are returned to initial level within 5-6 days.

Indications to use:

Arterial hypertension (monotherapy or in a combination with other antihypertensives).
Stable angina of exertion, vasospastic stenocardia (Printsmetal's stenocardia) (monotherapy or in a combination with other anti-anginal means).

Route of administration and doses:

Inside, accept irrespective of meal. The tablet can be swallowed entirely, to divide into parts or to chew, having washed down with a glass of water.
To adults and children 10 years are more senior (with body weight more than 40 kg) appoint 0.5 g 3 times a day; at the heavy course of an infection - on 0.75-1 g 3 times a day.
To children at the age of 3-5 years appoint 0.125 g 3 times a day, 5-10 years - on 0:25 g 3 times a day; at the heavy course of an infection - 60 mg/kg/days 3 times a day. Course of treatment of 5-12 days.
At acute uncomplicated gonorrhea appoint 3 g once; at treatment of women repeated reception of the specified dose is recommended.
At digestive tract acute infectious diseases (paratyphus, a typhoid) and bilious ways, at gynecologic infectious diseases adult - 1.5-2 g 3 times a day or on 1-1.5 g 4 times a day.
At a hay fever adult - 0.5-0.75 g 4 times a day within 6-12 days.
At a salmonellonositelstvo adult - 1.5-2 g 3 times a day during 2-4 weeks.
For prevention of an endocarditis at small surgical interventions adult - 3-4 g for 1 h before holding a procedure. If necessary appoint a repeated dose in 8-9 h. At children the dose is reduced twice.
At patients with a renal failure at KK of 15-40 ml/min. the interval between receptions is increased to 12 h; at KK lower than 10 ml/min. reduce a dose by 15-50%; at an anury - the maximum dose of 2 g/days.

Features of use:

When carrying out a course of treatment by Amosin it is necessary to exercise control of a condition of function of bodies of a hemopoiesis, a liver and kidneys.

Development of superinfection due to growth of microflora, insensitive to amoxicillin, is possible that demands corresponding change of antibacterial therapy.

At treatment of patients with bacteremia reaction of a bacteriolysis (Yarisha-Gerksgeymer's reaction) seldom develops.

At the patients having hypersensitivity to penicillin cross allergic reactions with tsefalosporinovy antibiotics are possible.

At treatment of slight diarrhea against the background of Amosin's use it is necessary to avoid purpose of the antidiarrheal drugs reducing an intestines peristaltics; it is possible to use a kaolin - or attapulgitsoderzhashchy antidiarrheal means. At heavy diarrhea it is necessary to carry out differential diagnosis and to appoint the corresponding therapy.

Treatment should be continued 48-72 more h after disappearance of clinical signs of a disease.

At simultaneous use of estrogensoderzhashchy oral contraceptives and amoxicillin it is necessary to use additional methods of contraception, whenever possible.

Side effects:

Allergic reactions: perhaps - a small tortoiseshell, a dermahemia, an erythema, a Quincke's disease, rhinitis, conjunctivitis; seldom - fever, joint pains, an eosinophilia, exfoliative dermatitis, a mnogoformny exudative erythema, Stephens-Johnson's syndrome, reactions similar to a serum disease; in isolated cases - an acute anaphylaxis.

From the alimentary system: dysbacteriosis, taste change, vomiting, nausea, diarrhea, stomatitis, glossitis, abnormal liver function, moderate increase in activity of hepatic transaminases; seldom - a pseudomembranous coloenteritis.

From TsNS and peripheral nervous system: excitement, uneasiness, sleeplessness, ataxy, confusion of consciousness, change of behavior, depression, peripheral neuropathy, headache, dizziness, convulsive reactions.

From an urinary system: seldom - intersticial nephrite.

From system of a hemopoiesis: leukopenia, neutropenia, Werlhof's disease, anemia.

Others: the complicated breath, tachycardia, vagina candidiasis, superinfection (especially at patients with chronic diseases or the lowered resistance of an organism).

Interaction with other medicines:

Antacids, glycosamine, purgatives, food, antibiotics of group of aminoglycosides at simultaneous use slow down and reduce amoxicillin absorption; ascorbic acid - increases its absorption.

Bactericidal antibiotics (including aminoglycosides, cephalosporins, Cycloserinum, Vancomycinum, rifampicin) show a synergism with amoxicillin; bacteriostatic drugs (macroleads, chloramphenicol, linkozamida, tetracyclines, streptocides) - antagonism.

Amoxicillin at simultaneous use increases efficiency of indirect anticoagulants (suppressing intestinal microflora, reduces synthesis of vitamin K and a prothrombin ratio); reduces efficiency of estrogensoderzhashchy oral contraceptives, ethinylestradiol (risk of development of intermenstrual bleedings), and also medicines in the course of which metabolism para-aminobenzoic acid is formed.

Diuretics, Allopyrinolum, оксифенбутазон, the phenylbutazone, NPVS and drugs blocking canalicular secretion at simultaneous use with Amosin reducing canalicular secretion, increase concentration of amoxicillin.

At simultaneous use of Amosin with Allopyrinolum the risk of development of skin rash increases.

Amoxicillin at simultaneous use reduces clearance and increases toxicity of a methotrexate.

Amoxicillin at simultaneous use strengthens digoxin absorption.

Contraindications:

Hypersensitivity to an amlodipin, other derivatives of dihydropyridine and other components of drug;
- heavy arterial hypotension (systolic arterial pressure is less than 90 mm hg);
- cardiogenic shock;
- an acute myocardial infarction during the first 28 days;
- unstable stenocardia (except for vasospastic);
- obstruction of the taking-out path of a left ventricle (including clinically significant stenosis of an aorta);
- age up to 18 years;
- lactose intolerance, deficit of lactase, glyukozo-galaktozny malabsorption.
 
Use at pregnancy Safety of use of an amlodipin at pregnancy is not established therefore use at pregnancy is possible only in that case when the advantage of use for mother exceeds potential risk for a fruit.
Are absent this, testimonial of excretion of an amlodipin with breast milk. However it is known that other blockers of "slow" calcium channels - dihydropyridine derivatives, are excreted with breast milk. In this connection, in need of purpose of the drug Amlorus® in the period of a lactation it is necessary to resolve an issue of the breastfeeding termination.
Women of childbearing age have to use reliable methods of contraception.

Overdose:

Symptoms: nausea, vomiting, diarrhea, disturbance of water and electrolytic balance (as a result of vomiting and diarrhea).

Treatment: gastric lavage, absorbent carbon, salt purgatives; the measures directed to maintenance of water and electrolytic balance; hemodialysis.

Storage conditions:

List B. In the dry, protected from light place at a temperature not above 25 °C. To store in the places unavailable to children. Period of validity 2 years. Not to apply after expiry date.

Issue conditions:

According to the recipe

Packaging:

Tablets of 250 mg: 10.

Tablets of 500 mg: 10.