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DRUGS & SUPPLEMENTS
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Aspirin:
Symtor Forte is a NSAIDs. It has anti-inflammatory, analgesic and antipyretic effect, and inhibits platelet aggregation. The mechanism of action is associated with inhibition of COX activity - the main enzyme metabolism of arachidonic acid which is a precursor of prostaglandins which play a major role in the pathogenesis of inflammation, pain and fever. Reduction of prostaglandins (mainly E1) in the thermoregulation center leads to a decrease in body temperature due to expansion of blood vessels of the skin and increase perspiration. Analgesic effect of Symtor Forte (Aspirin) is due to both central and peripheral effects. Reduces aggregation, platelet adhesion and thrombus formation through suppression of synthesis of thromboxane A2 in platelets.
Reduces mortality and risk of myocardial infarction in unstable stenocardia. It is effective in primary prevention of cardio-vascular system and secondary prevention of myocardial infarction. At a daily dose of 6 g or more inhibits the synthesis of prothrombin in the liver and increases the prothrombin time. Symtor Forte (Aspirin) increases fibrinolytic activity of plasma and reduces the concentration of vitamin K-dependent coagulation factors (II, VII, IX, X). Increases the rate of hemorrhagic complications in carrying out surgical procedures, increases the risk of bleeding during therapy with anticoagulants. It stimulates the excretion of uric acid (violating its reabsorption in the renal tubules) but in high doses. The blockade of COX-1 in the mucosa of the stomach leads to inhibition of gastroprotective prostaglandins, which may lead to ulceration of the mucous membrane and subsequent bleeding.
When administered orally Symtor Forte (Aspirin) is rapidly absorbed mainly from the proximal small intestine and to a lesser extent from the stomach. The presence of food in the stomach significantly affects the absorption of Symtor Forte (Aspirin).
Metabolised in the liver by hydrolysis with the formation of salicylic acid with subsequent conjugation with glycine or two drugs. The concentration of salicylates in blood plasma is variable.
About 80% of salicylic acid binds to plasma proteins. Salicylates easily penetrate into many tissues and body fluids, including the cerebrospinal, peritoneal and synovial fluid. In small quantities salicylates are found in brain tissue, traces - in bile, sweat and feces. Quickly penetrates the placental barrier in small amounts excreted in breast milk.
For newborns salicylates may displace bilirubin from its association with albumin and promote bilirubin encephalopathy.
Penetration into the joint cavity is accelerated in the presence of hyperemia and edema, and slows down in the proliferative phase of inflammation.
If you have acidosis most of salicylate becomes unionized acid, good penetration into the tissue, including in the brain.
Symtor Forte (Aspirin) withdraws mainly by active secretion in the tubules of the kidneys in unchanged form (60%) and in the form of metabolites. The withdraw of unchanged salicylate is dependent on the pH of urine (for alkalinization of urine increases ionized salicylates, worsening their reabsorption and increases excretion). T1/2 of Symtor Forte (Aspirin) is approximately 15 minutes. T1/2 of salicylate at a reception in low doses is 2-3 h, with an increase in dose may increase to 15-30 hours. Newborns' elimination of salicylate is much slower than in adults.
Rheumatism, rheumatoid arthritis, infectious-allergic myocarditis, fever during infectious and inflammatory diseases, pain syndrome, weak and medium intensity of various origins (including neuralgia, myalgia, headache); based prevention of thrombosis and embolism, primary and secondary prevention of myocardial infarction, prevention of violations of cerebral circulation by ischemic type.
In the clinical immunology and allergy: a gradually increasing doses for a prolonged "aspirin" desensitization and the formation of stable tolerance to NSAIDs in patients with "aspirin asthma" and "aspirin triad."
Individual. For oral administration dosing of Symtor Forte regimen depends on indication for use. Usual adult dose when used as antipyretic and analgesic is 500-1000 mg / day (up to 3 g) were divided into 3 admission.
In myocardial infarction, as well as for secondary prevention in patients after myocardial infarction - 40-325 mg 1 time a day (usually 160 mg). As an inhibitor of platelet aggregation - a dose of 300-325 mg / day, for a long time. At the dynamic circulatory disorders in men, cerebral thromboembolism, including to prevent a recurrence - 325 mg / day with gradual increase to a maximum of 1 g / day. For prevention of thrombosis or occlusion of the aortic shunt - by 325 mg every 7 h after intranasal gastric tube set, and then - through the mouth to 325 mg 3 times a day (usually in combination with dipyridamole, which abolished after 1 week, continuing the long-term treatment with Symtor Forte (Aspirin)).
Digestive system: nausea, vomiting, anorexia, epigastric pain, diarrhea; rarely - occurrence of erosive and ulcerative lesions, bleeding from the gastrointestinal tract, abnormal liver function.
Central nervous system: long-term use may be dizziness, headache, reversible visual disturbances, tinnitus, aseptic meningitis.
Hemopoietic system: rarely - thrombocytopenia, anemia.
Blood coagulation system: rarely - haemorrhagic syndrome, prolongation of bleeding time.
Urinary system: rarely - renal dysfunction, with prolonged use - acute kidney failure, nephrotic syndrome.
Allergic reactions: rarely - skin rash, Quincke's edema, bronchospasm, "aspirin triad" (a combination of bronchial asthma, recurrent nasal polyposis, and paranasal sinuses and intolerance of Symtor Forte (Aspirin) and medicines pirazolonic series).
Other: in some cases - Reye syndrome, long-term use - increased symptoms of chronic heart failure.
Exacerbation phase of erosive-ulcerative lesions in the gastrointestinal tract, gastro-intestinal bleeding, "aspirin triad", a history of indications urticaria, rhinitis, caused by taking Symtor Forte (Aspirin) and other NSAIDs, hemophilia, hemorrhagic diathesis, gipoprotrombinemii, dissecting aneurysm of the aorta, portal hypertension, deficiency of vitamin K, liver and / or renal failure, deficiency of glucose-6-phosphate dehydrogenase, Reye syndrome, children's age (under 15 years - the risk of developing Reye syndrome in children with hyperthermia on a background of viral diseases), I and III trimester of pregnancy, lactation, hypersensitivity to Symtor Forte (Aspirin) and other salicylates.
Symtor Forte (acetylsalicylic acid) is contraindicated in I and III trimester of pregnancy. In pregnancy trimester II can a one-off reception on the strict condition.
This medication has a teratogenic effect: when used in the I trimester leads to top palatoschisis, in the III trimester - cause inhibition of labor (inhibition of prostaglandin synthesis), premature closure of the ductus arteriosus in the fetus, pulmonary vascular hyperplasia and hypertension in the pulmonary circulation.
Symtor Forte (Aspirin) (acetylsalicylic acid) is excreted in breast milk, which increases the risk of bleeding in a child due to dysfunction of platelets, and therefore should not be applied Symtor Forte (Aspirin) in the mother during lactation.
Symtor Forte (Aspirin) with caution used in patients with liver diseases and kidney, bronchial asthma, erosive and ulcerative lesions, and bleeding from the digestive tract in history, with increased bleeding or while holding anticoagulant therapy, decompensated congestive heart failure.
Symtor Forte (Aspirin) even in small doses reduces the excretion of uric acid from the organism that can cause an acute attack of gout in predisposed patients. When conducting long-term therapy and / or use of Symtor Forte (Aspirin) in high doses required medical supervision and regular monitoring of hemoglobin levels.
The use of Symtor Forte (Aspirin) as anti-inflammatory drugs in a daily dose of 5-8 g is limited due to the high probability of adverse effects from the gastrointestinal tract.
Before surgery to reduce bleeding during surgery and postoperative period should stop taking salicylates for 5-7 days.
During prolonged therapy is necessary to conduct a general analysis of blood and study of occult blood.
The use of Symtor Forte (Aspirin) is contraindicated in pediatrics, as in the case of viral infection in children under the influence of Symtor Forte (Aspirin) increases the risk of developing Reye syndrome. Symptoms of Reye syndrome are prolonged vomiting, acute encephalopathy, liver enlargement.
Duration of treatment (without consulting a doctor) with Symtor Forte (Aspirin) should not exceed 7 days when administered as analgesic and more than 3 days as an antipyretic.
During treatment the patient should abstain from alcohol.
Undesirable combined use with other NSAIDs and glucocorticoids. For 5-7 days before surgery should stop taking.
The probability of NSAID-gastropathy decreases in the appointment after a meal, use of tablets with buffer additives or coated with a special enteric-soluble shell. The risk of hemorrhagic complications is minimal when used in doses less than 100 mg / day.
Note that in predisposed patients Symtor Forte (Aspirin) (even in small doses) reduces the excretion of uric acid from the body and can cause the development of acute attack of gout.
During prolonged therapy should regularly carry out the analysis of blood and to investigate faeces for occult blood. In connection with the observed cases hepatogenic encephalopathy is not recommended for relief of fever syndrome in children.
With simultaneous use of antacids containing magnesium and / or aluminum hydroxide, slow down and reduce the absorption of Symtor Forte (Aspirin).
With simultaneous use of calcium channel blockers, means limiting intake of calcium or increasing the excretion of calcium from the body, increases the risk of bleeding.
With simultaneous use with Symtor Forte (Aspirin) enhances the action of heparin and indirect anticoagulants, hypoglycemic funds derived sulfonylureas, insulin, methotrexate, phenytoin, valproic acid.
With simultaneous use of Symtor Forte (Aspirin) with SCS increases the risk of ulcerogenic effect and occurrence of gastrointestinal bleeding.
With simultaneous use of decreasing the effectiveness of diuretics (spironolactone, furosemide).
With simultaneous use of other NSAIDs increases the risk of side effects. Symtor Forte (Aspirin) may reduce plasma concentrations indomethacin, piroxicam.
With simultaneous use of gold drugs Symtor Forte (Aspirin) can induce liver damage.
With simultaneous use decreases effectiveness of uricosuric medications (including probenecid, sulfinpirazon, benzbromarone).
With simultaneous use of Symtor Forte (Aspirin) and alendronate sodium may develop severe esophagitis.
With simultaneous use of griseofulvin may be in breach Absorption of Symtor Forte (Aspirin).
There is one case of spontaneous hemorrhage in the iris while taking Ginkgo Biloba extract on the background of prolonged use of Symtor Forte (Aspirin) in a dose of 325 mg / day. It is believed that this may be due to additive inhibitory effect on platelet aggregation.
With simultaneous use of dipyridamole may increase Cmax of salicylate in plasma and AUC.
When applied simultaneously with Symtor Forte (Aspirin) increased concentration of digoxin, barbiturates and lithium salts in the blood plasma.
With simultaneous use of salicylates in high doses with carbonic anhydrase inhibitors can intoxication salicylates.
Symtor Forte (Aspirin) in doses of less than 300 mg have little effect on the effectiveness of captopril and enalapril. When Symtor Forte (Aspirin) (acetylsalicylic acid) is admistered in high doses may decrease the effectiveness of captopril and enalapril.
With simultaneous application of caffeine increases the rate of absorption, plasma concentrations and bioavailability of Symtor Forte (Aspirin).
With simultaneous use of Symtor Forte (Aspirin) with metoprolol may increase Cmax of salicylate in blood plasma.
In the application of pentazocine on the background of long-term use of Symtor Forte (Aspirin) in high doses there is a risk of severe adverse reactions in the kidneys.
With simultaneous application phenylbutazone reduces uricosuria caused by Symtor Forte (Aspirin).
With simultaneous application of ethanol may exacerbate the effects of Symtor Forte (Aspirin) on the gastrointestinal tract.
May occur after receiving a single large dose or prolonged use. If a single dose of less than 150 mg / kg, acute poisoning feel light, 150-300 mg / kg - moderate, when using higher doses - heavy.
Symptoms: salicylism syndrome (nausea, vomiting, tinnitus, blurred vision, dizziness, severe headache, malaise, fever - a poor prognostic sign in adults). More severe poisoning - stupor, convulsions and coma, noncardiogenic pulmonary edema, abrupt dehydration, violations ABE (initially - respiratory alkalosis, then - metabolic acidosis), renal failure and shock.
In chronic overdose concentration determined in plasma are poorly correlated with the severity of intoxication. The greatest risk of chronic intoxication is found among elderly people at reception for a few days more than 100 mg / kg / day. In children and elderly patients the initial signs of salicylism are not always visible, and therefore desirable to periodically determine the concentration of salicylates in the blood. Level above 70 mg% indicates moderate or severe poisoning; above 100 mg% - on extremely heavy, a poor prognosis. If poisoning moderate require hospitalization for at least 24 hours.
Treatment: the provocation of vomiting, the appointment of activated charcoal and laxatives, monitoring ABE and electrolyte balance, depending on the state of metabolism - the introduction of sodium bicarbonate, solution of sodium citrate or sodium lactate. Raising reserve alkalinity increases the excretion of Symtor Forte (Aspirin) by alkalinization of urine. Alkalinization of urine is shown at the level of salicylates above 40 mg%, is provided in / by infusion of sodium bicarbonate - 88 mEq in 1 liter of 5% glucose solution, the rate of 10-15 ml / kg / h. Restoring BCC and induction of diuresis (achieved by introducing a bicarbonate in the same dose and dilution, repeat 2-3 times); should be aware that intense infusion fluid elderly patients may lead to pulmonary edema. Not recommended the use of acetazolamide for alkalinization of urine (may cause acidemia and enhance the toxic effect of salicylates). Hemodialysis is shown at the level of salicylates over 100-130 mg%, and in patients with chronic poisoning - 40 mg% or lower in the presence of witnesses (refractory acidosis, progressive deterioration, severe damage of the CNS, pulmonary edema and renal failure). When pulmonary edema - a mixture of artificial ventilation, oxygen enriched, in the mode of positive end-expiratory pressure, to treat cerebral edema apply hyperventilation and osmotic diuresis.
Atorvastatin Calcium:
Symtor Forte is a lipid-lowering drugs of the statin group. An inhibition of HMG-CoA reductase leads to a series of sequential reactions that result in reduced intracellular cholesterol content and it is a compensatory increase in activity of LDL receptors and thus accelerate the catabolism of LDL cholesterol.
The lipid-lowering effect of statins is associated with lower levels of total cholesterol by LDL-C. The reduction in LDL cholesterol is dose-dependent and is not linear, but exponential. The inhibitory effect of Symtor Forte (Atorvastatin Calcium) on HMG-CoA reductase by about 70% determined by the activity of its circulating metabolites.
Statins do not affect the activity of lipoprotein lipase and hepatic, no significant effect on the synthesis and catabolism of free fatty acids, so their effect on triglycerides and again vicariously through their main effects on reducing LDL-C.
In addition to lipid-lowering actions, statins have beneficial effects in endothelial dysfunction (pre-clinical sign of early atherosclerosis) in the vascular wall, the state of atheroma, improves blood rheology, have antioxidant, antiproliferative properties.
Symtor Forte (Atorvastatin Calcium) lowers cholesterol levels in patients with homozygous familial hypercholesterolemia, which is usually not amenable to therapy with lipid-lowering agents.
Symtor Forte (Atorvastatin Calcium) is rapidly absorbed from the gastrointestinal tract. The absolute bioavailability is low (about 12%) due to first-pass clearance in gastrointestinal mucosa and / or due to the "first pass" through the liver, predominantly in the scene. Symtor Forte (Atorvastatin Calcium) is metabolized with the participation of isoenzyme CYP3A4 to form a number of substances which are inhibitors of HMG-CoA reductase inhibitors.
T1/2 from plasma is about 14 hours, although the T1/2 inhibitor activity of HMG-CoA reductase is approximately 20-30 hours, due to the involvement of active metabolites.
The plasma protein binding is 98%.
Symtor Forte (Atorvastatin Calcium) is excreted in the form of metabolites mainly in the bile.
Primary hypercholesterolemia in ineffectiveness of diet, combined hypercholesterolemia and hypertriglyceridemia, heterozygous and homozygous familial hypercholesterolemia with the ineffectiveness of diet.
The treatment by Symtor Forte is with a standard diet for patients with hypercholesterolemia. The dose is determined individually, depending on the initial cholesterol levels. This medication is taken orally. The initial dose is usually 10 mg 1 time / day. The effect is manifested within 2 weeks, and the maximum effect is for 4 weeks. If necessary, the dose can be gradually increased every 4 weeks or more. The maximum daily dose is 80 mg.
Digestive system: constipation, flatulence, dyspepsia, abdominal pain, nausea, diarrhea.
CNS and peripheral nervous system: headache, insomnia.
Other: asthenia, myalgia.
Liver disease in the active phase, increasing the serum transaminase activity more than 3 times of unknown origin, pregnancy, lactation (breastfeeding), hypersensitivity to Symtor Forte (Atorvastatin Calcium). Women of reproductive age not using reliable contraception.
Symtor Forte is contraindicated during pregnancy and lactation (breastfeeding).
It is not known whether Symtor Forte (Atorvastatin Calcium) is allocated in breast milk. Given the potential for adverse effects in infants, if necessary to use this drug during lactation it should decide on the termination of breastfeeding.
Women of reproductive age during treatment should use adequate contraceptive methods. Symtor Forte (Atorvastatin Calcium) may be used in women of childbearing age only if the probability of pregnancy is very low, and the patient informed about the possible risk of treatment for the fetus.
Category of the fetus by FDA - X.
Prior to and during treatment with Symtor Forte (Atorvastatin Calcium), especially if symptoms of liver damage, it is necessary to monitor liver function tests. With an increase in transaminase levels it should be monitored their activity up to normalization. If AST or ALT more than 3 times the norm persists, we recommend reducing the dose or withdrawal of Symtor Forte (Atorvastatin Calcium).
When prompted during the treatment of symptoms of myopathy it should determine the activity of creatine kinase. If a significant increase in CK levels is preserved, it is recommended to reduce the dose of Symtor Forte (Atorvastatin Calcium) or to cancel taking it.
The risk of myopathy during the treatment with Symtor Forte (Atorvastatin Calcium) increased, while the use of cyclosporine, fibrates, erythromycin, antifungal agents belonging to azoles, and niacin.
There is a likelihood of the following side effects, but not in all cases, a clear link with taking Symtor Forte (Atorvastatin Calcium): muscle cramps, myositis, myopathy, paresthesia, peripheral neuropathy, pancreatitis, hepatitis, cholestatic jaundice, anorexia, vomiting, alopecia, pruritus, rash, impotence, hyperglycemia and hypoglycemia.
The children experience of Symtor Forte (Atorvastatin Calcium) using at a dose of 80 mg / day is restricted.
With careful use Symtor Forte (Atorvastatin Calcium) in patients with chronic alcoholism.
When this drug applied simultaneously with:
- digoxin slightly increased concentration of digoxin in plasma.
- itraconazole greatly increases the concentration of Symtor Forte (Atorvastatin Calcium) in plasma, apparently due to inhibition of itraconazole its metabolism in the liver that occurs with the participation of isoenzyme CYP3A4; increased risk of myopathy.
- colestipol may decrease the concentration of Symtor Forte (Atorvastatin Calcium) in plasma, with lipid-lowering effect is enhanced.
- antacids containing magnesium hydroxide and aluminum hydroxide, reduce the concentration of Symtor Forte (Atorvastatin Calcium) by approximately 35%.
- cyclosporine, fibrates (including gemfibrozil), azole antifungals derivatives, nicotinic acid increases the risk of myopathy.
- erythromycin, clarithromycin moderately increased concentrations of Symtor Forte (Atorvastatin Calcium) in plasma, increases the risk of myopathy.
- ethinyl estradiol, norethisterone (norethindrone) slightly increases the concentration of ethinyl estradiol, norethisterone and (norethindrone) in blood plasma.
- protease inhibitors increases the concentration of Symtor Forte (Atorvastatin Calcium) in plasma, as protease inhibitors are inhibitors of the CYP3A4 isoenzyme.
Diltiazem, verapamil, isradipine inhibit isoenzyme CYP3A4, which participates in the metabolism of Symtor Forte (Atorvastatin Calcium) Sanis Health, so that while the use of these calcium channel blockers may increase the concentration of Symtor Forte (Atorvastatin Calcium) in plasma and increased risk of myopathy.
Treatment: symptomatic and supportive therapy. There is no specific antidote. Hemodialysis is ineffective.
Ramipril:
Symtor Forte (Ramipril) Karnataka Antibiotics & Pharmaceuticals belongs to the class of drugs classified as ACE inhibitors or Angiotensin-Converting-Enzyme inhibitor.
This product is a drug prescribed for the treatment of hypertension or high blood pressure, and for the prevention of heart failures succeeding heart attacks. Symtor Forte (Ramipril) Karnataka Antibiotics & Pharmaceuticals is also used for the prevention of heart attacks, stroke and other heart related problems.
The medication is major allergen especially to patients who have had histories of allergies. Ask for a skin test from your doctor if you are a person prone to allergies and more importantly if you are allergic to the components of Symtor Forte (Ramipril) Karnataka Antibiotics & Pharmaceuticals.
Before taking the medicine, inform your doctor if you have:
liver disease
kidney disease
And if you are on a salt restricted diet or taking salt substitutes, your doctor may lower you Symtor Forte (Ramipril) Karnataka Antibiotics & Pharmaceuticals dosage or even forbid you to take the drug.
Symtor Forte (Ramipril) Karnataka Antibiotics & Pharmaceuticals is also a grudge belonging to the pregnancy category D, which means that this medicine is a sure cause of birth defects in babies and may even cause death in the 2nd and third trimester of pregnancy.
The components of Symtor Forte (Ramipril) Karnataka Antibiotics & Pharmaceuticals are also passed through breast milk and the degree of harmful effects on the nursing infant is not known. Talk to your doctor first before deciding to take Symtor Forte (Ramipril) Karnataka Antibiotics & Pharmaceuticals if you are breast feeding.
Never take Symtor Forte (Ramipril) Karnataka Antibiotics & Pharmaceuticals when performing tasks that require mental and physical alertness such as driving or operating any kind of machinery. This medication is a powerful cause of drowsiness and dizziness.
Always maintain proper hydration when taking this medicine. Lack of fluids may cause low blood pressure and may enhance dizziness and fainting.
This medicine should be taken exactly as it is prescribed by your doctor.
Each dose must be taken with a full glass of water of about 6-8 ounces.
The intake of Symtor Forte (Ramipril) Karnataka Antibiotics & Pharmaceuticals can be with or without food.
Never stop medication without first consulting your doctor even if you begin to feel better, it still important that your termination of use of this medicine must be properly supervised by your doctor.
The dosage of Symtor Forte (Ramipril) Karnataka Antibiotics & Pharmaceuticals can only be effectively determined by your doctor.
If symptoms of overdose such as extreme drowsy and dizzy feeling, weakening, fainting and fatigue settles in, immediately seek medical help.
Do not take double doses of Symtor Forte (Ramipril) Karnataka Antibiotics & Pharmaceuticals; instead, skip the dose you missed especially if it near the time for the next dose.
Possible side effects of Symtor Forte (Ramipril) Karnataka Antibiotics & Pharmaceuticals may include:
allergic reactions
difficulty in urinating
arrhythmia
changes in heartbeat
chest pains
severe drowsiness
sore throat
fever
headache
fatigue
dry tickling cough
nausea
vomiting
diarrhea
anxiety and depression
If you experience any of these side effects and if they become bothersome and intolerable, consult your doctor.
This drug may react with drugs that contain potassium and potassium supplements such as K-Dur and Klor-Con.
Diuretics may also not work well with Symtor Forte (Ramipril) Karnataka Antibiotics & Pharmaceuticals as well as water pills such as Lasix, Bumex and Lozol.
Depending on the reaction of the Symtor Forte after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Symtor Forte not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.
Is Symtor Forte addictive or habit forming?Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.
Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.
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The information was verified by Dr. Rachana Salvi, MD Pharmacology