chlomid

The main pathway – oxidation and chlomid conjugation. The volume of distribution – about 450 ml / kg. Thioctic acid and its metabolites are excreted by the kidneys (80-90%). The half-life – 20 -50 minutes. The total plasma clearance – 10-15 ml / min.

Indications

Diabetic and alcoholic polyneuropathy.

Contraindications

Hypersensitivity to thioctic acid or other ingredients.

Pregnancy, lactation (not enough experience with the drug).

Clinical data on the use of the drug chlomid  in children and adolescents lacking in this regard to children and adolescents should not be prescribed the drug.

 

Dosing and Administration

The drug is used intravenously. The recommended dose for severe polyneuropathy is 1 vial (600 mg) 1 times a day for 2-4 weeks.

Subsequently, the patient is transferred to the treatment with Thioctacid ® BV is 600 mg (1 tablet) per day.

Intravenous administration of the drug should be carried out slowly (not faster than 2 ml / min).

Intravenous administration is also possible by using undiluted solution injection syringe and pump reliability. In this case, the time of administration should be not less than 12 minutes.

Because of the sensitivity to the light chlomid of the active substance, ampoules must be removed from the carton immediately prior to use.

Recommendations for infusion

The infusion solution should be protected from light (eg by wrapping the container with aluminum foil).

Solution for intravenous administration, protected from light, fit for 6 hours.

Allergic reactions:

Rarely – skin rash, hives, itching, eczema, redness of the skin, systemic allergic reactions up to anaphylactic shock.

From the nervous system and sensory organs: very rare – convulsions, diplopia.

From the blood and circulatory system:

Very rarely – purpura, petechiae and bleeding tendency (due to platelet function disorders), thrombocytopathy, thrombophlebitis.

General nature:

Often – by rapid intravenous injection can be observed an increase in intracranial pressure and difficulty breathing, which chlomid independently tested.

Nechasto- impaired sense of taste (metallic taste).

Rarely allergic reactions may occur at the site of infusion.

Rarely – nausea and vomiting.

Very rare – due to improved glucose utilization may decrease the level of glucose in the blood and appear symptoms of hypoglycemia (confusion, sweating, headache, visual disturbances).

 

 

Overdose

Cases of drug overdose thioctic acid in the form of a solution is not observed for intravenous administration.

If peredozirovki- symptomatic treatment, if necessary – anticonvulsant therapy, measures to support the functions of vital organs.

 

Interaction with other drugs

When concomitant administration of thioctic acid and cisplatin marked decrease in the efficiency of cisplatin. With simultaneous use of thioctic acid and insulin or oral hypoglycemic drugs their action can be amplified, so we recommend regular monitoring of blood glucose levels, especially at the beginning of therapy thioctic acid. In some cases the permissible reduction in the dose of hypoglycemic drugs to prevent the development of symptoms of hypoglycemia.

Ethanol and its metabolites weaken the effect of thioctic acid.

 

special instructions

Thioctic acid infusion solution is incompatible with dextrose, Ringer’s solution, and solutions of reacting with disulfide  with ethanol. Alcohol consumption is a risk factor for the development of polyneuropathy and may decrease the effectiveness of the drug , so patients should abstain from alcohol during treatment as a drug, and in the periods outside of treatment.

diabetic polyneuropathy Treatment should be carried out against the background of maintaining optimal blood glucose levels.

 

release Form

A solution for intravenous administration of 25 mg / ml.

In 24 ml of solution in a dark glass vial, hydrolytic type 1 Directly on the vial marked to show the place chlomid of application of force for opening the ampoule: two rings of red and white point.

5 vials in a plastic tray white, 1 pallet together with instructions for use in a cardboard box.

what is clomid

What is clomidside effects, like other phenothiazines, dose dependent and usually caused pronounced pharmacological effects of the drug. In applying the drug in the recommended dosage range of adverse effects in the majority of cases are mild and transient in nature. Heavy phenomena observed at high.

CNS: sedation, drowsiness; dizziness; sometimes -Violation consciousness, agitation, hallucinations, irritability, headache; rarely – seizures, extrapyramidal symptoms (tremor, muscle rigidity, akathisia, dyskinesia, dystonia), tardive dyskinesia; very rarely – depression, insomnia, neuroleptic malignant syndrome. On the part of the autonomic nervous system / anticholinergic effects often -suhost mouth, blurred vision, paresis of accommodation, stuffy nose; -toshnota sometimes, vomiting, diarrhea, constipation, loss of appetite, delay or urinary incontinence; -blednost rarely, tremors; very rarely – paralytic ileus. On the part of the cardiovascular system: often – orthostatic hypotension;Sometimes, changes, tachycardia; rarely – arrhythmias; rarely -trepetanie, ventricular fibrillation, sudden death. On the part of the endocrine system: often, with a long reception – hyperprolactinemia, galactorrhea; sometimes – amenorrhea, menstrual irregularities, weight change, erectile dysfunction and ejaculation; rarely – priapism; very rarely – breast tenderness, gynecomastia, peripheral edema. On the part of the peripheral blood: rare – leukopenia, agranulocytosis, thrombocytopenia; very rarely – anemia, leukocytosis. Liver: sometimes – abnormal liver enzymes;rarely hepatitis.

For the skin: rarely – dermatitis, skin rashes (including allergic), urticaria, increased photosensitivity, angioedema. Other: rarely – in the area of the parotid gland swelling, hyperthermia, respiratory depression. When long-term therapy Tiodazinom there are reports of rare cases of pigment retinopathy developed in patients receiving the drug in doses exceeding the maximum recommended dose of 800 mg per day.

Drug Interactions: The metabolism mediated by cytochrome  metabolized by the enzyme cytochrome what is clomid and, moreover, itself is an inhibitor of the pathway. Therefore drugs that inhibit this isoenzyme (eg, cimetidine, fluoxetine, paroxetine, moclobemide), may enhance the effects and prolong Tiodazina. Tritsklicheskie antidepressants . The simultaneous use of tricyclic antidepressants and phenothiazine derivatives may increase the plasma concentrations of drugs and / or phenothiazine derivative, which may cause cardiac arrhythmias. Anticonvulsants.  As other phenothiazines, can reduce the seizure threshold. In an application what is clomid may increase or decrease serum concentrations of phenytoin, and therefore may need to dose adjustment. When used together Tiodazina and carbamazepine concentrations of these drugs in serum are not changed. Antihypertensives and beta-blockers.

Due to suppress metabolism combined use of these agents Tiodazinom can lead to increased plasma concentrations of each drug, which may possibly lead to hypotension, cardiac arrhythmias or side effects of the central nervous system. Indirect anticoagulants. The combined use of Tiodazinom may intensify gipoprotrombinemicheskogo action due primarily to the competitive interaction at the level of enzymes. In this case, careful monitoring of prothrombin concentration in the plasma. The funds from the depressing effect on the central nervous system.  May enhance the effects of alcohol and other means, have a depressing effect on the central nervous system, benzodiazepines, opioids, barbiturates, antidepressants, and for anesthesia.  Concomitant use inhibitors can lengthen and intensify the sedative and antimuscarinic action of each of the drugs. Lithium preparations . You may experience severe neurotoxic complications, extrapyramidal disorders and somnambulism in patients receiving both drugs lithium and phenothiazine, including what is clomid. Means with anticholinergic action . In an application with Tiodazinom may increase anticholinergic effects of M-anticholinergics (atropine funds), antihistamines and tricyclic antidepressants, until such manifestations as “atropinovy psychosis”, pronounced constipation, paralytic ileus, hyperpyrexia with possible heat stroke. In these cases, it shows a thorough observation of the patient and correction of doses of drugs.

Antiparkinsonian agents. In an application Tiodazina and levodopa may weaken the effects of each of the drugs. Vasoconstrictor. With its ɑ-adrenoceptor blocking properties Tiodazin may weaken the pressor effect vasoconstrictor (epinephrine, dopamine , ephedrine, phenylephrine). quinidine . With simultaneous use of quinidine and Tiodazina may increase depressant effects of quinidine on the myocardium. Antiarrhythmic agents / elongation  interval . Given that phenothiazines, including can cause such changes  as a lengthening of the interval , caution should be exercised in their simultaneous application with the drugs having a similar property. Thiazide diuretics. . The simultaneous use of  and thiazide diuretics can lead to severe hypotension . In addition, due diuretic hypokalemia may enhance the cardiotoxic effects Tiodazina. Antidiabetics.  Effect on carbohydrate metabolism, and therefore in its application could disrupt the stability of the patient achieved during treatment antidiabetic agents. Antacids and antidiarrheal agents may reduce the absorption from the gastrointestinal -kishechnogo  tract.

Cards
with special caution in patients with glaucoma (especially the closure form), cardiovascular diseases, severe respiratory diseases, renal failure, Parkinson’s disease, epilepsy, prostatic hypertrophy, myasthenia gravis, pheochromocytoma. During treatment Tiodazinom prohibited alcohol intake, as well as driving vehicles, using machinery, and other activities that require quick response.

Overdose.
Increased side effects, the appearance of acute neuroleptic reactions. Especially should guard increase in body temperature, which can be one of the symptoms of neuroleptic malignant syndrome. In severe cases an overdose may experience different forms of impairment of consciousness up to coma.
Aid Measures: cessation of therapy Tiodazinom and any other antipsychotic drugs (neuroleptics), the appointment of correctors (central anticholinergics), administration of high doses of activated charcoal, gastric lavage, in convulsions intravenous diazepam, glucose solution, nootropics, vitamins , close monitoring of the cardiovascular, respiratory and central nervous system, symptomatic therapy.
In convulsions barbiturates should be avoided because they may increase the respiratory depression caused by phenothiazine derivatives.

 

clomiphene citrate

Rapidly absorbed from the gastrointestinal tract. Maximum plasma concentration is achieved 2-4 hours after administration. Bioavailability is an average of about 60%. There was a considerable interindividual variability of this parameter. Protein binding is high (over 95%).  Crosses the placenta and is excreted into breast milk. Tiodazin and its main metabolites (sulforidazin and clomiphene citrate mesoridazine) cross the blood-brain barrier and are found in the cerebrospinal fluid. The ratio of the concentration of metabolites in the cerebrospinal fluid in their plasma concentrations higher than the same ratio for the unchanged drug, indicating the important role of metabolites in the implementation of the antipsychotic drug action. Withdrawal. Withdrawal is carried out mainly in the feces (50%), via the kidneys as well as (at least 4% of unchanged drug in the form of about 30% – as metabolites). Plasma half-life is approximately 10 hours.

 

 

Indications for use:

A) schizophrenia and other psychoses

  • Treatment of exacerbations of schizophrenia.
  • Treatment of chronic schizophrenia. Clomiphene citrate also indicated for long-term treatment of patients who are hospitalized, and long-term maintenance treatment of outpatients with schizophrenia.
    B) anxiety and depression syndromes
  • In psychiatric practice – as monotherapy or as part of combination therapy in patients with agitated depression.
  • In general medical practice – as a sedative and anxiolytic – treatment of a variety of syndromes characterized by anxiety, a combination of anxiety and depression, tension and agitation, psychosomatic disorders and emotional disorders.
  • Long-term treatment of mixed anxiety and depression or psychotic depression.
    Bed and) indications in geriatric practice
  • As a neuroleptic and antipsychotic – treatment of severe cognitive disorders and behavioral disorders in geriatric patients with organic brain damage of varying severity.
  • As anxiolytics or sedative – treatment of anxiety, mixed anxiety-depressive states, senile agitation and insomnia.
    D) Indications in pediatric practice
  • As an antipsychotic – treatment of childhood schizophrenia, and severe behavioral disorders on the background of mental retardation and organic brain damage.
  • As anxiolytics or sedative – treatment of anxiety, tension and agitation; treatment of disorders of concentration in children with severe behavioral problems; hyperactivity treatment of cases that are resistant to stimulants; treatment of sleep disorders.
    D) Other readings
  • Treatment pronounced behavioral disorders in mentally retarded adults and in patients with deficiency of symptoms.
  • To reduce the severity of clomiphene citrate psychotic episodes as anxiety, agitation, hostility, hallucinations, and the syndrome of alcoholic absistentsii.
  • Vomiting of central origin. 

    Contraindications:

    Increased individual sensitivity to thioridazine hydrochloride, thioridazine base, or any other component of the formulation. Comatose states or state of severe depression of the central nervous system, history of severe hematological diseases, in particular depression medullary hematopoiesis.
    A history information of individual hypersensitivity reactions, such as severe photosensitivity or increased individual sensitivity to other phenothiazines.
    Severe heart disease, especially clinically significant arrhythmias (such as ventricular tachycardia).

    Dosage and administration:

    The dose and timing of the doses should be individualized depending on the severity of the disease and symptoms. Initiate therapy with the recommended dose, are at the lower boundary of the range. Then, in the course of treatment the dose is gradually increased to achieve maximum efficiency. When you achieve the maximum therapeutic effect gradually reduce the dose to maintenance. The daily dose is usually divided into 2-4 reception. Schizophrenia and other psychoses Exacerbation of schizophrenia in adult hospitalized patients: 100-600 mg / day – up to a maximum dose of 800 mg / day.Schizophrenia is a chronic flow: 100-600 mg / day. in hospitalized patients; 50-300 mg / day – in outpatients. Anxiety and depression syndromes in psychiatric practice with agitated depression patients: 25-200 mg / day. In general practice as a sedative and anxiolytic: 10-75 mg / day. In geriatric practice as neuroleptic / antipsychotic: 25-200 mg / day. As anxiolytics / sedatives: 10-75 mg / day. In the pediatric practice as an antipsychotic for the treatment of serious mental and emotional disorders in children older than 2 years: 1-3 mg / kg / day.

  • As an anxiolytic / sedative in children older than 2 years: 0.5-2 mg / kg / day. Other indications Treatment pronounced behavioral disorders in mentally retarded adults and in patients with deficiency of symptoms: 100-600 mg / day; the maximum dose – 800 mg / day. To reduce the severity of mental disorders with alcohol withdrawal syndrome:. 100-200 mg / day treatment of patients with low body weight, impaired renal function and / or liver, clomiphene citrate as well as elderly patients and children recommended under close supervision and to start with especially low doses and increase them slowly. patients with schizophrenia who are hospitalized, a clear positive effect is usually achieved within 2-3 weeks or more from the start of treatment. In patients with chronic psychosis in order to achieve the most pronounced effect it may take 6 weeks to 6 months. In contrast, in patients with acute psychotic condition improvement can be observed after 24-48 hours. In case of cancellation of long-term therapy Tiodazinom the dose recommended to be reduced gradually, over several weeks, as the sudden cancellation of the patients receiving the drug for a long time or in high doses, can lead in some cases to such phenomena as nausea, vomiting, tremor, dizziness, anxiety, agitation, insomnia, transient dyskinesia. These phenomena can create a false impression of occurrence in a patient of a depressive or psychotic state.

     

clomiphene citrate for men

Endogenous antioxidant (binds free radicals) in the body is produced in the oxidative decarboxylation of alpha-ketoksilot. As coenzyme mitochondrial multienzyme complexes involved in the oxidative decarboxylation of pyruvic acid and alpha-keto acids. Thereby reducing blood glucose and increased glycogen concentration in the liver, as well as overcome the insulin resistance. By the nature of the biochemical action similar to B vitamins involved in the regulation of lipid and carbohydrate metabolism, stimulates cholesterol metabolism, improves liver function. It has hepatoprotective, hypolipidemic, cholesterol-lowering, the hypoglycemic effect. Improves trophic neurons. Using the meglumine salt of thioctic clomiphene citrate for men acid in solution for intravenous administration (having a neutral reaction) reduces the severity of side reactions.

Pharmacokinetics

When ingestion rapidly and completely absorbed from the gastrointestinal tract (reception with food reduces the absorption). maximum concentration time – 40-60 minutes. Bioavailability – 30%.

It has the effect of “first pass” through the liver. The formation of metabolites occurs as a result of oxidation of the side chain and conjugation.

The volume of distribution – about 450 ml / kg. Thioctic acid and its metabolites are excreted by the kidneys (80-90%). The half – 20-50 minutes. The total plasma clearance – 10-15 ml / min.

When administered intravenously, the time to reach maximum concentration – 10-11 minutes, the maximum concentration – 25-38 mg / ml. The area under the curve of concentration – time – about 5 ug h / mL.

Indications for use

  • Diabetic polyneuropathy.
  • alcoholic polyneuropathyContraindications

    Hypersensitivity to the drug.

    Pregnancy during breastfeeding.

    Children’s age clomiphene citrate for men (efficacy and safety have not been established).

    Dosing and Administration

    Inside designate 600 mg 1 time per day. The tablets are not liquid, squeezed small amounts of liquid.

    The drug is also administered intravenously at a dose of 600 mg per day (1 ampoule concentrate for solution for infusion of 30 mg / ml or 1 bottle for infusion solution 12 mg / ml). At the beginning of the course the drug is administered intravenously for 2-4 weeks. Then the ingestion of the drug can be continued at a dose of 300-600 mg per day. The drug should be administered slowly, there is a maximum of 50 mg thioctic acid for 1 minute (which is equivalent to 1.7 ml concentrate for solution for infusion of 30 mg / ml).

    Regulation of a solution
    Content 1 ampoule (content equivalent to 600 mg of thioctic acid) is mixed with 50-250 ml of 0.9% sodium chloride and administered as an infusion over 20-30 minutes. Infusion produced from the flasks are placed in the enclosed lightproof suspension housings made of black polyethylene. When applying the solution for infusion in vials infusion  produced directly from these vials are placed in the enclosed lightproof suspension housings made of black polyethylene. Side effect

    When ingestion possible indigestion, including nausea, vomiting,

    Following intravenous administration rarely possible convulsions; diplopia; petechial hemorrhages in the mucous membranes, skin; thrombocytopenia purpura (purpura), thrombophlebitis; the rapid introduction may increase intracranial pressure (the emergence of a feeling of heaviness in the head); difficulty breathing. These side effects are alone.

    Allergic reactions: urticaria, systemic allergic reactions (up to the development of anaphylactic shock). Perhaps the development of hypoglycemia (due to improved glucose uptake).

    Overdose

    Symptoms include nausea, vomiting, clomiphene citrate for men headache. Treatment is symptomatic. Net.Vzaimodeystvie specific antidote with other drugs In vitro thioctic acid reacts with the metal ion complexes (e.g., cisplatin), and therefore while applying Tiogamma O (solution for infusion) may reduce the effect of cisplatin. Since sugar molecules thioctic acid forms poorly soluble complex compounds. Consequently, thioctic acid infusion solution is incompatible with dextrose, Ringer’s solution and solutions which can be reacted with compounds of SH-groups or having disulfide links. In an application Tiogamma O enhances the action of insulin and oral hypoglycemic agents. Alcohol (ethanol) reduces the therapeutic activity of thioctic acid.

    special instructions

    Patients taking t , should refrain from the use of alkogolya.U patients with diabetes requires constant monitoring of blood glucose levels, especially in the early stages of therapy. In some cases it is necessary to reduce the dose of insulin or oral hypoglycemic drug, in order to avoid hypoglycemia.

    Product form
    Film-coated tablets, 600 mg. 10 tablets in blister packs. At 3, 6, or blisters with instruction on use is placed in a cardboard box.
    The concentrate for solution for infusion 30 mg / ml in dark glass vials of 20 ml. At 5, 10, or 20 vials with hanging light protective sheath made of black polyethylene, and instructions for use are placed in a cardboard box.
    The solution for infusion 12 mg / ml in dark glass bottles of 50 ml; 1 or 10 vials with outboard clomiphene citrate for men on the number of bottles made from polyethylene black and instructions for use are placed in a cardboard box.

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