Hemodez instructions for use analogues. Reamberin: What to use instead of hemodez? Features of use for burns and radiation sickness

Otipax is a combination drug that has anti-inflammatory and local analgesic effects and is used in otolaryngological practice for local symptomatic (aimed at eliminating symptoms, not the cause of the disease) treatment of otitis media in adults and children. Thanks to his highest degree favorable safety profile, the drug is widely used in pediatrics, incl. and in newborns. If in the theater everything starts with a hanger, then problems with the ears almost always begin with ARVI. This statement is especially relevant in relation to children, because the latter are much more susceptible to infectious agents than adults. ARVI pathogens enter the body mainly through the upper Airways. Penetrating into the epithelial cells of the mucous membranes of the nasal cavity, pharynx and larynx, respiratory viruses are taken for intensive reproduction of their own kind, as a result of which inflammation develops with all the accompanying “bonuses” in the form of increased permeability of the vascular walls and increased exudation. Clinically, all this pathogenetic “whirlwind” is manifested by cough, runny nose, swelling of the mucous membranes and other dubious “charms”. The most common symptom ARVI is definitely a runny nose. With a runny nose, swelling of the mucous membrane of the nasopharynx develops, which can lead to acute otitis media. The danger of this disease is the risk of serious complications- mastoiditis, meningeal syndrome, meningitis, labyrinthitis, brain abscess and, possibly, sepsis. In this regard, the problem of otitis takes on a medical and social character, i.e.

j. inflammation of the middle ear is always fraught with hearing disorders and has all the prerequisites for the transition to the chronic phase in the form of adhesive and purulent otitis. With timely and adequate treatment of these unpleasant consequences manages to be avoided. Yes, when acute otitis media, as a rule, the problem can be solved without resorting to surgical methods, for example, using ear drops Otipax. This medicine contains phenazone and lidocaine. The analgesic-antipyretic phenazone has anti-inflammatory and analgesic effects. Lidocaine is a substance in demand in cases where it is necessary local anesthesia. The combination of phenazone and lidocaine provides fast, intense and long-lasting anesthesia. The components of the drug act locally and are not absorbed into the systemic circulation, which avoids clinically significant negative side reactions. When otipax is applied topically, it active ingredients and their derivatives are not defined by modern laboratory methods diagnostics in blood and other biological media, which confirms the absence systemic action on the body. The dosage regimen for otipax is as follows: 3-4 drops into the external auditory canal 2-3 times a day. Before using the drug, to avoid discomfort To prevent contact of cold drops with the auricle, it is recommended to warm the bottle in your palms. The duration of treatment should not exceed 10 days. Before the beginning drug therapy integrity should be verified eardrum. This is done for this purpose. to avoid complications due to contact pharmacologically active substances preparation with elements of the middle ear system.

Pharmacology

Combined drug for local application. It has a local anesthetic and anti-inflammatory effect.

Phenazone is an analgesic-antipyretic with anti-inflammatory and analgesic effects.

Lidocaine - local anesthetic. The combination of phenazone and lidocaine promotes a faster onset of anesthesia, and also increases its intensity and duration.

Pharmacokinetics

Does not penetrate the body if the eardrum is intact.

Release form

Ear drops are transparent, colorless or yellowish in color, with the smell of alcohol.

Excipients: sodium thiosulfate, ethanol, glycerol, water.

16 g - dark glass bottles (1) complete with a dropper (in a blister) - cardboard boxes.

Dosage

Drops are instilled into the external auditory canal, 3-4 drops 2-3 times a day. To avoid contact of the cold solution with the auricle, the bottle should be warmed in the palms of your hands before use.

The course of treatment is no more than 10 days.

Overdose

Data on overdose of the drug Otipax ® are not provided.

Interaction

Currently, there is no data on the interaction of the drug Otipax ® with other drugs.

special instructions

Before starting to use the drug, you must ensure the integrity of the eardrum. If the drug is used with a perforated eardrum, complications may develop due to contact of the active substance with components of the middle ear system.

It should be borne in mind that the drug contains an active substance that can give positive test during doping control.

Otipax - ear drops, the instructions for use of which position the popular drug as a drug for providing local anti-inflammatory and analgesic effects. An earlier name for a drug used to relieve pain for ear inflammation, there was Phenazone Lidocaine. It directly indicated the two main active ingredients included in the composition medicinal product, where lidocaine has a local analgesic effect, and phenazone is intended for an antiseptic and anti-inflammatory effect.

Otipax ear drops - local remedy For symptomatic treatment, recommended if it is necessary to eliminate negative symptoms various types otitis resulting from infection, elimination of complications of the main cold (viral, bacterial) lesion.

Otipax: composition

The use of 2 EFAs as part of a popular drug provides double effect for ear inflammations, providing antiseptic and anesthetic effect. 1 g of the substance is contained in the proportion of 10 mg (lidocaine), 40 mg (phenazone). The remaining auxiliary components - purified water, glycerol, sodium thiosulfate - are added to facilitate absorption and rapid absorption directly in the ear.

Release form

The sale is carried out in the form of a yellowish-lemon-colored solution mixed in a plastic dropper bottle with a special tip for administering the medicine to the destination. The product is difficult to confuse with other medications due to its convenient packaging and the characteristic smell of medical alcohol. Otipax, the cost of which is relatively affordable, is sold in any retail pharmacy, packaged in a special box with the appropriate inscription. The cardboard packaging contains 1 bottle of the product, with attached instructions for use.

Sometimes the product is sold in bottles made of dark glass and a convenient dropper, packaged separately. The standard glass bottle contains 16 mg medicinal composition. Drops are dispensed without a medical prescription.

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Pharmacological properties

Achievement therapeutic effect occurs due to the action of a combined composition of two main active substances, where phenazone provides an anti-inflammatory and antiseptic effect, because it belongs to the group of NSAIDs and inhibits the synthesis of prostaglandins, which are intensely produced in the body. Lidocaine, which disrupts the conduction of pain impulses, gives an analgesic effect that is prolonged and rapid. To the question whether Otipax is an antibiotic or not, the answer is definitely negative. The product disinfects and anesthetizes, but does not suppress the activity of pathogenic flora.

Indications for use

Otipax for ear congestion is prescribed in the case of several types of otitis, provided that the eardrum has remained intact and is intact. The optimal effect is ensured for otitis media that occurs after viral diseases, with acute otitis media and its barotraumatic form, resulting from pressure injuries. With strong pain symptom will quickly and effectively eliminate negative sensations, and patients who know how long it takes for Otipax to work prefer it to other medications.

Contraindications

Otipax drops are not recommended for use if you have an individual sensitivity to the OLVs included in their composition, allergic reactions to lidocaine, pregnancy or breastfeeding. The use of the drug in case of perforation of the eardrum of any etiology is unacceptable. IN new instructions it is stipulated that the systematic use of ear drops can give positive result during doping control of athletes.

Side effects

This is a topical product, so side effects arise in ear canal or auricle. These are minor allergic irritations leading to itching, irritation, swelling and hyperemia. skin, up to hives and rashes.

Otipax ear drops: instructions for use, method and dosage

There are no special restrictions on the dosage of the medicine, because it does not contain anything other than an antiseptic and anesthetic. However, the treatment period should be no more than 10 days. If recovery does not occur, the doctor prescribes drops to suppress pathogenic microflora

For adults

Adults instill 3-4 drops a day, no more than 4 times a day, for a decade to achieve a visible effect.

Children

Drops can be used in any childhood. They are dripped onto a cotton pad, which is inserted into the ear:

  • 1-2 drops are recommended for infants;
  • from one year to 2 – no more than 3;
  • from 3 years old you can drip 3-4 drops no more than 3 times a day, like adults.

The treatment course continues for 10 days and is not interrupted, even if visible relief has occurred.

During pregnancy

Otipax during pregnancy is considered a conditionally approved drug because it is not absorbed into the body. circulatory system. However, when side effects or signs of individual immunity, its use is immediately stopped.

Overdose

About cases of overdose in clinical characteristics There is no information about medications.

special instructions

Storage and shelf life

If a small amount of drops is required, Otipax is the leader in terms of shelf life. How long to store after opening is indicated in the instructions, but many ear drops have a much shorter shelf life after depressurization. The medicine can be stored in undamaged packaging for 5 years. If you start using the medicine and the seal of the Otipax bottle is broken, the shelf life after opening is no more than six months, provided that the specified storage conditions are met. The drops should be stored in a cool, dark place, out of direct sunlight, for the period indicated on the manufacturer’s packaging.

Otipax: analogues

The drug is from a French manufacturer, and if the consumer is not satisfied with the cost of Otipax, cheaper analogues can be looked for according to two principles: a complete analogue - with the same active active substance, industrial - with other components, but with a similar effect of use.

For an imported medicine, the cost is relatively affordable, but if you buy Otipax (price) at a high price, the cheap analogues are noticeably different and can save you from 150 to 30 rubles. Full analogues are Otirelax and Folicap; the use of Uniflox, Tsipromed, Otinum, Polydex and Sofradex is recommended as industrial ones.

Circular Federal service for supervision in the field of healthcare and social development(No. 1100-Pr/05 dated May 24, 2005) hemodesis was prohibited for subsequent use in clinical practice and its production has been suspended.

This decision caused an ambiguous reaction from the medical community because For many years doctors have used hemodesis at all stages of provision medical care, in patients various profiles and, often, this drug had to be sought.

By using hemodesis it was possible to “support” hemodynamics for prehospital stage, toxicologists used this drug as part of hemodilution, forced diuresis and other measures, cardiologists counted on antiplatelet properties hemodesis, anesthesiologists used hemodesis for the management of seriously ill patients postoperative period, psychiatrists used this drug as an infusion base for the administration of centrally acting drugs; in a word, many specialists widely used hemodesis being confident in its beneficial properties.

Let us recall that the composition hemodesis includes low molecular weight polyvinylpyrrolidones, with an average weight of 12,600 (maximum weight should not exceed 45,000), electrolytes such as sodium chloride (5.5 g), potassium chloride (0.42 g), calcium chloride (0.005 g), sodium bicarbonate ( 0.23 g) and pyrogen-free water (up to 1 l). According to one of the classifications of infusion media, hemodesis was classified as a blood substitute with a detoxifying effect, mainly due to its ability to bind and remove toxins from the body. The last property was established using colloidal dyes, which, against the background hemodesis excreted by the kidneys faster.

Polyvinylpyrrolidones also had the property of increasing BCC, as a result of which hemodesis used as part of volume therapy.
How did an “old” drug, tested in many situations, cease to satisfy urgent needs modern medicine?! Simple consumer questions arise to which the doctor needs to give clear answers:
What is the reason for this decision of the Federal Service?

What is the information about the adverse effect? hemodesis served as the basis for discontinuation of this drug?
How to replace the usual hemodesis, firmly included in the composition infusion therapy? Here, in fairness, we note that in none of the above (and other) cases of application hemodesis, unfortunately, there was no complete and precise conviction in the implementation of its specific action.
This drug was almost always used in combination with other infusion media or substances, except, perhaps, isolated cases applications hemodesis, and for some foodborne diseases in conditions clinical trials that time. However, hemodesis considered active, useful and safe. This belief arose from the fact that at the time when hemodesis appeared in clinical practice, on issues of comparative studies, safety assessment medicinal substances and registration criteria side effect medications were approached differently than is customary today.

Therefore, to answer the questions posed, a brief excursion into the history of the evolution of preclinical and clinical evaluation of drugs that has occurred over the past decades in world pharmacological practice is necessary and to characterize the specific and comparative activity hemodesis, and in the light of new views on the pharmacogenesis of those diseases and conditions in which this drug was used. Let's start with the main thing.

Medicines affect the quality of life of people and the focus of pharmacotherapy is dictated by specific pharmacological activity medicinal product, the impact of which is accompanied by the elimination clinical manifestations disease and speeding up the patient's recovery.
At the same time, any medicines, both the most modern and those used for a long time, carry with them potential danger, which may appear adverse reactions, even if the drugs are prescribed correctly by the doctor, or if they are taken correctly by the patient, because all medicines are xenobiotics, i.e. substances foreign to the human body that can change metabolic processes.

Moreover, the consequences of the action of medicinal substances may not be realized by the doctor, especially if he is not alert in this regard or if there is a lack of relevant information and, especially, if the doctor is convinced only of the beneficial effect of the drug. Last position it is necessary to emphasize, especially when doctors use “old” and seemingly time-tested, pharmacological substances.

We also note that according to studies conducted in the USA, where, as is known, the recording and control of complications of drug therapy is the most strict, compared to other countries, it was found that none of the existing modern methods monitoring the side effects of drugs does not fully monitor the frequency of their occurrence. It is generally accepted that in the average statistical hospital the incidence of severe consequences caused by taking known and proven drugs (so-called AE) is up to 10 cases per 100 hospitalizations, and average cost "severe consequences" averages $2,000. Thus, the annual economic cost from complications of pharmacotherapy exceeds $2 billion (Bates, et al, 1997; Morelli, 2000).

In the 60s (NEED TO CHECK), when the State Pharmacopoeia appeared hemodesis, a centralized system for monitoring the side effects of drugs, according to at least, the one that exists in our country now did not exist, therefore, for many of the effects that arose when prescribing hemodesis(and other substances), did not always pay attention, attributing them to phenomena of other categories (effects associated with the patient’s condition, effects of polypharmacy, etc.).

Note that at that time there were no double-blind, placebo-controlled trials. Also, it is important to emphasize that the preclinical evaluation of medicinal substances was not consistent modern rules GLP (and the rules themselves have not yet been finalized).
Assessment of the parameters of chronic toxicity and its types existed in a limited form. One of the rules that has survived to this day in the tactics of assessing the chronic toxicity of new pharmacological substances - single-use drugs (and the appointment hemodesis fit within this time frame) regulated the study of a new compound within 10 days, which was done in relation to hemodesis. But this is not the main point.

Included in hemodesis Polyvinylpyrrolidone, a fashionable drug in those years, with an average molecular weight of 12,600 daltons, was adopted as a potential carrier of pharmacological substances in order to increase the duration of their action. The working hypothesis that the low molecular weight polyvinylpyrrolidone base is not metabolized, is filtered by the kidneys, and is intact for the human body, served as the basis for the development of long-term active drugs. They tried to “plant” no-shpa (drotaverine), antihypertensive drugs that existed at one time and some others on polyvinylpyrrolidone pharmacological agents. Experimental studies of subtypes of chronic toxicity, immunotropic and other properties of new pharmacologically active substances, as well as assessment of their pharmacokinetics, began to be carried out later.

Note that in combination with polyvinylpyrrolidone, many substances lost their specific activity, so further development of this hypothesis was suspended.
Electrolytes included in the composition hemodesis, in general, satisfied the practice of infusion therapy, however, upon comparative analysis, it could be concluded that their composition was not balanced compared to other infusion media (see Table 1). Subsequently, this circumstance served as the basis for the formulation of one of the contraindications for the introduction hemodesis, - namely, severe electrolyte disorders and acid-base balance.

Table 1. Some electrolytes (in mmol/l) included in the composition hemodesis and other drugs

Absolute contraindications for use hemodesis was not, however, one of the first; pediatricians, then other specialists, noted the side effects that arose during the administration of this substance. various reactions in response to the introduction hemodesis, in the form of facial redness, lack of air, decreased blood pressure. Some patients "shaked", especially when administered quickly hemodesis. Toxicologists prescribed hemodesis only as part of infusion reinforcement with other media, especially sodium-containing ones. Note that when prescribed in isolated form, the effect of the “blood sorbent”, as it was sometimes called hemodesis, it was not possible to track, because The drug was almost always administered in combination with other infusion media. The patients had unclear renal disorders, including a reduction in diuresis with careful monitoring of the latter, especially with long-term treatment chronic intoxications industrial means.
Doctors tended to attribute these side effects to “allergic” reactions caused by hemodesis. Thus, gradually, an opinion was formed about the “allergenicity” of this drug, however, the drug continued to be widely used in clinical practice.

If we return to Table 1, it becomes clear that electrolyte composition hemodesis is not perfect, especially for the needs of toxicology, although polyvinylpyrrolion is capable of binding small molecules of poisons (MNiSMM).

This is where, in our opinion, the main feature of this carrier is hidden: it can bind other substances, releasing its own electrolytes (remember, this is one of the contraindications for prescribing hemodesis- violations electrolyte metabolism substances), and by binding MniSMM, polyvinylpyrrolidone can acquire new properties and allergenic characteristics due to its biochemical transformation.

Numerous works by Professor M.Ya. Malakhova, completed over the last 10 years, indicate that any pathological condition is accompanied by the accumulation of MniSMM, directly proportional to the severity of this condition. This means that for many diseases or conditions, hemodesis may be potentially dangerous and have an adverse effect on cell membranes that perform a barrier function in detoxification organs, for example, in the kidneys.

Today, sorption capacity hemodesis, even if it is very large (which is doubtful, since the methods for assessing it using colloidal dyes are outdated) cannot compete with modern ones by efferent methods used for detoxification purposes. Many of them on display nearby are capable of quickly and completely extracting poisons in case of poisoning and M&SMMs formed during various diseases. However, if the exposure time is long enough, then even these methods do not always “work”.

Promising pharmacological protection lies in the development of methods for enhancing natural detoxification, in particular, in that part when, under the influence of pharmacologically active (active) compounds, a kidney, liver, myocardial or any other cell becomes capable of maintaining energy metabolism and performing the function assigned to it by nature . Of course, this is a drug of the future, however, the needs of today dictate the need to find an adequate replacement gemodez, both in terms of the quality of action and pharmacoeconomic evaluation criteria.

What in return?

Among the group of blood substitutes - hemocorrectors, hemodesis was practically the only detoxification drug. Its analogue (neohemodez) and homolog (polydesis - a solution of low molecular weight polyvinyl alcohol) are practically not used. A group of blood substitutes with the function of oxygen transfer (emulsions of fluorocarbons, starches) are too expensive for wide application, have not been fully studied and clinical experience against them continues to accumulate. Preparations for protein parenteral nutrition and “hemodynamic” blood substitutes based on dextran or gelatin have a different direction of action and other indications for use.

The most widely used regulators of water-salt and acid-base status are:
0,9% NaCl solution- an unbalanced solution, quickly leaves the vascular bed, contraindicated in hypertensive de- and overhydration, suitable for short-term manipulations (for example, at the prehospital stage) or as a corrective agent.

Ringer-Locke solutions, Ringer-lactate (Hartmann solution), acesol, disol hlosol - solutions that are more “physiological” in their composition, compared to sodium chloride, are used both in isolated form and in combination with other infusion media, however, all of them are not able to specifically influence the energy metabolism in cells and do not have sorption properties.

Solutions containing phosphorylated carbohydrates are not used in our country, however, there are solutions that contain components of the tricarboxylic acid (tsKrebs) cycle, such as fumaric and succinic. The first drug is called mafusol, the second is reamberin. The advantages of the latter lie not only in the balanced composition of electrolytes (see Table 1), or in the presence of a specific carrier N-methylglucamine in the solution, but also in the fact that succinic acid plays an exceptional role in the Krebs cycle, compared to fumaric, malic and other acids.
REAMBERIN, relatively new drug, however, its preclinical and clinical examinations have been completed in full and meet modern requirements. It is very important to note that Reamberin is a domestic drug and not expensive. It has been quite well studied in clinical practice at both the prehospital and hospital stages, and there are favorable reviews of it from practical healthcare workers. Detailed Descriptions The actions of reamerin can be found in the specialized literature. Here we note only the fact that an important the positive side The actions of reamberin include its pronounced antihypoxic and detoxifying properties, which allows it to be recommended as a substrate antihypoxant, a modern substitute hemodesis.
Unfortunately (or vice versa, to the dignity evidence-based medicine) hemodesis, is not the only drug for which a sufficient number of negative observations have accumulated during use in medical practice. Another example is mannitol, a drug of relatively limited use compared, for example, with perindripril, however, it is practically irreplaceable in some clinical situations encountered in neurosurgery, toxicology, resuscitation, etc. Yes, the data recent years convincingly indicate the ability of mannitol to stimulate the development of apoptosis.

Unfortunately, unlike hemodesis, today there are no substitutes for mannitol, so sooner or later the question of synthesizing new drugs with an effect similar to mannitol, but without such a terrible side effect, will arise.
The decision of the Federal Service showed that changes are taking place in the cumbersome machine of monitoring the side effects of drugs, and evidence-based medicine methods are beginning to work in our country. Time will show.

V. V. Afanasyev
(department emergency medicine SPbMAPO, Institute of Toxicology).

Hemodez is a drug used in medical practice as an effective detoxification and plasma replacement agent.

pharmachologic effect

Hemodez is medicine, exhibiting a detoxification effect due to the polyvinylpyrrolidone included in its composition, which promotes the binding and rapid elimination of toxins circulating in the blood.

The drug Hemodez N differs from Hemodez in containing a lower molecular weight of povidone (polyvinylpyrrolidone), which significantly increases its detoxification abilities and increases the rate of excretion from the body by the kidneys. Due to the activation of renal blood flow by Hemodez, H increases glomerular filtration, and diuresis also increases. The drug is not metabolized and is completely eliminated from the body within 24 hours.

Release form and composition

Hemodez is produced in the form of a transparent yellowish infusion solution, in special bottles for blood substitutes of 100, 200 and 400 ml. The solution contains ions: calcium chloride, potassium chloride, sodium bicarbonate, sodium chloride, magnesium chloride, povidone with a molecular weight of 8000±2000 for Hemodez N and with a mass of 12,600±2700 for its analogue. The solution also contains water for injection as an excipient.

Indications for use of Hemodez according to the instructions

According to the instructions, Hemodez is indicated for:

  • State of shock - postoperative, post-traumatic, burn, hemorrhagic;
  • Intoxication in acute gastrointestinal diseases– dyspepsia, dysentery, salmonellosis;
  • Liver lesions, which are accompanied by the development of liver failure;
  • Pneumonia;
  • Burn disease;
  • Sepsis;
  • Acute radiation sickness;
  • Intrauterine infections;
  • Hemolytic disease in newborns.

An infusion solution is also used for toxicosis in pregnant women, chronic diseases liver, thyrotoxicosis, alcohol intoxication.

Methods of using Hemodez

According to the instructions, Hemodez is administered intravenously at a rate of 40-80 drops per minute, a device with a filter is used for infusions, and the prescribed single dose of the medicine depends on the age of the patient and the severity of the toxin damage. Before use, the drug must be brought to body temperature (35-36°C), a single dose for adults is 200-500 ml, for children - 5-10 ml per 1 kg of body weight. The intervals between injections of the solution should be at least 12 hours. The maximum single dose of Hemodez for adults is 500 ml, for children:

  • From 10 to 15 years – 200 ml;
  • From 5 to 10 years – 150 ml;
  • From 2 to 5 years – 100 ml;
  • Infant age – 50-70 ml.

Hemodez can be administered once or 2 times a day.

The course of therapy lasts from 1 to 10 days, depending on the patient’s condition and the severity of the disease:

  • In case of burn or radiation disease, acute gastrointestinal diseases with severe symptoms of intoxication, 1-2 infusions per day are given;
  • For manifestations of neonatal toxemia, as well as hemolytic disease the drug is administered 2-8 times, one or two infusions per day (daily or every other day);
  • In case of large-focal infarction, during the first day Hemodez is administered once in an amount of 200 ml, the same dosage is prescribed on the second day in case of complications ( cardiogenic shock, severe arrhythmia).

If necessary, subcutaneous administration of the drug is also possible, but in this case the effectiveness of the effect is reduced.

Contraindications to the use of Hemodez

As stated in the instructions, Hemodez is contraindicated for:

  • Hypersensitivity to the components of the drug;
  • Brain hemorrhage;
  • Cardiovascular failure;
  • Acute jades;
  • Thromboembolism;
  • Bronchial asthma;
  • Oliguria;
  • Anuria;
  • Intracranial hypertension;
  • Phlebothrombosis.

Side effects

When administered slowly, as shown in the instructions, the drug usually does not cause any side effects. When Hemodez is infused at a higher rate, a decrease in blood pressure, the occurrence of tachycardia, difficulty breathing. IN similar cases The administration of the drug is stopped and symptomatic therapy is carried out.

special instructions

The use of Hemodez is possible with the simultaneous use of albumin and gamma globulin for extensive burns. The drug can only be used if its packaging is intact and visual inspection The liquid in the bottle should not contain suspended matter or sediment.

Storage conditions for the drug Hemodez

Hemodez should be stored in a dark place out of reach of children.

Storage temperature range from 0°C to 20°C. It is important to know that freezing does not affect the quality of the drug.

Shelf life – 3 years.