Azenmarol 4 Agimexpharm medicine for myocardial infarction, heart disease (10 blisters x 10 tablets)

Dosage form Box of 10 blisters x 10 tablets
Specifications Acenocoumarol
Ingredient CPDP AGIMEXPHARM

Ingredient

Composition information	Content
Acenocoumarol	4mg

Uses

indications

Azenmarol drug indicated in the following cases:

Heart disease clogged: Preventing vascular blood clogged thrombosis, mitral valve disease, artificial valve. Preventive recurrence of myocardial infarction when it is impossible to use aspirin.

Acenocoumarol is a vitamin K-resistant cooumarin conductor. These drugs inhibit vitamin K Epoxid Reductase enzyme, resulting in the process of converting glutamic acid into gamma-carboxyglutamic acid of the precursor protein of blood clots II, VII, IX, X.

As such, vitamin K -resistant coumarin derivatives have an indirect anticoagulant effect by preventing the synthesis of the activity of the above coagulation factors (II, VII, IX, X).

After taking acenocoumarol, the effect on prolongrombin time is usually maximum within 24 to 48 hours, depending on the dose. After stopping the drug 48 hours, the prothrombin time is back before taking the drug.

After drinking, generally, vitamin K -resistant coumarin derivatives cause blood prothrombin within 36 to 72 hours.

Balance of anti -vitamin K treatments requires many days. After stopping the drug, anticoagulants can last for 2-3 days.

The drug may limit the development of the existing thrombosis and prevent secondary symptoms of thrombosis, although there is no direct thrombotic effect because it does not reverse the damage of ischemic tissue.

Compared to wafarin and phenprocoumon, acenocoumarol has the advantage of shorter effect time.

Dynamic pharmacokinetics

acenocoumarol is quickly absorbed through the gastrointestinal tract. Oral bioavailability reaches 60%. A significant part of isomorphic s (-)-acenocoumarol through initial metabolism in the liver, while the bioavailability of isomers R (+)-Acenocoumarol is 100%. The drug is strongly associated with plasma proteins (99%).

The peak concentration of the drug in plasma is within 1-3 hours. Distribution volume 0.16 - 0.34 liters/kg. Acenocoumarol through the placenta and a small part is detected in breast milk.

Acenocoumarol is metabolized in the liver by the cytochrom P450 enzyme system (isenzyme CYP2C9 isomered S isomer, r isomer is metabolized by some other isenzymes) into non -active amino and acetamid metabolites. Some other metabolites such as diastereoisometric alcohol and hydroxyl metabolites may be active. Clinicians need to know the possibility of some highly sensitive patients with acenocoumarol due to the polymorphism of the liver, and may have to reduce the dose in that patient.

Half lifetime elimination of acenocomarol is about 8 -11 hours.

The drug is excreted mainly in urine (60% in about 1 week) in the form of metabolism and partly through feces (29% in about 1 week).

Before taking Azenmarol 4 Agimexpharm medicine for myocardial infarction, heart disease (10 blisters x 10 tablets)

How to use

Acenocoumarol drugs used by oral, usually taken once at the same time at the same time.

Dosage

The dosage must be adjusted to achieve the purpose of preventing blood clotting mechanism that it does not occur but avoiding spontaneous bleeding. Dosage depends on the response of each person.

Normal oral dose:

The first day is 4 mg/day, the 2nd day is 4- 8mg/day.The appropriate biological test is to measure the time of prothrombin (PT) indicated by the International Normalized Ratio ( International Normalized Ratio).

Prothrombin time allows the exploration of factors II, VII, and X are factors that are reduced by vitamin K anti -vitamin K.

INR is a way to indicate the time to the sensitivity of the reagent (thromboplastin) used for testing, so it should reduce erratic changes between labo.

When not taking anti -vitamin K, Inr in normal people is 1. Inr above 3 is to use excess medicine. Inr above 5 is at risk of bleeding.

The first test was conducted 48 hours ± 12 hours after the first vitamin K -taking drug to detect an increase in individual sensitivity.

If Inr above 2, signaling will overdose when equilibrium, so the dose must be reduced.

The following tests are conducted daily or Japan until the INR is stable, then far away depending on the response, the longest is every 12 weeks.

Balance of treatment sometimes only reaches after weeks. After each dose change, check the Inr 1-2 days later and repeat until stable.

In general, Inr from 2-3 is recommended for prevention or treatment of venous thrombosis, including pulmonary embolism, atrial fibrillation, heart valve, or biological valve. play.

Dosage in the elderly:

The starting dose must be lower than the adult dose.

Due to the slow anticoagulant effect of vitamin K anti -vitamin drugs, heparin must be maintained at a constant dose throughout the necessary time, that is, until the INR is in the desired value for 2 consecutive days.

Only for vitamin K resistance after giving thrombin drugs (Danaparoid or Hirudin). If the day before the Inr ≥ 1.5 surgery, the vitamin K should be given injected with 1 - 5mg injected form. If the bleeding is good, it is possible to reuse the drug (acenocoumarol) with a normal maintenance dose on the surgical day or the next morning.

Patients stop the drug before surgery is considered to be high risk, so it may need support with a low molecular heparin (used for treatment). Need to stop the molecular heparin at least 24 hours before surgery. If surgery is at high risk of bleeding, do not reuse low molecular heparin within at least 48 hours after surgery.

Patients taking drugs (acenocoumarol) need urgent surgery that may slow down about 6 - 12 hours, it can be given intravenous 5 mg of vitamin K to reverse anticoagulant effect. If it is not possible to postpone, both vitamin K and dry prothrombin mixture (for example, 25 units/kg) and must be tested for Inr before surgery.What to do when overdose?

Symptoms:

The outstanding manifestation of overdose is bleeding, which can occur within 1-5 days after taking the medication. Symptoms of tachycardia, hypotension, peripheral circulatory disorders due to blood loss, nausea, vomiting, diarrhea and abdominal pain.

Management:

Overdose is usually based on Inr and signs of bleeding, adjustment measures must be sequentially so as not to risk thrombosis. If you have used anticoagulants but do not use vitamin K, need to re -test Inr 2-3 days later to make sure the INR has dropped.

If Inr

quit 1 time to take the medicine, then continue to treat at a lower doses when you have reached the desired INR.

Remove 1 or 2 times to take anticoagulant drugs, measure the Inr more often when you have achieved Inr desired, take the drug again at a lower dosage.

Stop the drug, use vitamin K from 1 - 3 mg by slow intravenous line.

Stop acenocoumarol, use 1 - 5 mg of Phytomenadion (vitamin K1) (use the type of injection instead of oral).

stop the drug, use vitamin K from 1 - 3 mg by slow intravenous intravenous.

Stop the drug, slow intravenous injection of 5 mg of vitamin K, use a dry prothrombin mixture (factor II, VII, IX and X) 25 - 50 units/kg (if there is no dry prothrombin mixture, replaced with fresh frozen plasma 15 ml/kg but the efficiency will be worse).

In case of poisoning due to an accident, it must also be evaluated according to INR and manifests bleeding complications. Must measure the Inr many days later (2-5 days), taking into account for half a long life of anticoagulant drugs. Use vitamin K to adjust the effects of anticoagulant drugs.

What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.

Side Effects

When using Azenmarol, you may experience unwanted effects (ADR):

The most common complications of bleeding, which can occur throughout the body: the central nervous system, the limbs, the organs, in the abdomen, in the eyeball, ....

Sometimes diarrhea occurs (may be accompanied by fatty fertilizer), individual joint pain.

rarely occur: hair loss; localized skin necrosis, possibly due to genetics lacking C protein or homogeneous factor is S protein; allergic skin.

Venous vasculitis, liver damage.

ADR management guide: When encountering side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

contraindicated

Azenmarol drugs contraindicated in the following cases:

Sensitive susceptible to Coumarin derivatives or any ingredients of the drug. New surgical intervention of neurological and eye or the ability to have surgery. Pyrazol, miconazole use systemic and vagina; phenylbutazol, chloramphenicol, diflunisal.

Be cautious when using

Must pay attention to the cognitive ability of the patient during the treatment process (the risk of wrong medication). Careful guidance for them to comply with accurate indications, understanding the risk and attitude of handling, especially for the elderly.

Must emphasize the daily medication at the same time.

Testing for international standardization ratio (INR) must be tested and at the same place.

In case of surgical intervention, each case must be considered to adjust or suspend anticoagulic drugs, based on the risk of patient thrombosis and the risk of bleeding associated with each type of surgery.

Monitor carefully and adjust the dose accordingly in medium and mild kidney failure or lower blood protein.

Hemorrhagic complications are prone to the first months of treatment, so it is necessary to monitor closely, especially when the patient goes home to return home.

Do not stop the drug suddenly.

The excipient of this drug has lactose so it should not be used for patients with Galactose intolerance, lactase deficiency or glucose-galactose.

The impact of the drug on the ability to drive and operate machinery

The drug does not affect the ability to drive or operate machinery.

Take drugs for pregnant and lactating women

Pregnancy:

There was a statistics of about 4% of the fetal deformity when the mother took this drug in the first quarter of pregnancy. In the next quarters, there is still risk (including miscarriage). Therefore, avoid being used for pregnant women, especially in the first 3 months and the last 3 months of pregnancy. Only use the drug when it is impossible for heparin.

Breastfeeding period:

Avoid breastfeeding. If you have to breastfeed, you should compensate for vitamin K for the child.

Interaction of drugs

A lot of drugs can interact with anti -vitamin K drugs, so they need to monitor patients for 3-4 days after adding or removing combined drugs.

Contraindications for coordination:

Aspirin (especially with high doses on 3G/day) increases anticoagulant effects and the risk of bleeding due to inhibition of platelet aggregation and transferring anticoagulant oral fluids from bonds with plasma proteins. With the irritation of the gastrointestinal tract mucosa.

Do not coordinate:

Aspirin with a dose of less than 3 g/day. If it is unavoidable, it is necessary to check the Inr more often, adjust the dose in and after 8 days of stopping chloramphenicol. Other painkillers should be used, for example paracetamol.

Caution when coordinating:

alopurinol, aminoglutethimid, amiodaron, androgen, antidepressants against serotonin, benzbromaron, bosentan, carbamazepin, cephalosporin, cimetidine (above 800 mg/day).

cisaprid, cholestyramin, corticoid (except hydrocortison used to replace in Addison disease), cyclin, cytotoxic drugs, fibrats, fungal azols, fluoroquinolones, heparin, hormonal hormones, enzyme induction drugs, statins, macrolid (except spiramycin).

Neviparin, Efavirenz, Imidazol group, Orlistat, Pentoxifyllin, Phenytoin, Propafenon, Ritonavir, Lopinavir, some sulfamids (sulfamethoxazol, sulfurazol, sulfamethizol), sucralfat, tamoxi Raloxifen), Tibolon, Vitamin E above 500 mg/day, alcohol, anti -platelets, thrombolytic drugs, ... also changes anticoagulant effects.

Storage

Leave a cool place, avoid light, temperature below 30⁰C.

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