Efferalgan effervescent powder 150mg upsa sas analgesic, reducing fever (12 packs)

Pain relief

The mechanism of pain relief has not been fully determined. Paracetamol can work primarily by inhibiting the number of pain relief lines including prostaglandin synthesis in the central nervous system (CNS) and at a smaller level, through peripheral effects by preventing the formation of pain impulses or by inhibiting the synthesis or the effect of other substances where the receptor is sensitive to mechanical stimulation or chemistry.

A reduction of fever

Paracetamol can reduce fever by impacting mainly on the hypothalamus center. This main impact may be related to prostaglandin synthesis in the hypothalamus.

pharmacokinetics

Absorption

Paracetamol when taken will be absorbed quickly and completely. The peak concentration in plasma is reached about 10 - 60 minutes after oral (see pharmacokinetic properties, pharmacokinetics, special patient groups).

Distribution

paracetamol is quickly distributed into most tissues.

In adults, the distribution of Paracetamol is about 1-2 liters/kg and in children between 0.7 - 1.0 liters/kg.

Paracetamol does not strongly connect with plasma proteins.

Metabolism

Paracetamol is metabolized mainly in the liver in two main paths in the liver: associated with glucuronic acid and associated with sulfuric acid; Combined with sulfuric acid quickly saturated when taking a higher dose but still within the scope of treatment. The saturation of the glucoronid process only appears when used higher, toxic to the liver.

A small part (less than 4%) is trips by Cytochrom P450 to form a high reaction intermediate (N-acetyl Benzoquinoneimin), under normal usage conditions, this intermediate will be detoxified by glutathion reduction and is eliminated in urine after connected with cystein and mercapturic acid. However, when poisoning with high doses of paracetamol, the amount of metabolites has this toxicity increases.

Elimination

Paracetamol metabolites are mainly eliminated in urine, in adults, about 90%of the dose is excreted for 24 hours, mainly in the form of glucuronid complex (about 60%) and sulfate complex (about 30%). Less than 5% are eliminated in constant form.

Selling time in plasma is about 2 hours.

Special patient groups

kidney failure

When the renal failure is severe, the slightly slow paracetamol excretion. For glucuronid and sulfate combinations, the elimination speed is slower in people with severe renal failure than healthy people. The minimum time between each medication is 6 hours or 8 hours when using paracetamol for these patients (see doses and usage, kidney failure).

Hepatic failure

Some clinical trials have shown the average decline of paracetamol metabolism in patients with chronic liver failure, including alcoholic cirrhosis, as shown by an increase in plasma paracetamol levels and longer selling time.

In these reports, the semi -discharged time of paracetamol in plasma is associated with reducing the synthesis of the liver, so it should be careful when using paracetamol in patients with liver failure and contraindicated when there is liver disease, which can compensate for active, especially alcoholic hepatitis, due to CYP2E1 induction, leading to an increase in the formation of toxic substances for the liver toxicity of Paracetamol.

Elderly

In the elderly, the pharmacokinetics and metabolism of paracetamol changes slightly, or unchanged. No dose adjustment in this patient group.

infants, children and children

Paracetamol pharmacokinetics parameters observed in young children and children are similar to observing in adults, except for the sale time in plasma slightly shorter (about 2 hours) compared to adults.

In newborns, the sale time in plasma is longer than in young children (about 3.5 hours).

Babies, young children and children to 10 years old excreting Glucuronid complex are significantly less and more significantly more sulfate than adults. The total amount of paracetamol excretion and its metabolites is the same at all ages.

This type of drug is for children weighing 10 to 40 kg (about 2 years old to 11 years old).

Note: The dose must be calculated by the weight of the child.

The appropriate age corresponds to the weight presented below just for reference. To avoid the risk of overdose, it is necessary to check and confirm the accompanying drugs (including prescription and non -prescription drugs) without paracetamol.

Efferalgan should be used at a private dose of 10 - 15 mg/kg/dose, every 4 to 6 hours, to the maximum daily dose of 60 mg/kg/day. The maximum dose per day should not exceed 3 g.

What to do when overdose?

signs and symptoms

may be at risk of poisoning, especially in patients with prolonged malnutrition and enzyme users. In particular, overdose can lead to death in these cases.

Symptoms usually appear in the first 24 hours, including nausea, vomiting, anorexia, pale skin, uncomfortable and sweating.

Overdose when taking a dose higher than 7.5 g of paracetamol in adults, or 140 mg/kg body weight in children will cause inflammation and destruction of liver cells, which can cause complete and non -recovery liver necrosis, leading to liver cell failure, metabolic acid infection and brain disease leading to coma and death.

At the same time, there is an increase in liver transaminase levels (AST, ALT), lactate dehydrogenase and bilirubin along with decreased prothrombin levels, which can occur from 12 to 48 hours after taking the drug. The clinical symptoms of liver damage often become pronounced at first after 1-2 days and reach a maximum after 3-4 days.

Emergency measures

Take it immediately to the hospital

Before starting treatment, taking a blood tube as soon as possible to quantify the concentration of paracetamol in plasma but not earlier 4 hours after taking paracetamol.

Quickly eliminate the amount of medicine used by gastrology.

The main detoxification is the use of the sulfhydryl compound, perhaps partly due to the addition of glutathion reserves in the liver.

n-acetylcysteine ​​works when taken or intravenously. It must be used to detoxify immediately, as soon as possible if less than 36 hours after taking paracetamol. Treatment with n-acetylcysteine ​​is more effective for less than 10 hours after taking paracetamol.

When drinking, dilute N-acetylcystein solution with water or drink without alcohol to achieve a 5% solution and must be taken within 1 hour after mixing.

Give N-acetylcystein oral at the first dose of 140 mg/kg, then give 17 more doses, each dose of 70 mg/kg every 4 hours apart. Termination of treatment if the paracetamol test in plasma shows the risk of low liver toxicity.

It is also possible to use N-acetylcystein by intravenous line: The initial dose is 150 mg/kg, mixed in 200 ml of 5%glucose, intravenous injection for 15 minutes; Then intravenously dose of 50 mg/kg in 500ml glucose 5% in 4 hours; Next is 100 mg/kg in 1 liter of solution within the next 16 hours.

Without 5% glucose solution, 0.9% sodium chloride solution may be used.

The unwanted effect of N-acetylcystein includes skin rash (including urticaria, no need to stop the drug), nausea, vomiting, diarrhea and anaphylactic reaction.

Without n-acetylcystein, methionine can be used. If you have used activated carbon before using methionin, you must suck activated carbon and/or salt bleach because they have the ability to reduce the absorption of paracetamol.

Symptomatic treatment

Must conduct liver tests at the beginning of treatment and repeat every 24 hours.

In most cases, the liver transaminase returns to normal after 1-2 weeks with the full recovery of the liver function. In case of being too heavy, liver transplant may need.

What to do when forgetting 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double dose to compensate for missed dose.

Notice immediately to the doctor or pharmacist the harmful reactions encountered when using the drug.

Be cautious when using

In case of severe liver disease or kidney disease (a doctor must be consulted before taking paracetamol).

Anorexia, incorrect or corrosion, prolonged malnutrition (poorly liver glutathion reserves).

Dehydration, reducing blood volume.

Doctors need to warn patients on signs of serious skin reactions such as Stevens-Johnson syndrome (SJS), toxic skin necrosis syndrome (Ten) or Lyell syndrome, acute overseas acne syndrome (AGEP).

If symptoms of pain persist for more than 5 days or a fever for more than 3 days or the drug is not effective enough or see other symptoms, no treatment will not be treated without consulting your doctor.

Due to sorbitol, this drug is not used in case of intolerance to fructose.

In patients who are following the salt diet, it is important to remember that each pack contains 55.7 mg of sodium to calculate the daily diet.

The ability to drive and operate machinery

does not affect.

Pregnancy

Paracetamol should only be used for pregnant women after being carefully evaluated between treatment benefits and risks in pregnant patients, recommended doses and drug use time must be closely monitored.

Breastfeeding period

Be careful when applying.

Medicinal interaction

If the doctor prescribes the measurement of uric acid or blood sugar levels, you need to report your doctor as your child is taking this medication.

Efferalgan's effect on other drugs

Efferalgan 150mg may increase the possibility of unwanted effects when used with other drugs.

Anticoagulant: Paracetamol long -doses of high doses increases the anticoagulant effect of cooumarin and conductor indoors.

Effect of other drugs on Efferalgan

Concentrated with Phenytoin, Barbiturat, Carbamazepine can lead to reduced paracetamol effectiveness and increase the risk of toxicity to the liver. Patients who are being treated with phenytoin should avoid large and/or prolonged paracetamols. Need to monitor patients on signs of toxicity for the liver.

Probenecid may reduce nearly twice in paracetamol's clearance by inhibiting its conjugate with glucuronic acid. Paracetamol dose should be considered when used simultaneously with probenecid.

salicylamid can extend the disposal time (t1/2) of paracetamol.

Enzyme induction substances: Be careful when using paracetamol with liver enzyme induction substances such as barbiturat, isoniazid, carbamazepine, rifampicin and ethanol ...