Efferalgan effervescent powder 250mg upsa sas analgesic, reducing fever (12 packs)

Dosage form Effervescent powder mixed oral solution
Specifications 12 package box
Ingredient Paracetamol

Ingredient

Composition information	Content
Paracetamol	250mg

Uses

indications

Efferalgal 250mg is used to treat pain and/or fever such as headache, flu, toothache, muscle aches, dysmenorrhea. The drug is used for children weighing from 17 - 50 kg.

Pharmacokinus

paracetamol is an analgesic and antipyretic with mild anti -inflammatory activity. Unlike traditional nonsteroidal anti -inflammatory drugs (NSAID), paracetamol does not inhibit platelet function at the dose of treatment.

Mechanism of action: The exact mechanism of paracetamol analgesic and antipyretic effects has not been determined. The mechanism of action can be related to the effects at the central and peripheral.

Pharmacokinetics

absorption

Paracetamol when taken will be absorbed quickly and completely. The peak concentration of plasma is about 10 - 60 minutes after drinking.

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 appears only when the dose is higher, toxic to the liver.

A small part (less than 4%) is metabolized by Cytochrom P450 forming a high reaction mediator (N-acetyl Benzoquinoneimin), under normal usage conditions, this intermediate will be detoxified by glutathion reduction and is eliminated in urine after connecting 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%). Under 5% is eliminated in constant form. Selling time for 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 taking paracetamol for these patients.

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 cautious when using paracetamol in liver failure patients 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 half -blooding time in plasma (about 2 hours) compared to adults. In infants, 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.

Before taking Efferalgan effervescent powder 250mg upsa sas analgesic, reducing fever (12 packs)

How to use

Take oral use.

Pour Efferalgan powder 250mg into the cup and then add a little liquid drink (such as water, milk, juice), drink immediately after completely dissolved.

Dosage

Efferalgan effervescent powder 250mg for children weighing from 17 to 50 kg (about 5 years old to 13 years old).

Dosage must be calculated by the child's weight:

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 dose of 10 - 15 mg/kg/dose, every 4 to 6 hours, to the maximum daily daily dose of 60 mg/kg/day.

Maximum daily dose must not exceed 3G.

Weight (kg) appropriate age* (year) Paracetamol/dose (mg) Number of packages/dose numbers

minimum mineral mineral methods (hour) Maximum daily dosage (pack) 25 5 to 250

(1000 mg)

(1500 mg)

(2000 mg)

(3000 mg)

≥ 50

13 Use another form of oral medication instead of

Renal failure: In patients with severe renal impairment, the minimum between each use Efferalgan 250mg should be adjusted according to the following table:

Creatinin clearance Drug usage distance 10ml/minute 8 hours The maximum daily dose should not exceed 60 mg/kg/day (no more than 2 g/day) in the following cases:

Adults weighing less than 50 kg. liver).

dehydrated. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.

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 7.5g of paracetamol in adults, or 140 mg/kg body weight in children will cause inflammation and cancel liver cells, which can cause complete and non -recovery liver necrosis, resulting in liver cell failure, metabolic acid infections 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 used, but the sulfhydryl compound, perhaps the impact is partly due to the addition of glutathion reserves in the liver. N-acetylcystein works when taken or intravenously. Must use antidote immediately, as soon as possible if less than 36 hours after taking paracetamol.

Treatment with n-acetylcystein 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 200ml 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.

If there is no 5% glucose solution, 0.9% sodium chloride solution may be used. The unwanted effect of n-acetylcystein includes leather 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 a liver test 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 you forget 1 dose? However, if the time of relaxation with the next dose is too short, skip the forgotten dose and continue the Efferalgan medicine schedule 250mg. Do not use double dose to compensate for missed dose.

Side Effects

Some side effects may be encountered when taking the drug including:

Blood and lymphatic disorders: reduced platelets, neutropenia, leukopenia. Inr. Drugs.

Warnings

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

Contraindicated

This drug is not used in the following cases:

Know there is an allergy to paracetamol or with propacetamol hydrochloride (the precursor of paracetamol) or other ingredients of the drug. Sorbitol's face).

Be cautious when using

In case of severe liver disease or kidney disease (a doctor must be consulted before using 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 seeing other symptoms, no treatment without consulting your doctor.

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

In patients who are doing a salt diet, it is important to remember that each pack contains 93mg of sodium to calculate the daily diet.

The ability to drive and operate machinery

does not affect.

pregnancy

does not apply.

The period of breastfeeding

does not apply.

Interactive drug

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

Effect of Efferalgan 250mg on other drugs: Efferalgan 250mg may increase the likelihood of unwanted effects when used with other drugs.

Anticoagulant: Paracetamol may increase the effects of anticoagulants.

Effect of other drugs on Efferalgan 250mg:

Concentrated use with phenytoin 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 ...

Storage

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

To be out of reach of children.

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