Meshanon 60mg Hasan tablets treat myasthenia gravis, intestinal off due to intestinal paralysis and postoperative urinary retention (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Pyridostigmin bromid

Ingredient

Composition information	Content
Pyridostigmin bromid	60mg

Uses

Indications

Treatment of muscle weakness, intestinal obstruction due to intestinal paralysis and postoperative urinary retention.

Pharmacokic

pyridostigmin bromid is a cholinesterase resistant, thus inhibiting the hydrolysis of acetylcholin. The mechanism of action of the drug is to compete with acetylcholine associated with cholinesterase enzymes, so acetylcholin accumulates in the sympathetic neurological synapes and its effects are prolonged and increased.

With essentially a four -level ammonium compound, Pyridostigmin Bromid has a favorable inhibitor of the enzyme that is like Neostigmin, but the effect appears slowly and lasts so the drug is used mainly in the treatment of myasthenia gravis . The distance between the doses of pyridostigmin is longer than Neostigmin, which facilitates the treatment of myasthenia gravis.In addition, Pyridostigmin Bromid has a weaker "muscarinic" effect than Neostigmin, so it is often better tolerated than patients with myasthenia gravis and the longer lasting effect of pyridostigmin bromid is also an advantage. Therefore, it is possible to combine pyridostigmin with Neostigmin in the treatment of myasthenia gravis, for example, using pyridostigmin during the day and evening, Neostigmin used in the morning.

The body -causing cholinergic response drug includes increased musculoskeletal and intestinal muscle tone, pupils, uterine spasms, bronchospasm, heartbeat slowly, increased secretion in suburban glands. Pyridostigmin has the same effect as cholin on the skeleton.

pharmacokinetics

absorption:

Pyridostigmin Bromid is poorly absorbed through the gastrointestinal tract with absolute bioavailability of 10 - 20 %. The maximum concentration in plasma is reached for 1-2 hours. Pyridostigmin is most absorbed in the duodenum.

Distribution:

pyridostigmin is distributed in extracellular fluids. The drug cannot enter the central nervous system. The drug through the placenta and reduces the activity of the fetal plasma cholinesterase after the mother takes high doses. The distribution volume is about 19 ± 12 liters.

Metabolism:

pyridostigmin is hydrolyzed by cholinesterase and metabolized in the liver.

Era:

About 80 - 90% of pyridostigmin is eliminated through the kidneys in the form of non -metabolic, drugs and metabolites are excreted in the urine. The disposal time of the drug is 1.05 - 1.86 hours when intravenous injection while the disposal time of the drug when used orally lasts about 3 hours. A very small part of milk.

Before taking Meshanon 60mg Hasan tablets treat myasthenia gravis, intestinal off due to intestinal paralysis and postoperative urinary retention (3 blisters x 10 tablets)

How to use

Take oral use. Take pills with water or other drinks without alcohol. If the patient is difficult to swallow, you can break the tablet in half.

Dosage

Treatment of myasthenia gravis:

Adults:

dose of 30 - 120 mg, used many times a day when it is necessary to work maximum (for example, when waking up or before meals). The effect of 1 use usually lasts 3 to 4 hours during the day and for longer effect (6 hours) when taking the drug when going to bed.

Total daily dose: 5 - 20 capsules (300 - 1200 mg) or may be higher in some patients.

Children

Children 6 - 12 years old: 1 tablet (60 mg).

Increase the dose gradually, each time increases 15 - 30 mg/day until the symptoms improve maximum.

Total daily dose: 30 - 360 mg.

Treatment of intestinal obstruction due to intestinal paralysis, postoperative urinary retention:

Adults:

dose of 1 - 4 capsules (60 - 240 mg)/day. Number of drugs depending on the needs of each patient.

Children

dose of 15 - 60 mg/day. Number of drugs depending on the needs of each patient.

Dosage in some special clinical subjects:

Elderly:

There is no specific recommendation for the dose of pyridostigmin bromid for elderly patients.

Patients with renal failure:

pyridostigmin bromid is excreted mainly through the kidneys in a constant form, so the dose should be reduced in patients with kidney disease and when treated, the dose should be detected.

Patients with liver failure:

There is no separate recommendation of the dose of pyridostigmin bromid for patients with liver failure.

Note: The above dose is for reference only. 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?

Muscarinic effect: abdominal cramps, increased intestinal motility, diarrhea, nausea, vomiting, increased salivation and bronchial fluid, increased sweating, pupils.

Nicotinic effect: muscle vibration, muscle weakness to paralysis, cramps .

Central nervous system: agitation, confusion, restlessness, stimulation, hallucinations, whirling.

circulatory: Slow heart rate, lower blood pressure to cardiovascular collapse, cardiac arrest.

Artificial ventilation if the patient has serious respiratory failure. Stop the drug immediately. Muscarinic effects are heaviest and can be controlled by atropine (2 mg, intravenously, then intramuscularly, every 2 to 4 hours, depending on the need to reduce shortness of breath), but avoid overdose of atropine.

What to do when you forget a dose? Do not take double the dose to compensate for the forgotten dose. If you forget more than one taken medicine, please contact the doctor for instructions.

Side Effects

Common, ADR> 1/100:

No report.

Uncommon, 1/1000

No report.

Unknown frequency:

Eyes: Dong Tu, increased tear secretion, regulatory disorders.

heart: arrhythmia (slow rhythm, tachycardia, atrial block), fainting, lowering blood pressure. Respiratory: Increasing bronchial secretion, bronchospasm. digestive: Nausea, vomiting, diarrhea, abdominal cramps, increased intestinal motility, increased salivation.

Skin and subcutaneous tissue: rash, increased sweating.

Muscle and connective tissue: Increase muscle weakness, muscle vibration, tremor, cramps, decrease in the muscles.

Kidney and urinary: urine.

Instructions on how to handle ADR:

Because these symptoms may be a manifestation of a choline power, it is necessary to notify the doctor immediately to screen for symptoms.

Warnings

Contraindications:

Meshanon 60 mg contraindicated in the following cases:

Hypersensitivity to pyridostigmin bromid or any ingredients of the drug.

Mechanical congestion of urinary or digestive tract.

Be cautious when used

Special prudence especially when using Meshanon 60 mg for patients with respiratory obstruction such as bronchial asthma and chronic obstructive pulmonary disease (COPD).

Caution in patients with the following diseases: Rhythmic rhythms such as slow rhythm and atrial block (older patients are more susceptible to arrhythmia than young people), new coronary ventilation, lower blood pressure, increased sympathetic nerves, digestive ulcers, epilepsy or Parkinson, hyperthyroidism.

When using Meshanon 60 mg with relatively high doses in muscle weak patients may have to use additional atropine or other antagonistic drugs to reduce muscarinic effects. Note the reduction of stomach - intestines may affect the absorption of the drug.

In all patients, it is important to note the difference of the "cholin power" due to the overdose of Meshanon 60 mg with the "muscle weakness" due to increased severity of the disease. Both attacks are manifested by muscle weakness, but while "myasthenia gravis" may require treatment for enhancement of cholinesterstase, and "cholinic attacks" should immediately stop treatment with cholinesterase and set appropriate support measures, including respiratory assistance.

Meshanon 60 mg demand is usually reduced after removing the thymus or when using additional therapy such as steroids, immunosuppressive drugs.

The drug contains lactose, patients with rare genetic problems galactose intolerance, lactase lactase deficiency or glucose-galactose should not use this drug.

The ability to drive and operate machinery

pyridostigmin bromid or inappropriate muscle weakness treatment causes pupils and regulating disorders. Meshanon 60 mg may reduce vision and lead to decline in reaction capacity as well as driving and operating machinery.

Pregnancy

The risk of mothers and children should be considered for evaluation with benefits in all cases, although the experience of using pyridostigmin bromid in pregnant patients with myasthenia gravis does not see the unwanted effect of the drug during pregnancy.

pyridostigmin bromid may pass through the placenta fence, so avoid using Pyridostigmin Bromid overdose; Babies should be monitored unwanted effects that may occur.

Using Pyridostigmin Bromid vein can cause uterine contractions (especially at the end of pregnancy).

Because the severity of myastheniastick often waveres significantly, special attention should be paid to avoiding cholin intensity due to overdose of Pyridostigmin as well as closely monitoring the same patient without pregnancy.

The period of breastfeeding

Small amount of pyridostigmin bromid is excreted into breast milk, which should be concerned about the effect possible for breastfed babies.

Interactive drug

Immune inhibitors: Pyridostigmin bromid needs can be reduced when coordinated with steroids, immunosuppressants, although the peak concentration in plasma and the AUC of pyridastigmin may be reduced when using high doses of corticosteroids.

methylcellulose and drugs containing methylcellulose in excipients can inhibit the complete absorption of pyridostigmin bromid.

antacentia Muscarinic: Atropin and Hyoscin fight against muscarinic effects of pyridostigmin bromid. These drugs can reduce gastric - intestinal motility, affecting the process of absorption of pyridostigmin bromid.

Mechanical relaxants: Pyridostigmin antagonists against the reducing muscle relaxants (pancuronium and vecuronium). Pyridostigmin can extend the effect of reducing muscle relaxants such as Suxamethonium.

Aminoglycosides, local anesthetic and systemic anesthetics, arrhythmia and other drugs interacting with muscle neurotransmitter can also interact with Pyridostigmin Bromid.

Storage

Store in a dry place, avoid light, temperatures below 30 ° C.

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