Midorhum OPV tablets reduce fever, reduce cough, pain, anti -allergy (10 blisters x 10 tablets)

loratadin: antihistamine drugs, receptor resistance H.

Dextromethorphan HBr: A dry cough.

Acetaminophen is a metabolic substance that is active of phenacetin, which has analgesic effect by preventing the occurrence of pulses causing pain in the peripheral. The drug has an antipyretic effect by inhibiting the central region of the hypothalamus. Acetaminophen is an analgesic - reducing fever that can replace aspirin, but acetaminophen does not have the effect of treating inflammation. With equal doses, acetaminophen has the same fever -reducing pain as aspirin. Acetaminophen reduces body temperature in fever but rarely reduces body temperature in normal people. Acetaminophen, with treatment, less impact on the cardiovascular and respiratory system, does not change acid -base balance, does not cause irritation, scratches or stomach bleeding as when using salicylate. When overdose of acetaminophen, N-acetyl-P-Benzoquinonimin's N-acetyl-P-Benzoquinimin is toxic to the liver.

Loratadin is a 3 -round antihistamine, has a selective antagonistic effect on peripheral H1 receptors and has no effect on inhibiting the central nervous system. Loratadine works to mitigate the symptoms of allergic rhinitis, prevent and float due to histamine release. Loratadine belongs to H1 histamine antagonistic drug group, 2nd generation (does not cause drowsiness).

dextromethorphan hydrobromid is a cough reduction drug that works on cough center in the brain. Dextromethorphan has no pain to relieve pain and generally have very little sedative effects. Dextromethorphan is used to reduce cough due to mild stimulation in bronchial and throat as usual cold or inhalation of stimulants. Dextromethorphan is most effective in the chronic, no sputum treatment.

pharmacokinetics

Acetaminophen is absorbed quickly and almost completely through the gastrointestinal tract. Carbon hydrate -rich foods reduce the absorption rate of acetaminophen. The peak concentration of plasma is within 30 to 60 minutes after drinking with the dose of treatment. Acetaminophen is quickly and evenly distributed in most body tissues. About 25% acetaminophen in the blood combined with plasma proteins. Acetaminophen's disposal time is 1.25 - 3 hours, which can last for toxic doses or in patients with liver damage. After the treatment dose, 90 to 100%of the urine can be found on the first day, mainly after the liver combination with glucuronic acid (about 60%), sulfuric acid (about 35%) or cysteine ​​(about 3%); It also detects a small amount of hydroxyl metabolites - chemicals and reducing acetyl. Children are less likely to glucuro than adults, acetaminophen is n-hydroxylation by cytochrom P450 to create N-acetyl-Benzoquinonim (NAPQ), a highly reactive intermediate. This metabolic substance normally reacts with sulfhydryl groups in glutathion and is dimidated. However, if taking high doses of acetaminophen, this metabolite is formed in sufficient amount to exhaust the glutathion of the liver; In that situation, NAPQ is not connected with glutathion toxic to liver cells, leading to inflammation and can lead to liver necrosis.

Loratadin absorbs quickly after oral, the antihistamine effect of the drug appears within 1-4 hours, reaches a maximum after 8-12 hours and lasts more than 24 hours. The concentration of loratadin and descarboethyloradin (desloratadin) reaches a stable state in most patients around the fifth day of medication. The average plasma peak concentration of loratadine and its active metabolites (desloratadin) respectively is 1.5 and 3.7 hours. The bioavailability of the drug increases and the time to reach the peak concentration is prolonged by food. 98% Loratadine binds to plasma proteins. Loratadin's disposal time is 8.4 hours and of desloratadine is 28 hours. The selling time of the drug varies among individuals, not affected by blood urea, increased in the elderly and cirrhosis. The clearance of the drug is 57 - 142 ml/min/kg and is not affected by blood urea but decreases in patients with cirrhosis. The distribution of the drug is 80 -120 liters/kg. Loratadin metabolizes the first time by the liver because the microsome cytochrome P450 enzyme system is mainly into Desloratadin, which is a metabolic substance with pharmacological effects. About 80% of the total dose of loratadin excreted equally into urine and stool in the form of metabolites, within 10 days. Loratadin and desloratadine into breast milk and reach the peak concentration equivalent to the concentration of drugs in plasma. Do not go through blood barriers - brain at normal doses.

Dextromethorphan is quickly absorbed through the gastrointestinal tract and works within 15 - 30 minutes after drinking, lasting about 6-8 hours. The drug is metabolized in the liver and excreted through the urine in the form of constant and Demethyl metabolites, among them dextrorphan also has a slight cough reduction effect.

Precautions when using

Caution and special warning when using drugs containing active ingredients Acetaminophen: The doctor needs to warn the patient about the signs of serious skin reactions, which are likely to cause death including Steven-Johnson syndrome, toxic epidermal necrosis (Ten), Lyell syndrome, acne syndrome (AGEP).

Patients need to stop taking acetaminophen and see a physician as soon as they see the rash or other manifestations in the skin or sensitive reactions during treatment. Patients with a history of such reactions should not use acetaminophen -containing preparations. Sometimes there are skin reactions including itchy and urticaria; Other sensitive reactions include larynx edema, angioedema and anaphylactic reactions that may rarely occur. Platelets, leukopenia and all bloody hematuria have occurred with the use of p-aminophenol derivatives, especially when used for large doses. Neutral leukemia and thrombocytopenic hemorrhage occur when using acetaminophen. Rarely loss of granulocytes in patients using acetaminophen.

Using many preparations containing acetaminophen and can lead to harmful consequences (such as overdose acetaminophen).

Be cautious when using acetaminophen for patients with anemia before, liver failure, kidney failure, alcoholic, chronic malnutrition or dehydration. Avoid high doses, prolonged use for people with liver failure.

Drinking plenty of alcohol can cause increased toxicity to the liver of acetaminophen, should avoid or limit drinking alcohol.

Using loratadin is at risk of dry mouth, especially in the elderly, and increases the risk of tooth decay. Therefore, it is necessary to clean oral teeth when using this medication.

Patients with coughing have too much sputum and chronic they are smokers, asthma or bronchiectasis.

Patients are at risk or are suffering from respiratory decline.

Using dextromethorphan is related to histamine release and should be cautious for children with allergies.

Abuse and dependence on dextromethorphan may occur (though rare), especially due to prolonged high doses.

Do not take medicine for more than 7 days.

The ability to drive and operate machinery

fatigue, dizziness, headache can occur this drug. Patients should be careful to drive, operate machinery, work on high and other cases.

Pregnancy

There are no complete studies and determine the safety of this drug for pregnant women. Therefore, this medication should only be used when it is really necessary, low doses and in a short time.

Breastfeeding period

Loratadin and metabolites Desloratadin secreted into breast milk. Therefore only use this drug when necessary, low doses and short time.

Drug interaction

Acetaminophen's absorption speed may be increased by metoclopramid or domperidon and absorbing decreased by Colestyramin.

Long -doses of high -dose acetaminophen increases the anticoagulant effects of cooumarin and conducting indandion.

It is necessary to pay attention to the possibility of serious heat lowering in patients using simultaneously phenothiazine and cooling therapy (such as acetaminophen).

Drinking too much alcohol and long -term increases the risk of acetaminophen's liver toxicity.

Anti -seizures (including Phenytoin, Barbiturat, Carbamazepin), Isoniazid, anti -tuberculosis drugs that can increase the toxicity of acetaminophen on the liver.

Probenecid may reduce the elimination of acetaminophen and increase the half -life of plasma of acetaminophen.

Loratadin is metabolized by Cytochrom P450 ISOENZYM CYP3A4 and CYP2D6, so use simultaneously with inhibitors or being chemical by these enzymes can make changes in plasma concentrations and may have unwanted effects. The above -mentioned drugs have an enzyme inhibitor include: cimetidine, erythromycin, ketoconazole, quinidine, fluconazole and fluoxetin.

Concomitance treatment of loratadine and cimetidine leads to an increase in loratadine concentration in plasma 60%, due to cimetidine inhibits metabolic of loratadin. This has no clinical manifestations.

Simultaneous treatment of loratadine and ketoconazole leads to an increase in loratadine levels in plasma 3 times, due to CYP3A4 inhibition. That has no clinical manifestations because Loratadin has a broad treatment index.

Concomitance of Loratadin and erythromycin leads to increased plasma Loratadin levels. AUC (area under the curve of the time by time) of Loratadin, an average increase of 40% and the AUC of the desloratadin increases an average of 46% compared to the single Loratadin treatment. On the center of the center, there is no change in the QTC range. Clinically, there is no manifestation of loratadin's safety change, and there is no notice of sedative effects or fainting phenomenon when treating these two drugs simultaneously. Dextromethorphan is metabolized by Cytochrom P450 Isoenzyme CYP2D6, so interacting with these enzyme inhibitors such as Amiodaron, Haloperidol, Propafenon, Thioridazin, Quinidine reduces the metabolism of dextromethorphan in the liver, increases the concentration of this substance in serums and increases the seres Dextromethorphan.

Simultaneously used with central neurological inhibitors can enhance the central neurological inhibitor of these drugs or of dextromethorphan.

Valdecobid increases the concentration of dextromethorphan in serum when used together. Dextromethorphan is used with linezolid causing Setoronin syndrome syndrome. Memantin can increase the frequency and unwanted effects of Memantin and Dextromethorphan so avoid combining. Do not use in combination with moclobemid.