Mifros 300mg Davipharm treat Wilson, cystinuria, arthritis (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Penicillamin

Ingredient

Composition informationContent
Penicillamin300mg

Uses

Indications

Mifros drug indicated in the following cases:

  • Cystinuria.

    penicilamine is a complex artificial agent with metal used to treat Wilson's disease, a genetic disease that causes too much sedimentation in the body tissue. In vitro, a copper atom attached to 2 penicilamine molecules, so 1g of penicilamin can lead to excretion of 200mg of copper. However, the actual amount of copper is excreted only about 1% of the above quantity.

    penicilamin also reduces excessive cystin secretion in the urinary cystin. There is a disulfid exchange between penicilamin and cystin that forms penicilamin-cystein disulfid, a more soluble substance than cystin and is easily excreted. Penicilamine interacts with the formation of tropocollagen molecules and divided them when formed.

    It is unclear that the mechanism of penicilamine in the treatment of rheumatism is like a joint, although the drug seems to prevent the activity of the disease. Unlike cellular immunosuppressants, penicilamine significantly reduces the low low IGM factor but does not significantly reduce the absolute level of immune globulin in serum. Unlike the actual immunosuppressant, penicilamine reduces T lymphocytes but does not reduce B in vitro lymphocytes.

    In vitro, penicilamine separates great phagocytic (low factors) although the relationship of this effect is with the effect of treating rheumatoid arthritis. In rheumatoid arthritis, may not see the treatment of the drug in the first 2 or 3 months of treatment. However, in patients with response, the first symptoms of symptoms such as pain, sensitivity, and swelling are often clear within 3 months. Optimal treatment time has not been determined. If the disease is relieved, it may last monthly, but usually it must be treated continuously.

    pharmacokinetics

    penicilamin is quickly absorbed but not completely (40 to 70%) from the digestive tract, difference between individuals. Food, antacids and iron reduces the absorption of the drug. The peak concentration of plasma is achieved after 1 to 3 hours, about 1 to 2 mg/l after taking the dose of 250 mg.

    The drug exists in free plasma plasma, penicilamin disulfid, and cystein - penicilamin disulfid. When the long -term treatment process ends, the slow -lasting phase lasts 4 to 6 days.

    more than 80% of penicilamine in plasma is associated with protein, especially albumin and ceruloplasmin. The drug is also associated with red blood cells and macrophages.

    A small percentage of dose is metabolized through the liver into S-Methyl-D-Penicilamin. The drug is excreted mainly through the form of disulfid.

    • Before taking Mifros 300mg Davipharm treat Wilson, cystinuria, arthritis (3 blisters x 10 tablets)

    How to use

    Mifros should be used at least 1 hour before meals or 2 hours after meals.

    Dosage

    Heavy rheumatoid arthritis progresses

    Adults

    Take the dose of 125 to 250 mg 24 hours in the first 4 weeks, then increase the dose of an additional amount in the initial dose, every 4 weeks until the disease is relieved. The maintenance dose depends on the response of each individual, usually 500 to 700 mg/24 hours divided 3 times.

    In the first few months, it may not be improved. A small number of patients may have to use up to 2000 mg/24 hours for a good effect. Treatment should be stopped if not effective within 12 months. When the dose responds, this level should be maintained for 6 months, then reduced to 250 mg/day, maintained within 2 to 3 months. The disease may recur after the medicine. However, if using another batch, most patients have a response.

    Children

    Using the dose of 15 to 20 mg/kg/24 hours, the starting dose should be 2.5 to 5.0 mg/kg/24 hours, increasing every 4 weeks, taking 3-6 months elderly: toxicity usually increases in the elderly, not related to kidney function. Starting dose: 50 - 125 mg 24 hours, for 4 - 8 weeks, then, every 4 weeks add an amount of initial dose until the disease is relieved. The highest dose can be up to 1000 mg/day.

    Wilson's disease

    penicilamine is a complex agent with copper, the treatment effect achieves high results when combined with a diet containing low metal copper (less than 1 mg/day).

    Adults

    1500 to 2000 mg/24 hours, divided several times 30 minutes before meals. The dose may be reduced to 750 to 1000 mg/day when the disease is controlled, by determining the amount of copper in urine 24 hours (need tests every 3 months). Do not use more than 1 year at a dose of 2000 mg/24 hours.

    Children

    can be up to 20 mg/kg/24 hours, divided many times, before meals. The smallest dose is 500 mg/24 hours. Elderly: can be up to 20 mg/kg/24 hours, divided many times, before meals. The dose needs to be adjusted until effective.

    Cystinuria

    Prevent and treat cystin stones.

    Treatment of stones

    Adults

    750 mg/ day, many times and especially at bedtime, the dose increases to 1500 - 2000 mg/ day. The dose is adjusted for cystin to eliminate in urine less than 100 mg/24 hours. Need to drink enough water throughout the day (3 liters) to ensure urine flow 2 ml/min.

    Children

    up to 30 mg/kg/day, divided many times and especially at bedtime, adjust the dose so that the urinary cystin level is below 100 mg/day.

    Elderly

    The minimum dosage is maintained so that cystinuria is below 100 mg/day.

    Prevention

    Adults

    Adults (without a history of creating cystin stones) but the amount of cystinuria exceeds 300 mg/ 24 hours. Use penicilamin 250 - 750 mg/ 24 hours, oral before going to bed. Adjust the dose for the amount of urinary cytinuria to less than 100 mg/24 hours at night. Drink plenty of water (3 liters) every day.

    Children

    No recommendations for dose.

    Elderly

    Adjust the dose so that cystinuria is below 100 mg/24 hours.

    Heavy metal poisoning (Pb)

    Adults

    use the dose of 1500 to 2000 mg/24 hours, divided into several times, until the amount of lead in urine is stable 0.5 mg/day.

    Children

    Dosage 20 to 25 mg/kg/day, many times, before meals.

    Elderly

    Take a dose of 20 mg/ kg/ day, until the amount of lead in urine is stable at 0.5 mg/ day.

    Progressive chronic hepatitis

    Adults

    For maintenance treatment, after the progression of the disease with corticosteroids, using penicilamine with the starting dose is 500 mg 24 hours, divided into several times, then increases within 3 months to a dose of 1.25 g/24 hours. During this time, the dose of corticosteroids must decrease and stop completely. During treatment, it is necessary to check the liver function periodically to assess the condition.

    Children and the elderly

    No recommendation.

    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 using overdose?

    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.

    Side Effects

    Most side effects of penicilamine depend on the dose. Deadly reactions can occur due to platelets, granulocytosis, anemia due to marrow failure.

    Common, ADR> 1/100

  • Systemic body: Reduce taste. 1/100
  • Systemic body: Skin rashes with fever, joint pain or lymph node disease.
  • liver: cholestasis, toxic hepatitis, pancreatitis

    Rare, ADR

  • Skin: Hair loss. Business.

    • Warnings

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

    Contraindicated

    Mifros drugs are contraindicated in the following cases:

  • Do not use drugs for pregnant women except for Wilson's disease or some cases of certain cystinuria.
  • Not used for breastfeeding women. Heavy.
  • Lupus erythema

    Be cautious when using

    Caution when using penicilamine for patients with kidney failure, if needed dose adjustment.

    Patients using penicilamin should be closely monitored. Blood formula and urine analysis test must be done weekly in the first two months of treatment and after each dose change. After this time, test once a month. If platelets drop below 120,000/mm3 or leukocyte below 2,500/mm3, the drug should be stopped. When the blood formula returns to normal, the drug can be used in low doses.

    If there is a proteinuria that needs to be monitored and quantified many times. If proteinuria continues to increase much (over 1 g/24 hours) or urinary bleeding should stop the drug or decrease the dose.

    should test liver function every 6 months. Kidney function also needs to be monitored once a month in the first 6 months, then every 3 months.

    Should take 25mg of pyridoxin daily for long -term patients with penicilamin because this drug increases the need for this vitamin.

    penicilamin works on collagen and eSlastin, slowing wound healing. Therefore, it is advisable to reduce the dose of penicilamin to 250mg/day for 6 weeks before surgery and during the postoperative period until the wound heals.

    Penicilamine is at risk (rare) causing immunodeficiency, such as systemic lupus, muscle inflammation, goodpasture syndrome and severe myasthenia gravis. So be cautious.

    penicilamin is a decomposition product of penicillin, so patients allergies to penicillin can give cross -allergic reactions to penicilamin, although very rare.

    To be out of reach of children.

    Using drugs for women during pregnancy and lactation

    Pregnancy

    penicilamin can be through the placenta and affect the collagen tissue in the fetus, causing some skin complications. There has been a teratogenic phenomenon. During the penicilamin period, the placenta can be passed through the placenta and affects collagen in the pregnancy, causing a pregnancy, if necessary, using the lowest doses of penicilamin.

    Breastfeeding period

    There is no enough safety document, so if using penicilamin should stop breastfeeding during medication.

    The effect of the drug on driving and operating machinery

    affects the ability to drive and operate the machinery of penicilamine has not been well known. However, the drug can cause blurring vision, reduced vision, thus cautious.

    Medicinal interaction

    When using penicilamine with iron compounds, penicilamine biological compounds decreased by about 35%, excreting of copper reduced by 28%. Even the amount of iron in Multivitamin preparations is enough to influence. Similarly, antacids containing magnesi, aluminum reduces 45% drug absorption due to gastric pH increase, reduces disulfid absorption.

    Probenecid reduces the effect of penicilamin in the treatment of cystinuria.

    chloroquin or hydrochloroquin in combination with penicilamine to treat rheumatoid arthritis is not more beneficial but also causes many unwanted effects and can reduce the effect of the drug. - Penicilamin in combination with sulfasalazin increases the effects but is also not obvious but often causes many unwanted effects.

    Do not use penicilamine for patients who are treating gold salt, malaria, toxic cells, oxyphenbutazon or phenylbutazon because these drugs tend to cause unwanted blood and kidney effects like penicilamine.

    Theoretically patients allergic to penicillin are often sensitive to penicilamin, but this does not happen.

    penicilamin can weaken collagen protein to form body tissues. Therefore, the dose should be reduced during surgery and increasing the dose again when the incision is healed.

    • Storage

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

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