Spinolac Fort Hasan treat cirrhosis, chronic congestive heart failure (5 blisters x 10 tablets)

Dosage form Box of 5 blisters x 10 tablets
Specifications Furosemid, Spironolactone

Ingredient

Composition information	Content
Furosemid	40mg
Spironolactone	50mg

Uses

indicated

Surprised edema due to secondary Aldosteron; Cirrhosis or chronic congestive heart failure.

Treatment in case patients resistance to diuretics in single therapy mode.

Instead of using Spironolacton and Furosemid separately at the corresponding dose level.

Treatment of idiopathic hypertension in aldosteron hypertension patients should be limited.

The combined drug should only be used when the dose level corresponds to the dose of each separate ingredient.

Pharmacology

Pharmacological classification: Diuretics and diuretics keep potassium.

Code ATC: C03EB01.

Mechanism of action

spironolacton:

Spironolacton is a steroid with an aldosteron structure (adrenal gland hormone), which is an unsatisfactory mineralocorticoid receptor antagonist (aldosteron) and is also an Androgen and progesterone receptor counterpart. Spironolacton has the effect of holding magnesi and potassium, sodium urinary, diuretic and lowering blood pressure due to inhibition of physiological competition of Aldosteron on a distance, heart muscle and vasoconstriction.

Effects in the kidney:

Spironolacton inhibits the physiological competition of Aldosteron on a distance, thus increasing the excretion of sodium chloride and water, reducing the excretion of potassium, phosphate, magnesium, ammonium, hydrogen ions. Spironolacton has the strongest diuretic effect in patients with aldosteron increases. Spironolacton starts to work relatively slowly, it takes 2 or 3 days to achieve the maximum effect and the drug reduces the slow effect for 2-3 days after the drug stops. Because most sodium is reabsorbed in the close tube, Spironolacton is relatively no effect when used alone and for the maximum effect, it is necessary to coordinate a number of reabsorbed diuretic pills in the almost thiazid or diuretic. The increase in magnesi and potassium secretion of thiazid diuretics and diuretics (Furosemid) will be reduced when used simultaneously with Spironolacton.

Cardiovascular effects:

Spironolacton reduces both systolic and diastolic blood pressure, the maximum hypotension effect is achieved after 2 weeks of treatment; Has the effect of protecting the heart when used for people with chronic heart failure; Help patients with congestive heart failure cause norepinephrin absorption and prevent myocardial fibrosis, keep sodium and excrete magnesi, potassium, may also restore the sensitivity of the pressure receptor.

Androgen resistant effects:

Spironolacton has anti -androgen effects in both men and women according to the complex mechanism and related to many effects of the drug; Causes increased plasma estradiol concentration.

Furosemid:

Furosemid is a sulfonamid diuretic that is a strong, fast -acting group, depending on the dosage. The main impact mechanism of Furosemid is to inhibit the Na+-K+-LC-Click co-transport system in the thick section of the branch on the Henle straps, increasing the excretion of these electrolytes, accompanied by increased water export exercises. The drug also reduces the reabsorption of Na+, Cl- and increases the excretion of K+ in the distance and can work directly on the nearby tube. Furosemid does not inhibit carbon dioxide and is not antagonistic with aldosteron; Increase the elimination of Ca+, Mg2+, hydrogen, ammonium, bicarbonate and maybe both phosphate through the kidneys. Losing a lot of potassium, hydrogen and chlorine can cause alkaline metabolism. Due to reducing plasma volume, it can cause hypotension but usually only mitigate.

Furosemid has the effect of renal vasodilation, reducing the impact of the kidney and blood flow through the kidney after taking the drug. In patients with congested heart failure with acute myocardial infarction, after furosemid intravenous injection, glomerular filtration power increases temporarily but significantly, while reducing peripheral vascular resistance and increasing peripheral vein. When taking high doses in patients with chronic renal impairment, the filtration rate of the glomeruli may increase temporarily. If the urinary tract is excessive due to the drug that reduces plasma volume, the blood flow may occur and reduces the rate of glomerular filtration.

Furosemid has less impact on blood glucose levels than thiazid, but can cause hyperglycemia, urinary glucose and glucose tolerance, which can be the result of hypotension.

pharmacokinetics

spironolacton:

absorb: Spironolacton is absorbed through the gastrointestinal tract, reaching the maximum concentration in the blood 1 hour after drinking, but still with concentrations can be measured at least 8 hours after drinking 1 dose. Food increases the absorption of drugs but does not mean clinically. Relative bioavailability of over 90% compared to the bioavailability of the best absorption is the Spironolacton solution in Polyethylen Glycol 400. Main. Spironolacton and metabolites excreted mainly through urine, partly through bile and fecal. Spironolacton or its metabolites can be through the placenta, canrenon distributed into milk but in very small amounts.

Furosemid:

absorb: Furosemid quickly absorbed through the gastrointestinal tract, bioavailable about 60 - 70%, but absorbed and erratic, affected by drugs, disease processes and the presence of food. However, the effect of diuretic when drinking when hungry or full at the same time is similar. In patients with heart failure, Furosemid absorption is very erratic. Born can be reduced to 10% in kidney disease, slightly increased in liver disease. When taken, the effect appears quickly after 1/2 hours, reaches the maximum effect after 1-2 hours and maintains the effect of 6-8 hours. The maximum reduction of blood pressure may not be clear until several days after starting the medication. In patients with renal failure, diuretic response can be extended. Higher amount of free Furosemid in heart patients, kidney failure and cirrhosis. Furosemid passes the placenta and distributed into breast milk. The sale time is from 30 to 120 minutes in normal people, prolonged in infants and patients with liver and kidney failure. The clearance of Furosemid does not increase when hemolysis.

Before taking Spinolac Fort Hasan treat cirrhosis, chronic congestive heart failure (5 blisters x 10 tablets)

How to use

Take oral use, so the best use is during breakfast and/or lunch. Do not take medicine in the evening, especially at the beginning of treatment, because of increased urine secretion at night.

Dosage

Patients who have been treated stably earlier need higher dose of spironolacton and furosemid: 1 - 2 capsules/day (50 - 100mg spironolacton, 40 - 80mg Furosemid)

Dosage in some special clinical subjects:

Children: Not suitable for children.

Clinical manifestations in acute or chronic overdose mainly depend on the extent and consequences of dehydration and electrolytes, such as reducing blood volume, dehydration, blood, arrhythmia due to excessive diuretic effect. Symptoms include severe hypotension (leading to shock), acute kidney failure, thrombosis, coma, soft paralysis, indifference and confusion.

How to handle

There is no specific antidote when the spironolacton overdose. Gastric lavage, vomiting, active carbon. Check the electrolyte balance and kidney function. Symptomatic treatment and support. If hyperboly hyperboly has an electrocardiogram change, sodium bicarbonate intravenous injection, calcium chloride and/or oral or glucose transmission with a fast -acting insulin preparation to reduce potassium levels; Give the ion exchange resin (sodium polystyrene sulfonate) to seize potassium ions, reducing blood potassium concentration. Patients with continuous hyperkalemia, may need hemorrhage.

There is no specific antidote for Furosemid. When an overdose of Furosemid, compensate for the amount of water and electrolytes lost. Check regularly in serum, carbon dioxide and blood pressure. Must ensure adequate drainage in patients with congestion of urine from the bladder (such as prostate hypertrophy). Hematoparoology does not increase Furosemid excretion.

What to do when forgetting a dose?

Side Effects

Unwanted effects are divided by frequency: Very common (ADR ≥ 1/10), common (1/100 ≤ ADR Furosemid is good for the body.

Blood and lymphatic system (unknown frequency): Bone marrow failure has been reported as a rare complication and need to stop treatment. Occasionally a platelet reduction occurs; In case of rarity, eosin leukemia or leukopenia; In some cases, especially inhalation decreased, anemia or hemolytic anemia. Hepatic cerebral disease may occur in patients with liver failure; Dizziness, fainting, loss of consciousness, headache. Calcium/kidney stones are reported in premature babies. Increasing urine excretion can cause discomfort in patients with urinary obstruction. Therefore, it may cause acute urinary retention accompanied by secondary complications in patients with dysfunction of bladder emptiness, prostate glands or urethral stenosis. Deaf, sometimes not recovered after taking or intravenously furosemid (rarely). liver, increased liver enzyme or acute pancreatitis (unknown frequency). Itching, urticaria, rash or damage caused by water balls, diverse roses, Pemphigoid water balls, Stevens-Johnson syndrome, poisoned skin necrosis, flaky dermatitis, bleeding, external pustular syndrome (AGEP) and drug syndrome with drugs with eosinophilia and many systemic symptoms (Dress). and electrolytes after prolonged diuretic treatment. Furosemid increases the excretion of sodium, potassium and water. Increase excretion of other electrolytes like calcium and magnesi. Potassium may decrease when the beginning of treatment (due to the early starting impact of Furosemid), and then increase again (due to the late starting impact of Spironolacton) while continuing treatment, especially in patients with renal impairment. Heavy electrolytes. Warning signs include thirst, headache, hypotension, confusion, cramps, tetany, muscle weakness, arrhythmia and digestive system. In the case of abnormal, fatigue, muscle weakness, it is necessary to consider the possibility of increasing potassium. Metabolic alkaline infections (such as unsatisfactory cirrhosis) may be worse when treated with Furosemid. Pseudo-Bartter syndrome can occur during abuse and/or use long-term Furosemid.

electrolyte disorders must be treated.

Diuretic can reduce blood volume and loss of fluid, especially in elderly patients. Dizziness or leg cramps may also occur when reducing blood volume, dehydration and hyperkalemia. Dehydration can lead to blood concentration and increased risk of thrombosis.

Cholesterol and blood triglycerides may increase when treated with Furosemid and return to normal limits within 6 months when long -term treatment.

Furosemid reduces glucose intolerance, reduces metabolic control in diabetes patients. People with hidden diabetes are likely to manifest into disease.

As with other diuretics, Furosemid treatment can lead to temporary increase in creatinine and blood urea levels. Blood uric acid can increase and gout attacks.

The immune system: Anaphylaxis and anaphylaxis, the exacerbation of the whole body lupus (unknown frequency). Spironolacton has been reported in tolerance in the gastrointestinal tract, rarely occur stomach ulcers (sometimes bleeding). Spironolacton can also cause drowsiness, headache, loss of air conditioning and mental disorders. Breast pain depends on the dose and female mammary glands that can occur in men and women. It is rare for lumpy or skinny skin, as well as light androgenic manifestations like him and irregular menstruation. In men can reduce erection function. When using Furosemid for premature babies in the first weeks after birth, it may increase the risk of arteriosclerotic existence. In some patients, this unwanted effect still exists even when stopping the drug.

Warnings

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

contraindicated

hypersensitivity to Spironolacton, Furosemid, Sulfonamid, derivatives with sulfonamid or any ingredients of the drug.

Patients with hypotension or dehydration (with or without hypotension).

Patients with impaired renal function (Creatinine clearance

Hyarassic hyperkalemia, severe hypotension, severe hypoglycemia, Addison disease.

Pregnant or lactating women.

Be cautious when using

Spironolacton can change the voice. Pay attention in patients whose voices are important for their work (actors, singers, teachers).

Make sure the amount of urine is released. Patients with partial urinary tract congestion (patients with prostate hypertrophy, reduced urination function) increases the risk of acute urinary retention and should be carefully monitored.

Take measures to remedy hypotension or reduce blood volume before starting treatment.

Particularly cautious, careful monitoring of the following patients:

Patients with hypotension.

Patients with risk of hypotension. calculated on the ears). Need to adjust the dose carefully.

Avoid using spinolac fort when potassium increases. It is recommended not to be used simultaneously with triamteren, amilorid, potassium supplements or non -steroid anti -inflammatory drugs because of hyperkalemia.

Be careful in patients who lose electrolytes. It is advisable to check the concentration of potassium, sodium, creatinine and glucose during serum during treatment; Especially closely monitoring in patients at high risk of electrolyte imbalance or serious dehydration. Reducing blood volume or dehydration and electrolyte, acid -base balance disorders need to be treated. Can temporarily stop using Spinolac Fort.

Regular testing of blood potassium in patients with impaired renal function and creatinine clearance Do not use Furosemid to diuretic in patients at high risk of kidney disease due to contrast drug as a measure to prevent.

Using Spironolacton simultaneously with drugs that cause hyperkalemia makes the hyperkalemia worse.

Spinolac Fort preparations contain lactose excipients, not used in patients with rare genetic disorders in galactose intolerance, Lapp lactase deficiency or glucose - galactose.

The effect of the drug on the ability to drive and operate machinery

The drug can reduce alertness affecting the ability to drive and operate machinery, especially at the beginning of treatment. Therefore, it is necessary to be cautious when driving, operating machinery, working on high or jobs that require alertness.

Using drugs for women during pregnancy and lactation

Pregnant women

Animal tests show that Furosemid is not harmful when used during pregnancy. There is clinical evidence of Furosemid's safety in the last three months of pregnancy. However, Furosemid passed the placenta.

Spironolacton and its metabolites through the placenta fence. Animal studies show that there is a female chemistry in the male's genitalia. Androgen resistance has been reported in humans with the risk of impact on non -obvious genitalia in male infants.

Spinolac Fort is not used during pregnancy except for the necessary medical reasons. Treatment during pregnancy should monitor the development of the fetus.

breastfeeding women

Furosemid is excreted in breast milk and can inhibit milk secretion. Canrenon, a metabolite of Spironolacton, appears in breast milk. Therefore, do not use Spinolac Fort in nursing women.

Medicinal interaction

The absorption of Spironolacton increases if taking medicine with food. The clinical involvement of this interaction is unknown.

cardiac glycosides, diuretics, hypertension drugs or other drugs that are likely to cause hypotension: It is necessary to be adjusted when used with spinolac Fort. Hypotension and impaired renal function may occur when taking Furosemid with ACE inhibitors or Angiotensin II receptor antagonists, or when increasing the dose of these drugs. At least three -day dose should be reduced or stop using Spinolac Fort before starting treatment with ACE inhibitors, Angiotensin II receptor antagonists or increased the dose of these drugs.

Potassium salts, potassium excretion, nonsteroidal anti -inflammatory drugs or ACE inhibitors: simultaneously used with Spinolac Fort causing hyperkalemia.

Strong diuretic: The risk of increased kidney toxicity. Therefore, it is necessary to carefully monitor the level of lithium and lithium dose if needed when used in combination. The conclusion of the thyroid hormone with the shipping protein leads to an increase in fleeting thyroid hormone, then reducing the total thyroid hormone. It is necessary to check the concentration of thyroid hormones. Amine causes hypertension: Spinolac Fort can reduce the effects of these drugs. This impact cannot be reversed, only combined with drugs when really necessary. In addition, the toxic effect on the kidneys of cisplatin increases if the Furosemid is not taken in low doses (40mg in patients with normal kidney function) and with positive fluid balance to achieve compulsory diuretic during treatment with CIPLATIN. Electrolytic disorders (hypotension, hypoglycemia) may increase the toxicity of some other drugs (preparations containing digitalis and drugs that extend QT). Blood. Probenecid, methotrexate are significantly excreted in the renal tubules that can reduce the effect of spinolac Fort. In contrast, Furosemid can reduce the excretion of these drugs in the kidneys. In case of high doses (Furosemid and other drugs), it can cause increased serum concentration and increase unwanted effects. Gout.

Storage

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

To be out of reach of children, read the instructions carefully before use.

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