VinCerol 1mg vinphaco medicine used in heart disease causes clogged, myocardial infarction (10 blisters x 10 tablets)

Dosage form Box of 10 blisters x 10 tablets
Specifications Acenocoumarol

Ingredient

Composition information	Content
Acenocoumarol	1mg

Uses

indications

Vincerol drugs are indicated in the following cases:

Heart disease clogged: Preventing vascular blood clogged thrombosis, mitral valve disease, artificial valve. Preventive recurrence of myocardial infarction when aspirin cannot be used. Treatment of deep vein thrombosis and pulmonary obstruction, and recurrent recurrence when replacing heparin. The reducing vitamin K is the element of a carboxylase to convert glutamic acid into gamma acid - carboxyglutamic acid. The four coagulation factors (factors II, VII, IX, X) and two inhibitors (proteins C and S) have gamma - carboxyglutamic groups needed to attach to phospholipid surfaces to catalyze their interactions. This is Acenocoumarol that has an indirect anticoagulant effect by preventing the synthesis of the activity of many coagulation factors. After taken, the drug causes blood prothrombin within 36 to 72 hours. Balancing treatment with acenocoumarol requires many days. After stopping the drug, anticoagulants can last for 2-3 days. The drug can limit the development of the existing thrombosis and prevent secondary symptoms of thrombosis, although there is no direct thrombotic effect because it does not reverse the damage of ischemic tissue.

Dynamic pharmacokinetics

Acenocoumarol is quickly absorbed through the gastrointestinal tract, oral bioavailability reaches about 60%. The peak concentration of the drug in plasma is within 1-3 hours. The drug is strongly associated with plasma proteins (97%). Only freedom is active and metabolized. The percentage of freedom and metabolism in the liver may increase due to enzyme induction. Acenocoumarol through the placenta and partially detected in breast milk.

The waste time of acenocoumarol is about 8 - 11 hours. The drug is excreted mainly through urine in the form of metabolism and partially in bile (feces).

Before taking VinCerol 1mg vinphaco medicine used in heart disease causes clogged, myocardial infarction (10 blisters x 10 tablets)

How to use

oral tablets. Take the tablet with a glass of water.

Dosage

The dosage must be adjusted to achieve the purpose of preventing blood clotting mechanism that it does not occur but avoiding spontaneous bleeding. Dosage depends on the response of each person.

Adult dose: In the first 2 days is 4mg/day, drink in the evening. From the third day, the biological test will allow the determination of treatment dose. This dose usually from 1 to 8 mg/day. The adjustment usually conducts each step 1 mg.

Biological monitoring and dose adjustment: The appropriate biological test is to measure prothrombin (PT) time indicated by the INR international standardization ratio. Prothrombin time allows the exploration of factors II, VII, and X are factors reduced by acenocoumarol. The IX factor is also reduced by acenocoumarol but is not explored by prothrombin time.

When not using acenocoumarol, Inr in normal people is 1. When taking the drug in the situations below, in most cases the intir's target needs to be 2.5, fluctuating between 2 and 3. Inr below 2 reflects the use of anticoagulants is not enough. Inr above 5 is at risk of bleeding.

Biological checkpoints: The first test is done 48 hours ± 12 hours after the first acenocoumarol drink to detect an individual's increased increase in sensitivity. If INR above 2, signaling will overdose when balanced, so the dose should be reduced. The 2nd test was prewer proceeded 3-6 days later. The tests after conducting every 2-4 days until the INR stabilizes, then gradually away, the longest is once a month.

Balance of treatment sometimes only reaches after weeks. After each dose change, check the Inr 2-4 days later and repeat when stable.

In general, Inr from 2-3 is recommended to prevent venous thrombosis, including pulmonary embolism, atrial fibrillation, heart valve, or biological valve. Inr from 2.5 to 3.5 is recommended after myocardial infarction, patients with mechanical valve, or in some patients with thrombosis or phospholipid syndrome. Higher Inr can be recommended for recurrent clogged.

Dosage for children: Experience using oral acenocoumarol for children is limited, starting and monitoring must be conducted at specialized facilities.

Avoid taking oral acenocoumarol for children who are breastfed under 1 month of age. The average dose when equilibrium to achieve INR is from 2-3 depending on age and weight: in children over 3 years old, the dose is calculated according to the weight of the adult. The starting dose for children is calculated by mg/kg/day as follows:

12 months - 3 years

3 years - 18 years old

0.08

0.05

Dosage in the elderly: The starting dose must be lower than the adult dose. The average balance dose in treatment is usually only 1/2 to 3/4 of adult dose.

Serial heparin treatment - Therapy: Due to the slow anticoagulant effect of acenocoumarol, heparin must be maintained with constant doses throughout the necessary time, that is, until the INR is in the desired value of 2 consecutive days. In case of heparin platelets, acenocoumarol should not be given soon after stopping heparin because of the risk of hyper coagulation due to protein S (anticoagulant) is reduced early. Only for acenocoumarol after giving thrombin drugs.

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?

If INR is on the treatment area but below 5, and the patient does not show signs of bleeding or does not need to quickly adjust blood clotting before surgery: 1 time to take 1 medication, then continue treatment at lower doses when he has reached the desired INR. If the INR is very close to the desired INR, then reduce the dose without having to quit the medication.

If Inr above 5 and less than 9, the patient does not show signs of bleeding other than bleeding or nosebleeds: remove 1 or 2 times to take the drug, measure the Inr more often and then reach the desired INR, take the medicine again at a lower doses.

If the patient has other risks of bleeding, giving up 1 time of taking the medicine and giving vitamin K from 2.5 mg according to oral or 0.5 - 1 mg by slow intravenous line for 1 hour.

If Inr is above 9 without bleeding, 1 time to take medicine and use vitamin K from 3 to 5 mg by oral, or 1 - 1.5 mg by slow intravenous line for 1 hour, allows to reduce Inr within 24 - 48 hours, then use acenocomarol again with lower doses, monitor Inr regularly and if needed to repeat treatment with vitamin K.

If it is necessary to quickly adjust the anticoagulant effect in the absence of severe bleeding or severe overdose (for example, Inr above 20), taking a dose of 10 mg of vitamin K slowly intravenously and depending on the requirements of emergency, combined with fresh frozen plasma. Vitamin K can repeat every 12 hours. After high doses of vitamin K treatment, there may be a period of time before the return of acenocoumarol. If you have to use anticoagulant drugs, it is necessary to consider using heparin for a while.

In case of poisoning due to an accident, it must also be evaluated according to INR and manifests bleeding complications. Must measure the Inr many days later (2-5 days), taking into account the prolonged semi -waste time of anticoagulant drugs. Use vitamin K to adjust the effect of the drug.

In an emergency, call the 115 emergency center immediately or go to the nearest local health station.

What to do when you forget 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

When using the drug, there are common unwanted effects (ADR) such as:

The most common complications of bleeding, which can occur throughout the body: the central nervous system, the limbs, the organs, in the abdomen, in the eyeball ... Ra: Hair loss, localized skin necrosis, may be due to genetic lack of protein C, or homogeneous factor is protein S, allergic skin.

Notify the physician with unwanted effects when using the drug.

Warnings

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

Contraindicated

Vincerol drugs contraindicated in the following cases:

Sensitive is known to the Coumarin derivatives or any ingredients in the drug. Brain (except for congestion elsewhere). whole body, vagina; phenylbutazon, chloramphenicol, diflunisal.

Be cautious when using

Please see more information about the drug in the instruction sheet of the use of the drug attached.

Must pay attention to the perception of patients during treatment (risk of taking the wrong medication). Careful guidance for them to comply with accurate indications, understanding the risk and attitude of handling, especially for the elderly.

Must emphasize the daily medication at the same time.

Must biological testing (INR) periodically and at the same place.

In case of surgical intervention, each case must be considered to adjust or suspend anticoagulic drugs, based on the risk of patient thrombosis and the risk of bleeding associated with each type of surgery.

Careful monitoring and appropriate dose adjustment in people with liver failure, kidney failure, or lower blood protein.

Hemorrhagic complications occur in the first months of treatment, so it is necessary to closely monitor, especially when the patient is hospitalized home.

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

should not drive or operate machinery when experiencing unwanted effects of the drug.

Use drugs for women during pregnancy and lactation

Pregnancy: There are statistics of about 4% of the fetal deformity when the mother uses this drug during the first quarter of pregnancy. In the next quarters, there is still risk (including miscarriage). Therefore, do not use drugs during pregnancy.

Breastfeeding period: Avoid breastfeeding. If you have to breastfeed, you should compensate for vitamin K.

Drug interaction

A lot of drugs can interact with acenocoumarol so it is necessary to monitor patients 3-4 days after adding or removing combined drugs.

Contraindications for coordination:

Aspirin (especially with high doses of over 3 g/day) increases anticoagulant effects, and the risk of bleeding due to platelet aggregation inhibits and Acenocoumarol moving out of links to plasma proteins.

Miconazole: Unexpected hemorrhage can be severe due to increased blood in the blood and inhibition of metabolism of acenocoumarol.

phenylbutazon: Increases anticoagulant effects in combination with gastrointestinal mucosa irritation.

Pyrazol nonsteroidal anti -inflammatory drugs: Increased risk of platelet bleeding and gastrointestinal mucosa.

Do not coordinate:

Aspirin at a dose of less than 3 g/day.

Non -steroid anti -inflammatory drugs, including the type of selective inhibition COX - 2.

chloramphenicol: Increases the effect of acenocoumarol due to reducing the metabolism of this drug in the liver. If it is not possible to avoid coordination, you must check the Inr more often, adjust the dose in and after 8 days of stopping chloramphenicol.

diflunisal: Increasing the effect of acenocoumarol due to competition associated with plasma proteins. Other painkillers should be used, for example paracetamol.

Caution when coordinating:

alopurinol, aminoglutethimid, amiodaron, androgen, antidepressants Serotonin, Benzbromaron, Bosentan, Carbamazepin, Cephalosporin, Cimetidin (above 800 mg/day), Cisaprid, Colestyramin, Corticoid (except Hydrocortison used to replace substance in Addison) Cyclin, cytotoxic drugs, fibrats, fungal Azols, fluoroquinolones, heparin, thyroid hormones, enzyme induction drugs, statins, macrolids (except for spiramycin), neviparin, efavirenz, imidazol group, orlistat, pentoxifylin, phenytoin, propafenon, propafenon, propafenon Ritonavir, Lopinavir, some sulfamids (sulfamethoxazol, sulfafurazol, sulfamethizol), sucralfate, cancer medicine (Tamoxifen, Raloxifen), Tibolon, Vitamin E above 500 mg/day, alcohol, anti -cubic platelet, also changing anti -coagulating effects.

Storage

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

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