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Tsiprinol indications for use. Tsiprinol solution: instructions for use

Photo of the drug

Latin name: Ciprinol

ATX code: J01MA02

Active substance: Ciprofloxacin

Analogs: Tsiprolet, Tsiprobay, Tsiprinol SR, Quintor, Tseprova

Manufacturer: KRKA (Slovenia)

Description is valid on: 03.10.17

Tsiprinol is an antibacterial drug from the fluoroquinolone group. In medical practice, this antibiotic is used to treat infectious and inflammatory processes caused by microorganisms sensitive to it. Active against intracellular microorganisms, gram-negative and gram-positive bacteria.

Active substance

Ciprofloxacin.

Release form and composition

Available in several dosage forms: tablets, a solution for infusion and a concentrate for preparing an infusion solution.

The tablets are film-coated and sold in 10 and 20 pieces per package.

The concentrate for the preparation of infusion solution is available in 10 ml ampoules.

As a ready-made solution for infusion, it is sold in bottles of 50, 100 and 200 ml.

Indications for use

Prescribed for the treatment of complicated and uncomplicated infectious diseases caused by microorganisms sensitive to ciprofloxacin:

Infections of the abdominal organs, peritonitis, bacterial infections of the gastrointestinal tract, biliary tract and gallbladder.
Pneumonia, respiratory tract infections.
Infections of the pelvic organs.
Infectious diseases of the paranasal sinuses and middle ear.
Kidney and urinary tract infections.
Infectious diseases of joints and bones.
Infections of soft tissues and skin.
Eye infections.
Sepsis.

The drug can be used for the prevention and treatment of infectious and inflammatory diseases in patients with reduced immunity.

Contraindications

Should not be prescribed for those with hypersensitivity to fluoroquinolones, pregnant and lactating women, as well as children and adolescents under 18 years of age.

Intravenous administration of the antibiotic is contraindicated in cases of glucose-6-phosphate dehydrogenase deficiency and pseudomembranous enterocolitis.

Use with great caution for mental illness, epilepsy, cerebrovascular accidents, severe renal or liver failure. Not recommended for use by elderly people.

Instructions for use Tsiprinol (method and dosage)

The dosage of the antibiotic depends on the location of the infection, the clinical picture of the disease, the general condition of the body, the age and body weight of the patient. The tablets should be taken before meals and washed down with plenty of water.

For respiratory and urinary tract infections, 250 mg is prescribed twice a day. In case of complicated course of the disease, the single dosage is increased to 500-750 mg.
For the treatment of uncomplicated gonorrhea, take a single dose of 500 mg. For gynecological infections, prostatitis, osteomyelitis and severe enterocolitis, the antibiotic is prescribed in a dosage of 500-750 mg every 12 hours.

It is also possible to administer the drug intravenously. The average single dose in this case will be 200 mg with a frequency of administration 2 times per day. The duration of treatment is 1-2 weeks or more.

Side effects

May cause the following side effects:

From the side of the central nervous system - headaches, insomnia, dizziness, feeling of fatigue, ringing in the ears, increased intracranial pressure, diplopia, hallucinations, psychosis.
From the digestive tract - lack of appetite, abdominal pain, flatulence, nausea, diarrhea, vomiting.
From the musculoskeletal system - pain in muscles and joints, muscle weakness.
From the cardiovascular system - hypotension, tachycardia.
Allergic reactions - redness of the skin, itching, urticaria.

Overdose

In case of overdose, the patient is given multiple gastric lavages and symptomatic treatment is prescribed.

Analogs

Analogs: Avelox, Maxaquin, Liproquin, Tsiprosan, Tariferid, Norfacin, Renor, Oflocid, Medociprin, Cipropane, Lomefloxacin, Ciprovin, Norilet, Siflox, Ciprolon, Microflox, Perti, Ciproquin, Quintor, Oflomak, Ciprobid, Negaflox and others.

Drugs with a similar mechanism of action (matching level 4 ATC code): Nolitsin.

pharmachologic effect

Tsiprinol disrupts DNA synthesis, which helps stop the growth and division of microorganisms. The use of an antibiotic is effective in the treatment of infectious diseases with intracellular localization of pathogens, since it is able to quickly penetrate into cells.

Shows high activity against gram-negative bacteria (salmonella, klebsiella, shigella, E. coli and others), gram-positive bacteria (staphylococci and streptococci) and intracellular microorganisms (mycobacterium tuberculosis, chlamydia, etc.). It has the highest effectiveness among all fluoroquinolones in the treatment of infectious diseases caused by the activity of Pseudomonas aeruginosa.
The drug is inactive against anaerobic bacteria and mycoplasmas. In addition, it is not effective against viral and fungal infections.
When taken orally, the antibiotic is well absorbed. The maximum content of its active substance in the blood is observed 1.5 hours after administration.

special instructions

With the development of severe and prolonged diarrhea, it is necessary to exclude the diagnosis of pseudomembranous colitis, which requires discontinuation of the drug and the appointment of appropriate treatment.
During treatment, to prevent crystalluria, it is unacceptable to increase the recommended daily dose. Patients should be provided with plenty of fluids to acidify the urine and maintain normal diuresis.
When the first symptoms of tenosynovitis appear, treatment with the drug should be stopped. Isolated cases of inflammation and tendon rupture have been described during treatment with fluoroquinolones.
Due to possible photosensitivity, contact with direct sunlight should be avoided.
When using drugs, you should refrain from engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

During pregnancy and breastfeeding

Contraindicated.

In childhood

Contraindicated under 18 years of age.

In old age

Prescribed with caution.

For impaired renal function

For patients with functional renal impairment, a single dose (for oral administration) is half the average daily dose.

For people on peritoneal dialysis or hemodialysis, the drug is prescribed after dialysis at a dose of 250-500 mg once every 24 hours.

For liver dysfunction

Prescribed with caution.

Drug interactions

Use together with theophylline increases the concentration of the latter in the blood plasma.
The simultaneous use of Tsiprinol and non-steroidal anti-inflammatory drugs (except aspirin) increases the risk of seizures.
Combination with other antibiotics leads to synergy.

Conditions for dispensing from pharmacies

Dispensed by prescription.

Storage conditions and periods

Store in a place protected from light and moisture, out of reach of children at a temperature not exceeding 25 °C. Shelf life - 5 years.

4.14 out of 5 (7 Votes)

In this article you can read the instructions for use of the drug Tsiprinol. Reviews of site visitors - consumers of this medicine, as well as the opinions of specialist doctors on the use of the antibiotic Tsiprinol in their practice are presented. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Analogues of Tsiprinol in the presence of existing structural analogues. Use for the treatment of infectious diseases in adults, children, as well as during pregnancy and lactation. Composition and interaction of the drug with alcohol.

Tsiprinol- a broad-spectrum antimicrobial drug from the group of fluoroquinolones. Acts bactericidal. Inhibits the enzyme DNA gyrase of bacteria, as a result of which DNA replication and the synthesis of cellular proteins of bacteria are disrupted. Ciprofloxacin acts both on reproducing microorganisms and on microorganisms in the resting phase.

The drug is active against gram-negative bacteria: Escherichia coli (Escherichia coli), Salmonella spp. (salmonella), Shigella spp. (Shigella), Citrobacter spp., Klebsiella spp. (klebsiella), Enterobacter spp., Proteus mirabilis, Proteus vulgaris, Serratia marcescens, Hafnia alvei, Edwardsiella tarda, Providencia spp., Morganella morganii, Vibrio spp., Yersinia spp., Haemophilus spp., Pseudomonas aeruginosa, Moraxella catarrhalis, Aeromonas spp. ., Pasteurella multocida, Plesiomonas shigelloides, Campylobacter jejuni, Neisseria spp.; intracellular microorganisms: Legionella pneumophila (legionella), Brucella spp., Chlamydia trachomatis (chlamydia), Listeria monocytogenes, Mycobacterium tuberculosis (mycobacterium), Mycobacterium kansasii, Mycobacterium avium-intracellulare; gram-positive bacteria: Streptococcus spp. (including Streptococcus pyogenes (streptococcus), Streptococcus agalactiae), Staphylococcus spp. (including Staphylococcus aureus (staphylococcus), Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus). Most staphylococci resistant to methicillin are also resistant to ciprofloxacin.

Streptococcus pneumoniae and Enterococcus faecalis are moderately sensitive to the drug.

Corynebacterium spp., Bacteroides fragilis, Pseudomonas cepacia, Pseudomonas maltophila, Ureaplasma urealyticum (ureaplasma), Clostridium difficile, Nocardia asteroides are resistant to the drug.

The effect of the drug against Treponema pallidum (treponema) has not been sufficiently studied.

When taking Tsiprinol, there is no development of parallel resistance to other antibiotics that do not belong to the group of gyrase inhibitors, which makes it highly effective against bacteria that are resistant to aminoglycosides, penicillins, cephalosporins, and tetracyclines.

Compound

Ciprofloxacin + excipients.

Pharmacokinetics

After taking the drug orally, Tsiprinol is quickly absorbed from the gastrointestinal tract. Eating slows down absorption but does not affect bioavailability. Bioavailability varies from 50% to 85%. Ciprofloxacin is well distributed in tissues and body fluids, with high concentrations found in bile, lungs, kidneys, liver, gallbladder, uterus, seminal fluid, prostate tissue, tonsils, endometrium, fallopian tubes and ovaries. The concentration of ciprofloxacin in these tissues is higher than in the blood serum. Ciprofloxacin also penetrates well into the fluids of the eye, bones, bronchial secretions, saliva, skin, muscles, pleura, peritoneum and lymph. It penetrates into the cerebrospinal fluid in a small amount, the concentration of ciprofloxacin in non-inflamed meninges is 6-10% of that in the blood serum, and in inflamed meninges - 14-37%. The concentration of ciprofloxacin in neutrophils is 2-7 times higher than in blood serum. Penetrates through the placental barrier.

Biotransforms in the liver (15-30%) with the formation of low-active metabolites (diethylciprofloxacin, sulfociprofloxacin, oxyciprofloxacin, formylciprofloxacin). Excreted primarily in urine (50-70%); 15-30% - with feces.

Indications

Infectious and inflammatory diseases caused by microorganisms sensitive to the drug, including:

respiratory tract: pneumonia (except for pneumococcal pneumonia), acute bronchitis and exacerbation of chronic bronchitis, bronchiectasis, cystic fibrosis (if the causative agent is gram-negative bacteria, especially Pseudomonas aeruginosa);
ear, nose and throat (sore throat, tonsillitis, acute otitis media, sinusitis, mastoiditis);
kidneys and urinary tract (uncomplicated and complicated infections of the lower and upper urinary tracts (urethritis, cystitis, pyelonephritis));
pelvic and genital organs (epididymitis, prostatitis, salpingitis, endometritis, oophoritis, tubular abscess and pelvioperitonitis, gonorrhea, chancroid, chlamydia);
abdominal organs (intraperitoneal abscess, cholecystitis, cholangitis (in combination with metronidazole or clindamycin));
infectious diarrhea (salmonellosis, campylobacteriosis, yersiniosis, shigellosis, cholera, typhoid fever, traveler's diarrhea, Salmonella typhi bacteria carriage);
skin and soft tissues (infected ulcers, infected wounds, abscesses, cellulitis, infections of the external auditory canal, infected burns);
musculoskeletal system (osteomyelitis, septic arthritis);
prevention and treatment of pulmonary anthrax;
prevention and treatment of infections in patients with reduced immunity (during treatment with immunosuppressants).

Release forms

Film-coated tablets 250 mg, 500 mg and 750 mg.

Solution for infusion and concentrate for preparing solution for infusion (injections in injection ampoules).

Extended-release film-coated tablets (Tsiprinol SR).

Instructions for use and dosage

The dosage regimen is set individually, depending on the location and severity of the infection, the condition of the body, age, body weight, and renal function of the patient.

For uncomplicated diseases of the kidneys and urinary tract, the drug is prescribed 250 mg 2 times a day, for complicated diseases - 500-750 mg 2 times a day.

For diseases of the lower respiratory tract - 250 mg 2 times a day, in severe cases - 500-750 mg 2 times a day.

When treating gonorrhea, the drug is prescribed once at a dose of 250-500 mg.

For enteritis, severe colitis, gynecological infections, prostatitis, osteomyelitis - 500-750 mg 2 times a day.

For the treatment of diarrhea - 250 mg 2 times a day.

For the prevention of surgical infections - 500-750 mg every other day.

The duration of treatment depends on the severity of the disease.

The tablets should be taken on an empty stomach with sufficient liquid.

Intravenous administration of the drug is possible. The dose of Tsiprinol is determined depending on the severity of the disease, the type of infection, the condition of the body, age, body weight, and kidney function of the patient.

The drug can be administered intravenously as a bolus, but more preferably intravenous drip (in the form of a dropper) for 30 minutes (200 mg) and 60 minutes (400 mg).

For acute gonorrhea, 100 mg of the drug is administered once.

To prevent postoperative infections, 200-400 mg of Tsiprinol is administered intravenously 30-60 minutes before surgery.

Long-acting tablets SR

Prescribed orally 1 time per day, after meals. The tablets should be swallowed whole, without chewing and with sufficient liquid.

The dose of Tsiprinol SR depends on the severity of the disease, type of infection, body condition, age, body weight and kidney function.

Side effect

nausea, vomiting;
diarrhea;
pseudomembranous colitis;
flatulence;
decreased appetite;
cholestatic jaundice (especially in patients with previous liver diseases);
hepatitis;
increased activity of liver transaminases, alkaline phosphatase, LDH, bilirubin;
headache;
dizziness;
increased fatigue;
sense of anxiety;
increased intracranial pressure;
insomnia;
nightmares;
confusion;
depression;
hallucination;
fainting;
migraine;
thrombosis of cerebral arteries;
disturbances of taste and smell;
visual impairment (diplopia, changes in color vision);
noise in ears;
hearing loss;
tachycardia;
heart rhythm disturbances;
arterial hypotension;
hot flashes (with intravenous administration);
eosinophilia, leukopenia, thrombocytopenia, neutropenia, anemia, thrombocytosis, hemolytic anemia;
arthritis;
tenosynovitis;
tendon rupture;
arthralgia;
myalgia;
interstitial nephritis;
glomerulonephritis;
hematuria;
urinary retention;
skin itching;
hives;
Quincke's edema;
Stevens-Johnson syndrome;
Lyell's syndrome;
candidiasis;
general weakness;
photosensitivity;
increased sweating;
phlebitis.

Contraindications

pseudomembranous colitis (for intravenous administration);
deficiency of glucose-6-phosphate dehydrogenase (for intravenous administration);
pregnancy;
lactation period (breastfeeding);
children and adolescents up to 18 years of age;
hypersensitivity to ciprofloxacin or other drugs from the fluoroquinolone group.

Use during pregnancy and breastfeeding

Tsiprinol is contraindicated for use during pregnancy and lactation (breastfeeding).

Use in elderly patients

The drug should be prescribed with caution to elderly patients.

Use in children

Contraindicated in children and adolescents under 18 years of age.

special instructions

If severe and prolonged diarrhea develops during or after treatment with ciprofloxacin, the diagnosis of pseudomembranous colitis should be excluded, which requires immediate discontinuation of the drug and the appointment of appropriate treatment.

If pain occurs in the tendons or when the first signs of tenosynovitis appear, treatment should be stopped due to the fact that isolated cases of inflammation and even tendon rupture have been described during treatment with fluoroquinolones.

During the treatment period, in order to avoid the development of crystalluria, it is unacceptable to increase the recommended daily dose. Patients should receive plenty of fluids to maintain normal diuresis and acidic urine.

Due to possible photosensitivity, contact with direct sunlight should be avoided during treatment with Tsiprinol.

During treatment, patients should not drink alcohol.

Impact on the ability to drive vehicles and operate machinery

When using the drug, you should refrain from engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Drug interactions

With the simultaneous use of Tsiprinol with didanosine, the absorption of ciprofloxacin is reduced due to the formation of complexes of ciprofloxacin with the magnesium and aluminum salts contained in didanosine.

Due to a decrease in the activity of microsomal oxidation processes in hepatocytes, ciprofloxacin increases the concentration and increases the half-life of theophylline and other xanthines.

With the simultaneous use of ciprofloxacin and oral hypoglycemic drugs, indirect anticoagulants, a decrease in the prothrombin index is observed.

With the simultaneous use of ciprofloxacin and non-steroidal anti-inflammatory drugs (NSAIDs) (excluding acetylsalicylic acid), the risk of developing seizures increases.

The simultaneous use of antacids, as well as drugs containing aluminum, zinc, iron and magnesium ions, can cause a decrease in the absorption of ciprofloxacin, therefore the interval between the administration of these drugs should be at least 4 hours.

With the simultaneous use of ciprofloxacin and cyclosporine, the nephrotoxic effect of the latter increases.

Metoclopramide accelerates the absorption of ciprofloxacin, which leads to a decrease in the time to reach its maximum concentration in the blood plasma.

Co-administration of uricosuric drugs leads to a slower elimination (up to 50%) and an increase in plasma concentrations of ciprofloxacin.

When combined with other antimicrobial drugs (beta-lactam antibiotics, aminoglycosides, clindamycin, metronidazole), synergism is usually observed. Ciprinol can be used in combination with azlocillin and ceftazidime for infections caused by Pseudomonas spp.; with mezlocillin, azlocillin and other beta-lactam antibiotics - for streptococcal infections; with isoxazolepenicillins and vancomycin - for staphylococcal infections; with metronidazole and clindamycin - for anaerobic infections.

Analogues of the drug Tsiprinol

Structural analogues of the active substance:

Alcipro;
Afenoxin;
Basijen;
Betaciprol;
Zindolin;
Ificipro;
Quintor;
Quipro;
Liproquin;
Microflox;
Oftocipro;
Procipro;
Recipro;
Syphlox;
Tseprova;
Ciloxane;
Cypraz;
Tsiprinol SR;
Ciprobay;
Ciprobid;
Cyprobrine;
Ciprodox;
Ciprolacare;
Tsiprolet;
Ciprolone;
Tsipromed;
Cypropane;
Tsiprosan;
Cyprosyn;
Ciprosol;
Ciprofloxabol;
Ciprofloxacin;
Citeral;
Cifloxinal;
Tsifran;
Ecotsifol.

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.

Fluoroquinolone antibiotics are used for therapeutic and prophylactic purposes in diseases of an infectious nature. These drugs include Tsiprinol. The concentration of the main element in the composition of the drug varies depending on the form of release. The prescription medication is used according to an individually selected dosage regimen, which reduces the risk of developing characteristic symptoms of an overdose.

Ciprofloxacin.

ATX

The number indicated in the registration certificate is LS-000047 - P N014323/01. Registration date - 07/22/08.

Release forms and composition

Pharmacies sell several forms of antimicrobial drug release. These are tablets, concentrate and solution for injection. All dosage forms are united by the fact that they contain ciprofloxacin hydrochloride monohydrate, the main component. Tsiprinol 500 is available only in tablet form, the active ingredient content is 500 mg.

The concentrate and solution require intravenous (drip or stream) administration. The concentrate is also used as a spray for the treatment of postoperative sutures and eye drops. The liquid (in both forms) is transparent and colorless. Less commonly, the solution is yellowish-green (depending on the manufacturer).

sodium carboxymethylcellulose;
silica;
primellose;
stearic acid;
polyvinylpyrrolidone.

The shell contains:

hydroxypropyl methylcellulose;
titanium dioxide;
dihydric alcohol;
talc.

Contour cellular packaging holds 10 oval biconvex tablets. Each has a notch (on one side). In a cardboard box - no more than 1 cellular package. Instructions for use are included.

pharmachologic effect

The active substance in any dosage form has a pronounced antibacterial property. The antibiotic belongs to the group of fluoroquinolones of the second generation. A selective topoisomerase inhibitor that targets the DNA of pathogenic microorganisms. Slows down the protein biosynthesis of bacteria.

The sensitivity of some microorganisms is due to a bacteriostatic effect. The drug is used as part of mono- and complex therapy in many areas of medicine. There is no high effectiveness against anaerobic microorganisms.

Gram-positive bacteria sensitive to ciprofloxacin:

Neisseria gonorrhoeae;
Pseudomonas aeruginosa;
Neisseria meningitidis;
Escherichia coli;
Salmonella spp;
Shigella spp.

Gram-negative bacteria sensitive to the drug:

Enterococcus spp;
Legionella spp;
Staphylococcus spp;
Chlamydia spp;
Campylobacter spp;
Mycobacterium spp;
Mycoplasma spp.

Anaerobic microorganisms whose resistance has been proven:

Clostridium difficile;
Nocardia asteroides;
Ureaplasma urealyticum.

Microorganisms that produce beta-lactamase are moderately sensitive to the drug.

Pharmacokinetics

The disintegration process of the tablet occurs in the gastrointestinal tract. Previously taken food does not affect absorption and bioavailability in any way (no more than 75% for the tablet form). The highest concentration of the main element can be determined 90-120 minutes after the first dose. The active substance is carried by the blood and is evenly distributed throughout all the soft tissues of the muscular frame, urinary and respiratory tract.

With intravenous administration of the infusion solution, the rate of absorption remains unchanged. Biotransformation occurs in the liver. Metabolites are inactive.

If the patient does not have any problems with the kidneys or urinary system, excretion of the medication (along with urine) takes 3-6 hours. When diagnosing renal failure and other pathologies, the elimination period spontaneously increases to 10-12 hours. It is not excreted by the intestines.

Penetrates through the placental barrier and into breast milk.

What does it help with?

The use of a fluoroquinolone antibiotic for medicinal purposes is carried out when diagnosing pathologies of infectious etiology and chronic inflammatory diseases in a patient. The annotation contains the following indications:

skin infections (abscess, ulcers, burns, sutures infected after surgical procedures);
infectious diseases of male and female pelvic organs (prostatitis, chlamydia, salpingitis);
respiratory tract infections (pneumonia, bronchitis);
ENT infections (tonsillitis, sinusitis, otitis media);
urinary tract infections (urethritis, pyelonephritis, cystitis);
infections of the digestive tract (intestinal disorders, cholangitis);
infections of bone tissue and joints (arthritis, osteomyelitis);
as a prevention of infectious and inflammatory processes in the body after surgical interventions.

Contraindications

Taking antibiotic tablets becomes impossible if the patient has absolute contraindications. These include:

last trimesters of pregnancy (2-3);
intolerance to the main component;
simultaneous use of Tizanidine and Ciprofloxacin;
children's age (up to 18 years).

An exception may be complications diagnosed in children 6-17 years old and caused by Pseudomonas aeruginosa.

Carefully

The inclusion of a medication in therapy should be cautious in patients with the following pathologies:

vascular cerebral atherosclerosis;
epilepsy;
mental illness;
severe renal and liver dysfunction.

Disorders of blood microcirculation in the brain are considered a relative contraindication to the use of the drug.

How to take Tsiprinol 500?

The dosage form is taken orally 2-3 times a day. The daily intake of the main component should not exceed 1500 mg. The tablets must be taken every 6 hours, regardless of meals. The treatment period is up to 14 days. The course and therapeutic dose can be increased with the permission of the attending physician.

Intravenous administration can be jet or drip. The latter is preferable. The dose for a single administration is 200 mg, for exacerbations - no more than 400 mg. The concentrate and solution for drip administration are mixed with the infusion solution (dextrose, fructose) to the required volume.

For diabetes

Diabetes mellitus requires careful use. The dosage regimen is adjusted in the direction of its reduction. Medical supervision is required.

Side effects

Any ailments that appear during antibiotic treatment are considered side effects. They manifest themselves in the digestive tract, central nervous system, sensory organs, genitourinary and musculoskeletal systems.

Gastrointestinal tract

Dyspepsia, anorexia, pseudomembranous colitis, taste disturbances, loss of appetite, fulminant hepatitis, hepatonecrosis are considered side effects from the digestive tract.

Blood-forming organs

The hematopoietic organs include anemia, thrombocytopenia, leukopenia, leukocytosis, thrombocytosis.

central nervous system

Side effects of the drug on the central nervous system manifest themselves in the form of convulsions, headaches, dizziness, depression, fainting, anxiety and visual-auditory hallucinations.

From the urinary system

From the urinary system, crystalluria, polyuria, hematuria, and internal bleeding are observed (rarely).

From the senses

There is a violation of the sense of smell, short-term blindness and deafness, and minor tinnitus.

From the skin

Rashes appear on the skin, accompanied by itching and burning. Possible formation of papules. Bruises form where small blood vessels rupture.

From the musculoskeletal system

From the musculoskeletal system, arthritis, myalgia, swelling and arthralgia develop. The risk of tendon rupture increases.

From the cardiovascular system

Side effects of the drug on the cardiovascular system are expressed in increased heart rate, decreased blood pressure and tachycardia.

Allergies

Allergic reactions to the drug are expressed in the form of urticaria, blistering, and exanthema. Increased sweating and general weakness appear in 12% of patients.

special instructions

If patients have relative contraindications (epilepsy, cerebrovascular disease), the antibiotic is prescribed only for health reasons. If diarrhea accompanies treatment with the drug throughout the entire course of treatment, then it is necessary to undergo examination for pseudomembranous colitis. If the diagnosis is confirmed, it is necessary to stop using the drug as soon as possible.

A quick word about medications. Ciprofloxacin

Ciprofloxacin during lactation (breastfeeding, breastfeeding): compatibility, dosage, elimination period

Excessive physical activity must be completely avoided. Prolonged exposure to the sun is unacceptable. An independent increase in the daily norm increases the risk of developing crystalluria.

Alcohol compatibility

The drug has negative compatibility with alcoholic beverages. Ethanol in combination with ciprofloxacin provokes severe intoxication.

Impact on the ability to operate machinery

Due to the lack of drowsiness, experts allow careful driving and other means of transportation.

Use during pregnancy and lactation

Prescription of Tsiprinol for 500 children

Not appointed under 18 years of age. Anthrax and cystic fibrosis of the lungs, previously diagnosed in children 5-17 years old, are considered exceptions.

Use in old age

Elderly patients should start with half the dose. The appointment is carried out under the supervision of a specialist.

Use for renal impairment

Careful use under specialist supervision.

Use for liver dysfunction

Relative contraindication. Careful handling required.

Overdose

Characteristic symptoms of overdose are expressed in the form of vomiting, fainting, headache, loss and confusion, pain in the chest and stomach, visual and auditory hallucinations. Treatment is determined symptomatically by the attending physician. Gastric lavage and intake of enterosorbent is mandatory.

Interaction with other drugs

Didazonin reduces the rate of absorption of the antibiotic. Theophyllines and xatins are eliminated from the body more slowly when taken simultaneously with an antibacterial medication. The thrombopropin index may decrease when the drug is used in combination with hypoglycemic drugs. The risk of developing fever and seizures increases with simultaneous use of non-steroidal anti-inflammatory drugs and an antibiotic.

Medicines that reduce the level of uric acid and promote its faster elimination can prolong the period of removal of ciprofloxacin from the body. The interval between taking antacids and antibiotics is 4-5 hours.

Analogs

The drug, which belongs to the fluoroquinolones, has several analogues that have a similar therapeutic effect. These include:

Syphlox. The tablet form contains 250-500 mg of ciprofloxacin. Price - from 150 rub.
Fact. Generic containing gemifloxacin mesylate (160-320 mg). Price - from 950 rub.
Lefoccin. Release form: tablets. Levofloxacin hemihydrate (250-500 mg). Price - from 300 rub.

Independent selection of a substitute is excluded.

Conditions for dispensing Cipronol 500 from pharmacies

Prescription holiday.

Can I buy it without a prescription?

Price

The cost of the tablet form in pharmacies is from 63 rubles.

Storage conditions of the drug

Keep away from animals, children, fire, sunlight and moisture.

Registration number: P N014323/01-271015
Trade name: Tsiprinol®
International nonproprietary name: ciprofloxacin
Dosage form: film-coated tablets

Compound
1 tablet 250 mg contains:
CORE:
Active substance:
Ciprofloxacin in the form of ciprofloxacin hydrochloride monohydrate 291.00 mg*
Excipients: microcrystalline cellulose 50.50 mg, sodium carboxymethyl starch (type A) 30.00 mg, povidone 4.00 mg, croscarmellose sodium 15.00 mg, colloidal silicon dioxide anhydrous 1.00 mg, magnesium stearate 2.50 mg
COVER: hypromellose 10.00 mg, talc 0.90 mg, titanium dioxide, E171 2.00 mg, propylene glycol 0.70 mg
* 291.00 mg of ciprofloxacin hydrochloride monohydrate corresponds to 250.00 mg of ciprofloxacin.
1 tablet 500 mg contains:
CORE:
Active substance:
Ciprofloxacin in the form of ciprofloxacin hydrochloride monohydrate 582.00 mg**
Excipients: microcrystalline cellulose 57.00 mg, sodium carboxymethyl starch (type A) 60.00 mg, povidone 8.00 mg, croscarmellose sodium 30.00 mg, colloidal silicon dioxide anhydrous 2.00 mg, magnesium stearate 9.00 mg
COVER: hypromellose 20.00 mg, talc 1.80 mg, titanium dioxide, E171 4.00 mg, propylene glycol 1.40 mg
** 582.00 mg of ciprofloxacin hydrochloride monohydrate corresponds to 500.00 mg of ciprofloxacin.

Description
Tablets 250 mg: round, biconvex tablets with a beveled edge and a score on one side, white film-coated.
Tablets 500 mg: oval, biconvex tablets with a score on one side, white film-coated.

Pharmacotherapeutic group: antimicrobial agent - fluoroquinolone
ATX code: J01MA02

Pharmacological properties
Pharmacodynamics
Ciprofloxacin is a synthetic broad-spectrum antibacterial drug from the group of fluoroquinolones.
Mechanism of action
Ciprofloxacin has in vitro activity against a wide range of gram-negative and gram-positive microorganisms. The bactericidal effect of ciprofloxacin is carried out through the inhibition of bacterial type II topoisomerases (topoisomerase II (DNA gyrase) and topoisomerase IV), which are necessary for the replication, transcription, repair and recombination of bacterial DNA.
Mechanisms of resistance
In vitro resistance to ciprofloxacin is often caused by point mutations in bacterial topoisomerases and DNA gyrase and develops slowly through multistep mutations.
Single mutations may result in decreased susceptibility rather than the development of clinical resistance, but multiple mutations generally lead to the development of clinical resistance to ciprofloxacin and cross-resistance to quinolone drugs. Resistance to ciprofloxacin, as to many other antibiotics, can develop as a result of decreased permeability of the bacterial cell wall (as often occurs in the case of Pseudomonas aerugitnosa) and/or activation of elimination from the microbial cell (efflux). The development of resistance caused by the Qnr coding gene localized on plasmids has been reported. Resistance mechanisms that lead to inactivation of penicillins, cephalosporins, aminoglycosides, macrolides and tetracyclines do not likely interfere with the antibacterial activity of ciprofloxacin. Microorganisms resistant to these drugs may be sensitive to ciprofloxacin. The minimum bactericidal concentration (MBC) usually does not exceed the minimum inhibitory concentration (MIC) by more than 2 times.
In vitro susceptibility testing
Reproducible criteria for ciprofloxacin susceptibility testing, approved by the European Committee on Antimicrobial Susceptibility Testing (EUCAST), are presented in the table below.
European Committee on Antibiotic Susceptibility Testing. Clinical MIC breakpoints (mg/L) for ciprofloxacin.

Microorganism Sensitive [mg/l] Resistant [mg/l]
Enterobacteriaceae ≤ 0.5 > 1
Pseudomonas spp. ≤ 0.5 > 1
Acinetobacter spp. ≤ 1 > 1
Staphylococcus1 spp. ≤ 1 > 1
Streptococcus pneumoniae2 ≤ 0.125 > 2
Haemophilus influenzae and Moraxella catarrhalis3 ≤ 0.5 > 0.5
Neisseria gonorrhae ≤ 0.003 > 0.06
Neisseria meningitidis ≤ 0.003 > 0.06
Boundary values not related to microorganism species4 ≤ 0.5 > 1

1. Staphylococcus spp. - breakpoints for ciprofloxacin and ofloxacin are associated with high-dose therapy.
2. Streptococcus pneumoniae - wild type S. pneumoniae is not considered susceptible to ciprofloxacin and ofloxacin and is therefore classified as intermediately susceptible.
3. Strains with MIC values above the sensitive/moderately sensitive threshold are very rare and have not been reported to date. Identification and antimicrobial susceptibility tests should be repeated when such colonies are detected, and the results should be confirmed by colony testing at a reference laboratory. Until evidence of clinical response is available for strains with confirmed MIC values above the currently used resistance threshold, they should be considered resistant. Haemophilus spp. /Moraxella spp. - it is possible to identify strains of Haemophilus influenzae with low sensitivity to fluoroquinolones (MIC for ciprofloxacin - 0.125-0.5 mg/l). There is no evidence of the clinical significance of low resistance in respiratory tract infections caused by H. influenzae.
4. Non-species-specific breakpoints were determined primarily on the basis of pharmacokinetics/pharmacodynamics data and are independent of species-specific MIC distributions. They are only applicable to species for which a species-specific susceptibility threshold has not been determined, and not to those species for which susceptibility testing is not recommended. For certain strains, the distribution of acquired resistance may vary across geographic regions and over time. Therefore, it is desirable to have local information on resistance, especially when treating severe infections.
Clinical and Laboratory Standards Institute data for MIC breakpoints (mg/L) and diffusion testing (zone diameter) using 5 mcg ciprofloxacin discs are presented in the table below.
Clinical and Laboratory Standards Institute. Breakpoints for MIC (mg/L) and diffusion testing (mm) using disks.

Microorganisms Sensitive Intermediate Resistant
Enterobacteriaceae 4a
> 21b 16-20b Pseudomonas aeruginosa and other bacteria not belonging to the family Enterobacteriaceae 4a
> 21b 16-20b Staphylococcus spp. 4a
> 21b 16-20b Enterococcus spp. 4a
> 21b 16-20b Haemophilus spp. > 21y - -
Neisseria gonorrhae 1
> 41d 28-40d Neisseria meningitidis 0.12e
> 35f 33-34f Bacillus anthracis Yersinia pestis Francisella tularensis

A. This reproducible standard is only applicable to broth dilution tests using cationically adjusted Mueller-Hinton broth (CAMHB) incubated with air at 35±2°C for 16-20 hours for strains of Enterobacteriaceae, Pseudomonas aeruginosa, etc. bacteria not belonging to the family Enterobacteriaceae, Staphylococcus spp., Enterococcus spp. and Bacillus anthracis; within 20-24 hours for Acinetobacter spp., 24 hours for Y. pestis (if growth is insufficient, incubate for another 24 hours).
b. This reproducible standard is only applicable to disc diffusion tests using air at 35+2°C for 16-18 hours.
V. This reproducible standard is only applicable to susceptibility disk diffusion tests with Haemophilus influenzae and Haemophilus parainfluenzae using broth test medium for Haemophilus spp. (NTM), which is incubated with air at a temperature of 35 °C ± 2 °C for 20-24 hours.
d. This reproducible standard is only applicable to disc diffusion tests using NTM incubated in 5% CO2 at 35°C ± 2°C for 16-18 hours.
e. This reproducible standard is only applicable to susceptibility tests (zone disc diffusion tests and MIC agar solution) using gonococcal agar and 1% specified growth supplement at 36°C ± 1°C (not to exceed 37°C) in 5% CO2 for 20-24 hours.
e. This reproducible standard is only applicable to broth dilution tests using cationic corrected Mueller-Hinton broth (CAMHB) supplemented with 5% sheep blood incubated in 5% CO2 at 35 ± 2 °C for 20-24 hours .
and. This reproducible standard is applicable only to broth dilution tests using cationically adjusted Mueller-Hinton broth (CAMHB) supplemented with a specified 2% growth supplement and incubated with air at 35 ± 2 °C for 48 hours.
In vitro sensitivity to ciprofloxacin
For certain strains, the distribution of acquired resistance may vary across geographic regions and over time. Therefore, it is desirable to have local information on resistance when testing strain susceptibility, especially when treating severe infections. If the local prevalence of resistance is such that the benefit of using the drug, at least against several types of infections, is questionable, it is necessary to consult a specialist.
In vitro studies have demonstrated the activity of ciprofloxacin against the following sensitive strains of microorganisms:
Aerobic gram-positive microorganisms:
Bacillus anthracis, Staphylococcus aureus (methicillin-sensitive), Staphylococcus saprophyticus, Streptococcus spp.
Aerobic gram-negative microorganisms:
Aeromonas spp., MoraxelIa catarrhalis, Brucella spp., Neisseria meningitidis, Citrobacter koseri, Pasteurella spp., Francisella tularensi, Salmonella spp., Haemophilus ducreyi, Shigella spp., Haemophilius influenzae, Vibrio spp., Legionella spp., Yersinia pestis.
Anaerobic microorganisms:
Mobiluncus spp.
Other microorganisms
Chlamydia trachomatis, Chlamydia pneumoniae, Mycoplasma home nis, Mycoplasma pneumoniae.
Varying degrees of sensitivity to ciprofloxacin have been demonstrated for the following microorganisms: Acinetobacter baumann, Burkholderia cepacia, Campylobacter spp., Citrobacter freundii, Enterococcus faecalis, Enterobacter aerogenes, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Klebsiella faecalis, Morganella morganii, Neisseria gonorrhoeae, Proteus mirabilis , Proteus vulgaris, Providencia spp., Pseudomonas aeruginosa, Pseudomonas fluorescens, Serratia marcescens, Streptococcus pneumoniae, Peptostreptococcus spp., Propionibacterium acnes.
It is believed that Staphylococcus aureus (methicillin-resistant), Stenotrophomonas maltophilia, Actinomyces spp., Enterococcus faecium, Listeria monocytogenes, Mycoplasma genitalium, Ureaplasma urealitycum, anaerobic microorganisms (with the exception of Mobiluncus spp., Peptostreptococcus spp., Propioni) have natural resistance to ciprofloxacin bacterium acnes ).
Pharmacokinetics
Suction
After oral administration, ciprofloxacin is rapidly absorbed mainly in the small intestine. The maximum concentration (Cmax) of ciprofloxacin in the blood serum is achieved after 1-2 hours. Bioavailability is about 70-80%. Cmax values in blood plasma and area under the concentration-time curve (AUC) increase in proportion to the dose.
Distribution
The binding of ciprofloxacin to plasma proteins is 20-30%; the active substance is present in the blood plasma mainly in non-ionized form. Ciprofloxacin is freely distributed in tissues and body fluids. The volume of distribution in the body is 2-3 l/kg. The concentration of ciprofloxacin in tissues significantly exceeds the concentration in serum.
Metabolism
Biotransformed in the liver. Four metabolites of ciprofloxacin can be detected in the blood in small concentrations: diethylciprofloxacin (M1), sulfociprofloxacin (M2), oxociprofloxacin (M3), formylciprofloxacin (M4), three of which (M1-M3) exhibit antibacterial activity in vitro, comparable to antibacterial activity of nalidixic acid. The in vitro antibacterial activity of the M4 metabolite, present in smaller quantities, is more consistent with the activity of norfloxacin.
Removal
Ciprofloxacin is excreted from the body primarily by the kidneys by glomerular filtration and tubular secretion, and a small amount is excreted through the intestines. Renal clearance is 0.18-0.3 l/h/kg, total clearance is 0.48-0.60 l/h/kg. Approximately 1% of the administered dose is excreted in bile. Ciprofloxacin is present in bile in high concentrations. In patients with unchanged renal function, the half-life (T1/2) is usually 3-5 hours. If renal function is impaired, T1/2 lengthens.

Indications for use
Uncomplicated and complicated infections caused by microorganisms sensitive to ciprofloxacin.
Adults
Respiratory tract infections. Ciprofloxacin is recommended to be prescribed for pneumonia caused by Klebsiella spp., Enterobacter spp., Proteus spp., Esherichia coli, Pseudomonas aeruginosa, Haemophilus spp., Moraxella catarrhalis, Legionella spp. and staphylococci.
Infections of the middle ear (otitis media), sinuses (sinusitis), especially if these infections are caused by gram-negative microorganisms, including Pseudomonas aeruginosa or staphylococci.
Eye infections.
Kidney and/or urinary tract infections.
Infections of the genital organs, including adnexitis, gonorrhea, prostatitis.
Infections of the abdominal cavity (bacterial infections of the gastrointestinal tract, biliary tract, peritonitis).
Skin and soft tissue infections.
Sepsis.
Infections or prevention of infections in immunocompromised patients (patients taking immunosuppressants or patients with neutropenia).
Selective intestinal decontamination in immunocompromised patients.

Prevention and treatment of infections caused by Neisseria meningitidis.
Children
Treatment of complications caused by Pseudomonas aeruginosa in children with cystic fibrosis of the lungs from 5 to 17 years old.
Prevention and treatment of pulmonary anthrax (infection with Bacillus anthracis).
Current official guidelines on the use of antibacterial agents must be taken into account.

Contraindications
Hypersensitivity to ciprofloxacin or other drugs from the fluoroquinolone group, as well as to excipients (see section "Composition").
The simultaneous use of ciprofloxacin and tizanidine due to clinically significant side effects (hypotension, drowsiness) associated with an increase in the concentration of tizanidine in the blood plasma (see section “Interactions with other drugs”).

Carefully
For diseases of the central nervous system: epilepsy, decreased seizure threshold (or history of seizures), severe cerebral atherosclerosis, cerebrovascular accident, organic brain lesions or stroke, mental illness (depression, psychosis), severe hepatic and/or renal failure, tendon damage from previous quinolone treatment, increased risk of QT prolongation or torsade de pointes (eg, congenital long QT syndrome, heart disease (heart failure, myocardial infarction, bradycardia), electrolyte imbalance (eg, hypokalemia, hypomagnesemia)), simultaneous use of drugs that prolong the QT interval (including class IA and III antiarrhythmics, tricyclic antidepressants, macrolides, antipsychotics), simultaneous use with inhibitors of the CYP1A2 isoenzyme (including theophylline, methylxanthine, caffeine, duloxetine, clozapine, ropinirole, olanzapine), myasthenia gravis, glucose-6-phosphate dehydrogenase deficiency, use in elderly patients.

Use during pregnancy and breastfeeding
Pregnancy
The safety of ciprofloxacin during pregnancy has not been established. However, based on the results of animal studies, the possibility of adverse effects on the articular cartilage of newborns cannot be completely excluded, and therefore ciprofloxacin should not be prescribed to pregnant women.
At the same time, no teratogenic effects (malformations) were established in animal studies.
Breastfeeding period
Ciprofloxacin is excreted into breast milk. Due to the potential risk of damage to joint cartilage in newborns, ciprofloxacin should not be given to nursing women.
Use in children
Ciprofloxacin is not recommended for use in children under 18 years of age for the treatment of other infectious diseases, except for the treatment of complications of cystic fibrosis of the lungs (in children from 5 to 17 years of age) caused by Pseudomonas aeruginosa, and for the treatment and prevention of pulmonary anthrax (after suspected or proven infection with Bacillus anthracis).
The use of ciprofloxacin in children should be started only after assessing the benefit/risk ratio due to possible side effects on joints and tendons.

Directions for use and doses
Orally, regardless of the time of meal, without chewing, with a small amount of liquid.
If the drug is used on an empty stomach, the active substance is absorbed faster. In this case, the tablets should not be taken with dairy products or drinks fortified with calcium (for example, milk, yogurt, juices with a high calcium content). Calcium contained in regular food does not affect the absorption of ciprofloxacin.
If, due to the severity of the condition or for other reasons, the patient is unable to take tablets, he is recommended to undergo parenteral therapy with an infusion solution of ciprofloxacin, and after improvement of the condition, switch to taking the tablet form of the drug.
In the absence of other prescriptions, it is recommended to follow the following dosage regimen:
Adults
Table 1. Recommended daily dose of the drug Tsiprinol®, film-coated tablets 250 mg, 500 mg

Respiratory tract infections (depending on the severity of the infection and the patient’s condition) from 2 x 500 mg to 2 x 750 mg
Infections of the genitourinary system:
acute, uncomplicated from 2 x 250 mg to 2 x 500 mg
cystitis in women (before menopause) 1 x 500 mg
complicated from 2 x 500 mg to 2 x 750 mg
adnexitis, prostatitis, orchitis, epididymitis from 2 x 500 mg to 2 x 750 mg
Gonorrhea
extragenital acute, uncomplicated 1 x 500 mg
Diarrhea 2 x 500 mg
Other infections (see section "Indications for use") 2 x 500 mg
Particularly severe, life-threatening, including streptococcal pneumonia recurrent infections in cystic fibrosis of the lungs infections of bones and joints septicemia peritonitis Especially in the presence of Pseudomonas, Staphylococcus or Streptococcus 2 x 750 mg
Pulmonary anthrax (treatment and prevention) 2 x 500 mg
Prevention of invasive infections caused by Neisseria meningitidis 1 x 500 mg

Dosage regimen for elderly patients (over 65 years of age)
Elderly patients should be prescribed lower doses of ciprofloxacin depending on the severity of the disease and creatinine clearance (CC).
Children and teenagers
In the absence of other prescriptions, the following dosage regimen should be followed:
For the treatment of complications of pulmonary cystic fibrosis caused by Pseudomonas aeruginosa (in children from 5 to 17 years of age), the recommended dose of ciprofloxacin is 10 mg/kg body weight intravenously 3 times a day (maximum dose 1200 mg). The duration of therapy is 10-14 days.
Table 2. Recommended daily dose of Tsiprinol®, film-coated tablets 250 mg, 500 mg in children

Indications Daily dose of ciprofloxacin (mg)
Infections in fibrinocystic degeneration (cystic fibrosis) 2 x 20 mg/kg body weight (maximum dose 750 mg)
Inhalational anthrax (post-exposure) 2 x 15 mg/kg body weight (maximum dose 500 mg)

Dosage regimen for pulmonary anthrax (treatment and prevention), see information in tables 1 and 2
The drug should be started immediately after suspected or confirmed infection.
The total duration of treatment with ciprofloxacin for pulmonary anthrax is 60 days.
Dosage regimen for impaired renal or hepatic function in adults
Table 3. Recommended dosages for patients with renal failure

Creatinine clearance (ml/min/1.73 m2) Plasma creatinine (mg/100 ml) Total daily dose of ciprofloxacin when taken orally
30-60 1.4-1.9 maximum 1000 mg

Patients with renal failure on hemodialysis
1. With CC 30-60 ml/min/1.73 m2 (moderate renal failure) or its plasma concentration 1.4-1.9 mg/100 ml, the maximum daily dose of ciprofloxacin when taken orally should be 1000 mg.
2. For CC On the days of hemodialysis, ciprofloxacin is taken after the procedure.
Outpatients with renal failure on continuous peritoneal dialysis
The maximum daily dose of ciprofloxacin for oral administration should be 500 mg (1 tablet of Ciprinol® 500 mg or 2 tablets of Ciprinol® 250 mg).
Patients with liver failure
No dose adjustment is required.
Patients with renal and liver failure
The dosage regimen is similar to that described in paragraphs 1 and 2.
Children with impaired renal and/or liver function
The dosage regimen has not been studied in children with impaired renal and/or liver function.
Duration of therapy
The duration of treatment depends on the severity of the disease, clinical and biological control. It is important to continue treatment systematically for at least 3 days after the disappearance of fever or other clinical symptoms.
Average duration of treatment
1 day for acute uncomplicated gonorrhea and cystitis;
up to 7 days for infections of the kidneys, urinary tract, abdominal organs;
the entire period of neutropenia in immunocompromised patients;
no more than 2 months for osteomyelitis;
from 7 to 14 days for other infections.
For infections caused by Streptococcus spp., due to the risk of late complications, treatment should continue for at least 10 days.
For infections caused by Chlamydia spp., treatment should also be continued for at least 10 days.

Side effect
The adverse reactions listed below were classified as follows: “very common” (≥ 10), “common” (from ≥ 1/100 to Adverse reactions that were recorded only during post-marketing observations, and the frequency of which has not been assessed, are designated “frequency unknown” .

* More often in patients with a predisposition to developing prolongation of the QT interval.
The incidence of the following adverse reactions with intravenous administration and with the use of stepwise therapy with ciprofloxacin (with intravenous administration of the drug followed by oral administration) is higher than with oral administration.

Often Vomiting, increased activity of liver transaminases, rash
Uncommon Thrombocytopenia, thrombocythemia, confusion and disorientation, hallucinations, paresthesia and dysesthesia, convulsions, vertigo, visual disturbances, hearing loss, tachycardia, vasodilation, decreased blood pressure, reversible liver dysfunction, jaundice, renal failure, edema
Rare: Pancytopenia, bone marrow depression, anaphylactic shock, psychotic reactions, migraine, impaired sense of smell, impaired hearing, vasculitis, pancreatitis, liver tissue necrosis, petechiae, tendon rupture

Children
Arthropathy has been frequently reported in children.

Overdose
In cases of oral overdose, reversible toxic effects on the renal parenchyma have been observed in several cases. Therefore, in case of overdose, in addition to standard measures (gastric lavage, after which you should take activated charcoal, administration of large amounts of fluid), it is recommended to monitor kidney function, including pH and acidity of urine, in order to prevent the development of crystalluria, take magnesium- and calcium-containing antacids, which reduce the absorption of ciprofloxacin. Using hemo- or peritoneal dialysis, only a small amount of ciprofloxacin is removed (less than 10%).

Interaction with other drugs
Drugs that cause QT prolongation
Caution should be exercised when ciprofloxacin is used concomitantly, as with other fluoroquinolones, in patients receiving drugs known to prolong the QT interval (for example, class IA and III antiarrhythmic drugs, tricyclic antidepressants, macrolides, antipsychotics) (see section "Special Instructions") .
Chelation formation
Concomitant use of tablet forms of ciprofloxacin and cation-containing drugs, mineral supplements containing calcium, magnesium, aluminum, iron, sucralfate, antacids, polymeric phosphate compounds (such as sevelamer, lanthanum carbonate) and drugs with a large buffer capacity (such as didanosine tablets) containing magnesium, aluminum or calcium reduces the absorption of ciprofloxacin. In such cases, ciprofloxacin should be taken either 1-2 hours before or 4 hours after taking these drugs.
This restriction does not apply to drugs belonging to the class of histamine H2 receptor blockers.
Eating food and dairy products
The simultaneous use of ciprofloxacin and dairy products or drinks fortified with minerals (for example, milk, yogurt, calcium-fortified orange juice) should be avoided as the absorption of ciprofloxacin may be reduced. However, calcium, which is part of other foods, does not significantly affect the absorption of ciprofloxacin.
Omeprazole
With the simultaneous use of ciprofloxacin and drugs containing omeprazole, a slight decrease in Cmax of the drug in the blood plasma and a decrease in AUC may be observed.
Theophylline
The simultaneous use of ciprofloxacin and drugs containing theophylline may cause an undesirable increase in the concentration of theophylline in the blood plasma and, accordingly, the occurrence of theophylline-induced side effects; in very rare cases, these side effects can be life-threatening for the patient. If the simultaneous use of these two drugs is unavoidable, it is recommended to constantly monitor the concentration of theophylline in the blood plasma and, if necessary, reduce the dose of theophylline (see section "Special instructions", Cytochrome P 450).
Other xanthine derivatives
The simultaneous use of ciprofloxacin and caffeine or pentoxifylline (oxpentifylline) may lead to an increase in the concentration of xanthine derivatives in the blood serum.
Nonsteroidal anti-inflammatory drugs
The simultaneous use of very high doses of quinolones (DNA gyrase inhibitors) and some non-steroidal anti-inflammatory drugs (excluding acetylsalicylic acid) can provoke seizures.
Cyclosporine
With the simultaneous use of ciprofloxacin and drugs containing cyclosporine, a short-term transient increase in plasma creatinine concentration was observed. In such cases, it is necessary to determine the concentration of creatinine in the blood plasma twice a week.
Oral hypoglycemic agents
With the simultaneous use of ciprofloxacin and oral hypoglycemic agents, mainly sulfonylureas (for example, glibenclamide, glimepiride), the development of hypoglycemia is presumably due to an increased effect of oral hypoglycemic agents (see section "Side effects").
Probenecid
Probenecid slows down the rate of excretion of ciprofloxacin by the kidneys. The simultaneous use of ciprofloxacin and drugs containing probenecid leads to an increase in the concentration of ciprofloxacin in the blood plasma.
Phenytoin
With the simultaneous use of ciprofloxacin and phenytoin, a change (increase or decrease) in the concentration of phenytoin in the blood plasma was observed. To avoid weakening of the anticonvulsant effect of phenytoin due to a decrease in its concentration, as well as to prevent adverse events associated with phenytoin overdose when discontinuing ciprofloxacin, it is recommended to monitor phenytoin therapy in patients taking both drugs, including determining the concentration of phenytoin in the blood plasma during the entire period simultaneous use of both drugs and for a short time after completion of combination therapy.
Methotrexate
With the simultaneous use of methotrexate and ciprofloxacin, the renal tubular transport of methotrexate may slow down, which may be accompanied by an increase in the concentration of methotrexate in the blood plasma. This may increase the likelihood of side effects from methotrexate. In this regard, patients receiving concomitant therapy with methotrexate and ciprofloxacin should be closely monitored.
Tizanidine
As a result of a clinical study involving healthy volunteers with the simultaneous use of ciprofloxacin and drugs containing tizanidine, an increase in the concentration of tizanidine in the blood plasma was revealed: an increase in Cmax by 7 times (from 4 to 21 times), an increase in AUC by 10 times (from 6 to 21 times). 24 times). An increase in the concentration of tizanidine in the blood serum is associated with hypotensive (lowering blood pressure) and sedative (drowsiness, lethargy) side effects. Therefore, the simultaneous use of ciprofloxacin and drugs containing tizanidine is contraindicated.
Duloxetine
Clinical studies have shown that the simultaneous use of duloxetine and potent inhibitors of the CYP1A2 isoenzyme (such as fluvoxamine) may lead to an increase in the AUC and Cmax of duloxetine. Although there is no clinical data on possible interactions with ciprofloxacin, the likelihood of such an interaction can be anticipated when ciprofloxacin and duloxetine are used concomitantly.
Ropinirole
The simultaneous use of ropinirole and ciprofloxacin, a moderate inhibitor of the CYP1A2 isoenzyme, leads to an increase in the Cmax and AUC of ropinirole by 60 and 84%, respectively. Monitor for adverse effects of ropinirole during concomitant use with ciprofloxacin and for a short time after completion of combination therapy.
Lidocaine
In a study on healthy volunteers, it was found that the simultaneous use of drugs containing lidocaine and ciprofloxacin, a moderate inhibitor of the CYP1A2 isoenzyme, leads to a 22% decrease in the clearance of lidocaine when administered intravenously. Despite the good tolerability of lidocaine, when used simultaneously with ciprofloxacin, side effects may increase due to interaction (see section “Special instructions”, Cytochrome P 450).
Clozapine
With simultaneous use of clozapine and ciprofloxacin at a dose of 250 mg for 7 days, an increase in serum concentrations of clozapine and N-desmethylclozapine was observed by 29% and 31%, respectively. The patient's condition should be monitored and, if necessary, the dosage regimen of clozapine should be adjusted during its simultaneous use with ciprofloxacin and for a short time after completion of combination therapy (see section "Special Instructions", Cytochrome P 450).
Sildenafil
With simultaneous use of ciprofloxacin at a dose of 500 mg and sildenafil at a dose of 50 mg in healthy volunteers, a 2-fold increase in Cmax and AUC of sildenafil was observed. In this regard, the use of this combination is possible only after assessing the benefit/risk ratio.
Vitamin K antagonists
The simultaneous use of ciprofloxacin and vitamin K antagonists (for example, warfarin, acenocoumarol, phenprocoumon, fluindione) may lead to an increase in their anticoagulant effect. The magnitude of this effect may vary depending on concomitant infections, age and general condition of the patient, so it is difficult to assess the effect of ciprofloxacin on increasing the INR. The INR should be monitored frequently during concomitant use of ciprofloxacin and vitamin K antagonists, as well as for a short time after completion of combination therapy.

special instructions
Severe infections, staphylococcal infections and infections caused by gram-positive and anaerobic bacteria
When treating severe infections, staphylococcal infections and infections caused by anaerobic bacteria, ciprofloxacin should be used in combination with appropriate antibacterial agents.
Infections due to Streptococcus pneumoniae
The drug Tsiprinol® is not recommended for the treatment of infections caused by Streptococcus pneumoniae due to its lack of effectiveness against the pathogen.
Genital tract infections
For genital infections suspected of being caused by strains of Neisseria gonorrhoeae resistant to fluoroquinolones, information about local resistance to ciprofloxacin should be taken into account and the sensitivity of the pathogen should be confirmed in laboratory tests.
Heart disorders
Ciprofloxacin has an effect on prolongation of the QT interval (see section "Side effects"). Given that women have a longer average QT interval compared to men, they are more sensitive to drugs that cause QT prolongation. Elderly patients also have increased sensitivity to the effects of drugs that prolong the QT interval. Caution should be exercised when using the drug Tsiprinol® simultaneously with drugs that prolong the QT interval (for example, antiarrhythmic drugs of classes IA and III, tricyclic antidepressants, macrolides and antipsychotic drugs) (see section "Interaction with other drugs"), or in patients with increased risk of prolongation of the QT interval or development of torsade de pointes (for example, with congenital long QT syndrome, electrolyte imbalance (for example, with hypokalemia, hypomagnesemia), as well as with heart diseases such as heart failure, myocardial infarction, bradycardia).
Use in children
It was found that ciprofloxacin, like other drugs of this class, causes arthropathy of large joints in animals. When analyzing the current data on the safety of ciprofloxacin in children under 18 years of age, most of whom have cystic fibrosis, no connection has been established between cartilage or joint damage with the drug. It is not recommended to use the drug Ciprinol® in children for the treatment of diseases other than the treatment of complications of cystic fibrosis of the lungs (in children from 5 to 17 years old) associated with Pseudomonas aeruginosa and for the treatment and prevention of pulmonary anthrax (after suspected or proven infection with Bacillus anthracis) .
Hypersensitivity
Sometimes, after taking the first dose of ciprofloxacin, hypersensitivity to the drug may develop (see section “Side effects”), including allergic reactions, which should be reported to your doctor immediately. In rare cases, after the first use, anaphylactic reactions up to anaphylactic shock may occur. In these cases, the use of the drug Tsiprinol® should be stopped immediately and appropriate treatment should be carried out.
Gastrointestinal tract
If severe and prolonged diarrhea occurs during or after treatment with ciprofloxacin, the diagnosis of pseudomembranous colitis should be excluded, which requires immediate discontinuation of the drug and the appointment of appropriate treatment (vancomycin orally at a dose of 250 mg 4 times a day). The use of drugs that suppress intestinal motility is contraindicated.
Hepatobiliary system
Cases of liver necrosis and life-threatening liver failure have been reported with the use of ciprofloxacin. If you have the following signs of liver disease, such as anorexia, jaundice, dark urine, itching, a painful abdomen, you should stop taking Tsiprinol® (see section “Side Effects”).
Patients taking the drug Tsiprinol® and who have had liver disease may experience a temporary increase in the activity of liver transaminases and alkaline phosphatase or cholestatic jaundice.
Musculoskeletal system
Patients with myasthenia gravis should use the drug Ciprinol® with caution, as an exacerbation of symptoms is possible.
At the first signs of tendinitis (painful swelling in the joint area, inflammation), use of the drug Tsiprinol® should be stopped, physical activity should be avoided, as there is a risk of tendon rupture, and also consult a doctor.
When taking the drug Tsiprinol®, cases of tendinitis and tendon rupture (mainly the Achilles tendon), sometimes bilateral, may occur within the first 48 hours after the start of therapy. Inflammation and rupture of the tendon may occur even several months after stopping treatment with Ciprinol®. Elderly patients and patients with tendon diseases who are simultaneously treated with glucocorticosteroids have an increased risk of tendinopathy.
The drug Ciprinol® should be used with caution in patients with a history of tendon diseases associated with taking quinolones.
Nervous system
The drug Tsiprinol®, like other fluoroquinolones, can provoke convulsions and reduce the threshold for convulsive readiness. In patients with epilepsy and a history of central nervous system diseases (for example, a decrease in the seizure threshold, a history of seizures, cerebrovascular accidents, organic brain lesions or stroke), due to the risk of developing adverse reactions from the central nervous system, ciprofloxacin should be used only in cases where the expected clinical effect exceeds the possible risk of side effects of the drug.
Cases of status epilepticus have been reported when using ciprofloxacin (see section "Side effects"). If convulsions occur, use of the drug Tsiprinol® should be discontinued.
Psychiatric reactions may occur even after the first use of fluoroquinolones, including the drug Ciprinol®. In rare cases, depression or psychotic reactions may progress to suicidal thoughts and suicide attempts, including completed ones (see section "Side effects"). If the patient develops one of these reactions, you should stop taking Cyprinol® and tell your doctor.
Cases of sensory or sensorimotor polyneuropathy, hypoesthesia, dysesthesia or weakness have been reported in patients taking fluoroquinolones, including Ciprinol®. If symptoms such as pain, burning, tingling, numbness, or weakness occur, patients should inform their doctor before continuing to use the drug.
Skin
When taking Ciprinol®, a photosensitivity reaction may occur, so patients should avoid contact with direct sunlight and UV light. Treatment should be discontinued if symptoms of photosensitivity are observed (for example, changes in the skin reminiscent of sunburn) (see section "Side effects").
Cytochrome P450
It is known that ciprofloxacin is a moderate inhibitor of the CYP1A2 isoenzyme. Caution should be exercised when using the drug Ciprinol® simultaneously with drugs metabolized by these isoenzymes, such as theophylline, methylxanthine, caffeine, duloxetine, clozapine, olanzapine, ropinirole, since an increase in the concentration of these drugs in the blood serum, due to inhibition of their metabolism by ciprofloxacin, may cause specific adverse reactions.
To avoid the development of crystalluria, it is unacceptable to exceed the recommended daily dose; sufficient fluid intake and maintaining an acidic urine reaction are also necessary.
In in vitro conditions, ciprofloxacin can interfere with the bacteriological study of Mycobacterium tuberculosis, inhibiting its growth, which can lead to false negative results when diagnosing this pathogen in patients taking the drug Tsiprinol®.

film-coated tablets

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International Classification of Diseases (ICD-10)

A40 Streptococcal septicemia A41 Other septicemia A54 Gonococcal infection H66 Suppurative and unspecified otitis media J01 Acute sinusitis J02 Acute pharyngitis J03 Acute tonsillitis J04 Acute laryngitis and tracheitis J15 Bacterial pneumonia, not elsewhere classified J20 Acute bronchitis J31 Chronic rhinitis, nasopharyngitis and pharyngitis J32 Chronic sinusitis J35.0 Chronic tonsillitis J37 Chronic laryngitis and laryngotracheitis J42 Chronic bronchitis, unspecified K05 Gingivitis and periodontal diseases K12 Stomatitis and related lesions K65.0 Acute peritonitis K81.0 Acute cholecystitis K81.1 Chronic cholecystitis K83.0 Cholangitis L01 Impetigo L02 Abs skin process, boil and carbuncle L03 Phlegmon L08.0 Pyoderma M00 Pyogenic arthritis M86 Osteomyelitis N10 Acute tubulointerstitial nephritis N11 Chronic tubulointerstitial nephritis N30 Cystitis N34 Urethritis and urethral syndrome N41 Inflammatory diseases of the prostate gland N70 Salpingitis and oophoritis N71 Inflammatory diseases of the uterus ki, except cervix N72 Inflammatory disease of the cervix uterus N73.0 Acute parametritis and pelvic cellulitis O08.0 Infection of the genital tract and pelvic organs caused by abortion, ectopic and molar pregnancy Z29.2 Other type of preventive chemotherapy

Pharmacological group

Antibacterial drug of the fluoroquinolone group

pharmachologic effect

A broad-spectrum antimicrobial drug from the group of fluoroquinolones. Acts bactericidal. Inhibits the enzyme DNA gyrase of bacteria, as a result of which DNA replication and the synthesis of cellular proteins of bacteria are disrupted. Ciprofloxacin acts both on reproducing microorganisms and on microorganisms in the resting phase.

A drug active against gram-negative bacteria: Escherichia coli, Salmonella spp., Shigella spp., Citrobacter spp., Klebsiella spp., Enterobacter spp., Proteus mirabilis, Proteus vulgaris, Serratia marcescens, Hafnia alvei, Edwardsiella tarda, Providencia spp., Morganella morganii, Vibrio spp., Yersinia spp., Haemophilus spp., Pseudomonas aeruginosa, Moraxella catarrhalis, Aeromonas spp., Pasteurella multocida, Plesiomonas shigelloides, Campylobacter jejuni, Neisseria spp.; intracellular microorganisms: Legionella pneumophila, Brucella spp., Chlamydia trachomatis, Listeria monocytogenes, Mycobacterium tuberculosis, Mycobacterium kansasii, Mycobacterium avium-intracellulare; gram-positive bacteria: Streptococcus spp. (including Streptococcus pyogenes, Streptococcus agalactiae), Staphylococcus spp. (including Staphylococcus aureus, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus). Most staphylococci resistant to methicillin are also resistant to ciprofloxacin.

To the drug moderately sensitive Streptococcus pneumoniae, Enterococcus faecalis.

To the drug stable Corynebacterium spp., Bacteroides fragilis, Pseudomonas cepacia, Pseudomonas maltophila, Ureaplasma urealyticum, Clostridium difficile, Nocardia asteroides.

The effect of the drug against Treponema pallidum has not been sufficiently studied.

Pharmacokinetics

Suction

After taking the drug orally, ciprofloxacin is rapidly absorbed from the gastrointestinal tract. Eating slows down absorption, but does not affect Cmax or bioavailability. Bioavailability varies from 50% to 85%. C max in the blood serum of healthy volunteers after oral administration of the drug at a dose of 250 mg, 500 mg, 750 mg and 1000 mg is achieved after 1-1.5 hours and is 0.76 mg/ml, 1.6 mg/ml, 2.5 mg/ml and 3.4 mg/ ml respectively.

Distribution

Ciprofloxacin is well distributed in tissues and body fluids, with high concentrations found in bile, lungs, kidneys, liver, gallbladder, uterus, seminal fluid, prostate tissue, tonsils, endometrium, fallopian tubes and ovaries. The concentration of ciprofloxacin in these tissues is higher than in the blood serum. Ciprofloxacin also penetrates well into the fluids of the eye, bones, bronchial secretions, saliva, skin, muscles, pleura, peritoneum and lymph. It penetrates into the cerebrospinal fluid in a small amount, the concentration of ciprofloxacin in non-inflamed meninges is 6-10% of that in the blood serum, and in inflamed meninges - 14-37%. The concentration of ciprofloxacin in neutrophils is 2-7 times higher than in blood serum.

Vd is 2-3.5 l/kg.

Plasma protein binding - 30%.

Penetrates through the placental barrier.

Metabolism and excretion

Pharmacokinetics in special clinical situations

In chronic renal failure T1/2 increases to 12 hours.

Infectious and inflammatory diseases caused by microorganisms sensitive to the drug, including:

Respiratory tract infections;

Ear, nose and throat infections;

Kidney and urinary tract infections;

Infections of the genital organs (gonorrhea, prostatitis, adnexitis, postpartum infections);

Infections of the digestive system (including mouth, teeth, jaws), gallbladder and bile ducts;

Infections of the skin, mucous membranes and soft tissues;

Infections of the musculoskeletal system;

Peritonitis;

Prevention and treatment of infections in patients with reduced immunity (during therapy with immunosuppressants).

Pseudomembranous colitis (for intravenous administration);

Glucose-6-phosphate dehydrogenase deficiency (for intravenous administration);

Pregnancy;

Lactation period (breastfeeding);

Children and adolescents up to 18 years of age;

Hypersensitivity to ciprofloxacin or other drugs from the fluoroquinolone group.

WITH caution the drug is prescribed for cerebral atherosclerosis, cerebrovascular accidents, mental illness, epilepsy, convulsive syndrome, severe renal or liver failure, and elderly patients.

From the digestive system: nausea, vomiting, diarrhea, pseudomembranous colitis, flatulence, loss of appetite, cholestatic jaundice (especially in patients with previous liver diseases), hepatitis, hepatonecrosis, increased activity of liver transaminases, alkaline phosphatase, LDH, bilirubin.

From the central nervous system and peripheral nervous system: headache, dizziness, fatigue, anxiety, tremor, increased intracranial pressure, peripheral paraalgesia, insomnia, nightmares, confusion, depression, hallucinations and other manifestations of psychotic reactions (rarely progressing to states in which the patient may harm himself) , fainting, migraine, cerebral artery thrombosis.

From the senses: disturbances of taste and smell, visual disturbances (diplopia, changes in color vision), tinnitus, hearing loss.

From the cardiovascular system: tachycardia, heart rhythm disturbances, arterial hypotension, hot flashes (with intravenous administration).

From the hematopoietic system: eosinophilia, leukopenia, thrombocytopenia, neutropenia; with intravenous administration, granulocytopenia, anemia, thrombocytosis, and hemolytic anemia are also possible.

From the musculoskeletal system: rarely - arthritis, tendovaginitis, tendon rupture; arthralgia, myalgia (with intravenous administration).

From the urinary system: crystalluria, interstitial nephritis, glomerulonephritis, dysuria, polyuria, albuminuria, hematuria, increased levels of urea, creatinine; urinary retention, decreased nitrogen excretory function of the kidneys.

Allergic reactions: itching, urticaria, Quincke's edema, Stevens-Johnson syndrome, arthralgia; vasculitis, erythema nodosum, exudative erythema multiforme, Lyell's syndrome (with intravenous administration).

Adverse reactions associated with chemotherapy: candidiasis.

Others: general weakness, photosensitivity; increased sweating, hyperglycemia (with intravenous administration).

Local reactions: with intravenous administration - pain and burning, phlebitis.

Overdose

Treatment: a specific antidote is unknown. Gastric lavage and monitoring of the patient's condition are indicated, and symptomatic therapy is provided if necessary. It is necessary to ensure sufficient fluid intake into the body. A small amount of ciprofloxacin (less than 10%) can be eliminated by hemodialysis or peritoneal dialysis.

special instructions

Due to possible photosensitivity, contact with direct sunlight should be avoided during treatment with Tsiprinol.

Impact on the ability to drive vehicles and operate machinery

When using the drug, you should refrain from engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

For renal failure

In case of liver dysfunction

The drug is prescribed with caution in cases of severe liver failure.

Elderly

WITH caution the drug is prescribed to elderly patients.

Use during pregnancy and breastfeeding

The drug is contraindicated for use during pregnancy and lactation (breastfeeding).

Drug interactions

Due to a decrease in the activity of microsomal oxidation processes in hepatocytes, ciprofloxacin increases the concentration and increases the half-life of theophylline and other xanthines.

With the simultaneous use of ciprofloxacin and oral hypoglycemic drugs, indirect anticoagulants, a decrease in the prothrombin index is observed.

With the simultaneous use of ciprofloxacin and NSAIDs (excluding acetylsalicylic acid), the risk of developing seizures increases.

With the simultaneous use of ciprofloxacin and cyclosporine, the nephrotoxic effect of the latter increases.

Metoclopramide accelerates the absorption of ciprofloxacin, which leads to a decrease in the time to reach its maximum concentration in the blood plasma.

Co-administration of uricosuric drugs leads to a slower elimination (up to 50%) and an increase in plasma concentrations of ciprofloxacin.

When combined with other antimicrobial drugs (beta-lactam antibiotics, aminoglycosides, clindamycin, metronidazole), synergism is usually observed. Ciprinol ® can be used in combination with azlocillin and ceftazidime for infections caused by Pseudomonas spp.; with mezlocillin, azlocillin and other beta-lactam antibiotics - for streptococcal infections; with isoxazolepenicillins and vancomycin - for staphylococcal infections; with metronidazole and clindamycin - for anaerobic infections.

The dosage regimen is set individually, depending on the location and severity of the infection, the condition of the body, age, body weight, and renal function of the patient.

At uncomplicated kidney and urinary tract diseases the drug is prescribed 250 mg 2 times a day, with complicated- 500-750 mg 2 times/day.

At diseases of the lower respiratory tract- 250 mg 2 times/day, in severe cases- 500-750 mg 2 times/day.

At treatment of gonorrhea the drug is prescribed once at a dose of 250-500 mg.

At enteritis, severe colitis, gynecological infections, prostatitis, osteomyelitis- 500-750 mg 2 times/day.

For treatment of diarrhea- 250 mg 2 times/day.

For prevention of surgical infections- 500-750 mg every other day.

The duration of treatment depends on the severity of the disease.

Patients with impaired renal function a single dose of the drug for oral administration is half the average daily dose.

At chronic renal failure the drug is prescribed depending on creatinine clearance.

For patients undergoing hemodialysis or peritoneal dialysis, the drug is prescribed after dialysis at a dose of 250-500 mg once every 24 hours.

The tablets should be taken on an empty stomach with sufficient liquid.

It is possible to administer the drug intravenously. The dose of Tsiprinol is determined depending on the severity of the disease, the type of infection, the condition of the body, age, body weight, and kidney function of the patient.

The drug can be administered intravenously as a bolus, but more preferably intravenously by drip over 30 minutes (200 mg) and 60 minutes (400 mg).

At acute gonorrhea 100 mg of the drug is administered once.

For prevention of postoperative infections- 200-400 mg of Tsiprinol is administered intravenously 30-60 minutes before surgery.

Storage conditions and shelf life

The drug should be stored in a place protected from light and moisture, out of reach of children, at a temperature not exceeding 25°C. Shelf life - 5 years.