Instructions for Citramon-Forte tablets blister No. 100
Composition
active ingredients: 1 tablet contains acetylsalicylic acid 320 mg, paracetamol 240 mg, caffeine (calculated on dry matter) 40 mg;
Excipients: cocoa; citric acid monohydrate; povidone; croscarmellose sodium; talc; calcium stearate.
Dosage form
Pills.
Main physicochemical properties: solid, regular, round cylinders, the upper and lower surfaces of which are flat, the edges of the surfaces are beveled, with a dividing line on one side, light brown in color with specks, with the smell of cocoa.
Pharmacotherapeutic group
Analgesics and antipyretics. Acetylsalicylic acid, combinations without psycholeptics.
ATX code N02B A51.
Pharmacological properties
Pharmacodynamics
A combined drug, the effect of which is due to the properties of the components that make up its composition.
Acetylsalicylic acid has an antipyretic and anti-inflammatory effect, reduces pain, especially caused by the inflammatory process, and also moderately inhibits platelet aggregation and thrombus formation, and improves microcirculation in the focus of inflammation.
Paracetamol has analgesic, antipyretic and weak anti-inflammatory effects, which is associated with its effect on the thermoregulation center in the hypothalamus and its weak ability to inhibit prostaglandin synthesis in peripheral tissues.
Caffeine increases the reflex excitability of the spinal cord, stimulates the respiratory and vasomotor centers, dilates the blood vessels of skeletal muscles, brain, heart, kidneys, reduces platelet aggregation; reduces drowsiness, fatigue, increases mental and physical performance. In this combination, caffeine in a small dose has almost no stimulating effect on the central nervous system, but contributes to the normalization of the tone of brain vessels and the acceleration of blood flow.
The combination of acetylsalicylic acid and paracetamol potentiates the analgesic effect of the drug. Both the analgesic and antipyretic effects of acetylsalicylic acid and paracetamol are enhanced when used simultaneously with caffeine.
Pharmacokinetics
Acetylsalicylic acid is rapidly absorbed when administered orally, with sufficient blood concentration observed after 30 minutes, and maximum concentration after 2 hours. Part of the drug is absorbed in the stomach, the majority in the small intestine.
Paracetamol is well absorbed in the upper digestive tract, metabolized in the liver. Penetrates the blood-brain barrier, enters the cerebrospinal fluid, synovial fluid, and penetrates into breast milk. The maximum therapeutic effect is achieved 30-60 minutes after administration. The maximum concentration of the drug in the blood is observed after 2-2.5 hours. The half-life is 2-4 hours. In healthy volunteers, it is excreted from the body with urine after 4-4.5 hours, in patients with impaired renal function - after 8-12 hours.
Caffeine increases gastric secretion. The mechanism of action of caffeine is due to the inhibition of the enzyme phosphodiesterase, which leads to the accumulation of cyclic adenosine monophosphate inside the cells. Cyclic adenosine monophosphate stimulates metabolism in organs and tissues, including muscles and the central nervous system.
The components of the drug and metabolic products are excreted from the body by the kidneys.
Indication
Mild or moderate pain syndrome: headache or toothache, pain during primary dysmenorrhea; migraine, arthralgia, myalgia, neuralgia, especially diseases of inflammatory origin (frontitis, sinusitis), rheumatic diseases, diseases accompanied by hyperthermia of various etiologies (as an antipyretic).
Contraindication
Hypersensitivity to the components of the drug and to other non-steroidal anti-inflammatory drugs (NSAIDs).
Acute peptic ulcers of the stomach and duodenum, history of gastrointestinal bleeding, acute pancreatitis, Gilbert's syndrome.
History of bronchial asthma, urticaria or rhinitis caused by the use of salicylates or NSAIDs.
Disorders in the blood coagulation system: hemorrhagic diseases (hemophilia, hemorrhagic diathesis), hypoprothrombinemia, severe anemia, increased tendency to bleed.
Inhibition of bone marrow hematopoiesis (leukopenia, anemia, including hemolytic), acute hematoporphyria.
Severe hepatic and/or renal insufficiency.
Glucose-6-phosphate dehydrogenase deficiency.
Surgical interventions accompanied by significant bleeding.
Combination with methotrexate at a dosage of 15 mg per week or more (see “Interaction with other medicinal products and other types of interactions”).
Combination with monoamine oxidase inhibitors (MAOIs) and within 2 weeks after discontinuation of MAO inhibitors (see "Interaction with other medicinal products and other types of interactions").
Increased excitability, insomnia, thrombosis, thrombophlebitis, epilepsy, hyperthyroidism, arterial hypertension, atherosclerosis, organic diseases of the cardiovascular system, decompensated heart failure, cardiac conduction disorders, paroxysmal tachycardia, ischemic heart disease, acute myocardial infarction, portal hypertension, tendency to vasospasm, prostatic hypertrophy, severe forms of diabetes mellitus, old age, glaucoma (due to the presence of caffeine in the tablet).
Interaction with other medicinal products and other types of interactions
Contraindicated combinations
The use of methotrexate in doses of 15 mg per week or more increases the hematological toxicity of methotrexate (reduction in renal clearance of methotrexate by anti-inflammatory agents and displacement of methotrexate from plasma protein binding by salicylates).
Concomitant use of caffeine with MAO inhibitors may cause a dangerous increase in blood pressure.
Combinations to be used with caution
Acetylsalicylic acid
Concomitant use of ibuprofen prevents irreversible platelet inhibition by acetylsalicylic acid. Treatment of patients at risk of cardiovascular disease with ibuprofen may limit the cardioprotective effect of acetylsalicylic acid.
The simultaneous use of acetylsalicylic acid and anticoagulants increases the risk of bleeding.
The simultaneous use of high doses of salicylates with NSAIDs (due to a mutually reinforcing effect) increases the risk of ulcers and gastrointestinal bleeding.
Concomitant use with uricosuric agents such as benzobromarone, probenecid reduces the effect of uric acid excretion (due to competition for uric acid excretion by the renal tubules).
When used simultaneously with digoxin, the concentration of the latter in the blood plasma increases due to a decrease in renal excretion.
With the simultaneous use of high doses of acetylsalicylic acid and oral antidiabetic drugs from the group of sulfonylurea derivatives or insulin, the hypoglycemic effect of the latter is enhanced due to the hypoglycemic effect of acetylsalicylic acid and the displacement of sulfonylurea bound to blood plasma proteins.
Diuretics in combination with high doses of acetylsalicylic acid reduce glomerular filtration by reducing prostaglandin synthesis in the kidneys.
Systemic glucocorticosteroids (excluding hydrocortisone), which are used for replacement therapy in Addison's disease, reduce the level of salicylates in the blood during corticosteroid treatment and increase the risk of overdose after the end of treatment.
When used with corticosteroids, the risk of gastrointestinal bleeding increases.
Acetylsalicylic acid enhances the effect of phenytoin.
Angiotensin-converting enzymes (ACE) in combination with high doses of acetylsalicylic acid cause a decrease in glomerular filtration due to inhibition of vasodilator prostaglandins and a decrease in the antihypertensive effect.
When used simultaneously with valproic acid, acetylsalicylic acid displaces it from its association with blood plasma proteins, increasing the toxicity of the latter.
Ethyl alcohol contributes to damage to the mucous membrane of the digestive tract and prolongs bleeding time due to the synergism of acetylsalicylic acid and alcohol.
Enhances the effect of heparin, oral anticoagulants (dicoumarin derivatives), reserpine, steroid hormones and hypoglycemic agents. Simultaneous administration with other non-steroidal anti-inflammatory drugs (ibuprofen), methotrexate, triiodothyronine increases the risk of side effects. Reduces the effectiveness of spironolactone, furosemide, antihypertensives, antigout drugs that promote the excretion of uric acid.
Selective serotonin reuptake inhibitors: increase the risk of upper gastrointestinal bleeding due to the possibility of a synergistic effect.
The drug enhances the effect of agents that reduce blood clotting and platelet aggregation, the side effects of corticosteroids, sulfonylureas, and methotrexate.
Combination with barbiturates, anticonvulsants, salicylates, rifampicin, and alcohol should be avoided.
The absorption rate of paracetamol may increase with simultaneous use with domperidone and decrease with simultaneous use with cholestyramine. Paracetamol increases the elimination time of chloramphenicol by 5 times. With repeated use, paracetamol may enhance the effect of indirect anticoagulants (dicoumarin derivatives). Antacid drugs may reduce the degree of absorption of the compound, as well as slow down this absorption. Chronic alcohol consumption may increase the hepatotoxicity of paracetamol due to excessive formation of the toxic metabolite - phenacetin (CYP 2E1 induction), and also cause depletion of glutathione depots in liver cells. In addition, CYP 2E1 inducers are carbamazepine, barbiturates, isoniazid, phenytoin, rifampin, ritonavir, etc., which cause the same effect as chronic alcohol consumption. When used simultaneously with glucocorticoids (dexamethasone), the likelihood of ulcerogenic and hepatotoxic effects of the drug increases, and the risk of gastrointestinal bleeding increases. Sulfinpyrazone may induce increased formation of phenacetin. Paracetamol may reduce the clearance of busulfan. Long-term use of paracetamol together with NSAIDs or salicylates increases the risk of developing toxic nephropathy, as well as kidney and bladder cancers. Paracetamol may interact with coumarin and indadione anticoagulants, enhancing their hypothrombinemic response, therefore, based on appropriate laboratory monitoring, dose modification may be necessary. In high concentrations, paracetamol may inhibit the action of insulin. Metoclopramide accelerates the absorption of paracetamol.
Antidepressants and other microsomal oxidation stimulants - these drugs increase the production of hydroxylated active metabolites that affect liver function, causing the possibility of developing severe intoxications with small overdoses of the drug. Paracetamol reduces the effectiveness of diuretics. Coumarin derivatives (warfarin) with long-term use of paracetamol increase the risk of bleeding.
Caffeine
Caffeine enhances the effect (improves bioavailability) of analgesics-antipyretics, potentiates the effects of xanthine derivatives, alpha- and beta-adrenomimetics, and psychostimulants.
Cimetidine, hormonal contraceptives, isoniazid enhance the effects of caffeine.
Caffeine reduces the effect of opioid analgesics, anxiolytics, hypnotics and sedatives, is an antagonist of anesthetics and other drugs that depress the central nervous system, and a competitive antagonist of adenosine and adenosine triphosphoric acid drugs.
When caffeine is used simultaneously with ergotamine, the absorption of ergotamine in the digestive tract improves, and with thyroid-stimulating agents, the thyroid effect increases.
Caffeine reduces lithium concentration in the blood
Caffeine is highly metabolized by liver microsomal enzymes, and this is a determining factor in the interactions of caffeine with other drugs due to a decrease or increase in the metabolism of these compounds. Certain antibiotics reduce the clearance of caffeine, thereby increasing the risk of toxic effects of this compound. The most important representatives of such antibiotics are ciprofloxacin, enoxacin, norfloxacin, ofloxacin and erythromycin. Concomitant use of caffeine with barbiturates can weaken their hypnotic and spasmolytic effects. Antiarrhythmic drugs, such as mexiletine, reduce the clearance of caffeine by approximately 50%, thereby increasing the risk of toxic effects of this compound. Concomitant use of caffeine with β-blockers can lead to mutual inhibition of the therapeutic effect. When used concomitantly with lithium, caffeine increases the urinary excretion of this compound and, therefore, reduces its therapeutic effect.
The effectiveness of the drug may decrease when used simultaneously with cholestyramine, anticholinergics, antidepressants, and alkaline substances.
Application features
You should consult a doctor before using the drug.
Do not use the drug with other products containing paracetamol or acetylsalicylic acid.
Do not exceed the indicated doses of the drug. For short-term use.
The drug should be used with caution in patients with a history of gastrointestinal ulcers, including chronic or recurrent peptic ulcer disease or a history of gastrointestinal bleeding; concomitant use of anticoagulants.
Patients with impaired kidney and liver function should consult a doctor regarding the possibility of using the drug.
Patients with liver and kidney dysfunction should reduce the dose of Citramon-Forte or increase the interval between doses. In case of impaired kidney and liver function, the interval between doses should be at least 8 hours.
Since acetylsalicylic acid, like all non-selective non-steroidal anti-inflammatory drugs, causes irritation of the mucous membrane of the digestive tract, this drug should be taken only after meals, washed down with water, alkaline mineral waters, sodium bicarbonate solution (preferably milk).
In case of hyperthermia, the drug should be prescribed only if other analgesics and antipyretics are ineffective, as there is a risk of developing Reye's syndrome. If vomiting occurs as a result of using the drug, Reye's syndrome should be suspected.
It should be taken into account that patients with alcoholic liver disease are at increased risk of hepatotoxic effects of paracetamol; the drug may affect the results of laboratory tests for blood glucose and uric acid.
During surgical operations (including dental), the use of drugs containing acetylsalicylic acid may increase the likelihood of bleeding due to inhibition of platelet aggregation for some time after the use of acetylsalicylic acid. The use of the drug should be discontinued 5-7 days before surgery (to reduce the risk of increased bleeding).
The patient must inform the doctor in advance about taking Citramon-Forte.
In patients with allergic complications, including bronchial asthma, allergic rhinitis, urticaria, skin itching, mucosal edema and nasal pollinosis, as well as in combination with chronic respiratory tract infections and in patients with hypersensitivity to nonsteroidal anti-inflammatory drugs, bronchospasm or an attack of bronchial asthma may develop, therefore the use of NSAIDs in this category of patients is contraindicated.
Acetylsalicylic acid, which is part of the drug, even in small doses can reduce the excretion of uric acid from the body, which can cause an acute attack of gout in sensitive patients.
Since acetylsalicylic acid causes irritation of the mucous membrane, the drug should not be used in children due to the risk of developing Reye's syndrome. In patients with bronchial asthma, allergic diseases, hypersensitivity to NSAIDs, an allergic reaction or exacerbation of the underlying disease is possible.
During treatment with the drug, it is not recommended to consume excessive amounts of beverages containing caffeine (e.g. coffee, tea). This may cause sleep disturbances, tremors, feelings of tension, irritability, and an unpleasant feeling behind the chest due to palpitations.
Do not drink alcoholic beverages during treatment (increased risk of gastrointestinal bleeding).
Patients who take analgesics every day for mild arthritis should consult a doctor. Before using the drug, a doctor should be consulted if the patient is using warfarin or similar drugs that have an anticoagulant effect.
It should not be used in case of hypersensitivity to analgesics, anti-inflammatory, antirheumatic drugs, and with caution, with simultaneous use of anticoagulants and the presence of circulatory disorders (e.g. renal vascular pathology, congestive heart failure, hypovolemia, extensive surgery, sepsis or severe bleeding), since acetylsalicylic acid also increases the risk of impaired renal function and acute renal failure. Ibuprofen may reduce the inhibitory effect of acetylsalicylic acid on platelet aggregation.
The drug may affect the results of laboratory tests for blood glucose and uric acid.
It is not recommended to use the drug without consulting a doctor for more than 5 days as an analgesic and more than 3 days as an antipyretic.
If symptoms persist, consult a doctor.
If the headache becomes persistent, you should see a doctor.
It is contraindicated for patients with bronchial asthma, with increased bleeding and with special caution - with simultaneous therapy with anticoagulants (coumarin and heparin), with impaired liver function and kidney diseases, as well as with simultaneous anti-inflammatory therapy.
May alter the results of doping control tests in athletes. Makes diagnosis of "acute abdomen" difficult.
Ability to influence reaction speed when driving vehicles or other mechanisms
The drug may affect the speed of neuromuscular transmission, therefore, during treatment with the drug, it is necessary to refrain from driving vehicles and working with dangerous mechanisms.
Use during pregnancy or breastfeeding
The drug is contraindicated during pregnancy.
In the third trimester of pregnancy, taking salicylates in high doses (more than 300 mg/day) can lead to miscarriage and decreased labor contractions, as well as cardiopulmonary toxicity (premature closure of the ductus arteriosus) in children.
The use of acetylsalicylic acid in large doses shortly before delivery can lead to intracranial bleeding, especially in premature infants.
If it is necessary to prescribe the drug, breastfeeding should be discontinued.
Method of administration and doses
The drug is used orally during or after meals. Adults and children over 16 years of age are prescribed 1 tablet 2-3 times a day. For the relief of acute pain - 2 tablets at a time. The maximum daily dose is 6 tablets in 3 doses. The drug should not be taken for more than 5 days as an analgesic and more than 3 days as an antipyretic (without the prescription and supervision of a doctor).
Do not use drugs containing acetylsalicylic acid in children with acute respiratory viral infections (ARI), with or without fever, without consulting a doctor. Some viral diseases, especially influenza A, influenza B and chickenpox, carry a risk of developing Reye's syndrome, which requires urgent medical intervention. If these conditions are accompanied by prolonged vomiting, this may be a sign of Reye's syndrome.
For the above reasons, the use of the drug is contraindicated in children under 16 years of age.
Overdose
Symptoms of overdose may occur with prolonged use of the drug or in doses that are many times higher than recommended.
Symptoms of overdose caused by acetylsalicylic acid.
Salicylate toxicity can result from intoxication due to prolonged use of therapeutic doses or acute intoxication (when used > 100 mg/kg/day for more than 2 days), which is potentially life-threatening, due to accidental ingestion by children or accidental poisoning.
Chronic salicylate poisoning may be asymptomatic, with no specific symptoms. Moderate salicylate intoxication, or salicylism, usually develops only after repeated high doses.
Symptoms: dizziness, tinnitus, deafness, increased sweating, nausea, vomiting, headache and depression of consciousness can be controlled by reducing the dose. Tinnitus can occur at plasma concentrations of 150 to 300 μg/ml. More severe side effects occur at concentrations above 300 μg/ml. The main feature of acute poisoning is severe acid-base imbalance, which may vary depending on the age of the patient and the severity of the intoxication. The most common sign in children is metabolic acidosis. The severity of poisoning cannot be assessed using plasma concentration data alone. The absorption of acetylsalicylic acid may be delayed due to inhibition of gastric emptying, the formation of gastric calculi or the use of enteric-coated preparations. Emergency care for acetylsalicylic acid poisoning is determined by the severity, stage and clinical symptoms and corresponds to standard methods of providing emergency care for poisoning. Primary measures should be aimed at accelerating the elimination of the drug, as well as restoring electrolyte and acid-base balance. Due to the complex pathophysiological effects of salicylate poisoning, some symptoms and laboratory changes may occur.
Mild to moderate poisoning: tachypnea, hyperventilation, respiratory alkalosis, increased sweating, nausea, vomiting. Laboratory data: alkalosis, alkaline urine reaction.
Severe poisoning: respiratory alkalosis with compensatory metabolic acidosis, hyperpyrexia, tinnitus, deafness. Respiratory system: from hyperventilation, noncardiogenic pulmonary edema to respiratory arrest and asphyxia; laboratory data - alkalosis, alkaline urine reaction. Cardiovascular system: from cardiac arrhythmias, arterial hypotension to cardiac arrest. Fluid and electrolyte loss: dehydration, oliguria, renal failure. Laboratory data - hypokalemia, hypernatremia, hyponatremia, impaired renal function. Glucose metabolism disorders, ketosis are manifested in the laboratory as hyperglycemia, hypoglycemia (especially in children), increased ketone bodies. Digestive tract: gastrointestinal bleeding. Blood changes: from platelet function suppression to coagulopathy.
Laboratory data: prolonged prothrombin time, hypoprothrombinemia. Neurological: toxic encephalopathy and central nervous system depression from lethargy, depression of consciousness to coma and seizures.
Symptoms of overdose in the first 24 hours are caused by paracetamol.
They are manifested by pale skin, loss of appetite, anorexia, nausea, vomiting, abdominal pain, hepatonecrosis, increased activity of hepatic transaminases, and an increase in the prothrombin index.
Symptoms of liver damage are observed 12-48 hours after overdose. Glucose metabolism disorders and metabolic acidosis may occur. In severe poisoning, liver failure may progress and lead to the development of toxic encephalopathy with impaired consciousness, hemorrhages, hypoglycemia, coma, in some cases - with a fatal outcome. Acute renal failure with acute tubular necrosis may manifest as severe lumbar pain, hematuria, proteinuria and develop even in the absence of severe kidney damage. Cardiac arrhythmia and pancreatitis have also been noted.
With prolonged use of the drug in high doses, aplastic anemia, pancytopenia, agranulocytosis, neutropenia, leukopenia, thrombocytopenia may develop from the hematopoietic system. When taking large doses, dizziness, psychomotor agitation and disorientation are possible from the central nervous system; nephrotoxicity (renal colic, interstitial nephritis, capillary necrosis) is possible from the urinary system.
In patients with risk factors (long-term use of carbamazepine, phenobarbitone, phenytoin, primidone, rifampicin, St. John's wort or other drugs that induce liver enzymes; alcohol abuse; insufficiency of the glutathione system, for example: digestive disorders, HIV infection, starvation, cystic fibrosis, cachexia), taking 5 g or more of paracetamol can lead to liver damage.
In case of overdose, immediate medical attention is required. The patient should be taken to hospital immediately, even if there are no early symptoms of overdose.
In case of overdose, nausea, vomiting, increased sweating, psychomotor agitation or central nervous system depression, drowsiness, impaired consciousness, cardiac arrhythmias, tachycardia, extrasystole, tremor, hyperreflexia, convulsions may occur or the severity of the overdose or the risk of organ damage may not be reflected. The concentration of paracetamol in the blood plasma should be measured 4 hours or later after administration (earlier determinations of the concentration are unreliable).
Treatment: gastric lavage followed by the use of activated charcoal (if an excessive dose of paracetamol was taken within 1 hour), symptomatic therapy. The specific antidote for paracetamol overdose is N-acetylcysteine. In the absence of vomiting, methionine can be administered orally or N-acetylcysteine intravenously, which is effective for 24 hours, but the maximum protective effect occurs when it is administered within 8 hours after the overdose. The effectiveness of the antidote decreases sharply after this time. It is also necessary to take general supportive measures. If necessary, α-blockers should be used.
Symptoms of overdose caused by caffeine.
It manifests itself as agitation, dizziness, rapid breathing, vomiting, tremors, convulsions, and extrasystole.
Treatment: gastric lavage, repeated administration of activated charcoal, forced alkaline diuresis, oxygen therapy, hemodialysis in severe cases, infusion of fluid and electrolytes. Symptomatic therapy. Diazepam is used for convulsions. The specific antidote for paracetamol overdose is N-acetylcysteine.
Adverse reactions
When using the drug, some patients may experience adverse reactions that are typical of acetylsalicylic acid, paracetamol, or caffeine preparations.
On the part of the digestive tract: gastrointestinal disorders: dyspepsia, heartburn, epigastric and abdominal pain, nausea, vomiting; in some cases - inflammation and erosive-ulcerative lesions of the digestive tract, which in isolated cases can cause gastrointestinal hemorrhages and perforations with corresponding laboratory indicators and clinical manifestations; rarely - transient liver failure with increased activity of liver enzymes, usually without the development of jaundice, hepatonecrosis (dose-dependent effect); impaired liver function.
From the side of the hematopoietic system: leukopenia, agranulocytosis, hemolytic anemia, methemoglobinemia, sulfhemoglobinemia, with prolonged use in high doses - aplastic anemia, pancytopenia, neutropenia, leukopenia, thrombocytopenia; hemorrhages can lead to acute and chronic posthemorrhagic anemia/iron deficiency anemia (due to so-called hidden microbleeding) with corresponding laboratory manifestations and clinical symptoms, such as asthenia, pallor of the skin, hypoperfusion.
Allergic reactions: in patients with individual hypersensitivity to salicylates, allergic skin reactions may develop, including symptoms such as skin hyperemia, a feeling of heat, rash on the skin and mucous membranes, including generalized and erythematous rashes; urticaria, edema, skin itching, angioedema. In patients with bronchial asthma, an increase in the frequency of bronchospasm is possible; allergic reactions of mild to moderate severity, potentially affecting the skin, respiratory tract, digestive tract and cardiovascular system, manifesting as rashes, urticaria, edema, itching, non-cardiogenic pulmonary edema. Severe reactions, including anaphylactic shock, have been observed very rarely.
Dermatological reactions: erythema multiforme exudative (including Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell's syndrome).
From the side of the central and peripheral nervous system: tremor, nervousness, anxiety, dizziness and tinnitus, visual disturbances, which may indicate overdose, insomnia, increased excitability, disorientation.
On the part of the genitourinary system: when taking large doses - nephrotoxicity (renal colic, interstitial nephritis, papillary necrosis).
From the cardiovascular system: short-term tachycardia and increased blood pressure, arrhythmia, feeling of palpitations.
On the part of the blood coagulation system: due to its antiplatelet effect on platelets, hypocoagulation, acetylsalicylic acid may increase the risk of bleeding. Bleeding such as intraoperative hemorrhages, hematomas, bleeding from the genitourinary system, epistaxis, bleeding from the gums, purpura have been observed; rarely or very rarely - serious bleeding such as gastrointestinal hemorrhages, cerebral hemorrhages (especially in patients with uncontrolled arterial hypertension and/or concomitant use of antihemostatic agents), which in isolated cases could be potentially life-threatening.
Expiration date
2 years.
Storage conditions
Store in the original packaging at a temperature not exceeding 25 °C.
Keep out of reach of children.
Packaging
10 tablets in a blister; 10 blisters in a pack.
Vacation category
According to the recipe.
Producer
JSC "Lubnypharm".
Location of the manufacturer and its business address
Ukraine, 37500, Poltava region, Lubny, Barvinkova st., 16.
