Flu
 
 
 
 
PARCETAMOL SINUS , comprimate Compozitie: Un comprimat contine paracetamol 500mg, maleat de cloraniramina 3mg, clorhidrat de pseudoefedrina 30mg si excipienti: povidona, amidon pregelatinizat, acid stearic, talc, stearat de magneziu.

Grupa farmacoterapeutica: Decongestionante nazale de uz sistematic, simpatomimetice, combinatii.

Indicatii terapeutice: Paracetamol Sinus este indicat pentru profilaxia si tratamentul rinitelor alergice si vasomotorii si pentru tratamentul simptomatic al racelii comune si gripei (pentru ameliorarea stranutului, rinoreei, congestiei nazale si sinusale, febrei, cefaleei si durerilor musculare).

Contraindicatii:

* Hipersensibilitate la paracetamol, fenacetina sau alte antiimflamatoare (risc crescut de reactii alergice); hipersensibilitate la cloraniramina sau alte antihistaminice; hipersensibilitate la pseudoefedrina sau alte amine simpatomimetice; hipersensibilitate la oricare dintre excipientii produsului.
* Deficit de glucozo-6-fosfat dehidrogenaza.
* Insuficienta renala severa (riscul de reactii adverse renale poate fi crescut in cazul administrarii prelungite de doze mari).
* Tulburari uretro-prostatice cu risc de retentie urinara.
* Glaucom cu unghi inchis sau predispozitie la glaucom cu unghi inchis; glaucom cu unghi deschis.
* Hipersensibilitate arteriala severa.
* Insuficienta hepatocelulalra.
* Insuficienta coronariana severa.
* Tratament concomitent cu inhibitori de monoamino-oxidaza (IMAO) non-selective (vezi Interactiuni).
* Copii sub 12 ani.

Precautii:

Se recomanda sa nu se depaseasca dozele recomandate.

Daca apar reactii de hipersensibilitate, tratamentul va fi intrerupt imediat.

Tratamentul va fi intrerupt daca apar palpitatii, tahicardie, greata.

Datorita continutului in paracetamol, asocierea cu antiimflamatoare nesteroidiene se va face la doze adaptate si se va evita administrarea pe termen lung.

Clorfeniramina se administreaza cu prudenta la copii si la varstnici.

Datorita prezentei clorfeniraminei, nu se recomanda administrarea de Paracetamol Sinus cu alcool etilic sau medicamente care contin alcool etilic (vezi Interactiuni).

Similar celorlalte simpatomimetice pseudoefedrina se administreaza cu prudenta la pacienti cu hipertiroidie, boli cardiovasculare (hipertensiune arteriala, cardiopatie ischemica etc.), diabet zaharat si psihoze.

Sportivii trebuie atentionati ca produsul contine pseudoefedrina care poate da rezultate pozitiva la testele practicate la controlul antidoping.

Nu se recomanda asocierea cu simpatomimetice.

Administrarea indelungata poate scadea sau inhiba secretia salivara, prin aceasta contribuind la dezvoltarea cariilor, bolilor periodontale, candidozei orale.

Interactiuni: agonistii morfinici, antiacidele, carbunele activat si anticolinergicele scad viteza de absorbtie a paracetamolului, dar nu si cantitatea totala absorbita, iar cisaprida ii creste rata de absorbtie. Toxicitatea paracetamolului este crescuta de administrarea concomitenta de alcool etilic, antiinflamatoare nesteroidiene, acid acetilsalicilic sau alti salicilati, barbiturice, carbamazepina, hidantoina, rifampicina, sulfinpirazona, saruri de aur. Paracetamolul creste riscul de aparitie a reactiilor adverse ale anticoagulantelor orale, antifungicelor - derivati de imidazol, carmustinei si inruditelor, doxorubicinei si inruditelor, izoniacidei si inruditelor, mercaptopurinei, ciclosporinei, cloramfenicolului, metothrexatului. Estrogenii si contraceptivele estro-progestative cresc metabolismul hepatic al paracetamolului. Paracetamolul poate reduce reactiile adverse ale interferonului.

Riscul de aparitie a reactiilor adverse ale clorfeniraminei este crescut de administrarea concomitenta cu deprimante ale sistemului nervos central SNC (antidepresive sedative, barbiturice, hipnotice, analgezice opioide, metadona, neuroleptice, anxiolitice, alcool etilic), atropina si alte anticolinergice (antipresive triciclice, antiparkinsoniene, anticolinergice centrale, antispastice neurotrope, disopiramida, neuroleptice fenotiazinice), fenitoina. Este contraindicata asocierea cu alcool etilic, sultoprida si inhibitori de monoaminooxidaza (IMAO).

De asemenea este contraindicata asocierea cu IMAO si datorita continutului de pseudoefedrina. Pseudoefedrina se asociaza cu prudenta cu guanetidina sau cu substante inrudite si cu anestezice volatile halogenate.

Interactiuni cu testele de laborator:

Paracetamolul poate modifica rezultatele unor teste de laborator: glicemiei, concetratiei serice de acid 5-hidroxiindolacenic, testul de bentiromida pentru evaluarea functiei hepatice, concentratia plasmatica de acid uric, bilirubina, lactat-dehidrogenaza, transaminaze, masurarea timpului de protrombina.

Clorfeniramina poate inhiba raspunsul la testele de hipersensibilitate cutanata, inducand astfel rezultate fals-negative, de aceea este recomandabil sa se opreasca administrarea clorfeniraminei cu cel putin 72 de ore inainte de efectuarea testelor cutanate care utilizeaza extracte alergenice.

Atentionari speciale:

Paracetamol

Se impun precautii in caz de alcoolism si afectiuni hepatice, incluzand hepatita virala (creste riscul hepato-toxicitatii) si in caz de insufucuenta renala grava (numai in cazul tratamentului de lunga durata cu doze mari, in tratamentul ocazional fiind acceptabil). Este necesara monitorizarea functiilor hepatice in cazul tratamentului de lunga durata si cu doze mari la pacientii cu leziuni hepatice preexistente.

Clorfeniramina

In caz de insuficienta renala grava se impune prudenta, datorita riscului de acumulare. Clorfeniramina se va administra cu precautie la pacientii cu afectiuni cardiovasculare (mai ales la hipertensivi), presiune intraoculara crescuta, astm bronsic, ulcer gastro-duodenal, obstructie pilorica si epilepsie.

Pseudoefedrina

Este necesara supravegherea atenta a pacientilor cu tulburari de mictiune, indeosebi varstnici cu adenom de prostata, datorita actiunii alfa-simpatomimeticelor asupra sfincterului vezical intern.

Varstnici

Se recomanda prudenta la varstici deoarece:

* au un risc crescut de aparitie a hipotensiunii ortostatice, vertijului sau sedarii;
* pot prezenta constipatie cronica (risc de ileus paralitic);
* exista o probabilitate crescuta de hipertrofie de prostata corelata cu varsta, ceea ce necesita ajustarea dozelor.

Sarcina si alaptarea: nu se recomanda administrarea de Paracetam Sinus in timpul sarcinii si alaptarii.

Capacitatea de conduce vehicule sau de a folosi utilaje: datorita reactiilor adverse pe care le are (de exemplu somnolenta, vertij, tulburari de acomodare etc.), produsul poate influenta capacitatea de a conduce vehicule sau de folosi utilaje.

Doze si mod de administrare:

Adulti: 1-2 comprimate Paracetamol Sinus de 3 ori pe zi (nu se vor administra mai mult de 6 comprimate / zi si mai mult de 2 comprimate / priza).

Copii intre 12-15 ani: 2-3 comprimate Paracetamol Sinus / zi (nu se recomanda mai mult de 3 comprimate / zi si mai mult de 1 comprimat / priza).

In caz de insuficienta renala cu clearance-ul creatininei < 10ml/min., intervalul intre 2 doze trebuie sa fie de cel putin 8 ore.

Comprimatele se vor administra cu o jumatate de ora inainte de mese; se recomanda ingestia comprimatelor cu o cantitate suficienta de lichid.

Reactii adverse:

Pot apare rar reactii alergice (crize de astm bronsic, dermatita alergica, edem angio-neuronic, febra, eruptii cutanate, urticariene si eritemoase, soc anafilactic), afectarea sistemului nervos central SNC (agitatie, ameteli, dureri de cap, confuzie, convulsii, cosmaruri, senzatii de frica, halucinatii, insomnie, iritabilitate, neliniste, nervozitate, parestezii, psihoza, slabiciune, sedare, somnolenta, tremor, vedere incetosata sau alte tulburari de vedere), tulburari cardiovasculare (aritmii, bradi- sau tahicardie, colaps, hipertensiune tranzitorie, hipotensiune ortostatica, lesin, palpitatii), tulburari respiratorii (cresterea vascozitatii secretiilor bronsice, deprimare respiratorie, congestie nazala, senzatie de uscaciune la nivelul gurii, nasului si gatului), tulburari gastro-intestinale (anorexie, constipatie, dureri abdominale, greata, varsaturi), tulburari uro-genitale (disurie, retentie de urina, colica renala, insuficienta renala acuta, piurie sterila, ginecomastie, inhibarea ejacularii, scaderea libidoului, impotenta), tulburari hematologice (anemie hemolitica, agranulocitoza, leucopenie, neutropenie, pancitopenie, trombocitopenie), transpiratii, blefarospasm, icter si hipoglicemie.

Supradozaj:

Simptome

Administrarea in exces provoaca poftei de mancare, greata, varsaturi, dureri abdominale, diaree, hematomegalie, icter, scurtarea respiratiei, tahipnee, dispnee, cefalee, ameteli, somnolenta sau stimularea SNC cu halucinatii, convulsii, nervozitate, neliniste, tremor, slabiciune, stare de rau general, putand evolua pana la encefalopatie hepatica (cu tulburari ale functiilor crebrale, confuzie, agitatie, stupoare), coma, edem cerebral, tulburari de coagulare, sangerari gastro-intestinale, coagulare intravasculara diseminata, hipoglicemie, acidoza metabolica, aritmii cardiace, colaps cardio-vascular, necroza tubulara renala si insuficienta renala acuta.

Tratament

Tratamentul trebuie instituit rapid, chiar daca manifestarile sunt minore la inceput si se va face in spital. Consta in evacuarea continutului gastric prin provocarea de varsaturi sau lavaj gastric; administrarea de N-acetilcisteina intravenos 150mg/kgc (in 200ml solutie izotona) in decurs de 15 minute, apoi 15mg/kgc (in 500ml) in 4 ore si ulterior 100mg/kgc (in 1000ml) in urmatoarele 16 ore (deci un total de 300mg/kgc in 20 de ore) sau metionina 2,5g la intervale de 4 ore, pana la o doza totala de 10g; monitorizarea functiei renale si cardiace; efectuarea testelor hepatice; mentinerea echilibrului hidro-electrolitic, oxigeno-terapie, corectarea hipoglicemiei si administrarea de vitamina K, de plasma proaspata congelata sau a unui concentrat de factori de coagulare (in functie de timpul de protrombina); administrarea de diazepam, intravenos pentru tratarea convulsiilor; combaterea hipokaliemiei prin perfuzarea lenta a unei solutii diluate de clorura de potasiu, cu masurarea concentratiilor serice de potasiu; psihiatric in caz de ingestie voluntara.

Pastrare:

A nu se utiliza dupa data de expirare inscrisa pe ambalaj.

A se pastra la temperaturi intre 15-25Β°C, in ambalajul original.

A nu se lasa la indemana copiilor.

Ambalaj:

Cutie cu 2 blistere a cate 10 comprimate.

* Atentie! Continutul acestei rubrici are caracter informativ si nu poate inlocui sfaturile sau indicatiile personalului medical calificat. Informatiile prezentate in aceste pagini nu trebuie folosite pentru tratarea problemelor de sanatate sau pentru a inlocui tratamentele prescrise de personalul medical calificat.


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