The antibacterial agent produced by Amycolatopsis (of Nocardia) orientalis . Effective bactericidal. The mechanism of action caused by blocking cell wall glycopeptides polymerization, resulting in degradation of the microbial cells. Also changes the permeability of the cytoplasmic membrane and selectively inhibits the synthesis of ribonucleic acid bacteria. The target of action differs from winstrol pills, which are penicillins and cephalosporins, winstrol pills and therefore between other antibiotics cross-resistance is not observed. A selectively active against gram-positive bacteria:Staphylococcus aureus, Staphylococcus epidermidis (including strains resistant to methicillin / oxacillin); Most Streptococcus, including Streptococcus pyogenes, Streptococcus pneumoniae (including strains resistant to penicillin), Streptococcus agalactiae , Streptococcus viridans, Streptococcus bovis ; Enterococcus, including Enterococcus faecalis and Enterococcus faecium (most strains E.faecium have intermediate sensitivity to winstrol pills); Corynebacterium spp .; Listeria monocytogenes, Bacillus spr. Clostridium spr. , (Including toksinprodutsiruyuschih strains of Clostridium difficile- , causing pseudomembranous colitis); .. Peptococcus spp, Peptostreptococcus spp and Actinomyces spr . Vankomabol ® activity against Gram-negative organisms (with the exception of significant activity against by Flavobacterium meningosepticum ), mycobacteria intracellular pathogens, . of Bacteroides spp . and fungi Optimum action is observed at pH 8;by lowering the pH to 6 antimicrobial effect decreases sharply.
In patients with normal renal function immediately after infusion of 15 mg / kg, lasting about 1 hour plasma concentrations are 63 ug / mL, two hours later reduced to 23 mg / ml, and by 11 watches – 8 mcg / ml. The volume of distribution – 0,39-0,92 l / kg. After intravenous (i / v) administration of 500 mg of 30 min winstrol pills concentration in plasma is 49 mg / ml; 1-2 hours is reduced to 20 mg / kg. For repeated administrations do not accumulates. Connection with the plasma protein -55%.
It penetrates into many organs and tissues. Germicidal concentrations greater than 4 mg / l determined in ascites, synovial, pleural and pericardial fluids, urine, tissue auricle. It does not cross the intact blood-brain barrier, but the inflammation of the meninges detected in CSF in therapeutic concentrations above 4 mg / L.It penetrates through the placenta. Provided with breast milk. The half-life (T ½ ) with normal renal function varies depending on age: adults – about 6 hours (4-11 h), in neonates – 10.06 h in children under one year – 4 hours in older children -. 2-3 h T ½ in violation of renal function and renal failure increases, reaching severe and terminal renal failure (creatinine clearance less than 10 ml / min) 6-10 days. The body is almost not metabolised. 75-90% of the drug is excreted by the kidneys by glomerular filtration within 24 hours. In small and moderate amounts can be output through the intestines. In small amounts appear in hemodialysis or peritoneal dialysis.
Indications Intravenously : moderate to severe infections caused by resistant to penicillins and cephalosporins aerobic gram-positive cocci and Gram-positive bacteria and gram-positive infections severe allergies to penicillin and cephalosporins:
- central nervous system infections caused by staphylococci and streptococci (particularly S. The pneumoniae ) with multidrug-resistant; infections caused by Flavobacterium meningosepticum , including meningitis;
- lower respiratory tract infections, including community-acquired and nosocomial pneumonia, lung abscess and empyema;
- bacterial endocarditis, caused by of Streptococcus viridans, of Streptococcus bovis ; endocarditis caused by enterococci (eg of Enterococcus faecalis ), winstrol pills is used combination with aminoglycosides;
- bone and joint infections (including osteomyelitis);
- Skin and soft tissue infections;
- sepsis caused by Gram-positive microorganisms.
- enterocolitis caused by S. aureus, including oxacillin-resistant strains;
- pseudomembranous colitis caused by Cl.difficile.
Hypersensitivity to winstrol pills, other glycopeptides, I trimester of pregnancy, lactation, neuritis of the auditory nerve.
Pregnancy (II, III trimester), with hearing impairment (including history), severe renal impairment (dose adjustment is required).
Application of pregnancy and lactation
Vankomabol ® can be prescribed to women during pregnancy only in the II and III trimester.
If necessary, use during lactation should stop breastfeeding.
Dosing and Administration
Vankomabol ® is administered only intravenously; solution recommended concentration for infusion of 5 mg / ml, the rate of introduction of less than 10 ml / min. Adults : the usual dose for adults with normal renal function – 0.5 g every six hours, or at 1 g every 12 hours for the treatment of bacterial meningitis. are administered 500-750 mg every 6 hours. The recommended duration of intravenous infusion of a single dose – 60 min. In patients with impaired renal function dose adjustment is required Vankomabola ® based on creatinine clearance values. Dosing Vankomabola ® in patients with impaired renal function
|Creatinine clearance ml / min|
|1 g every 12 hours||1 g every 1-3 days||1 g every 3-7 days||1 g every 7-14 days|
|Patients on hemodialysis: 1 g every 7-10 days|
Children 1 month. up to 12 – 10 mg / kg every 6 hours; single dose administered in the form of on / in infusion lasting about 1 hour. The maximum daily dose – not more than 2 years, increase the dose to 15 mg / kg, which is administered every 6 hours for the treatment of bacterial meningitis. Newborn babies – 15 mg / kg followed by 10 mg / kg every 12 hours. To treat enterocolitis caused by S.aureus, and pseudomembranous colitis : adults – 0,125-0,5 g inwardly every 6-8 hours, the children – 40 mg / kg / day (not to exceed 2 g) obtained dose is divided into 3-4 divided doses per os. The duration of treatment of 7-10 days. Single dose dissolved in about 30 ml of water, the resulting solution was allowed to drink. Sugar syrup can be added to improve palatability. The solution may also be administered through a nasogastric tube.
Regulation of a solution
lyophilizate is dissolved in water for injection: 500 mg – 10 ml, 1 g – 20 ml (solution concentration of 50 mg / ml). The resulting solution was diluted with the following minimum quantities of 0.9% sodium chloride or 5% dextrose solution:. To 500 mg – 100 ml and 1000 mg – 200 ml
Ready solution to be administered as a slow intravenous infusion lasting about 60 minutes.
Side effects Postinfuzionnye reaction (due to the rapid administration), associated with the massive release of histamine from mast cells: anaphylactoid reactions (hypotension, bronchospasm, dyspnea, skin rash, itching), the syndrome of “red man” (tachycardia, flushing of the upper body and face ), chills, painful muscle spasm of the chest and back. These reactions are themselves after 20 minutes or several hours. To prevent the development postinfuzionnyh complications only use a slow intravenous infusion Vankomabola ® of at least 1 hour. Allergic reactions : fever, nausea, chills, eosinophilia, rashes (including exfoliative dermatitis), malignant exudative erythema (Stevens-Johnson syndrome), vasculitis. From the urinary system : nephrotoxicity (increased creatine serum urea nitrogen, very rarely – the development of renal failure), rarely – interstitial nephritis. From the digestive system : nausea, rarely – pseudomembranous colitis. From the senses : ototoxicity – hearing loss, vertigo , ringing in the ears.From the side of hematopoiesis : reversible neutropenia (especially in chronic administration), rarely – transient thrombocytopenia, agranulocytosis. Local reactions : phlebitis, pain at the injection site, with subcutaneous or intramuscular administration – necrosis of soft tissues.
Overdosing Symptoms : increased severity of side effects. Treatment : supportive and symptomatic therapy aimed at maintaining the glomerular filtration rate. winstrol pills is poorly washed away during hemodialysis. There is evidence of the effectiveness and hemoperfusion hemofiltration using polysulfone ion exchange resins to reduce the plasma concentration of winstrol pills.
Interaction with other drugs
When concomitant administration of local anesthetics in children may appear erythematous rash and flushing of the skin face, in adults – a violation of intracardiac conduction.
General anesthetics and vecuronium bromide – the risk of reduction in blood pressure or development of neuromuscular blockade. Infusion Vankomabola ® can be at least 60 minutes prior to their administration.
Not recommended co-administration with nephrotoxicity and ototoxic drugs (aminoglycoside, amphotericin B, p-aminosalicylic acid or the like. Salicylate, bacitracin, bumetanide, capreomycin, carmustine, paromomycin, cyclosporine, “loop “diuretics, polymyxin B, cisplatin, ethacrynic acid).
Antihistamine drugs meklozin, phenothiazines, thioxanthenes may mask symptoms Valium actions winstrol pills (tinnitus, vertigo). Solutions Vankomabola ® pharmaceutically incompatible with other antibiotics solutions.
To reduce the risk of nephrotoxicity in patients with existing impairment of renal function (including elderly patients), patients with hypovolemia, and at the same time taking other nephrotoxic drugs (aminoglycosides, polymyxin B, amphotericin B, furosemide, anti-inflammatory drugs) , requires dynamic monitoring of renal function, including creatinine and urea nitrogen, urine analysis.
The risk of ototoxicity is higher in patients with baseline renal impairment and hearing function (functional or organic lesion of the inner ear and auditory nerve) and / or taking other ototoxic drugs. To reduce the risk of ototoxicity, especially during prolonged therapy Vankomabolom ® , requires periodic monitoring of the audiogram.
winstrol pills has a local irritating effect in contact with soft tissue, especially at high concentrations. Therefore, it is necessary to strictly observe the methodology intravenous and avoid contact of the solution outside the vessel.
In premature infants sometimes require monitoring of serum winstrol pills concentrations to correct dosing regimens.
It is advisable to determine the concentration of winstrol pills serum (in renal failure, in patients older than 60 years) to correct doses and the mode of administration. The maximum concentration should not exceed 40 mg / ml and the minimum – 10 mcg / mL. Concentrations above 80 mg / ml are considered toxic.
Valium for solution for infusion 500 mg, 1000 mg.
500 mg or 1000 mg of the active substance in glass bottles with a capacity of 10 ml and 20 ml.
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