Bendazole, Metamizole Sodium, Papaverine

Pharmacological properties

analgin-dibazole-papaverine is a combined preparation with analgesic, antispasmodic and vasodilating effects, due to the specific action of its components. the drug also has antihypertensive and antipyretic effects.

Metamizole sodium monohydrate - NSAIDs of the pyrazolone derivative group - has anti-inflammatory, analgesic and antipyretic effects. The mechanism of action is due to inhibition of COX and blocking the synthesis of prostaglandins from arachidonic acid, as well as a violation of pain extra- and proprioreceptive impulses, an increase in the threshold of excitability of thalamic centers of pain sensitivity, and an increase in heat transfer.

Bendazole hydrochloride has an antispasmodic, vasodilating, hypotensive effect, and also has a stimulating effect on the functions of the spinal cord and helps to restore the functions of peripheral nerves, has a moderate immunostimulating effect.

Papaverine hydrochloride has myotropic, antispasmodic, hypotensive effects. It blocks PDE, causes the accumulation of cyclic adenosine monophosphate (cAMP) and a decrease in the calcium content in the cell, relaxes the smooth muscles of blood vessels and internal organs.

Pharmacokinetics When taken orally, it is rapidly and completely absorbed. It is hydrolyzed in the intestinal walls to form an active metabolite. The action develops after 20–40 minutes and reaches a maximum after 2 hours. It is metabolized in the liver. It is allocated by kidneys.

Indications

Pain syndrome associated with spasm of blood vessels or smooth muscles of internal organs.

Application

Take orally after a meal with a little water. adults 1-2 tablets 1-2 times a day. The maximum daily dose is 4 tablets.

The course of treatment depends on the nature and course of the disease, the effect achieved, the nature of the complex pharmacotherapy used, which is used, but the duration of treatment should not exceed 3 days.

Children. Not applicable (see CONTRAINDICATIONS).

Contraindications

Known or suspected hypersensitivity to any of the substances that make up the drug, pyrazolone derivatives (butadione, tribuzon, antipyrine); suspected acute surgical pathology; diseases, the course of which occurs with a decrease in muscle tone, convulsive syndrome; glaucoma, traumatic brain injury, severe heart failure, av blockade, arterial hypotension, diabetes mellitus, hypothyroidism, adrenal insufficiency, prostate hypertrophy, congenital glucose-6-phosphate dehydrogenase deficiency, anemia of any etiology, cytostatic or infectious neutropenia, leukopenia, , thrombocytopenia, hepatoporphyria, severe hepatic and renal impairment, chronic nephritis with edema and impaired nitrogen-excreting renal function, ba, respiratory depression, bro nsoobstructive syndrome, gastric and duodenal ulcers, accompanied by bleeding; hypotonic colitis, habitual constipation; simultaneous use of MAO inhibitors. During pregnancy and breastfeeding. childhood. age over 75 years (risk of hyperthermia).

Side effects

On the part of the immune system: manifestations of hypersensitivity reactions, including rashes on the skin and mucous membranes, itching, facial flushing, flushing of the skin, urticaria, conjunctivitis, burning in the throat, dry cough, runny nose, shortness of breath, angioedema, bronchospastic syndrome, anaphylactic shock, Stevens-Johnson syndrome, Lyell syndrome.

From the nervous system: drowsiness, excessive sweating, dizziness, headache, anorexia.

From the cardiovascular system: AV block, arrhythmia, ventricular extrasystole, decreased cardiac output, decreased blood pressure, pain in the heart, hot flashes, palpitations, sensation of heat, hyperthermia, weakness, numbness, tremor, loss of consciousness; with prolonged use - deterioration in ECG, ventricular fibrillation, asystole, ventricular flutter, orthostatic hypotension, collapse, apnea.

On the part of the blood system and lymphatic system: with prolonged use, leukopenia, granulocytopenia, agranulocytosis, anemia, thrombocytopenia, eosinophilia are possible.

From the digestive system: dry mouth, nausea, discomfort in the stomach, constipation, increased activity of hepatic transaminases, jaundice, hepatitis.

From the hepatobiliary system: hepatitis.

From the urinary system: usually in patients with impaired renal function and / or when using the drug in excessive doses - transient oliguria, anuria, proteinuria, interstitial nephritis, urine staining in red.

In case of any adverse reactions, it is necessary to stop the use of the drug and be sure to consult a doctor.

special instructions

Before starting treatment with the drug, consult your doctor.

Do not exceed recommended doses of the drug. Since metamizole sodium has anti-inflammatory and analgesic properties, it can mask the signs of infection, the symptoms of noncommunicable diseases and complications with pain, and may complicate their diagnosis. Do not use to eliminate acute abdominal pain until the cause is clarified.

When using the drug should abandon the use of alcohol and drugs that depress the central nervous system.

The drug should be used with caution in patients:

• with existing allergic diseases (including hay fever) or with such diseases in the history due to an increased risk of allergic reactions;
• with inflammatory bowel diseases, including ulcerative colitis and Crohns disease;
• with cardiovascular failure;
• with a tendency to arterial hypotension;
• with supraventricular tachycardia;
• with a history of kidney disease (pyelonephritis, glomerulonephritis);
• with impaired liver and / or kidney function.

Use with caution in patients with a long alcohol history, weakened individuals; elderly people due to the risk of hyperthermia and an increase in the frequency of adverse reactions, especially from the digestive tract; with the simultaneous use of cytostatic drugs (only under the supervision of a physician). The drug should be used with caution in reducing intestinal motility.

You should immediately discontinue the drug and consult a doctor immediately if there is unmotivated chills, fever, sore throat, difficulty swallowing, bleeding gums, blanching of the skin, with rashes on the skin and mucous membranes, asthenia, with the development of vaginitis or proctitis. With the onset of symptoms of impaired liver function, including gastrointestinal upsets, jaundice and an increase in the level of liver enzymes, it is necessary to stop using the drug. You should inform your doctor about the occurrence of such symptoms: hot flashes, sweating, headache, fatigue, jaundice, nausea, discomfort in the stomach, constipation.

When using the drug, it is possible to stain urine in red due to the excretion of the metabolite of metamizole sodium, which does not have clinical significance. When taking the drug, the development of orthostatic hypotension is possible.

When using the drug, it is necessary to control the composition of peripheral blood (leukocyte formula).

Do not use the drug longer than the prescribed period without consulting a doctor.Regular long-term use of the drug is not recommended because of the myelotoxicity of metamizole sodium. With prolonged use of the drug (more than 7 days), it is necessary to control the composition of peripheral blood (due to the myelotoxicity of metamizole), kidney and liver function.

When applying to children, it is necessary to conduct constant medical monitoring.

Smoking reduces the effectiveness of the drug.

If the signs of the disease do not begin to disappear or, conversely, the health condition worsens or undesirable effects appear, it is necessary to suspend the use of the drug and consult a doctor regarding further use.

Use during pregnancy or lactation. It is not recommended to use during pregnancy and lactation.

The ability to influence the reaction rate when driving vehicles or other mechanisms. During treatment, you should avoid driving and working with complex mechanisms.

Interactions

X-ray contrast agents, colloidal blood substitutes, penicillin: should not be used during treatment with metamizole sodium.

NSAIDs: their analgesic and antipyretic effects are potentiated and the likelihood of additive unwanted side effects increases.

Oral hypoglycemic drugs, indirect anticoagulants, corticosteroids, phenytoin, indomethacin: metamizole sodium increases the activity of these drugs by displacing them from the connection with the protein.

Methotrexate: Metamizole sodium in high doses can lead to an increase in the concentration of methotrexate in blood plasma and an increase in its toxic effects (primarily on the digestive tract and blood formation system).

Diuretics (furosemide): a decrease in the diuretic effect is possible.

Sulfanilamide hypoglycemic drugs: increased hypoglycemic effect.

Ethanol: metamizole sodium enhances its sedative effect.

Levodopa, methyldopa: a decrease in the hypotensive effect of methyldopa and the antiparkinsonian effect of levodopa.

Cyclosporin: with simultaneous use, the concentration of cyclosporin in the blood decreases.

Nitrofurantoin: data on the development of hepatitis when used together with the drug are known.

Sarkolizin, thiamazole (methimazole), drugs that suppress bone marrow activity, including gold preparations: the likelihood of hematotoxicity, including the development of leukopenia, is increased.

Phenylbutazone, glutethimide, barbiturates and other inducers of microsomal liver enzymes reduce the effectiveness of metamizole sodium.

Sedatives, tranquilizers (diazepam, trimethosine, etc.), codeine, anaprilin, H blockers₂-histamine receptors and propranolol enhance the analgesic effect of metamizole sodium.

Tricyclic antidepressants (amitriptyline, doxepin, etc.), hormonal contraceptives and allopurinol: the simultaneous use of metamizole sodium with these drugs can lead to increased toxicity.

Antihypertensive drugs (agents that affect the renin-angiotensin system), antidepressants, antispasmodics, sedatives, diuretics, saluretics, procainamide, reserpine, quinidine, phentolamine: increased hypotensive effect.

Chlorpromazine or other phenothiazine derivatives: severe hypothermia may develop.

Phentolamine: potentiates the effect of papaverine on the cavernous bodies of the penis.

Cardiac glycosides: marked increase in contractile function of the myocardium due to a decrease in OPSS.

Morphine: a decrease in the antispasmodic activity of papaverine is possible.

Adsorbents, astringents and enveloping agents: reduced absorption of the drug in the digestive tract.

The effectiveness of the drug decreases with smoking.

Caution is necessary while using the drug with salicylates.

Overdose

Symptoms: hypothermia, marked decrease in hell, arrhythmia, tachycardia, partial or complete av blockade, acute agranulocytosis, neutropenia, hemorrhagic syndrome, respiratory muscle paralysis, hyperventilation, decreased tissue perfusion, headache, anxiety, lethargy, drowsiness, dizziness, light-headedness, impaired consciousness, impaired vision, ataxia, nystagmus, diplopia, tinnitus, CNS depression, convulsive syndrome, collapse, coma, cyanosis, metabolic acidosis, hyperglycemia, hyperkalemia, oliguria, anuria, dysphagia, nausea, vomiting, diarrhea , constipation, gastrointestinal tract disorders, gastralgia, gastritis, impaired liver function, acute liver failure and / or acute liver failure, skin rashes, shortness of breath, moderate asphyxia, redness of the skin, general weakness, palpitations, sensation of heat, excessive sweating.

Treatment: drug withdrawal, induction of vomiting, gastric lavage, maintaining blood pressure, the use of enterosorbents, saline laxatives, forced diuresis, symptomatic therapy aimed at maintaining vital functions. In severe cases, hemodialysis, hemoperfusion, peritoneal dialysis are possible.

At the first symptoms of an overdose, seek medical attention immediately.

Storage conditions

In the original packaging at a temperature not exceeding 25 ° c.