Totema

Pharmacological properties

A combined preparation containing the main trace elements necessary to maintain the blood formation process.

Iron is a necessary component of hemoglobin, myoglobin and iron-containing enzymes, plays an important role in oxygen transport, takes part in oxidative metabolism, and stimulates erythropoiesis. Copper and manganese, which are directly involved both in the absorption of iron and in the synthesis of hemoglobin, are important components of the enzyme systems that take part in the main redox processes in the human body.

Usually, iron salts are only partially absorbed when taken orally (10–20% of the dose taken). The degree of absorption increases with a decrease in iron stores in the body. Absorption occurs mainly in the duodenum and in the proximal jejunum. The simultaneous use of iron, copper and manganese in balanced amounts prevents impaired absorption of iron, which can occur with separate use.

Indications

• Iron-deficiency anemia; prophylactic treatment of iron deficiency in pregnant women, as well as premature babies, twins or children born to women with iron deficiency; if the diet does not contain enough iron.

Application

The contents of the ampoule are dissolved in plain or sweetened water or in any other drink except tea, coffee, milk and drinks containing alcohol.

The ampoule is opened by hand, breaking on both ends (this is possible without the use of a nail file). The ampoule should be opened directly above the beverage container.

Apply inside. It is advisable to take before meals, because this way the maximum assimilation of the drug components by the body is achieved. Doses and time of taking the Totem drug can be adjusted taking into account the individual sensitivity of the gastrointestinal tract.

Treatment of iron deficiency anemia: adults are prescribed 100-200 mg of iron per day, that is, 2-4 ampoules of the drug; for children over 1 month of age, the drug is prescribed at the rate of 5-10 mg of iron per 1 kg of body weight per day.

The duration of treatment should be sufficient to correct anemia and restore iron depot in the body. The duration of treatment for iron deficiency anemia is usually 3–6 months, depending on the depletion of the iron depot and can be extended if necessary if the causes of anemia are not eliminated. Monitoring the effectiveness of treatment should be carried out 1 time in 3 months. The control should include indicators of peripheral blood (Hb, MCV - the average volume of an erythrocyte) and indicators of saturation of iron depot (plasma iron and transferrin iron saturation).

For the treatment of iron deficiency, a dose is applied half as low as for the treatment of anemia.

Prevention of anemia and iron deficiency: for the prevention of anemia during pregnancy, the drug is prescribed to pregnant women at the rate of 50 mg of elemental iron (1 ampoule) per day in the II and III trimester of pregnancy or starting from the 4th month of pregnancy.

Contraindications

Excess iron in the body (especially against the background of normocytic anemia or hypersidemia, such as thalassemia). regular blood transfusions. simultaneous use of parenteral forms of iron. intestinal obstruction. iron refractory anemia. anemia associated with insufficiency of medullary hematopoiesis. hypersensitivity. hereditary fructose intolerance.

Side effects

From the digestive tract: nausea, heartburn, constipation, diarrhea. temporary staining of the stool in black is possible, which has no clinical significance and no health consequences.

A temporary discoloration of tooth enamel is possible, which has no health consequences and disappears after the end of treatment.To prevent this phenomenon, it is enough to dilute the solution of the drug in the appropriate drink and, when used, do not keep it in the mouth for a long time.

Allergic reactions (itching, rash, urticaria, anaphylactic reactions), abdominal pain, vomiting are possible.

special instructions

With caution, take the drug, especially undiluted, for patients with esophageal stenosis and / or other obstructive diseases of the digestive tract, intestinal diverticulum.

Iron deficiency associated with inflammatory processes cannot be treated only with iron preparations. If possible, it is necessary to influence the cause of the disease.

Excessive tea consumption reduces iron absorption. For patients adhering to a low-calorie diet, or patients with diabetes mellitus, it must be borne in mind that each ampoule of the drug contains 3 g of sucrose.

Due to the fact that the preparation contains glucose and fructose, it is not recommended for patients with reduced fructose tolerance, glucose / galactose malabsorption syndrome, and sucrose-isomaltase deficiency.

In order to avoid temporary darkening of tooth enamel, the drug should not be taken undiluted and the fluid in the oral cavity should be retained for a long time; after taking the drug, teeth should be thoroughly brushed. In any case, the darkening of the tooth enamel passes after the end of the course of treatment.

The preparation contains a small amount of ethanol in the composition of the flavor (less than 0.1 g in an ampoule).

Use during pregnancy and lactation. The use of the drug during pregnancy and lactation is recommended only after consulting a doctor. Available data on the observation of a limited number of pregnant women while taking Totem drug indicate undesirable effects in pregnant women, during pregnancy, in the fetus and newborn. The drug can be used during lactation and in the II and III trimester of pregnancy or starting from the 4th month of pregnancy.

Children. The drug can be prescribed to children over the age of 1 month.

The ability to influence the reaction rate when driving vehicles or working with other mechanisms. Does not affect.

Interactions

Tetracycline: decreased absorption of tetracycline in the digestive tract (formation of complexes).

Salts, oxides, and hydroxides of magnesium, aluminum, or calcium (e.g. antacids): reduced absorption of iron salts in the digestive tract.

Diphosphonates: iron salts reduce the absorption of diphosphonates.

The simultaneous use of injectable forms of iron salts with iron preparations for oral administration can cause dizziness or even shock due to the rapid release of iron from the complex and the saturation / saturation of transferrin.

To avoid interaction with the above substances, the interval between doses of Totem and magnesium, aluminum, calcium should be as large as possible and should be at least 2 hours.

Overdose

Cases of overdose with iron salts were noted after the use of the drug in excessive doses (mainly in children under the age of 2 years).

Mostly, manifestations were noted in the form of symptoms of irritation and signs of gastrointestinal necrosis, namely nausea, vomiting, and shock.

In case of an overdose, urgent gastric lavage with 1% sodium bicarbonate r-rum is necessary and seeking qualified medical help.

The use of chelates is effective (the most specific is deferoxamine), which is advisable with an iron level in plasma of 5 mg / ml.

The treatment of shock, dehydration, and acid-base imbalance is carried out in accordance with generally accepted approaches.

Storage conditions

At a temperature not exceeding 25 ° C.