Torendo ku-tab instructions for use, contraindications, side effects, reviews. Cough tablets - official instructions for use, types of mucaltic drugs, how to choose the right drug What does a torrent kutab tablet look like

Kachel is an unpleasant symptom of various diseases. It is generally accepted that this symptom is something bad that must be eliminated immediately. However, it is not always worth getting rid of a cough. In many cases, it helps the patient more than he does harm.

Pharmacological production supplies a variety of drugs for the treatment of coughs to pharmacy chains. Doctors recommend the newest drugs to their patients, forgetting about old proven drugs. In recent years, it is rare to see the drug Cough tablets in the appointment. However, the drug is found to be effective, safe and inexpensive.

The instruction for the drug "Cough pills" positions it as a safe expectorant drug, based on the herbal composition. The active active ingredient of the medication is thermopsis herb powder. Each tablet contains 6.7 mg of this component.

The principle of action of the active substance is based on provocation of irritation. Once in the human body, thermopsis causes a reflex secretion of bronchial secretions. At the same time, muscle activity increases. The mucus that collects in the bronchi and lungs is evacuated naturally.

Thermopsis has long been used in medicine. The plant has established itself as an effective remedy in the treatment of diseases of the respiratory system.

The second active ingredient of the drug is sodium bicarbonate. One tablet accounts for 250 mg of this agent. It has a thinning effect on phlegm, making it thinner. In this form, mucus is removed more easily.

Acting in a complex, the two substances of the drug help to easily evacuate thick phlegm from the lower respiratory tract.

The manufacturer uses potato starch and talc as minor ingredients. In medicine, cough tablets are positioned as a phytopreparation with an expectorant effect.

Release form

The medication is available in the form of white flat pills. Tablets are packed in blisters of 10 pieces.

Each pack contains one or two such blisters. The trade name "Cough tablets" is indicated on the front of the package.

The same medicine is available in paper packaging, 10 tablets each.

Due to its natural composition, the medication belongs to non-prescription drugs. You can buy it at your nearest pharmacy.

The low cost makes the medicine affordable for everyone. A pack of 10 tablets costs no more than 50 Russian rubles.

Shelf life and storage conditions

The manufacturer indicates that the drug is suitable for use within 4 years. During this time, the pills must be stored in a dry place. The ambient temperature should not exceed 25 degrees. The tablets should be kept out of the reach of children.

Appointments for use

tracheitis;
bronchitis;
pneumonia;
chronic pathologies of the respiratory tract

It is prescribed for dry and unproductive coughs. The tablets are effective in the formation of thick, viscous, difficult to separate mucus and in the absence of a cough reflex to remove it..

It is a mistake to believe that medication will help calm an annoying cough. The medicine, on the other hand, irritates the airways so that phlegm is excreted from them.

If the mucus stagnates in the bronchi, then harmful microorganisms will begin to multiply in it, which is fraught with the occurrence of a secondary infection.

How to take cough drops

In order for the treatment to be effective and short-lived, you must first consult a specialist.

Only a doctor can reliably establish the cause of an unpleasant symptom and prescribe suitable medications.

If a person is categorically disposed, then it is necessary to carefully read the instructions before using the drug and strictly follow the specified algorithm.

Dosage

Adult patients the medicine is recommended in a single dose of 1 tablet, three times a day. The duration of treatment is limited to five days. The maximum permissible single serving of the drug is 14 tablets, and the daily dose is 42.
Children over 12 years old the medication is prescribed in the amount of half the adult dose - 1/2 tablet. Frequency rate of application is 2-3 times. Duration of use is 3-5 days.

The medicine is taken orally with a comfortable amount of water. Drinking more fluids is recommended when treating a dry cough, as this will improve the thinning of mucus and speed up the secretion of phlegm.

In such cases, the pulmonologist selects an individual dosage and establishes a separate regimen.

Interaction with other medicines and the possibility of complex use

Often, cough tablets are prescribed in complex treatment. The drug is combined in non-steroidal anti-inflammatory drugs that eliminate fever and pain. Often combined with antibiotics and immunomodulators.

If the patient is taking any medications prescribed by other specialists, then the doctor who recommends the cough tablets should be consulted.

If the doctor prescribes Cough tablets with other medications, then he will definitely talk about the possibility of their joint use. If you use it yourself, you should read an important point from the instructions indicating interaction.

Astringents, substances covering the stomach, antacids and adsorbents reduce the effectiveness of the herbal remedy. Medicines used for diseases of the gastrointestinal tract interfere with the absorption of alkaloids. These medicines should be taken at least 2 hours apart. In this case, the cough medicine must be taken first.
Medicines based on codeine or other substances that cause antitussive action should not be used simultaneously with thermopsis. These drugs are called antagonists and have the opposite effect.

Contraindications, precautions and adverse reactions

Despite the safe composition and small number of components, the drug has its own contraindications. Under no circumstances should Cough tablets be used if:

The patient has a hypersensitivity to the constituents or has previously had an allergy to drugs with thermopsis;
The patient suffers from gastric or intestinal ulcer, which is in an acute stage.
With extreme caution, cough tablets should be taken by allergy sufferers, as well as by patients with severe liver or kidney disease.
For pregnant women, the drug is contraindicated, since the effect of the active substance on the fetus has not been thoroughly studied.

Thermopsis passes into breast milk, so this medication should not be taken during lactation. If treatment is required by a nursing mother, then it is necessary to resolve the issue of temporarily stopping breastfeeding or pick up.

Unpleasant consequences of therapy

Most of the patients taking the drug tolerate the treatment well. Only in some cases, thermopsis provokes side effects, expressed by allergies and dyspeptic disorders.

It is forbidden to use a medication in a dosage exceeding that established by the manufacturer, unless recommended by a doctor.

An overdose is accompanied by symptoms such as nausea, urge to vomit. In such cases, the patient is prescribed gastric lavage, the intake of adsorbents and symptomatic agents that alleviate the condition.

If you feel worse during treatment, you should stop taking the medication and seek medical help.

Additionally

In recent decades, medicine has taken a colossal step forward. Modern cough medicines help quickly and effectively.

Most medicines have chemical components in their composition, which causes distrust. These drugs are expensive. Cough pills have a lot of positive qualities:

are inexpensive and sold without a prescription, available to every consumer, with the exception of those with contraindications;
have a safe composition, act quickly and efficiently;
have a long shelf life, do not require special storage conditions;
in just 3-5 days, a dry and unproductive cough is converted into a wet and light cough.

In contact with

Latin name: Zalasta
ATX code: N05AH03
Active substance: Olanzapine
Manufacturer: KRKA POLSKA, Sp.z.o.o (Poland).
Leave from the pharmacy: On prescription
Storage conditions: not more than 30 0 С.
Shelf life: 36 months.

The medicine Zalasta Ku-Tab is a good remedy for restoring the nervous system and eliminating its severe disorders. It is a neuroleptic drug that has a pronounced antipsychic effect. Only a doctor should prescribe it, because self-use can negatively affect the state of health. But nevertheless, you should first carefully study all its important features and rules of use.

Indications for use

Before using the drug Zalasta Ku-Tab, you should carefully consider the indications. It is commonly used to treat nervous system disorders from the following:

as part of the treatment of manifestations of schizophrenia. This tool provides a beneficial maintenance of improvement in clinical symptoms during long-term treatment therapy in patients who have a positive initial response to the drug;
used in the treatment of moderate to severe manifestations of mania;
in the preventive therapy of manifestations of mania during bipolar disorder.

Composition and release forms

The action and effect of the drug is provided due to its composition. It is important to know what components it includes:

the active ingredient of the drug is olanzapine. It is thanks to him that the antipsychic effect is exerted;
auxiliary elements include cellactose, pregelatinized starch powder, colloidal anhydrous silicon dioxide, corn starch, and so on.

Zalasta is produced in pill form. It is imperative to consider their description - they have a light yellow tint, coated with an enteric structure, have a biconvex shape. There is an inscription "5" at the top. Small blotches with a dark color are allowed on the surface.

Each blister contains 7 tablets. Blisters are packed in cardboard boxes. Each pack contains 4 blisters.

Medicinal properties

Zalasta is an antipsychotic medication that has a broad pharmacological spectrum of action. It is an antipsychotic that can have different effects, with some important characteristics:

neuroleptic effect is associated with blocking dopamine D2-receptors included in the mesolimbic and mesocortical systems;
the sedative effect is carried out by blocking the adrenergic receptors of the reticular formation in the brain stem;
the medication has an antiemetic effect. It is achieved by blocking dopamine D2 receptors in the trigger area of the vomiting center;
the hypothermic property is produced by blocking dopamine receptors in the hypothalamus.

When using the drug, its active component olanzapine inhibits the activity of reproductive symptoms - eliminates the manifestations of delirium, hallucinations. It also prevents the development of negative manifestations of mental states.

Pharmacokinetics

The cost of one package of Zalasta is 1200-1500 rubles.

The main element is capable of exhibiting an increased rate of absorption, it does not depend on the consumption of food. Achievement of the maximum concentration of olanzapine in blood plasma after oral administration lasts 5-8 hours.

The rate of binding to proteins (albumin and glycoprotein) reaches 93%. The main element enters through the histohematogenous barriers, namely the BBB. Metabolization takes place in the liver. Excretion is carried out mainly by the kidneys. Excreted in the urine in the form of metabolites.

Mode of application

Zalast must be taken orally. The instructions for use recommend taking the tablets correctly, for this it is worth performing the following steps:

the medicine should be used once a day;
use is not affected by food consumption;
the initial dose of medication for schizophrenia should be 10 mg per day;
to eliminate all manifestations of mania, it is worth taking 10-20 mg per day at a time;
the medication is often taken in combination therapy. 10 mg is taken at a time.

According to the patient's condition, the dosage of the medication can be adjusted. If it is used as part of preventive therapy for manifestations of bipolar disorders that occur in remission, then the initial dosage of the drug should be 10 mg per day. Withdrawal of medication should be slow.

During pregnancy and breastfeeding

Studies on the effect of the active substance olanzapine on the development of pregnancy and the formation of the unborn child have not been carried out. There are facts about what effect the substance has during this period. However, the use of the drug when carrying a baby is allowed, provided that the positive effect for the mother is higher than the possible harm to the child.

Before treatment for Zalastaya is prescribed, women should inform the doctor about the presence of pregnancy or planning it. In rare cases, therapy with this medication causes tremors. Also, sometimes arterial hypertension, signs of lethargy, drowsiness may appear in children who were born to mothers who used the medication in the last term.

Numerous studies of the drug have shown that the constituent components enter the composition of breast milk. The average dose that the baby receives when the equilibrium concentration of the active substance is reached should be 1.8% of the total dosage. It is for this reason that Zalastu Ku-Tab is not recommended for breastfeeding.

Contraindications and precautions

When using Zalasta medication, contraindications should be taken into account:

contraindicated in angle-closure glaucoma;
not for adolescents under 18;
while breastfeeding;
in no case is it taken if galactose intolerance, lapp lactase deficiency or glucose-galactose malabsorption has been identified;
not used if there is an increased sensitivity to the constituent elements.

There is a list of conditions for which it is worth taking the medicine with caution:

if there is heart, renal and hepatic impairment
when signs of prostatic hyperplasia are detected
if manifestations of obstruction of the intestinal tract in a paralytic form are detected
for epileptic seizures
if attacks of convulsive syndrome are possible
with leukopenia and neutropenia with different genesis
with pathologies with cerebrovascular and cardiovascular nature
elderly patients.

In addition, when using, it is worth considering special instructions:

if it is taken by people with diabetes, it is important to constantly monitor blood glucose levels. Sometimes, when using the medication, manifestations of hyperglycemia or decompensation of diabetes mellitus occur;
abrupt withdrawal of the drug can rarely cause unpleasant conditions - excessive sweating, sleep disturbances, tremors, anxiety, nausea and vomiting. It is advisable that when the use of the medication is canceled, the dosage should be reduced gradually;
Zalasta Ku-Tab tablets should not be used in the treatment of psychosis during Parkinson's disease, which are caused by the use of dopaminomimetics. In these situations, manifestations of parkinsonism and hallucinations are intensified;
due to the fact that there is a high mortality rate, the drug is not recommended for use as part of therapeutic therapy during psychosis and behavioral disorders during dementia;
it is imperative to be careful while taking it simultaneously with other medications of central influence and alcohol-containing drinks;
used with caution by people in the elderly group, they may have signs of postural arterial hypotension. Patients over 65 years of age require constant monitoring of blood pressure;
in very rare situations, the use of medications containing olanzapine causes the development of venous thromboembolism;
it is not necessary to drive a car while taking an antipsychotic, as well as to perform work that requires increased attention. The fact is that the medication can slightly reduce the concentration.

Cross-drug interactions

Admission with monotherapy rarely causes unpleasant symptoms. But if the medication is combined with other medications, then unforeseen conditions may appear. To avoid this, you should pay attention to the interaction of Zalasta Ku-Tab with other medicines:

it is not recommended to take in conjunction with activated carbon. The fact is that when Zalasta is taken with this sorbent, the absorption rate of olanzapine drops by 50-60%;
olanzapine reduces the effectiveness of dopamine agonists;
caution must be observed during simultaneous use with other medicines with central exposure;
when using Zalasta with alcoholic beverages, a depressive effect of the medication on the nervous system is possible.

Side effects

Many patients claim that while taking the drug, the development of side symptoms does not occur, but this is only if you follow all the recommendations that are indicated in the instructions. But still, do not forget that Zalasta Ku-Tab has a number of side effects:

sometimes arterial hypotension occurs
drowsiness may occur
dizziness
dry mouth
stool problems
increased appetite
signs of asthenia
weight gain
manifestations of eosinophilia
rashes on the surface of the skin
itching sensation
urticaria symptoms
swelling
gait problems
body temperature may rise
visual hallucinations.

Overdose

It is worth using the drug Zalasta correctly, for this it is recommended to follow all the recommendations that are indicated in the instructions. If the drug is used in a high dose, the following conditions may appear:

excessive agitation, aggressiveness
manifestations of an extrapyramidal nature
tachycardia
decreased consciousness, coma may develop
blood pressure rarely decreases, a person may fall into a coma, cardiac arrhythmias may occur, sometimes convulsions may appear
in acute overdose, if a dose of 450 mg is taken, then death can occur.

During an overdose, it is important to carry out symptomatic treatment, depending on the symptomatic condition of the patient. It is also important to monitor the work of vital organs.

Analogs

Sometimes there are cases when the drug Zalasta Ku-Tab is not possible to use. This may be due to contraindications, side symptoms. Also, this medication is not always available in pharmacies. For this reason, it is necessary to know what other antipsychotic drugs are that have a similar composition and effect.

Manufacturer: NOVARTIS PHARMACEUTICALS U.K., Ltd. (United Kingdom).

Price: from 990-1700 rubles.

It is an antipsychotic. It has antipsychotic, sedative, and antihistamine properties. It is used in the treatment of schizophrenia in patients who have resistance to the influence of other antipsychotics or lack of a therapeutic effect. It is also recommended to be taken in therapy to prevent the development of relapses of suicidal attempts in patients who have schizoid disorders, in the treatment of the manifestation of psychosis.

Pros:

good action
simple application
rarely causes side symptoms.

Minuses:

there are contraindications
high price
available by prescription.

Producer: Eli Lilly (Great Britain), Lilly del Caribe Inc. (Puerto Rico), Patheon Italia (Italy).

Price: from 2500 to 5000 rubles.

The medication has a strong antipsychotic effect. The composition contains the main element olanzapine. It is produced in two forms - tablets and powder, from which the solution is made. It is recommended for use in the treatment of acute manifestations of schizophrenia, chronic forms of delusional disorders, to eliminate bipolar psychosis, thyzoaffective disorders with productive symptoms.

Pros:

several forms of release
high efficiency
few side symptoms.

Minuses:

there are contraindications
high price
sold only upon presentation of a prescription.

Manufacturer: San Pharmaceutical Industries Ltd (India).

Price: from 150 to 500 rubles.

Thiodazine is a neuroleptic for the treatment of nervous system disorders. The composition contains an active substance - thioridazine hydrochloride. Its dosage can be different - 10 mg, 25 mg, 50 mg and 100 mg. Available in the form of film-coated tablets. It is recommended to take with exacerbation of schizophrenia, with chronic schizophrenia, depression, anxiety, psychosomatic disorders and emotional disorders.

Pros:

simple use
affordable price
high efficiency.

Minuses:

there are contraindications
prescription dispensing
many side symptoms.

Vizarsin Ku-tab: instructions for use and reviews

Vizarsin Ku-tab - a medicine for the treatment of erectile dysfunction; PDE-5 inhibitor.

Release form and composition

Vizarsin Ku-tab is produced in the form of tablets dispersed in the oral cavity: slightly biconvex, round, almost white or white, with a mint smell, possibly the presence of dark inclusions (1 pc. In a blister, in a cardboard box 1 or 2 blisters; by 4 pcs. In a blister, in a cardboard box 1, 2 or 3 blisters).

Composition of 1 tablet:

active substance: sildenafil - 25, 50 or 100 mg;
additional components: aspartame, neohesperidin dihydrochalcone (E959), calcium silicate FM1000, crospovidone type A, mannitol, hyprolose, mint flavor, magnesium stearate, peppermint flavor (field mint oil, acacia gum, water, levomenthol, sorbitol), maltodextinol.

Pharmacological properties

Pharmacodynamics

Sildenafil is a potent selective inhibitor of cyclic guanosine monophosphate (cGMP), a specific phosphodiesterase type 5 (PDE-5). The substance restores impaired erectile function under conditions of sexual stimulation by increasing blood flow in the vessels of the penis.

The physiological mechanism leading to an erection of the penis is the release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation.

By activating the enzyme guanylate cyclase, NO causes an increase in the level of cGMP and subsequent relaxation of the smooth muscle cells of the cavernous tissue, which promotes its filling with blood.

Without exerting a direct relaxing effect on the isolated human corpus cavernosum, sildenafil enhances the effect of NO due to the suppression of PDE-5, which is responsible for the breakdown of cGMP. During the activation of the NO / cGMP system, which occurs during sexual stimulation, inhibition of PDE-5 by sildenafil leads to an increase in the concentration of cGMP in the corpus cavernosum. Therefore, for the positive pharmacological effect of Vizarsin Ku-tab, sexual stimulation is necessary.

In vitro studies have demonstrated that sildenafil is selective for PDE-5, which is involved in the development of erection. This effect of the substance in relation to PDE-5 is significantly superior to its activity in relation to other known PDEs. In relation to PDE-6, which is involved in phototransmission in the retina, the selectivity of the action of sildenafil is 10 times less. When used in the maximum recommended doses, its selectivity to PDE-5 exceeds that to PDE-1 by 80 times, and to PDE-2, 3, 4, 7, 8, 9, 10 and 11 - by 700 times or more. The noted activity of sildenafil to PDE-3 (cAMP-specific isoform of PDE), which takes part in the control of cardiac muscle contractility, is approximately 4000 times weaker than the activity to PDE-5.

The agent can cause a temporary slight decrease in blood pressure (BP), usually without clinical manifestations. After taking Vizarsin Ku-tab at a dose of 100 mg, the maximum decrease in systolic blood pressure in the supine position was approximately 8.3 mm Hg. Art., and diastolic blood pressure - 5.3 mm Hg. Art. This effect is associated with the vasodilating effect of sildenafil, presumably due to an increase in the level of cGMP in the smooth muscle cells of the vascular walls. In healthy volunteers, a single use of the drug in a dose of less than 100 mg did not cause clinically significant changes in the electrocardiogram (ECG). Sildenafil did not affect cardiac output and did not lead to impaired blood flow through stenotic arteries.

In the presence of erectile dysfunction and stable angina pectoris in patients who regularly received antianginal drugs (with the exception of nitrates), after taking Vizarsin Ku-tab in comparison with placebo, there were no significant differences in the time interval before the development of an angina attack during an exercise test.

In some cases, 1 hour after taking sildenafil at a dose of 100 mg using the Farnsworth Munsell 100-shade test, patients showed a temporary change in the ability to distinguish certain shades of colors (blue / green). These changes were not detected 2 hours after taking the drug. It is assumed that the impairment in color recognition is due to inhibition of PDE-6. No effect of the agent on contrast perception, visual acuity, electroretinogram, pupil diameter or intraocular pressure was noted. In patients diagnosed with an early stage of age-related macular degeneration, Vizarsin Ku-tab at a dose of 100 mg with a single dose did not lead to clinically significant changes in vision, assessed by the corresponding tests (visual acuity, color perception, Amsler grating, photostress and Humphrey perimetry).

When taking 100 mg of sildenafil in healthy volunteers, no changes in sperm morphology or motility were observed.

In studies using fixed doses of sildenafil, the number of men who reported improved erections was 62% at a dose of 25 mg, 74% at a dose of 50 mg, 82% at a dose of 100 mg, compared with 25% in the placebo group. ... The analysis of the international index of erectile dysfunction showed that in addition to improving erection, the use of the drug also increased the quality of orgasm and ensured the achievement of satisfaction from intercourse. The effectiveness and safety of Vizarsin Ku-tab were preserved with prolonged use.

Pharmacokinetics

Sildenafil is rapidly absorbed. After oral administration on an empty stomach, the maximum concentration (Cmax) of the substance in the blood plasma is reached within 30–120 minutes (median 60 minutes). Absolute bioavailability is approximately 41% (25 to 63%). In the dose range of 25-100 mg sildenafil pharmacokinetics [Cmax and area under the concentration-time curve (AUC)] is linear. Taking the drug with food reduces the rate of absorption, while the period for reaching the maximum concentration (T Cmax) increases by about 60 minutes, and Cmax decreases by about 29%.

The volume of distribution (Vd) of the drug in a state of equilibrium concentration averages 105 liters, after a single oral dose of 100 mg Cmax can be equal to 440 ng / ml (the coefficient of variation is 40%). Due to the fact that the binding of the active substance and its main circulating metabolite to blood plasma proteins reaches 96%, the average plasma concentration of the free fraction of sildenafil can be 18 ng / ml (38 nmol). 1.5 hours after oral administration of 100 mg of Vizarsin Q-tab in healthy volunteers, less than 0.0002% of the dose was found in the semen (average 188 ng).

The process of metabolic transformation of sildenafil occurs mainly in the liver with the participation of cytochrome P450 microsomal isoenzymes: CYP3A4 (main pathway) and CYP2C9 (additional pathway). Sildenafil's main circulating metabolite is formed by N-demethylation of sildenafil. The selectivity of the metabolite in relation to PDE is comparable to that of sildenafil, the activity of the metabolite to PDE-5 in vitro can be 50% of the activity of the substance in the initial dose. In the blood plasma of healthy volunteers, the level of this metabolic product is equal to 40% of the level of sildenafil, and it undergoes further biotransformation, its half-life (T 1/2) is approximately 4 hours.

The total clearance of sildenafil is 41 liters per hour, the final T 1/2 is 3-5 hours. Excretion of the substance in the form of metabolites is carried out mainly by the intestines - about 80% of the dose, and to a lesser extent by the kidneys - about 13% of the dose.

Indications for use

Sexual arousal is required for the effect of the drug.

Contraindications

Absolute:

myocardial infarction or cerebrovascular accident (stroke), suffered in the last 6 months;
arterial hypotension (blood pressure below 90/50 mm Hg);
severe heart failure, unstable angina and other severe forms of cardiovascular lesions, in the presence of which sexual activity is not recommended for men;
severe functional disorders of the liver;
congenital fructose intolerance (since sorbitol is included in Vizarsin Q-tab);
phenylketonuria (since the aspartame contained in the product is a source of phenylalanine);
loss of vision in one eye due to a non-arteritic form of anterior ischemic neuropathy of the optic nerve (non-arteritis AION), regardless of whether this pathology is associated or not with the previous use of PDE-5 inhibitors;
hereditary degenerative diseases of the retina (hereditary retinal dystrophies), such as retinitis pigmentosa (with the possible presence of genetic disorders of the retinal PDE), since the safety profile of sildenafil in such patients has not been studied;
simultaneous use with NO donors (including amyl nitrite) or nitrates in any form due to the fact that sildenafil can enhance the antihypertensive effect of nitrates (mediated through NO / cGMP);
combined use with other drugs for the treatment of erectile dysfunction, since the efficacy and safety of Vizarsin Ku-tab in this combination has not been studied;
age under 18;
combination with ritonavir;
hypersensitivity to any of the constituents of the drug.

Vizarsin Ku-tab is not intended for use in women.

Relative contraindications (sildenafil must be used with extreme caution in the presence of the following conditions / diseases):

life-threatening arrhythmias;
syndrome of multiple systemic atrophy or obstruction of the outflow tract of the left ventricle of the heart [hypertrophic obstructive cardiomyopathy (GOKMP), aortic stenosis];
blood pressure readings above 170/100 mm Hg. Art .;
conditions predisposing to the occurrence of priapism (leukemia, multiple myeloma, sickle cell anemia);
anatomical deformity of the penis (cavernous fibrosis, angulation, or Peyronie's disease);
period of exacerbation of gastric ulcer or duodenal ulcer, diseases accompanied by bleeding (due to the lack of information on the safety of use);
a history of indications of episodes of development of non-arteritis AION;
simultaneous administration of alpha-blockers.

Instructions for use of Vizarsin Ku-tab: method and dosage

Vizarsin Ku-tab is taken orally.

Oral dispersible tablets can be used as an alternative form for patients who have difficulty swallowing film-coated tablets of the Vizarsin preparation. Because oral dispersible tablets are fragile and break easily, it is not recommended to squeeze them through the foil of the package. Do not take the tablet with wet hands as it may begin to dissolve.

Before taking, you need to take a blister with the drug and bend it along the line of the gap. To open the blister, gently pull on the edge of the foil and carefully remove the tablet by shaking it out into the palm of your hand. After that, the pill must be immediately put on the tongue, and in order to facilitate swallowing, keep in the mouth for several seconds until it is completely dissolved. Then Vizarsin Ku-tab can be washed down with liquid.

Do not mix the dispersible tablet with food in the mouth. When using the drug with fatty foods, its effect may be observed later than when taken on an empty stomach.

For most adult men, the recommended dose is 50 mg, which should be taken approximately 1 hour before sexual activity if needed. The dose of Vizarsin Ku-tab, taking into account its tolerability and effectiveness, can be increased to 100 mg or reduced to 25 mg. The maximum allowable dose should not exceed 100 mg, taken no more than 1 time per day.

Side effects

nervous system: very often - headache; often - dizziness; infrequently - hypesthesia, drowsiness; rarely - fainting, impaired cerebral circulation; with an unknown frequency - seizures, transient ischemic attack, recurrent seizures;
gastrointestinal tract: often - dyspepsia; infrequently - nausea, dry mouth, vomiting;
musculoskeletal and connective tissue: infrequently - myalgia;
mammary gland and genitals: infrequently - bleeding from the penis, hematospermia; with an unknown frequency - prolonged erection, priapism;
urinary system: infrequently - hematuria;
skin and subcutaneous tissue: infrequently - skin rash; with an unknown frequency - toxic epidermal necrolysis (Lyell's syndrome), Stevens-Johnson syndrome;
cardiovascular system (CVS): often - a feeling of hot flashes; infrequently - tachycardia, palpitations; rarely - atrial fibrillation, increase / decrease in blood pressure, myocardial infarction; with an unknown frequency - unstable angina pectoris, ventricular arrhythmia, sudden cardiac death;
labyrinthine disorders and the organ of hearing: often - tinnitus, vertigo; rarely - deafness;
organ of vision: often - visual impairment, chromatopsia (impaired color perception); infrequently - violation of lacrimation, damage to the conjunctiva; with an unknown frequency - visual field defect, occlusion of retinal vessels, non-arteritic AION;
organs of the chest and mediastinum, respiratory system: often - nasal congestion; rarely - nosebleeds;
immune system: rarely - hypersensitivity reactions;
laboratory and instrumental data: infrequently - increased heart rate;
other disorders: infrequently - increased fatigue, chest pain.

Overdose

With a single dose of Vizarsin Ku-tab in doses of less than 800 mg, side effects were similar to those when using sildenafil at lower doses, but the frequency and severity of these disorders increased. The use of the drug in a dose of 200 mg did not lead to an increase in its effect, however, it caused an increase in the frequency of undesirable reactions, such as nasal congestion, dyspepsia, headache, dizziness, flushing, and visual disturbances.

In case of an overdose, symptomatic treatment is performed. Hemodialysis is ineffective because sildenafil has a strong bond with blood plasma proteins and is not excreted by the kidneys.

special instructions

Before starting drug therapy in order to diagnose erectile dysfunction and determine the possible causes of their development, it is necessary to study the patient's history and conduct a thorough clinical examination.

Since there is a certain risk from CVS due to sexual activity, it is necessary to assess the patient's condition before starting any course of treatment for erectile dysfunction. Mortality rates from CVD diseases and the incidence of myocardial infarction with sildenafil did not differ from those in the placebo group.

In the course of the post-marketing use of sildenafil, there have been reports of serious cardiovascular complications (associated with the use of this drug) including sudden cardiac death, myocardial infarction, ventricular arrhythmia, unstable angina pectoris, transient ischemic attack, cerebrovascular hemorrhage / hypotension. The majority of patients in this group had cardiovascular risk factors. Many of these cases occurred during or immediately after sexual activity, and a small number during the short period after taking sildenafil without sexual activity. It is impossible to establish a direct connection between the development of these pathologies and any factors.

Due to the fact that Vizarsina Ku-tab has a vasodilating effect, leading to a temporary and slight decrease in blood pressure, before starting it, it is necessary to carefully assess the possible threat of these undesirable manifestations against the background of certain concomitant diseases, especially with sexual activity. Increased susceptibility to vasodilating action is observed in patients with GOKMP, aortic stenosis, or with a rare syndrome of multiple systemic atrophy, accompanied by severe impairment of autonomic regulation of blood pressure.

Since alpha-blockers are vasodilators, when combined with PDE-5 inhibitors, the threat of an excessive decrease in blood pressure is aggravated. Patients receiving alpha-blockers should take Vizarsin Ku-tab with caution, since with an individual predisposition, this can cause symptomatic arterial hypotension, usually observed within 4 hours after taking sildenafil.

To minimize the likelihood of developing this complication, it is necessary to start taking Vizarsin Ku-tab against the background of treatment with alpha-blockers only after stabilization of hemodynamic parameters is achieved. Also in this case, it is recommended to reduce the initial dose of sildenafil to 25 mg. For patients already receiving sildenafil when prescribing therapy with alpha-blockers, it is advisable to start the use of the latter with a low dose. The subsequent decrease in blood pressure with this combination can be caused by a gradual increase in the dose of alpha-blockers. The patient should be informed about how he should act in case of signs of orthostatic hypotension.

Against the background of treatment with all PDE-5 inhibitors (including sildenafil), there have been rare reports of the occurrence of non-arteritic AION, which proceeds with deterioration or loss of vision. The development of this pathology was noted in patients, most of whom had such risk factors as hyperlipidemia, diabetes mellitus, age over 50, deepening (excavation) of the optic nerve head, ischemic heart disease (IHD), arterial hypertension. The causal relationship between the development of this complication and the use of PDE-5 inhibitors could not be determined. In case of sudden loss of vision, it is necessary to stop taking Vizarsin Ku-tab and immediately consult a specialist.

During therapy with PDE-5 inhibitors, including sildenafil, cases of loss or sudden hearing loss have been reported, mainly in patients who had risk factors for these adverse reactions. It is impossible to establish whether the loss or sudden deterioration of hearing is related to taking sildenafil. With the development of these violations, it is required to refuse to take the drug and immediately seek medical help.

Influence on the ability to drive vehicles and complex mechanisms

There is no information about the negative impact of Vizarsin Ku-Tab on the ability to work with complex mechanisms and drive a car. However, since dizziness, decreased blood pressure, blurred vision, chromatopsia and other similar effects may occur while taking the drug, in these situations, patients need to determine their individual susceptibility to the use of sildenafil, especially at the beginning of therapy and when adjusting the dose.

Application during pregnancy and lactation

Vizarsin Ku-tab according to the registered indication is not intended for use in women.

Childhood use

Vizarsin Ku-tab is not used in pediatric practice.

With impaired renal function

In the presence of mild or moderate functional renal impairment [creatinine clearance (CC) 30–80 ml / min], the pharmacokinetic parameters of sildenafil did not change after a single dose of 50 mg. When compared with healthy peers, the average Cmax and AUC values of the N-demethylated metabolite increased by 73 and 126%, respectively. Against the background of severe renal failure (CC below 30 ml / min), there was a decrease in the clearance of sildenafil, leading to an increase in Cmax and AUC values by about 2 times (by 88 and 100%, respectively) when compared with patients without renal impairment from the same age group. groups.

With renal failure of mild and moderate severity (CC 30–80 ml / min), dose adjustment is not necessary.

Patients with severe renal insufficiency need to reduce the dose of Vizarsin Q-tab to 25 mg. Depending on the tolerance and effectiveness of the drug, it can be further increased to 50 and 100 mg.

For violations of liver function

In the presence of class A and B liver cirrhosis according to the Child-Pugh classification, the clearance of sildenafil decreases, which causes an increase in Cmax and AUC (by 47 and 84%, respectively) in comparison with patients of the same age group with normal liver activity. In patients with severe liver dysfunction, the pharmacokinetics of the drug have not been studied.

With existing hepatic pathologies (in particular, with cirrhosis), the dose of Vizarsin Ku-tab must be reduced to 25 mg, with a possible further increase to 50 and 100 mg, taking into account the tolerability and result of therapy.

Use in the elderly

In healthy patients aged 65 years and older, the clearance of sildenafil is reduced, and the plasma level of this substance and its active N-demethylated metabolite is approximately 90% higher than in young men 18–45 years old. The plasma concentration of free sildenafil, taking into account the age-related characteristics of binding to proteins, increases by about 40%.

Elderly patients do not need a dose adjustment of Vizarsin Ku-tab.

Drug interactions

Possible effect of other drugs / agents on the pharmacokinetic parameters of sildenafil:

isozymes of cytochrome P450 (according to in vitro studies): a decrease in clearance may be observed;
inhibitors of the CYP3A4 isoenzyme (including cimetidine, erythromycin, ketoconazole): there is a decrease in drug clearance, but the frequency of adverse reactions does not increase (sildenafil should be taken with a dose of 25 mg);
ritonavir (a potent inhibitor of cytochrome P450), HIV protease inhibitor (2 times / day at a dose of 500 mg): AUC and Cmax in blood plasma increase 11 and 4 times, respectively, after 24 hours the plasma level of sildenafil is approximately 200 ng / ml (when taking one sildenafil - 5 ng / ml; the combination is contraindicated);
saquinavir (an inhibitor of the isoenzyme CYP3A4), an inhibitor of HIV protease (3 times / day at a dose of 1200 mg): AUC and Cmax of sildenafil (1 time / day at a dose of 100 mg) increases by 210 and 140%, respectively;
itraconazole and ketoconazole (potent inhibitors of the CYP3A4 isoenzyme): a pronounced effect on the pharmacokinetics of the drug is possible;
erythromycin (5 days, 2 times / day at a dose of 500 mg): AUC increases by 182%;
azithromycin (3 days, 500 mg per day): AUC, Tmax, Cmax, T ½ of sildenafil or its main metabolite do not change;
cimetidine (800 mg): the plasma concentration of sildenafil (50 mg) is increased by 56%;
aluminum / magnesium hydroxide: with a single dose, the bioavailability of the drug does not change;
Nicorandil (a hybrid of a nitrate and a potassium channel activator): there is a possibility of a serious interaction between these agents;
thiazides and thiazide-like diuretics, loop and potassium-sparing diuretics, inhibitors of the CYP2C9 isoenzyme (phenytoin, warfarin, tolbutamide), inhibitors of the CYP2D6 isoenzyme (tricyclic antidepressants, selective serotonin reuptake inhibitors of serotonin inhibitors) (ACE), beta-blockers: changes in the pharmacokinetic parameters of the drug were not identified;
grapefruit juice: a slight increase in the level of the active substance in the blood plasma is possible.

Possible effects of Vizarsin Ku-tab on the pharmacokinetics of other drugs / agents:

isozymes of cytochrome P450 2C9, 1A2, 2C19, 2E1, 2D6, and 3A4 [concentration of semi-maximum inhibition (IC 50) ≥150 μmol]: according to in vitro studies, the effect of the drug on the clearance of substrates of these isoenzymes is unlikely;
doxazosin (alpha-blocker) in doses of 4/8 mg: in patients with benign prostatic hyperplasia and stable hemodynamics achieved with doxazosin, rare cases of symptomatic orthostatic hypotension, manifested by dizziness, but without fainting are possible;
warfarin (40 mg), tolbutamide (250 mg): no interaction with sildenafil (50 mg) was found;
acetylsalicylic acid (150 mg): additional lengthening of bleeding time when combined with the drug (50 mg) has not been established;
ethanol: when combined with sildenafil (50 mg) in healthy volunteers, the hypotensive effect of ethanol does not increase (Cmax of ethanol in blood serum is about 80 mg / dl);
alpha-blockers, blockers of slow calcium channels, blockers of adrenergic neurons, centrally acting drugs, vasodilators, angiotensin II receptor antagonists, ACE inhibitors, beta-blockers, diuretics and other antihypertensive drugs: differences in side effects with these combinations from the effects in patients taking placebo , not marked;
amlodipine: against the background of arterial hypertension, an additional decrease in blood pressure was established, which is comparable to that when using only sildenafil;
saquinavir and ritonavir (HIV protease inhibitors): no changes in the pharmacokinetic parameters of these agents were noted.

Analogs

Analogs of Vizarsin Ku-tab are: Silafil, Vizarsin, Viasan-LF, Dinamiko, Sildenafil, Ridzhamp, Vildegra, Taxier, Viatail, Erexesil, Revazio, Maxigra, Sildenafil VERTEX, Viagra, Sildenafil Ol, Sildenafil SZ, Tornetisron.

Terms and conditions of storage

Store in its original packaging out of the reach of children, at a temperature not exceeding 25 ° C.

Shelf life is 2 years.

Cough pills (that's what they are called) are an affordable medicine that helps to get rid of a common symptom of respiratory diseases, a cough reflex accompanied by mucus, or the so-called dry.

They have been present on the pharmaceutical market for more than a dozen years. In Soviet times, a package of the drug cost only a few cents and was in every home medicine cabinet. Today thermopsis tablets are still available and in demand, they are produced from natural plant materials and do not contain chemical components.

The active substance of cough tablets is herb thermopsis. It is a medicinal perennial plant from the legume family that grows in the Urals, Siberia, Mongolia and Tibet. The medicinal properties of the plant are due to its composition. The leaves and stems of Thermopsis contain five varieties of alkaloids, saponins, mucous compounds, tannins, essential oils, resins, ascorbic acid.

Clinical and pharmacological group

Phytopreparation with expectorant action.

Conditions of sale from pharmacies

Can buy without a doctor's prescription.

Price

How many cough tablets are in pharmacies? The average price is at the level of 30 rubles.

Composition and form of release

The tool is available in tablet form. Each gray (sometimes greenish) tablet is made from a compressed powder containing:

Thermopsis (0.0067 g);
Sodium hydrogen carbonate (0.25 g).

Thermopsis is a plant that grows throughout North America and Asia. It has long been known as an effective cough suppressant and is often used in pharmaceuticals to create quality medicines. The cough tablets contain a sufficient amount of extracts from this herb, which explains the therapeutic effect.

pharmachologic effect

elimination of intestinal atony, which is especially useful for chronic constipation, irritable bowel syndrome, after surgery on the abdominal cavity;
stimulating appetite- it is used for anorexia of a somatic and neurogenic nature, in case of a deterioration in appetite in infectious and inflammatory diseases;
increased systemic pressure- that is why the herb is used for arterial hypotension;
sputum discharge - the substances entering the plant not only transform an unproductive cough into a wet one, but also help remove mucus and phlegm from the bronchi and alveoli;
expansion of small vessels, relief of headaches - in this case, a phytopreparation is able to eliminate cephalalgia due to vascular spasm or muscle tension;
sedation- useful in the treatment of depression, anxiety, psychosis.
the plant is able to increase the tone of the uterus, has an anti-inflammatory effect, relieves the symptoms of fever (weakness, chills).

As for sodium bicarbonate, it helps to reduce the viscosity of sputum, thereby stimulating the secretion of the bronchial glands.

All components of these tablets are ideally absorbed by the digestive tract. The maximum effect of the drug is observed thirty to forty minutes after oral administration, and lasts for two to six hours. The medication is excreted from the body by the bronchial glands, the mucous layer of the respiratory tract and the kidneys.

Indications for use

Cough pills are prescribed to patients orally for the symptomatic treatment of respiratory diseases accompanied by an obsessive paroxysmal and unproductive cough, namely:

Laryngotracheitis;
Bronchiolitis;

Contraindications

Any form of the drug containing thermopsis extract is contraindicated in the following conditions:

bronchial asthma;
respiratory failure;
periods of pregnancy and lactation;
individual intolerance to the components of the drug;
peptic ulcer and 12 duodenal ulcer (including history);
pulmonary diseases with a tendency to hemoptysis (tuberculosis, lung cancer);
acute form of pyelonephritis or glomerulonephritis.

Hypertensive patients should be approached with extreme caution in taking thermopsis-based drugs, since the likelihood of an increase in blood pressure is high during treatment. Under the supervision of a physician and only according to indications, the drug is prescribed to children under 12 years of age.

Appointment during pregnancy and lactation

Data on the safety of Cough tablets for pregnant women and the fetus are not provided and it is not known whether the treatment may negatively affect the intrauterine development of the child. Given these data, Cough tablets are contraindicated for use at all stages of pregnancy.

The active active ingredients of the drug can be excreted in breast milk and enter the baby's body, therefore, cough tablets should not be taken by nursing mothers. If necessary, drug treatment should decide whether to stop lactation or consult a doctor for another effective and safe cough medicine.

Dosage and method of administration

As indicated in the instructions for use, the dosage of cough tablets for different ages is as follows:

For children over 12 years old, the drug is prescribed in a tablet 2 to 3 times a day. The treatment time usually does not exceed five days. If the course is completed, but the cough remains, the decision to extend therapy can only be made by a doctor.
Adults also take a pill three times a day, the course of treatment lasts from 3 to 5 days. With the permission of the doctor, the number of tablets can be increased under the constant supervision of medical personnel.

Since the herb thermopsis has an effect that irritates the gastric mucosa and nerve endings, an overdose of the drug can provoke severe nausea and vomiting.

To eliminate the problem, gastric lavage is used. This drug is not prescribed to small children, as they can react to its composition, and also babies have a very high sensitivity to various drugs that cause nausea. The vomiting center, which is not completely formed, quickly reacts to the irritant and the medicine causes severe vomiting and the appearance of allergic reactions.

Side effect

The presence of an individual intolerance to the active components of the thermopsis herbal medicine in the patient, as well as the use of doses exceeding the recommended ones, can lead to the development of such undesirable reactions from the body:

nausea, vomiting;
paroxysmal pain in the abdomen (upper part and peri-umbilical region);
allergic reactions (itchy rash, acute urticaria, angioedema, less often anaphylactic shock).

If you use herb with licorice in syrup for a long time or in the wrong doses, then the likelihood of occurrence of the phenomena of "bromism" increases: frequent cough, lethargy, nasal congestion and rhinorrhea, apathy, decreased memory properties, acute conjunctivitis, vomiting, skin rashes. In this case, the medication is canceled and symptomatic therapy is prescribed.

Overdose

In case of an overdose of the drug in adults and children, digestive disorders, including nausea and vomiting, are observed. In such situations, symptomatic therapy is required.

special instructions

To improve the dilution and separation of sputum, it is recommended to prescribe a plentiful warm drink.

The use of the drug does not affect the performance of potentially hazardous activities that require increased attention and speed of psychomotor reactions (driving vehicles, working with moving mechanisms, the work of a dispatcher and an operator).

Interaction with other drugs

Adsorbents, astringents and coating agents can reduce the absorption of alkaloids that make up the herb thermopsis in the gastrointestinal tract.

Cough tablets should not be used concurrently with drugs containing codeine and other antitussive drugs, as this makes it difficult to cough up phlegm.

Registration number: Р N001049 / 02 dated 12.12.2007
Trade name: CYCLOFERON® (CYCLOFERON®)
Dosage form: enteric-coated tablets.

Generic name: meglumine acridone acetate

Composition:

One tablet contains: active ingredient - meglumine acridone acetate in terms of acridoneacetic acid - 150.00 mg, obtained according to the following recipe: acridoneacetic acid - 150.00 mg, meglumine (N-methylglucamine) - 146.00 mg;
excipients: povidone K 30 - 7.93 mg, calcium stearate - 3.07 mg, hypromellose - 2.73 mg, polysorbate 80 - 0.27 mg;
enteric coating: methacrylic acid and ethyl acrylate copolymer - 23.21 mg, propylene glycol - 1.79 mg.

Description: yellow round biconvex enteric-coated tablets. On a cross-section, the kernel is yellow.

Pharmacotherapeutic group: immunostimulating agent. ATX code - L03AX

Pharmacological properties

Pharmacodynamics

Cycloferon is a low-molecular-weight interferon inducer, which determines a wide range of its biological activity (antiviral, immunomodulatory, anti-inflammatory, etc.). Cycloferon is effective against herpes viruses, influenza and other pathogens of acute respiratory diseases. Has a direct antiviral effect, suppressing the reproduction of the virus in the early stages (1-5th day) of the infectious process, reducing the infectivity of viral progeny, leading to the formation of defective viral particles. Increases the body's nonspecific resistance against viral and bacterial infections.

Pharmacokinetics

When taking a daily dose, the maximum concentration in blood plasma is reached after 2-3 hours, gradually decreases by the 8th hour, and after 24 hours Cycloferon is found in trace amounts. The half-life of the drug is 4–5 hours, so its use in recommended doses does not create conditions for accumulation in the body.

Indications for use

In adults in complex therapy:

herpes infection.

In children from the age of four in complex therapy:

flu and acute respiratory diseases;
herpes infection.

In children from the age of four for the prevention of influenza and acute respiratory diseases.

Contraindications

Pregnancy, breastfeeding period, children under 4 years of age (due to imperfect swallowing), individual intolerance to the components of the drug, decompensated liver cirrhosis.

Carefully

In case of diseases of the digestive system in the stage of exacerbation (erosion, stomach and / or duodenal ulcers, gastritis and duodenitis) and allergic reactions in history, be sure to consult your doctor before taking the drug.

During pregnancy and during breastfeeding

The use of the drug during pregnancy and during breastfeeding is contraindicated.

Methods of administration and dosage

Inside, once a day, 30 minutes before meals, without chewing, drinking ½ glass of water, in age dosages:

children 4–6 years old: 150 mg (1 tablet) per dose;
children 7-11 years old: 300-450 mg (2-3 tablets) per appointment;
adults and children over 12 years old: 450-600 mg (3-4 tablets) per dose.

It is advisable to repeat the course 2-3 weeks after the end of the first course.

In adults:

In the treatment of influenza and acute respiratory diseases, the drug is taken on the 1st, 2nd, 4th, 6th, 8th day (course of treatment - 20 tablets). Treatment should be started at the first symptoms of the disease.
For severe flu, six tablets are taken on the first day. If necessary, symptomatic therapy is additionally carried out (antipyretic, analgesic, expectorant drugs).
In case of herpes infection, the drug is taken for 1, 2, 4, 6, 8, 11, 14, 17, 20, 23 days (course of treatment - 40 tablets). Treatment is most effective when the first symptoms of the disease appear.

In children from the age of four:

For influenza and acute respiratory diseases, the drug is taken in age-related doses on days 1, 2, 4, 6, 8, 11, 14, 17, 20, 23. The course of treatment is from 5 to 10 receptions, depending on the severity of the condition and the severity of clinical symptoms.
With herpes infection, the drug is taken on the 1st, 2nd, 4th, 6th, 8th, 11th, 14th day of treatment. The course of treatment may vary depending on the severity of the condition and the severity of the clinical symptoms.
For urgent non-specific prophylaxis of influenza and acute respiratory diseases (with direct contact with patients with influenza or acute respiratory infections of a different etiology, during an influenza epidemic): on the 1st, 2nd, 4th, 6th, 8th day. Then take a break of 72 hours (three days) and continue the course for 11, 14, 17, 20, 23 days. The general course is from 5 to 10 receptions.

Side effects

According to the World Health Organization, adverse effects are classified according to the frequency of their development as follows:

- very frequent (≥ 1/10);
- frequent (≥ 1/100 - - infrequent (≥ 1/1000 - - rare (≥ 1/10000 - - very rare (- frequency unknown (cannot be determined from available data)).
Immune system disorders: very rarely - angioedema.
Skin and subcutaneous tissue disorders: very rarely - rash, urticaria.
If any of the undesirable effects indicated in the instructions are aggravated or you notice any other undesirable effects that are not indicated in the instructions, inform your doctor.

Overdose

There are no data on drug overdose.

Interaction with other medicinal products

Cycloferon is compatible with all drugs used in the treatment of these diseases (interferons, chemotherapeutic, symptomatic drugs, etc.). Enhances the action of interferons and nucleoside analogs. Reduces the side effects of chemotherapy, interferon therapy.

special instructions

Cycloferon does not affect the ability to drive vehicles.
In case of diseases of the thyroid gland, it is necessary to consult an endocrinologist.
If the next dose of the drug is missed, then at the first opportunity, without taking into account the time interval and doubling the dosage, continue the course according to the begun scheme.
In the absence of a therapeutic effect, you must consult a doctor.