Ascophen ULTRA, 250 mg+65 mg+250 mg 10 pcs

Name: Ascophen ULTRA, 250 mg+65 mg+250 mg 10 pcs
SKU: 337994
Availability: InStock

€4.28

EAN: 4601669012746 SKU: 337994 Categories: Medicine, Migraine, Neurology and Psychiatry

Pharmacotherapeutic group: analgesic combined (non-steroidal anti-inflammatory agent + analgesic non-narcotic agent + psychostimulant).

The ATX code: [N02BA71].

Pharmacological properties

Pharmacodynamics:

A combined drug containing paracetamol, acetylsalicylic acid and caffeine.

Acetylsalicylic acid has antipyretic and anti-inflammatory effects, reduces pain, especially caused by inflammation, and inhibits platelet aggregation and thrombosis, improves microcirculation in the inflamed area.

Caffeine increases reflex excitability of the spinal cord, stimulates respiratory and vasomotor centers, increases blood vessels of skeletal muscles, brain, heart and kidneys; it decreases platelet aggregation; it reduces sleepiness and fatigue and increases mental and physical performance.

In this combination, a small dose of caffeine has practically no stimulating effect on the central nervous system, but it increases the tone of cerebral blood vessels and accelerates blood flow.

Paracetamol has analgesic, antipyretic and very weak anti-inflammatory activity, due to its effect on the thermoregulation center in the hypothalamus and weak ability to inhibit the synthesis of prostaglandins (Pg) in peripheral tissues.

Pharmacokinetics

Acetylsalicylic acid

When taken orally, absorption is complete. During absorption it undergoes presystemic elimination in the intestinal wall and systemic elimination in the liver (deacetylated). It is rapidly hydrolyzed by cholinesterases and albumin esterase, therefore half-life period is not more than 15-20 minutes.

In the body it circulates (75-90% in connection with albumin) and is distributed in the tissues as salicylic acid anion. The time of reaching maximum concentration is 2 hours. It is metabolized mainly in liver with formation of 4 metabolites found in many tissues and urine.

Extracted mainly by active secretion in the renal tubules as salicylate (60%) and its metabolites. Excretion of unchanged salicylate depends on urine pH (when urine is alkaline, ionization of salicylates increases, their reabsorption is impaired and excretion significantly increases).

The elimination rate depends on the dose: when taking small doses, the elimination half-life is 2-3 hours, with increasing doses it may increase to 15-30 hours. In infants the elimination of salicylates is much slower than in adults.

Caffeine

When taken orally absorption is good, occurs throughout the intestine. Absorption is mainly due to lipophilicity rather than water solubility.

The time to reach maximum concentration is 50-75 minutes after oral administration, the maximum concentration is 1.6-1.8 mg/l. It is rapidly distributed in all organs and tissues of the body; easily penetrates through the blood-brain barrier and the placenta.

The volume of distribution in adults is 0.4 – 0.6 l/kg, in infants 0.78-0.92 l/kg. Binding with blood proteins (albumin) is 25-36%. More than 90% is metabolized in liver, in children during first years of life up to 10-15%. In adults about 80% of caffeine dose is metabolized to paraxanthine, about 10% to theobromine and about 4% to theophylline.

These compounds are subsequently demethylated to monomethylxanthines and then to methylated uric acids. The elimination half-life in adults is 3.9-5.3 h (sometimes up to 10 h). Excretion of caffeine and its metabolites is carried out by kidneys (1-2% in adults is excreted unchanged).

Paracetamol

The absorption is high, the maximum concentration is reached after 0.5-2 hours; the maximum concentration is 5-20 mcg/ml. Binding with plasma proteins is 15%. Penetrates through the blood-brain barrier. Less than 1% of the dose taken by a nursing mother passes into breast milk.

The therapeutic effective concentration of paracetamol in plasma is achieved when administered at a dose of 10-15 mg/kg. It is metabolized in liver (90-95%): 80% enters into conjugation reactions to form inactive glucuronides and sulfates; 17% undergoes hydroxylation to form 8 active metabolites, which conjugate with glutathione to form already inactive metabolites.

With a lack of glutathione these metabolites can block the enzyme systems of hepatocytes and cause their necrosis. CYP2E1, CYP1A2 isoenzymes are also involved in metabolism of the drug, and to a lesser extent CYP3A4 isoenzyme. The elimination half-life is 1-4 hours. Excreted by the kidneys as metabolites, mainly conjugates, less than 5% unchanged. In elderly patients the drug clearance is decreased and the elimination half-life is increased.

Indications

Pain syndrome of moderate to mild intensity of different origin in adults and children over 15 years:

headache;
migraine;
dental pain;
neuralgia;
arthralgia;
malgia;
algodysmenorrhea (menstrual pain).

Fever syndrome in adults: in acute respiratory diseases, influenza.

Active ingredient

Acetylsalicylic acid, Caffeine, Paracetamol

Composition

Active ingredients:

Acetylsalicylic acid – 250.0 mg,

Paracetamol – 250.0 mg,

Caffeine (caffeine anhydrous) – 65.0 mg.

Auxiliary substances:microcrystalline cellulose – 66.01 mg, hyprolose (low-substituted hydroxypropyl cellulose) – 21.50 mg, talc – 10.00 mg, hyprolose (hydroxypropyl cellulose) – 7.30 mg, colloidal silicon dioxide (aerosil) – 3.40mg, stearic acid – 2.50 mg, calcium stearate – 1.29 mg.

Shell: Opadray 20A28380 WHITE – 13.5 mg [hypromellose (hydroxypropyl methylcellulose 2910) – 4.556 mg, hydroxypropylcellulose – 4.556 mg, talc – 2.700 mg, titanium dioxide – 1.688 mg].

How to take, the dosage

The drug is administered orally during or after meals.

Interaction

Acetylsalicylic acid

Other nonsteroidal anti-inflammatory drugs: Increased damaging effect on the mucosa of the gastrointestinal tract (GIT), increased risk of gastrointestinal bleeding. If concomitant use is necessary, it is recommended to use gastroprotectors for prevention of NPVG1-induced gastrointestinal ulcers, so concomitant use is not recommended.

Glucocorticosteroids:

Increased damaging effect on gastrointestinal mucosa, increased risk of gastrointestinal bleeding. It is recommended to use gastroprotectors, especially in patients older than 65 years old; therefore concomitant use is not recommended.

Oral anticoagulants (such as coumarin derivatives): Acetylsalicylic acid (ASA) may potentiate the effect of anticoagulants. Clinical and laboratory monitoring of bleeding time and prothrombin time is necessary. Simultaneous use is not recommended.

Thrombolytics:

Increased risk of bleeding. The use of ASA in patients within the first 24 hours after acute stroke is not recommended. Simultaneous use is not recommended.

Heparin:

Increased risk of bleeding. Clinical and laboratory monitoring of bleeding time is required. Simultaneous use is not recommended.

Platelet aggregation inhibitors (ticlopidine, paracetamol, clopidogrel, cilostazol): Increased risk of bleeding. Clinical and laboratory monitoring of bleeding time is required. Simultaneous use is not recommended.

Selective serotonin reuptake inhibitors (SSRIs): Concurrent use may affect blood clotting or platelet function, resulting in an increased risk of bleeding in general and gastrointestinal bleeding in particular, so concomitant use is not recommended.

Phenytoin: ASA increases the plasma concentration of phenytoin, which requires monitoring.

Valproic acid: ASA disrupts binding to plasma proteins and therefore may increase its toxicity. Monitoring of plasma concentrations of valproic acid is necessary.

Aldosterone antagonists (spironolactone, canrenoate): ASA may decrease their activity due to impaired sodium excretion, proper control of blood pressure is necessary.

Loop diuretics (e.g., furosemide): ASA may decrease their activity due to impaired glomerular filtration caused by inhibition of prostaglandin synthesis in the kidneys.

Concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) may lead to acute renal failure, especially in dehydrated patients. If diuretics are used simultaneously with ASA, it is necessary to ensure sufficient rehydration of the patient and monitor renal function and blood pressure, especially at the beginning of treatment with diuretics.

Hypotensive drugs (ACE inhibitors, angiotensin II receptor antagonists, “slow” calcium channel blockers): ASA can reduce their activity due to inhibition of prostaglandin synthesis in the kidneys. Simultaneous use may lead to acute renal failure in elderly or dehydrated patients. If diuretics are used concomitantly with ASA, it is necessary to ensure adequate rehydration of the patient and monitor renal function and blood pressure. When concomitant use with verapamil, bleeding time should be monitored.

Uricosuric agents (e.g. probenecid, sulfinpyrazone): ASA may decrease their activity due to inhibition of tubular reabsorption leading to high plasma concentration of ASA.

Methotrexate ≤15 mg/week: ASA, like all NSAIDs, reduces tubular secretion of methotrexate, increasing its plasma concentration and thus its toxicity. In this regard, concomitant use of NSAIDs in patients receiving high doses of methotrexate is not recommended (see section “Contraindications”).

In patients receiving low doses of methotrexate, the risk of interaction between methotrexate and NSAIDs should also be considered, especially if renal function is impaired. If combined therapy is necessary, it is necessary to monitor general blood count, liver and kidney function, especially in the first days of treatment.

Sulfonylurea derivatives and insulin: Asc increases their hypoglycemic effect, so when taking a high dose of salicylates it may be necessary to reduce the dose of hypoglycemic drugs. It is recommended to monitor blood glucose levels more frequently.

Alcohol: Increases the risk of gastrointestinal bleeding; concomitant use should be avoided.

Paracetamol

Inducers of microsomal liver enzymes or potentially hepatotoxic substances (e.g., alcohol, rifampicin, isoniazid, hypnotics and antiepileptics including phenobarbital, phenytoin and carbamazepine): Increased toxicity of paracetamol, which may lead to liver damage even with non-toxic doses of paracetamol, so liver function should be monitored. Simultaneous use is not recommended.

Chloramphenicol: Paracetamol may increase the risk of increased concentration of chloramphenicol. Simultaneous use is not recommended.

Zidovudine: Paracetamol may increase the tendency to develop neutropenia, in connection with which hematological parameters should be monitored. Simultaneous use is possible only with the permission of the doctor.

Probenecid: Probenecid decreases the clearance of paracetamol, which requires reducing the dose of paracetamol. Simultaneous use is not recommended.

Indirect anticoagulants: Repeated administration of paracetamol for more than one week increases the anticoagulant effect. Episodic administration of paracetamol has no significant effect.

Propantelin and other drugs that slow gastric evacuation: Decreases the rate of absorption of paracetamol, which may delay or reduce rapid pain relief.

Metoclopramide and other drugs that accelerate gastric evacuation: Increases the rate of paracetamol absorption and therefore the effectiveness and onset of analgesic action.

Colestiramine: Decreases the rate of absorption of paracetamol, so if maximum analgesia is required, colestiramine is not taken before 1 hour after taking paracetamol.

Caffeine
Sleeping pills (e.g., benzodiazepines, barbiturates, H1-histamine receptor blockers): Simultaneous use may decrease the sleeping effect or reduce the anticonvulsant effect of barbiturates, therefore simultaneous use is not recommended. If simultaneous use is necessary, it is reasonable to take the combination in the morning.

Lithium: Caffeine withdrawal may increase the plasma concentration of lithium because caffeine increases renal clearance of lithium, so a reduction in the lithium dose may be required when caffeine is withdrawn. Simultaneous use is not recommended.

Disulfiram: Patients on disulfiram treatment should be cautioned to avoid using caffeine to avoid the risk of worsening alcohol withdrawal syndrome, due to the stimulant effect of caffeine on the cardiovascular and central nervous systems.

Ephedrine-like substances: Increased risk of drug addiction. Simultaneous use is not recommended.

Sympathomimetics or levothyroxine: By mutual potentiation may increase the chronotropic effect. Simultaneous use is not recommended.

Theophylline: Simultaneous use reduces the excretion of theophylline.

Antibacterials from quinolone group, enoxacin and pipemic acid, terbinafine, cimetidine, fluvoxamine and oral contraceptives: Increased caffeine half-life due to inhibition of liver cytochrome P450, so patients with liver dysfunction, heart rhythm disorders and latent epilepsy should avoid using caffeine.

Nicotine, phenytoin and phenylpropanolamine: Decreases the terminal half-life of caffeine.

Clozapine: Caffeine increases the serum concentration of clozapine, probably through both pharmacokinetic and pharmacodynamic mechanisms. Monitoring of the serum concentration of clozapine is necessary. Concurrent use is not recommended.

Effect on laboratory studies

High doses of ASA may distort the results of a number of clinical and biochemical laboratory studies.

The use of paracetamol may affect the results of uric acid determination by the phosphoric acid/peroxidase method and glycemia by the glucose oxidase/peroxidase method.

Caffeine can reverse the effects of dipyridamole on myocardial blood flow, thus distorting the results of this study. It is necessary to refrain from taking caffeine for 8-12 h.

Special Instructions

General

This medication should not be taken concomitantly with medications containing ASA or paracetamol.

Similar to other migraine medications, caution should be exercised to rule out other potentially serious neurological disorders before starting treatment of suspected migraine in patients who have not previously been diagnosed with migraine, or in those patients in whom migraine presents with atypical symptoms.

If patients experience vomiting during >20% of migraine attacks or require bed rest during >50% of attacks, the drug should not be used.

If migraine after taking the first two tablets of the drug does not stop, it is necessary to seek medical attention.

The drug should not be used if during at least the last three months the patient had more than 10 headache attacks per month. In this case, the headache should be suspected due to excessive use of medication and the treatment should be cancelled.

In addition, patients should seek medical attention. Caution should be exercised in patients with risk factors for dehydration, such as vomiting, diarrhea, or before or after major surgery.

Because of its pharmacodynamic properties, the drug may mask signs and symptoms of infection.

Due to the content of acetylsalicylic acid in the drug

The drug should be used with caution in patients with gout, impaired renal or hepatic function, dehydration, uncontrolled arterial hypertension, deficiency of glucose-6-phosphate dehydrogenase and diabetes.

Due to inhibition of platelet aggregation by ASA the drug may lead to prolongation of bleeding time during and after surgical interventions (including minor ones, such as tooth extraction).

The drug should not be used simultaneously with anticoagulants and other drugs that disrupt blood clotting without physician’s supervision (see section “Interaction with other medicinal products”). Patients with blood clotting disorders should be closely monitored. Caution should be exercised in case of meto- or menorrhagia.

If a patient develops bleeding or gastrointestinal ulceration while taking the drug, it should be discontinued immediately. At any time of treatment with any NSAIDs, potentially fatal bleeding, ulceration and perforation of the GI tract may occur, with or without precursors and severe gastrointestinal complications in the history.

These complications tend to be more severe in older patients. Alcohol, glucocorticosteroids and NSAIDs may increase the risk of gastrointestinal bleeding (see section “Interaction with other medicinal products”).

The drug may contribute to the development of bronchospasm and exacerbation of bronchial asthma (including bronchial asthma due to intolerance to analgesics) or other hypersensitivity reactions. Risk factors include bronchial asthma, seasonal allergic rhinitis, nasal polyposis, chronic obstructive pulmonary disease, chronic respiratory tract infections (especially those associated with symptoms characteristic of allergic rhinitis).

These phenomena may also occur in patients with allergic reactions (e.g., skin, including itching and urticaria) to other substances. In such patients it is recommended to exercise special caution.

Children under 18 years of age should not be prescribed medicines containing acetylsalicylic acid as an antipyretic because they can increase the risk of Reye’s syndrome in case of viral infection. Symptoms of Reye syndrome are hyperpyrexia, prolonged vomiting, metabolic acidosis, nervous system and mental disorders, hepatomegaly and liver dysfunction, acute encephalopathy, respiratory disorders, seizures, coma.

ASK can distort the results of laboratory tests of thyroid function due to false positive low concentrations of levothyroxine (T4) and triiodothyronine (Tz) (see section “Interaction with other medicines”).

Due to the paracetamol content of the drug

Caution should be exercised when prescribing the drug to patients with impaired renal or hepatic function or alcohol dependence.

The risk of paracetamol poisoning is increased in patients taking other potentially hepatotoxic drugs or drugs that induce microsomal liver enzymes (such as rifampicin, isoniazid, chloramphenicol, sleeping pills and anticonvulsants, including phenobarbital, phenytoin and carbamazepine). Patients with alcoholism in anamnesis are in a special risk group for liver damage (see section “Interaction with other medicinal products”).

Serious skin reactions such as acute generalized exanthematous pustulosis, Stevens-Johnson syndrome, toxic epidermal necrolysis may develop during drug administration, which may be fatal. Patients should be informed about the signs of serious skin reactions. The drug should be discontinued at the first manifestations of skin reactions or any other signs of hypersensitivity.

Due to the caffeine content of the drug

The drug should be used with caution in patients with gout, hyperthyroidism and arrhythmia.

When using the drug it is necessary to limit consumption of products containing caffeine, because the excessive intake of caffeine can lead to nervousness, irritability, insomnia and, in some cases, palpitations.

Influence on ability to drive vehicles and mechanisms

Studies on the effect on the ability to drive vehicles and operate mechanisms have not been conducted. In case of adverse reactions such as dizziness or somnolence, you should refrain from these activities and inform the physician.

Contraindications

Hypersensitivity to the main or excipients of the drug;
Errotic ulcers of the gastrointestinal tract (in the acute phase), gastrointestinal bleeding or perforation, peptic ulcer in the anamnesis;
complete or incomplete combination of bronchial asthma, recurrent polyposis of the nose and sinuses, and intolerance to acetylsalicylic acid or other non-steroidal anti-inflammatory drugs (including acetylsalicylic acid or other non-steroidal anti-inflammatory drugs).ч. history);
hemophilia and other blood clotting disorders; hemorrhagic diathesis, hypoprothrombinemia;
vitamin K deficiency;
portal hypertension;

chronic heart failure III-IV functional class by NYHA;

arterial hypertension grade III;

pregnancy;

pregnancyperiod of breastfeeding;

glaucoma;

deficiency of glucose-6-phosphate dehydrogenase;

surgical interventions with profuse bleeding;

children under 15 years of age as an anesthetic, with febrile syndrome under 18 years of age;

concurrent administration of methotrexate at a dose greater than 15 mg/week.

With caution

. Mild to moderate renal or hepatic impairment, advanced age, gout, alcoholism, epilepsy and susceptibility to seizures, chronic heart failure NYHA functional class I-II, coronary heart disease, cerebrovascular disease, peripheral artery disease, smoking, chronic obstructive pulmonary disease, concomitant use of methotrexate at a dose less than 15 mg/week, concomitant therapy with anticoagulants, advanced age, concomitant use with nonsteroidal anti-inflammatory drugs, glucocorticosteroids, anticoagulants, antiaggregants, selective serotonin reuptake inhibitors.

Side effects

Many of the listed adverse reactions are clearly dose-dependent and vary from patient to patient. The frequency of adverse drug reactions is classified according to the recommendations of the World Health Organization: very common (>1/10), common (>1/100 to ≤1/10), infrequent (>1/1000 to ≤1/100), rare (>1/10000 to ≤1/1000), very rare (≤1/10000), frequency unknown (frequency of occurrence cannot be determined based on available data).

Infections and invasions:
rarely – pharyngitis.

Metabolic and nutritional disorders:
rarely – decreased appetite.

Mental disorders:
often – nervousness;
infrequently – insomnia;
rarely – anxiety, euphoric mood, inner tension.

Nervous system disorders:
often – dizziness;
infrequently – tremor, paresthesias, headache;
rarely – taste disorder, attention disorder, amnesia, impaired movement coordination, hyperesthesia, pain in the paranasal sinuses.

Visual organ disorders:
rarely – visual impairment.

Hearing organ disorders:
infrequent – tinnitus.

Cardiovascular system disorders:
infrequent – arrhythmia.

Vascular disorders:
rarely – hyperemia, peripheral circulation disorders.

Respiratory system disorders, thoracic and mediastinal organs:
rarely – nasal bleeding, hypoventilation, rhinorrhea.

Disorders of the digestive system:
frequently – nausea, abdominal discomfort;
infrequently – dry mouth, diarrhea, vomiting;
rarely – belching, flatulence, dysphagia, paresthesias in the mouth, increased salivation.

Skin and subcutaneous tissue disorders:
rarely – hyperhidrosis, itching, urticaria.

Musculoskeletal system disorders:
rarely – musculoskeletal stiffness, neck pain, back pain, muscle spasms.

General disorders:
infrequently – fatigue, increased excitability;
rarely – asthenia, heaviness in the chest.

Other:
infrequent – increased heart rate.

Post-registration follow-up data

	System-organ class
Immune system side	Hypersensitivity
Mental disorders	Anxiety
Nervous system disorders	Migraine, somnolence
Skin and subcutaneous tissue disorders		Erythema, rash, angioedema, erythema multiforme
Cardiovascular system disorders		Heart palpitations
Vascular disorders		Decreased blood pressure
Respiratory system, thoracic and mediastinal organ disorders	Shortness of breath, bronchospasm <
Digestive system disorders		Epigastric pain, dyspepsia, abdominal pain, gastrointestinal bleeding (including upper gastrointestinal tract, bleeding from the stomach, from gastric ulcer, from duodenal ulcer, from rectum), gastrointestinal erosive ulcers (including gastric, duodenal, colonic ulcer, peptic ulcer)
gastrointestinal disorders/td>
Liver and biliary tract disorders	Hepatic insufficiency <./td>
General disorders	Malaise, discomfort

There are no data on exacerbation or extension of the range of adverse effects of individual components when used in combination according to the instructions for use.

The increased risk of bleeding after taking acetylsalicylic acid persists for 4-8 days. Severe bleeding (e.g., cerebral hemorrhage) is very rare, especially in patients with untreated arterial hypertension and (or) with concomitant use of anticoagulants, in some cases life-threatening.

If you experience or worsen the side effects listed in the instructions, or if you notice any other side effects not listed in the instructions, tell your doctor.

Overdose

Acetylsalicylic acid.

In mild intoxication – dizziness, tinnitus, deafness, increased sweating, nausea, vomiting, headache and confusion. Occurs at plasma concentrations of 150-300 µg/ml.

The treatment is dose reduction or discontinuation of therapy.

At concentrations above 300 µg/ml, more severe intoxication occurs, manifesting as hyperventilation, fever, anxiety, ketoacidosis, respiratory alkalosis, and metabolic acidosis. Central nervous system depression may lead to coma, and cardiovascular collapse and respiratory failure may also occur.

The highest risk of chronic intoxication is seen in children and the elderly when more than 100 mg/kg/day is taken for several days.

Treatment- If ingestion of more than 120 mg/kg of salicylates is suspected, activated charcoal is given repeatedly orally within the last hour.If more than 120 mg/kg of salicylates are taken, their plasma concentration should be determined, although it is impossible to predict its severity based on this indicator alone; clinical and biochemical parameters should also be considered.

If plasma concentrations exceed 500 µg/ml (350 µg/ml for children younger than 5 years), intravenous sodium bicarbonate administration effectively removes salicylates from plasma. If plasma concentrations exceed 700 µg/ml (lower concentrations in children and the elderly) or in severe metabolic acidosis, hemodialysis or hemoperfusion is the therapy of choice.

Paracetamol overdose. In overdose intoxication is possible, especially in elderly patients, children, patients with liver disease (caused by chronic alcoholism), in patients with nutritional disorders, as well as in patients taking microsomal liver enzyme inducers, in which lightning hepatitis, liver failure, cholestatic hepatitis, cytolytic hepatitis may develop, in the above cases – sometimes with fatal outcome.

The clinical picture of acute overdose develops within 24 hours after taking paracetamol. Symptoms: gastrointestinal disorders (nausea, vomiting, decreased appetite, abdominal discomfort and (or) abdominal pain), pale skin.

Hepatocyte cytolysis with complete and irreversible liver necrosis, liver failure, metabolic acidosis and encephalopathy occurs when administered to adults 7.5 g or more or children more than 140 mg/kg at one time, which may lead to coma and death.

12-48 hours after administration of paracetamol an increase in the activity of microsomal liver enzymes, lactate dehydrogenase, bilirubin concentration and prothrombin decrease is noted. Clinical symptoms of liver damage appear 2 days after overdose of the drug and reach their maximum on the 4th-6th day.

The treatment is immediate hospitalization. Determination of plasma paracetamol quantification before starting treatment as soon as possible after overdose.

The administration of SH-group donators and precursors of glutathione synthesis-methionine and acetylcysteine-is most effective in the first 8 hours. The need for additional therapeutic measures (further administration of methionine, intravenous (IV) administration of acetylcysteine) is determined depending on the concentration of paracetamol in the blood, as well as on the time elapsed after its administration.

Symptomatic treatment. Laboratory studies of the activity of microsomal liver enzymes should be performed at the beginning of treatment and then – every 24 hours. In most cases, microsomal liver enzyme activity normalizes within 1-2 weeks. In very severe cases, liver transplantation may be necessary.

Caffeine.Common symptoms are gastralgia, agitation, delirium, anxiety, nervousness, restlessness, insomnia, mental agitation, muscle twitching, confusion, seizures, dehydration, rapid urination, hyperthermia, headache, increased tactile or pain sensitivity, nausea and vomiting (sometimes with blood), tinnitus.

In severe overdose, hyperglycemia may occur. Cardiac disorders are manifested by tachycardia and arrhythmia.

Treatment – dose reduction or abolition of caffeine.

Pregnancy use

Administration of the drug is contraindicated during pregnancy and breastfeeding because the safety of this combination in pregnant and breastfeeding women has not been studied.

Similarities

Ascophen-P, Coffil-plus, Citramon Ultra, Citramon, Citramon P, Citramon-ExtraCap, Brustrio

Additional information

Weight	0.015 kg
Shelf life	2 years.
Conditions of storage	Store in the original package, in a dry place at a temperature no higher than 25 ° C.
Manufacturer	Pharmstandard-Leksredstva, Russia
Medication form	pills
Brand	Pharmstandard-Leksredstva