Cofaceal-plus, tablets 20 pcs

Combination drug. The drug has analgesic, antipyretic and psychostimulant effects.

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

Caffeine increases reflex excitability of the spinal cord, excites respiratory and vasomotor centers, dilates blood vessels of skeletal muscles, brain, heart and kidneys, reduces platelet aggregation; it reduces sleepiness and fatigue, increases mental and physical performance. In this combination, a small dose of caffeine has almost 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, which is associated with its effect on the thermoregulation center in the hypothalamus and weak ability to inhibit the synthesis of prostaglandins in the peripheral tissues.

Indications

Cofaceal-Plus is used in adults with mild to moderate pain syndrome (of different genesis):

In adults and children over 15 years old to reduce elevated body temperature, with “colds” and other infectious and inflammatory diseases.

Active ingredient

Composition

How to take, the dosage

The drug is used orally after meals, 1-2 tablets 2-3 times a day. Maximum daily dose is 6 tablets. A break between doses of the drug should be at least 4 hours. In order to decrease irritating effects on the gastrointestinal tract the drug should be taken after a meal with water, milk or alkaline mineral water.

In case of impaired renal or hepatic function, a break of at least 6 hours between doses.

The drug should not be taken for more than 5 days when prescribed as a pain reliever and for more than 3 days as an antipyretic. Other dosages and routes of administration are determined by the physician.

Interaction

Acetylsalicylic acid increases the toxicity of methotrexate, reducing its renal clearance, valproic acid; enhances the effects of non-steroidal anti-inflammatory drugs, narcotic analgesics, oral hypoglycemic drugs, heparin, indirect anticoagulants, thrombolytics and antiaggregants, sulfonamides (including co-trimoxazole), T3 (triiodothyronine); reduces the effect of uricosuric drugs (benzbromaron, sulfinpyrazone), hypotensive drugs, diuretics (spironolactone, furosemide).

Glucocorticosteroid drugs, ethanol and ethanol-containing drugs increase the damaging effect on the gastrointestinal mucosa, increase the risk of gastrointestinal bleeding.

Enhances concentrations of digoxin, barbiturates, lithium salts in plasma.

Antacids containing magnesium ions and/or aluminum ions slow down and impair absorption of acetylsalicylic acid

Myelotoxic drugs increase manifestations of hematotoxicity of acetylsalicylic acid.

Paracetamol reduces the effectiveness of uricosuric drugs. Concomitant use of paracetamol in high doses increases the effect of anticoagulant drugs (decrease in the synthesis of procoagulant factors in the liver).

The inducers of microsomal liver enzymes (phenytoin, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants), ethanol and hepatotoxic medicines increase production of hydroxylated active metabolites, which leads to possibility of severe intoxications even in case of small overdose.

Long-term use of barbiturates reduces the effectiveness of paracetamol. Simultaneous use of paracetamol and ethanol increases the risk of hepatotoxic effects.

Microsomal oxidation inhibitors (including cimetidine) reduce the risk of hepatotoxic effects.

Long-term co-use of paracetamol and other non-steroidal anti-inflammatory drugs increases the risk of developing “analgesic” nephropathy and renal papillary necrosis, the onset of terminal renal failure.

The simultaneous long-term administration of high-dose paracetomol and salicylates increases the risk of developing kidney or bladder cancer.

Diflunisal increases the plasma concentration of paracetamol by 50% – risk of hepatotoxicity.

Myelotoxic drugs increase the manifestation of hematotoxicity of the drug.

The T1/2 of chloramphenicol is increased 5-fold under exposure to paracetamol. When repeatedly taken, paracetamol may increase the effect of anticoagulants (coumarin derivatives).

Caffeine is an adenosine antagonist (large doses of adenosine may be required).

When caffeine and barbiturates, primidone, anticonvulsant drugs (hydantoin derivatives, especially phenytoin) are used together, caffeine metabolism may be increased and clearance may be increased; cimetidine, oral contraceptive drugs, disulfiram, ciprofloxacin, norfloxacin decrease metabolism of caffeine in the liver (slowing its excretion and increasing its concentration in blood).

Mexiletine – reduces caffeine excretion by up to 50%; nicotine – increases the rate of caffeine excretion.

Monoamine oxidase inhibitors, furazolidone, procarbazine, and selegiline – large doses of caffeine can cause dangerous cardiac arrhythmias or marked increases in blood pressure.

Caffeine reduces absorption of calcium medications into the biliary tract.

Decreases the effect of narcotic and sleeping medications.

Increases urinary excretion of lithium preparations.

Accelerates absorption and enhances the effect of cardiac glycosides and increases their toxicity.

The co-use of caffeine with beta-adrenoblockers may lead to mutual suppression of therapeutic effects; with adrenergic bronchodilators – to additional stimulation of the central nervous system.

Special Instructions

The drug is not prescribed as anesthetic in adolescents under 18 years of age, as antipyretic in children 15 years of age with acute respiratory diseases caused by viral infections due to the risk of Reye syndrome (encephalopathy and acute fatty liver dystrophy with acute development of hepatic
failure).

Long-term use of the drug requires monitoring of peripheral blood and functional status of the liver.

As acetylsalicylic acid slows blood clotting, the patient should warn the physician in advance about taking the drug if they are going to have surgery.

Acetylsalicylic acid at low doses reduces uric acid excretion. In patients with the appropriate predisposition, this may in some cases provoke an attack of gout.

At the time of treatment, ethanol should be avoided (increased risk of gastrointestinal bleeding).

Impact on driving and operating machinery

When taken orally in high doses (up to 8 pills/day), the caffeine in the drug impairs concentration, so avoid driving and engaging in potentially dangerous activities requiring increased concentration and quick psychomotor reactions.

Contraindications

Side effects

Gastralgia, nausea, vomiting, hepatotoxicity, nephrotoxicity, gastrointestinal erosive ulcers, allergic reactions (including Stevens-Johnson syndrome, Lyell), tachycardia, increased blood pressure, bronchospasm. Reye syndrome in children (hyperpyrexia, metabolic acidosis, nervous system and mental disorders, vomiting, liver dysfunction).

Dizziness, headache, visual disturbances, tinnitus, decreased platelet aggregation, hypocoagulation, hemorrhagic syndrome (nasal bleeding, bleeding gums, purpura, etc.), renal damage with papillary necrosis; deafness.

Overdose

Symptoms due to acetylsalicylic acid: in mild intoxication – nausea, vomiting, gastralgia, dizziness, tinnitus; severe intoxication – lethargy, drowsiness, collapse, seizures, bronchospasm, difficult breathing, anuria, bleeding.

Initially, central pulmonary hyperventilation leads to respiratory alkalosis (shortness of breath, choking, cyanosis, sweating). As intoxication increases, progressive respiratory paralysis and dissociation of oxidative phosphorylation cause respiratory acidosis.

The symptoms due to paracetamol: during the first 24 h after ingestion – pallor of the skin, nausea, vomiting, anorexia, abdominal pain; impaired glucose metabolism, metabolic acidosis. Symptoms of liver dysfunction may appear 12-48 hours after overdose. In severe intoxication – hepatic failure with progressive encephalopathy, coma, death; acute renal failure with tubular necrosis (including in the absence of severe liver damage); arrhythmia, pancreatitis.

Chronic overdose:

The symptoms caused by acetylsalicylic acid: with prolonged use – dizziness, headache, visual disturbances, tinnitus, decreased platelet aggregation, hypocoagulation, hemorrhagic syndrome (nose bleeding, bleeding gums, purpura and others), kidney damage with papillary necrosis, deafness.

The symptoms caused by paracetamol: with prolonged use in high doses, hepatotoxic and nephrotoxic effects are possible (renal colic, hemolytic anemia, aplastic anemia, methemoglobinemia, pancytopenia). Hepatotoxic effect in adults occurs when taking 10 g or more.

Treatment: continuous monitoring of changes in the parameters of acid-base balance (ABB) and electrolyte balance; depending on the state of metabolism – administration of sodium hydrocarbonate, sodium citrate or sodium lactate. Increasing reserve alkalinity enhances excretion of acetylsalicylic acid due to alkalinization of urine. In the presence of liver damage, donators of SH-groups and precursors of glutathione synthesis – methionine – are administered within 8-9 hours after overdose and acetylcysteine – within 8 hours. The need for additional therapeutic measures (further administration of methionine, intravenous administration of acetylcysteine) is determined depending on the concentration of paracetamol in the blood, as well as on the time elapsed after its administration.

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

Pregnancy use

Similarities