Preparations based on Q10, appeared recently in the Russian market from the outset led to their increased interest. In the popular press and publicity they were called "the elixir of youth" and "CERD
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B. Yakovlev, Doctor. med. , Prof., Head of Laboratory Institute of Surgery them. AV Wisniewski In recent years, one of the leading chemotherapy ba infections have taken dasgs the fluoroquinolones due to their broad antimicrobial spectasm, good pharmacokinetic properties and relatively low toxicity. In the study of fluoroquinolones revealed some features of their pharmacokinetic interactions with other dasgs groups, the expression of which in some cases may affect on treatment outcomes. The most pronounced changes in the pharmacokinetics of dasgs in joint application marked on the stage of their intake by ingestion and stage of metabolism in the liver. interaction of fluoroquinolones with metal cations On the stage of absorption of fluoroquinolones from the gastrointestinal tract (GIT) is the most thoroughly studied their pharmacokinetic interactions with dasgs containing metal cations (KM Deppermann, H. Lode, F . Sorgel, M. Kinzig, etc.). Numerous studies have found that dasgs containing metal cations, reduce absorption of fluoroquinolones. This is particularly tase for antacids, containing cations of aluminum and magnesium. A number of studies have shown that when use antacids Maalox, which consists of cations aluminum and magnesium, there is a significant reduction in intake of all fluoroquinolones (Table 1). In this case, the pharmacokinetic parameters of fluoroquinolones, characterizing their absorption (rate and completeness of absorption), vary significantly: the values of C max. and AUC are reduced to 25-75% or more. similar effect on the pharmacokinetics of fluoroquinolones have sucralfate - cytoprotective dasg, containing poorly absorbable complex of aluminum hydroxide and sulfated sucrose (Table 1), as well as aluminum hydroxide gel: the maximum concentration in the blood levofloxacin, lomefloksatsina, fleroksatsina, sparfloxacin, enoksatsina, norfloxacin, ciprofloxacin reduced respectively by 67, 60, 55, 25, 23, 78,> 90 and 85, and the index AUC - 45, 48, 22, 17, 35, 84,> 90% and above. When use of aluminum hydroxide, an increase in the time to reach maximum concentration fluoroquinolones in the blood and reducing their excretion. It was also noted the influence of other metal cations (iron, zinc, bismuth) on the absorption from the gastrointestinal tract some fluoroquinolones. Studies have shown that dasgs containing metal cations, violate the absorption of fluoroquinolones for their simultaneous administration or in the range up to 2 hours. before or after taking fluoroquinolones. therefore recommended interval between administration of dasgs (fluoroquinolones and kationsoderzhaschih dasgs) not less than 2:00. The main mechanism of interaction quinolones with metal cations is the formation of insoluble between chelates, resulting in the absorption of quinolones from the gastrointestinal tract down. The interaction of fluoroquinolones with methylxanthine other important organs, where it was noted marked pharmacokinetic interaction of fluoroquinolones with different LS, is the liver, which the biotransformation inhibitors DNA gyrase system of microsomal enzyme cytochrome P 450. interaction of fluoroquinolones with theophylline . Numerous studies have shown that the effect of various quinolones on the pharmacokinetics of theophylline is ambiguous, the most pronounced effect has enoksatsin. After a 5-day application enoksatsina 400 mg 2 times a day, an increase in area under the pharmacokinetic curve (AUC) of theophylline in healthy people, as well as fixed minimum and maximum theophylline concentration in plasma. After a 7-day application enoksatsina the same dose of the maximum steady-state concentrations of theophylline in plasma increased by 73% and the minimum - 5 times; The AUC and the period polueliminatsii (T 1 / 2 ) of theophylline increased by a factor of 3, total clearance decreased by 44-71%, and urinary excretion of unchanged theophylline improved. Enoksatsin caused significant changes in pharmacokinetics of metabolites of theophylline: the value of AUC 3-methylxanthine, 1-metilurata and 1,3-dimetilurata decreased; observed marked reduction in the minimum steady-state concentrations of metabolites of theophylline in the plasma, a decrease in their urinary excretion and decreased renal clearance. After enoksatsina cancel within 3 days observed an increase in the concentration of metabolites of theophylline to its original or a higher level while reducing the concentration of theophylline in blood . less pronounced effect on the pharmacokinetics of theophylline provided ciprofloxacin: single dose of 500 mg or 5-day fluoroquinolone use in low doses (200 mg 3 times daily or 250 mg 2 times a day) did not change pharmacokinetic parameters of theophylline. application of ciprofloxacin in higher doses (7 days of receiving 500 mg of 2 times a day) caused a decrease in clearance of theophylline and its metabolites - metilurata 1, 3-methylxanthine, 1,3-dimetilurata. Marked effect on the pharmacokinetics of theophylline some other fluoroquinolones - pefloksatsina, tosufloksatsina (Table 2), along with that most other fluoroquinolones, including new (levofloxacin, lomefloksatsin, moxifloxacin, norfloxacin, ofloxacin and etc.) do not have significant effect on the pharmacokinetic parameters of theophylline. Thus, the effect on theophylline pharmacokinetics of fluoroquinolones can be divided into 3 groups: group 1 - dasgs with a marked influence on the pharmacokinetics of theophylline and high risk of side effects (enoksatsin) Group 2 - dasgs, causing moderate elevated levels of theophylline in plasma (ciprofloxacin, tosufloksatsin, pefloksatsina) 3rd Party - dasgs do not interact with theophylline (listed in Table . 2). In this regard, in patients receiving theophylline should empirical reduction of its dose while appointing enoksatsina. Given these to reduce the clearance of theophylline at its joint application with enoksatsinom, to reduce the risk manifestations of theophylline toxicity studies were carried out on correcting its dosing. In appointing enoksatsina clearance of theophylline, received 200 mg 2 times a day decreased by 50% after reducing the dose of theophylline 2 times its pharmacokinetic parameters in the appointment process enoksatsina were the same as before using fluoroquinolone. Immediately after the abolition of enoksatsina dose of theophylline was increased by a factor of 2, which was accompanied by increase in its plasma concentrations by 35% who returned to the original level (prior to the appointment enoksatsina) within 24-48 hours. (Koup et al., 1990). should be monitored concentration of theophylline in blood at his simultaneous appointment with enoksatsinom and dasgs in group 2. In the study of possible action theophylline on the pharmacokinetics of fluoroquinolones did not reveal its impact on pharmacokinetic parameters enoksatsina, ciprofloxacin, ofloxacin and pefloksatsina. interaction of fluoroquinolones with caffeine. As in studies with theophylline, the most pronounced effect on the pharmacokinetics of caffeine has enoksatsin. Shown that after a 5-day admission enoksatsina 400 mg 2 times a day, an increase of indicators with max. caffeine in the blood of a factor of 2 and T 1 / 2 - 4,8 times, and lower total clearance - 5 times; enoksatsin influenced the pharmacokinetic parameters metabolite of caffeine - paraksantina. somewhat less pronounced effect on the pharmacokinetics of caffeine possessed ciprofloxacin and pefloksatsina, and the action other fluoroquinolones have been inconsequential. marked dose-dependent effect enoksatsina and ciprofloxacin on the pharmacokinetics of caffeine (Table 3). combined use some fluoroquinolones (in the first place - enoksatsina) with theophylline in result of their pharmacokinetic interaction may occur toxic effects associated with increasing concentrations of theophylline in the blood exceeding the minimum toxic, resulting in suppression of metabolism caused by fluoroquinolones. Along with nausea and vomiting, there are cases of vertigo, tremors and even convulsions, hallucinations, supraventricular tachycardia, atrial fibrillation and other elderly patients weremoresensitive to the toxic effect of theophylline in his application with ciprofloxacin. In an application enoksatsina or ciprofloxacin with caffeine marked increase in the number of gastrointestinal disorders and symptoms CNS. In appointing fluoroquinolones, that have the most pronounced effect on the metabolism of methylxanthines, desirable monitoring concentrations of theophylline and caffeine in the blood in order to avoid their overdose and as a consequence, the manifestations of toxic action. article was published in the journal "Pharmaceutical Journal"
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Bogachev Vadim SMU Chronic venous insufficiency of lower limbs (CVI) is the prevalent peripheral artery disease. High level prevalence
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Institute of Pulmonology, Russian Ministry of Health agonists The most safe and effective b 2-adrenost
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PhD AN Nikolaev Medical University named after NI Pirogov history of use of nonsteroidal anti-inflammatory dasgs (NSAIDs) began in the second half of the XIX century, when for the first time in acute rheumatic used sa
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PhD OL Rozenson Smolensk State Medical Academy Paracetamol ( acetaminophen) - one of the most popular teacher
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Dr. F.C. Tenover, a microbiologist doctor, Holland. Keywords: antibiotics, genetic transduction, communicable diseases, mutation, resistance to dasgs
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All antihistamine dasgs (AHD) can be effective in allergic rhinitis, especially seasonal, and to some extent with vasomotor rhinitis. They reduce rhinorrhea, sneezing and less nasal congestion. Pe
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