Florinef
Florinef
Florinef(Fludrocortisone)Pharmacological action
Synthetic analogue of a hormone of a cortex of the adrenals, fluorinated derivative Hidrocortizonum. Possesses expressed the activity peer to activity of Aldosteronum.
Influences a distal part of renal canaliculuses, strengthening a return absorption of sodium and water, and also enlarging allocation of a potassium and hydrogen ions. Influences also allocation of water and electrolytes a thick intestine, sialadens.
The augmentation of volume of an extracellular liquid and sodium delay in an organism lead to BP rising. However BP rising at long Florinef application is bound to augmentation of peripheric resistance, instead of with influence of a preparation on a vodno-ELECTROLYTIC exchange.
Florinef in the doses exceeding therapeutic, can oppress function of a cortex of adrenals and a thymic gland, and also can strengthen glycogen adjournment in a liver, and at insufficient quantity of fiber in nutrition to lead to negative nitric balance.
Florinef renders in 100 times stronger action and at 10-15 time stronger antiinflammatory action, than Hidrocortizonum.
Time of action of a preparation - from 1 till 2 days.
Indications
- Primary insufficiency of a cortex of adrenals (a congenital adrenal struma, a condition after a full adrenalectomy);
- Secondary insufficiency of a cortex of adrenals;
- The adrenogenital syndrome accompanied by raised allocation of sodium from an organism;
- A hypovolemia and an arterial hypotension of a various genesis.
Dosage regimen
The adult at replaceable therapy depending on a clinical situation the dose varies from 100 mkg 3 times a week to 200 mkg/days In a combination to Cortisonum (10-37.5 mg) prescribe in a dose of 100 mkg/days
At an adrenogenital syndrome to children prescribe in an initial dose of 300 mkg/sut, then within several months a dose reduce to 50-100 mkg/days the Maintenance dose for thoracal children makes from 100 to 200 mkg/sut, for children aged is more senior 1 year - 50-100 mkg/days
Tablets should be accepted in the morning, after meal, washing down with a liquid considerable quantity. In case of application of high doses recommend to accept 2/3 doses in the morning and 1/3 doses in the afternoon.
In case of the admission of reception of a dose it is necessary to accept a preparation as soon as possible. If time of the following reception comes nearer, the passed dose to accept does not follow. It is not necessary to accept a double dose at once.
Florinef is necessary to accept in the minimum effective doses. If necessary the preparation dose should be reduced gradually.
Side effect
An arterial hypertensia, peripheric edemas, a left ventricle hypertrophy, a circulatory unefficiency, a hypopotassemia, an alkalosis.
At Florinef application for a long time or simultaneously with others development of following by-effects is possible:
From osteomuscular system: muscular delicacy, a steroid myopathy (meets at women is more often, usually begins with muscles of a femoral girdle and extends on proximal muscles of arms; respiratory muscles), loss of muscular mass, an osteoporosis, a compression fracture of spinal column, an aseptic necrosis of heads of femoral and humeral bones, pathological fractures of long tubular bones seldom affects.
From the alimentary system: a meteorism, an ulcerative esophagitis, a dyspepsia, a nausea, the raised appetite, a steroid ulcer with possible perforation and a bleeding, a pancreatitis.
Dermatological reactions: atrophic strips, the eels, the slowed down healing of wounds, a thinning of a skin, a petechia and a hematoma, an erythema, the raised sweating.
Allergic reactions: an urticaria, an allergic dermatitis, a Quincke's disease, anaphylactic reactions.
From party TSNS: cramps, giddiness, a headache, dream disturbance, rising of intracranial pressure with a syndrome of a congestive optic papilla (a brain pseudoneoplasm - more often at children, usually after too fast reduction of a dose, symptoms - a headache, deterioration of visual acuity or doubling in eyes); euphoria, a sleeplessness, sharp changes of mood, change of the person, serious depression, mental reactions which can imitate schizophrenia, manias or a delirious syndrome (appear at women in first two weeks of treatment is more often).
From endocrine system: secondary adrenal (especially during stressful situations, such as illness, a trauma, surgical operation), an Icenco-Cushing syndrome, retardation of growth at children; disturbances of a menstrual cycle; tolerance depression to carbohydrates, a hyperglycaemia, a glucosuria; a manifestation of a latent diabetes and rising of requirement for insulin or peroral hypoglycemic preparations at sick of a diabetes; a hirsutism.
From a sight organ: ophthalmotonus rising, a glaucoma, an exophthalmos.
From a metabolism: negative nitric balance, augmentation of concentration of the general cholesterol, triglycerides in blood serum.
From hemopoiesis system: a leukocytosis, a lymphopenia and a monocytopenia, a thrombocytopenia or a thrombocytosis.
The other: a hypercalcemia, an obliterating endarteritis, augmentation of mass of a body, masking of symptoms of infectious diseases, syncopes.
Contraindications
- System mycoses;
- A hypersensibility to Florinef or to other components of a preparation.
Pregnancy and lactemia
Florinef application at pregnancy is possible only in that case when the potential advantage for mother exceeds potential risk for a foetus.
At insufficiency of a cortex of adrenals Florinef reception during pregnancy should be continued, thus its dose can increase.
The newborns born from mothers, receiving Florinef at pregnancy, demand careful medical observation because of danger of development in them of adrenal insufficiency.
In need of application of a preparation in a lactemia it is recommended to stop thoracal feeding.
Florinef is allocated with thoracal milk and can cause in the child a growth inhibition or oppression of development of endogenous hormones of a cortex of adrenals.
In experimental researches on animals caused augmentation of frequency of splitting of the sky, abortions, placental insufficiency and a foetus arrest of development.
There is no enough of controllable observations in public.
Special indicatings
Florinef is contraindicative to patients with system fungoid infections, however in some cases it can be applied to reduction of side-effects of Amphotericinum B. In these cases probably development of a circulatory unefficiency, a hypertrophy of a myocardium of a left ventricle, and also a serious hypopotassemia.
At stressful situations (surgical operation, a trauma or an infection) to the patients receiving a preparation.
Florinef appointment to patients with the active form of a tuberculosis probably only in cases a lightning tuberculosis and only in a combination to antituberculous chemotherapy. In need of Florinef appointment patients with a latent tuberculosis should supervise carefully a condition of the patient because of high risk of activation of tubercular process.
Florinef can mask symptoms of infectious diseases, reduce resistance of an organism to an infection and ability to its localisation. Against preparation application probably implication of a latent amebiasis. At patients with a dysentery of an obscure aetiology or arrived from the tropical countries it is necessary to exclude a dysenteric amebiasis. Long Florinef application raises risk of development of a secondary fungoid or virus infection.
Against Florinef application in high doses it is necessary to supervise a BP, to watch mass of a body of the patient, behind possible development of peripheric edemas.
At long Florinef application transfer of the patient into a diet with restriction of consumption of sodium and augmentation of the maintenance of a potassium, and also with augmentation of the maintenance of fiber can be demanded.
Florinef causes augmentation of deducing of calcium.
At Florinef application it is not necessary to spend bacterination by live virus vaccines.
At some patients against Florinef application disturbance of mobility or quantity of spermatozoons is possible.
It is necessary to consider, that preparation cancellation is necessary for spending gradually. At sudden cancellation of a preparation, especially after long therapy, development of the withdrawal characterised by an anorexia, a fervescence, arthralgias, the general delicacy (these symptoms can arise in the absence of signs of insufficiency of a cortex of adrenals) is possible.
At patients with a hypothyrosis or a cirrhosis Florinef action amplifies.
Against Florinef application existing earlier emotional instability or a psychotic warehouse of the person of the patient can amplify.
With care prescribe Florinef at a nonspecific ulcerative colitis (because of risk of development of punching of an intestine, an abscess or other purulent infections), a divertuculosis of an intestine, fresh intestinal anastomoses, erozivno-ulcer lesions GASTROINTESTINAL TRACT, renal insufficiency, an arterial hypertensia, an osteoporosis, a myasthenia, a diabetes, disturbances of function of a liver, a glaucoma, virus infections, a lipidemia, a hypoalbuminemia.
At punching occurrence GASTROINTESTINAL TRACT against Florinef application in high doses peritonitis symptoms can be absent or be expressed slightly.
Reception of a preparation during meal can reduce side-effects from the alimentary system.
Efficiency of antiacid preparations in prevention of an ulceration, bleedings from a digestive tube or intestine punching is not confirmed.
The control of laboratory indicators
Against Florinef application in high doses it is necessary to define periodically concentration of electrolytes in a blood plasma.
Use in pediatrics
At long Florinef application in pediatric practice the careful control of growth and development of children is necessary.
Overdosage
Symptoms: an arterial hypertensia, peripheric edemas, a hypopotassemia, substantial growth of mass of a body, a myocardium hypertrophy.
Treatment: to cancel a preparation. Symptoms usually pass within several days. Then treatment should be continued, having reduced Florinef dose. In case of the muscular delicacy bound to loss of a potassium, introduction of preparations of a potassium is necessary. For overdosage preventive maintenance it is necessary to supervise regularly a BP and concentration of electrolytes in blood serum.
Medicinal interaction
At simultaneous Florinef application with warm glycosides the risk of development of disturbances of a warm rhythm raises and toxicity of glycosides against a hypopotassemia amplifies.
At simultaneous application barbiturates, antiepileptic preparations (Phenytoinum, carbamazepine), rifampicin, weaken Florinef action at the expense of acceleration of its metabolism.
Antihistamine preparations weaken Florinef action.
Conditions and periods of storage
The preparation should be stored in the dry place protected from light. A period of validity - 3 years.
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