Alex (ANTIHISTAMINICES)

treatment of symptoms of year-round and seasonal allergic rhinitis and allergic conjunctivitis (such as itching, sneezing, nasal congestion, rhinorrhea, lacrimation, conjunctival hyperemia),

hay fever (hay fever),

urticaria,

allergic dermatoses, including atopic dermatitis, accompanied by itching and rashes.

It is indicated in adults and children from 6 months and older for relief:

- nasal and ocular symptoms of year-round (persistent) and seasonal (intermittent) allergic rhinitis and allergic conjunctivitis: itching, sneezing, nasal congestion, rhinorrhea, lacrimation, conjunctival hyperemia,

- symptoms of chronic idiopathic urticaria.

Symptomatic treatment of allergic rhinitis and conjunctivitis (including year-round and seasonal), hay fever( pollinosis), idiopathic urticaria and other allergic dermatoses accompanied by itching and rashes.

Symptomatic treatment of allergic rhinitis and conjunctivitis (including year-round and seasonal), hay fever( pollinosis), idiopathic urticaria and other allergic dermatoses accompanied by itching and rashes.

Inside.

Children over 6 years old and adults: the initial dose is 5 mg (1/2 table. or 10 drops) 1 time a day, if necessary, you can increase it to 10 mg (1 table. or 20 drops) 1 time a day. Sometimes the initial dose is 5 mg (1/2 table. or 10 drops) may be sufficient to achieve a therapeutic effect. The daily dose is 10 mg (1 table. or 20 drops).

Children from 6 to 12 months: 2.5 mg (5 drops) 1 time a day.

Children from 1 to 2 years old: 2.5 mg (5 drops) up to 2 times a day.

Children from 2 to 6 years old: 2.5 mg (5 drops) 2 times a day or 5 mg (10 drops) 1 time a day.

In patients with renal insufficiency, the dose is reduced depending on the creatinine clearance: with a creatinine Cl of 30-49 ml/min — 5 mg once a day, with 10-29 ml/min — 5 mg every other day.

Since Alex (ANTIHISTAMINICES)^® it is excreted from the body by the kidneys, when prescribing the drug to patients with renal insufficiency and elderly patients, the dose should be adjusted depending on the amount of creatinine clearance. Creatinine clearance for men can be calculated based on the concentration of serum creatinine, using the following formula:

Cl creatinine clearance, ml/min

Creatinine clearance for women can be calculated by multiplying the obtained value by a factor of 0.85.

In adult patients with renal and hepatic insufficiency, the dosage is carried out according to the table above.

In children with renal insufficiency, the dose is adjusted taking into account creatinine clearance and body weight.

Patients with impaired liver function alone do not need to adjust the dosage regimen.

Inside.

The drops are dissolved in a small amount of water before taking them.

Adults and adolescents over 12 years of age: 10 mg (20 drops or 1 tablet) once a day, preferably at night.

Children aged 6-12 years: 5 mg (10 drops or 1/2 tablet) 2 times a day (morning and evening) or 10 mg (20 drops or 1 whole tablet) in the evening.

Children aged 1-6 years it is recommended to prescribe Alex (ANTIHISTAMINICES)^® in the dosage form of drops for oral administration.

Children aged 2-6 years: 5 mg (10 drops per day) once. You can also divide this dose into 2 doses of 2.5 mg (5 drops in the morning and evening).

Children aged 1-2 years: 2.5 mg (5 drops) 2 times a day.

Special patient groups

It may be necessary to reduce the dose in patients with elderly patients.

By impaired renal function the dose should be set individually, in accordance with the function of the kidneys. The table below will help you select the dose. To use this table, the patient's creatinine Cl in ml/min should be evaluated. After determining the serum creatinine concentration (mg/dl), the creatinine Cl value can be estimated using the following formula:

Creatinine Cl = [(140−age, years) × body weight, kg)/ (72-serum creatinine, mg/dl]

When calculating creatinine clearance for women, the result should be multiplied by 0.85. The table shows the doses depending on the Cl of creatinine.

Table

Dose selection depending on creatinine clearance

Inside, drip into a spoon or dissolve in water.

The amount of water to dissolve the drug should correspond to the amount of liquid that the patient (especially the child) is able to swallow. The solution should be taken immediately after preparation.

Adults. 10 mg (20 drops) 1 time a day. Sometimes an initial dose of 5 mg (10 drops) may be sufficient if it allows for satisfactory symptom control.

Old age. In elderly patients with normal renal function, there is no need to reduce the dose.

Impaired renal function. When prescribing the drug to patients with impaired renal function in cases where alternative treatment cannot be prescribed, the dose should be adjusted depending on the amount of Cl creatinine, since cetirizine is mainly excreted from the body by the kidneys.

The Cl creatinine index for men can be calculated based on the concentration of serum creatinine in blood plasma using the following formula:

Creatinine Cl, ml / min = (140-age, years) × body weight, kg)/(72 × Creatinine Cl_sivaram, mg/dl).

Creatinine Cl for women can be calculated by multiplying the obtained value by a factor of 0.85.

Impaired liver function. Patients with impaired liver function do not need to adjust the dosage regimen. In patients with impaired liver and kidney function, a dosage adjustment is recommended (see the table above).

Children. Use in children from 6 to 12 months is possible only on the prescription of a doctor and under strict medical supervision. Children from 6 to 12 months — 2.5 mg (5 drops) 1 time a day, from 1 year to 6 years-2.5 mg (5 drops) 2 times a day, from 6 to 12 years-5 mg (10 drops) 2 times a day, over 12 years-10 mg (20 drops) 1 time a day, sometimes an initial dose of 5 mg (10 drops) may be sufficient if it allows you to achieve satisfactory control of symptoms.

In children with renal insufficiency, the dose is adjusted to take into account Cl creatinine and body weight.

Instructions for opening the bottle

The bottle is closed with a lid with a safety device that prevents children from opening it. The bottle opens with a strong downward pressure of the lid, followed by unscrewing it counterclockwise. After use, the bottle cap must be tightly screwed back on.

Inside, swallowing whole, with a small amount of water, regardless of the time of the meal.

The drug Zincet is used as prescribed by a doctor (to avoid complications).

Children from 2 to 6 years: 2.5 mg (1/2 teaspoon of syrup) 2 times a day or 5 mg (1 teaspoon) 1 time a day, from 6 to 12 years: 10 mg (1 table. or 2 teaspoons of syrup) 1 time a day or 5 mg (1/2 table. or 1 teaspoon of syrup) 2 times a day, morning and evening, adults and children over 12 years: 10 mg (1 table. or 2 teaspoons of syrup) 1 time a day.

In the elderly or in patients with severe hepatic and / or renal impairment, the drug is prescribed by a doctor individually, in a reduced dose.

If you accidentally miss the time of taking the drug, the next dose should be taken as soon as possible. In the event that the time of the next dose of the drug is approaching, the next dose should be taken according to the schedule, without increasing the total dose.

Inside, swallowing whole, with a small amount of water, regardless of the time of the meal.

The drug Alex (ANTIHISTAMINICES) is used as prescribed by a doctor (to avoid complications).

Children from 2 to 6 years: 2.5 mg (1/2 teaspoon of syrup) 2 times a day or 5 mg (1 teaspoon) 1 time a day, from 6 to 12 years: 10 mg (1 table. or 2 teaspoons of syrup) 1 time a day or 5 mg (1/2 table. or 1 teaspoon of syrup) 2 times a day, morning and evening, adults and children over 12 years: 10 mg (1 table. or 2 teaspoons of syrup) 1 time a day.

In the elderly or in patients with severe hepatic and / or renal impairment, the drug is prescribed by the doctor individually, in a reduced dose.

If you accidentally miss the time of taking the drug, the next dose should be taken as soon as possible. In the event that the time of the next dose of the drug is approaching, the next dose should be taken according to the schedule, without increasing the total dose.

Cetirizine-the active substance of the drug Alex (ANTIHISTAMINICES)^® — it is a metabolite of hydroxyzine, belongs to the group of competitive histamine antagonists and blocks H₁- histamine receptors.

Cetirizine prevents the development and facilitates the course of allergic reactions, has antipruritic and antiexudative effects. Cetirizine affects the early histamine-dependent stage of allergic reactions, limits the release of inflammatory mediators at the late stage of an allergic reaction, and also reduces the migration of eosinophils, neutrophils and basophils, and stabilizes the membranes of mast cells. Reduces capillary permeability, prevents the development of tissue edema, relieves smooth muscle spasm. Eliminates the skin reaction to the introduction of histamine, specific allergens, as well as cooling (with cold urticaria). Reduces histamine-induced bronchoconstriction in mild bronchial asthma

Cetirizine does not have anticholinergic and antiserotonin effects. In therapeutic doses, the drug practically does not cause a sedative effect. After taking cetirizine in a single dose of 10 mg, its effect develops after 20 minutes (in 50% of patients), after 60 minutes (in 95% of patients) and lasts for more than 24 hours.Against the background of course treatment, tolerance to the antihistamine effect of cetirizine does not develop. After discontinuation of therapy, the effect persists for up to 3 days.

Cetirizine is a metabolite of hydroxyzine, belongs to the group of competitive histamine antagonists and blocks H₁- histamine receptors.

In addition to the antihistamine effect, cetirizine prevents the development and facilitates the course of allergic reactions: at a dose of 10 mg 1 or 2 times a day, it inhibits the late phase of eosinophil aggregation in the skin and conjunctiva of patients exposed to atopy.

Clinical efficacy and safety. Studies in healthy volunteers have shown that cetirizine at doses of 5 or 10 mg significantly inhibits the reaction in the form of rash and redness to the introduction of histamine into the skin in high concentrations, but a correlation with the effectiveness has not been established. In a 6-week placebo-controlled study involving 186 patients with allergic rhinitis and concomitant bronchial asthma of mild and moderate severity, it was shown that taking cetirizine at a dose of 10 mg once a day reduces the symptoms of rhinitis and does not affect lung function.

The results of this study confirm the safety of the use of cetirizine in patients suffering from allergies and mild to moderate bronchial asthma.

In a placebo-controlled study, it was shown that taking cetirizine at a dose of 60 mg / day for 7 days did not cause a clinically significant prolongation of the QT interval. Taking cetirizine at the recommended dose showed an improvement in the quality of life of patients with year-round and seasonal allergic rhinitis.

Children. In a 35-day study involving patients aged 5-12 years, there were no signs of immunity to the antihistamine effect of cetirizine. The normal reaction of the skin to histamine was restored within 3 days after discontinuation of the drug with its repeated use.

In a 7-day placebo-controlled trial of cetirizine in the dosage form syrup with 42 patients aged 6 to 11 months, the safety of the drug was demonstrated.

Cetirizine was administered at a dose of 0.25 mg / kg 2 times a day, which approximately corresponded to 4.5 mg per day (the dose range was from 3.4 to 6.2 mg per day).

Use in children from 6 to 12 months is possible only on the prescription of a doctor and under strict medical supervision.

The pharmacokinetic parameters of cetirizine vary linearly.

Suction. After oral administration, the drug is quickly and completely absorbed from the gastrointestinal tract. Food intake does not affect the completeness of absorption, although its rate decreases. In adults after a single dose of the drug at a therapeutic dose of C_max in the blood plasma is 300 ng / ml and is reached after (1±0.5) hours.

Distribution. Cetirizine binds to plasma proteins by (93±0.3)%. V_d it is 0.5 l/kg. When taking the drug at a dose of 10 mg for 10 days, cetirizine accumulation is not observed.

Metabolism. In small amounts, it is metabolized in the body by O-dealkylation (unlike other H antagonists₁- histamine receptors, which are metabolized in the liver by the cytochrome system) to form a pharmacologically inactive metabolite.

Output. In adults, T_1/2 it is approximately 10 hours, in children from 6 to 12 years — 6 hours, from 2 to 6 years-5 hours, from 6 months to 2 years-3.1 hours. Approximately 2/3 of the dose of the drug is excreted by the kidneys in unchanged form.

In elderly patients and patients with chronic liver diseases with a single dose of the drug at a dose of 10 mg T_1/2 increases by about 50%, and system clearance decreases by 40%.

In patients with mild renal insufficiency (creatinine Cl >40 ml/min), the pharmacokinetic parameters are similar to those in patients with normal renal function.

In patients with moderate renal insufficiency and in patients on hemodialysis (creatinine Cl <7 ml / min), when taking the drug orally at a dose of 10 mg T_1/2 it is prolonged by 3 times, and the total clearance is reduced by 70% relative to these indicators in patients with normal renal function, which requires a corresponding change in the dosage regimen.

Cetirizine is practically not removed from the body during hemodialysis.

The pharmacokinetic parameters of cetirizine when used in doses from 5 to 60 mg vary linearly.

Suction. C_max in the blood plasma, it is reached after (1±0.5) h and is 300 ng / ml.

Various pharmacokinetic parameters, such as C_max in blood plasma and AUC, have a homogeneous character.

Food intake does not affect the full absorption of cetirizine, although its rate decreases. The bioavailability of various dosage forms of cetirizine (solution, capsules, tablets) is comparable.

Distribution. Cetirizine binds to plasma proteins by (93±0.3)%.

V_d it is 0.5 l/kg. Cetirizine does not affect the binding of warfarin to proteins.

Metabolism. Cetirizine does not undergo extensive primary metabolism.

Output. T_1/2 it is approximately 10 hours.

When taking the drug at a daily dose of 10 mg for 10 days, cetirizine accumulation was not observed.

Approximately 2/3 of the taken dose of the drug is excreted in the urine in an unchanged form.

Elderly patients. In 16 elderly patients with a single dose of the drug at a dose of 10 mg T_1/2 It was 50% higher and clearance was 40% lower compared to non-elderly patients. The decrease in cetirizine clearance in elderly patients is probably associated with a decrease in renal function in this category of patients.

Kidney failure. In patients with mild renal insufficiency (creatinine Cl >40 ml/min), the pharmacokinetic parameters are similar to those in healthy volunteers with normal renal function.

In patients with moderate renal insufficiency and in patients on hemodialysis (creatinine Cl <7 ml / min), when taking the drug orally at a dose of 10 mg T_1/2 it is extended by 3 times, and the total clearance is reduced by 70% relative to healthy volunteers with normal kidney function.

For patients with moderate or severe renal insufficiency, a corresponding change in the dosage regimen is required (see "Method of administration and doses").

Cetirizine is poorly removed from the body during hemodialysis.

Liver failure. In patients with chronic liver diseases (hepatocellular, cholestatic and biliary cirrhosis) with a single dose of the drug at a dose of 10 or 20 mg T_1/2 increases by about 50%, and clearance decreases by 40% compared to healthy subjects. Dose adjustment is only necessary in the case of a patient with hepatic insufficiency there is also a concomitant renal failure.

Children. T_1/2 in children from 6 to 12 years is 6 hours, from 2 to 6 years-5 hours, from 6 months to 2 years-reduced to 3.1 hours.

When studying the drug interaction of cetirizine with pseudoephedrine, cimetidine, ketoconazole, erythromycin, azithromycin, diazepam, glipizide and antipyrine, clinically significant adverse interactions were not detected.

When used concomitantly with theophylline (400 mg / day), the total clearance of cetirizine decreases by 16% (the kinetics of theophylline does not change).

When used concomitantly with ritonavir, the AUC of cetirizine increased by 40%, while the same indicator of ritonavir slightly changed (-11%).

Concomitant use with macrolides (azithromycin, erythromycin) and ketoconazole showed no ECG changes.

When using the drug in therapeutic doses, no data were obtained on the interaction with alcohol (at a blood alcohol concentration of 0.5 g/l). However, you should refrain from drinking alcohol during therapy with the drug in order to avoid depression of the central nervous system.

Before the appointment of allergological tests, a three-day "washing" period is recommended due to the fact that H₁- histamine receptor blockers inhibit the development of skin allergic reactions.

No drug interactions of cetirizine with other drugs were observed.

Based on the results of the conducted studies of drug interaction of cetirizine, in particular, studies of interaction with pseudoephedrine or theophylline at a dose of 400 mg/day, no clinically significant interactions were established.

Concomitant use of cetirizine with alcohol and other drugs that depress the central nervous system may contribute to a further decrease in concentration and reaction speed, although cetirizine does not enhance the effect of alcohol (at its concentration in the blood of 0.5 g/l).

It is not recommended to combine the drug with other drugs Since without consulting a doctor. When taken simultaneously with bronchodilators containing theophylline as the active substance, an increase in the frequency of side effects of the drug Zincet. Data on the interaction of cetirizine with alcohol have not yet been obtained. Despite this, the consumption of alcoholic beverages in the treatment of drug Since is not recommended.

It is not recommended to combine the drug Alex (ANTIHISTAMINICES) with other drugs without consulting a doctor. When taken simultaneously with bronchodilators containing theophylline as the active substance, an increase in the frequency of side effects of the drug Alex (ANTIHISTAMINICES). Data on the interaction of cetirizine with alcohol have not yet been obtained. Despite this, the use of alcoholic beverages in the treatment with the drug Alex (ANTIHISTAMINICES) is not recommended.