Spasmalgin

The Atropine (Spasmalgin)® (Atropine (Spasmalgin)) Auto-injector is indicated for the treatment of poisoning by susceptible organophosphorous nerve agents having cholinesterase activity as well as organophosphorous or carbamate insecticides. The Atropine (Spasmalgin) (Atropine (Spasmalgin)) auto-injector should be used by persons who have had adequate training in the recognition and treatment of nerve agent or insecticide intoxication. Pralidoxime chloride may serve as an important adjunct to Atropine (Spasmalgin) therapy.

The Atropine (Spasmalgin)® (Atropine (Spasmalgin)) is intended as an initial treatment of the muscarinic symptoms of insecticide or nerve agent poisonings (generally breathing difficulties due to increased secretions); definitive medical care should be sought immediately. The Atropine (Spasmalgin)® (Atropine (Spasmalgin)) Auto-injector should be administered as soon as symptoms of organophosphorous or carbamate poisoning appear (usually tearing, excessive oral secretions, wheezing, muscle fasciculations, etc.) In moderate to severe poisoning, the administration of more than one Atropine (Spasmalgin)® (Atropine (Spasmalgin)) may be required until atropinization is achieved (flushing, mydriasis, tachycardia, dryness of the mouth and nose). In severe poisonings, it may also be desirable to concurrently administer an anticonvulsant if seizure is suspected in the unconscious individual since the classic tonic-clonic jerking may not be apparent due to the effects of the poison. In poisonings due to organophosphorous nerve agents and insecticides it may also be helpful to concurrently administer a cholinesterase reactivator such as pralidoxime chloride.

Codeine (Spasmalgin) sulfate is an opioid analgesic indicated for the management of mild to moderately severe pain where the use of an opioid analgesic is appropriate.

Papaverine (Spasmalgin) is recommended in various conditions accompanied by spasm of smooth muscle, such as vascular spasm associated with acute myocardial infarction (coronary occlusion), angina pectoris, peripheral and pulmonary embolism, peripheral vascular disease in which there is a vasospastic element, or certain cerebral angiospastic states; and visceral spasm, as in ureteral, biliary, or gastrointestinal colic.

For systemic use of Paracetamol (Spasmalgin) Sante Naturelle: prevention and treatment of hypo- and avitaminosis of vitamin C; providing increased need for vitamin C during growth, pregnancy, lactation, with heavy loads, fatigue and during recovery after prolonged severe illness; in winter with an increased risk of infectious diseases.

For intravaginal use: chronic or recurrent vaginitis (bacterial vaginosis, nonspecific vaginitis) caused by the anaerobic flora (due to changes in pH of the vagina) in order to normalize disturbed vaginal microflora.

Atropine (Spasmalgin) produces many effects in the body such as reducing muscle spasms and fluid secretions.

Atropine (Spasmalgin) is used to help reduce saliva, mucus, or other secretions in your airway during a surgery. Atropine (Spasmalgin) is also used to treat spasms in the stomach, intestines, bladder, or other organs.

Atropine (Spasmalgin) is sometimes used as an antidote to treat certain types of poisoning.

Atropine (Spasmalgin) may also be used for purposes not listed in this medication guide.

Codeine (Spasmalgin) is an opioid pain medication. An opioid is sometimes called a narcotic.

Codeine (Spasmalgin) is used to treat mild to moderately severe pain.

Codeine (Spasmalgin) may also be used for purposes not listed in this medication guide.

Papaverine (Spasmalgin) belongs to the group of medicines called vasodilators. Vasodilators cause blood vessels to expand, thereby increasing blood flow. Papaverine (Spasmalgin) is used to produce erections in some men with erectile dysfunction. When Papaverine (Spasmalgin) is injected into the penis (intracavernosal), it increases blood flow to the penis, which results in an erection.

Papaverine (Spasmalgin) injection should not be used as a sexual aid by men who do not have erectile dysfunction. If the medicine is not used properly, permanent damage to the penis and loss of the ability to have erections could result.

Papaverine (Spasmalgin) is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, Papaverine (Spasmalgin) is used in certain patients with the following medical conditions:

• Low doses of a three-drug combination of Papaverine (Spasmalgin), phentolamine, and alprostadil as an injection may be used to treat erectile dysfunction.

Paracetamol (Spasmalgin) (acetaminophen) is a pain reliever and a fever reducer. The exact mechanism of Paracetamol (Spasmalgin) of is not known.

Paracetamol (Spasmalgin) is used to treat many conditions such as headache, muscle aches, arthritis, backache, toothaches, colds, and fevers. It relieves pain in mild arthritis but has no effect on the underlying inflammation and swelling of the joint.

Paracetamol (Spasmalgin) may also be used for other purposes not listed in this medication guide.

CAUTION! PRIMARY PROTECTION AGAINST EXPOSURE TO CHEMICAL NERVE AGENT AND INSECTICIDE POISONING IS THE WEARING OF PROTECTIVE GARMENTS INCLUDING MASKS, DESIGNED SPECIFICALLY FOR THIS USE.

INDIVIDUALS SHOULD NOT RELY SOLELY UPON THE AVAILABILITY OF ANTIDOTES SUCH AS Atropine (Spasmalgin) AND PRALIDOXIME TO PROVIDE COMPLETE PROTECTION FROM CHEMICAL NERVE AGENT AND INSECTICIDE POISONING.

Immediate evacuation from the contaminated environment is essential. Decontamination of the poisoned individual should occur as soon as possible.

The Atropine (Spasmalgin)® (Atropine (Spasmalgin)) Auto-injector is indicated for the treatment of poisoning by susceptible organophosphorous nerve agents having cholinesterase activity as well as organophosphorous or carbamate insecticides. The Atropine (Spasmalgin)® (Atropine (Spasmalgin)) auto-injector should be used by persons who have had adequate training in the recognition and treatment of nerve agent or insecticide intoxication. Pralidoxime chloride may serve as an important adjunct to Atropine (Spasmalgin) therapy.

The Atropine (Spasmalgin)® (Atropine (Spasmalgin)) is intended as an initial treatment of the muscarinic symptoms of insecticide or nerve agent poisonings (generally breathing difficulties due to increased secretions); definitive medical care should be sought immediately. The Atropine (Spasmalgin)® (Atropine (Spasmalgin)) Auto-injector should be administered as soon as symptoms of organophosphorous or carbamate poisoning appear (usually tearing, excessive oral secretions, wheezing, muscle fasciculations, etc.) In moderate to severe poisoning, the administration of more than one Atropine (Spasmalgin)® (Atropine (Spasmalgin)) may be required until atropinization is achieved (flushing, mydriasis, tachycardia, dryness of the mouth and nose). In severe poisonings, it may also be desirable to concurrently administer an anticonvulsant if seizure is suspected in the unconscious individual since the classic tonic-clonic jerking may not be apparent due to the effects of the poison. In poisonings due to organophosphorous nerve agents and insecticides it may also be helpful to concurrently administer a cholinesterase reactivator such as pralidoxime chloride.

It is recommended that three (3) Atropine (Spasmalgin)® (Atropine (Spasmalgin)) auto-injectors be available for use in each person at risk for nerve agent or organophosphate insecticide poisoning; one (1) for mild symptoms plus two (2) more for severe symptoms as described below. No more than three (3) Atropine (Spasmalgin)® (Atropine (Spasmalgin)) injections should be used unless the patient is under the supervision of a trained medical provider. Different dose strengths of the Atropine (Spasmalgin)® (Atropine (Spasmalgin)) are available depending on the recipient's age and weight.

• Adults and children weighing over 90 lbs (generally over 10 years of age)..............Atropine (Spasmalgin)® (Atropine (Spasmalgin)) 2 mg (green)
• Children weighing 40 lbs to 90 lbs (generally 4 to 10 years of age)..............Atropine (Spasmalgin)® (Atropine (Spasmalgin)) 1 mg (dark red)
• Children weighing 15 lbs to 40 lbs (generally 6 months to 4 years of age)..............Atropine (Spasmalgin)® (Atropine (Spasmalgin)) 0.5 mg (blue)

NOTE: Children weighing under 15 lbs (generally younger than 6 months old) should ordinarily not be treated with the Atropine (Spasmalgin)® auto-injector. Atropine (Spasmalgin) doses for these children should be individualized at doses of 0.05 mg/kg.

Treatment of MILD SYMPTOMS

One (1) Atropine (Spasmalgin)® (Atropine (Spasmalgin)) is recommended if two or more MILD symptoms of nerve agent (nerve gas) or insecticide exposure appear in situations where exposure is known or suspected.

Two (2) additional Atropine (Spasmalgin)® (Atropine (Spasmalgin)) injections given in rapid succession are recommended 10 minutes after receiving the first Atropine (Spasmalgin)® (Atropine (Spasmalgin)) injection if the victim develops any of the SEVERE symptoms listed below. If possible, a person other than the victim should administer the second and third Atropine (Spasmalgin)® (Atropine (Spasmalgin)) injections.

Treatment of SEVERE SYMPTOMS:

If a victim is encountered who is either unconscious or has any of the SEVERE symptoms listed below, immediately administer three (3) Atropine (Spasmalgin)® (Atropine (Spasmalgin)) injections into the victim's mid-lateral thigh in rapid succession using the appropriate weight-based Atropine (Spasmalgin)® (Atropine (Spasmalgin)) dose.

MILD SYMPTOMS of nerve agent or insecticide exposure include the following:

-Blurred vision, miosis

-Excessive unexplained teary eyes

-Excessive unexplained runny nose

-Increased salivation such as sudden unexplained excessive drooling

-Chest tightness or difficulty breathing

-Tremors throughout the body or muscular twitching

-Nausea and/or vomiting

-Unexplained wheezing or coughing

-Acute onset of stomach cramps

-Tachycardia or bradycardia

SEVERE SYMPTOMS of exposure to nerve agent or insecticides include the following:

-Strange or confused behavior

-Severe difficulty breathing or severe secretions from your lungs/airway

-Severe muscular twitching and general weakness

-Involuntary urination and defecation (feces)

-Convulsions

-Unconsciousness

All victims should be evacuated immediately from the contaminated environment. Medical help should be sought immediately. Protective masks and clothing should be used when available. Decontamination procedures should be undertaken as soon as possible. If dermal exposure has occurred, clothing should be removed and the hair and skin washed thoroughly with sodium bicarbonate or alcohol as soon as possible.

Emergency care of the severely poisoned individual should include removal of oral and bronchial secretions, maintenance of a patent airway, supplemental oxygen and, if necessary, artificial ventilation. In general, Atropine (Spasmalgin) should not be used until cyanosis has been overcome since Atropine (Spasmalgin) may produce ventricular fibrillation and possible seizures in the presence of hypoxia.

Pralidoxime (if used) is most effective if administered immediately or soon after the poisoning. Generally, little is accomplished if pralidoxime is given more than 36 hours after termination of exposure unless the poison is known to age slowly or re-exposure is possible, such as in delayed continuing gastrointestinal absorption of ingested poisons. Fatal relapses, thought to be due to delayed absorption, have been reported after initial improvement. Continued administration for several days may be useful in such patients.

Close supervision of all moderately to severely poisoned patients is indicated for at least 48 to 72 hours.

An anticonvulsant such as diazepam may be administered to treat convulsions if suspected in the unconscious individual. The effects of nerve agents and some insecticides can mask the motor signs of a seizure.

IMPORTANT: PHYSICIANS AND/OR OTHER MEDICAL PERSONNEL ASSISTING EVACUATED VICTIMS OF NERVE AGENTS AND INSECTICIDE POISONING SHOULD AVOID EXPOSING THEMSELVES TO CONTAMINATION BY THE VICTIM'S CLOTHING. AGGRESSIVE AND SAFE DECONTAMINATION IS STRONGLY SUGGESTED.

Instructions for administering Atropine (Spasmalgin)® (Atropine (Spasmalgin)) (please refer to the illustrated Self Aid and Caregiver Directions for Use elsewhere):

Warning: Giving additional Atropine (Spasmalgin)® (Atropine (Spasmalgin)) injections by mistake in the absence of actual nerve agent or insecticide poisoning may cause an overdose of Atropine (Spasmalgin) which could result in temporary incapacitation (inability to walk properly, see clearly or think clearly for several or more hours). Patients with cardiac disease may be at risk for serious adverse events, including death.

How supplied

The Atropine (Spasmalgin)® (Atropine (Spasmalgin)) is supplied in three strengths. The Atropine (Spasmalgin)® 0.5 mg provides Atropine (Spasmalgin) Injection (Atropine (Spasmalgin), 0.42 mg/0.7 ml), Atropine (Spasmalgin)® 1 mg provides Atropine (Spasmalgin) Injection (Atropine (Spasmalgin), 0.84 mg/0.7 ml), and Atropine (Spasmalgin)® 2 mg provides Atropine (Spasmalgin) Injection (Atropine (Spasmalgin), 1.67 mg/0.7 ml) in sterile solution for intramuscular injection. The Atropine (Spasmalgin)® (Atropine (Spasmalgin)) is a self-contained unit designed for self or caregiver administration.

Store at 25° C (77° F); excursions permitted to 15–30° C (59–86° F)

Keep from freezing. Protect from light.

Manufactured by: MERIDIAN MEDICAL TECHNOLOGIES, INC., 10240 Old Columbia Road, COLUMBIA, MD 21046. FDA Rev date: 9/17/2004

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet,

Oral, as sulfate:

Generic: 15 mg, 30 mg, 60 mg

Dosing: Adult

Pain management (analgesic):

Injection [Canadian product]:

Opioid-naive patients: IM, SubQ: 30 to 60 mg every 4 to 6 hours as needed (use the lowest effective dose for the shortest period of time necessary)

Conversion from oral Codeine (Spasmalgin) or another opioid: IM, SubQ: Refer to product labeling for dose conversions.

Oral: Note:

Immediate release (tablet, oral solution [Canadian product]): Initial: 15 to 60 mg every 4 hours as needed; maximum total daily dose: 360 mg/day; patients with prior opioid exposure may require higher initial doses. Note: The American Pain Society recommends an initial dose of 30 to 60 mg for adults with moderate pain (American Pain Society 2016).

Controlled release: Codeine (Spasmalgin) Contin [Canadian product]: Note: Titrate at intervals of ≥48 hours until adequate analgesia has been achieved. Daily doses >600 mg/day should not be used; patients requiring higher doses should be switched to an opioid approved for use in severe pain. In patients who receive both Codeine (Spasmalgin) Contin and an immediate release or combination Codeine (Spasmalgin) product for breakthrough pain, the rescue dose of immediate release Codeine (Spasmalgin) product should be ≤12.5% of the total daily Codeine (Spasmalgin) Contin dose.

Opioid-naive patients: Initial: 50 mg every 12 hours

Conversion from immediate release Codeine (Spasmalgin) preparations: Immediate release Codeine (Spasmalgin) preparations contain ~75% Codeine (Spasmalgin) base. Therefore, patients who are switching from immediate release Codeine (Spasmalgin) preparations may be transferred to a ~25% lower total daily dose of Codeine (Spasmalgin) Contin, equally divided into 2 daily doses every 12 hours.

Conversion from a combination Codeine (Spasmalgin) product (eg, Codeine (Spasmalgin) with acetaminophen or aspirin): See table:

Conversion from another opioid analgesic: Using the patient's current opioid dose, calculate an equivalent daily dose of immediate release Codeine (Spasmalgin). A ~25% lower dose of Codeine (Spasmalgin) Contin should then be initiated, equally divided into 2 daily doses.

Discontinuation of therapy: When discontinuing chronic opioid therapy, the dose should be gradually tapered down. An optimal universal tapering schedule for all patients has not been established (CDC [Dowell 2016]). Proposed schedules range from slow (eg, 10% reductions per week) to rapid (eg, 25% to 50% reduction every few days) (CDC 2015). Tapering schedules should be individualized to minimize opioid withdrawal while considering patient-specific goals and concerns as well as the pharmacokinetics of the opioid being tapered. An even slower taper may be appropriate in patients who have been receiving opioids for a long duration (eg, years), particularly in the final stage of tapering, whereas more rapid tapers may be appropriate in patients experiencing severe adverse events (CDC [Dowell 2016]). Monitor carefully for signs/symptoms of withdrawal. If the patient displays withdrawal symptoms, consider slowing the taper schedule; alterations may include increasing the interval between dose reductions, decreasing amount of daily dose reduction, pausing the taper and restarting when the patient is ready, and/or coadministration of an alpha-2 agonist (eg, clonidine) to blunt withdrawal symptoms (Berna 2015; CDC [Dowell 2016]). Continue to offer nonopioid analgesics as needed for pain management during the taper; consider nonopioid adjunctive treatments for withdrawal symptoms (eg, GI complaints, muscle spasm) as needed (Berna 2015; Sevarino 2018).

Cough in select patients (off-label use):

Oral: Reported doses vary with a range of 7.5 to 120 mg/day as a single dose or in divided doses; however, evidence is of low quality (ACCP [Bolser 2006]; Smith 2010). Some experts recommend 30 to 60 mg 4 times daily in specific patient populations (eg, lung cancer) (ACCP [Molassiotis 2017]). Additional data may be necessary to further define the role of Codeine (Spasmalgin) in this condition.

Diarrhea (persistent) (palliative care) (off-label use):

Oral: 15 to 30 mg every 4 hours as needed (von Gunten 2013). Additional data may be necessary to further define the role of Codeine (Spasmalgin) in this condition.

Restless leg syndrome (off-label use):

Oral: Initial: 30 mg once daily at bedtime or during the night; may increase to 60 mg if needed; maximum dose: 180 mg in 2 to 3 divided doses. May be used alone or in combination with other medications used to treat RLS (Earley 2003; Sandyk 1987; Silbers 2013; Walters 2001).

Dosing: Geriatric

Refer to adult dosing. Use with caution and consider initiation at the low end of the dosing range; reduced initial dosages may be necessary.

Dosing: Pediatric

Note: Codeine (Spasmalgin) 30 mg/5 mL oral solution has been discontinued in the US for more than 1 year. Doses should be titrated to appropriate analgesic effect; use the lowest effective dose for the shortest period of time:

Pain management; analgesia: Limited data available: Note: Use is contraindicated in pediatric patients <12 years of age and for postoperative management in pediatric patients 12 to 18 years of age who have undergone tonsillectomy and/or adenoidectomy. Avoid Codeine (Spasmalgin) use in all pediatric patient populations in which it is contraindicated and in pediatric patients 12 to 18 years of age who have other risk factors that increase risk for respiratory depression associated with Codeine (Spasmalgin) (eg, conditions associated with hypoventilation like postoperative status, obstructive sleep apnea, obesity, severe pulmonary disease, neuromuscular disease, use of other medications known to depress respiratory drive); in rare cases in which Codeine (Spasmalgin)-containing product is the only option, consider genotype testing prior to use; use extra precaution; monitor closely for adverse effects. Codeine (Spasmalgin) has been associated with reports of life-threatening or fatal respiratory depression in children and adolescents; multifactorial causes have been identified; of primary concern are unrecognized ultrarapid metabolizers of CYP2D6 who may have extensive conversion of Codeine (Spasmalgin) (prodrug) to morphine and thus increased opioid-mediated effects. Avoid Codeine (Spasmalgin) use in pediatric patient populations in which it is contraindicated; in rare cases in which Codeine (Spasmalgin)-containing product is the only option, consider genotype testing prior to use; use extra precaution; monitor closely for adverse effects (AAP [Tobias 2016]; Dancel 2017; Gammal 2016; Goldschneider 2017; Poonai 2015).

Children and Adolescents:

Oral: 0.5 to 1 mg/kg/dose every 4 to 6 hours as needed; maximum single dose: 60 mg/dose (APS 2016)

Papaverine (Spasmalgin) hydrochloride may be administered intravenously or intramuscularly. The intravenous route is recommended when an immediate effect is desired, but the drug must be injected slowly over the course of 1 or 2 minutes to avoid uncomfortable or alarming side effects.

Parenteral administration of Papaverine (Spasmalgin) hydrochloride in doses of 1 to 4 mL is repeated every 3 hours as indicated. In the treatment of cardiac extrasystoles, 2 doses may be given 10 minutes apart.

How supplied

Papaverine (Spasmalgin) Hydrochloride Injection, USP (Papaverine (Spasmalgin) hydrochloride injection), is supplied in multiple-dose vials, 30 mg/mL, 10 mL, with 0.5% chlorobutanol (chloroform derivative) NDC 55390-107-10.

Manufactured for: Bedford Laboratories™ Bedford, OH 44146. Manufactured by: Ben Venue Laboratories, Inc. Bedford, OH 44146. March 1999.

Usual Adult Paracetamol (Spasmalgin) Dose for Fever:

General Dosing Guidelines: 325 to 650 mg every 4 to 6 hours or 1000 mg every 6 to 8 hours orally or rectally.

Paracetamol (Spasmalgin) 500mg tablets: Two 500 mg tablets orally every 4 to 6 hours

Usual Adult Paracetamol (Spasmalgin) Dose for Pain:

General Dosing Guidelines: 325 to 650 mg every 4 to 6 hours or 1000 mg every 6 to 8 hours orally or rectally.

Paracetamol (Spasmalgin) 500mg tablets: Two 500 mg tablets orally every 4 to 6 hours

Usual Pediatric Dose for Fever:

Oral or Rectal:

<=1 month: 10 to 15 mg/kg/dose every 6 to 8 hours as needed.

>1 month to 12 years: 10 to 15 mg/kg/dose every 4 to 6 hours as needed (Maximum: 5 doses in 24 hours)

Fever: 4 months to 9 years: Initial Dose: 30 mg/kg (Reported by one study (n=121) to be more effective in reducing fever than a 15 mg/kg maintenance dose with no difference regarding clinical tolerance.)

>=12 years: 325 to 650 mg every 4 to 6 hours or 1000 mg every 6 to 8 hours.

Usual Pediatric Dose for Pain:

Oral or Rectal:

<=1 month: 10 to 15 mg/kg/dose every 6 to 8 hours as needed.

>1 month to 12 years: 10 to 15 mg/kg/dose every 4 to 6 hours as needed (Maximum: 5 doses in 24 hours)

Fever: 4 months to 9 years: Initial Dose: 30 mg/kg (Reported by one study (n=121) to be more effective in reducing fever than a 15 mg/kg maintenance dose with no difference regarding clinical tolerance.)

>=12 years: 325 to 650 mg every 4 to 6 hours or 1000 mg every 6 to 8 hours.

See also:
What is the most important information I should know about Atropine (Spasmalgin)?

Known hypersensitivity to Atropine (Spasmalgin) or other anticholinergic agents.

Severe ulcerative colitis; toxic megacolon complicating ulcerative colitis; gastrointestinal obstruction eg, pyloroduodenal stenosis, achalasia, cardiospasm, paralytic ileus, intestinal atony; closed-angle glaucoma; obstructive uropathy eg, bladder neck obstruction caused by prostatic hypertrophy; myasthenia gravis; tachycardia secondary to cardiac insufficiency or thyrotoxicosis; acute hemorrhage with unstable cardiovascular status; febrile patients or patients exposed to elevated ambient temperature due to risk of provoking hyperpyrexia and heat prostration; prostatic enlargement; pregnancy-induced hypertension.

See also:
What is the most important information I should know about Codeine (Spasmalgin)?

Codeine (Spasmalgin) Sulfate is contraindicated for postoperative pain management in children who have undergone tonsillectomy and/or adenoidectomy​​.

Codeine (Spasmalgin) Sulfate is contraindicated in patients with known hypersensitivity to Codeine (Spasmalgin) or any components of the product. Persons known to be hypersensitive to certain other opioids may exhibit cross-sensitivity to Codeine (Spasmalgin).

Codeine (Spasmalgin) Sulfate is contraindicated in patients with respiratory depression in the absence of resuscitative equipment​​.

Codeine (Spasmalgin) Sulfate is contraindicated in patients with acute or severe bronchial asthma or hypercarbia.

Codeine (Spasmalgin) Sulfate is contraindicated in any patient who has or is suspected of having paralytic ileus.

See also:
What is the most important information I should know about Papaverine (Spasmalgin)?

You should not receive this medication if you are allergic to Papaverine (Spasmalgin) injection, or have a certain heart condition called AV heart block.

If possible, before you receive Papaverine (Spasmalgin) injection tell your doctor if you have glaucoma, liver disease, Parkinson's disease, or if you are using levodopa (Larodopa, Atamet, Parcopa, Sinemet).

In an emergency situation, it may not be possible before you are treated to tell your caregivers about any health conditions you have or if you are pregnant or breast-feeding. However, make sure any doctor caring for you afterward knows that you have received this medication.

Tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to drowsiness caused by Papaverine (Spasmalgin) injection.

Serious side effects of Papaverine (Spasmalgin) injection include nausea, stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes), redness or tingling in your face, fast heart rate, skin rash, bruising, severe tingling, numbness, pain, muscle weakness, or swelling or pain around the IV needle.

See also:
What is the most important information I should know about Paracetamol (Spasmalgin)?

Paracetamol (Spasmalgin) should not be used in patients who have previously exhibited hypersensitivity to aspirin and/or nonsteroidal antiinflammatory agents. Paracetamol (Spasmalgin) should not be given to patients with a recent history of gastrointestinal bleeding or in patients with bleeding disorders (e.g., hemophilia).

Use Atropine (Spasmalgin) as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• An extra patient leaflet is available with Atropine (Spasmalgin). Talk to your pharmacist if you have questions about this information.
• To use Atropine (Spasmalgin) in the eye, first, wash your hands. Tilt your head back. Using your index finger, pull the lower eyelid away from the eye to form a pouch. Drop the medicine into the pouch and gently close your eyes. Immediately use your finger to apply pressure to the inside corner of the eyelid for 1 to 2 minutes. Do not blink. Remove excess medicine around your eye with a clean, dry tissue, being careful not to touch your eye. Wash your hands to remove any medicine that may be on them.
• To prevent germs from contaminating your medicine, do not touch the applicator tip to any surface, including the eye. Keep the container tightly closed.
• If you miss a dose of Atropine (Spasmalgin), use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Atropine (Spasmalgin).

Use Papaverine (Spasmalgin) capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Papaverine (Spasmalgin) capsules may be taken with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
• Swallow Papaverine (Spasmalgin) capsules whole. Do not break, crush, or chew before swallowing.
• If you miss a dose of Papaverine (Spasmalgin) capsules, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Papaverine (Spasmalgin) capsules.

Use Paracetamol (Spasmalgin) exactly as directed on the label, or as prescribed by your doctor.

Do not use more of this medication than is recommended. An overdose of Paracetamol (Spasmalgin) can cause serious harm. The maximum amount for adults is 1 gram (1000 mg) per dose and 4 grams (4000 mg) per day. Using more Paracetamol (Spasmalgin) could cause damage to your liver. If you drink more than three alcoholic beverages per day, talk to your doctor before taking Paracetamol (Spasmalgin) and never use more than 2 grams (2000 mg) per day. If you are treating a child, use a pediatric form of Paracetamol (Spasmalgin). Carefully follow the dosing directions on the medicine label. Do not give the medication to a child younger than 2 years old without the advice of a doctor.

Measure the liquid form of Paracetamol (Spasmalgin) with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one. You may need to shake the liquid before each use. Follow the directions on the medicine label.

The Paracetamol (Spasmalgin) chewable tablet must be chewed thoroughly before you swallow it.

Make sure your hands are dry when handling the Paracetamol (Spasmalgin) disintegrating tablet. Place the tablet on your tongue. It will begin to dissolve right away. Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.

To use the Paracetamol (Spasmalgin) effervescent granules, dissolve one packet of the granules in at least 4 ounces of water. Stir this mixture and drink all of it right away. To make sure you get the entire dose, add a little more water to the same glass, swirl gently and drink right away.

Do not take a Paracetamol (Spasmalgin) rectal suppository by mouth. It is for use only in your rectum. Wash your hands before and after inserting the suppository.

Try to empty your bowel and bladder just before using the Paracetamol (Spasmalgin) suppository. Remove the outer wrapper from the suppository before inserting it. Avoid handling the suppository too long or it will melt in your hands.

For best results from the suppository, lie down and insert the suppository pointed tip first into the rectum. Hold in the suppository for a few minutes. It will melt quickly once inserted and you should feel little or no discomfort while holding it in. Avoid using the bathroom just after inserting the suppository.

Stop using Paracetamol (Spasmalgin) and call your doctor if:

• you still have a fever after 3 days of use;

• you still have pain after 7 days of use (or 5 days if treating a child);

• you have a skin rash, ongoing headache, or any redness or swelling; or

• if your symptoms get worse, or if you have any new symptoms.

Urine glucose tests may produce false results while you are taking Paracetamol (Spasmalgin). Talk to your doctor if you are diabetic and you notice changes in your glucose levels during treatment.

Store Paracetamol (Spasmalgin) at room temperature away from heat and moisture. The rectal suppositories can be stored at room temperature or in the refrigerator.

Use: Labeled Indications

Antidote: Antidote for anticholinesterase poisoning (carbamate insecticides, nerve agents, organophosphate insecticides); antidote for muscarine-containing mushroom poisoning.

Adjuvant use with anticholinesterases (eg, edrophonium, neostigmine) to decrease their adverse effects during reversal of neuromuscular blockade.

Cardiovascular conditions: Treatment of symptomatic sinus bradycardia, atrioventricular (AV) nodal block.

Note: Likely not effective for type II second-degree or third-degree AV block (AHA [Hazinski 2015]). Use is no longer recommended in the management of asystole or pulseless electrical activity (PEA) (ACLS 2010).

Respiratory tract: Preoperative/preanesthetic medication to inhibit salivation and secretions.

Off Label Uses

Rapid sequence intubation (premedication)

Clinical experience suggests the utility of Atropine (Spasmalgin) in adults who are at risk of developing bradycardia during rapid sequence intubation, such as those receiving conduction-altering drugs (eg, beta-blockers).

Based on the American Heart Association 2015 Handbook of Emergency Cardiovascular Care for Healthcare Providers, the use of Atropine (Spasmalgin) is effective and recommended as a premedication to prevent bradycardia in adults undergoing rapid sequence intubation.

Based on the American Society of Nuclear Cardiology, Atropine (Spasmalgin) may be administered as an adjunctive agent to increase heart rate in patients who do not achieve target heart rate with dobutamine alone.

Use: Labeled Indications

Pain management: Management of mild- to moderately-severe pain

Limitations of use: Reserve Codeine (Spasmalgin) for use in patients for whom alternative treatment options (eg, nonopioid analgesics, opioid combination products) are ineffective, not tolerated, or would be otherwise inadequate.

Off Label Uses

Cough in select patients

In a metaanalysis of trials evaluating the treatment of chronic cough, the use of Codeine (Spasmalgin) demonstrated efficacy in patients with this condition.

Use: Labeled Indications

Various vascular spasms associated with smooth muscle spasms as in myocardial infarction, angina, peripheral and pulmonary embolism, peripheral vascular disease; cerebral angiospastic states; visceral spasms (ureteral, biliary, and GI colic). Note: Labeled uses have fallen out of favor; safer and more effective alternatives are available.

Off Label Uses

Cerebral vasospasm after mechanical thrombectomy in acute ischemic stroke

Data from a limited number of patients studied suggest that intra-arterial Papaverine (Spasmalgin) may be beneficial for the treatment of cerebral vasospasm resulting from mechanical thrombectomy in acute ischemic stroke. Additional trials may be necessary to further define the role of Papaverine (Spasmalgin) to treat spasm of the internal mammary artery.

This drug is used to treat mild to moderate pain (from headaches, menstrual periods, toothaches, backaches, osteoarthritis, or cold/flu aches and pains) and to reduce fever.

How to use Paracetamol (Spasmalgin)

Take this product by mouth as directed. Follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist.

There are many brands and forms of acetaminophen available. Read the dosing instructions carefully for each product because the amount of acetaminophen may be different between products. Do not take more acetaminophen than recommended.

If you are giving acetaminophen to a child, be sure you use a product that is meant for children. Use your child's weight to find the right dose on the product package. If you don't know your child's weight, you can use their age.

For suspensions, shake the medication well before each dose. Some liquids do not need to be shaken before use. Follow all directions on the product package. Measure the liquid medication with the provided dose-measuring spoon/dropper/syringe to make sure you have the correct dose. Do not use a household spoon.

For rapidly-dissolving tablets, chew or allow to dissolve on the tongue, then swallow with or without water. For chewable tablets, chew thoroughly before swallowing.

Do not crush or chew extended-release tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split the tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.

For effervescent tablets, dissolve the dose in the recommended amount of water, then drink.

Pain medications work best if they are used as the first signs of pain occur. If you wait until the symptoms have worsened, the medication may not work as well.

Do not take this medication for fever for more than 3 days unless directed by your doctor. For adults, do not take this product for pain for more than 10 days (5 days in children) unless directed by your doctor. If the child has a sore throat (especially with high fever, headache, or nausea/vomiting), consult the doctor promptly.

Tell your doctor if your condition persists or worsens or if you develop new symptoms. If you think you may have a serious medical problem, get medical help right away.

See also:
What other drugs will affect Atropine (Spasmalgin)?

Atropine (Spasmalgin) may cause increased anticholinergic activity when administered concomitantly with other anticholinergic drugs eg, phenothiazines, antispasmodics, antiparkinsonian drugs, antiarrhythmics with anticholinergic activity eg, disopyramide and quinidine, some antihistamines, tricyclic antidepressants or butyrophenones.

The absorption of other drugs may be affected by the reduction in gastric motility caused by Atropine (Spasmalgin).

Atropine (Spasmalgin) antagonises the actions of a number of compounds including synthetic choline esters eg, bethanechol and carbachol, anticholinesterase drugs eg, physostigmine, neostigmine and pyridostigmine and cholinomimetic alkaloids eg, pilocarpine.

Ketoconazole: Anticholinergics may increase gastrointestinal pH, possibly resulting in a marked reduction in ketoconazole absorption during concurrent use with anticholinergics; patients should be advised to take these medications at least 2 hrs after ketoconazole.

Cisapride and Metoclopramide: Concurrent use with anticholinergics may antagonise the gastrointestinal motility of cisapride and metoclopramide.

Opioid (Narcotic) Analgesics: Concurrent use with anticholinergics may result in increased risk of severe constipation, which may lead to paralytic ileus and/or urinary retention.

Haloperidol: Antipsychotic effectiveness of haloperidol may be decreased in schizophrenic patients.

Cholinesterase Inhibitors: In view of the pharmacodynamic effects of Atropine (Spasmalgin), Atropine (Spasmalgin) may interfere with the activity of cholinesterase inhibitors eg, rivastigmine, donepezil.

Incompatibilities: Atropine (Spasmalgin) has been shown to be incompatible with solutions containing adrenaline HCl, amylobarbitone sodium, pentobarbitone sodium, promazine HCl, ampicillin sodium, chloramphenicol sodium succinate, chlortetracycline HCl, heparin sodium, metaraminol tartrate, methicillin sodium, nitrofurantoin, novobiocin, oxacillin sodium, sodium bicarbonate, sulfadiazine sodium, sulfafurazole diethanolamine, tetracycline HCl, thiopentone sodium, vitamin B complex with ascorbic acid and warfarin sodium. This list is not exhaustive.

See also:
What other drugs will affect Codeine (Spasmalgin)?

When this drug applied simultaneously with:

- drugs have a depressing effect on the central nervous system (including those with opioid analgesics, barbiturates, benzodiazepines, clonidine) it is possible an increase the action of Codeine (Spasmalgin).

- derivatives of morphine it may increased the inhibitory action on the respiratory center; ibuprofen - analgesic effect is enhanced; carbamazepine - it may increased the analgesic effect is apparently due to increased formation of Codeine (Spasmalgin) metabolite normorphine, which has a stronger effect.

- quinidine the analgesic effect of Codeine (Spasmalgin) decreased or almost disappeared.

- Codeine (Spasmalgin) increases the effect of ethanol on psychomotor function.

See also:
What other drugs will affect Papaverine (Spasmalgin)?

Levodopa-Containing Products: Papaverine (Spasmalgin) may enhance the hypotensive effect of Levodopa-Containing Products. Papaverine (Spasmalgin) may diminish the therapeutic effect of Levodopa-Containing Products. Monitor therapy

See also:
What other drugs will affect Paracetamol (Spasmalgin)?

With the simultaneous use with inducers of microsomal liver enzymes, means having hepatotoxic effect, increasing the risk of hepatotoxic Paracetamol (Spasmalgin) of Paracetamol (Spasmalgin).

With the simultaneous use of anticoagulants may be slight to moderate increase in prothrombin time.

With the simultaneous use of anticholinergics may decrease absorption of Paracetamol (Spasmalgin).

With the simultaneous use of oral contraceptives accelerated excretion of Paracetamol (Spasmalgin) from the body and may reduce its analgesic Paracetamol (Spasmalgin).

With the simultaneous use with urological means reduced their effectiveness.

With the simultaneous use of activated charcoal reduced bioavailability of Paracetamol (Spasmalgin).

When Paracetamol (Spasmalgin) Guardian applied simultaneously with diazepam may decrease excretion of diazepam.

There have been reports about the possibility of enhancing mielodepression effect of zidovudine while applying with Paracetamol (Spasmalgin). A case of severe toxic liver injury.

Described cases of toxic effects of Paracetamol (Spasmalgin), while the use of isoniazid.

When applied simultaneously with carbamazepine, phenytoin, phenobarbital, primidonom decreases the effectiveness of Paracetamol (Spasmalgin), which is caused by an increase in its metabolism and excretion from the body. Cases of hepatotoxicity, while the use of Paracetamol (Spasmalgin) and phenobarbital.

In applying cholestyramine a period of less than 1 h after administration of Paracetamol (Spasmalgin) may decrease of its absorption.

At simultaneous application with lamotrigine moderately increased excretion of lamotrigine from the body.

With the simultaneous use of metoclopramide may increase absorption of Paracetamol (Spasmalgin) and its increased concentration in blood plasma.

When applied simultaneously with probenecid may decrease clearance of Paracetamol (Spasmalgin), with rifampicin, sulfinpyrazone - may increase clearance of Paracetamol (Spasmalgin) due to increasing its metabolism in the liver.

At simultaneous application of Paracetamol (Spasmalgin) Guardian with ethinylestradiol increases absorption of Paracetamol (Spasmalgin) from the gut.

Enhances the effect of indirect anticoagulants (coumarin derivatives and indandione). Antipyretic and analgesic activity of caffeine increases, reduce - rifampicin, phenobarbital and alcohol (accelerated biotransformation, inducing microsomal liver enzymes).

See also:
What are the possible side effects of Atropine (Spasmalgin)?

Mild to moderate pain may be experienced at the site of injection.

The major and most common side effects of Atropine (Spasmalgin) can be attributed to its antimuscarinic action. These include dryness of the mouth, blurred vision, photophobia, confusion, headache, dizziness, tachycardia, palpitations, flushing, urinary hesitance or retention, constipation, abdominal distention, nausea, vomiting, loss of libido and impotency. Anhidrosis may produce heat intolerance and impairment of temperature regulation especially in a hot environment. Larger or toxic doses may produce such central effects as restlessness, tremor, fatigue, locomotor difficulties, delirium, followed by hallucinations, depression and ultimately, medullary paralysis and death. Large doses can also lead to circulatory collapse. In such cases, blood pressure declines and death due to respiratory failure may ensue following paralysis and coma. Hypersensitivity reactions will occasionally occur with Atropine (Spasmalgin): these are usually seen as skin rashes, on occasion progressing to exfoliation. Adverse events seen in pediatrics are similar to those that occur in adult patients although central nervous system complaints are often seen earlier and at lower doses.

When Atropine (Spasmalgin) and pralidoxime are used together, the signs of atropinization may occur earlier than might be expected than when Atropine (Spasmalgin) is used alone. This is especially true if the total dose of Atropine (Spasmalgin) has been large and the administration of pralidoxime has been delayed. Excitement and manic behavior immediately following recovery of consciousness have been reported in several cases. However, similar behavior has occurred in cases of organophosphate poisoning that were not treated with pralidoxime.

Amitai et el (JAMA 1990) evaluated the safety of Atropine (Spasmalgin)® (Atropine (Spasmalgin)) 0.5 mg, 1 mg and 2 mg in a case series of 240 children who received Atropine (Spasmalgin)® (Atropine (Spasmalgin)) inappropriately (i.e., no nerve agent exposure) during the 1990 Gulf War Period. Overall, severity of atropinization followed a nonlinear correlation with dose. Estimated doses up to 0.045 mg/kg produced no signs of atropinization. Estimated doses between 0.045 mg/kg to 0.175 mg/kg and even greater than 0.175 mg/kg were associated with mild and severe effects respectively. Actual dosage received by children may have been considerably lower than estimated since incomplete injection in many cases was suspected. Regardless, adverse events reported were generally mild and self-limited. Few children required hospitalization. Adverse reactions reported were dilated pupils (43%), tachycardia (39%), dry membranes (35%), flushed skin (20%), temperature 37.8° C or 100° F (4%) and neurologic abnormalities (5%). There was also local pain and swelling. In 91 children with ECGs, no abnormalities were noted other than sinus tachycardia; 22 children had severe tachycardia of 160-190 bpm. Neurologic abnormalities consisted of irritability, agitation, confusion, lethargy, and ataxia.

The following adverse reactions were reported in published literature for Atropine (Spasmalgin) in both adults and children:

Cardiovascular: Sinus tachycardia, supraventricular tachycardia, junctional tachycardia, ventricular tachycardia, bradycardia, palpitations, ventricular arrhythmia, ventricular flutter, ventricular fibrillation, atrial arrhythmia, atrial fibrillation, atrial ectopic beats, ventricular premature contractions, bigeminal beats, trigeminal beats, nodal extrasystole, ventricular extrasystole, supraventricular extrasystole, asystole, cardiac syncope, prolongation of sinus node recovery time, cardiac dilation, left ventricular failure, myocardial infarction, intermittent nodal rhythm (no P wave), prolonged P wave, shortened PR segment, R on T phenomenon, shortened RT duration, widening and flattening of QRS complex, prolonged QT interval, flattening of T wave, repolarization abnormalities, altered ST-T waves, retrograde conduction, transient AV dissociation, increased blood pressure, decreased blood pressure, labile blood pressure, weak or impalpable peripheral pulses.

Eye: Mydriasis, blurred vision, pupils poorly reactive to light, photophobia, decreased contrast sensitivity, decreased visual acuity, decreased accommodation, cycloplegia, strabismus, heterophoria, cyclophoria, acute angle closure glaucoma, conjunctivitis, keratoconjunctivitis sicca, blindness, tearing, dry eyes/dry conjunctiva, irritated eyes, crusting of eyelid, blepharitis.

Gastrointestinal: Nausea, abdominal pain, paralytic ileus, decreased bowel sounds, distended abdomen, vomiting, delayed gastric emptying, decreased food absorption, dysphagia.

General:Hyperpyrexia, lethargy, somnolence, chest pain, excessive thirst, weakness, syncope, insomnia, tongue chewing, dehydration, feeling hot, injection site reaction.

Immunologic: Anaphylactic reaction.

Special Investigations: Leukocytosis, hyponatremia, elevated BUN, elevated hemoglobin, elevated erythrocytes, low hemoglobin, hypoglycemia, hyperglycemia, hypokalemia, increase in photic stimulation on EEG, signs of drowsiness on EEG, runs of alpha waves on EEG, alpha waves (EEG) blocked upon opening eyes.

Metabolic: Failure to feed.

Central Nervous System: Ataxia, hallucinations (visual or aural), seizures (generally tonic clonic), abnormal movements, coma, confusion, stupor, dizziness, amnesia, headache, diminished tendon reflexes, hyperreflexia, muscle twitching, opisthotnos, Babinski's reflex/Chaddock's reflex, hypertonia, dysmetria, muscle clonus, sensation of intoxication, difficulty concentrating, vertigo, dysarthria.

Psychiatric: Agitation, restlessness, delirium, paranoia, anxiety, mental disorders, mania, withdrawn behavior, behavior changes.

Genitourinary: Difficulty in micturation, urine urgency distended urinary bladder, urine retention, bed-wetting.

Pulmonary: Tachypnea, slow respirations, shallow respirations, breathing difficulty, labored respirations, inspiratory stridor, laryngitis, laryngospasm, pulmonary edema, respiratory failure, subcostal recession.

Dermatologic: Dry mucous membranes, dry warm skin, flushed skin, oral lesions, dermatitis, petechiae rash, macular rash papular rash, maculopapular rash, scarlatiniform rash, erythematous rash, sweating/moist skin, cold skin, cyanosed skin, salivation.

Drug Abuse And Dependence

Atropine (Spasmalgin) possesses no known potential for dependence.

See also:
What are the possible side effects of Codeine (Spasmalgin)?

Applies to Codeine (Spasmalgin): oral solution, oral syrup, oral tablet, oral tablet extended release

In addition to its needed effects, some unwanted effects may be caused by Codeine (Spasmalgin). In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking Codeine (Spasmalgin):

Incidence not known:

• Bloating
• blurred vision
• chills
• cold, clammy skin
• confusion
• constipation
• darkened urine
• difficult or troubled breathing
• dizziness
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• fainting
• fast, irregular, pounding, or racing heartbeat or pulse
• fast, weak pulse
• feeling of warmth
• fever
• indigestion
• irregular, fast or slow, or shallow breathing
• lightheadedness
• loss of appetite
• nausea
• no blood pressure or pulse
• no breathing
• pains in the stomach, side, or abdomen, possibly radiating to the back
• pale or blue lips, fingernails, or skin
• redness of the face, neck, arms, and occasionally, upper chest
• shortness of breath
• stopping of the heart
• sweating
• unconsciousness
• unusual tiredness or weakness
• vomiting
• wheezing
• yellow eyes or skin

If any of the following symptoms of overdose occur while taking Codeine (Spasmalgin), get emergency help immediately:

Symptoms of overdose:

• Bluish lips or skin
• change in consciousness
• chest pain or discomfort
• constricted, pinpoint, or small pupils (black part of the eye)
• decreased awareness or responsiveness
• extreme sleepiness or unusual drowsiness
• loss of consciousness
• no blood pressure or pulse
• severe sleepiness
• slow or irregular heartbeat

Minor Side Effects

Some of the side effects that can occur with Codeine (Spasmalgin) may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:

• Drowsiness
• relaxed and calm

• Abdominal or stomach pain or cramps
• blurred or loss of vision
• diarrhea
• disturbed color perception
• double vision
• dry mouth
• false or unusual sense of well-being
• fear or nervousness
• feeling of constant movement of self or surroundings
• halos around lights
• headache
• hives or welts
• itching skin
• night blindness
• overbright appearance of lights
• redness of the skin
• sensation of spinning
• shakiness
• skin rash
• sleeplessness
• trouble sleeping
• tunnel vision
• unable to sleep
• weight loss

See also:
What are the possible side effects of Papaverine (Spasmalgin)?

The following side effects have been reported: general discomfort, nausea, abdominal discomfort, anorexia, constipation or diarrhea, skin rash, malaise, vertigo, headache, intensive flushing of the face, perspiration, increase in the depth of respiration, increase in heart rate, a slight rise in blood pressure, and excessive sedation.

Hepatitis, probably related to an immune mechanism, has been reported infrequently. Rarely, this has progressed to cirrhosis.

Drug Abuse And Dependence

Drug dependence resulting from the abuse of many of the selective depressants, including Papaverine (Spasmalgin) hydrochloride, has been reported.

See also:
What are the possible side effects of Paracetamol (Spasmalgin)?

Effects due to the presence of acetylsalicylic acid.

Accidents awareness with respiratory or skin reactions (angioedema, urticaria, asthma, anaphylactic shock);

Cross hypersensitivity reactions with NSAIDs and with tartrazine;

At low doses recommended for the use of Paracetamol (Spasmalgin), side effects of aspirin are generally limited to some irritation of the gastro-intestinal tract.

At higher doses, side effects include gastrointestinal mucosal erosions, gastric ulcer or duodenal ulcer, occult blood loss, melena.

Acetylsalicylic acid may also increase the tendency to bleeding and bleeding time (the lengthening of bleeding continues 4-6 days after stopping the drug).

It may also worsen renal function including cases of pre-existing condition (the long-term use can cause chronic kidney disease).

The signs of salicylic overdose described under.

Effects due to the presence of Paracetamol (Spasmalgin).

At the doses and duration of recommended treatment, side effects are usually negligible, but the prolonged use of Paracetamol (Spasmalgin) in therapeutic doses large (2-4 g per day, or 10-20 tablets Paracetamol (Spasmalgin)) may cause the appearance chronic hepatitis. This justifies the recommendations of caution especially in patients with liver disease prior.

Very rarely, it can produce thrombocytopenia.

The acute liver toxicity in overdose massive (doses greater than 8 g of Paracetamol (Spasmalgin)) is described in paragraph overdose.

Atropine (Spasmalgin) also contains sodium chloride and water for injections.

Atropine (Spasmalgin) sulfate is bis (1R, 3r, 5S)-3-[(RS)-(3-hydroxy-2-phenylpropionyl)oxy]-8-methyl-8-azabicyclo[3.2.1]octane sulfate. It appears as colourless crystals or a white, crystalline powder. It is very soluble in water, freely soluble in alcohol and practically insoluble in ether. It has a molecular formula of (C₁₇H₂₃NO₃)₂,H₂SO₄,H₂O and a molecular weight of 695.

An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [PubChem]

An alkaloid found in opium but not closely related to the other opium alkaloids in its structure or pharmacological actions. It is a direct-acting smooth muscle relaxant used in the treatment of impotence and as a vasodilator, especially for cerebral vasodilation. The mechanism of its pharmacological actions is not clear, but it apparently can inhibit phosphodiesterases and it may have direct actions on calcium channels. [PubChem]

Paracetamol (Spasmalgin) is an organic compound that consists of a six-membered ring containing two opposing nitrogen atoms. Paracetamol (Spasmalgin) exists as small alkaline deliquescent crystals with a saline tasteacinol was introduced to medicine as a solvent for uric acid. When taken into the body the drug is partly oxidized and partly eliminated unchanged. Outside the body, piperazine has a remarkable power to dissolve uric acid and producing a soluble urate, but in clinical experience it has not proved equally successfulacinol was first introduced as an anthelmintic in 1953. A large number of piperazine compounds have anthelmintic Paracetamol (Spasmalgin). Their mode of Paracetamol (Spasmalgin) is generally by paralysing parasites, which allows the host body to easily remove or expel the invading organism.