Coficil-plus pills, 20pcs

Composition

Pharmacological action

Combined drug. The drug has analgesic, antipyretic and psychostimulating effects.

Acetylsalicylic acid has an antipyretic and anti-inflammatory effect, relieves pain, especially caused by the inflammatory process, and also moderately inhibits platelet aggregation and thrombosis, improves microcirculation in the focus of inflammation.

Caffeine increases the reflex excitability of the spinal cord, excites the respiratory and vasomotor centers, expands the blood vessels of skeletal muscles, brain, heart, kidneys, reduces platelet aggregation; reduces drowsiness, fatigue, increases mental and physical performance. In this combination, caffeine in a small dose has almost no stimulating effect on the central nervous system, but it increases the tone of brain vessels and accelerates blood flow.

Paracetamol has analgesic, antipyretic and extremely weak anti-inflammatory effect, which is associated with its effect on the center of thermoregulation in the hypothalamus and its weak ability to inhibit prostaglandin synthesis in peripheral tissues.

Indications

Coficil-Plus is used in adults with mild and moderate pain syndrome (of various origins):

• headache;
• migraine;
• toothache;
• neuralgia;
• myalgia;
• arthralgia;
• algodismenorrhea (pain during menstruation).

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

Use during pregnancy and lactation

Contraindicated use during pregnancy in the first and third trimester, in the second trimester of pregnancy, a single dose of the drug is possible in the recommended doses only if the expected benefit to the mother exceeds the potential risk to the fetus. If it is necessary to use the drug during lactation, stop breastfeeding.

Contraindications

• children up to age 15 years;
• increased individual sensitivity to the components of the drug;
• erosive-ulcerative lesions of the gastrointestinal tract (in the phase of exacerbation);
• gastrointestinal bleeding;
• increased bleeding tendency;
• complete or incomplete combination of bronchial asthma, recurrent polyposis of the nose and paranasal sinuses and intolerance of acetilsalicilico acid or other NSAIDs (including in the anamnesis);
• hemorrhagic diathesis (hemophilia, von Willebrand disease, teleangiectasia, hypoprothrombinemia, thrombocytopenia, thrombocytopenic purpura);
• dissecting aortic aneurysm;
• portal hypertension;
• a vitamin K deficiency;
• deficiency of glucose-6-phosphate dehydrogenase;
• severe hypertension;
• severe coronary heart disease;
• glaucoma;
• increased irritability;
• sleep disorders;
• surgical intervention, soprovozhdayutsya bleeding.

With caution:  hyperuricemia, urate nephrolithiasis, gout, peptic ulcer of the stomach and/or duodenum (in the anamnesis), severe heart failure, liver disease, elderly age.

Side effects

Gastralgia, nausea, vomiting, hepatotoxicity, nephrotoxicity, erosive and ulcerative lesions of the gastrointestinal tract, allergic reactions (including Stevens-Johnson, Lyell syndrome), tachycardia, increased blood pressure, bronchospasm. Reye’s syndrome in children (hyperpyrexia, metabolic acidosis, disorders of the nervous system and psyche, vomiting, liver function disorders).

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

The interaction of

Acetylsalicylic acid increases the toxicity of methotrexate, also reducing its renal clearance, valproic acid enhances the effects of non-steroidal anti-inflammatory drugs, narcotic analgesics, oral hypoglycemic drugs, heparin, indirect anticoagulants, and thrombolytics, and antiplatelet agents, sulfonamides (including co-trimoxazole), T 3 (triiodothyronine); reduces the effect of uricosuric drugs (benzbromarone, sulfinpirazon), antihypertensive drugs, diuretics (spironolactone, furosemide).

Glucocorticosteroids, ethanol and ethanol-containing drugs increase the damaging effect on the mucous membrane of the gastrointestinal tract, increase the risk of gastrointestinal bleeding.

Increases the concentration of digoxin, barbiturates, lithium salts in plasma.

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

Myelotoxic drugs increase the manifestations of hematotoxicity of acetylsalicylic acid.

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

Inducers of microsomal liver enzymes (phenytoin, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants), ethanol and hepatotoxic drugs increase the production of hydroxylated active metabolites, which causes the possibility of severe intoxication even with a small overdose.

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

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

Long-term concomitant use of paracetamol and other nonsteroidal anti-inflammatory drugs increases the risk of developing” analgesic ” nephropathy and renal papillary necrosis, the onset of end-stage renal failure.

Concomitant long-term use of high-dose paracetamol and salicylates increases the risk of developing kidney or bladder cancer.

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

Myelotoxic drugs increase the manifestations of hematotoxicity of the drug.

Under the influence of paracetamol, T_1/2 of chloramphenicol increases by 5 times. If taken again, paracetamol may increase the effect of anticoagulants (coumarin derivatives).

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

With the combined use of caffeine and barbiturates, primidone, anticonvulsant drugs (hydantoin derivatives, especially phenytoin), it is possible to increase the metabolism and increase the clearance of caffeine; cimetidine, oral contraceptive drugs, disulfiram, ciprofloxacin, norfloxacin-a decrease in the metabolism of caffeine in the liver (slowing its excretion and increasing its concentration in the blood).

Mexiletine-reduces the elimination of caffeine by up to 50%; nicotine-increases the rate of elimination of caffeine.

Monoamine oxidase inhibitors, furazolidone, procarbazine and selegiline-high doses of caffeine can cause dangerous cardiac arrhythmias or a pronounced increase in blood pressure.

Caffeine reduces the absorption of calcium supplements into the biliary tract.

Reduces the effect of narcotic and hypnotic drugs.

Increases the excretion of lithium preparations in the urine.

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

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

How to take, course of use and dosage

The drug is used orally after meals 1-2 tablets 2-3 times a day. The maximum daily dose is 6 tablets. The break between taking the drug should be at least 4 hours. To reduce the irritant effect on the gastrointestinal tract, the drug should be taken after meals, washed down with water, milk, alkaline mineral water.

In case of impaired kidney or liver function, the break between meals is at least 6 hours.

The drug should not be taken for more than 5 days when prescribed as an analgesic and for more than 3 days as an antipyretic. Other dosages and dosage regimens are set by the doctor.

Overdose

Symptoms caused by acetylsalicylic acid:  with mild intoxication – nausea, vomiting, gastralgia, dizziness, ringing in the ears; severe intoxication – lethargy, drowsiness, collapse, convulsions, bronchospasm, difficulty breathing, anuria, bleeding.

Initially, central hyperventilation of the lungs leads to respiratory alkalosis (shortness of breath, suffocation, cyanosis, perspiration). As intoxication increases, progressive respiratory paralysis and uncoupling of oxidative phosphorylation cause respiratory acidosis.

Paracetamol-related symptoms: during the first 24 hours after use – pallor of the skin, nausea, vomiting, anorexia, abdominal pain; impaired glucose metabolism, metabolic acidosis. Symptoms of impaired liver function may appear 12-48 hours after an overdose. With severe intoxication – liver failure with progressive encephalopathy, coma, death; acute renal failure with tubular necrosis (including in the absence of severe liver damage); arrhythmia, pancreatitis.

Chronic overdose:

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

Paracetamol-related symptoms: long-term use in high doses may cause hepatotoxic and nephrotoxic effects (renal colic, hemolytic anemia, aplastic anemia, methemoglobinemia, pancytopenia). The hepatotoxic effect in adults is manifested when taking 10 g or more.

Treatment: constant monitoring of changes in the parameters of the acid-base state (CBS) and electrolyte balance; depending on the state of metabolism – the introduction of sodium bicarbonate, sodium citrate or sodium lactate. Increasing reserve alkalinity increases the excretion of acetylsalicylic acid by alkalizing the urine. In the presence of liver damage, donors of SH-groups and precursors of the synthesis of glutathione – methionine are administered within 8-9 hours after overdose and acetylcysteine-within 8 hours. The need for additional therapeutic measures (further use of methionine, intravenous use of acetylcysteine) is determined depending on the concentration of paracetamol in the blood, as well as on the time elapsed after taking it.

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

Special instructions

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

With prolonged use of the drug, monitoring of peripheral blood and the functional state of the liver is necessary.

Since acetylsalicylic acid slows down blood clotting, the patient, if he is going to have surgery, should warn the doctor in advance about taking the drug.

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

During treatment, you should stop using ethanol (increased risk of gastrointestinal bleeding).

Influence on the ability to drive motor vehicles and manage mechanisms

When taken orally in high doses (up to 8 tablets per day), caffeine, which is part of the drug, makes it difficult to concentrate, so it is necessary to refrain from driving vehicles and engaging in potentially dangerous activities that require increased concentration of attention and speed of psychomotor reactions.

Storage conditions

In a dry place protected from light at a temperature not exceeding 25°C. Keep out of reach of children.

Shelf

life is 3 years.

Active ingredients

: Acetylsalicylic acid, Caffeine, Paracetamol

Dosage form

Tablets