Kofan Instant (Tablets) Instructions for Use

Marketing Authorization Holder

Bosnalijek, JSC (Bosnia And Herzegovina)

ATC Code

N02BE51 (Paracetamol in combination with other drugs, excluding psycholeptics)

Active Substances

Caffeine (Ph.Eur.)

Paracetamol (Rec.INN)

Propyphenazone (Rec.INN)

Dosage Form

Kofan Instant

Tablets 200 mg+200 mg+50 mg: 20 pcs.

Dosage Form, Packaging, and Composition

Tablets white in color, round.

10 pcs. – blister packs (2) – cardboard packs.

Clinical-Pharmacological Group

Combination analgesic-antipyretic

Pharmacotherapeutic Group

Non-narcotic analgesic agent (NSAID + psychostimulant + non-narcotic analgesic)

Pharmacological Action

Combined medicinal product. The combination of the three components of the drug leads to a mutual enhancement of their pharmacological action.

Paracetamol and Propyphenazone have analgesic and antipyretic effects. Paracetamol is a non-narcotic analgesic. It blocks COX only in the CNS, acting on pain and thermoregulation centers (in inflamed tissues, cellular peroxidases neutralize the effect of paracetamol on COX), which explains the almost complete absence of an anti-inflammatory effect. The lack of effect on the synthesis of prostaglandins (PG) in peripheral tissues determines the absence of a negative effect on water-salt metabolism (retention of sodium and water) and the gastrointestinal mucosa.

Propyphenazone is a pyrazolone derivative. The mechanism of action is carried out by inhibiting COX, which is involved in the formation of prostaglandins from arachidonic acid.

Caffeine increases the reflex excitability of the spinal cord, excites the respiratory and vasomotor centers, dilates blood vessels of skeletal muscles, brain, heart, kidneys, reduces platelet aggregation; reduces drowsiness, feeling of fatigue. In this combination, Caffeine in a small dose has practically no stimulating effect on the CNS, but contributes to the regulation of cerebral vascular tone, reduces drowsiness, and enhances the analgesic effect of other components of the drug.

Pharmacokinetics

Paracetamol

Absorption is high, plasma protein binding is 15%, T_max is 20-30 min. Penetrates the BBB. Less than 1% of the dose taken by a nursing mother passes into breast milk. The therapeutic effective concentration of paracetamol in plasma is achieved when it is prescribed at a dose of 10-15 mg/kg.

Metabolized in the liver: 80% undergoes conjugation with glucuronic and sulfuric acids to form inactive metabolites; 17% undergoes hydroxylation to form inactive metabolites, which conjugate with glutathione and form inactive metabolites. With a deficiency of glutathione, these metabolites can block the enzyme systems of hepatocytes and cause their necrosis. T_1/2 is 2-3 h. In elderly patients, the clearance of paracetamol decreases and the half-life increases. Excreted by the kidneys unchanged 3%.

Propyphenazone

C_max of propyphenazone in plasma is reached after 30 min. Metabolized in the liver. T_1/2 is 1-1.5 h. Combination with paracetamol increases its elimination time by 40%, which plays a significant role, as it allows to reduce the number of drug doses per day. Excreted by the kidneys.

Caffeine

Time to reach C_max is 1 h; T_1/2 is 3.5 h; 65-80% of caffeine is excreted by the kidneys mainly in the form of 1-methylxanthine, 1-methyluric acid and acetylated uracil derivatives, a small amount is converted to theophylline and theobromine.

Indications

Relief of mild to moderate pain of various origins: headache; migraine; toothache; arthralgia; myalgia; primary dysmenorrhea.

As an antipyretic for febrile conditions against the background of infectious and inflammatory diseases (ARVI, including influenza, etc.).

ICD codes

Dosage Regimen

Take orally with a sufficient amount of liquid.

For adults and adolescents over 12 years of age, take one tablet as a single dose.

If pain or fever persists, repeat the dose after 4-6 hours.

Do not exceed three tablets within a 24-hour period.

The total duration of self-treatment without medical consultation should not exceed 3-5 days as an analgesic or 3 days as an antipyretic.

For patients with hepatic or renal impairment, or in the elderly, extend the dosing interval to at least 8 hours and do not exceed two tablets in 24 hours.

Discontinue use and consult a physician if symptoms persist or worsen.

Adverse Reactions

From the nervous system dizziness, insomnia.

From the gastrointestinal tract nausea, vomiting, heaviness and discomfort in the stomach area;

From the hematopoietic system thrombocytopenia, agranulocytosis, hemolytic anemia.

Allergic reactions skin rash, itching, urticaria, angioedema, exudative erythema multiforme (including Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell’s syndrome).

Contraindications

Hypersensitivity to the components of the drug; severe renal and/or hepatic insufficiency; deficiency of the enzyme glucose-6-phosphate dehydrogenase; bone marrow depression (leukopenia, anemia, including hemolytic); acute hematoporphyria; complete or incomplete combination of bronchial asthma, recurrent polyposis of the nose and paranasal sinuses and intolerance to NSAIDs (including history); conditions accompanied by respiratory depression; intracranial hypertension; acute myocardial infarction; coronary artery disease; arrhythmias; arterial hypertension; peptic ulcer of the stomach and duodenum; glaucoma; insomnia; pregnancy; lactation period; children under 12 years of age.

With caution benign hyperbilirubinemias (including Gilbert’s, Dubin-Johnson, Rotor syndromes), elderly age, alcoholism, epilepsy and a tendency to convulsive seizures.

Use in Pregnancy and Lactation

Contraindicated during pregnancy and lactation (breastfeeding).

Use in Hepatic Impairment

Contraindicated in severe hepatic insufficiency.

Use in Renal Impairment

Contraindicated in severe renal insufficiency.

Pediatric Use

Contraindication: children under 12 years of age.

Geriatric Use

With caution : elderly age.

Special Precautions

With long-term use (more than 5 days), monitoring of the peripheral blood picture and functional state of the liver is necessary.

During treatment, one should refrain from consuming alcoholic beverages (increased risk of gastrointestinal bleeding).

Excessive consumption of caffeine-containing products (coffee, tea) during treatment may cause symptoms of overdose.

Taking the drug may complicate the diagnosis in acute abdominal pain syndrome.

Effect on ability to drive vehicles and mechanisms

During the reception, caution should be exercised when driving vehicles and engaging in other activities that require increased concentration and speed of psychomotor reactions.

Drug Interactions

The effectiveness of this combination may decrease with simultaneous use with cholestyramine, anticholinergics, antidepressants, alkaline substances.

With simultaneous use with barbiturates, anticonvulsants, ethanol, the hepatotoxic effect is significantly increased.

Metoclopramide accelerates the absorption of paracetamol.

Under the influence of paracetamol, the half-life of chloramphenicol increases by 5 times.

Simultaneous use of paracetamol in high doses enhances the effect of anticoagulants.

Myelotoxic agents enhance the manifestations of hematotoxicity of paracetamol.

Caffeine accelerates the absorption of ergotamine; reduces the absorption of calcium preparations; reduces the effect of narcotic and hypnotic drugs, increases the excretion of lithium preparations; accelerates the absorption and enhances the action of cardiac glycosides, increases their toxicity.

Simultaneous use of caffeine with beta-blockers may lead to mutual suppression of therapeutic effects, with beta-agonists to additional stimulation of the CNS and other toxic effects.

Caffeine may reduce the clearance of theophylline, and possibly other xanthines, increasing the possibility of additive pharmacodynamic and other toxic effects.

MAO inhibitors, furazolidone, procarbazine, selegiline and large doses of caffeine can cause the development of dangerous cardiac arrhythmias or a significant increase in blood pressure.

Nicotine increases the rate of caffeine excretion.

Caffeine is an antagonist of adenosine.

Propyphenazone may enhance the action of oral hypolipidemic agents, sulfonamide drugs, anticoagulants, the ulcerogenic effect of glucocorticosteroids, reduces the effectiveness of potassium-sparing diuretics.

Storage Conditions

Store at 2°C (36°F) to 25°C (77°F). Keep in original packaging, protected from light. Keep out of reach of children.

Dispensing Status

Over-the-Counter

Important Safety Information

This information is for educational purposes only and does not replace professional medical advice. Always consult your doctor before use. Dosage and side effects may vary. Use only as prescribed.