Aspirin Complex effervescent powder in sachets 10 pcs.

Pharmacological properties of the drug Aspirin complex

A combined drug, the effect of which is due to the active components included in its composition. Pharmacodynamics. Acetylsalicylic acid has antipyretic, analgesic, anti-inflammatory and antiplatelet effects. The main mechanism of action of acetylsalicylic acid is the inactivation of the COX enzyme, as a result of which the synthesis of prostaglandins, prostacyclins and thromboxane is disrupted. Due to a decrease in the production of prostaglandins, the severity of their pyrogenic effect on thermoregulation centers decreases. In addition, the sensitizing effect of prostaglandins on sensory nerve endings is reduced, which leads to a decrease in the sensitivity of the latter to pain mediators. The antiplatelet effect of acetylsalicylic acid is due to an irreversible disruption of the synthesis of thromboxane A2 in platelets, as well as its ability to reversibly block COX in endothelial cells, in which prostacyclin, which has antiplatelet activity, is synthesized. Phenylephrine bitartrate is a sympathomimetic. When interacting with α-adrenergic receptors, it causes a narrowing of the arterioles of the nasal mucosa, helping to reduce swelling of the upper respiratory tract and paranasal sinuses, reduces rhinorrhea, lacrimation, and facilitates nasal breathing. Chlorphenamine maleate is an inhibitor of histamine H1 receptors, has an antiallergic effect, reduces the permeability of blood vessels in the mucous membrane of the upper respiratory tract, eliminates itching in the eyes and nose, relieves sneezing and lacrimation. Pharmacokinetics. After ingestion, acetylsalicylic acid is converted into the main metabolite - salicylic acid. Absorption of acetylsalicylic and salicylic acid in the digestive tract occurs quickly and completely. The maximum level of concentration in the blood plasma is reached after 10–20 minutes (acetylsalicylic acid) or 45–120 minutes (total level of salicylates). The degree of binding to plasma proteins depends on the concentration and is 49–70% for acetylsalicylic acid and 66–98% for salicylic acid. 50% of the administered dose of the drug is metabolized during the initial passage through the liver. Metabolites of acetylsalicylic and salicylic acid are glycine conjugate of salicylic acid, gentisic acid and its glycine conjugate. The drug is excreted in the form of metabolites mainly by the kidneys. The half-life of acetylsalicylic acid is 20 minutes; salicylic acid - increases in proportion to the dose taken and amounts to 2; 4 and 20 hours at a dose of 0.5; 1 and 5 g respectively. The drug penetrates the blood-brain barrier, as well as into breast milk and synovial fluid. Phenylephrine bitartrate is absorbed from the gastrointestinal tract and metabolized in the intestinal wall and in the liver through the formation of sulfate conjugates. Phenylephrine and its metabolites are almost completely excreted by the kidneys, the half-life is 21–34 hours. Chlorphenamine is absorbed relatively slowly from the gastrointestinal tract, the maximum concentration in the blood plasma is reached 2–6 hours after oral administration. The half-life is about 24 hours in adults, 9–11 hours in children and more than 24 hours in elderly people. 78–90% of chlorphenamine binds to blood plasma proteins and is distributed in tissues and penetrates the BBB. Chlorphenamine is metabolized mainly in the liver by dimethylation, forming homo- and dimethyl derivatives. The excretion of chlorphenamine and its metabolites is carried out by the kidneys and depends on the pH of the urine.

Use of the drug Aspirin complex

Dissolve the contents of the sachet in a glass of water at room temperature and apply orally after meals. Adults and children over 15 years of age: one sachet every 6–8 hours. The maximum daily dose is 4 sachets, the interval between doses of the drug should be at least 6 hours. Patients with concomitant liver or kidney dysfunction should reduce the dose of the drug or increase it interval between doses. The period of use of the drug without consulting a doctor should not exceed 5 days for pain relief and 3 days when used as an antipyretic.

Contraindications to the use of the drug Aspirin complex

acute or chronic peptic ulcer of the stomach or duodenum;
BA caused by the use of salicylates or other NSAIDs;
hemorrhagic diathesis, increased tendency to bleeding, hemophilia, hypoprothrombinemia;
severe renal failure;
severe liver failure;
hypersensitivity to acetylsalicylic acid, other salicylates, antihistamines, sympathomimetics, tartazine (cross-reactions with acetylsalicylic acid) or any component of the drug;
polyposis of the nasal mucosa associated with asthma and intolerance to acetylsalicylic acid;
arterial hypertension (AH);
angina pectoris;
coronary insufficiency;
urinary retention;
hyperthyroidism;
diabetes.

Contraindicated in children under 12 years of age, during pregnancy and breastfeeding. The drug is not prescribed to children under 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 degeneration with the development of acute liver failure). One of the signs of Reye's syndrome is persistent vomiting. Use with caution in patients with chronic lung and kidney diseases, glaucoma, pheochromocytoma, cardiovascular diseases, diabetes mellitus, anemia and prostate hypertrophy.

ASPIRIN COMPLEX effervescent powder 3.5475g N10

It should be borne in mind that acetylsalicylic acid can cause bronchospasm, an attack of bronchial asthma or other hypersensitivity reactions. Risk factors are the presence of bronchial asthma, nasal polyps, fever, chronic bronchopulmonary diseases, a history of allergies (allergic rhinitis, skin rash).

Acetylsalicylic acid may increase the tendency to bleeding, which is associated with its inhibitory effect on platelet aggregation. This should be taken into account if surgical interventions are necessary (including minor surgical interventions, such as tooth extraction). Before surgery, to reduce bleeding during surgery and in the postoperative period, you should stop taking the drug 5-7 days in advance and notify the doctor.

When used in children for acute viral infections, drugs containing acetylsalicylic acid increase the risk of Reye's syndrome (vomiting, acute encephalopathy, liver enlargement). Therefore, the use of Aspirin® Complex in this category of patients is contraindicated.

During treatment, it is not recommended to drink alcohol due to the increased risk of side effects from the gastrointestinal tract caused by taking acetylsalicylic acid and the increased sedative effect of chlorphenamine.

Due to the fact that when using chlorphenamine, changes in allergy skin test parameters are possible, it is recommended to inform your doctor about the use of the drug and discontinue it 3 days before skin tests.

During treatment, it is not recommended to use painkillers, sympathomimetics, guanethidine and beta-blockers.

It is not recommended to take the drug systematically and for prophylactic purposes before vaccinations.

Patients limiting their salt intake should take into account that each sachet contains sodium bicarbonate.

The active component phenylephrine, which is part of the drug, can cause a positive result during a doping test in athletes.

With renal failure and reduced plasma albumin levels, the risk of drug toxicity increases.

Impact on the ability to drive vehicles and operate machinery

Aspirin® Complex may cause drowsiness and, therefore, impair the ability to drive a car and operate moving machinery.

Side effects of the drug Aspirin complex

Acetylsalicylic acid From the gastrointestinal tract: nausea, anorexia, pain in the epigastric region. In some cases, especially with frequent and long-term use of the drug, the appearance of erosive and ulcerative lesions of the digestive tract, sometimes complicated by latent or clinically significant bleeding (melena). Allergic reactions: urticaria, skin rashes, angioedema (Quincke's edema), bronchospasm and shortness of breath (especially in patients with asthma). From the hematopoietic system: very rarely - the development of thrombocytopenia, anemia (due to hidden bleeding from the gastrointestinal tract), hypoprothrombinemia. From the central nervous system and sensory organs: dizziness, ringing in the ears, headache, hearing loss. From the urinary system: renal failure, acute interstitial glomerulonephritis. In isolated cases (≤1%), toxic liver damage, especially in patients with rheumatoid arthritis, anemia, Reye's syndrome in children (with hepatogenic encephalopathy). Phenylephrine bitartrate From the central nervous system and sensory organs: headache, dry mouth, insomnia, nausea, excitability, anxiety. In isolated cases: from the central nervous system - severe headache, inappropriate behavior; from the cardiovascular system - increased blood pressure, tachycardia; from the urinary system - painful or difficult urination. Chlorphenamine maleate From the nasopharynx and organs of vision: dryness of the mucous membrane of the mouth and nose, impaired accommodation (blurred vision); from the cardiovascular system - tachycardia; from the gastrointestinal tract - constipation; from the urinary system - urinary retention, painful or difficult urination; from the central nervous system and sensory organs - impaired attention, drowsiness, dizziness. Children and elderly patients may experience lethargy or excitability, anxiety, irritability, and dizziness. If any side effects occur, the drug should be discontinued.

Special instructions for the use of the drug Aspirin complex

Aspirin Complex is used with caution when: combined with anticoagulant drugs; peptic ulcers of the gastrointestinal tract or a tendency to bleeding from the gastrointestinal tract; impaired renal and/or liver function; hypersensitivity to NSAIDs. In patients with allergic diseases, including asthma, allergic rhinitis, urticaria, itching, swelling of the mucous membrane or nasal polyposis, as well as in combination with chronic respiratory tract infections and in patients with hypersensitivity to NSAIDs during treatment with Aspirin Complex, it is possible development of asthma attacks. During surgical procedures (including dental), the use of drugs containing acetylsalicylic acid may increase the likelihood of bleeding. The use of phenylephrine before inhalation anesthesia increases the risk of heart rhythm disturbances, therefore, a few days before planned surgical treatment, you should stop taking the drug or use it if absolutely necessary and only after consulting a doctor. During treatment, you should not drink alcohol due to the increased risk of developing adverse reactions from the gastrointestinal tract associated with taking acetylsalicylic acid and the sedative effect of chlorphenamine. The use of chlorphenamine may affect the results of skin allergy tests, so you should warn your doctor about taking this drug and stop it 3 days before conducting diagnostic tests. During treatment, it is not recommended to use painkillers, sympathomimetics, guanethidine and beta-adrenergic blockers. It is not recommended to use the drug systematically for prophylactic purposes before vaccination. Patients on a low-sodium diet should note that each packet contains 268 mg sodium (equivalent to 1710.73 sodium bicarbonate). The active component of the drug, phenylephrine, can cause a positive result during a doping test in athletes. In elderly patients with renal failure and reduced levels of plasma albumin, the risk of toxic effects of the drug increases. In elderly patients, anticholinergic and CNS-stimulating effects may develop when using the drug in normal doses. Taking acetylsalicylic acid, even in low doses, reduces the excretion of uric acid, which can cause an acute attack of gout in patients with a predisposition. During pregnancy and breastfeeding. The use of the drug is contraindicated in the first and third trimesters of pregnancy. In the second trimester of pregnancy, a one-time dose is possible according to strict indications. Acetylsalicylic acid is excreted in breast milk, which increases the risk of bleeding in the child due to impaired platelet function, therefore, with long-term use of acetylsalicylic acid during breastfeeding, the issue of stopping it should be decided. Influence on the ability to drive vehicles and other mechanisms. Aspirin Complex may cause drowsiness and, therefore, impair the ability to drive vehicles and other machinery.

Aspirin Complex pores No. 10

Compound

Active ingredients:

acetylsalicylic acid - 500 mg;
phenylephrine hydrotartrate - 15.58 mg;
chlorphenamine maleate - 2 mg.

Excipients: anhydrous citric acid - 1220 mg, sodium bicarbonate - 1709.6 mg, lemon flavor - 100 mg, quinoline yellow dye (E104) - 0.32 mg.

Pharmacokinetics

Acetylsalicylic acid,
when taken orally, is rapidly absorbed mainly from the proximal small intestine and to a lesser extent from the stomach. The presence of food in the stomach significantly changes the absorption of acetylsalicylic acid. Metabolized in the liver by hydrolysis to form salicylic acid, followed by conjugation with glycine or glucuronide. The concentration of salicylates in blood plasma is variable. About 80% of salicylic acid binds to blood plasma proteins. Salicylates easily penetrate many tissues and body fluids, incl. into the cerebrospinal, peritoneal and synovial fluids. Salicylates are found in small quantities in brain tissue, traces in bile, sweat, and feces. It quickly penetrates the placental barrier and is excreted in small quantities in breast milk. It is excreted primarily by active secretion in the renal tubules unchanged (60%) and in the form of metabolites. The excretion of unchanged salicylate depends on the pH of the urine (with alkalinization of the urine, the ionization of salicylates increases, their reabsorption worsens and excretion increases significantly). T1/2 of acetylsalicylic acid is approximately 15 minutes. T1/2 of salicylate when taken in low doses is 2-3 hours, with increasing doses it can increase to 15-30 hours.

Chlorphenamine

relatively slowly absorbed from the gastrointestinal tract. Cmax is reached after 2.5-6 hours. Bioavailability is low - 25-50%. Subject to a first-pass effect through the liver. Plasma protein binding is about 70%. Chlorphenamine is widely distributed in the organs and tissues of the body and penetrates the central nervous system. Intensively metabolized in the liver to form desmethyl- and didesmethylchlorphenamine. The unchanged drug and its metabolites are excreted primarily in the urine. Excretion depends on urine pH and urine flow rate. Only trace amounts of chlorphenamine are detected in feces. Chlorphenamine is characterized by significant interindividual variability in pharmacokinetic parameters: T1/2 varies from 2 to 43 hours.

Phenylephrine

after oral administration it is poorly absorbed from the gastrointestinal tract. Metabolized with the participation of MAO in the intestinal wall and during the “first pass” through the liver. The bioavailability of phenylephrine is low.

Indications for use

Use to relieve symptoms of “colds”, ARVI, flu, such as: high fever and chills, headache and muscle pain, runny nose and/or nasal congestion, sore throat and sneezing.

Contraindications

hypersensitivity to acetylsalicylic acid and other NSAIDs or other components of the drug;
erosive and ulcerative lesions of the gastrointestinal tract (in the acute phase), chronic or recurrent course of peptic ulcer;
asthma caused by taking salicylates or other NSAIDs;
bleeding disorders such as hemophilia; hypoprothrombinemia;
severe impairment of liver and/or kidney function;
nasal polyposis associated with bronchial asthma and intolerance to acetylsalicylic acid;
arterial hypertension;
angina pectoris;
enlargement of the thyroid gland;
combined use with oral anticoagulants;
combined use with monoamine oxidase inhibitors, including 15 days after stopping their use;
combined use of methotrexate at a dose of 15 mg per week or more;
urinary retention;
pregnancy (I and III trimester), breastfeeding period.

The drug is not prescribed to children under 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 degeneration with acute development of liver failure).

With caution: In patients with lung and kidney disease, glaucoma, pheochromocytoma, cardiovascular diseases, diabetes mellitus, prostatic hypertrophy, and anemia.

Directions for use and doses

Dissolve the contents of the sachet in a glass of water at room temperature.
Take orally after meals. Adults and children over 15 years of age: one sachet every 6-8 hours.

The maximum daily dose is 4 sachets, the interval between doses of the drug should be at least 6 hours.

The duration of treatment (without consulting a doctor) should not exceed 5 days when prescribed as an analgesic and more than 3 days when prescribed as an antipyretic.

Storage conditions

Store out of the reach of children at a temperature not exceeding 25°C.

Best before date

4 years. Do not use after expiration date.

special instructions

Acetylsalicylic acid may cause bronchospasm, an attack of bronchial asthma or other hypersensitivity reactions.
Risk factors are the presence of bronchial asthma, nasal polyps, fever, chronic bronchopulmonary diseases, a history of allergies (allergic rhinitis, skin rashes). Acetylsalicylic acid may increase the tendency to bleeding, which is associated with its inhibitory effect on platelet aggregation. This should be taken into account when surgical interventions are necessary, including minor procedures such as tooth extraction. Before surgery, to reduce bleeding during surgery and in the postoperative period, you should stop taking the drug 5-7 days in advance and notify the doctor. Children should not be prescribed medications containing acetylsalicylic acid, since in the case of a viral infection the risk of Reye's syndrome increases. Symptoms of Reye's syndrome are prolonged vomiting, acute encephalopathy, and liver enlargement.

During treatment, it is not recommended to drink alcohol due to the increased risk of side effects from the gastrointestinal tract associated with taking acetylsalicylic acid, and the increased sedative effect of chlorphenamine.

During treatment, it is not recommended to use painkillers, sympathomimetics, guanethidine and beta-blockers.

It is not recommended to take the drug systematically and for prophylactic purposes before vaccinations.

Patients limiting their salt intake should note that each sachet contains sodium bicarbonate.

The active component phenylephrine, which is part of the drug, can cause a positive result during a doping test in athletes.

With renal failure and reduced plasma albumin levels, the risk of toxic effects of the drug increases.

Description

A remedy for eliminating the symptoms of acute respiratory infections and “colds” (NSAIDs + alpha-adrenergic agonist + H1-histamine receptor blocker).

Dosage form

Effervescent powder for the preparation of a solution for oral administration in the form of a mixture of crystalline powders from almost white to white with a yellowish tint.

Use in children

Use is contraindicated in children under 15 years of age.

Pharmacodynamics

Combined drug for oral administration.
Acetylsalicylic acid

has analgesic, antipyretic and anti-inflammatory effects. The mechanism of action is the irreversible inhibition of the enzyme cyclooxygenase, which regulates the synthesis of prostaglandins. Acetylsalicylic acid inhibits platelet aggregation by blocking the synthesis of thromboxane A2.

Chlorphenamine

- a blocker of histamine H1 receptors, has an antiallergic effect, relieves symptoms such as sneezing and lacrimation.

Phenylephrine

is a sympathomimetic and, having a vasoconstrictor effect, reduces swelling of the mucous membranes of the nose and paranasal sinuses, resulting in easier breathing.

Side effects

Acetylsalicylic acid

From the digestive system: dyspepsia, nausea, vomiting, stomach and duodenal ulcers, gastrointestinal bleeding, incl. hidden; rarely - toxic liver damage, especially in patients with juvenile rheumatoid arthritis.

From the blood coagulation system: hypoprothrombinemia.

From the hematopoietic system: rarely - anemia.

From the side of the central nervous system: dizziness, ringing in the ears, headache, hearing loss.

From the urinary system: renal failure, acute interstitial glomerulonephritis.

Allergic reactions: urticaria, exanthema, angioedema, rhinitis, bronchospasm, shortness of breath.

From the body as a whole: hyperhidrosis; rarely - Reye's syndrome in children.

Chlorphenamine

From the body as a whole: dry mouth, dry mucous membrane of the oral cavity and nose, impaired accommodation (blurred vision).

From the cardiovascular system: tachycardia.

From the digestive system: constipation.

From the urinary system: urinary retention, difficulty and pain when urinating.

From the side of the central nervous system: impaired attention, drowsiness, dizziness. Children and elderly patients may experience lethargy, agitation, dizziness, anxiety, and irritability.

Phenylephrine

From the central nervous system: headache, dry mouth, insomnia, nausea, excitability, anxiety; rarely - severe headache, inappropriate behavior.

From the cardiovascular system: rarely - increased blood pressure, tachycardia.

From the genitourinary system: rarely - painful or difficult urination.

Use during pregnancy and breastfeeding

Contraindicated for use during pregnancy (especially in the first and third trimesters) and during breastfeeding.

Interaction

Acetylsalicylic acid

With the simultaneous use of ethanol, cimetidine and ranitidine with acetylsalicylic acid, the toxic effect of the latter increases.
With the simultaneous use of heparin and indirect anticoagulants with acetylsalicylic acid, the risk of bleeding increases due to the suppression of platelet function and the displacement of indirect anticoagulants from communication with blood plasma proteins.
Acetylsalicylic acid reduces the absorption of indomethacin, fenoprofen, naproxen, flurbiprofen, ibuprofen, diclofenac, piroxicam.
With the simultaneous use of GCS with acetylsalicylic acid, the risk of secondary damage to the gastrointestinal mucosa increases.
Acetylsalicylic acid, when used simultaneously, can increase the concentration of phenytoin due to its displacement from protein binding.
With the simultaneous use of antidiabetic drugs (including insulin) with acetylsalicylic acid, the hypoglycemic effect is enhanced due to the fact that acetylsalicylic acid in a high dose has hypoglycemic properties and displaces sulfonylurea derivatives from binding to plasma proteins.
Acetylsalicylic acid, when used simultaneously, may enhance the ototoxic effect of vancomycin.
With the simultaneous use of methotrexate with acetylsalicylic acid, the effect of methotrexate is enhanced by reducing renal clearance and displacing it from protein binding.
Salicylates, when used simultaneously, reduce the uricosuric effect of probenecid and sulfinpyrazone due to competitive tubular elimination of uric acid.
With the simultaneous use of zidovudine with acetylsalicylic acid, a mutual increase in toxic effects is observed.

Chlorphenamine

With simultaneous use, chlorphenamine can enhance the inhibitory effect on the central nervous system of ethanol, hypnotics, tranquilizers, antipsychotics (neuroleptics), and centrally acting analgesics.
With simultaneous use, chlorphenamine enhances the anticholinergic effect of anticholinergic drugs (atropine, antispasmodics, tricyclic antidepressants, MAO inhibitors).

Phenylephrine

With the simultaneous use of phenylephrine and MAO inhibitors (antidepressants - tranylcypromine, moclobemide; antiparkinsonian drugs - selegiline), severe side effects are possible in the form of intense headache, increased blood pressure and body temperature.
With simultaneous use of phenylephrine with beta-blockers, increased blood pressure and severe bradycardia are possible.
With simultaneous use of phenylephrine with sympathomimetics, the effect of the latter on the central nervous system and cardiovascular system increases. Possible agitation, irritability, insomnia.
The use of phenylephrine before inhalation anesthesia increases the risk of heart rhythm disturbances. Treatment with phenylephrine should be discontinued several days before elective surgery.
When used concomitantly, rauwolfia alkaloids may reduce the therapeutic effect of phenylephrine.
With simultaneous use of phenylephrine and caffeine, the therapeutic and toxic effects of the latter may be enhanced.
In isolated cases, with simultaneous use of phenylephrine with indomethacin or bromocriptine, severe arterial hypertension may develop.
With simultaneous use of phenylephrine with antidepressants from the group of selective serotonin reuptake inhibitors (fluvoxamine, paroxetine, sertraline), both the body's sensitivity to sympathomimetics and the risk of developing serotonergic syndrome may increase.
When used simultaneously, phenylephrine reduces the hypotensive effect of antihypertensive drugs from the sympatholytic group (reserpine, guanethidine).

Overdose

Symptoms: nausea, vomiting, ringing in the ears, deterioration of hearing and vision, rapid breathing, severe headache, imbalance, severe drowsiness, heart rhythm disturbance.
Treatment: gastric lavage, administration of activated carbon, symptomatic therapy.

Impact on the ability to drive vehicles and operate machinery

Aspirin® Complex may cause drowsiness and, therefore, impair the ability to drive a car and operate moving machinery.

Drug interactions Aspirin complex

acetylsalicylic acid, when used in combination with heparin and indirect anticoagulants, enhances their effect by disrupting platelet functions and displacing indirect anticoagulants from their connection with proteins; when combined with NSAIDs, it reduces the absorption of indomethacin, fenoprofen, naproxen, flurbiprofen, ibuprofen, diclofenac, piroxicam; when combined with corticosteroids, increases the risk of secondary gastrointestinal damage and may cause ulceration or bleeding; with phenytoin can increase the concentration of the latter in the blood plasma by displacing it from protein binding. Ethyl alcohol, cimetidine and ranitidine increase the toxicity of acetylsalicylic acid. Acetylsalicylic acid enhances the effect of antidiabetic drugs and insulin due to its hypoglycemic properties (when used in high doses) and displacement of sulfonylurea derivatives from protein binding; increases the ototoxic effect of vancomycin; enhances the effect of methotrexate due to renal clearance and displacing it from protein binding; worsens the uricosuric effect of probenecid and sulfinprazone due to competitive tubular elimination of uric acid; enhances the toxic effect of zidovudine. Phenylephrine bitartrate: when used in combination with MAO inhibitors (antidepressants - tranylcypromine, monchlobemide, antiparkinsonian drugs - selegiline), severe side effects may occur in the form of intense headache, increased blood pressure and body temperature; when taken in combination with beta-adrenergic receptor blockers, hypertension and severe bradycardia may occur. Phenylephrine enhances the effect of sympathomimetics on the central nervous system and cardiovascular system. When used in combination, excitability, irritability, and insomnia are possible. The use of rauwolfia alkaloids with phenylephrine prolongs the effect of the latter. Phenylephrine, in turn, slows down the effect of antihypertensive drugs of the sympatholytic group, such as reserpine, guanethidine. Combined use with caffeine may enhance the pharmacological and toxic effects of phenylephrine; with indomethacin and bromocriptine - in some cases severe hypertension occurs; with selective serotonin reuptake inhibitors (fluvoxamine, paroxetine, sertraline) - sensitivity to sympathomimetics increases and there is a risk of developing a serotonergic effect. Chlorphenamine maleate can enhance the inhibitory effect of alcohol, hypnotics, tranquilizers, antipsychotics, and centrally acting analgesics on the central nervous system; enhances the anticholinergic effect of atropine, antispasmodics, tricyclic antidepressants, MAO inhibitors, antiparkinsonian drugs.

Aspirin Complex effervescent powder in sachets 10 pcs.

Acetylsalicylic acid. Combination with Methotrexate at a dose of > 15 mg per week is contraindicated. Combinations of drugs that are used with caution: Methotrexate at a dose of less than 15 mg/week: With simultaneous use of drugs, the hematological toxicity of methotrexate increases due to the fact that NSAIDs in general reduce the renal clearance of methotrexate, and salicylags, in particular, displace it from association with plasma proteins . Anticoagulants (coumarin, heparin): when taking ASA and indirect anticoagulants simultaneously, the risk of bleeding increases due to suppression of platelet function, damage to the mucous membrane of the stomach and duodenum and displacement of oral anticoagulants from their connection with plasma proteins. Other NSAIDs with salicylates in high doses (at a dose of 3 g/day or more): with simultaneous use of drugs due to the synergistic effect, the risk of ulcers of the gastrointestinal mucosa and bleeding increases. Uricosuric drugs (probenecid, sulfinpyrazone): the therapeutic effect of uricosuric drugs is reduced due to competitive tubular elimination of uric acid. Digoxin: with simultaneous use of drugs, the concentration of digoxin in plasma increases due to a decrease in its excretion. Antidiabetic drugs (insulin, sulfonylurea): the hypoglycemic effect is enhanced due to the fact that ASA in a high dose has hypoglycemic properties and displaces sulfonylurea from binding to plasma proteins. Thrombolytics/antiplatelet drugs of other classes (ticlopidine): increased risk of bleeding. Diuretics in combination with ASA at a dose of 3 g/day or more: glomerular filtration is reduced due to a decrease in the synthesis of prostaglandins in the kidneys. Systemic glucocorticosteroids (GCS), with the exception of hydrocortisone (used to treat Addison's disease): with simultaneous use of drugs, the concentration of salicylates in the blood decreases, since GCS enhances the elimination of salicylates. Angiotensin-converting enzyme (ACE) inhibitors: with simultaneous use of ACE inhibitors and ASA at a dose of 3 g/day or more, a decrease in the hypotensive effect of ACE inhibitors is observed due to a decrease in glomerular filtration. Valproic acid: ASA disrupts the binding of valproic acid to plasma proteins, resulting in increased toxicity. Alcohol: when combined with ASA, the damaging effect on the mucous membrane of the gastrointestinal tract increases and bleeding time prolongs. Phenylephrine. Monoamine oxidase inhibitors (MAO inhibitors): with the simultaneous use of phenylephrine and MAO inhibitors (antidepressants - tranylcypromine, moclobemide; antiparkinsonian drugs - selegiline), severe side effects are possible in the form of intense headache, increased blood pressure and body temperature. Beta-blockers - with simultaneous use, an increase in blood pressure (arterial hypertension) and severe bradycardia is possible. Sympathomimetics: with simultaneous use, the effect of sympathomimetics on the central nervous system and cardiovascular system is enhanced. Possible agitation, irritability, insomnia. Inhalational anesthetics: The use of filephrine before inhalational anesthesia increases the risk of cardiac arrhythmias. Treatment with phenylephrine should be discontinued several days before elective surgery. Rauwolfia alkaloids - with simultaneous use, the therapeutic effect of phenylephrine may be reduced. Caffeine: Concomitant use may increase the therapeutic and toxic effects of caffeine. Indomethacin, bromocriptine: in isolated cases, when phenylephrine is used concomitantly with indomethacin or bromocriptine, severe arterial hypertension is possible. Selective serotonin reuptake inhibitors: when used simultaneously with antidepressants of this group (fluvoxamine, paroxetine, sertraline), both the body's sensitivity to sympathomimetics and the risk of developing a serotonergic effect may increase. Antihypertensive drugs from the sympatholytic group, such as reserpine, guanethidine: phenylephrine reduces the hypotensive effect of these drugs. Chlorphenamine. Alcohol, hypnotics, tranquilizers, antipsychotics (neuroleptics), neutral analgesics: chlorphenamine may enhance the depressant effect of these drugs on the central nervous system. Anticholinergic drugs (atropine, antispasmodics, tricyclic antidepressants, MAO inhibitors, antiparkinsonian drugs): chlorphenamine enhances the anticholinergic effect of these drugs.