Citramon-Darnitsa painkillers tablets, 6 pcs.

Characteristics of the drug

The main component in the composition is caffeine. It activates the central nervous system, increases the degree of arousal, and is used for:

• activation of respiratory, brain, vasomotor centers,
• reducing the lumens of blood vessels,
• increased breathing,
• muscle relaxation,
• stabilization of the heart, diuresis.

Citramon is approved to block several types of headaches. It is used to increase blood pressure levels in a single dose if there are no signs of hypertension. Caffeine allows you to gently gain weight and normalize sleep. Allowed for complex therapy in combination with ergot alkaloids and analgesics.

The second substance is acetylsalicylic acid. Aspirin relieves mild to moderate pain and is used to block the inflammatory process and reduce fever. Can be used as a medicine to prevent arterial or venous thrombosis. The substance helps to temporarily relieve discomfort associated with chronic lupus, rheumatoid arthritis, and osteoarthritis. Included in a complex to reduce the risk of death, the formation of unstable angina or myocardial infarction.

The third substance is paracetamol. The substance is used to eliminate pain and reduce fever. It does not have anti-inflammatory or antiplatelet effects. The substance is added to many medications and eliminates acute respiratory infections in the early stages of their occurrence.

We studied the composition of Citramon. It is aimed at influencing intracranial pressure in the direction of growth. The product does not cause dilation of blood vessels. Citramon increases low blood pressure .

Citramon increases or decreases blood pressure

Citramon-Darnitsa painkillers tablets, 6 pcs.

Symptoms of overdose may occur with prolonged use of the drug or when used in doses many times higher than recommended.

Overdose symptoms caused by acetylsalicylic acid

Salicylate toxicity may occur due to long-term use of therapeutic doses or acute intoxication when using >100 mg/kg/day for more than 2 days (accidental ingestion by children or accidental overdose), which is life-threatening. Chronic poisoning with salicylates can be asymptomatic because it does not have specific symptoms. Moderate salicylate intoxication, or salicylicism, usually develops only after repeated use of high doses.

Symptoms: dizziness, tinnitus, deafness, excessive sweating, nausea, vomiting, headache and depression of consciousness can be controlled by reducing the dose. Tinnitus may occur at plasma concentrations between 150 and 300 mcg/ml. More severe side effects occur at concentrations greater than 300 mcg/ml. The main feature of acute poisoning is a severe disturbance of the acid-base balance, which can vary depending on the age of the patient and the severity of intoxication. A common symptom in children is metabolic acidosis. The severity of poisoning cannot be assessed by plasma concentrations alone. The absorption of acetylsalicylic acid may be slowed down due to inhibition of gastric emptying, the formation of stones in the stomach or as a result of the use of enteric-coated drugs.

Emergency care for acetylsalicylic acid poisoning is determined by the severity, stage and clinical symptoms and corresponds to standard methods of providing emergency care for poisoning. Priority measures should be aimed at accelerating the withdrawal of the drug, as well as restoring the electrolyte and acid-base balance. Due to the complex pathophysiological effects of salicylate poisoning, several symptoms and laboratory changes may occur.

Mild and moderate poisoning: tachypnea, hyperventilation, respiratory alkalosis, increased sweating, nausea, vomiting. Laboratory data: alkalosis, alkaline urine reaction.

Severe poisoning: respiratory alkalosis with compensatory metabolic acidosis, hyperpyrexia, tinnitus, deafness. Respiratory system: from hyperventilation, non-cardiogenic pulmonary edema to respiratory arrest and asphyxia; laboratory data: alkalosis, alkaline urine reaction. Cardiovascular system: from cardiac arrhythmias, arterial hypotension to cardiac arrest. Loss of fluid and electrolytes, dehydration, oliguria, renal failure. Laboratory data: hypokalemia, hypernatremia, hyponatremia, renal dysfunction. Impaired glucose metabolism and ketosis are laboratory manifested in the form of hyperglycemia, hypoglycemia (especially in children), and increased levels of ketone bodies. Gastrointestinal tract: gastrointestinal bleeding. On the part of the blood from inhibition of platelet function to coagulopathies. Laboratory data: increased prothrombin time, hypoprothrombinemia. Neurological: toxic encephalopathy and depression of the central nervous system from lethargy, depression of consciousness to coma and convulsions.

Symptoms of overdose in the first 24 hours caused by paracetamol: pale skin, loss of appetite, anorexia, nausea, vomiting, abdominal pain, hepatonecrosis, increased activity of liver transaminases, increased prothrombin index. Symptoms of liver damage are observed 12-48 hours after an overdose. Impaired glucose metabolism and metabolic acidosis may occur. In severe poisoning, liver failure can progress and lead to the development of toxic encephalopathy with impaired consciousness, hemorrhage, hypoglycemia, coma, and in some cases, death. Acute renal failure with acute tubular necrosis can manifest as severe lumbar pain, hematuria, proteinuria and develop even in the absence of severe kidney damage. Cardiac arrhythmia and pancreatitis were also noted.

With long-term use of the drug in large doses, the hematopoietic organs may develop aplastic anemia, pancytopenia, agranulocytosis, neutropenia, leukopenia, thrombocytopenia. When taking large doses, the central nervous system may experience dizziness, psychomotor agitation, and disorientation; from the urinary system - nephrotoxicity (renal colic, interstitial nephritis, capillary necrosis).

Liver damage is possible in adults who took 10 g or more paracetamol, and in children who took more than 150 mg/kg body weight. In patients with risk factors (long-term use of carbamazepine, phenobarbital, phenytoin, primidone, rifampicin, St. John's wort or other drugs that induce liver enzymes, alcohol abuse, glutathione system deficiency, for example: digestive disorders, HIV infection, fasting, cystic fibrosis, cachexia ) Taking 5g or more of paracetamol may cause liver damage.

In case of overdose, emergency medical care is required. The patient should be taken to hospital immediately, even if there are no early symptoms of overdose.

In case of overdose, nausea, vomiting, increased sweating, psychomotor agitation or central nervous system depression, drowsiness, impaired consciousness, cardiac arrhythmia, tachycardia, extrasystole, tremor, hyperreflexia, convulsions may be observed, or the severity of the overdose or the risk of organ damage may not be indicated. Plasma concentrations of paracetamol should be measured 4 hours or later after administration (earlier concentration determinations are unreliable).

Treatment: gastric lavage followed by the use of activated charcoal (if an excessive dose of paracetamol was taken within 1 hour), symptomatic therapy. A specific antidote for paracetamol overdose is N-acetylcysteine. In the absence of vomiting, it is possible to use methionine orally or N-acetylcysteine, which is effective within 24 hours, but the maximum protective effect occurs when used within 8 hours after an overdose. The effectiveness of the antidote decreases sharply after this time. It is also necessary to take general support measures. If necessary, a-blockers should be used.

Symptoms of overdose caused by caffeine: agitation, dizziness, rapid breathing, vomiting, trembling, convulsions, extrasystole.

Treatment: gastric lavage, repeated administration of activated charcoal, forced alkaline diuresis, oxygen therapy, hemodialysis in severe cases, infusion of fluids and electrolytes. Symptomatic therapy. For seizures, diazepam should be used.

Low pressure exposure

Among the list of medical symptoms of low blood pressure are: dizziness, problems with the quality of vision - this is especially felt when driving a car. All of these symptoms indicate low blood pressure and can cause loss of concentration and sluggish reactions. The symptoms can be easily suppressed with Citramon.

Low blood pressure indicates other pathologies. A list of popular diseases and conditions is presented below:

• excessive bleeding
• complex course of infection,
• dehydration,
• heart attack or heart failure,
• severe allergic reaction,
• diseases of the endocrine system affecting the thyroid gland, low blood sugar, and the formation of diabetes mellitus.

I wonder if Citramon increases or decreases blood pressure ? Doctors do not recommend taking the drug frequently to improve blood pressure levels. The drug has a short-term effect and is not indicated for long-term treatment. Thanks to the caffeine it contains, the medicine increases blood pressure rather than lowers it. Caffeine is present in many common foods that people consume every day. Coffee fans feel addicted to it. A similar condition occurs with frequent use:

• strong black tea,
• sweet soda,
• energy workers.

People who prefer these drinks feel a constant need for caffeine. The use of tablets that contain it does not affect intracranial pressure and does not increase it.

Citramon P tablets No. 10

Compound

Active ingredients: acetylsalicylic acid - 240 mg;
caffeine - 30 mg; paracetamol - 180 mg. Excipients: cocoa powder - 22.5 mg, potato starch - 50.13 mg, citric acid - 5 mg, talc - 9.12 mg, calcium stearate - 5.5 mg, medical gelatin - 0.48 mg, cellulose microcrystalline - 0.55 mg, povidone K-30 (medium molecular weight polyvinylpyrrolidone) - 6.72 mg.

Pharmacokinetics

Acetylsalicylic acid

When taken orally, absorption is complete. During absorption, it undergoes presystemic elimination in the intestinal wall and systemic elimination in the liver (deacetylated). The resorbed part is quickly hydrolyzed by cholinesterases and albuminesterase, so the half-life is no more than 15-20 minutes.

It circulates in the body (75-90% due to albumin) and is distributed in tissues in the form of salicylic acid anion. The time to reach maximum concentration is 2 hours. Metabolized primarily in the liver with the formation of 4 metabolites found in many tissues and urine.

It is excreted primarily by active secretion in the renal tubules in the form of salicylate (60%) and its 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). The rate of elimination depends on the dose: when taking small doses, the half-life is 2-3 hours, with increasing doses it can increase to 15-30 hours. In newborns, the elimination of salicylates is much slower than in adults.

Caffeine

When taken orally, absorption is good and occurs throughout the intestine. Absorption occurs primarily due to lipophilicity rather than water solubility. The time to reach maximum concentration is 50 - 75 minutes after oral administration, the maximum concentration is 1.58 - 1.76 mg/l. Quickly distributed in all organs and tissues of the body; easily penetrates the blood-brain barrier and placenta.

The volume of distribution in adults is 0.4 - 0.6 l/kg, in newborns - 0.78 - 0.92 l/kg. Communication with blood proteins (albumin) - 25 - 36%. More than 90% is metabolized in the liver, in children of the first years of life up to 10-15%. In adults, about 80% of a caffeine dose is metabolized to paraxanthine, about 10% to theobromine, and about 4% to theophylline. These compounds are subsequently demethylated into monomethylxanthines and then into methylated uric acids. The half-life in adults is 3.9 - 5.3 hours (sometimes up to 10 hours), in newborns - 65-130 hours, by 4-7 months of life it decreases to the same value as in adults. Caffeine and its metabolites are excreted by the kidneys (1-2% is excreted unchanged in adults, and up to 85% in newborns).

Paracetamol

Absorption is high, maximum concentration is achieved after 0.5 -2 hours; maximum concentration - 5 - 20 mcg/ml. Communication with plasma proteins - 15%. Penetrates the blood-brain barrier. Less than 1% of the dose of paracetamol taken by a nursing mother passes into breast milk. The therapeutically effective concentration of paracetamol in plasma is achieved when administered at a dose of 10-15 mg/kg.

Metabolized in the liver (90 - 95%): 80% enters into conjugation reactions with glucuronic acid and sulfates to form inactive metabolites; 17% undergoes hydroxylation to form 8 active metabolites, which conjugate with glutathione to form inactive metabolites. With a lack of glutathione, these metabolites can block the enzyme systems of hepatocytes and cause their necrosis. The CYP2E1 isoenzyme is also involved in the metabolism of the drug. The half-life is 1 - 4 hours. It is excreted by the kidneys in the form of metabolites, mainly conjugates, only 3% unchanged. In elderly patients, drug clearance decreases and the half-life increases.

Indications for use

Pain syndrome of mild and moderate severity (of various origins): headache, migraine, toothache, neuralgia, myalgia, arthralgia, algodismenorrhea.

Feverish syndrome: with acute respiratory infections; with the flu.

Contraindications

• hypersensitivity to the components of the drug;
• erosive and ulcerative lesions of the gastrointestinal tract (in the acute phase);
• gastrointestinal bleeding;
• “aspirin” asthma;
• hemophilia;
• hemorrhagic diathesis;
• hypoprothrombinemia;
• portal hypertension;
• vitamin deficiency K;
• renal failure;
• I and III trimesters of pregnancy;
• lactation period (breastfeeding);
• deficiency of glucose-6-phosphate dehydrogenase;
• severe arterial hypertension;
• severe course of ischemic heart disease;
• glaucoma;
• increased excitability;
• sleep disorders;
• surgical interventions accompanied by bleeding;
• childhood (up to 15 years - the risk of developing Reye's syndrome in children with hyperthermia due to viral diseases).

With caution: gout, liver disease.

Directions for use and doses

Adults

• Orally (during or after meals, drinking enough water at each dose).
• For headaches, the recommended dose is 1 - 2 tablets; in case of severe headaches, the next dose is 4 - 6 hours later.
• For migraine, the recommended dose is 2 tablets when symptoms appear, if necessary, re-take after 4 - 6 hours. For the treatment of headaches and migraines, the drug is used for no more than 4 days.
• For pain syndrome - 1-2 tablets; the average daily dose is 3-4 tablets, the maximum daily dose is 8 tablets.
• The drug should not be taken for more than 5 days as an analgesic drug and for more than 3 days as an antipyretic.
• Other doses and dosage regimens are determined by the doctor.

Elderly (over 65 years old)

In elderly patients, especially those with low body weight, caution should be exercised. Patients with liver and kidney failure

The effect of impaired liver or kidney function on the pharmacokinetics of the drug has not been studied. Given the mechanism of action of acetylsalicylic acid and paracetamol, their use may aggravate liver or kidney failure. In this regard, the drug is contraindicated in patients with severe hepatic or renal insufficiency (see section “Contraindications”), and in patients with mild to moderate hepatic and renal insufficiency it should be used with caution.

If there is no improvement after treatment, or symptoms worsen, or new symptoms appear, you should consult your doctor. Use the drug only according to the indications, method of administration and in the doses indicated in the instructions.

Storage conditions

In a dry place, protected from light, at a temperature not exceeding 25 °C.

Keep out of the reach of children.

Best before date

4 years. Do not use after the expiration date.

special instructions

Children should not be prescribed medications containing acetylsalicylic acid, since in the case of a viral infection they can increase the risk of Reye's syndrome. Symptoms of Reye's syndrome are prolonged vomiting, acute encephalopathy, and liver enlargement.

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 undergoing surgery, must notify the doctor in advance about taking the drug.

In patients with hypersensitivity or asthmatic reactions to salicylates or their derivatives, acetylsalicylic acid can only be prescribed with special precautions (in an emergency setting).

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

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

Description

Analgesic-antipyretic combined composition.

Dosage form

Tablets are light brown with inclusions, flat-cylindrical with a chamfer and a score, with the smell of cocoa.

Use in children

Children under 15 years of age should not be prescribed medications containing acetylsalicylic acid, since in the case of a viral infection they can increase the risk of Reye's syndrome. Symptoms of Reye's syndrome are prolonged vomiting, acute encephalopathy, and liver enlargement.

Action

Combined drug.

Acetylsalicylic acid

has antipyretic and anti-inflammatory effects, relieves pain, especially caused by the inflammatory process, and also moderately inhibits platelet aggregation and thrombus formation, improves microcirculation at the site of inflammation.

Caffeine

increases reflex excitability of the spinal cord, stimulates the respiratory and vasomotor centers, dilates 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 virtually no stimulating effect on the central nervous system, but helps normalize cerebral vascular tone and accelerate blood flow.

Paracetamol

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

Side effects

From the digestive system: gastralgia, nausea, vomiting, hepatotoxicity, erosive and ulcerative lesions of the gastrointestinal tract.

From the urinary system: nephrotoxicity,

Allergic reactions: skin manifestations, Stevens-Johnson syndrome, Lyell's syndrome, bronchospasm.

From the cardiovascular system: tachycardia, increased blood pressure,

With long-term use: dizziness, headache, visual impairment, tinnitus, decreased platelet aggregation, hypocoagulation, hemorrhagic syndrome (including nosebleeds, bleeding gums, purpura), kidney damage with papillary necrosis; deafness; Reye's syndrome in children (hyperpyrexia, metabolic acidosis, nervous system and mental disorders, vomiting, liver dysfunction).

Use during pregnancy and breastfeeding

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

Acetylsalicylic acid has a teratogenic effect; when used in the first trimester of pregnancy, it leads to a malformation - cleft palate; in the third trimester - to inhibition of labor (inhibition of prostaglandin synthesis), to closure of the ductus arteriosus in the fetus, which causes hyperplasia of the pulmonary vessels and hypertension in the vessels of the pulmonary circulation.

It is excreted in breast milk, which increases the risk of bleeding in the baby due to impaired platelet function.

Interaction

• Strengthens the effect of heparin, indirect anticoagulants, reserpine, steroid hormones and hypoglycemic drugs.
• Co-administration with other NSAIDs and methotrexate increases the risk of side effects.
• Reduces the effectiveness of spironolactone, furosemide, antihypertensive drugs, as well as anti-gout drugs that promote the excretion of uric acid.
• Barbiturates, rifampicin, salicylamide, antiepileptic drugs and other stimulants of microsomal oxidation contribute to the formation of toxic paracetamol metabolites that affect liver function.
• Metoclopramide accelerates the absorption of paracetamol.
• Under the influence of paracetamol, T1/2 of chloramphenicol increases 5 times. When taken repeatedly, paracetamol may enhance the effect of anticoagulants (dicoumarin derivatives).
• The simultaneous use of paracetamol and ethanol increases the risk of developing hepatotoxic effects.
• Caffeine accelerates the absorption of ergotamine.

Overdose

• Acetylsalicylic acid

For mild intoxications - dizziness, tinnitus, deafness, increased sweating, nausea, vomiting, headache and confusion. Occurs at plasma concentrations of 150 - 300 mcg/ml. Treatment is dose reduction or discontinuation of therapy. At concentrations above 300 mcg/ml, more severe intoxication occurs, manifested by hyperventilation, fever, anxiety, ketoacidosis, respiratory alkalosis and metabolic acidosis. Depression of the central nervous system can lead to coma, and cardiovascular collapse and respiratory failure may also occur.

The greatest risk of developing chronic intoxication is observed in children and the elderly when taking more than 100 mg/kg/day for several days.

Treatment: if there is a suspicion of ingestion of more than 120 mg/kg of salicylates, activated charcoal is administered orally several times during the last hour.

When taking more than 120 mg/kg of salicylates, their plasma concentration should be determined, although it is impossible to predict its severity based on this indicator alone; clinical and biochemical parameters must also be taken into account.

If plasma concentrations exceed 500 mcg/mL (350 mcg/mL for children <5 years), intravenous sodium bicarbonate is effective in removing salicylates from plasma.

If plasma concentrations exceed 700 mcg/mL (lower concentrations in children and the elderly) or in severe metabolic acidosis, hemodialysis or hemoperfusion is the treatment of choice.

• Caffeine

Common symptoms include gastralgia, agitation, delirium, anxiety, nervousness, restlessness, insomnia, mental agitation, muscle twitching, confusion, convulsions, dehydration, frequent urination, pyrexia, headache, increased sensitivity to touch or pain, nausea and vomiting (sometimes with blood), tinnitus. In case of severe overdose, hyperglycemia may occur. Cardiac disorders are manifested by tachycardia and arrhythmia.

Treatment: dose reduction or withdrawal of caffeine.

• Paracetamol

In case of overdose, intoxication is possible, especially in elderly patients, children, patients with liver diseases (caused by chronic alcoholism), in patients with nutritional disorders, as well as in patients taking inducers of microsomal liver enzymes, in which fulminant hepatitis, liver failure, cholestatic hepatitis, cytolytic hepatitis, in the above cases - sometimes with a fatal outcome.

The clinical picture of acute overdose develops within 24 hours after taking paracetamol.

Symptoms: gastrointestinal disorders (nausea, vomiting, loss of appetite, abdominal discomfort and (or) abdominal pain), pale skin. When administered simultaneously to adults of 7.5 g or more or to children of more than 140 mg/kg, cytolysis of hepatocytes occurs with complete and irreversible liver necrosis, the development of liver failure, metabolic acidosis and encephalopathy, which can lead to coma and death. 12 to 48 hours after the administration of paracetamol, there is an increase in the activity of microsomal liver enzymes, lactate dehydrogenase, bilirubin concentration and a decrease in prothrombin content. Clinical symptoms of liver damage appear 2 days after an overdose of the drug and reach a maximum on days 4–6.

Treatment: immediate hospitalization.

Determination of the quantitative content of paracetamol in blood plasma before starting treatment as early as possible after an overdose. The introduction of SH-group donors and precursors for glutathione synthesis - methionine and acetylcysteine ​​- is most effective in the first 8 hours. The need for additional therapeutic measures (further administration of methionine, intravenous administration of acetylcysteine) is determined depending on the concentration of paracetamol in the blood, as well as the time elapsed after its administration.

Symptomatic treatment: laboratory tests of the activity of microsomal liver enzymes should be carried out at the beginning of treatment and then every 24 hours. In most cases, the activity of microsomal liver enzymes normalizes within 1-2 weeks. In very severe cases, a liver transplant may be required.

Impact on the ability to drive vehicles and operate machinery

No studies have been conducted to study the effect on the ability to drive vehicles or operate machinery. If you experience undesirable reactions such as dizziness or drowsiness, you should refrain from these activities and inform your doctor.

Use for high blood pressure

In Citramon, the instructions for increasing or lowering blood pressure detail all available contraindications for taking Citramon. The guidelines note that treatment is prohibited in the presence of persistently elevated intracranial pressure. Taking it aggravates the condition; before starting therapy, it is necessary to conduct a laboratory diagnostic study and find out why the headache hurts.

Medical signs of high blood pressure include:

• cephalalgia - pressing, dull,
• impaired visual acuity with a feeling of blurriness,
• nosebleeds,
• dizziness.

The following symptoms appear with low blood pressure:

• dizziness,
• short-term fainting,
• decreased vision,
• weakness,
• vomit,
• nausea.

Certain medical manifestations are observed with both high and low blood pressure. To correctly assess the condition, you should take into account the following data:

• The use of the product is permitted in case of pale skin, thirst and hunger, chills (only with low intracranial pressure).
• The product should not be taken if you have symptoms of a hypertensive crisis, headaches, or throbbing in the temples.

Therapy with Citramon in the latter situation will cause aggravation of cephalalgia. Treatment is necessary only for low blood pressure, otherwise the body's reaction to the drug will be unpredictable. Doctors recommend not to take any medications uncontrollably, especially if you feel pain. Without diagnosis and proper identification of the causes of poor health, you can make things worse and provoke an exacerbation of hidden pathological processes. Headaches of the pathological type require complex therapy, and not temporary relief of symptoms with analgesics. People are interested in whether Citramon is for high or low blood pressure ? If you experience low blood pressure, this drug increases it.

Side effects

Citramon for high or low blood pressure is prescribed without a prescription; it can be bought at any pharmacy. Despite its harmless composition, it has side effects.

Citramon side effects

A person may notice the following conditions:

• If there is an overdose, then dyspeptic disorders appear: vomiting, diarrhea, nausea.
• The composition contains acetylsalicylic acid, which has an irritating effect on the mucous membrane of the stomach and intestines. Therefore, when using Citramon, pain, abdominal discomfort, and ulcers in the gastrointestinal tract may appear.
• The appearance of nosebleeds or stomach bleeding. If bleeding is minimal, you should stop taking the drug and use a hemostatic agent. If there is massive blood loss and the condition worsens, you should urgently call an ambulance.
• Large dosages of Citramon with long-term use have a negative effect on the liver. One of the substances of this drug (paracetamol) has a hepatotoxic effect. At a moderate dosage, the drug does not have a negative effect on the body.

Instructions for use CITRAMONUM-BORIMED

Symptoms.

Symptoms of paracetamol overdose. Liver damage is possible in adults who took 10 g or more of paracetamol, and in children who took the drug more than 150 mg/kg body weight. In the first 24 hours:

• pallor, nausea, vomiting, anorexia and headache, hepatonecrosis, increased activity of “liver” transaminases, increased prothrombin index. Liver damage may appear 12-48 hours after taking excess doses of the drug. Impaired glucose metabolism and metabolic acidosis may occur. In severe poisoning, liver failure can lead to encephalopathy, coma and death. Acute renal failure with acute tubular necrosis can develop even in the absence of severe kidney damage. Cardiac arrhythmia was also noted. With long-term use of high doses, aplastic anemia, thrombocytopenia, pancytopenia, agranulocytosis, neutropenia, leukopenia are possible.

Symptoms of caffeine overdose. Large doses of caffeine can cause pain in the epigastric region, vomiting, diuresis, rapid breathing, extrasystole, tachycardia or cardiac arrhythmia, and affect the central nervous system (dizziness, insomnia, nervous agitation, irritability, state of passion, anxiety, tremor, convulsions).

Symptoms of an overdose of acetylsalicylic acid. In case of an overdose of salicylates, chronic intoxication resulting from long-term therapy is possible (use of the drug more than 100 mg/kg/day for more than 2 days can lead to toxic effects), as well as acute intoxication, the causes of which may be accidental use by children or an unintentional overdose.

Chronic poisoning with salicylates can be hidden, since its symptoms are nonspecific. Moderate chronic intoxication caused by salicylates occurs, as a rule, only after repeated doses of large doses.

Symptoms Impaired balance, dizziness, ringing in the ears, deafness, increased sweating, nausea and vomiting, headache, confusion. These symptoms can be controlled by reducing the dose. Tinnitus can occur when the concentration of salicylates in the blood plasma is more than 150-300 mcg/ml. Serious adverse reactions occur when the concentration of salicylates in the blood plasma is more than 300 mcg/ml. Acute intoxication is indicated by a pronounced change in the acid-base balance, which may differ depending on the age and severity of intoxication. The severity of the condition cannot be determined solely on the basis of the concentration of salicylates in the blood plasma.

Treatment:

discontinuation of the drug, gastric lavage with activated charcoal and administration of saline laxatives (magnesium sulfate) to prevent absorption of the drug in the stomach and intestines. Introduction of alkalizing agents to maintain urine pH values ​​at 7.5-8.0. When the level of salicylates in plasma exceeds 300 mg/l (2.2 mmol/l) in children and 500 mg/l (3.6 mmol/l) in adults, forced alkaline diuresis is indicated (provided by intravenous infusion of sodium bicarbonate 88 mEq/l and 5% glucose at a rate of 10-15 ml/kg/h with furosemide 40-60 mg). The volume of circulating blood is restored and the acid-base state is corrected. In case of cerebral edema, artificial ventilation of the lungs with an oxygen-enriched mixture in positive end-expiratory pressure mode is indicated. For cerebral edema, hyperventilation is performed in combination with the administration of osmotic diuretics.

In the presence of liver damage, a specific antidote of paracetamol, N-acetylcysteine, is administered. A 20% solution of N-acetylcysteine ​​is used intravenously and orally:

• first dose 140 mg/kg (0.7 ml/kg), then 70 mg/kg (0.35 ml/kg). A total of 17 doses are administered. The most effective treatment is started in the first 10 hours after the development of intoxication. If more than 36 hours have passed since intoxication, treatment is ineffective.

If the prothrombin index increases by more than 1.5, vitamin K1 (phytomenadione) 1-10 mg is used; if the prothrombin index increases to more than 3.0, it is necessary to begin infusion of native plasma or a concentrate of coagulation factors (1-2 units).

When treating intoxication, hemodialysis is contraindicated. It is unacceptable to use antihistamines and glucocorticosteroids. It is not recommended to use acetazolamide to alkalinize urine in the treatment of intoxication due to the possibility of developing acidemia and increasing the toxic effect of salicylate on the patient's body.

Contraindications

Among the contraindications are the following:

• having an allergic reaction to aspirin,
• bronchial asthma,
• gastric and duodenal ulcers in the acute phase,
• Crohn's disease
• ulcerative colitis,
• pregnancy,
• blood diseases,
• cirrhosis of the liver,
• hepatitis.

Do Citramon tablets increase or decrease blood pressure ? Citramon can be used a limited number of times, depending on the situation, with low blood pressure. Other medications are used to treat such conditions. If hypertension is controlled and if there is low blood pressure, then Citramon can be used as an analgesic or antipyretic. For high blood pressure, it is better to resort to other appropriate medications. Now you know, Citramon lowers or increases blood pressure and pulse .