Instructions for use SORBIFER™ DURULES® (SORBIFER™ DURULES®)


Instructions for use SORBIFER™ DURULES® (SORBIFER™ DURULES®)

Sorbifer™ Durules® should not be combined with the following drugs:

Zinc:

with simultaneous use, the absorption of zinc salts decreases.

Clodronate and risendronate

:

  • in vitro
    studies have shown that preparations containing iron form a complex with clodronate.
    Although in vivo
    have not been conducted, it can be assumed that the absorption of clodronate is reduced when used together.

Deferoxamine

:

  • When used together, the absorption of both deferoxamine and iron is reduced due to the formation of complexes.

Levodopa, carbidopa

:

  • when ferrous sulfate is co-administered with levodopa and carbidopa - probably due to the formation of complexes - the bioavailability of levodopa in healthy volunteers is reduced by 50%, and carbidopa by 75%.

Methyldopa (levorotatory)

:

  • When iron salts (iron sulfate and gluconate) are used together with methyldopa - probably due to the formation of chelate complexes - the bioavailability of methyldopa decreases, which may worsen its hypotensive effect.

Penicillamine

:

  • when penicillamine is used together with iron salts - probably due to the formation of chelate complexes - the absorption of both penicillamine and iron salts is reduced.

Alendronate

:

  • in an in vitro
    , preparations containing iron formed complexes with alendronate, reducing the absorption of the latter.
    In vivo
    results are not available.

Tetracycline

:

  • when used together, the absorption of both tetracycline and iron is reduced, therefore, when used in combination, the maximum possible time interval should be maintained, which is at least 3 hours between doses. The use of iron-containing drugs worsens the enterohepatic cycle of doxycycline, both when taken orally and when administered intravenously, so the combined use of these drugs should be avoided.

Thyroid hormones

:

  • When iron-containing drugs and thyroxine are used together, the absorption of the latter may decrease, which can lead to the failure of replacement therapy.

Cimetidine

:

  • when used together with Sorbifer™ Durules® with cimetidine, the decrease in gastric acidity caused by cimetidine reduces iron absorption. Therefore, when used in combination, the maximum possible time interval should be maintained, which is at least 2 hours.

Chloramphenicol

:

  • The effect of treatment with iron supplements appears later. The formation of red blood cells is suppressed and hemoglobin levels decrease.

When Sorbifer™ Durules® is used with tea, coffee, eggs, dairy products, wholemeal bread, cereals or foods rich in fiber, iron absorption may be reduced.

Interactions associated with ascorbic acid

Increases the concentration of salicylates in the blood (increases the risk of developing crystalluria), ethinyl estradiol, benzylpenicillin, and tetracyclines

.
Reduces the concentration of oral contraceptives
.
Increases the activity of norepinephrine
.
Reduces the anticoagulant effect of coumarin derivatives, heparin
.
Improves the absorption of iron preparations
, as well as iron from food (due to the conversion of ferric iron to divalent iron).
Increases the overall clearance of ethyl alcohol
.
May affect the effectiveness of disulfiram
in the treatment of chronic alcoholism.
The simultaneous use of ascorbic acid and deferox
does not increase the excretion of iron.

Acetylsalicylic acid, oral contraceptives, fresh juices and alkaline drinks

reduce the absorption and assimilation of ascorbic acid.

Ascorbic acid increases renal excretion of amphetamine

.

Plasma ascorbate concentration decreases with smoking

and taking
oral contraceptives
.

Concomitant use of acetylsalicylic acid

and ascorbic acid may interfere with the absorption of ascorbic acid. The renal excretion of salicylate is not affected and does not lead to a decrease in the anti-inflammatory effect of acetylsalicylic acid.

Concomitant use of aluminum-containing antacids

may increase urinary excretion of aluminum. The simultaneous administration of antacids and ascorbic acid is not recommended, especially in patients with renal failure.

Combined use with amygdalin

(alternative therapy) may cause cyanide toxicity.

Concomitant use of ascorbic acid with deferoxamine

increases urinary iron excretion and may lead to cases of cardiomyopathy and heart failure in patients with idiopathic hemochromatosis and thalassemia receiving deferoxamine who are subsequently given ascorbic acid. Ascorbic acid should be used with caution in these patients and cardiac function monitored.

Ascorbic acid may interfere with the biochemical determination of creatinine, uric acid and glucose in blood and urine samples.

pharmachologic effect

Antianemic drug. Iron is an essential component of the body, necessary for the formation of hemoglobin and the occurrence of oxidative processes in living tissues.

Durules technology provides a gradual release of the active ingredient (iron ions) over a long period of time. The plastic matrix of Sorbifer Durules tablets is completely inert in the digestive juice, but completely disintegrates under the action of intestinal peristalsis, when the active ingredient is completely released.

Ascorbic acid helps improve iron absorption.

Contraindications to the use of the drug

- stenosis of the esophagus and/or other obstructive changes in the digestive tract;

- increased iron content in the body (hemosiderosis, hemochromatosis);

- impaired iron utilization (lead anemia, sideroblastic anemia, hemolytic anemia);

- children under 12 years of age (due to lack of clinical data);

- hypersensitivity to the components of the drug.

Carefully _

The drug should be used for gastric and duodenal ulcers, inflammatory bowel diseases (enteritis, diverticulitis, ulcerative colitis, Crohn's disease).

Pharmacokinetics

Suction

Durules is a technology that ensures a gradual release of the active substance (iron ions) and a uniform supply of the drug. Taking 100 mg 2 times a day provides 30% greater absorption of iron from Sorbifer Durules compared to conventional iron preparations.

Absorption and bioavailability of iron are high. Iron is absorbed primarily in the duodenum and proximal jejunum.

Distribution

Plasma protein binding - 90% or more. Deposited in the form of ferritin or hemosiderin in hepatocytes and cells of the phagocytic macrophage system, a small amount - in the form of myoglobin in muscles.

Removal

T1/2 is 6 hours.

Dosage regimen

I take the drug orally. Film-coated tablets should not be split or chewed. The tablet should be swallowed whole and washed down with at least half a glass of liquid.

Adults and teenagers

1 tablet is prescribed. 1-2 times/day. If necessary, for patients with iron deficiency anemia, the dose can be increased to 3-4 tablets/day in 2 doses (morning and evening) for 3-4 months (until the iron depot in the body is replenished).

During pregnancy and lactation for the purpose of prevention

prescribed 1 tablet/day;
For treatment,
1 tablet is prescribed. 2 times/day (morning and evening).

Treatment should be continued until the optimal hemoglobin level is achieved. To further replenish the depot, you may need to continue taking the drug for another 2 months.

Overdose

Symptoms:

abdominal pain, vomiting and diarrhea mixed with blood, fatigue or weakness, hyperthermia, paresthesia, pale skin, cold clammy sweat, acidosis, weak pulse, decreased blood pressure, palpitations. In case of severe overdose, signs of peripheral circulatory collapse, coagulopathy, hyperthermia, hypoglycemia, liver damage, renal failure, muscle cramps and coma may appear after 6-12 hours.

Treatment:

in case of overdose, consult a doctor immediately. It is necessary to rinse the stomach, inside a raw egg, milk (to bind iron ions in the gastrointestinal tract); deferoxamine is administered. Symptomatic therapy.

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