Etaperazine tablets 4 mg No. 50

pharmachologic effect

Antipsychotic drug (neuroleptic), piperazine derivative of phenothiazine. It is believed that the antipsychotic effect of phenothiazines is due to the blockade of postsynaptic dopamine receptors in the mesolimbic structures of the brain. Perphenazine has a strong antiemetic effect, the central mechanism of which is associated with inhibition or blockade of dopamine D2 receptors in the chemoreceptor trigger zone of the cerebellum, and the peripheral mechanism is associated with blockade of the vagus nerve in the gastrointestinal tract. Has alpha-adrenergic blocking activity. Anticholinergic activity and sedation may occur from weak to moderate intensity, the hypotensive effect is weak. Has a pronounced extrapyramidal effect. The antiemetic effect may be enhanced by anticholinergic and sedative properties. Has a muscle-relaxing effect.

Pharmacodynamics and pharmacokinetics

The drug affects the central nervous system. This is an antipsychotic drug that has a wide spectrum of action. It has antipsychotic , antiemetic and cataleptogenic effects. In addition, the drug has alpha-adrenolytic activity. Anticholinergic and sedative effects occur to a weak or moderate extent. The hypotensive and muscle-relaxing effects are weakly expressed. The neuroleptic effect is combined with a stimulating one .

The drug is also characterized by a selective effect on deficiency symptoms. Significant extrapyramidal abnormalities are possible.

Etaperazine is well absorbed from the gastrointestinal tract. Significant fluctuations in maximum plasma . Strong binding to plasma proteins. The drug is intensively broken down, mainly in the liver. Excreted through the kidneys and with bile.

special instructions

Perphenazine should be used with caution in case of hypersensitivity to other phenothiazine drugs.

Phenothiazines are used with extreme caution in patients with pathological changes in the blood picture, liver dysfunction, alcohol intoxication, Reye's syndrome, as well as breast cancer, cardiovascular diseases, predisposition to the development of glaucoma, Parkinson's disease, gastric and duodenal ulcers , urinary retention, chronic respiratory diseases (especially in children), epileptic seizures, vomiting; in elderly patients (increased risk of excessive sedation and hypotensive effects), in depleted and weakened patients.

The development of tardive dyskinesia during the use of perphenazine is more likely in elderly patients, women and those with brain damage. Parkinsonian extrapyramidal reactions are more often observed in elderly patients, dystonic extrapyramidal reactions - in younger people. Symptoms of these disorders may occur in the first few days of treatment or after long-term therapy and may recur even after a single dose.

In case of hyperthermia, which is one of the elements of NMS, perphenazine should be discontinued immediately.

The simultaneous use of phenothiazines with absorbent antidiarrheals should be avoided.

During the treatment period, avoid drinking alcohol.

Recommendations for the use of perphenazine in children under 12 years of age have not been established. Children, especially those with acute illness, are more likely to develop extrapyramidal symptoms when using phenothiazines.

Impact on the ability to drive vehicles and operate machinery

It should be used with caution in patients engaged in potentially hazardous activities that require a high speed of psychomotor reactions.

Contraindications

The following contraindications to the use of this drug are known: progressive systemic diseases of the brain and spinal cord, cirrhosis , hemolytic jaundice , hematopoietic disorders, thromboembolic diseases, pregnancy , breastfeeding , hepatitis , nephritis , myxedema , decompensated heart disease , hypersensitivity to the active substance, late stages of bronchiectasis diseases .

Etaperazine tablets 4 mg No. 50

Compound

Active substance: perphenazine dihydrochloride (etaperazine) 4 mg.
Excipients: lactose monohydrate, potato starch, calcium stearate.

Excipients of the shell: sucrose, magnesium hydroxycarbonate, povidone, colloidal silicon dioxide, tropeolin, quinoline yellow, indigo carmine, titanium dioxide, beeswax.

Pharmacokinetics

Like all phenothiazine derivatives, it is well absorbed from the gastrointestinal tract.
Plasma protein binding - 90%. Bioavailability is 40% after oral administration. Perphenazine is extensively metabolized in the liver by sulfoxylation, hydroxylation, dealkylation and glucuronidation to form a number of metabolites. Significant variations in maximum plasma concentrations have been observed among patients taking phenothiazine derivatives. Hydroxylation of perphenazine is carried out with the participation of the CYP 2D6 isoenzyme of the cytochrome P450 enzyme system and, therefore, depends on genetic polymorphism, that is, from 7% to 10% of the population of the Caucasus and a small percentage of the population of Asia have low activity or its complete absence, the so-called “ low" metabolism. Patients who are "low" CYP 2D6 metabolizers will metabolize perphenazine more slowly and have higher plasma concentrations of etaperazine compared to patients who are normal or "high" metabolizers. After oral administration of perphenazine, its maximum concentration in plasma, according to studies, is observed after 1-3 hours, 7-hydroxyperphenazine - 2-4 hours. The average equilibrium maximum concentrations (Cmax) are 984 pg/ml and 509 pg/ml, respectively. The time to reach equilibrium concentration (Css) when taken orally is 72 hours.

It is excreted mainly by the kidneys and partly with bile. The half-life of perphenazine does not depend on the dose and is 9-12 hours, 7-hydroxyperphenazine 10-19 hours.

Indications for use

• Schizophrenia in adults.
• Severe nausea and vomiting in adults.

Contraindications

• Severe toxic depression of the function of the central nervous system (CNS) and comatose states of any etiology;
• patients taking high doses of drugs that depress the central nervous system (barbiturates, alcohol, anesthetics, analgesics, antihistamines);
• inhibition of bone marrow hematopoiesis;
• hematopoietic disorders;
• severe renal or liver failure;
• decompensated hypothyroidism;
• subcortical brain damage with or without dysfunction of the hypothalamus;
• progressive systemic diseases of the brain and spinal cord;
• late stages of bronchiectasis;
• diseases accompanied by a risk of thromboembolic complications;
• hypersensitivity to the components of the drug;
• cardiovascular diseases in the stage of decompensation;
• violation of intracardiac conduction;
• deficiency of lactase, sucrase/isomaltase;
• intolerance to lactose, sucrose;
• glucose-galactose malabsorption.

With caution:
Alcoholism (predisposition to hepatotoxic reactions); pathological changes in the blood; breast cancer (as a result of the secretion of prolactin induced by phenothiazine derivatives, the potential risk of disease progression and resistance to drugs prescribed to patients with endocrine and metabolic diseases and cytostatic drugs increases); angle-closure glaucoma; prostatic hyperplasia with clinical manifestations; mild to moderate renal or liver failure; peptic ulcer of the stomach and duodenum (during exacerbation); diseases accompanied by an increased risk of thromboembolic complications; Parkinson's disease (extrapyramidal effects increase); epilepsy; chronic diseases accompanied by breathing problems (especially in children); Reye's syndrome (increased risk of hepatotoxicity in children and adolescents); cachexia; vomiting (the antiemetic effect of phenothiazine derivatives may mask vomiting associated with overdose of other drugs); patients during alcohol withdrawal; depression (possibility of suicide remains); elderly age.

Directions for use and doses

Inside, after eating. Elderly patients may take it before bedtime.

Doses are selected individually according to the severity of the condition.

Elderly, malnourished and debilitated patients usually require a lower initial dose.

When the maximum therapeutic effect is achieved, the dose is gradually reduced to maintenance.

Schizophrenia: For adults not previously treated with antipsychotic drugs, the initial dose is 4-8 mg 3 times a day. For patients with chronic disease, if necessary, the dose is increased to 64 mg/day. The duration of treatment depends on the patient’s condition and the severity of side effects and ranges from 1-4 months or more.

Severe nausea and vomiting: adults are prescribed 8-16 mg 2-4 times a day as an antiemetic drug.

Storage conditions

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

Best before date

3 years. Do not use after the expiration date stated on the package.

special instructions

Elderly patients with dementia-related psychosis treated with antipsychotic drugs have an increased risk of death. Extrapyramidal disorders occur more often when taking high doses. Tardive dyskinesia occurs more often in older patients, especially women, while dystonia occurs more often in younger people. If signs or symptoms of tardive dyskinesia occur, consider discontinuing antipsychotic treatment (however, some patients may require continued treatment despite the presence of the syndrome).

Perphenazine may lower the seizure threshold, so caution should be exercised when using the drug in patients with a predisposition to seizure disorders and during alcohol withdrawal. With simultaneous treatment with perphenazine and anticonvulsants, an increase in the dose of the latter may be required. During therapy with perphenazine, alcohol intake should be avoided, because Additive effects and hypotension may occur.

The risk of suicide and the risk of antipsychotic overdose may be increased in patients who abuse alcohol during treatment due to the potentiation of the depressive effect of the drug on the central nervous system.

Caution should be exercised when prescribing the drug to patients with depression. The possibility of suicide in such patients remains during treatment, so it is necessary to exclude them from access to a large number of medications during treatment until complete remission occurs. Perphenazine should be used with caution in patients with a history of serious side effects from other phenothiazines. Some of the adverse reactions of perphenazine occur more often when taking high doses.

Perphenazine should be used with great caution in persons exposed to heat or cold because Phenothiazine derivatives inhibit the temperature regulation mechanism and, depending on the ambient temperature, can lead to hyperthermia and heat stroke or hypothermia and respiratory failure. A significant increase in body temperature can be caused by individual hypersensitivity. If hyperthermia occurs, treatment should be discontinued immediately.

Perphenazine increases the body's sensitivity to sunlight. It is recommended to use sunscreen, especially if patients have fair skin, and wear protective clothing when outdoors, as well as avoid prolonged exposure to the sun, tanning beds, and the use of ultraviolet lamps. Perphenazine should be used with caution in patients suffering from respiratory disorders due to the possible development of acute pulmonary infection, as well as in chronic respiratory diseases such as bronchial asthma or emphysema. Antipsychotic drugs increase the concentration of prolactin in the blood, which persists with long-term use.

Symptoms may include breast enlargement, dysmenorrhea, decreased libido, or nipple discharge. Caution should be exercised when prescribing the drug to patients receiving atropine or similar drugs, as well as those who have contact with phosphorus-containing insecticides (an additive anticholinergic effect is possible).

During treatment, liver and kidney functions (with long-term therapy), peripheral blood patterns, and prothrombin index should be monitored. If signs or symptoms of blood dyscrasia occur, treatment should be discontinued and appropriate therapy instituted. Treatment should also be stopped if there are abnormalities in liver tests or if the blood urea nitrogen level is abnormal. Most cases of agranulocytosis were observed between 4 and 10 weeks of therapy. During this period, patients should be especially careful to monitor for sore throat or symptoms of infection. If the number of leukocytes decreases significantly, the drug should be discontinued and appropriate therapy should be started.

Jaundice that develops (rarely) during treatment (between 2 and 4 weeks of therapy) is usually considered a hypersensitivity reaction. In this case, the clinical picture is similar to that of infectious hepatitis, but the results of liver function tests are characteristic of obstructive jaundice. It is usually reversible, but cases of chronic jaundice have been reported. Sudden death has been rarely reported in patients receiving phenothiazines. In some cases, the cause of death was cardiac arrest, in others it was asphyxia due to a deficiency of the cough reflex. The antiemetic effect may mask symptoms of toxicity caused by overdose of other drugs and make it difficult to diagnose diseases such as intestinal obstruction, Reye's syndrome, brain tumors, or other encephalopathies. Patients with diabetes mellitus should take into account that the carbohydrate content in one single dose of the drug (1 tablet) corresponds to: dosage 4 mg - 0.012 XE, dosage 6 mg - 0.015 XE. dosage 10 mg - 0.018 XE. Caution should be exercised when using perphenazine in older adults because they may be more sensitive to the effects of the drug and the development of side effects such as extrapyramidal symptoms and tardive dyskinesia. Neuroleptic malignant syndrome (NMS), the development of which is possible while taking any classical antipsychotic drugs, is a potentially fatal complex of symptoms. Diagnosing patients with this syndrome is difficult.

In the differential diagnosis, it is important to identify cases where the clinical picture includes serious medical conditions (eg, pneumonia, systemic infection, etc.), other extrapyramidal symptoms, central anticholinergic toxicity, heat stroke, drug fever, and primary pathologies of the central nervous system.

ZNS management should include:

1) immediate cessation of the use of antipsychotic drugs and other concomitant medications if necessary;

2) intensive symptomatic therapy and medical control;

3) treatment of any underlying serious health problems that require specific procedures.

There are no generally accepted specific pharmacological treatment regimens. It is recommended to carefully monitor patients who are taking large doses of phenothiazine derivatives and who are undergoing surgery and interventions due to the possible development of hypotensive effects.

Description

Antipsychotic (neuroleptic).

Pharmacodynamics

Antipsychotic (neuroleptic), phenothiazine derivative; has a sedative effect. antiallergic, weak anticholinergic, antiemetic, muscle relaxant. weak hypotensive and hypothermic effect, eliminates hiccups. The antipsychotic effect is due to the blockade of dopamine D2 receptors in the mesolimbic and mesocortical systems. Blockade of D2-dopamine receptors in polyneuronal synapses of the brain causes relief of the productive symptoms of psychosis: delusions and hallucinations. The antipsychotic effect is combined with a pronounced activating effect and a selective effect on syndromes occurring with lethargy, lethargy, apathy, primarily with substuporous phenomena, as well as on apatoabulic states. The sedative effect is due to the blockade of adrenergic receptors in the reticular formation of the brain stem. The severity of sedation is from weak to moderate. Has a strong antiemetic effect. Antiemetic activity is associated with inhibition of the trigger zone of the vomiting center due to blockade of D2-dopamine receptors (central effect) and a decrease in secretion and motility of the gastrointestinal tract (GIT) as a result of blockade of m-cholinergic receptors (peripheral effect). Inhibition of dopamine receptors in the nigrostriatal zone and tubuloinfundibular region can cause extrapyramidal disorders and hyperprolactinemia. The peripheral alpha-adrenergic blocking effect is manifested by a decrease in blood pressure (the hypotensive effect is weakly expressed), and the H1-antihistamine effect is manifested by an antiallergic effect. Hypothermic effect - blockade of dopamine receptors in the hypothalamus. It has superior antipsychotic activity to chlorpromazine. The antipsychotic effect develops after 4-7 days and reaches a maximum after 1.5-6 months (depending on the nature of the disease).

Side effects

Not all of the following side effects have been reported with perphenazine.
However, pharmacological similarities with other phenothiazine derivatives require that each be taken into account. Many of these side effects can be avoided by reducing the dose. From the nervous system and sensory organs: extrapyramidal disorders (especially dystonic) - spasm of the muscles of the back and neck, face, tongue, tonic spasm of the masticatory muscles, difficulty speaking and swallowing, a feeling of stiffness in the throat, oculogyric crises, spasm and pain in the limbs, stiffness of the arms and legs, hyperreflexia, akathisia. parkinsonism, ataxia; drowsiness, lethargy, lethargy, muscle weakness, decreased motivation, dizziness, miosis, mydriasis, blurred vision, glaucoma, pigmentary retinopathy, deposits in the lens and cornea, paradoxical reactions - exacerbation of psychotic symptoms, catalepsy, catatonic-like states, paranoid reactions, lethargy, lethargy , paradoxical arousal, anxiety, hyperactivity, nighttime confusion, strange dreams, sleep disturbance. Their frequency and severity usually increase with increasing dose, but there is significant individual variation in the propensity to develop such symptoms. Extrapyramidal symptoms are usually corrected by the simultaneous use of effective antiparkinsonian drugs or dose reduction. In some cases, however, these extrapyramidal reactions may persist after perphenazine treatment is discontinued.

Tardive dyskinesia: rhythmic, involuntary movements of the tongue, face, mouth, and jaw (eg, tongue thrusting, cheek puffing, mouth pucker, chewing movements). Sometimes this may be accompanied by involuntary movements of the limbs. There is no effective treatment for tardive dyskinesia. There is evidence that worm-like movements of the tongue may be an early sign of the syndrome and if treatment is stopped, this syndrome may not develop.

From the cardiovascular system: increase and decrease in blood pressure. orthostatic hypotension, changes in heart rate, tachycardia (especially with an unexpected significant increase in dose), bradycardia, cardiac arrest, weakness and dizziness, arrhythmia, fainting, changes in the electrocardiogram, nonspecific (quinidine-like effect).

Blood disorders (hematopoiesis, hemostasis): leukopenia, agranulocytosis, eosinophilia, hemolytic anemia, thrombopenic purpura, pancytopenia.

From the gastrointestinal tract: nausea, vomiting, diarrhea, constipation, anorexia, increased appetite and body weight, polyphagia, abdominal pain, dry mouth, increased salivation, liver damage (bile stasis), cholestatic hepatitis, jaundice.

Allergic reactions: skin rash, urticaria, erythema, eczema, exfoliative dermatitis, itching. hyperhidrosis, skin photosensitivity, bronchial asthma, fever, anaphylactoid reactions, laryngeal edema and Quincke's edema, angioedema.

Other: pallor, perspiration, intestinal and bladder atony, urinary retention. frequent urination or urinary incontinence, polyuria, nasal obstruction, kidney damage, increased intraocular pressure, skin pigmentation, photophobia, unusual secretion of breast milk, breast enlargement and galactorrhea in women, gynecomastia in men, menstrual irregularities, amenorrhea, changes in libido, decreased ejaculation, syndrome of inappropriate secretion of antidiuretic hormone, false-positive pregnancy test, hyperglycemia, hypoglycemia, glucosuria. peripheral edema, systemic lupus erythematosus syndrome.

Neuroleptic malignant syndrome: hyperthermia, muscle rigidity, mental status changes, autonomic instability (irregular pulse and blood pressure fluctuations, tachycardia, sweating and cardiac arrhythmia).

Use during pregnancy and breastfeeding

Perphenazine easily crosses the placental barrier and is quickly excreted in breast milk, so the possibility of using the drug is determined by the doctor if the potential benefit to the mother outweighs the potential risk to the fetus or child.

Neonates whose mothers took perphenazine late in pregnancy or during labor may show signs of toxicity, such as lethargy, tremors, and excessive excitability. In addition, these newborns have a low Apgar score.

With prolonged treatment of the mother, or when using high doses, as well as in the case of prescribing the drug shortly before birth, monitoring the activity of the nervous system of the newborn is justified.

Interaction

When using Etaperazine simultaneously with other drugs, it is possible:

• with drugs that have a depressing effect on the central nervous system (anesthetics, narcotic analgesics, ethanol and drugs containing it, barbiturates, tranquilizers, etc.) increased depression of the central nervous system, as well as respiratory depression;
• with tricyclic antidepressants, maprotiline or monoamine oxidase inhibitors - the sedative and anticholinergic effects may be prolonged and intensified, and the risk of developing neuroleptic malignant syndrome may increase.
• with anticonvulsants - it is possible to lower the threshold of convulsive readiness;
• with drugs for the treatment of hyperthyroidism - the risk of developing agranulocytosis increases;
• with other drugs that cause extrapyramidal reactions - an increase in the frequency and severity of extrapyramidal disorders is possible;
• with antihypertensive drugs - severe orthostatic hypotension is possible;
• with ephedrine - the vasoconstrictor effect of ephedrine may be weakened. Concomitant use with tricyclic antidepressants, selective serotonin reuptake inhibitors, for example, fluoxetine, sertraline and paroxetine. which inhibit the cytochrome P450 2D6 isoenzyme (CYP 2D6), can sharply increase plasma concentrations of phenothiazine derivatives and other antipsychotic drugs. When prescribing these drugs to patients already receiving antipsychotic therapy, careful monitoring is essential and dose reduction may be necessary to avoid side effects and toxicity. The administration of alpha and beta adrenergic agonists (epinephrine) and sympathomimetics (ephedrine) can lead to a paradoxical decrease in blood pressure. The antiparkinsonian effect of levodopa is reduced due to blocking of dopamine receptors. Perphenazine may inhibit the effects of amphetamines, clonidine, and guanethidine.

Perphenazine enhances the m-anticholinergic effects of other drugs, while the antipsychotic effect of the antipsychotic may decrease.
When perphenazine is used concomitantly with prochlorperazine, which is related in chemical structure, prolonged loss of consciousness may occur.

When used together with antiparkinsonian drugs and lithium preparations, absorption in the gastrointestinal tract decreases. When used simultaneously with lithium preparations, the rate of excretion of lithium salts by the kidneys increases and the severity of extrapyramidal disorders increases. Early signs of lithium salt intoxication (nausea and vomiting) may be masked by the antiemetic effect of perphenazine.

Aluminum- and magnesium-containing antacid drugs or antidiarrheal adsorbents reduce the absorption of perphenazine.

Perphenazine may increase blood sugar and impair diabetes control. Dosage adjustment of antidiabetic drugs is necessary.

Reduces the effect of anorexigenic drugs (with the exception of fenfluramine).

Reduces the effectiveness of the emetic effect of apomorphine, enhances its inhibitory effect on the central nervous system.

Increases plasma concentrations of prolactin and interferes with the action of bromocriptine. Probucol, astemizole. Cisapride, disopyramide, erythromycin, pimozide, procainamide and quinidine further prolong the QT interval, which increases the risk of developing ventricular tachycardia.

When used together with thiazide diuretics, increased hyponatremia. Combination with beta-blockers enhances the hypotensive effect, increasing the risk of developing irreversible retinopathy, arrhythmias and tardive dyskinesia. Medicines that inhibit bone marrow hematopoiesis increase the risk of myelosuppression.

Overdose

In case of an overdose of the drug, acute neuroleptic reactions may occur. An increase in body temperature, which may be one of the symptoms of neuroleptic malignant syndrome, should be especially alarming. In severe cases of overdose, various forms of impaired consciousness may occur, including coma. Exceeding therapeutic dosages of perphenazine may be accompanied by extrapyramidal reactions, changes in the electrocardiogram - prolongation of the QTc interval, expansion of the QRS complex.

Helpful measures: discontinuation of antipsychotic therapy, prescription of correctors, intravenous administration of diazepam, glucose solution, symptomatic therapy.

Impact on the ability to drive vehicles and operate machinery

During the treatment period, it is necessary to refrain from engaging in potentially hazardous activities, working with machinery, or driving a car, because perphenazine may impair mental and/or physical performance and also cause drowsiness (especially in the first 2 weeks of treatment).

Overdose

neuroleptic may occur . In such cases, the temperature often rises. coma is also possible .

The drug should be stopped immediately. Intravenous administration of Diazepam , nootropic drugs, dextrose solution , vitamins B and C is indicated. Treatment is symptomatic .

Interaction

Suppression of the nervous and respiratory systems increases when combined with drugs that depress the nervous system, as well as ethanol-containing drugs and ethanol .

Combination with drugs that provoke extrapyramidal reactions increases the number and frequency of extrapyramidal disorders. Fluoxetine can also cause extrapyramidal symptoms and dystonia .

Anticonvulsants may lower the seizure threshold , and medications to treat hyperthyroidism , in turn, increase the likelihood of agranulocytosis .

Interaction with drugs that cause hypotension may cause orthostatic hypotension .

Combination with drugs that have anticholinergic effects may lead to an increase in anticholinergic effect, and the antipsychotic effect of the antipsychotic may be reduced.

Concomitant use of Etaperazine with MAO inhibitors , tricyclic antidepressants and Maprotiline increases the likelihood of developing NMS . And combination with antacids , lithium salts and antiparkinsonian drugs interferes with the absorption of phenothiazines .

Interactions with amphetamines , clonidine , Epinephrine , Levodopa and Guanethidine may reduce their effect.

Combination with Ephedrine may weaken its vasoconstrictor effect.

Side effects

From the central nervous system: drowsiness, akathisia, blurred vision, dystonic extrapyramidal reactions, parkinsonian extrapyramidal reactions.

From the liver: rarely - cholestatic jaundice.

From the hematopoietic system: rarely - agranulocytosis.

Metabolic disorders: rarely - heat stroke, melanosis.

Allergic reactions: rarely - skin rash accompanied by contact dermatitis.

Dermatological reactions: rarely - photosensitivity.

Effects due to anticholinergic action: possible dry mouth, accommodation disturbances, constipation, difficulty urinating.

Etaperazine price, where to buy

Tablets of 10 mg (50 pieces in a package) cost approximately 300 rubles. And the price of Etaperazine in 4 mg tablets (50 pieces in a package) is about 270 rubles.

• Online pharmacies in RussiaRussia

ZdravCity

• Etaperazine tablets p.p.o.
  4 mg 50 pcs. JSC Tatkhimfarmpreparaty 344 rub. order

Dosage

For adults and children over 12 years of age, when taken orally, the daily dose is 4-80 mg. In the chronic course of the disease and in resistant cases, the daily dose can be increased to 150-400 mg. The frequency of administration and duration of treatment are determined individually.

For adults and children over 12 years of age, with intramuscular administration, a single dose is 5-10 mg. For intravenous administration, a single dose is 1 mg.

Maximum doses: adults and children over 12 years of age with intramuscular administration - 15-30 mg/day, with intravenous administration - 5 mg/day.