Amoxicillin
Amoxicillin: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Drug interactions
- 14. Analogs
- 15. Terms and conditions of storage
- 16. Terms of dispensing from pharmacies
- 17. Reviews
- 18. Price in pharmacies
Latin name: Amoxicillin
ATX code: J01CA04
Active ingredient: amoxicillin (amoxicillin)
Producer: Biochemist, JSC (Russia), Dalkhimfarm (Russia), Organika, JSC (Russia), STI-MED-SORB (Russia), Hemofarm (Serbia)
Description and photo update: 2019-16-09
Prices in pharmacies: from 21 rubles.
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Amoxicillin is an antibacterial drug, semi-synthetic penicillin.
Release form and composition
Dosage forms of Amoxicillin:
- tablets: almost white or white, flat-cylindrical, with a dividing line and a chamfer (10 pcs. or 20 pcs. in blisters, in a cardboard box 1, 2, 5, 10, 50 or 100 packs; 24 pcs. in glass jars of dark color, in a cardboard box 1 can; 20 pcs. in polymer cans or bottles, in a cardboard box 1 can or bottle);
- capsules: gelatinous; in a dose of 250 mg - size No. 2, with a dark green cap and a white with a yellow tinge of the body, in a dose of 500 mg - size No. 0, with a red cap and a yellow body; inside the capsules there is a granular powder with a color from light yellow to white, its clumping is allowed (250 mg each: 8 pcs. in blisters, in a cardboard box 2 blisters; 10 pcs. in blisters, in a cardboard box 1 or 2 packages; 10 or 20 pieces in a can, in a cardboard box 1 can; 500 mg each: 8 pieces in blisters, in a cardboard box 2 blisters; 8 pieces in a blister strip, in a cardboard box 1 or 2 packages; 10 pcs. in blisters, in a cardboard box 1, 2, 50 or 100 packages);
- granules for the preparation of a suspension for oral administration: granular powder from white with a yellow tint to white, after dissolving in water - a yellowish suspension with a fruity odor (40 g each in dark glass bottles with a capacity of 100 ml, in a cardboard box 1 bottle included with a measuring spoon with divisions of 2.5 ml and 5 ml).
1 tablet contains:
- active substance: amoxicillin trihydrate (in terms of amoxicillin) - 250 mg or 500 mg;
- auxiliary components: potato starch, magnesium stearate, polysorbate-80 (tween-80), talc.
1 capsule contains:
- active substance: amoxicillin trihydrate - 286.9 mg or 573.9 mg, which corresponds to the content of 250 mg or 500 mg of amoxicillin;
- auxiliary components: microcrystalline cellulose PH 102, magnesium stearate, titanium dioxide (E171), gelatin.
Additionally, as part of the capsule shell:
- size 2: cap - quinoline yellow dye (E104), indigo carmine (E132), body - quinoline yellow dye (E104);
- size no. 0: cap - sunset yellow dye (E110), azorubin dye (E122), body - iron oxide yellow dye (E172).
5 ml of the finished suspension (2 g of granules) contains:
- active substance: amoxicillin trihydrate (in terms of amoxicillin) - 250 mg;
- auxiliary components: sodium saccharinate dihydrate, sucrose, simethicone S184, sodium benzoate, guar gum, sodium citrate dihydrate, strawberry flavor, raspberry flavor, edible passion flower flavor.
Pharmacological properties
Pharmacodynamics
Amoxicillin is a semi-synthetic penicillin, an antibacterial bactericidal acid-resistant drug with a broad spectrum of action. The mechanism of action is due to the ability of amoxicillin to cause lysis of bacteria, inhibiting transpeptidase and disrupting the synthesis of the supporting protein of the cell wall peptidoglycan during division and growth.
Sensitivity to the drug is shown by gram-positive and gram-negative microorganisms.
Amoxicillin is active against the following bacteria:
- aerobic gram-positive bacteria: Corynebacterium speciales (spp.), Staphylococcus spp. (except for strains producing penicillinase), Bacillus anthracis, Listeria monocytogenes, Enterococcus faecalis, Streptococcus spp. (including Streptococcus pneumoniae);
- aerobic gram-negative bacteria: Brucella spp., Bordetella pertussis, Shigella spp., Escherichia coli, Klebsiella spp., Neisseria meningitidis, Neisseria gonorrhoeae, Haemophilus influenzae, Salmonella spp., Vibrio cholerabis, Proteteus
- others: Leptospira spp., Clostridium spp., Borrelia burgdorferi, Helicobacter pylori.
Microorganisms that produce penicillinase and other beta-lactamases are not sensitive to the drug, since beta-lactamases destroy amoxicillin.
Pharmacokinetics
After oral administration, amoxicillin is rapidly and almost completely (93%) absorbed. The absorption is not affected by simultaneous food intake, the drug is not destroyed in the acidic environment of the stomach. The maximum concentration is reached after 1–2 hours and is 0.0015–0.003 mg / ml after taking a dose of 125 mg and 0.0035–0.005 mg / ml after taking a dose of 250 mg. The clinical effect begins to develop in 1 / 4-1 / 2 hours and lasts 8 hours.
Has a large volume of distribution. The concentration level increases in proportion to the dose of the drug. High concentrations of amoxicillin are found in plasma, pleural and peritoneal fluids, sputum, bronchial secretions, lung and bone tissue, intestinal mucosa, urine, prostate, female genital organs, adipose tissue, middle ear fluid, and the contents of skin blisters. Penetrates into fetal tissue, with normal liver function - into the gallbladder, where its content can exceed the plasma concentration by 2-4 times. In the purulent secretion of the bronchi, it is poorly distributed. When used during pregnancy, the content of amoxicillin in the vessels of the umbilical cord and amniotic fluid is 25-30% of the concentration level in the plasma of the woman's body.
It is excreted in breast milk in small quantities. The blood-brain barrier overcomes poorly, the concentration in the cerebrospinal fluid when using amoxicillin for the treatment of meningitis (inflammation of the meninges) is not more than 20%.
Plasma protein binding - 17%.
It is metabolized incompletely with the formation of inactive metabolites.
The half-life (T 1/2) is 1-1.5 hours. Through the kidneys, 50–70% is excreted unchanged. Of these, by glomerular filtration - 20%, tubular excretion - 80%. 10–20% is excreted through the intestines.
T 1/2 in case of impaired renal function with creatinine clearance (CC) of 15 ml / min or less increases to 8.5 hours.
With hemodialysis, amoxicillin is removed.
Indications for use
According to the instructions, Amoxicillin is indicated for the treatment of infectious and inflammatory diseases caused by sensitive microorganisms:
- respiratory tract infections - acute bronchitis, exacerbation of chronic bronchitis, bronchopneumonia, lobar pneumonia;
- ENT infections - sinusitis, tonsillitis, pharyngitis, acute otitis media;
- infections of the skin and soft tissues - secondarily infected dermatoses, erysipelas, impetigo;
- infections of the genitourinary system - cystitis, pyelonephritis, urethritis, gonorrhea;
- gynecological infections - endometritis, cervicitis;
- intestinal infections - typhoid fever, paratyphoid fever, shigellosis (dysentery), salmonellosis, salmonella carriers;
- peptic ulcer of the stomach and duodenum (as part of combination therapy);
- abdominal infections - enterocolitis, peritonitis, cholecystitis, cholangitis;
- meningococcal infection;
- listeriosis (acute and latent forms);
- leptospirosis;
- borreliosis (Lyme disease);
- sepsis;
- endocarditis (prevention during dental and other minor surgical interventions).
Contraindications
- liver failure;
- bronchial asthma;
- hay fever;
- lymphocytic leukemia;
- Infectious mononucleosis;
- colitis due to antibiotic use (including history);
- breast-feeding;
- hypersensitivity to beta-lactam antibiotics, including penicillins, cephalosporins, carbapenems;
- individual intolerance to the components of the drug.
Additional contraindications for certain forms of Amoxicillin:
- tablets: allergic diseases (including anamnesis), age up to 10 years with a body weight of less than 40 kg;
- capsules: atopic dermatitis, history of gastrointestinal tract diseases, age up to 5 years;
- granules: glucose-galactose malabsorption syndrome, sucrase (isomaltase) deficiency, fructose intolerance, atopic dermatitis, a history of gastrointestinal tract diseases.
It is recommended to prescribe Amoxicillin with caution to patients with renal insufficiency, a history of bleeding, prone to the development of allergic reactions (including a history), during pregnancy.
In addition, care should be taken when using tablets to treat patients with a history of diseases of the gastrointestinal tract.
Instructions for the use of Amoxicillin: method and dosage
Pills
Amoxicillin tablets are taken orally with 100-200 ml of water, before or after meals.
The doctor prescribes the dose and the period of treatment individually, taking into account the clinical indications.
For adults and children weighing more than 40 kg over the age of 10 years, a single dose of Amoxicillin is usually 500 mg.
For the treatment of severe infections and recurrent infections, adults are prescribed a daily dose of 2250-3000 mg, divided into 3 doses, for children - at the rate of no more than 60 mg per 1 kg of the child's weight per day, divided into 3 doses.
Recommended dosage of Amoxicillin:
- acute uncomplicated gonorrhea: 3000 mg, men take it once, women are advised to repeat the indicated dose the next day;
- gynecological infectious diseases, acute infections of the biliary tract and gastrointestinal tract (typhoid fever, paratyphoid fever): 1500-2000 mg 3 times a day or 1000-1500 mg 4 times a day;
- severe forms of meningitis, septicemia: adults - up to 6000 mg per day, divided into 3-4 doses; children - 250-500 mg 3 times a day. The duration of the course is 5–7 days;
- otitis media and other similar infections: children - 250-500 mg 2 times a day;
- leptospirosis: adults - 500-750 mg 4 times a day for 6-12 days;
- listeriosis: adults - 500 mg 3 times a day. The duration of the course of treatment is from 6 to 12 days;
- salmonella: adults - 1500-2000 mg 3 times a day for 14-28 days;
- prevention of endocarditis: adults - 3000-4000 mg 1 hour before surgery. In 8-9 hours after minor surgery, a repeated dose may be prescribed. For children, the dose is reduced by 2 times.
In case of impaired renal function, the daily dose of Amoxicillin depends on creatinine clearance (CC) and can be:
- CC 15-40 ml / min: the usual dose, but the interval between doses is increased to 12 hours;
- CC less than 10 ml / min: the dose should be reduced by 15-50%.
The maximum daily dose for anuria is 2000 mg.
Capsules
Amoxicillin capsules are taken orally with a sufficient amount (100-200 ml) of water, regardless of the meal.
The dosage regimen is prescribed by the attending physician, taking into account the localization, severity of the infection and the sensitivity of the pathogen.
It is necessary to observe equal time intervals between doses of a single dose.
When prescribing high doses, it is allowed to take the drug 2 times a day, observing an interval of 12 hours between doses.
Standard dosage regimen of Amoxicillin for adults: 1 pc. at a dose of 250 mg 3 times a day. For severe infection - 1 pc. at a dose of 500 mg 3 times a day. The duration of the course of treatment is set individually, it can be from 5 to 12 days.
The maximum daily dose is 6000 mg.
The standard dosage regimen of Amoxicillin is used to treat infectious diseases of the upper respiratory tract, ear, throat, nose, genitourinary system (except for gonorrhea), gynecological infections (in the absence of fever), infections of the skin and soft tissues, infections of the abdominal region.
After normalization of body temperature and reliable destruction of the causative agent of the infection, it is recommended to continue taking capsules for 2-3 days in order to prevent a relapse of the disease.
The recommended dosage of Amoxicillin for the treatment of certain pathologies in adults:
- lower respiratory tract infections: 500 mg 3 times a day;
- acute uncomplicated infections of the urinary tract: short-term high-dose therapy - 3000 mg 2 times a day with an interval of 10-12 hours;
- acute uncomplicated gonorrhea: 3000 mg - once (in combination with probenecid). Women should take the indicated dose again because of the multiple nature of the lesion and the risk of infection passing to the pelvic organs;
- gynecological infections (complicated by fever), intestinal infections (except for salmonella carriers): 1500-2000 mg 3 times a day or 1000-1500 mg 4 times a day;
- Salmonella carrier: 1500-2000 mg 3 times a day for 14-28 days;
- peptic ulcer of the stomach and duodenum (as part of complex therapy): 750-1000 mg 2 times a day;
- prevention of endocarditis: a single dose of 3000 mg 1 hour before minor surgery (including dental surgery) or 4 hours before surgery with general anesthesia. Perhaps the appointment of a repeated appointment in 6 hours;
- leptospirosis: 500-750 mg 4 times a day for 6-12 days.
There are no specific recommendations for elderly patients.
In case of impaired renal function with CC more than 30 ml / min, correction of the dosage regimen of Amoxicillin is not required.
In severe renal impairment, a single dose should be reduced or the interval between doses of Amoxicillin increased.
The maximum daily dose for patients with CC 10-30 ml / min - 1000 mg (500 mg 2 times a day), with CC less than 10 ml / min, or with peritoneal dialysis - 500 mg (250 mg 2 times a day).
The use of capsules for the treatment of children over the age of 5 years is indicated only if the prescribed daily dose is at least 500 mg (250 mg 2 times a day).
The standard dosage regimen of Amoxicillin for children, taking into account body weight:
- children weighing up to 20 kg: at the rate of 25 mg per 1 kg of the child's weight per day, in case of severe infection - 50 mg per 1 kg of body weight per day. The daily dose is divided into 3 doses;
- children weighing from 20 to 40 kg: 40–90 mg per 1 kg of the child's weight per day, the dose is divided into 2-3 doses;
- children weighing over 40 kg: use the adult dosing regimen.
The maximum daily dose is 2000 mg.
Recommended dosage of Amoxicillin for certain indications in children:
- tonsillitis: 50 mg per 1 kg of the child's weight per day. The received dose is divided into 3 doses;
- severe course of acute otitis media or relapse (as an alternative therapy regimen): 750 mg 2 times a day for 2 days;
- prevention of endocarditis: a single dose of 1500 mg 1 hour before the intervention without general anesthesia or 4 hours before the operation under general anesthesia. If necessary, the initial dose can be taken again after 6 hours.
In case of impaired renal function in children with CC more than 30 ml / min, no dosage adjustment is required. With CC 10-30 ml / min, children are prescribed the frequency of taking Amoxicillin 2 times a day, this corresponds to 2/3 of the usual dose. When CC is less than 10 ml / min, the drug is prescribed once a day, which corresponds to taking 1/3 of the usual children's dose.
It is recommended that you strictly observe the same time intervals between doses.
Granules
The finished suspension is taken orally, washed down with a large (100-200 ml) amount of water, before or after meals.
To prepare the suspension, you need to pour water into the bottle to the indicated risk, then shake well. The prepared solution should be stored at 2–8 ° C in the refrigerator for no more than 14 days. Shake the contents of the bottle before each dose.
5 ml of suspension (1 scoop) contains 250 mg of amoxicillin.
Standard dosage regimen of Amoxicillin:
- adults and children over 10 years of age with a body weight above 40 kg: 10 ml (500 mg) 3 times a day, with a severe form of an infectious disease - 15-20 ml (750-1000 mg) 3 times a day;
- children 5-10 years old: 5 ml (250 mg) of the suspension 3 times a day;
- children aged 2 to 5 years: 2.5 ml (125 mg) 3 times a day;
- children from three months to 2 years: at the rate of 20 mg per 1 kg of body weight per day, the daily dose is divided into 3 doses;
- children under the age of three months: the maximum daily dose is 30 mg per 1 kg of the child's weight, divided into 2 doses after the same time. In newborns (including premature infants), the dose is reduced and / or the interval between doses is increased.
The duration of the course of treatment is 5–12 days.
The recommended dosage of Amoxicillin for the treatment of certain pathologies:
- acute uncomplicated gonorrhea: 60 ml once, women are recommended to take the specified dose again;
- acute infections of the biliary tract and gastrointestinal tract (paratyphoid fever, typhoid fever), gynecological infections: adults - 30-40 ml 3 times a day or 20-30 ml 4 times a day;
- peptic ulcer of the stomach and duodenum (as part of complex therapy): 15–20 ml 2 times a day;
- leptospirosis: adults - 10-15 ml 4 times a day for 6-12 days;
- salmonella: adults - 30-40 ml 3 times a day, course duration - from 14 to 28 days;
- prevention of endocarditis: adults - 60–70 ml once, children - 30–35 ml of suspension 1 hour before minor surgery. If necessary, a repeated dose can be taken after 8-9 hours.
In case of impaired renal function with a CC of 15–40 ml / min, the suspension is prescribed 2 times a day. With CC below 10 ml / min, the daily dose should be reduced by 15-50%. The maximum daily dose of Amoxicillin for anuria is 40 ml of suspension.
Side effects
- from the digestive system: impaired taste, nausea, vomiting, dysbiosis, diarrhea, stomatitis, pseudomembranous colitis, glossitis, liver dysfunction, increased activity of moderate hepatic transaminases, cholestatic jaundice, acute cytolytic hepatitis;
- from the nervous system: insomnia, agitation, headache, anxiety, confusion, dizziness, ataxia, behavioral change, peripheral neuropathy, depression, convulsive reactions;
- allergic reactions: fever, urticaria, skin hyperemia, rhinitis, conjunctivitis, erythema, eosinophilia, angioedema, joint pain, exfoliative dermatitis, Stevens-Johnson syndrome, erythema multiforme (multiforme), exudative erythema, allergic vaculitis, anaphylactic reactions serum sickness;
- laboratory parameters: neutropenia, leukopenia, agranulocytosis, anemia, thrombocytopenic purpura;
- from the urinary system: crystalluria, interstitial nephritis;
- others: tachycardia, shortness of breath, vaginal candidiasis, superinfection (more often in the treatment of chronic infections or in patients with reduced body resistance).
In addition, the following side effects may develop, which have been reported when taking certain forms of Amoxicillin:
- tablets: allergic reactions in the form of skin rash, itching, toxic epidermal necrolysis, generalized exanthematous pustulosis, hepatic cholestasis, eosinophilia;
- capsules: dry mouth, "black hairy" tongue, candidiasis of the skin and mucous membranes, increased prothrombin time and blood clotting time, staining of tooth enamel yellow, brown or gray;
- granules: "black hairy" tongue, discoloration of tooth enamel, hemolytic anemia, acute generalized exanthematous pustulosis.
Overdose
Symptoms: nausea, imbalance in water and electrolyte balance against the background of vomiting and diarrhea.
Treatment: immediate gastric lavage, intake of saline laxatives, activated carbon. Prescribing treatment aimed at maintaining water and electrolyte balance. The use of hemodialysis is shown.
special instructions
The appointment of Amoxicillin is possible only if there is no indication in the patient's detailed history of allergic reactions to beta-lactam antibiotics (including penicillins, cephalosporins). For prophylactic purposes, the simultaneous administration of antihistamines is indicated.
When using estrogen-containing oral contraceptives, women should be advised to additionally use barrier methods of contraception during treatment with amoxicillin.
With concomitant therapy with anticoagulants, consideration should be given to a possible reduction in their dose.
For the treatment of acute respiratory viral infections, the use of antibiotics is ineffective.
Amoxicillin should not be prescribed for the treatment of infectious mononucleosis due to the risk of developing an erythematous skin rash and worsening symptoms of the disease.
It is not recommended to use oral forms of amoxicillin for the treatment of patients with diseases of the gastrointestinal tract, which are accompanied by continuous diarrhea or vomiting.
If a mild diarrhea occurs while taking amoxicillin, antidiarrheal agents containing kaolin or attapulgite can be used, avoiding the use of drugs that slow down intestinal motility.
If you develop severe diarrhea with loose, watery, greenish, pungent-smelling stools, including blood, fever and severe abdominal pain, you should see your doctor right away. These symptoms may indicate a severe complication of antibiotic therapy in the form of the development of clostridial pseudomembranous colitis.
Influence on the ability to drive vehicles and complex mechanisms
Due to the risk of dizziness, agitation and other behavioral disorders during the period of treatment, patients are advised to exercise extreme caution in potentially hazardous activities, including driving vehicles and mechanisms.
Application during pregnancy and lactation
During gestation, the use of Amoxicillin is possible only if the expected therapeutic effect for the mother, in the opinion of the doctor, exceeds the potential threat to the fetus.
The use of the drug during lactation is contraindicated. If necessary, the appointment of amoxicillin breastfeeding should be discontinued.
Pediatric use
It is contraindicated to prescribe Amoxicillin tablets to children under the age of 10 years with a body weight of less than 40 kg, capsules - to children under 5 years old.
Over the age of 5 years, the use of capsules is indicated in cases where the prescribed daily dose is at least 500 mg (250 mg 2 times a day).
With impaired renal function
Amoxicillin should be used with caution to treat patients with renal failure.
The usual dosage regimen for tablets and granules is used in patients with CC above 40 ml / min, for capsules - with CC above 30 ml / min.
In severe renal impairment, dose adjustment is required. It is produced taking into account QC by reducing a single dose or increasing the interval between doses of Amoxicillin.
With a CC of 15-40 ml / min, the usual dose is prescribed, but the interval between doses is increased to 12 hours, with CC less than 10 ml / min, the dose should be reduced by 15-50%.
The maximum daily dose of Amoxicillin for anuria is 2000 mg.
In case of impaired renal function in children with CC more than 30 ml / min, no dosage adjustment is required. With CC 10-30 ml / min, children are prescribed 2/3 of the usual dose, increasing the interval between doses up to 12 hours. In children with CC less than 10 ml / min, the frequency of taking the drug is 1 time per day, or they are prescribed 1/3 of the usual children's dose.
For violations of liver function
It is contraindicated to prescribe Amoxicillin for liver failure.
Drug interactions
With the simultaneous use of Amoxicillin:
- ascorbic acid: causes an increase in the degree of absorption of the drug;
- aminoglycosides, antacids, laxatives, glucosamine: help to slow down and reduce absorption;
- ethanol: reduces the rate of absorption of amoxicillin;
- digoxin: increases its absorption;
- probenecid, phenylbutazone, oxyphenbutazone, indomethacin, acetylsalicylic acid: cause an increase in the concentration of amoxicillin in the blood plasma, slowing down its elimination;
- methotrexate: the risk of developing the toxic effects of methotrexate increases;
- indirect anticoagulants and drugs, during the metabolism of which para-aminobenzoic acid is formed: against the background of a decrease in the synthesis of vitamin K and the prothrombin index, due to the suppression of intestinal microflora by amoxicillin, the risk of breakthrough bleeding increases;
- allopurinol: increases the risk of developing allergic skin reactions;
- oral contraceptives: the reabsorption of estrogen in the intestine decreases, which leads to a decrease in the effectiveness of contraception;
- bactericidal antibiotics (cycloserine, vancomycin, aminoglycosides, cephalosporins, rifampicin): cause synergism of antibacterial action;
- bacteriostatic drugs (sulfonamides, macrolides, lincosamides, chloramphenicol, tetracyclines): help to weaken the bactericidal effect of amoxicillin;
- metronidazole: the antibacterial activity of amoxicillin increases.
Analogs
Analogs of Amoxicillin are: tablets - Amoxicillin Sandoz, Ecobol, Flemoxin Solutab, Ospamox, capsules - Hikontsil, Amosin, Ampiox, Hikontsil, Ampicillina Trihydrate.
Terms and conditions of storage
Keep out of reach of children, protected from light at temperatures up to 25 ° C, granules and capsules - protect from moisture.
Shelf life: tablets - 3 years, capsules, granules - 4 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Amoxicillin
Reviews of Amoxicillin from patients and doctors are mostly positive. They indicate the effectiveness of the drug in the treatment of many infectious diseases due to the wide spectrum of antibiotic activity. They note the rapid onset of clinical action, good tolerance, the absence of severe side effects, and an acceptable price.
The price of Amoxicillin in pharmacies
The price of Amoxicillin for a package containing 16 tablets at a dose of 250 mg can be from 64 rubles, 20 tablets at a dose of 250 mg - from 30 rubles, 20 tablets at a dose of 500 mg - from 68 rubles, a 100 ml bottle with granules per dose 250 mg / 5 ml - from 103 rubles, 16 capsules at a dose of 500 mg - from 108 rubles.
Amoxicillin: prices in online pharmacies
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Drug name Price Pharmacy |
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Amoxicillin 250 mg tablets 20 pcs. RUB 21 Buy |
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
