Taksakad - Instructions For Use, Reviews, Price, Analogues

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Taksacad

Taksakad: 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. Use in the elderly
14. Drug interactions
15. Analogs
16. Terms and conditions of storage
17. Terms of dispensing from pharmacies
18. Reviews
19. Price in pharmacies

Latin name: Taxacad

ATX code: L01CD01

Active ingredient: paclitaxel (Paclitaxel)

Manufacturer: CJSC Biocad (Russia)

Description and photo update: 2019-09-07

Concentrate for solution for infusion Taksakad

Taksacad is an antineoplastic drug.

Release form and composition

The drug is produced in the form of a concentrate for the preparation of a solution for infusion, which is a transparent viscous colorless or light yellow liquid [5 ml (30 mg), 16.7 ml (100 mg), 23.3 ml (140 mg), 25 ml (150 mg), 35 ml (210 mg), 41.7 ml (250 mg), 43.3 ml (260 mg), 46 ml (276 mg), 50 ml (300 mg) and 60 ml (360 mg) in vials of neutral glass, in a cardboard box 1 bottle and instructions for use Taksakada].

Composition of 1 ml of concentrate:

active substance: paclitaxel - 6 mg;
auxiliary components: macrogol glyceryl ricinoleate, ethanol.

Pharmacological properties

Pharmacodynamics

Paclitaxel is a semi-synthetic anticancer agent. Its mechanism of action is due to the stimulation of the assembly of microtubules from dimeric tubulin molecules, the stabilization of their structure by suppressing depolymerization, as well as inhibition of dynamic reorganization in the interphase. As a result of these reactions, the mitotic function of the cell is disrupted.

Taksacad also induces the formation of abnormal clusters or bundles of microtubules throughout the cell cycle and promotes the formation of multiple stars of microtubules during mitosis.

According to experimental data, paclitaxel reduces reproductive function, has embryotoxic and mutagenic properties.

Pharmacokinetics

After intravenous (iv) administration of the solution, the plasma concentration of the drug decreases in accordance with the two-phase kinetics.

The pharmacokinetics of paclitaxel were determined following infusion at doses of 135 and 175 mg / m ² during 3 and 24 h half-life (T. _1/2) is 13-52,7 hours, total clearance - 12,2-23,8 l / h / m, these indicators vary depending on the dose and duration of administration. The volume of distribution (V _d) is 198–688 l / m.

With long-term use of Taksacada, cumulation is not observed. About 89% of the substance binds to plasma proteins.

In vitro studies on liver microsomes have shown that the drug is metabolized in the liver to alpha-hydroxypaclitaxel with the participation of the CYP2C8 isoenzyme, to 6-alpha-3-paradihydroxypaclitaxel and 3-para-hydroxypakitaxel with the participation of the CYP3A4 isoenzyme.

After intravenous infusion of paclitaxel (15–275 mg / m ²) for 1, 6 or 24 hours, about 1.3–12.6% of the dose was excreted unchanged by the kidneys. After 3 hours of administration of radioactive paclitaxel at doses of 225–250 mg / m ^{2, the} elimination for 120 hours was carried out by: intestines - 71%, kidneys - 14%. Most of the excreted by the intestines were metabolites (mainly 6-alpha-hydroxypaclitaxel), approximately 5% of the administered radiopharmaceutical was excreted unchanged.

Indications for use

Mammary cancer:

first-line therapy of advanced cancer or metastatic cancer with trastuzumab in patients with immunohistochemically confirmed 2+ or 3+ HER-2 expression levels; in combination with anthracycline drugs, if there are no contraindications to their use;
first-line therapy of advanced cancer or metastatic cancer after disease recurrence within 6 months from the start of adjuvant therapy in combination with anthracycline drugs, if there are no contraindications to their use;
second-line therapy of late stage cancer or metastatic cancer with disease progression after previous combination chemotherapy (treatment should include anthracycline drugs, if there are no contraindications to their use);
adjuvant therapy in the presence of metastases in the lymph nodes after the standard combination treatment.

Ovarian cancer:

first-line therapy of advanced cancer or residual tumor (more than 1 cm) together with platinum preparations after the initial laparotomy;
second-line therapy of metastatic cancer after standard therapy that did not give a positive result.

Non-small cell lung cancer: therapy of choice in patients not planned for radiation and / or surgery, either alone or in combination with platinum.

Kaposi's sarcoma due to acquired immunodeficiency syndrome (AIDS): second-line therapy.

Contraindications

Absolute:

baseline neutrophil count <1500 / μL in patients with solid tumors;
concomitant serious uncontrolled infections in patients with Kaposi's sarcoma;
the initial or detected in the course of treatment the content of neutrophils <1000 / μl in patients with Kaposi's sarcoma due to AIDS;
age up to 18 years;
During pregnancy and breastfeeding;
known hypersensitivity to any component of Taksacada.

Relative:

acute infectious diseases (for example, herpes, shingles, or chickenpox);
thrombocytopenia (<100,000 / μl);
arrhythmia;
myocardial infarction (history);
severe course of coronary heart disease;
liver failure.

Taksakad, instructions for use: method and dosage

Taksacad is injected through a system with a membrane filter equipped with pores no larger than 0.22 microns. Immediately before use, a solution is prepared from the concentrate to the final concentration of paclitaxel in the range of 0.3-1.2 mg / ml. For dilution, it is allowed to use a 0.9% sodium chloride solution, 5% dextrose solution in Ringer's solution or 5% dextrose solution in 0.9% sodium chloride solution. Due to the presence of the carrier base in the composition of the dosage form, the prepared solutions can become opalescent, while the opalescence remains even after filtration.

When stored in a refrigerator in unopened vials, a precipitate may form, which, after reaching room temperature and gentle stirring (and even without stirring), dissolves again. This phenomenon does not affect the quality of the drug. However, the solution should not be used if it remains cloudy or contains an insoluble precipitate.

During preparation, storage and administration of the drug, equipment should be used that does not contain PVC parts (for example, polyolefin, polypropylene or glass).

Since Taksacad is a cytotoxic substance, precautions must be taken when working with it: use gloves, do not allow the concentrate to come into contact with the eyes, skin and mucous membranes. If this happens, you should immediately wash the skin and mucous membranes with soap and water; the eyes are washed with plenty of water.

After dilution, solutions should be refrigerated.

To avoid the development of severe hypersensitivity reactions, all patients undergo premedication with glucocorticosteroids, blockers of H ₁ and H ₂ -histamine receptors.

Possible premedication options:

diphenhydramine at a dose of 50 mg (or its equivalent) IV 30-60 minutes before the introduction of Taksacad;
dexamethasone at a dose of 20 mg (or its analog) intravenously 30-60 minutes before the administration of Taksacad or by mouth 12 and 6 hours before the administration of the drug;
cimetidine at a dose of 300 mg i.v. 30-60 minutes before the introduction of Taksacad;
ranitidine at a dose of 50 mg i.v. 30-60 minutes before the administration of Taksacad.

Recommended dosing regimens for ovarian cancer:

first-line therapy: 175 mg / m ² every 3 weeks as a 3-hour / v infusion followed by administration of a platinum drug, or 135 mg / m ² every 3 weeks as a 24-hour / v infusion followed by administration of the drug platinum;
second-line therapy (monotherapy): 175 mg / m ² every 3 weeks as a 3-hour intravenous infusion.

Recommended dosing regimens for breast cancer:

first-line therapy as monotherapy: 175 mg / m ² every 3 weeks as a 3-hour intravenous infusion;
first-line therapy in combination therapy with trastuzumab: 175 mg / m ² every 3 weeks as a 3-hour intravenous infusion on the day preceding the administration of trastuzumab. If the latter is well tolerated, Taksacad is subsequently administered immediately after trastuzumab;
first-line therapy in a combination therapy with doxorubicin: 220 mg / m ² every 3 weeks as a 3-hour / v infusion 24 hours after the administration of Doxorubicin (50 mg / m ²);
second-line therapy: 175 mg / m ² every 3 weeks in the form of a 3-hour intravenous infusion;
adjuvant therapy: Taksacad is administered after standard combination therapy at 175 mg / m ² as a 3-hour intravenous infusion. In total, 4 courses are usually prescribed at 3-week intervals.

Recommended dosing regimens for non-small cell lung cancer:

monotherapy: 175-225 mg / m ² every 3 weeks in the form of a 3-hour intravenous infusion;
Combination therapy: 175 mg / m ² every 3 weeks as a 3-hour / v infusion followed by administration of a platinum drug, or 135 mg / m ² every 3 weeks as a 24-hour / v infusion followed by administration of a platinum drug …

Possible dosing regimens for second-line treatment of AIDS-related Kaposi's sarcoma:

135 mg / m ² every 3 weeks in the form of a 3-hour intravenous infusion;
100 mg / m ² every 2 weeks as a 3-hour intravenous infusion (45-50 mg / m ² per week).

Dosing regimen correction

Repeated courses of therapy with Taksacad are prescribed for patients with solid tumors only after reaching a neutrophil level of at least 1500 / μl of blood and platelet count - 100,000 / μl of blood, and in patients with Kaposi's sarcoma caused by AIDS - 1000 / μl and 75,000 / μl of blood, respectively … If severe neutropenia develops during the treatment period (keeping the neutrophil level less than 500 / μL of blood for more than 7 days) or severe peripheral neuropathy, the dose of Taksacad should be reduced by 20% in subsequent courses. Neutropenia and neurotoxicity are dose-dependent.

For Kaposi's sarcoma in patients with advanced AIDS, the following measures are recommended, depending on the level of immunosuppression:

the appointment of Taxacada only if the content of neutrophils is ≥ 1000 / μl of blood, platelets - ≥ 75,000 / μl;
reduction of the oral dose of dexamethasone to 10 mg (as part of premedication);
reducing the dose of Taksacada by 25% in case of severe peripheral neuropathy or severe neutropenia during subsequent courses of therapy;
the appointment of granulocyte colony-stimulating factor (G-CSF) if necessary.

Patients with hepatic insufficiency and the associated increased risk of toxicity (with grade III – IV myelosuppression) require careful monitoring of the patient's condition and dose adjustment.

Recommended doses for the first course of therapy with a 24-hour infusion, depending on the activity of hepatic transaminases and / or the concentration of bilirubin in the blood serum:

<2 × VGN (upper limit of the norm) and ≤ 26 μmol / l - 135 mg / m ²;
2–10 × VGN and ≤ 26 μmol / l - 100 mg / m ²;
<10 × VGN and 28–129 μmol / l - 50 mg / m ²;
≥ 10 × ULN or> 129 μmol / L - Taksacad is not recommended.

Recommended doses for the first course of therapy with a 3-hour infusion, depending on the activity of hepatic transaminases and / or the concentration of bilirubin in the blood serum:

<10 × VGN and ≤ 22 μmol / l - 175 mg / m ²;
<10 × VGN and 22–35 μmol / l - 135 mg / m ²;
<10 × VGN and 35–86 μmol / L - 90 mg / m ²;
≥ 10 × ULN or> 86 μmol / L - Taksacad is not recommended.

Side effects

The reported side effects in terms of frequency and severity do not differ when using Taksacad for different indications. However, in patients with AIDS-related Kaposi's sarcoma, severe infections (including opportunistic ones), febrile neutropenia and inhibition of hematopoiesis are more often observed and proceeded.

Side effects with monotherapy

By the frequency of development, adverse reactions are classified as follows: very often - ≥ 1/10, often - from ≥ 1/100 to <1/10, infrequently - from ≥ 1/1000 to <1/100, rarely - from ≥ 1/10000 up to <1/1000, very rarely - <1/10000, with an unknown frequency - the available data do not allow an accurate estimate of the frequency of occurrence:

immune system: very often - minor hypersensitivity reactions (most often manifested by hyperemia and skin rash); infrequently - severe hypersensitivity reactions requiring appropriate treatment, for example, edema, generalized urticaria, chills, back pain, angioedema, decreased blood pressure, impaired respiratory function; rarely * - anaphylactic reactions (including fatal); very rarely * - anaphylactic shock;
cardiovascular system: very often - a decrease in blood pressure, changes in the electrocardiogram (ECG); often - bradycardia; infrequently - tachycardia with bigeminy, increased blood pressure, asymptomatic ventricular tachycardia, cardiomyopathy, atrioventricular block, syncope, thrombophlebitis, thrombosis, myocardial infarction; very rarely * - supraventricular tachycardia, atrial fibrillation, shock;
musculoskeletal system: very often - myalgia, arthralgia; unknown frequency * - systemic lupus erythematosus;
nervous system: very often - neurotoxicity (mainly peripheral neuropathy); rarely * - motor neuropathy

(may cause slight limb weakness); very rarely * - dizziness, ataxia, headache, confusion, autonomic neuropathy (manifested by orthostatic hypotension and paralytic intestinal obstruction), encephalopathy, convulsions, tonic-clonic seizures;
respiratory system: rarely * - pleural effusion, shortness of breath, pulmonary embolism, pulmonary fibrosis, interstitial pneumonia, respiratory failure; very rarely * - cough;
hematopoietic organs: very often - fever, anemia, bleeding, neutropenia, leukopenia, thrombocytopenia, myelosuppression; rarely * - febrile neutropenia; very rarely * - myelodysplastic syndrome, acute myeloid leukemia;
liver and biliary tract: very rarely * - hepatic encephalopathy and hepatonecrosis, possibly fatal;
digestive system: very often - diarrhea, nausea, mucositis, vomiting; rarely * - ischemic colitis, intestinal obstruction, pancreatitis, intestinal perforation; very rarely * - constipation, esophagitis, anorexia, ascites, pseudomembranous colitis, mesenteric artery thrombosis;
organ of hearing: very rarely * - ototoxicity, vertigo (vestibular dizziness), tinnitus, hearing loss;
organ of vision: very rarely * - photopsy, visual impairment and / or reversible lesions of the optic nerve (for example, ocular migraine, ciliated scotoma), destruction of the vitreous body of the eye; unknown frequency * - macular edema;
skin, subcutaneous tissue and skin appendages: very often - alopecia; often: minor transient changes in the skin and nails; rarely * - skin fibrosis, erythema, rash, pruritus, phlebitis, exfoliation of the skin, inflammation of the subcutaneous fat, skin lesions resembling the effects of radiation therapy, skin necrosis; very rarely * - urticaria, exfoliative dermatitis, onycholysis, epidermal necrolysis, Stevens-Johnson syndrome, exudative erythema multiforme; with an unknown frequency - cutaneous lupus erythematosus *, scleroderma;
local reactions: often - erythema, pain, induration, local edema;
laboratory parameters: often - increased activity of alkaline phosphatase and aspartate aminotransferase (AST); infrequently - an increase in the concentration of bilirubin; rarely * - increased serum creatinine concentration;
others: very often - the addition of secondary infections; infrequently - septic shock; rarely * - dehydration, fever, general malaise, asthenia, peripheral edema, pneumonia, sepsis; unknown frequency * - tumor lysis syndrome.

* Side effects reported in post-marketing studies.

Side effects of combination therapy

Paclitaxel + radiation therapy: Cases of radiation pneumonitis have been reported.

Paclitaxel + cisplatin in the first line of therapy for ovarian cancer: compared with therapy with cyclophosphamide and cisplatin, the frequency and severity of neurotoxicity, hypersensitivity, arthralgia and myalgia are higher, and the manifestations of myelosuppression are lower. When using cisplatin at a dose of 75 mg / m ^2, manifestations of severe neurotoxicity appear less frequently with the combined use of paclitaxel at a dose of 135 mg / m ² as a 24-hour infusion than at a dose of 175 mg / m ² as a 3-hour infusion.

Paclitaxel + doxorubicin in breast cancer therapy: patients who have not previously received chemotherapy are known to develop congestive heart failure, and patients who received chemotherapy courses, especially with anthracyclines, often experienced ventricular failure, decreased left ventricular ejection fraction, violation of cardiac activity. In rare cases, myocardial infarction was noted.

Paclitaxel + trastuzumab in the first line of treatment for metastatic breast cancer: Compared to paclitaxel monotherapy, side effects such as insomnia, fever, chills, sinusitis, rhinitis, nosebleeds, rashes, herpes sores, acne, arthralgia, diarrhea, cough were more common, accidental injuries, infections, increased blood pressure, tachycardia, heart failure, reactions at the injection site.

Paclitaxel + trastuzumab in the second line of therapy (after anthracycline drugs): compared with paclitaxel monotherapy, the frequency and severity of cardiac disorders are higher. In most cases, the disorders are reversible after appropriate treatment, but rare cases of death are known.

Overdose

An overdose of Taksacada can manifest itself as bone marrow aplasia, mucositis, and peripheral neuropathy.

The specific antidote for paclitaxel is unknown.

special instructions

Treatment with Taksacad should always be accompanied by the supervision of a physician who has experience with anticancer chemotherapeutic agents.

If the drug is used in conjunction with cisplatin, Taksacad should be administered first.

Injection site reactions

Local reactions with the introduction of Taxacada were usually mild. The most frequently observed: tenderness and pain at the injection site, erythema, edema, as well as hemorrhages, which sometimes led to the development of cellulite. With a 24-hour infusion, similar reactions were noted more often than with a 3-hour infusion. Their onset can be noted both during the infusion and within a few days after it (up to 10 days).

Serious hypersensitivity reactions

Despite the premedication, up to 1% of cases of development of serious hypersensitivity reactions are recorded, the frequency and severity of which do not depend on the treatment regimen and dose of Taksacada.

The most commonly reported allergic reactions are: chest pain, increased blood pressure, tachycardia, hot flashes, increased sweating, pain in the extremities, abdominal pain, choking. With the development of such reactions, the administration of Taxacad is immediately stopped and appropriate treatment is prescribed. Repeated courses of the drug are contraindicated in the future.

Myelosuppression

The suppression of bone marrow function (mainly the development of neutropenia) is due to the Taksacada regimen and is dose-dependent. This is a major toxic reaction that may require a dose reduction.

It was noted that in patients who received previous X-ray therapy, neutropenia is less common, manifests itself in a mild degree and does not worsen with the accumulation of Taxacade in the body.

Infections are very common, including pneumonia, pneumonitis, and sepsis. Fatalities have been reported. The most complicated were urinary tract infections. There is at least one known case of development of opportunistic infection in immunosuppressed patients (Kaposi's sarcoma caused by AIDS and HIV infection).

For patients with severe neutropenia, maintenance therapy is recommended, including G-CSF.

A decrease in the number of platelets below 100,000 / μL was detected at least once during treatment with paclitaxel, sometimes below 50,000 / μL. There are also known cases of bleeding, most of which were local, and their frequency did not depend on the scheme of administration and dose of Taksacada.

During the period of anticancer therapy, regular monitoring of the blood picture is shown. Taksacad should not be used in patients with neutrophil counts <1500 / μL of blood and platelet counts <100,000 / μL of blood, and in patients with AIDS-related Kaposi's sarcoma - <1000 / μL and <75,000 / μL, respectively. If severe neutropenia develops during the treatment period (maintaining the neutrophil level <500 / μl of blood for more than 7 days), during subsequent courses, the dose of Taksacad should be reduced by 20%, for patients with Kaposi's sarcoma caused by AIDS - by 25%.

Effect on the gastrointestinal tract

Nausea, vomiting, diarrhea, and / or mild to moderate mucositis are very common in all patients. Cases of mucositis depend on the Taksacada regimen, and are more common with 24-hour infusion than with 3-hour infusion.

Despite the simultaneous administration of G-CSF, rare cases of neutropenic enterocolitis (typhlitis) are known in patients who received paclitaxel (both in monotherapy and as part of a combination treatment).

Effects on the nervous system

Adverse reactions from the nervous system, their frequency and severity are mainly dose-dependent.

Peripheral neuropathy is common and is usually mild. Its incidence increases with continued treatment with paclitaxel. Paresthesia often manifests itself in the form of hyperesthesia. In patients who have had episodes of severe neuropathy, with subsequent courses, the dose of Taksacad is reduced by 20%, in patients with Kaposi's sarcoma caused by AIDS - by 25%. In some cases, peripheral neuropathy is the basis for the withdrawal of paclitaxel. After withdrawal, symptoms usually decrease or disappear completely within a few months.

Permanent optic nerve injuries diagnosed in patients have rarely been reported using the VEP (visual evoked potentials) method.

Physicians should consider the possible effects of ethanol, which is contained in Taksacada as an adjunct.

Effects on the cardiovascular system

Bradycardia, an increase / decrease in blood pressure observed with the administration of paclitaxel, is usually asymptomatic and does not require treatment. Bradycardia and a decrease in blood pressure are more common during the first three hours of infusion.

There are also known cases of ECG changes in the form of such re-polarization disorders as early extrasystole, sinus tachycardia and sinus bradycardia.

It is recommended to provide patients with monitoring of vital signs, especially during the first hour of infusion. When paclitaxel is used with doxorubicin or trastuzumab for the treatment of metastatic breast cancer, cardiac function should be monitored.

When symptoms of cardiac conduction disturbances appear, continuous ECG monitoring of the cardiovascular system and the appointment of appropriate therapy are necessary.

Severe cardiac pathologies can become the basis for the temporary and even complete cancellation of Taksakada.

Contraception

Throughout the course of anticancer therapy and for at least 3 months after its completion, patients should use reliable methods of contraception.

Influence on the ability to drive vehicles and complex mechanisms

During the period of drug treatment, it is recommended to refrain from potentially hazardous activities.

Premedication before the administration of Taksacada can also reduce the speed of psychomotor reactions and the ability to concentrate.

Application during pregnancy and lactation

Taksacad is contraindicated in pregnant women and women who are breastfeeding.

Pediatric use

There is insufficient data indicating the safety and efficacy of the drug in children; therefore, Taksacad is not used in pediatrics.

With impaired renal function

There is no information on the negative impact of Taksakada.

For violations of liver function

Patients with hepatic impairment are at risk of toxicity-related side effects. Especially increased the likelihood of myelosuppression of 3-4 degrees. In this regard, this group of patients requires careful monitoring, if necessary, it is recommended to correct the therapy regimen.

Use in the elderly

No information available.

Drug interactions

doxorubicin: paclitaxel may increase serum levels of doxorubicin and doxorubicinol (an active metabolite). In cases where paclitaxel is administered before doxorubicin, as well as with a duration of its administration exceeding the recommended one, side effects such as stomatitis and neutropenia are more pronounced;
cisplatin: in cases where the introduction of cisplatin precedes paclitaxel, there was a greater severity of myelosuppression and a decrease in paclitaxel clearance (by 33%) than with the introduction of cisplatin after paclitaxel;
substrates, inhibitors and inducers of CYP2C8 and CYP3A4 isoenzymes: since CYP2C8 and CYP3A4 isoenzymes are involved in the metabolism of paclitaxel, caution is required with the simultaneous use of substrates (for example, rosiglitazone, lovastatin, midazolam, simvastatin silt, elefiretripatine, inhibitors (eg gemfibrozil, erythromycin, indinavir, ritonavir, nelfinavir, ketoconazole, fluoxetine) or inducers (eg phenytoin, nevirapine, carbamazepine, rifampicin, efavirenz) of these isoenzymes.

Analogs

Taksakada analogs are Abitaxel, Abraxan, Velbin, Vero-Vincristine, Verotecan, Vinblastin-Lance, Vinkatera, Vinorelbin, Jevtana, Docetaxel, Javlor, Iriten, Cabazred, Kolotekan, Maverex, Oncodocel, Paxin and dr.

Terms and conditions of storage

Store in compliance with the following conditions: a place out of the reach of children and protected from light, temperature - no higher than 25 ° C.

Shelf life is 2 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews about Taksakada

In reviews about Taksakada, which are found mainly on specialized forums of cancer patients, they note that this domestic drug is a generic of the original Taxol drug. In most cases, patients receive it free of charge at oncological dispensaries. Many indicate that the drug is no less effective than the original, but is often worse tolerated. Nevertheless, tolerance, as well as the therapeutic effect, depend on a variety of factors (including on the therapy regimen, duration of infusion and concomitant drugs), therefore, they are characterized by wide individual variability.

Price for Taksacad in pharmacies

The price of Taksacad, a concentrate for the preparation of a solution for infusion (6 mg / ml), depends on the volume of the bottle, the region of sale and the pharmacy network. The approximate cost of 1 bottle with a volume of 5 ml - 1500-1950 rubles, a volume of 16.7 ml - 2000-3350 rubles, a volume of 25 ml - 6555 rubles, a volume of 41.7 ml - 7820 rubles, a volume of 50 ml - 8000 rubles …

Maria Kulkes Medical journalist About the author

Education: First Moscow State Medical University named after I. M. Sechenov, 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!