Immard
Immard: 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. Drug interactions
- 12. Analogs
- 13. Terms and conditions of storage
- 14. Terms of dispensing from pharmacies
- 15. Reviews
- 16. Price in pharmacies
Latin name: Immard
ATX code: P01BA02
Active ingredient: Hydroxychloroquine (Hydroxychloroquine)
Manufacturer: Ipca Laboratories, India
Description and photo update: 18.10.2018
Prices in pharmacies: from 400 rubles.
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Immard is a remedy against malaria.
Release form and composition
The dosage form of the release is film-coated tablets: almost white or white, biconvex, round, “HCQS” is engraved on one side (10 tablets in a blister, 3, 6 or 10 blisters in a carton box).
1 tablet contains:
- active substance: hydroxychloroquine sulfate - 200 mg;
- excipients: magnesium stearate, corn starch, calcium hydrogen phosphate, colloidal silicon dioxide, talc, polysorbate-80;
- shell: talc, macrogol, hypromellose, titanium dioxide.
Pharmacological properties
Pharmacodynamics
The drug against malaria, intensely inhibits erythrocyte forms (hematoschizotropic drug). Seals lysosomal membranes and interferes with the release of lysosomal enzymes, impairs RNA synthesis, DNA reduplication and Hb utilization by erythrocyte forms of plasmodium.
Produces anti-inflammatory and immunosuppressive effects, reduces the activity of proteolytic enzymes (collagenase and protease), chemotaxis of lymphocytes, leukocyte activity, inhibits free radical processes.
Pharmacokinetics
Absorption is variable. The time required for semi-absorption is 3.6 hours (1.9–5.5 hours). Bioavailability is 74%. The connection with plasma proteins is 45%. The time to reach the highest concentration of the drug in the blood (TC max) is 3.2 hours (2-4.5 hours), the highest concentration (C max) after oral administration of 155 mg is 948 ng / ml, after oral administration of 310 mg - 1895 ng / ml. It is collected in tissues with a high degree of metabolism (kidneys, liver, spleen, lungs - in these organs, the concentration exceeds plasma by 200-700 times; in the central nervous system, leukocytes, erythrocytes) and in tissues that are rich in melanin. In rather low concentrations, it appears in the walls of the gastrointestinal tract. In small quantities, it is determined in breast milk, passes through the placental barrier. Volume of distribution: measured in plasma is 44.257 liters, in blood - 5.522 liters. The metabolic process takes place partially in the liver with the formation of active desethylated metabolites. The half-life from plasma is 32 days, from blood - 50 days. 23-25% is excreted by the kidneys unchanged and less than 10% - with bile. The excretion rate is very low and can be detected for a long time in the urine after stopping treatment.
Indications for use
- radical treatment of malaria caused by susceptible strains of Plasmodium falciparum;
- suppressive therapy and therapy of acute attacks of malaria caused by Plasmodium ovale, Plasmodium vivax, Plasmodium malariae (except for hydroxychloroquine-resistant cases) and susceptible strains of Plasmodium falciparum;
- rheumatoid arthritis;
- photodermatitis;
- lupus erythematosus (discoid and systemic).
Contraindications
- hypersensitivity to any component of the drug;
- retinopathy (including a history of maculopathy);
- age up to 6 years and body weight less than 31 kg;
- long-term therapy in childhood;
- pregnancy and the period of breastfeeding.
Diseases / conditions in which Immard must be used with caution (relative contraindications):
- diseases of the cardiovascular system and central nervous system;
- psychosis (including a history);
- psoriasis;
- porphyria;
- skin reactions;
- visual disturbances (narrowing of the visual fields, impaired color vision, decreased visual acuity), joint intake of medications that can cause negative ophthalmic reactions (risk of progression of retinopathy and visual disturbances);
- renal and / or hepatic failure, hepatitis, a single dose of drugs that adversely affect the function of the kidneys and / or liver;
- severe gastrointestinal diseases;
- violation of bone marrow hematopoiesis;
- hypersensitivity to quinine;
- deficiency of glucose-6-phosphate dehydrogenase.
Instructions for the use of Immard: method and dosage
Immard tablets are taken orally (inside), with meals or with a glass of milk. 155 mg of hydroxychloroquine base is equivalent to 200 mg of hydroxychloroquine sulfate.
- rheumatoid arthritis: starting dose in adults - 400–600 mg per day, maintenance dose - 200–400 mg per day;
- systemic and discoid lupus erythematosus: starting dose for adults - 400-800 mg per day, maintenance dose - 200-400 mg per day;
- juvenile arthritis: the dose should not exceed 6.5 mg / kg or 400 mg per day (the lowest dose is chosen);
- photodermatosis: daily dose - up to 400 mg, therapy should be limited to periods of maximum solar exposure;
- malaria: suppressive therapy in adults is 400 mg daily every 7th day; in children, the weekly suppressive dose is 6.5 mg / kg, however, regardless of body weight, it should not be higher than the dose for adults (400 mg). If conditions permit, suppressive treatment is prescribed 14 days before exposure, in another case, an initial double dose can be prescribed: 800 mg for adults, 12.5 mg / kg (should not exceed 800 mg) for children, divided into 2 doses with a pause in 6 o'clock. Suppressive therapy is recommended to continue for 8 weeks after leaving the endemic area;
- therapy of an acute attack of malaria: starting dose for adults - 800 mg, then after 6-8 hours - 400 mg, then - 400 mg on the 2nd and 3rd days of treatment (a total of 2000 mg of hydroxychloroquine sulfate). Alternatively, a single dose of 800 mg may be effective. The total dose prescribed to children for 3 days is 32 mg / kg (should not exceed 2000 mg): the first dose is 12.5 μg / kg (should not exceed 800 mg), the second dose is 6.5 mg / kg (should not exceed 400 mg) 6 hours after the first dose, the third dose - 6.5 mg / kg (should not exceed 400 mg) 18 hours after the second dose, the fourth dose - 6.5 mg / kg (should not exceed 400 mg) 24 hours after the third dose.
The dose for adults can be calculated in the same way as for children, that is, per 1 kg of body weight.
Side effects
- musculoskeletal and nervous systems: myopathy or neuropathy, leading to increasing myasthenia gravis and atrophy of the proximal muscle groups, weight loss, decreased tendon reflexes, sensory disturbances, abnormal nerve conduction, dizziness, headache, psychosis, nervousness, emotional lability, convulsions;
- sensory organs: tinnitus, hearing loss, photophobia, visual acuity disturbance, accommodation disturbance, edema and clouding of the cornea, scotoma, with prolonged use of large doses - retinopathy (including pigmentation disturbances and visual field defects), optic nerve atrophy, ciliary muscle dysfunction, keratopathy;
- cardiovascular system: with long-term treatment with large doses - cardiomyopathy, atrioventricular blockade, myocardial dystrophy, decreased myocardial contractility, myocardial hypertrophy;
- digestive system: decreased appetite, nausea, vomiting, diarrhea, abdominal pain of a spastic nature, hepatotoxicity (liver failure, abnormal liver function);
- hematopoietic system: aplastic anemia, thrombocytopenia, neutropenia, agranulocytosis, hemolytic anemia (in patients with glucose-6-phosphate dehydrogenase deficiency);
- skin: itching, skin rash (including bullous and generalized pustular), pigmentation disorders of the skin and mucous membranes, hair discoloration, alopecia, photosensitivity, Stevens-Johnson syndrome (exudative erythema multiforme), exacerbation of psoriasis (including with fever and hyperleukocytosis), aggravation of porphyria.
Overdose
Symptoms:
- cardiotoxicity (with chronic intoxication - myocardial hypertrophy of both ventricles, impaired conduction along the His bundle);
- visual impairment;
- lowering blood pressure;
- neurotoxicity (irritability, headache, dizziness, convulsions, coma);
- respiratory arrest and cardiac arrest.
An increased danger of overdose is for young children, in whom taking 1–2 g of the drug can be fatal.
In case of symptoms of an overdose, gastric lavage should be performed, the patient should be given activated charcoal (the dose of activated charcoal should be 5 times higher than the taken dose of the drug). Forced diuresis and alkalinization of urine (for example, with ammonium chloride to a urine pH of 5.5–6.5) are recommended, as a result of which the excretion of 4-aminoquinoline in the urine increases. Symptomatic therapy may be prescribed, including the appointment of diazepam for seizures and anti-shock therapy.
It is necessary to monitor the concentration of sodium in the blood serum and carry out careful medical monitoring of the patient's condition for at least 6 hours after the relief of symptoms.
special instructions
Before starting and during treatment, it is necessary to carry out an ophthalmological examination at least once every 6 months.
The survey should be carried out more often if:
- the daily dose of the drug is more than 6.5 mg / kg without increased body weight (the actual weight used to set the dose for obese patients may lead to an overdose);
- reduced visual acuity;
- the total dose exceeds 200 g;
- patient age> 65 years;
- there is evidence of renal failure.
The use of daily doses of more than 6.5 mg / kg increases the risk of developing retinopathy and accelerates its appearance. If negative reactions from vision appear (decreased visual acuity, change in color perception, etc.), the drug must be canceled immediately (changes in the retina can progress even after the drug is discontinued, therefore, patients should be under the supervision of a specialist).
During the entire course of therapy, constant monitoring of the cellular composition of the blood, the state of skeletal muscles (including tendon reflexes) is required.
The drug must be canceled in case of manifestations of muscle weakness, revealing a deviation from the norm of hematological parameters.
Influence on the ability to drive vehicles and complex mechanisms
During treatment, it is recommended to be careful when driving vehicles and engaging in other potentially hazardous activities that require speed of psychomotor reactions and increased concentration.
Application during pregnancy and lactation
The use of Immard tablets during pregnancy and lactation is possible only for health reasons (if the expected benefit to the mother outweighs the possible risk to the fetus). In therapeutic doses, it can cause damage to the central nervous system in infants or the fetus (vestibular and auditory ototoxicity, up to deafness), pathological retina pigmentation and retinal bleeding (newborns are most sensitive to toxic reactions of 4-aminoquinolines, the presence of which in small amounts in mother's milk may be justified by taking the drug).
Pediatric use
According to the instructions, Immard is contraindicated for persons under the age of 6 years and weighing less than 31 kg.
Drug interactions
The effect of hydroxychloroquine sulfate on drugs / substances in combined use:
- digoxin: an increase in its concentration in plasma;
- aminoglycosides: enhancement of the blocking effect on neuromuscular conduction;
- hypoglycemic drugs: increasing the effect of the latter (a decrease in their dose is required);
- alkaline drinks and alkalis: accelerating their excretion from the body;
- penicillamine: an increase in plasma concentrations and the risk of its adverse reactions from the urinary system, hematopoietic organs and skin reactions;
- glucocorticosteroids, salicylates, class Ia antiarrhythmic drugs, hemato-, hepato- and neurotoxic drugs: increasing their side effects.
With a single use of antacids, the interval between doses should be at least 4 hours (decrease in absorption).
Analogs
Immard's analogs are: Hydroxychloroquine, Plaquenil.
Terms and conditions of storage
Store in a dry place away from light at a temperature not exceeding 25 ° C. Keep out of the reach of children.
Valid for 2 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Immard
According to reviews, Immard is generally well tolerated. Some patients taking the drug note a quick effect.
Price for Immard in pharmacies
The price of Immard 200 mg (30 tablets per pack) is about 400 rubles.
Immard: prices in online pharmacies
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Drug name Price Pharmacy |
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Immard tablets p.p. 200mg 30 pcs. RUB 400 Buy |
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Immard 200 mg film-coated tablets 30 pcs. 420 RUB Buy |
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!
