Monural
Monural: 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. Drug interactions
- 13. Analogs
- 14. Terms and conditions of storage
- 15. Terms of dispensing from pharmacies
- 16. Reviews
- 17. Price in pharmacies
Latin name: Monural
ATX code: J01XX01
Active ingredient: fosfomycin (fosfomycin)
Producer: Zambon Switzerland Ltd (Switzerland)
Description and photo update: 2019-19-08
Prices in pharmacies: from 312 rubles.
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Monural is an antibiotic drug used in the treatment of diseases of the genitourinary system.
Release form and composition
Monural is produced in the form of granules for the preparation of a solution for oral administration: white, with a tangerine smell (2 or 3 g in laminated multilayer bags, 1 or 2 bags in a cardboard box).
The composition of 1 g of granules includes:
- Active substance: fosfomycin - 2 or 3 g (in the form of trometamol fosfomycin - 3.754 or 5.631 g, respectively);
- Auxiliary components: saccharin, tangerine and orange flavors, sucrose.
Pharmacological properties
Pharmacodynamics
Monural has a bactericidal effect.
The active substance of the drug, trometamol fosfomycin, is one of the broad-spectrum antibiotics derived from phosphonic acid. The mechanism of its action is associated with the suppression of the first stage of the synthesis of the bacterial cell wall.
As a structural analog of phosphoenol, pyruvate enters into a competitive interaction with the enzyme N-acetyl-glucosamino-3-o-enolpyruvyl transferase. Due to this, irreversible, specific and selective inhibition of the specified enzyme is observed, which ensures the absence of cross-resistance with other classes of antibacterial agents and the possibility of synergy (synergism is noted with cephalexin, amoxicillin, pipemidic acid).
Exhibits activity against most gram-positive and gram-negative microorganisms: Morganella morganii, Serratia spp., Pseudomonas spp., Enterococcus spp., Enterococcus faecalis, Staphylococcus aureus, Staphylococcus saprophyticus, Staphylococcus saprophyticus. spp., Klebsiella pneumoniae, Klebsiella spp.
Also fosfomycin helps to reduce the adhesion of a number of bacteria to the epithelium of the urinary tract.
Pharmacokinetics
After oral administration, trometamol fosfomycin is rapidly absorbed from the gastrointestinal tract. With a single dose of 3000 mg of the substance, the bioavailability is from 34 to 65%. The time to reach C max (maximum concentration), which in plasma is 22–32 μg / ml, varies from 2 to 2.5 hours.
Trometamol does not bind to plasma proteins of fosfomycin, in the body it dissociates into trometamol and fosfomycin, and is not further metabolized. It accumulates mainly in the urine. When a single dose of more than 3000 mg is taken, a high concentration (1053–4415 mg / l) is observed in the urine; for most common causative agents of urinary tract infections, it is 99% bactericidal. MIC (minimum inhibitory concentration) –128 mg / l, maintained in urine for 24–48 hours, which allows for a single-dose course of treatment.
T 1/2 (half-life) from plasma is 4 hours. It is excreted by the kidneys unchanged (up to 95%), while high concentrations are created in the urine. Approximately 5% is excreted in the bile.
With a moderate decrease in renal function, including its physiological decrease in elderly patients, T 1/2 of fosfomycin is somewhat lengthened, while its concentration in urine remains at a therapeutic level.
Indications for use
- Nonspecific bacterial urethritis;
- Bacterial cystitis (acute course);
- Recurrent bacterial cystitis (acute attacks);
- Postoperative urinary tract infections;
- Asymptomatic massive bacteriuria in pregnant women;
- Urinary tract infections during surgery and transurethral diagnostic studies (for prevention).
Contraindications
- Severe renal failure (with creatinine clearance less than 10 ml per minute);
- Age up to 5 years;
- Hypersensitivity to drug components.
For lactating and pregnant women, Monural is prescribed only in cases where the intended benefits of therapy are higher than the possible harm to the child and fetus.
Instructions for use of Monural: method and dosage
Monural is taken orally, dissolved in 1/3 glass of water, on an empty stomach - 2 hours before or after a meal (preferably in the evening before bedtime), after having emptied the bladder.
Adults, as a rule, are prescribed 3 g of the drug once in 1 dose. In the treatment of severe or recurrent infections, as well as elderly patients, it may be necessary to take Monural again after 24 hours at the same dose.
For the prevention of urinary tract infection during diagnostic transurethral procedures and surgical interventions, 3 g of the drug is prescribed 3 hours before and 24 hours after the first dose.
For children from 5 years old, Monural is prescribed only once in a dose of 2 g.
Patients with renal insufficiency need to reduce the dose and increase the interval between doses of the drug.
Side effects
- Digestive system: heartburn, nausea, diarrhea;
- Others: allergic reactions, skin rash.
Overdose
The risk of developing an overdose of Monural is minimal.
Therapy: forced diuresis.
special instructions
Patients with diabetes mellitus, when prescribing Monural, should take into account that the granules of one package of 2 g include 2.1 g of sucrose, 3 g each - 2, 213 g of sucrose.
Application during pregnancy and lactation
Pregnancy and lactation are relative contraindications to the use of Monural. Treatment is possible only after assessing the balance of benefits and possible risks.
Pediatric use
According to the instructions, Monural is contraindicated in patients under 5 years of age.
With impaired renal function
- renal failure: correction of the dosage regimen is required;
- renal failure in severe degree (with creatinine clearance <10 ml / min): therapy is contraindicated.
Drug interactions
With the combined use of Monural with metoclopramide, the concentration of fosfomycin in urine and blood serum may decrease (the combination of drugs is not recommended).
Analogs
Monural's analogs are: Ekofomural, Fosmicin, Fosfomycin, Urofosfabol, Forteraz, Espa-Fotsin, Cystoral, 5-NOK, Hexamethylenetetramine, Dioxidin, Cubicin, Nitroxoline, Sanguirithrin, Amizolid, Zenix, Ristomycin sulfate.
Terms and conditions of storage
Keep out of reach of children under normal conditions.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Monural
Reviews about Monural are in most cases positive. They note the rapid action of the drug, neutral taste, good tolerance, convenient form of release and dosage regimen. Among the shortcomings, they point to high cost and, in some cases, low efficiency, as well as allergic reactions.
Price for Monural in pharmacies
The approximate price for Monural, granules for the preparation of a solution for oral administration, for 1 sachet of 2 g is 348–394 rubles; 3 g - 421–556 RUB
Monural: prices in online pharmacies
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Drug name Price Pharmacy |
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Monural granules for preparation of oral solution 2 g 1 pc. RUB 312 Buy |
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Monural granules for prig solution for internal approx. 2g 374 r Buy |
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Monural granules for preparation of oral solution 3 g 1 pc. 447 r Buy |
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Monural granules for prig solution for internal approx. 3d 459 r Buy |
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Monural granules for prig solution for internal approx. 3g 2 pcs. 719 RUB Buy |
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Monural granules for preparation of oral solution 3 g 2 pcs. 719 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!
