Combipeck
Kombipek: 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: Combipec
ATX code: R03DB04
Active ingredients: salbutamol + theophylline (Salbutamol + Theophylline)
Manufacturer: CJSC "Pharmapek" (Russia)
Description and photo update: 2020-10-08
Prices in pharmacies: from 320 rubles.
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Kombipek is a combined bronchodilating drug.
Release form and composition
The drug is produced in the form of prolonged-release tablets 6 mg + 200 mg, 8 mg + 200 mg and 10 mg + 200 mg, biconvex, white, sometimes with a weak specific odor (10 pcs. In blisters, in a cardboard box 5 contour cell packages and instructions for use of Kombipek).
Composition for 1 tablet of prolonged action:
- active substances: anhydrous theophylline - 200 mg; salbutamol hemisuccinate - 6, 8 or 10 mg;
- auxiliary components: calcium stearic acid, interpolymer complex of polymethacrylic acid and macrogol.
Pharmacological properties
Pharmacodynamics
The pharmacological properties of Kombipek are due to the properties that are inherent in theophylline and salbutamol separately:
- theophylline: a phosphodiesterase inhibitor that increases the accumulation of cAMP (cyclic adenosine monophosphate) in tissues, which leads to a decrease in the contractile activity of smooth muscle. It dilates blood vessels (mainly vessels of the skin, brain and kidneys) and bronchi; reduces pressure in the pulmonary circulation and pulmonary vascular resistance; stimulates the respiratory center; inhibits platelet aggregation; increases renal blood flow as well as strength and heart rate; has a moderate diuretic effect;
- salbutamol: selective beta 2 -adrenomimetic, which has a pronounced bronchodilator effect and prevents bronchospasm; increases the vital capacity of the lungs, reduces resistance in the airways; prevents the release of neutrophil chemotaxis factor and histamine.
Kombipek is a slow-release drug, therefore it cannot be used to relieve emergency and urgent conditions.
The bronchodilating effect develops gradually, 30 minutes after taking the drug, and a pronounced effect is manifested after 3-6 hours. Theophylline and salbutamol are released in dosage, which ensures their constant concentrations in the blood for 10-12 hours. A stable effect develops after several days of therapy … To achieve a therapeutic concentration of theophylline in the blood during the day, it is necessary to take Kombipek twice a day.
Pharmacokinetics
After a single dose of Kombipek, the processes of absorption and excretion of active substances proceed slowly. The maximum concentrations of theophylline and salbutamol in the blood are observed after 3-9 hours and are 4.07 ± 0.24 μg / ml and 6.58 ± 0.49 ng / ml, respectively. The half-life is 11.7 ± 8.3 h for theophylline and 7.15 ± 2.55 h for salbutamol, and the mean retention time of the active components is 19 ± 11.4 h and 12.7 ± 3.2 h, respectively.
It should be noted that the maximum serum concentrations of theophylline and salbutamol do not reach those levels that, according to the literature, correspond to therapeutic ones.
After repeated administration of Kombipek, the equilibrium concentration of theophylline is 6.67 ± 1.17 μg / ml, and that of salbutamol is 4.25 ± 0.591 ng / ml. The absolute bioavailability of theophylline is 56.6%. Volumes of distribution of active ingredients: for theophylline - 0.536 ± 0.124 l, for salbutamol - 11.6 ± 2.3 l.
The active components are biotransformed in the liver. As a result of the biotransformation of theophylline, inactive metabolites are formed, which are excreted by the kidneys and are partially secreted in breast milk. In unchanged form, about 10% of theophylline is excreted. More than 90% of salbutamol is excreted unchanged in the bile and urine, another 10% in the form of glucuronide.
Indications for use
Kombipek is used for the prevention and treatment of reversible airway obstruction in chronic obstructive bronchitis, bronchial asthma (including nocturnal attacks of bronchial asthma), pulmonary emphysema, and other diseases of the respiratory system, accompanied by bronchospasm.
Contraindications
Absolute:
- renal or hepatic impairment;
- pyloroduodenal narrowing;
- recent history of gastrointestinal bleeding;
- gastroesophageal reflux;
- exacerbation of peptic ulcer of the duodenum and stomach;
- pulmonary edema;
- chronic heart failure;
- acute myocardial infarction;
- cardiac ischemia;
- heart defects (including aortic stenosis);
- unstable angina;
- extrasystole;
- tachyarrhythmia;
- myocarditis;
- hemorrhagic stroke;
- severe arterial hypotension or hypertension;
- common vascular atherosclerosis;
- retinal hemorrhage;
- glaucoma;
- pheochromocytoma;
- thyrotoxicosis;
- sepsis;
- diabetes mellitus in the stage of decompensation;
- increased seizure activity;
- epilepsy;
- period of pregnancy and lactation;
- children and adolescents up to 16 years old;
- hypersensitivity to the main or auxiliary components, as well as xanthine derivatives - theobromine, caffeine and pentoxifylline.
Relative (Kombipek tablets are used with caution):
- history of peptic ulcer of the duodenum and stomach;
- prolonged hyperthermia;
- uncontrolled hypothyroidism (due to the risk of cumulation);
- hyperplasia of the prostate;
- elderly age.
Kombipek, instructions for use: method and dosage
Kombipek extended-release tablets are taken orally, after meals. They should not be chewed, crushed or dissolved in water, but should be swallowed whole with the required amount of water.
The recommended dose of Kombipek is 1 tablet twice a day. Maximum daily doses: theophylline - 12-14 mg / kg body weight (no more than 1200 mg), salbutamol - 32 mg.
The doctor determines the optimal dose of salbutamol and the duration of treatment. The following criteria are taken into account: the clinical picture of bronchial obstruction, the presence of concomitant diseases, the individual tolerance of the drug, the patient's body weight (treatment begins with the minimum dose) and the simultaneous administration of other drugs. On average, the duration of the course varies from 1 to 3 months. If Kombipek is effective and well tolerated, the therapeutic course may be prolonged.
Side effects
In patients taking Kombipek, the following side reactions from organs and systems may develop:
- digestive system: nausea, vomiting, gastralgia, dry mouth, feeling of heaviness in the stomach, heartburn, diarrhea, gastroesophageal reflux, exacerbation of peptic ulcer disease; with prolonged therapy - a deterioration in appetite;
- respiratory system: pulmonary edema, frequent shallow breathing;
- cardiovascular system: arrhythmia, tachycardia, decreased blood pressure, increased frequency of angina attacks, palpitations, extrasystole, sensation of blood rushes to the skin of the face, cardialgia, myocardial ischemia, collapse;
- central nervous system (CNS): headache, nervous tension, anxiety, dizziness, irritability, insomnia, convulsions, agitation, tremor;
- allergic reactions: itching, rash, Quincke's edema;
- laboratory tests: a decrease in the level of potassium in the blood, hyperglycemia, albuminuria, an increase in the concentration of free fatty acids in the blood, the appearance of blood in the urine;
- other reactions: increased sweating.
Side effects of Kombipek decrease with dose reduction or disappear on their own during the first 2-3 weeks of treatment.
Side effects of monopreparations (salbutamol and theophylline) in case of their overdose are described: urinary retention, allergic reactions (Quincke's edema, erythematous rash, urticaria), neuropsychiatric disorders (including tremor of the fingers, photophobia, psychomotor agitation, anxiety, convulsions, confusion …
The advantage of Combipek in comparison with taking monopreparations is the slow release of active substances, which, according to some indicators, have multidirectional effects (for example, salbutamol retains urine, and theophylline has diuretic properties), which significantly eliminates the unwanted side effects that are inherent in monopreparations.
Overdose
In case of an overdose of Kombipek, the following symptoms appear: bleeding from the gastrointestinal tract, nausea, gastralgia, vomiting (including blood), diarrhea, tachycardia, superficial rapid breathing, ventricular arrhythmias, insomnia, headache, anxiety, tremors, motor agitation, photophobia, facial redness, seizures and hallucinations. In the case of severe intoxication, epileptoid seizures may occur (especially in adolescents 16-18 years old), blood pressure decreases, renal failure develops with the appearance of myoglobin in the urine, metabolic acidosis, hypoxia, hypokalemia and hyperglycemia may occur, skeletal muscle necrosis, as well as confusion consciousness.
If you suspect poisoning, you must cancel Kombipek. The patient is washed the stomach, given activated charcoal and laxatives, prescribed forced diuresis, hemodialysis, plasma and hemosorption, washed the intestines with a combination of electrolytes and polyethylene glycol. With tachycardia, symptomatic therapy is carried out using cardioselective beta-blockers. If the patient has seizures, oxygen therapy is prescribed and the airway is maintained. Convulsions are stopped by intravenous administration of diazepam at a dose of 0.1–0.3 mg / kg (no more than 10 mg). In case of severe nausea and vomiting, use ondansetron or metoclopramide (intravenously).
special instructions
In smokers, theophylline may be less effective.
During treatment, care must be taken to consume large amounts of foods or drinks containing caffeine.
Kombipek is not used to relieve emergency conditions. When using prolonged forms, the concentration of theophylline in the blood should be monitored periodically.
Sustained-release drugs significantly reduce the likelihood of dose-dependent side effects.
Influence on the ability to drive vehicles and complex mechanisms
Considering the possible side effects from the nervous system (dizziness, tremors, convulsions, etc.), during the period of treatment with Kombipek, you should not drive vehicles and do other work that requires a high concentration of attention and a quick reaction.
Application during pregnancy and lactation
Kombipek tablets are contraindicated in pregnant and lactating women.
Pediatric use
Kombipek is not prescribed for children and adolescents under 16 years of age.
With impaired renal function
Kombipek is not used in renal failure.
For violations of liver function
Kombipek is contraindicated in patients with hepatic impairment.
Drug interactions
Theophylline-mediated drug interactions:
- enterosorbents and antidiarrheals: reduce the absorption of theophylline;
- drugs for general anesthesia, mineralocorticosteroids and glucocorticosteroids, as well as drugs that stimulate the central nervous system: theophylline increases the likelihood of adverse reactions, increases the risk of ventricular arrhythmias drugs for general anesthesia, increases the neurotoxicity of substances that excite the central nervous system;
- macrolide antibiotics, fluoroquinolones, allopurinol, isoprenaline, disulfiram, small doses of ethanol, methotrexate, propafenone, verapamil, lincomycin, cimetidine, enoxacin, recombinant interferon-alpha, thiabendazole, mexiletine, ticlopidine vaccine and reducing its dose);
- phenytoin, phenobarbital, rifampicin, carbamazepine, aminoglutethimide, isoniazid, moracizin, sulfinpyrazone, and oral estrogen-containing contraceptives: increase theophylline clearance (an increase in its dose may be required);
- beta-blockers and lithium preparations: theophylline reduces their effectiveness;
- diuretics and beta-adrenomimetics: theophylline enhances their effect.
Theophylline can be used concomitantly with antispasmodics. It is combined with caution with anticoagulants. Co-administration with other xanthine derivatives is not recommended.
Drug interactions due to salbutamol:
- nitrates and antihypertensive drugs: salbutamol reduces their effectiveness, increases the likelihood of glycoside intoxication;
- tricyclic antidepressants and monoamine oxidase inhibitors: enhance the effect of salbutamol (possibly a sharp drop in blood pressure);
- thyroid hormones: salbutamol enhances their cardiotropy;
- stimulants of the central nervous system: salbutamol increases the pharmacological effectiveness of drugs in this group;
- anticholinergics: may increase intraocular pressure;
- levodopa and drugs for inhalation anesthesia: when used concomitantly with salbutamol, they increase the risk of severe ventricular arrhythmias;
- xanthines: salbutamol increases the likelihood of tachyarrhythmias;
- glucocorticosteroids and diuretics: potentiate the hypokalemic effect of salbutamol.
Salbutamol should not be used concomitantly with non-selective beta-blockers.
Analogs
Kombipek's analogs are Atimos, Astalin, Vertasort, Clenbuterol, Oxis Turbuhaler, Salbutabs, Salamol Steri-Neb, Salbutamol, Salgim, Striverdi Respimat, Foradil, Cybutol Cyclocaps, etc.
Terms and conditions of storage
Keep out of the reach of children, protected from light and moisture, at a temperature not exceeding 25 ° C.
The shelf life is 5 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Kombipek
According to reviews, Kombipek is a fairly effective drug. It copes well with chronic obstructive bronchitis, coughing attacks in bronchial asthma and other types of coughs, especially those accompanied by spasms. The effect of the drug is mild, the cost is average.
At the same time, users note a large number of contraindications to the use of Kombipek and frequent side effects (headaches, irritability, insomnia, dizziness, loss of appetite, etc.). The drug should be taken with caution and only as directed by a doctor (with an individual dose selection).
Kombipek price in pharmacies
The price of Kombipek depends on the dosage of the tablets. So, the drug can be bought in pharmacies at the following prices:
- extended-release tablets 6 mg + 200 mg, 50 pcs. in the package - 320-340 rubles;
- prolonged release tablets 8 mg + 200 mg, 50 pcs. in the package - 370–500 rubles;
- extended-release tablets 10 mg + 200 mg, 50 pcs. in the package - 380-510 rubles.
Kombipek: prices in online pharmacies
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Drug name Price Pharmacy |
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Kombipek 6 mg + 200 mg prolonged release tablets 50 pcs. 320 RUB Buy |
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Kombipek 8 mg + 200 mg prolonged release tablets 50 pcs. 390 RUB Buy |
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!
