Rocefin
Rocefin: 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: Rocephin
ATX code: J01DD04
Active ingredient: ceftriaxone (ceftriaxone)
Manufacturer: F. Hoffmann-La Roche, Ltd. (Switzerland)
Description and photo update: 2019-09-09
Prices in pharmacies: from 499 rubles.
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Rocefin is a bactericidal drug for parenteral use from the group of III generation cephalosporins, a wide spectrum of long-acting action against gram-positive and gram-negative microorganisms.
Release form and composition
Rocefin's dosage form is a powder: from white to yellowish-orange color, from which they are prepared:
- solution for intramuscular (i / m) administration: 0.25 g, 0.5 g or 1 g of powder in glass vials of hydrolytic class 1 EF, sealed with a butyl rubber stopper, crimped with an aluminum cap, closed with a plastic lid, complete with a hermetically sealed ampoule 1% lidocaine solution: 2 ml - for Rocefin 0.25 g and 0.5 g or 3.5 ml for Rocefin 1 g; the solvent ampoule is equipped with a blue dot, two green and blue rings are applied on the tip; in a cardboard box 1 set;
- solution for intravenous (IV) administration: 0.25 g, 0.5 g or 1 g of powder in glass vials of hydrolytic class 1 EF, sealed with a butyl rubber stopper, crimped with an aluminum cap, closed with a plastic lid, complete with a hermetically sealed ampoule with water for injection: 5 ml - for Rocefin 0.25 g and 0.5 g or 10 ml for Rocefin 1 g; the solvent ampoule is equipped with a blue dot; in a cardboard box 1 set;
- solution for infusion: 2 g of powder in glass vials of hydrolytic class 1 EF, sealed with a butyl rubber stopper, crimped with an aluminum cap, closed with a plastic lid; in a cardboard box 1 bottle;
- solution for i / v and i / m administration: 1 g of powder in glass vials of hydrolytic class 1 EF, sealed with a butyl rubber stopper, crimped with an aluminum cap, closed with a plastic lid; in a cardboard box 1 bottle; 143 bottles in a cardboard box (for hospitals).
Each pack also contains instructions for the use of Rocefin.
1 set for preparation of solution for intramuscular injection contains:
- active substance (1 bottle of powder): ceftriaxone - 0.25 g, 0.5 g or 1 g (in the form of ceftriaxone disodium salt 0.2983 g, 0.5965 g or 1.193 g);
- solvent: lidocaine solution 1%.
1 set for preparation of solution for intravenous administration contains:
- active substance (1 bottle of powder): ceftriaxone - 0.25 g, 0.5 g or 1 g (in the form of ceftriaxone disodium salt 0.2983 g, 0.5965 g or 1.193 g);
- solvent: water for injection.
1 vial of powder for the preparation of a solution for infusion contains the active ingredient: ceftriaxone - 2 g (in the form of ceftriaxone disodium salt 2.386 g).
1 bottle of powder for preparation of a solution for i / v and i / m administration contains the active ingredient: ceftriaxone - 1 g (in the form of ceftriaxone disodium salt 1.193 g).
Pharmacological properties
Pharmacodynamics
Ceftriaxone is an antibiotic of the III generation cephalosporin group for parenteral use. It is characterized by long-term action. The bactericidal activity is based on the suppression of the synthesis of cell membranes.
The substance has a wide range of effects in relation to gram-negative / gram-positive microorganisms. It is noted for its high resistance to most β-lactamases (penicillinases and cephalosporinases), which are produced by gram-positive / gram-negative bacteria.
Gram-positive aerobes
Rocefin is active: Streptococcus pneumoniae, Streptococcus viridans, Streptococcus agalactiae (β-hemolytic, group B), coagulase-negative staphylococci, Staphylococcus aureus (methicillin-susceptible strains), Streptococcus pyogenes, groups A-hemolytic nor B).
The exception is methicillin-resistant Staphylococcus spp., Which are resistant to cephalosporins, including ceftriaxone. Enterococcus faecalis, Listeria monocytogenes, and Enterococcus faecium are generally also resistant.
Gram-negative aerobes
Rocephin is active: Plesiomonas shigelloides, Alcaligenes odorans, Proteus mirabilis, Neisseria gonorrhoeae, Neisseria meningitidis, Pasteurella multocida, Haemophilus ducreyi, Haemophilus parainfluenzae, Haemophilus influenzae, Hafnia alvei, Klebsiella oxytoca, Capnocytophaga spp, Acinetobacter lwoffii, Borrelia burgdorferi, Aeromonas hydrophila, Alcaligenes. faecalis, Acinetobacter anitratus (mainly A. baumannii) *, alkaligenic bacteria, Citrobacter diversus (including C. amalonaticus), Citrobacter freundii *, Escherichia coli, Enterobacter spp. * (including Enterobacter aerogenes *, Enterobacterle cloacae *) **, Moraxella spp. (including Moraxella osloensis, Moraxella catarrhalis), Morganella morganii, Proteus penneri *, Proteus vulgaris *, Pseudomonas spp. (including Pseudomonas fluorescens *), Providencia spp.(including Providencia rettgeri *), Shigella spp., Salmonella spp. (including Salmonella typhi), Serratia spp. * (including Serratia marcescens *), Yersinia spp. (including Yersinia enterocolitica), Vibrio spp.
* Some of the isolates of these species show resistance to ceftriaxone, which is mainly associated with the formation of β-lactamases, which are encoded by chromosomes.
** Some of the isolates of these species show resistance due to the formation of a number of plasmid-mediated β-lactamases.
Many of the strains of the above microorganisms are multiresistant to other antibiotics (aminopenicillins, ureidopenicillins, first and second generation cephalosporins and aminoglycosides) and are susceptible to ceftriaxone. Experiments have shown that Treponema pallidum is sensitive to ceftriaxone. In clinical trials, ceftriaxone is highly effective against primary and secondary syphilis. Clinical isolates of P. aeruginosa are resistant to ceftriaxone with very few exceptions.
Anaerobes
Rocefin active: Clostridium spp. (except C. difficile), Peptostreptococcus spp., Fusobacterium spp. (including Fusobacterium nucleatum), Gaffkia anaerobica (formerly called Peptococcus), Bacteroides spp. (bile sensitive) *.
* Some of the isolates of these species are resistant to ceftriaxone, which is associated with the formation of β-lactamases.
Many strains of β-lactamase-forming Bacteroides spp. Are resistant to ceftriaxone. (in particular B. fragilis), as well as Clostridium difficile.
Pharmacokinetics
The pharmacokinetic processes of ceftriaxone are non-linear. All basic parameters depend on the dose, which are based on the total concentrations of the substance, except for T 1/2 (half-life).
After a single intramuscular injection of Rocefin at a dose of 1 g, C max (maximum concentration) of ceftriaxone in plasma is approximately 81 mg / l, the time to reach it is 2-3 hours. After intravenous and intramuscular administration, the AUC value (area under the concentration-time curve) is the same. Thus, the bioavailability of ceftriaxone after i / m administration is 100%.
The V d (volume of distribution) of ceftriaxone ranges from 7 to 12 liters. After 1–2 g injection, the substance penetrates well into body fluids and tissues. For more than 24 hours, its concentrations are much higher than the minimum inhibitory concentrations for most infectious agents in more than 60 fluids and tissues, including the lungs, heart, biliary tract, liver, tonsils, middle ear, nasal mucosa, bones, and prostate secretions and cerebrospinal, pleural and synovial fluids. Ceftriaxone, after intravenous administration, quickly penetrates into the cerebrospinal fluid, where bactericidal concentrations are observed in relation to sensitive microorganisms for 24 hours.
During the use of ceftriaxone, its reversible binding to albumin occurs, while the degree of binding decreases with increasing concentration, decreasing, in particular, from 95% at a plasma concentration of less than 100 mg / l to 85% at a concentration of 300 mg / l. Due to the lower concentration of albumin in the interstitial fluid, the fraction of free ceftriaxone in it exceeds the plasma one.
In children, including newborns, the penetration of ceftriaxone through the inflamed meninges is noted. 24 hours after intravenous administration at a dose of 50 mg / kg and 100 mg / kg of body weight (for newborns and infants, respectively), the concentration of the substance in the cerebrospinal fluid is higher than 1.4 mg / l. C max in cerebrospinal fluid averages 18 mg / l, the time to reach it is approximately 4 hours after intravenous administration. The average concentration of ceftriaxone in the cerebrospinal fluid with bacterial meningitis is 17% of the plasma concentration, with aseptic meningitis - 4%. In 2-24 hours after administration of 50 mg / kg in adult patients with meningitis, the concentration of ceftriaxone in the cerebrospinal fluid is many times higher than the minimum inhibitory concentrations for the most common pathogens of meningitis.
Penetration of ceftriaxone through the placental barrier is noted; in small concentrations, the substance is excreted in breast milk.
Ceftriaxone does not undergo systemic metabolism; under the influence of the intestinal flora, it turns into inactive metabolites.
The total plasma clearance of ceftriaxone is 10 to 22 ml / min. Renal clearance is 5–12 ml / min. 50-60% of ceftriaxone is excreted unchanged in the urine, 40-50% in the bile. In adults, T 1/2 is approximately 8 hours.
In newborns, approximately 70% of the dose is excreted in the urine. In children, in the first 8 days of life, T 1/2 is 2 or 3 times higher than in adults. Also, in patients over 75 years old, the T 1/2 is 2-3 times higher than in younger patients.
In case of impaired renal or hepatic function, the pharmacokinetic parameters of ceftriaxone change slightly, usually only a slight increase in T 1/2 is observed. If only the renal function is impaired, the excretion of the substance in the bile increases, if only the hepatic function is impaired, the excretion in the urine increases.
Indications for use
Rocefin is used to treat the following infectious lesions caused by pathogens sensitive to ceftriaxone:
- tick-borne borreliosis (Lyme disease) in the stage of disseminated infection;
- infections of the gastrointestinal tract and biliary tract, peritonitis, other infections of the abdominal organs;
- infections of the skin, joints, bones, soft tissues, as well as wound lesions;
- infectious diseases in immunocompromised patients;
- urinary tract and kidney infections;
- pneumonia, infections of ENT organs, other respiratory tract lesions;
- genital infections, including gonorrhea;
- meningitis;
- sepsis.
Also, the antibiotic Rocefin is used for perioperative prevention of infections.
Contraindications
Rocefin is contraindicated in case of hypersensitivity to cephalosporins, including ceftriaxone, as well as to any other component of the solution.
Rocefin should not be used if there is a history of severe hypersensitivity reactions (for example, anaphylactic) to other 5-lactam antibiotics, such as penicillins, carbapenems and monobactams.
With caution, due to the increased risk of complications, it is recommended to use Rocefin during breastfeeding (lactation), with hyperbilirubinemia in newborns, especially in premature infants, and also in case of hypersensitivity to penicillins.
Rocefin, instructions for use: method and dosage
Rocefin solution is administered intramuscularly or intravenously.
The recommended dosage regimen for adults and children over 12 years old, weighing more than 50 kg, is 1-2 g once a day with an interval of 24 hours. In the case of severe infections or infections caused by pathogens moderately sensitive to ceftriaxone, the daily dose may be increased to 4 g. The duration of the course of therapy depends on the clinical course of the disease. However, the introduction of the drug Rocefin should be continued for at least 2-3 days after confirming the eradication of the pathogen and normalizing the temperature, as always with antibiotic therapy.
The standard course is 4-14 days, but with complicated infections, a longer treatment may be required at the discretion of the attending physician.
Infections caused by Streptococcus pyogenes require a course of therapy for at least 10 days.
General rules for using solutions: the drug is administered immediately after preparation. The chemical and physical stability of the prepared solutions is maintained at room temperature - for 6 hours, at a temperature of 2-8 ° C (in the refrigerator) - for 24 hours. The color of the solutions can vary, depending on the duration of storage and concentration, from amber yellow to pale yellow. In this case, the color does not affect the tolerability of Rocefin or its effectiveness.
Methods for the preparation and use of Rocefin solution:
- i / m injection: 0.25 g or 0.5 g of Rocefin is dissolved in 2 ml, 1 g - in 3.5 ml of 1% lidocaine solution; the prepared solution is injected deep into a sufficiently large muscle (gluteus); it is recommended to inject no more than 1 g into the same muscle; it is impossible to inject a solution containing lidocaine intravenously;
- IV injection: 0.25 g or 0.5 g of Rocefin is dissolved in 5 ml, 1 g - in 10 ml of sterile water for injection; injected slowly, preferably into large veins, over 5 minutes;
- IV infusion: 2 g of Rocefin is diluted in 40 ml of one of the following calcium ion-free infusion solutions: water for injection, 0.45% sodium chloride solution with 2.5% dextrose solution, 0.9% sodium chloride solution, 6-10% hydroxyethyl starch solution, 5% or 10% dextrose solution, 6% dextran solution in 5% dextrose solution; Do not mix or add Rocefin to solutions containing other antimicrobial drugs or other solvents, except for those listed above, due to possible incompatibility; infusion should last at least half an hour.
For the preparation of solutions of the drug Rocefin for intravenous administration and their dilution in the future, it is impossible to use solvents containing calcium (Hartman's or Ringer's solution, for example) due to the likelihood of precipitates of calcium salts of ceftriaxone, which is also possible when mixing Rocefin and calcium-containing solutions in the case of using one venous access.
You can also not use Rocefin simultaneously with calcium-containing solutions for intravenous administration, including prolonged infusion of calcium-containing drugs, during parenteral nutrition, for example, using the Y-connector. At the same time, for all groups of patients, except for newborns, sequential administration of Rocefin and calcium-containing solutions is allowed after thorough rinsing of the infusion systems with a compatible fluid between infusions.
There is no data on the interaction of oral calcium-containing drugs and ceftriaxone, as well as ceftriaxone for intramuscular administration and preparations containing calcium for intravenous or oral administration.
When prescribing Rocefin once a day, children from the neonatal period to 12 years of age are recommended to observe the following dosage regimen:
- from birth to 14 days: 0.02-0.05 g / kg of body weight, but not more than 0.05 g / kg;
- 15 days-12 years: 0.02-0.08 g / kg body weight;
- up to 12 years, but with a mass of more than 50 kg: use the dosage regimen for adults.
The use of ceftriaxone is contraindicated in premature babies up to 41 weeks inclusive (total chronological and gestational age). Rocefin is contraindicated in newborns younger than 28 days who are already undergoing or are expected to undergo intravenous therapy with calcium-containing solutions, including prolonged calcium-containing infusions, for example, with parenteral nutrition, due to the risk of precipitating calcium salts of ceftriaxone.
Doses in / in 0.05 g / kg or higher for infants and children under 12 years of age are administered by drip for at least half an hour. IV infusion in newborns is carried out for an hour (to reduce the potential risk of developing bilirubin encephalopathy).
Recommended courses of therapy depending on the disease:
- bacterial meningitis in children (infants and young children): therapy begins with a dose of 0.1 g / kg (maximum up to 4 g) once a day; after identification of the pathogen, as well as determining its sensitivity, it is recommended to reduce the dose accordingly. The best results were achieved with the duration of therapy for meningococcal meningitis - 4 days, meningitis caused by Haemophilus influenzae - 6 days, meningitis caused by Streptococcus pneumoniae - 7 days;
- tick-borne borreliosis (Lyme disease): 0.05 g / kg (maximum - up to 2 g) 1 time per day, for adults and children, the course of therapy is 14 days;
- gonorrhea (caused by strains of microorganisms penicillinase-forming and penicillinase-forming): a single intramuscular injection of Rocefin at a dose of 0.25 g for adults and children over 12 years old, weighing more than 50 kg;
- acute otitis media: a single intramuscular injection in the following doses: children - 0.05 g / kg (maximum - up to 1 g), adults - 1-2 g; in the case of severe infection or with the ineffectiveness of previous therapy (according to limited data), Rocefin can also be effective with the intramuscular administration of a daily dose of 1-2 g for 3 days;
- perioperative prophylaxis: a single dose of 1 to 2 g of ceftriaxone (depending on the degree of infectious risk) 30-90 minutes before the start of the surgery; for surgery on the colon and rectum, Rocefin and one of the 5-nitroimidazoles, for example, ornidazole, are administered simultaneously, but separately.
In old and senile age, dose adjustment of Rocefin is not required, provided that there are no severe renal and / or liver dysfunctions.
Side effects
The following adverse reactions were most often recorded in clinical studies during therapy with ceftriaxone: leukopenia, eosinophilia, thrombocytopenia, rash, increased activity of liver enzymes, diarrhea.
Description of the frequency of adverse reactions in accordance with the classes of organs and systems, using the following classification:> 1/10 - very often,> 1 / 100-1 / 1000-1 / 10,000- <1/1000 - rarely, <1/10 000, including isolated cases - very rare:
- infections and invasions: infrequently - fungal infections of the genital organs; rarely - pseudomembranous colitis;
- blood and lymphatic system: often - leukopenia, thrombocytopenia, eosinophilia; infrequently - anemia, coagulopathy, granulocytopenia;
- nervous system: infrequently - dizziness, headache;
- respiratory system, chest and mediastinal organs: rarely - bronchospasm;
- gastrointestinal tract: often - loose stools, diarrhea; infrequently - nausea, vomiting;
- hepatobiliary system: often - increased activity of liver enzymes (aspartate aminotransferase (ACT), alanine aminotransferase (ALT), alkaline phosphatase (ALP));
- skin and subcutaneous tissue: often - rash; infrequently - itching; rarely - urticaria;
- kidneys and urinary tract: rarely - glucosuria, hematuria;
- general disorders and disorders at the injection site: infrequently - pain at the injection site, phlebitis, fever; rarely - chills, swelling;
- results of instrumental and laboratory studies: infrequently - an increase in the level of creatinine in the blood.
Side effects observed with the use of Rocefin in the post-registration period (determining their relationship with the use of the drug, as well as the frequency of occurrence is not always possible):
- gastrointestinal tract: stomatitis, glossitis, pancreatitis, taste disturbance;
- blood system and lymphatic system: an increase in prothrombin and thromboplastin time, thrombocytosis, a decrease in prothrombin time, hemolytic anemia (isolated episodes of agranulocytosis (<500 cells / μL) have been recorded, in most cases developing 10 days after the start of treatment with a cumulative dose of 20 g and more);
- immune system: hypersensitivity reactions, anaphylactic shock;
- skin and subcutaneous tissue: acute generalized exanthematous pustulosis; isolated cases of severe adverse reactions, such as Stevens-Johnson syndrome, exudative erythema multiforme, Lyell's syndrome (toxic epidermal necrolysis);
- nervous system: convulsions;
- organ of hearing and labyrinthine disorders: vertigo;
- infections and infestations: superinfections.
Overdose
The main symptoms are nausea, diarrhea, vomiting.
Therapy: symptomatic. Peritoneal dialysis and hemodialysis are ineffective. There is no specific antidote.
special instructions
The use of Rocefin, like other cephalosporins, even with a detailed history taking does not exclude the possibility of anaphylactic shock. In patients with hypersensitivity to penicillin, cross-allergic reactions are also possible.
The use of cephalosporin, like other antibiotics, can lead to the development of superinfection.
No dose adjustment of ceftriaxone is required in patients with hepatic impairment unless renal impairment is present.
In case of impaired renal function, there is no need to reduce the dose of Rocefin, provided the liver is functioning normally. Only in the case of renal failure with creatinine clearance (CC) less than 10 ml / min, the daily dose of Rocefin should not exceed 2 g. Ceftriaxone is not excreted during hemodialysis or peritoneal dialysis, therefore the patient does not need an additional dose of the drug at the end of dialysis.
In the case of a combination of severe renal and hepatic impairment, careful monitoring of the effectiveness and safety of the antibiotic is required.
Rare episodes of changes in prothrombin time in patients receiving Rocefin are described. Therefore, in case of diagnosed vitamin K deficiency due to a violation of its synthesis in the body or nutritional problems, it may be necessary to control prothrombin time during therapy and an additional prescription of vitamin K in an amount of 10 mg per week before or during treatment (in case of an increase in prothrombin time).
After using ceftriaxone in doses exceeding the standard recommended, ultrasound examination of the gallbladder revealed shadows, which are precipitates of the calcium salt of ceftriaxone, mistaken for stones. They disappear mainly after completion of the course or upon discontinuation of therapy. In rare cases, such changes give any symptomatology, but even then only conservative therapy is recommended. If the formation of precipitates of the calcium salt of ceftriaxone is accompanied by clinical symptoms, then the decision to discontinue therapy is made by the attending physician.
Rare episodes of pancreatitis, possibly resulting from obstruction of the biliary tract, during therapy with Rocefin are described. But in most of these patients, risk factors for bile stagnation were previously noted, for example, due to previous therapy of serious diseases or completely parenteral nutrition. At the same time, a triggering role in the development of pancreatitis of precipitates formed in the biliary tract under the influence of Rocefin cannot be ruled out.
Long-term therapy with cephalosporin requires regular monitoring of the blood count.
Occasionally, patients may experience false positive results: Coombs' tests, tests for galactosemia, determination of glucose in urine. During Rocefin therapy, it is recommended to determine glucosuria, if necessary, only by the enzymatic method.
Influence on the ability to drive vehicles and complex mechanisms
There is no information confirming or refuting the effect of Rocefin on the ability to drive vehicles. However, due to the likelihood of dizziness and other undesirable symptoms that may affect the reaction rate and attention, patients are advised to be careful when driving vehicles and complex mechanisms.
Application during pregnancy and lactation
In pregnant women, the safety of Rocefin therapy has not been established. Ceftriaxone crosses the placental barrier. During pregnancy, especially in the first trimester, the drug should be prescribed only under strict indications, provided that the expected benefit to the mother exceeds the potential risk to the fetus.
When conducting preclinical experimental studies of reproductiveness, embryotoxic, fetotoxic, teratogenic effects or other adverse effects of Rocefin on the fertility of females and males, the process of childbirth, perinatal / postnatal development of the fetus were not identified.
Ceftriaxone in low concentrations is excreted in breast milk. Care must be taken when prescribing it during breastfeeding.
Pediatric use
In newborns (especially premature infants) with hyperbilirubinemia, Rocefin should be used with caution.
Drug interactions
- potent diuretics (furosemide) - the simultaneous use of Rocefin in high doses did not cause renal dysfunction;
- aminoglycosides - there is no evidence that cephalosporin increases their nephrotoxicity;
- ethanol - combined use with Rocephin does not cause a disulfiram-like reaction, since ceftriaxone does not contain the N-methylthiotetrazole group inherent in some other cephalosporins, which can cause alcohol intolerance and bleeding;
- probenecid - does not affect the excretion of Rocefin;
- bacteriostatic antibiotics - reduce the bactericidal effect of the drug;
- chloramphenicol - according to the results of in vitro studies, its antagonism with ceftriaxone was found;
- infusion solutions containing calcium (Hartman's or Ringer's solution) - cannot be mixed with Rocefin;
- amsacrine, vancomycin, fluconazole, aminoglycosides - ceftriaxone should not be mixed with these substances / drugs due to incompatibility.
Analogs
Rocefin's analogs are: Azaran, Betasporin, Axone, Biotraxon, Lendacin, Lifaxon, Ificef, Longacef, Loraxon, Medaxon, Movigip, Megion, Oframax, Tercef, Torocef, Ceftriaxon Elfa, Stericef, Kabaxon Ceftriaxon, Tsseftriaxone, Forcef, Cefatrin, Cefogram, Ceftriabol, Cefson, Ceftriaxone, Ceftriaxone-Darnitsa.
Terms and conditions of storage
Store in a dark place at temperatures up to 30 ° C. Keep out of the reach of children.
The shelf life is 3 years.
The finished solution is stored at room temperature - up to 6 hours, at a temperature of 2-8 ° C (in the refrigerator) - up to 24 hours.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Rocefin
Reviews about Rocefin are mostly positive. The drug is characterized as highly effective, and most often it has good tolerance. The cost is assessed as high.
Price for Rocefin in pharmacies
The approximate price of Rocefin (powder for solution preparation, in a bottle of 1 g) is: for intramuscular injection - 482-524 rubles, for intravenous and intramuscular administration - 506-519 rubles, for intravenous administration - 489-519 rubles.
Rocefin: prices in online pharmacies
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Drug name Price Pharmacy |
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Rocefin 1 g powder for preparation of solution for intramuscular administration complete with solvent 3.5 ml 1 pc. RUB 499 Buy |
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Rocefin 1 g powder for preparation of solution for intravenous administration complete with solvent 10 ml 1 pc. RUB 499 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!
