Sincumar
Sincumar: 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. In case of impaired renal function
- 11. For violations of liver function
- 12. Use in the elderly
- 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: Syncumar
ATX code: B01AA07
Active ingredient: acenocoumarol (acenocoumarol)
Manufacturer: Alkaloida Chemical Company Zrt. (Hungary)
Description and photo update: 2018-17-05
Syncumar is an indirect anticoagulant, vitamin K antagonist.
Release form and composition
Sincumar is produced in the form of tablets: white, round, flat, with beveled edges, odorless, on one side with the inscription SYNCU, on the other - with a dividing line; break surface - white (10 pcs. in a blister strip, 5 packs in a cardboard box).
1 tablet contains:
- active substance: acenocoumarol - 2 mg;
- additional components: magnesium stearate, gelatin, starch, lactose, talc.
Pharmacological properties
Pharmacodynamics
Acenocoumarol is an indirect anticoagulant, a dioxycoumarin derivative, an antagonist of vitamin K. The drug leads to a violation of the synthesis of blood coagulation factors - II (prothrombin), VII, IX and X. The maximum effect of the drug is observed 3-5 days after the start of administration as a result of the action plasma of previously synthesized active factors of the prothrombin complex. On the first day of therapy, lengthening of prothrombin time is achieved due to a decrease in factor VII activity, the half-life of which is 4-6 hours. In the future, a decrease in the activity of factors IX, X and prothrombin is consistently noted, the half-life of which is 20-24, 48-76 and 72-100 hours, respectively.
Pharmacokinetics
Acenocoumarol is well and rapidly absorbed from the gastrointestinal tract. After oral administration, the maximum concentration of the substance (C max) in plasma is reached after 3 hours. Plasma protein binding is approximately 98% of the dose of the drug entered the body. The substance is biotransformed in the liver, the half-life is approximately 8-9 hours. About 60% of the drug, mainly in the form of metabolites, is excreted in the urine, the remaining amount in the feces.
The level of acenocoumarol in the blood does not affect the degree of increase in the prothrombin index or an increase in prothrombin time.
Indications for use
- thrombophlebitis;
- thrombosis;
- thromboembolic complications occurring against the background of myocardial infarction;
- embolism of various organs (treatment / prevention);
- thromboembolic complications in the postoperative period (prevention).
Contraindications
- diseases occurring with reduced blood clotting (including hemorrhagic diathesis);
- hemorrhagic stroke (during the first 2 months);
- hypoprothrombinemia (below 70%);
- severe functional disorders of the liver;
- renal failure;
- malignant neoplasms;
- arterial hypertension;
- pericarditis;
- protracted endocarditis;
- aortic dissection;
- diabetic retinopathy;
- peptic ulcer and 12 duodenal ulcer, ulcerative colitis;
- bleeding from open wounds;
- hypovitaminosis K and C;
- postpartum eclampsia and preeclampsia;
- threatening miscarriage;
- pregnancy and lactation;
- physical exhaustion;
- hypersensitivity to any of their components of the drug.
It is contraindicated to use Syncumar immediately after surgical interventions in neurology, ophthalmology and dentistry, as well as within 4 days after organ biopsy, lumbar puncture or aortic puncture.
Instructions for the use of Sincumar: method and dosage
Syncumar is taken orally once a day at the same time.
The attending physician determines the dose individually, taking into account the indicators of blood coagulation. The recommended daily dose on the first day of the course is 6–8 mg, on the following days - 4 mg. Reception of Syncumar is carried out under the control of prothrombin time, the indicator of which should be limited to 2-3.5 seconds.
Side effects
During the period of treatment with Syncumar, the following undesirable effects may develop: headache, diarrhea, nausea, alopecia, allergic reactions (including skin rash, Quincke's edema), bleeding, hemorrhages on the mucous membranes and skin (according to the degree of reduction in the likelihood of their occurrence) - hematuria, bleeding from the gums, petechiae, post-traumatic hematoma, melena, metrorrhagia, hemarthrosis, hemorrhagic stroke.
It is extremely rare against the background of therapy that there may be necrosis of the subcutaneous tissue and skin, and the syndrome of purple feet. The latter occurs after several weeks of using the drug and manifests itself in the form of bluish hyperpigmentation of the feet, as well as pain in the area of the big toes and their hyperpigmentation. When the limb is lifted and the pressure is applied, the hyperpigmentation disappears. The development of this complication is presumably due to the presence of cholesterol microthrombi.
Skin necrosis caused by taking Syncumar initially manifests itself in the form of erythema or maculopapular rash that occurs on the buttocks, thighs, chest, in some cases on the face, upper limbs, genitals. When the first symptoms of this serious adverse reaction are detected, it is necessary to immediately stop taking acenocoumarol and begin therapy with vitamin K or heparin to prevent the development of complete necrosis.
With withdrawal, the risk of blood clots is exacerbated.
Overdose
A sign of an overdose of Syncumar is most often hemorrhagic diathesis, expressed in the form of bruising, menorrhagia, hematuria, prolonged bleeding from superficial wounds, bleeding of the gums, nosebleeds.
In the case of a sharp increase in prothrombin time and the occurrence of hemorrhagic syndrome, vitamin K (phytomenadione) is slowly injected intravenously at a dose of 5-10 mg, the effect usually occurs after 6-10 hours. With the development of life-threatening bleeding, an additional transfusion of fresh frozen plasma in a volume of 10-15 ml / kg or a prothrombin complex concentrate containing blood coagulation factor VII is prescribed.
special instructions
During the period of therapy, it is necessary to monitor the concentration of prothrombin in the blood and indicators of the prothrombin index (prothrombin time should be no more than 4), as well as the presence of erythrocytes in the urine. The patient should take into account the likelihood of the risk of bleeding and bleeding while taking the drug and must agree with the attending physician the appointment of other drugs.
Patients with heart failure should regularly carry out laboratory monitoring of anticoagulant therapy and, if necessary, reduce the dose of Syncumar.
During treatment, intramuscular injections should be avoided. If these injections are urgently needed, they should be performed in the upper limb area, because there possible bleeding is diagnosed more quickly and it is easier to stop them with a pressure bandage.
2-3 days before tooth extraction or planned surgery, you should refuse to take the drug, since the value of the prothrombin time should be below 1.5. To achieve this within 24 hours, in case of urgent surgical intervention, intravenous administration of 5-10 mg of vitamin K may be required.
During the period of use of Syncumar, the general condition of the patient and changes in the hemocoagulation system should be carefully monitored. Treatment with the drug should be discontinued if bleeding or bleeding develops.
Against the background of hyperlipidemia, hypothyroidism, edema, nephrotic syndrome, increased intake of vitamin K with food, the need for acenocoumarol increases.
In the presence of a syndrome of impaired absorption, diarrhea, fever, hyperthyroidism, hypoalbuminemia caused by liver and / or kidney disease, circulatory insufficiency, accompanied by congestion, as well as fasting, the need for acenocoumarol decreases.
If hemorrhagic manifestations are absent with a significant increase in prothrombin time, it is recommended to refrain from using acenocoumarol with daily monitoring of this indicator. In this case, the intake of tabletted vitamin K in a dose of 2.5–5 mg may be prescribed.
Application during pregnancy and lactation
During pregnancy and lactation, the use of Syncumar is contraindicated.
With impaired renal function
Syncumar is contraindicated in patients with renal insufficiency.
For violations of liver function
According to the instructions, Syncumar is contraindicated in patients with severe functional liver disorders.
Use in the elderly
Elderly people, especially in the presence of severe atherosclerosis, require frequent laboratory monitoring of therapy. If necessary, patients in this age group may require dose adjustment.
Drug interactions
Interaction reactions that are possible with the combined use of Sinumar with other drugs:
- antihistamines, carbamazepine, haloperidol, griseofulvin, phenytoin, chlordiazepoxide, barbiturates, oral contraceptives, aminoglutethimide, ascorbic acid, sucralfate, rifampicin, mercaptopurine, meprobamate, colestipolum effect, sodium (ameprobamate), colestipolum;
- amiodarone, allopurinol, azapropazone, fenofibrate, disulfiram, dextrothyroxine, cimetidine, chlorpromazine, chloral hydrate, quinidine sulfate, tetracyclines, fluoroquinolones, quinolones, penicillins (intravenous in high doses), macrolides, sodium aminoglycosin, mefenamic acid, ethacrynic acid, acetylsalicylic acid, clofibrate, MAO inhibitors, indomethacin, ibuprofen, glucagon, phenylbutazone, sulfinpyrazone, anabolic hormones, salicylates, propafenone, pentoxifylline, naproxen, methyldioxide, myconopazoxol inhalation anesthesia: the effect of acenocoumarol is enhanced;
- diuretics (including furosemide), ethanol, ranitidine: the effect of acenocoumarol can be both enhanced and weakened;
- antiepileptic drugs (phenobarbital, phenytoin), sulfonylurea derivatives (tolbutamide, chlorpropamide): the effect of these drugs is enhanced;
- nonsteroidal anti-inflammatory drugs: the antithrombotic effect of acenocoumarol increases (if necessary, paracetamol is recommended as a pain reliever during treatment).
The effect of Sincumar decreases after eating a diet high in vitamin K (soybeans, green peas, cauliflower, broccoli, spinach, lettuce, cabbage, liver).
When using a drug with an unexplained effect on acenocoumarol or interacting with it, the prothrombin time should be often monitored to select an individual dose.
Analogs
The drug has no analogues for the active substance. In terms of pharmacological action, the analogues of Sincumar are Fenilin-Zdorovye, Warfarin-FS, Warfarin Orion, Warfarin Nycomed, Warfarex, etc.
Terms and conditions of storage
Store at temperatures up to 30 ° C and humidity below 70%, out of the reach of children.
The shelf life is 5 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Sincumar
The few reviews about Syncumar are mostly positive. Patients who took the drug note its effectiveness in the treatment and prevention of thrombosis and thrombophlebitis.
The disadvantages of the drug include the development of dizziness, nausea and vomiting, which occur at the beginning of the intake and then pass in most cases on their own.
The price of Sincumar in pharmacies
The price of Syncumar can be in the range of about 460-580 rubles per pack containing 50 tablets.
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!
