PegIntron
PegIntron: 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. Drug interactions
- 13. Analogs
- 14. Terms and conditions of storage
- 15. Terms of dispensing from pharmacies
- 16. Reviews
- 17. Price in pharmacies
Latin name: PegIntron
ATX code: L03AB10
Active ingredient: Peginterferon alfa-2b (Peginterferon alfa-2b)
Producer: Schering-Plow Brinny Company (Ireland)
Description and photo update: 02.10.2019
PegIntron is an antiviral, immunostimulating, immunomodulatory drug of peginterferon alfa-2b.
Release form and composition
Dosage form PegIntron - lyophilisate for the preparation of a solution for subcutaneous (s / c) administration: almost white or white powder without impurities, complete with a solvent: water for injection - a transparent colorless liquid that does not contain visible particles (0.05; 0, 08; 0.10 or 0.12 mg in glass vials with a volume of 2 ml, complete with 0.7 ml of solvent in an ampoule with a volume of 2 ml, 1 set per package; 0.05; 0.08; 0.10 each; 0.12 or 0.15 mg with 0.7 ml of solvent in two-chamber syringe pens, complete with a needle for subcutaneous injections and 2 napkins for treating the skin and membrane of the syringe pen at the injection site, 1 set per package).
An excess amount of solvent is necessary to compensate for losses during the dissolution of the lyophilisate and during the introduction of the finished solution.
The active substance is peginterferon alfa-2b:
- Bottle: in 0.5 ml of the finished solution - 0.05; 0.08; 0.10 or 0.12 mg;
- Syringe pen: in 0.5 ml of the finished solution - 0.05; 0.08; 0.10; 0.12 or 0.15 mg.
Auxiliary components: sodium dihydrogen phosphate, sodium hydrogen phosphate, polysorbate 80, sucrose.
Pharmacological properties
Pharmacodynamics
Recombinant interferon alpha-2b is isolated from an Escherichia coli clone containing a plasmid fusion that encodes interferon alpha-2b of human leukocytes. In vivo and in vitro studies, it has been shown that the biological activity of the drug is due to interferon alpha-2b. Interferons bind to specific receptors located on the cell surface. In studies of other interferons, their species-specificity has been demonstrated, which, however, is not always manifested. For example, some species of monkeys (rhesus monkeys) are sensitive to human type 1 interferons. Interferon binds to the cell membrane and initiates a number of intracellular reactions, including the process of starting the synthesis of certain enzymes. This process is thought to cause various cellular effects of interferons,including deceleration of cell proliferation, suppression of viral reproduction in infected cells, as well as enhancement of specific cytotoxicity of lymphocytes and phagocytic activity of lymphocytes. Any of the listed effects can mediate the therapeutic effect of interferon.
Recombinant interferon alpha-2b also suppressed viral replication in vivo and in vitro experiments. Despite the fact that the exact mechanism of action of interferon is not known, it is believed that it alters the metabolism of cells in the body, which leads to suppression of viral reproduction. If replication does occur, then the newly formed virions cannot leave the cell.
Pharmacodynamics of the drug in increasing doses was studied with a single use of PegIntron in healthy volunteers. The following parameters were assessed: changes in temperature in the oral cavity, the number of neutrophils and leukocytes, as well as the concentration of 2'5'-oligoadenylate synthetase and serum neopterin. In persons receiving the drug, there was a slight increase in body temperature, depending on the dose. A single injection of PegIntron at a dose of 0.25–2 μg / kg of body weight per week resulted in a dose-dependent increase in serum neopterin concentration. The decrease in the number of leukocytes and neutrophils by the end of the fourth week was correlated with the dose of the drug.
Pharmacokinetics
PegIntron is a derivative of interferon alpha-2b, combined with polyethylene glycol (pegylated interferon alpha-2b), and consists mainly of mono-pegylated molecules. The half-life (T 1/2) of the drug exceeds the half-life of non-pegylated interferon alpha-2b. When PegIntron is de-pegylated, interferon alpha-2b is released. The bioactivity of the drug is qualitatively similar to the biological activity of free interferon alpha-2b, but is weaker.
After subcutaneous administration, the maximum serum concentration is reached after 15–44 hours and persists for 48–72 hours. The total (AUC) and maximum (C max) concentrations of PegIntron increase in proportion to the administered dose. The apparent volume of distribution of the drug is about 0.99 L / kg. With repeated administration, the accumulation of immunoreactive interferons occurs, but the biological activity of the drug changes slightly. The half-life of PegIntron ranges from 27-33 hours, the apparent clearance is 22 ml / h / kg. There is no complete description of the mechanisms of clearance of interferons, however, it has been established that the proportion of renal clearance of PegIntron is approximately 30% of the total clearance.
With a single administration of the drug at a dose of 1 μg / kg in patients with impaired renal function, T 1/2, AUC and C max increased in proportion to the degree of existing renal failure. When used for one month (1 injection per week), there was a decrease in drug clearance by 17% in patients with moderate renal failure (with creatinine clearance of 30–49 ml / min) and by 44% in patients with severe renal failure (with creatinine clearance 10–29 ml / min). At the same time, creatinine clearance was the same in patients on hemodialysis and in patients without hemodialysis. When conducting monotherapy, a dose reduction of the drug is required in patients with moderate and severe renal insufficiency.
The pharmacokinetics of PegIntron in children and adolescents under 18 years of age and in patients with impaired liver function have not been specifically studied.
With a single subcutaneous injection at a dose of 1 μg / kg, the pharmacokinetics of the drug did not depend on age, therefore, PegIntron is prescribed for elderly patients in the same doses as for younger patients.
In clinical studies, neutralizing antibodies to interferon, which suppress the antiviral activity of PegIntron, were analyzed. The frequency of their detection in patients receiving the drug at a dose of 0.5 mg / kg was about 1.1%.
Indications for use
PegIntron is used for the treatment of chronic hepatitis B and C in patients over 18 years of age, in the absence of liver disease in the stage of decompensation.
In medical practice, it is considered optimal to treat chronic hepatitis C with a combination of ribavirin with interferon alfa-2b preparations, including peginterferon alfa-2b. With this combination therapy, the recommendations for the use of ribavirin should also be followed.
Contraindications
- History of autoimmune disease, incl. autoimmune hepatitis;
- A history of severe mental illness or severe mental disorders, incl. suicidal thoughts or attempts and severe depression;
- Severe diseases of the cardiovascular system, unstable or uncontrollable during the previous six months;
- Dysfunction of the thyroid gland, in which it is not possible to normalize its work with the help of drug therapy;
- Renal dysfunction with creatinine clearance (CC) ≤50 ml / min (for use in combination with ribavirin);
- Liver disease in the stage of decompensation;
- Epilepsy, dysfunction of the central nervous system (CNS);
- Pregnancy, including that of a woman, whose male partner is to be combined therapy with PegIntron with ribavirin;
- Breastfeeding (lactation) period;
- Children and adolescents up to 18 years of age (due to lack of experience in use);
- Hypersensitivity to any interferons, incl. to peginterferon alfa-2b, and to other components of the drug.
PegIntron is used with caution in diseases with an increased risk of disability: lung diseases, incl. chronic obstructive pathologies; diabetes mellitus with a tendency to develop ketoacidosis; violation of blood clotting (thrombophlebitis, pulmonary embolism); severe myelosuppression.
Instructions for use of PegIntron: method and dosage
Treatment with PegIntron should be started by a physician experienced in working with patients with hepatitis B and C, further therapy should also be carried out under his supervision.
The drug is administered subcutaneously, each time choosing a new injection site.
The dose is selected individually and depends on the safety of use and the predicted efficacy of peginterferon alfa-2b. In the course of treatment, the dose is adjusted if undesirable reactions are observed or laboratory data change; in case of persistence of undesirable effects or their reappearance after the dose adjustment, the therapy is discontinued.
For the treatment of chronic hepatitis B, the dose of PegIntron is determined at the rate of 0.001-0.0015 mg / kg of body weight, injections are made once every 7 days for a period of six months to a year. If chronic hepatitis B caused by genotype C or D viruses is difficult to treat, higher doses and / or a longer course may be required to achieve the desired therapeutic effect.
For the treatment of chronic hepatitis C (monotherapy), the dose of the drug is determined at the rate of 0.0005 or 0.001 mg / kg of body weight, injections are made once every 7 days for at least six months. If, after the first six months of treatment, the RNA virus is eliminated from the serum, then the course must be continued for another six months, which in general will be 1 year. When, after six months, the RNA virus is still detected in the serum, therapy should be discontinued.
When combined therapy of chronic hepatitis C with peginterferon alfa-2b with ribavirin, the dose of PegIntron is determined at the rate of 0.0015 mg / kg of body weight, injections are made once every 7 days.
Ribavirin (200 mg capsules) is taken orally daily, simultaneously with meals, in a daily dose calculated depending on body weight:
- Up to 65 kg: 800 mg (4 capsules) - 2 pcs. in the morning and 2 pcs. in the evening;
- From 65 to 85 kg: 1000 mg (5 capsules) - 2 pcs. in the morning and 3 pcs. in the evening;
- More than 85 kg: 1200 mg (6 capsules) - 3 pcs. in the morning and 3 pcs. in the evening.
Dosage regimen of PegIntron and ribavirin in combination therapy of chronic hepatitis C, calculated depending on body weight; dosage of a pen / vial (mg / 0.5 ml) / dose for the administration of peginterferon alfa-2b once a week (ml) / daily dose of ribavirin (mg) / number of capsules 200 mg (pcs.):
- Up to 40 kg: 0.05 / 0.5 / 800/4 (2 in the morning + 2 in the evening);
- From 40 to 50 kg: 0.08 / 0.4 / 800/4 (2 in the morning + 2 in the evening);
- From 51 to 64 kg: 0.08 / 0.5 / 800/4 (2 in the morning + 2 in the evening);
- From 65 to 75 kg: 0.1 / 0.5 / 1000/5 (2 in the morning + 3 in the evening);
- From 76 to 85 kg: 0.12 / 0.5 / 1000/5 (2 in the morning + 3 in the evening);
- More than 85 kg: 0.15 (only pens) / 0.5 / 1200/6 (3 in the morning + 3 in the evening).
Recommended duration of treatment depending on the genotype of the virus:
- Genotype 1 virus: if after 3 months of treatment the elimination of virus RNA from the blood serum is not observed, then with continued therapy it is very unlikely that a persistent virological response will appear. Patients with a virological response after 3 months of treatment should continue the course for another 9 months (the total duration of therapy is about 12 months). At a low concentration of the virus (no more than 2 million copies / ml), if after a month of therapy, the RNA of the virus was eliminated, and it was not detected in the subsequent period, then after 6 months therapy can be discontinued (course duration - 6 months) or continued further for 6 months (course duration - 12 months); but it should be borne in mind that the risk of relapse after a course of 6 months total is higher than after a 12-month course;
- Genotype 2 or 3 virus: for all patients in this group, the duration of the course of therapy is 6 months;
- Genotype 4 virus: it is noted that patients in this group are difficult to treat; according to clinical observations of a group of 66 patients, it was revealed that for the treatment of genotype 4 virus, it is possible to use the tactics of therapy for genotype 1 virus.
In the event of significant adverse reactions or deviations of these laboratory parameters during monotherapy with peginterferon alfa-2b or during complex treatment with peginterferon alfa-2b and ribavirin, dosage adjustment or drug withdrawal is required until the undesirable effects cease.
In monotherapy, the dose of peginterferon alfa-2b is reduced to half the therapeutic dose if the neutrophil count is less than 750 / μl and the platelet count is less than 50,000 / μl; injections of the drug are discontinued when the neutrophil count is less than 500 / μl, and the platelet count is less than 25,000 / μl.
Dose adjustments in combination therapy of peginterferon alfa-2b with ribavirin should be performed by a physician. If, after changing the doses, the tolerance of treatment does not improve, the use of PegIntron and / or ribavirin must be discontinued.
Monotherapy for renal failure, dose adjustment:
- Renal failure of moderate severity, with CC 30-50 ml / min - the initial dose of peginterferon alfa-2b is reduced by 25%;
- Severe renal failure, with CC 10-29 ml / min (including patients on hemodialysis) - the initial dose of peginterferon alfa-2b is reduced by 50%.
If the serum creatinine content rises above 2 mg / dL, the course should be interrupted.
Therapy with PegIntron and ribavirin in patients with mild renal failure, with CC ≥ 50 ml / min, may cause anemia; in patients with CC ≤ 50 ml / min, combination therapy should not be performed.
The lyophilisate and the solvent in the syringe pen are mixed immediately before administration according to the method described in the attached package insert.
PegIntron in vials should be diluted only with the solvent included in the kit: with a sterile syringe 0.7 ml of water for injection must be injected into a vial with a lyophilisate, which must be gently shaken until the powder is completely dissolved; the dissolution time of the lyophilisate is no more than 10 minutes (usually faster); the required dose (up to 0.5 ml) of the solution is drawn into a sterile syringe; Do not mix peginterferon alfa-2b with other medicinal substances / drugs.
Before administration, the finished solution must be inspected: it must be colorless, transparent, and not contain visible particles. When color changes or visible inclusions appear, do not use the solution. It is recommended to enter the finished product immediately, and if this is not possible, store it at a temperature of 2-8 ° C for no more than 24 hours. The solution remaining after the injection cannot be used in the future, it should be disposed of in accordance with current requirements.
Side effects
Side effects due to monotherapy with PegIntron are mainly mild or moderate, discontinuation of therapy does not require:
- Most often (more than 10%): pain and inflammation at the injection site, headache, dizziness, increased fatigue, insomnia, irritability, fever, chills, depression, anxiety, nausea, alopecia, flu-like symptoms, joint pain, musculoskeletal pain, abdominal pain, diarrhea, asthenia, pharyngitis, anorexia, weight loss, impaired concentration;
- Less often (from 2% to 10%): dry skin, itching, general malaise, sweating, rash, pain in the right hypochondrium, apathy, emotional lability, confusion, agitation, nervousness, viral infections, cough, shortness of breath, drowsiness, pain in the chest, changes in the thyroid gland, dyspepsia, paresthesia, hypertension, hyperesthesia, hypesthesia, neutropenia, blurred vision, bloating, decreased libido, erythema, unstable stools, constipation, dry mouth, vomiting, eye pain, conjunctivitis, nasal congestion, sinusitis, menorrhagia, hot flashes, menstrual irregularities;
- Rarely: serious problems from the central nervous system (including suicidal thoughts and attempts), psychosis (including hallucinations), aggressive behavior, sometimes aimed at others; as well as peripheral neuropathy, seizures, hypertriglyceridemia, pancreatitis, arrhythmia, diabetes.
In addition, granulocytopenia (<750 / μl) was observed in 4% of patients receiving PegIntron at a dose of 0.0005 mg / kg and 7% of patients receiving 0.001 mg / kg, and in 1% and 3% (respectively) thrombocytopenia (<70,000 / μl).
Side effects in combination therapy with peginterferon alfa-2b with ribavirin:
- Most often (from 5% to 10%): rhinitis, taste perversion, tachycardia;
- Less often (2% to 5%): damage to the lacrimal gland, thirst, fainting, arterial hypotension, arterial hypertension, aggressive behavior, palpitations, tremors, glossitis, stomatitis, bleeding gums, ulcerative stomatitis, tinnitus, hearing impairment / loss, otitis media, eczema, fungal infection, respiratory disorders, bronchitis, rhinorrhea, hypersensitivity reactions to sunlight, prostatitis, lymphadenopathy, increased hair fragility;
- Very rare: aplastic anemia.
Both with monotherapy and with combined treatment with peginterferon alfa-2b with ribavirin, the following can be observed:
- Rarely: ophthalmic pathologies, including retinopathies (including edema of the optic nerve head), blockage of the veins or arteries of the retina, hemorrhages in the retina, focal changes, limitation of fields or decreased visual acuity, optic neuritis; cardiovascular disorders, including arrhythmias (presumably associated with previous diseases and with therapy with drugs with cardiotoxic action, carried out previously); cardiomyopathy in patients with no history of cardiovascular disease may be reversible after completion of interferon alfa therapy;
- Very rare: rhabdomyolysis, renal failure, impaired renal function, myositis, myocardial infarction, cardiac ischemia, cerebral ischemia, cerebral hemorrhage, ulcerative or ischemic colitis, encephalopathy, sarcoidosis (exacerbation of sarcoidosis), Stevens-Johnson syndrome, exudative erythema multiforme, epidermal exudative necrolysis, necrosis (tissue necrosis) at the injection site.
Due to the use of alpha interferons, various autoimmune pathologies were noted, as well as disorders mediated by the immune system, incl. idiopathic thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP).
Overdose
In clinical studies, cases of unintentional overdose of PegIntron have been noted. In the noted cases, the recommended therapeutic dose was exceeded no more than twice. No serious side effects reported. The undesirable reactions that occurred went away on their own, the drug was not required to be canceled.
special instructions
For severe mental disorders (including history), treatment can only be started after a thorough personal examination and appropriate treatment for the mental disorder.
In some cases, severe disorders of the central nervous system are observed, incl. with signs of depression, during therapy with PegIntron, especially in elderly patients who have taken high doses of the drug. Given the potential complexity of such undesirable effects, it is recommended to ensure constant monitoring of patients during therapy and for 6 months after its completion. These effects are generally reversible, but some patients may need up to 3 weeks to recover fully after stopping peginterferon alfa-2b. If symptoms persist or worsen during treatment, especially suicidal intentions, depression, aggressive behavior, it is required to interrupt the course and ensure timely referral to a psychiatrist.
Patients with heart failure, arrhythmias, myocardial infarction (including data in the anamnesis) need to be under constant medical supervision; before and during therapy, it is recommended to do an electrocardiogram (ECG). With arrhythmias (mainly supraventricular), as a rule, their usual treatment is sufficient, but in exceptional cases it may be necessary to cancel PegIntron.
In case of immediate allergic reactions (urticaria, angioedema, bronchospasm, anaphylaxis) PegIntron should be canceled and adequate symptomatic treatment should be immediately prescribed; discontinuation of therapy does not require transient rashes.
Before starting therapy, it is recommended to investigate renal function in all patients; patients with renal insufficiency during therapy require careful monitoring, if necessary, adjust the dose of PegIntron to decrease.
At the first signs of liver disease decompensation, therapy should be interrupted.
Fever can be a concomitant manifestation of influenza-like syndrome, a common side effect with interferon treatment, but with persistent fever, other causes of its occurrence must be excluded.
Adequate hydration of the patient is required to avoid hypotension associated with a decrease in fluid volume in the body; fluid replacement may be necessary.
In rare cases, during therapy with PegIntron, the formation of infiltrates of unclear etiology, pneumonitis or pneumonia was observed in the lungs, incl. with a lethal outcome. Therefore, in cases of cough, fever, shortness of breath, or other respiratory symptoms, patients should have a chest x-ray. If infiltrates or signs of pulmonary insufficiency are visible on the radiograph of the lungs, it is necessary to monitor them, and, if necessary, to cancel the drug. Such reactions are more typical for patients with chronic hepatitis C who received interferon alfa, but they were also recorded during the treatment of cancer patients. Immediate cancellation of PegIntron and therapy with glucocorticosteroids (GCS) lead to cure of the side effects from the lungs.
The appearance of autoantibodies and clinical manifestations of autoimmune pathologies more often occur, probably during interferon therapy of patients predisposed to autoimmune disorders.
When a patient complains of a limitation of visual fields or a decrease in visual acuity, a thorough ophthalmological examination is required. More often, such undesirable effects occur in the case of concomitant diseases, therefore, in case of diabetes mellitus or arterial hypertension, an ophthalmologist should be examined by an ophthalmologist before starting therapy with PegIntron.
Pathological changes in the periodontal tissues and teeth were recorded in patients during combination therapy with peginterferon alfa-2b and ribavirin. Their long-term combined use causes dry mouth, which can contribute to tooth decay and damage to the oral mucosa. During therapy, you need to brush your teeth twice a day and regularly undergo sanitation. After vomiting, rinse your mouth thoroughly.
In the treatment of chronic hepatitis C, cases (2.8%) of thyroid dysfunction - hyperthyroidism or hypothyroidism - were observed, which were controlled by standard treatment. The mechanism of the effect of peginterferon alfa-2b on thyroid function is not reliably known. It is recommended to determine the serum thyroid-stimulating hormone level in patients before starting therapy, and in case of any disorders of the thyroid gland, use standard therapy. PegIntron should not be used if such therapy does not maintain thyroid-stimulating hormone activity at a normal level.
There are descriptions of episodes of exacerbation of sarcoidosis and psoriasis during therapy with interferon alfa-2b, therefore, it is recommended to use the drug in patients with sarcoidosis or psoriasis only if the expected benefit from therapy is significantly higher than the possible risk of complications.
The safety and efficacy of using PegIntron, both in monotherapy and in combination with ribavirin, in organ transplant recipients has not been fully studied. According to the results of preliminary data, an increase in episodes of rejection of the transplanted kidney was noted, there are also reports of rejection of the transplanted liver, but a reliable causal relationship between the rejection of transplanted organs and the intake of interferon alpha has not been established.
Before starting therapy and during treatment, all patients are recommended to do general and biochemical blood tests, the following values of indicators are permissible: neutrophils> 1500 / μl, platelets> 100,000 / μl. In addition, the level of lipids in the blood should be monitored, since with the use of interferon alpha-2b, cases of hypertriglyceridemia and an increase in triglycerides in the blood plasma, sometimes pronounced, were observed.
In the event of the appearance of such adverse reactions as drowsiness, fatigue, confusion against the background of the use of PegIntron, it is not recommended to drive complex equipment or vehicles.
Application during pregnancy and lactation
Studies in primates have shown that interferon alpha-2b has an abortive effect. PegIntron is thought to have a similar effect and should therefore not be used in pregnant women.
The drug is allowed to be used in women of fertile age only if they use effective contraceptives during the entire period of treatment.
There are no data on the excretion of the drug in breast milk. Women who are breastfeeding should discontinue treatment or breastfeeding after weighing the expected benefits to the mother and the potential risks to the baby.
During pregnancy, combined treatment with PegIntron and ribavirin is contraindicated, since the latter has a pronounced embryotoxic and teratogenic effect even when used in doses of 1/20 of the recommended therapeutic dose.
Treatment with PegIntron and ribavirin can only be started after a pregnancy test and a negative result.
Women of reproductive age who receive ribavirin and PegIntron, as well as their male partners, must use reliable contraceptive methods throughout the entire period of therapy and within six months after its end, since ribavirin can accumulate inside cells and is extremely slowly excreted from the body. Within 6 months after the end of treatment, a repeated pregnancy test should be performed every month.
With impaired renal function
When monotherapy with PegIntron in patients with moderate renal impairment, the initial dose of the drug should be reduced by 25%.
In severe renal failure, as well as in patients on hemodialysis, it is necessary to reduce the initial dose by 50%. If the serum creatinine level rises above 2 mg / dL, further treatment with PegIntron is not recommended.
Combined therapy with ribavirin can only be performed if creatinine clearance is 50 ml / min or more (mild renal failure). Treatment is carried out with caution, as anemia may develop.
Combination therapy with ribavirin is contraindicated in patients with moderate to severe renal impairment.
For violations of liver function
According to the instructions, PegIntron should not be used in patients with severely impaired liver function, since the efficacy and safety of the drug in this group has not been studied.
Drug interactions
Multiple combined use of PegIntron and ribavirin did not reveal any signs of pharmacokinetic interaction between them.
Analogs
The analogue of PegIntron is PegAltevir.
Terms and conditions of storage
Store out of the reach of children at a temperature of 2-8 ° C.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about PegIntron
Patients leave a variety of reviews about PegIntron. In most cases, the drug was reported to be effective in the treatment of chronic hepatitis. Negative ratings were due to such side effects of PegIntron as aggression, hallucinations, suicidal thoughts and psychosis.
Price for PegIntron in pharmacies
The price of PegIntron in 2 ml vials (dosage 100 mcg) ranges from 3665 to 3897 rubles. Vials with lyophilisate for the preparation of a solution of 120 mcg can be purchased at a price of 8509 rubles. The cost of a lyophilisate for preparing a solution of 150 mcg (in vials) is 3568 rubles.
The price of PegIntron in syringe pens with a solvent, a needle and napkins (at a dosage of 120 mcg and 150 mcg) ranges from 3568 to 3665 rubles.
PegIntron in two-chamber syringe pens CLEARCLICK can be bought in pharmacies at prices ranging from 3665 to 4894 rubles (dosage 100 mcg), from 8200 to 8509 rubles (dosage 120 mcg) and from 9200 to 10 650 rubles (dosage 150 mcg).
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!
