METIPRED: instructions for using the medicine, structure, Contraindications

Active material: Methylprednisolone
When ATH: H02AB04
CCF: GCS for injection
ICD-10 codes (testimony): A15, A17.0, B15, B16, B17.1, B18.1, B18.2, C34, C81, C90.0, Q91, Q92, D59, D59.1, D60, D61, D69.3, D69.5, D70, D86, E05, E06, E25, E27.1, E27.2, E27.4, G35, G93.6, H10.1, H10.2, H10.4, H10.5, H16, H16.2, H20.0, H20.1, H30, H44.1, H46, I01, J30.1, J30.3, J45, J46, J63.2, J69, J82, J84, K50, K51, K72, K73, L10, L13.0, L20.8, L21, L23, L24, L26, L40, L50, L51.1, L51.2, M05, M07, M08, M10, M15, M30, M32, M33, M34, M45, M65, M71, M75.0, M77, N00, N04, R11, R57.0, R57.1, R57.8, T14.3, T78.2, T78.3, T79.4, T80.6, T88.7, Z94
When CSF: 04.01
Manufacturer: ORION CORPORATION (Finland)

METIPRED: dosage form, composition and packaging

Pills from white to almost white, round, flat, with a beveled edge and transverse Valium on one side.

Excipients: lactose monohydrate, corn starch, magnesium stearate, gelatin, talc, Purified water.

30 PC. – vials of dark glass (1) – packs cardboard.
100 PC. – vials of dark glass (1) – packs cardboard.
30 PC. – plastic bottles (1) – packs cardboard.
100 PC. – plastic bottles (1) – packs cardboard.

Pills from white to almost white, round, flat, with a beveled edge, transversely Valium and applied code “ORN 346” on one side.

Excipients: lactose monohydrate, corn starch, magnesium stearate, gelatin, talc, Purified water.

30 PC. – vials of dark glass (1) – packs cardboard.
100 PC. – vials of dark glass (1) – packs cardboard.
30 PC. – plastic bottles (1) – packs cardboard.
100 PC. – plastic bottles (1) – packs cardboard.

Valium for drug of a solution for I / O, and the / m as a white or slightly yellowish, hygroscopic lyophilized powder.

Excipients: Sodium hydroxide.

Bottles (1) – packs cardboard.

Valium for drug of a solution for I / O, and the / m as a white or slightly yellowish, hygroscopic lyophilized powder; enclosed solvent – transparent colorless liquid.

Excipients: Sodium hydroxide.

Solvent: water d / and (4 ml).

Bottles (1) together with the solvent (amp. 1 PC.) – packs cardboard.

METIPRED: pharmachologic effect

Synthetic corticosteroids. Anti-inflammatory, antiallergic, immunosuppressive effect, It increases the sensitivity of beta-adrenergic receptors to endogenous catecholamines.

Interacts with specific cytoplasmic receptors (GCS receptors exist in all tissues, especially a lot of them in the liver) to form the complex, inducing the formation of proteins (incl. enzymes, regulating the vital processes in the cells).

Effects of methylprednisolone on protein metabolism: It reduces the amount of globulin in plasma, It increases the synthesis of albumin in the liver and kidneys (with increasing ratio of albumin / globulin), synthesis and decreases protein catabolism increases in muscle tissue.

Effects of methylprednisolone on lipid metabolism: increased synthesis of higher fatty acids, and triglycerides, redistributes fat (fat accumulation occurs mainly in the area of ​​the shoulder girdle, person, life), It leads to the development of hypercholesterolemia.

Effects of methylprednisolone on carbohydrate metabolism: increases the absorption of carbohydrates from the digestive tract, It increases the activity of glucose-6-phosphatase (increases the supply of glucose from the liver into the blood), fosfoenolpiruvatkarboksilazy increases the activity and synthesis aminotransferases (activate gluconeogenesis), promotes hyperglycemia.

Effects of methylprednisolone on water-electrolyte metabolism: delaying sodium and water in the body, It stimulates the excretion of potassium (mineralocorticoid activity), reduces the absorption of calcium from the gastrointestinal tract, reduces bone mineralization.

Anti-inflammatory effect is due to inhibition of the release of eosinophils and mast cells, inflammatory mediators, lipokortinov inducing formation and reduce the number of mast cells, producing hyaluronic acid, with decreasing capillary permeability, stabilization of cell membranes (especially lysosomal) organelles and membranes. Valid for all stages of the inflammatory process: It inhibits prostaglandin synthesis at the level of arachidonic acid (Lipokortin inhibits phospholipase A2, liberatiou suppresses arachidonic acid inhibits the biosynthesis endoperekisey, leukotrienes, contributing incl. inflammation, allergies), synthesis of pro-inflammatory cytokines (incl. interleukin 1, tumor necrosis factor alpha), increases the resistance of the cell membrane to the action of various damaging factors.

Immunosuppressive effect is due to the called involution of lymphoid tissue, inhibition of lymphocyte proliferation (especially T lymphocytes), suppression of B-cell migration and interaction of T- and B-lymphocytes, inhibition of cytokine release (Interleukin-1, 2, Gamma-interferon) of lymphocytes and macrophages and decrease antibody production.

Antiallergic action develops due to a decrease of synthesis and secretion of mediators of allergy, brake release from sensitized mast cells and basophils, histamine and other biologically active substances, reducing the number of circulating basophils, T- and B-lymphocytes, mast cells, suppression of lymphoid and connective tissue, reducing the sensitivity of the effector cells to the mediators of allergy, inhibition antibody, changes in immune response.

When obstructive respiratory diseases caused by the action, mainly, inhibition of inflammation, prevent or reduce the severity of mucosal edema, reduction of eosinophil infiltration submucosal bronchial epithelium and deposition in the bronchial mucosa of circulating immune complexes, and braking erozirovaniya and desquamation of the mucous. It increases the sensitivity of beta-adrenergic receptors of the bronchi of small and medium-sized to endogenous catecholamines and exogenous sympathomimetics, It reduces the viscosity of mucus by reducing its production.

It inhibits the synthesis and secretion of ACTH and second – the synthesis of endogenous corticosteroids.

Hinders connective tissue reaction in the inflammatory process and reduces the possibility of the formation of scar tissue.

METIPRED: pharmacokinetics

Absorption and distribution

If ingestion is rapidly absorbed, absorption is greater than 70%. Treated effect “first pass” through the liver.

When i / m administration and absorption of a full fast enough. Bioavailability with the / m introduction of 89%.

C_max after ingestion of 1.5 no, when i / m administration – 0.5-1 no. C_max after / in a dose of 30 mg / kg for 20 or m / drip in a dose of 1 g for 30-60 m, reaches 20 ug / ml. C_max After the / m 40 mg for 2 h up 34 ug / ml.

Plasma protein binding (Only albumin) – 62% regardless of the dose.

Metabolism

It is metabolized primarily in the liver. Metaʙolitы (11-keto- and 20-hydroxy compound) They do not possess glucocorticoid activity and displayed mainly kidneys. During 24 h around 85% injected dose found in urine, and about 10% – Calais. Penetrates the GEB and placental barrier. Metabolites detected in breast milk.

Deduction

T_1/2 from blood plasma after oral administration is about 3.3 no, when administered parenterally – 2.3-4 and h, probably, It does not depend on the route of administration. Due to the intracellular activity revealed a pronounced difference between the T_1/2 methylprednisolone from plasma and T_1/2 the whole organism (about 12-36 no). Pharmaceuticals persists even, when the concentration of drug in the blood is not determined.

METIPRED: testimony

Orally

• systemic connective tissue disease (SLE, scleroderma, periarteritis nodosa, dermatomyositis, rheumatoid arthritis);
• acute and chronic inflammatory diseases of the joints – podagricheskiy and psoriaticheskiy arthritis, osteoarthritis (incl. posttraumatic), polyarthritis (incl. senile), frozen shoulder, ankylosing spondylitis (ankylosing spondylitis), yuvenilynыy arthritis, Still's syndrome in adults, ʙursit, nonspecific tenosynovitis, synovitis and epicondylitis;
• rheumatic fever, rheumatic carditis, chorea;
• bronchial asthma, asthmatic status;
• acute and chronic allergic diseases – incl. Allergic reactions to drugs and food, serum sickness, hives, nasal allergy, angioedema, drug rash, pollen disease;
• skin diseases – pemphigus, psoriasis, eczema, atopic dermatitis (common atopic), contract dermatitis (with damage to a large area of ​​the skin), drug reaction, seborrheic dermatitis, exfoliative dermatitis, toxic epidermal necrolysis (Lyell's syndrome), bullous dermatitis herpetiformis, Stevens-Johnson syndrome;
• swelling of the brain (incl. amid brain tumor or associated with surgery, radiotherapy or head injury) after a preliminary parenteral corticosteroids;
• ocular allergy – allergic conjunctivitis form;
• inflammatory diseases of the eye – transferred ophtalmia, heavy sluggish front and posterior uveitis, optic neuritis;
• primary or secondary adrenal insufficiency (incl. condition after the removal of the adrenal glands);
• congenital adrenal hyperplasia;
• kidney disease of autoimmune origin (incl. acute glomerulonephritis);
• nephrotic syndrome;
• subacute thyroiditis;
• diseases of the blood and hematopoietic system – agranulocytosis, panmyelopathy, autoimmunnaya gemoliticheskaya anemia, lymph- and myeloid leukemias, lymphogranulomatoses, trombotsitopenicheskaya purpura, secondary thrombocytopenia in adults, erythroblastopenia (эritrotsitarnaya anemia), Congenital (erythroid) gipoplasticheskaya anemia;
• interstitial lung disease – Acute alveolitis, fibrosis lyegkikh, sarcoidosis stage II-III;
• tuberculous meningitis, pulmonary tuberculosis, inhalation pneumonia (in combination with a specific chemotherapy);
• berylliosis, Loffler's syndrome (not amenable to other therapy);
• lung cancer (in combination with cytostatics);
• multiple sclerosis;
• yazvennыy colitis, Crohn's disease, Local enteritis;
• hepatitis;
• hypoglycemic states;
• prevention of graft rejection reaction during organ transplantation;
• hypercalcemia on the background of cancer, nausea and vomiting during cytostatic therapy;
• multiple myeloma.

Parenteral (Emergency therapy for conditions, requiring a rapid increase in the concentration of corticosteroids in the body)

• state of shock (ambustial, traumatic, operating, toxic, cardiogenic) the ineffectiveness of a vasoconstrictor, plazmozameshchath drugs and other symptomatic therapy;
• allergic reactions (acute severe), transfusion shock, anaphylactic shock, anaphylactoid reactions;
• swelling of the brain (incl. amid brain tumor or associated with surgery, radiotherapy or head injury);
• bronchial asthma (severe form), asthmatic status;
• SLE, rheumatoid arthritis;
• acute adrenal insufficiency;
• thyrotoxic crisis;
• acute hepatitis, pechenochnaya coma;
• decrease inflammation and prevent scarring restrictions (for poisoning cauterizing liquids).

METIPRED: dosing regimen

Dose and duration of treatment is determined by the doctor individually depending on the indication and the severity of the disease.

Pills

All the recommended daily dose taken orally once daily dose or double - in a day with the circadian rhythm of secretion of endogenous corticosteroids in the range of 6 to 8 a.m.. The high daily dose can be divided into 2-4 admission, at the same time in the morning should be a large dose. Tablets should be taken during or immediately after a meal, drinking a small amount of liquid.

The initial dose may be from 4 mg 48 mg of methylprednisolone per day, depending on the nature of the disease. At less severe diseases usually sufficient use of lower doses, although some patients may require higher doses. High doses may be needed for such diseases and conditions, as multiple sclerosis (200 mg / day), swelling of the brain (200-1000 mg / day) and organ transplantation (to 7 mg / kg / day). If after a reasonable period of time not received a satisfactory clinical effect, the drug should be withdrawn and the patient another type of therapy.

Babies dose determined by the physician based on weight or body surface. At adrenal insufficiency – inside 0.18 mg / kg or 3.33 mg / m²/sut 3 admission, other testimony – by 0.42-1.67 mg / kg or 12.5-50 mg / m²/sut 3 admission.

Chronic administration of the drug daily dose should be reduced gradually. Duration of therapy should not be discontinued abruptly.

Valium for drug of a solution for I / O, and the / m

Preparation is administered parenterally in the form of slow I / jet injection or / infusion, and / o Injection.

A solution for injection is prepared by adding the solvent to the vial with lyophilized prior to use. The mixed solution contains 62.5 mg / mL methylprednisolone.

As adjunctive therapy in life-threatening conditions introduced 30 mg / kg body weight / in for at least 30 m. The introduction of this dose can be repeated every 4-6 h for maximum 48 no.

Pulse therapy in the treatment of diseases, in which the effective GCS therapy, during exacerbations of the disease and / or ineffectiveness of standard therapy.

The above dose should be administered for at least 30 m. Administration may be repeated, If within a week after the treatment has not been reached to improve, or if required by the condition of the patient.

To improve the quality of life in cancer in the terminal stage introduced 125 mg / day in / day for up to 8 weeks.

Chemotherapy, characterized slight or srednevyrazhennym vomitoxin, introduced 250 mg / in for at least 5 min for 1 hours before the administration of the chemotherapeutic drug, at the beginning of chemotherapy, as well as after its completion. Chemotherapy, characterized expressed emetic effect, introduced 250 mg / in for at least 5 min in combination with appropriate doses of metoclopramide or butyrophenone for 1 hours before the administration of the chemotherapeutic drug, then 250 mg / chemotherapy in early and after closure.

At other indications starting dose is 10-500 mg / w depending on the disease. To short course of severe acute conditions may require higher doses. The starting dose, not exceeding 250 mg, It is administered in / for at least 5 m, doses above 250 mg is administered for at least 30 m. Subsequent doses are administered in / in or / m, The duration of intervals between administrations depends on the response of the patient to therapy and on his clinical status.

Babies should be administered a lower dose (but not less than 0.5 mg / kg / day), However, when choosing the dose primarily consider the severity of the condition and the patient's response to therapy, and not age and body weight.

METIPRED: side effects

The frequency and severity of side effects depends on the duration of use, the value of the dosage used and the possibility of compliance circadian rhythm of destination metipred.

On the part of the endocrine system: reduced glucose tolerance, steroid diabetes, a manifestation of latent diabetes mellitus, adrenal suppression, Cushing's syndrome (moon face, obesity, pituitary type, girsutizm, increased blood pressure, dysmenorrhoea, amenorrhea, muscular weakness, striae), delayed sexual development in children.

From the digestive system: nausea, vomiting, pancreatitis, Steroid ulcers of the stomach and duodenum, erosive esophagitis, gastrointestinal bleeding, perforation of the wall of the digestive tract, appetite disorders, indigestion, flatulence, Ikotech; rarely – increase in liver transaminases and alkaline phosphatase.

Cardio-vascular system: Arrhythmia, bradycardia (up to heart failure); in predisposed patients the development or enhancement of cardiac insufficiency, ECG changes, typical of hypokalemia, increased blood pressure, hypercoagulation, thrombosis; in patients with acute and subacute myocardial infarction may spread necrosis, slowing the formation of scar tissue, which can lead to rupture of the heart muscle.

From the central and peripheral nervous system: delirium, disorientation, euphoria, hallucinations, affective insanity, depression, paranoia, intracranial hypertension, nervousness, anxiety, insomnia, dizziness, vertigo, pseudotumor cerebellum, headache, convulsions.

From the senses: zadnyaya subkapsulyarnaya cataracts, increased intraocular pressure with possible damage to the optic nerve, propensity to develop secondary bacterial, fungal or viral infections of the eye, trophic changes of the cornea, exophthalmos, sudden loss of vision (by parenteral administration in the head, Neck, turbinates, scalp may be the deposition of crystals of the drug in the vessels of the eye).

Metabolism: increased excretion of calcium, hypocalcemia, weight gain, negative nitrogen balance (increased protein breakdown), increased sweating; due to mineralocorticoid activity – sodium and fluid retention (peripheral edema), gipernatriemiya, gipokaliemichesky syndrome (kaliopenia, arrhythmia, myalgia or muscle spasm, unusual weakness and fatigue).

On the part of the musculoskeletal system: slowing growth and ossification processes in children (premature closure of the epiphyseal growth zones), osteoporosis (rarely – pathological fractures, aseptic necrosis of the humeral head and femur), muscle tendon rupture, steroidnaya myopathy, reduced muscle mass (atrophy).

Dermatological reactions: delayed wound healing, petechiae, ecchymosis, thinning of the skin, Hyper- or hypopigmentation, steroid acne, striae, propensity to development of pyoderma and candidiasis.

Allergic reactions: skin rash, itch, anaphylactic shock, Local allergic reactions.

Local reactions when administered parenterally: burning, numbness, pain, tingling at the site of administration, infection of the injection site; rarely – necrosis of surrounding tissues, scarring at the injection site, atrophy of the skin and subcutaneous tissue with the / m introduction (particularly dangerous administration in the deltoid muscle).

Other: development or exacerbation of infection (the appearance of this side effect contribute jointly used immunosuppressants and vaccination), leucocyturia, withdrawal, “tides” blood to the head.

METIPRED: Contraindications

For short-term use for health reasons only contraindication is hypersensitivity to methylprednisolone or components of the drug.

The children in the period of growth GCS should be used only if absolutely indicated and under close medical supervision.

FROM caution should be prescribed in the following diseases and conditions:

• gastrointestinal diseases – gastric ulcer and duodenal ulcer, esophagitis, gastritis, acute or latent peptic ulcer, recently established intestinal anastomosis, UC with the threat of perforation or abscess, diverticulitis;
• parasitic and infectious diseases of viral, fungal or bacterial origin (currently or recently transferred, including the recent contact with a patient) – herpes simplex, herpes zoster (viremicheskaya phase), enable vetryanaya, kor, ameʙiaz, strongiloidoz, systemic mycosis; active and latent tuberculosis (Application for serious infectious diseases is permissible only against the background of specific therapy);
• before- and post-vaccination period (8 weeks before and 2 weeks after vaccination), lymphadenitis after BCG vaccination, immunodeficiency states (incl. AIDS or HIV infection);
• diseases of the cardiovascular system (incl. recent myocardial infarction – in patients with acute and subacute myocardial infarction may spread necrosis, slowing the formation of scar tissue and, thereby, – rupture of the heart muscle), severe chronic heart failure, arterial hypertension, hyperlipidemia;
• endocrine diseases – diabetes (incl. violation of carbohydrate tolerance), thyrotoxicosis, gipotireoz, pituitary Kyshinga, obesity (III-IV degrees);
• severe chronic renal and / or hepatic insufficiency, nefrourolitiaz;
• hypoalbuminemia and condition, predisposing to its occurrence;
• systemic osteoporosis, myasthenia gravis, acute psychosis, polio (except bulbar form of encephalitis), openly- zakrыtougolynaya and glaucoma;
• pregnancy.

METIPRED: Pregnancy and lactation

When pregnancy (especially in the I trimester) drug should be used only for health.

Because corticosteroids penetrate into breast milk, if necessary, use during lactation (breast-feeding), should stop breast-feeding.

METIPRED: Special instructions

Store the prepared solution for parenteral administration should be at a temperature of from 15 ° to 20 ° C and used within 12 no. When the prepared solution is stored in a refrigerator at 2 ° to 8 ° C., it can be used for 24 no.

During treatment metipred (especially long) you must observe ophthalmologist, BP control, the state of water and electrolyte balance, and peripheral blood, and the glucose concentration in the blood.

In order to reduce the side effects can be assigned to antacids, and increase the flow of potassium in the body (diet, potassium supplements). Food should be rich in protein, Vitamins, limiting fat content, carbohydrate and salt.

Effect of the drug is enhanced in patients with hypothyroidism and liver cirrhosis. The drug can enhance existing emotional instability or psychotic disturbances. When referring to a history of psychosis metipred at high doses prescribed under strict medical supervision.

Caution should be used in acute and subacute myocardial infarction due to the possibility of the spread of necrosis, slowing down the formation of scar tissue and cardiac muscle rupture.

In stressful situations during maintenance treatment (incl. surgery, trauma, infectious diseases) should be to adjust the dose of the drug due to increased demand for SCS.

With the sudden cancellation, especially in the case of the prior use of high doses of, may develop withdrawal (anorexia, nausea, lethargy, generalized musculoskeletal pain, generalized weakness), as well as exacerbation of disease, about which he was appointed metipred.

During treatment metipred should not be vaccinated due to lower immune response and, thereby, decrease in vaccine efficacy.

Appointing metipred when intercurrent infections, septic conditions and tuberculosis, you must at the same time to treat with antibiotics bactericidal action.

In children during long-term treatment metipred careful observation of the dynamics of growth and development. Babies, that during treatment in contact with patients with measles or chickenpox, prophylactically prescribe specific immunoglobulins.

Due to the weak mineralocorticoid effect for replacement therapy in adrenal insufficiency metipred used in combination with a mineralocorticoid.

In patients with diabetes should monitor the concentration of glucose in the blood and if necessary to adjust the dose giloglikemicheskih means.

Showed radiological control of bone-joint system (Photos pozvonochnika, brush).

Metipred in patients with latent infectious diseases, kidney and urinary tract infections can cause leukocyturia, which may be of diagnostic value.

Metipred increases metabolites 11- and 17 oksiketokortikosteroidov.

METIPRED: overdose

Symptoms: may increase the side effects described above.

Treatment: symptomatic. It is necessary to reduce the dose metipred.

METIPRED: drug interaction

Co-administration of methylprednisolone:

• with inducers of hepatic microsomal enzymes (phenobarbital, rifampicin, phenytoin, theophylline, ephedrine) reduces its concentration (increase in metabolic rate);
• with diuretics (especially thiazide and carbonic anhydrase inhibitors) and amphotericin B leads to increased excretion of potassium and increase the risk of heart failure; carbonic anhydrase inhibitors, and “loop” diuretics can increase the risk of osteoporosis;
• with sodium-containing drugs contributes to the development of edema and increased blood pressure;
• with cardiac glycosides leads to a deterioration in their tolerance and an increased likelihood of developing ventricular extrasytholia (due cause hypokalemia);
• with indirect anticoagulants contributes to attenuation (Strengthening less) their actions (require dose adjustment);
• with anticoagulants and thrombolytics leads to an increased risk of bleeding from ulcers in the gastrointestinal tract;
• with ethanol and NSAIDs helps to increase the risk of erosive-ulcerative lesions in the gastrointestinal tract and the development of bleeding (in combination with NSAIDs to treat arthritis may reduce the dose of GCS due to summation of therapeutic effect);
• with indomethacin increases the risk of side effects of methylprednisolone (displacement of indomethacin methylprednisolone connection with albumin);
• with paracetamol increases the risk of hepatotoxicity (induction of liver enzymes and the formation of toxic metabolite of paracetamol);
• with acetylsalicylic acid accelerates its excretion and reduces the concentration in the blood (the abolition of methylprednisolone levels of salicylates in the blood increases, and increases the risk of side effects);
• with insulin and oral hypoglycemic drugs, antihypertensives reduced their effectiveness;
• vitamin D reduces its effect on calcium absorption in the intestine;
• with GH, the effectiveness of the latter decreases;
• with praziquantel reduces the concentration of the latter;
• M-holinoblokatorami (including antihistamines, and tricyclic antidepressants) and nitrates promotes intraocular pressure;
• with isoniazid and mexiletine increases their metabolism (especially “slow” acetylators), which leads to a decrease in their plasma concentrations.

ACTH increases the effects of methylprednisolone.

Ergocalciferol and parathyroid hormone hinder the development of osteopathy, called methylprednisolone.

Cyclosporin and ketoconazole, slowing down the metabolism of methylprednisolone, may in some cases increase its toxicity.

At the same time the appointment of androgens and anabolic steroid drugs with methylprednisolone contribute to the development of peripheral edema, hirsutism and acne.

Estrogen and oral contraceptives reduce estrogensoderzhaschie clearance of methylprednisolone, which may be accompanied by increased expression of his actions.

Mitotane and other inhibitors of adrenocortical function may necessitate increasing the dose of methylprednisolone.

While the use of live virus vaccines, and in comparison with other types of immunization increases the risk of activation of viruses and development of infections.

Immunosuppressive drugs increase the risk of infections and lymphoma or other lymphoproliferative disorders, associated with Epstein-Barr virus.

Antipsychotic drugs (neuroleptics) azathioprine and increase the risk of developing cataracts in the appointment of methylprednisolone.

Co-administration of antacids reduces absorption of methylprednisolone.

While the use of antithyroid drugs is reduced, and on thyroid hormone – increased clearance of methylprednisolone.

Pharmaceutical interaction

Possible pharmaceutical incompatibility methylprednisolone with other I / administered drugs. It is recommended to be administered separately from other drugs (in / bolus, or through another IV, as a second solution).

METIPRED: terms of dispensing from pharmacies

The drug is released under the prescription.

METIPRED: terms and conditions of storage

List B. The drug is in the form of tablets should be stored in a place inaccessible to children at temperature from 15 ° to 25 ° C. The lyophilized powder should be stored out of reach of children, dark place at a temperature of 15 ° to 25 ° C. Shelf life – 5 years.

The reconstituted solution should be stored in a refrigerator at 2 ° to 8 ° C. 24 no.