Hydrocortisone-Richter - official * instructions for use. Contraindications to the use of the drug. The use of funds for otitis media and sinusitis

How I would like to be able to purchase a drug that could solve everything once and for all existing problems with health. But so far this is not possible. And so everyone is forced to spend a lot of time, money and effort to maintain their own physical state at a level necessary for the normal functioning of the body. Finding a high-quality highly specialized drug sometimes takes an incredible amount of time. This article is written to help you save some money. Below will be considered detailed description a drug called "Hydrocortisone-Richter", which is actively used in modern medicine to fight a wide range of diseases. And in all these cases, this amazing remedy is effective, as you can see in the course of reading. Who is shown "Hydrocortisone-Richter"? How should it be applied? What are the contraindications to its use? How safe is it? Do I need to see a doctor or is my own knowledge enough to draw up an individual treatment regimen? Are there any substitutes for the drug in question? All this and some other nuances of the use of the drug "Hydrocortisone Richter" you can find out by reading this article.

Compound

Main operating components, which are part of the preparation "Hydrocortisone-Richter", are hydrocortisone acetate in the amount of one hundred and twenty-five milligrams, as well as lidocaine hydrochloride monohydrate in the amount of twenty-six and a half milligrams. Auxiliary components for the drug in question are povidone; sodium phosphate; tpropyl parahydroxybenzoate; sodium dihydrogen phosphate; methyl parahydroxybenzoate; sodium chloride; dimethylacetamide;

Pharmacological properties

The drug "Hydrocortisone-Richter" is a glucocorticosteroid agent. The main effect that the drug in question has on the patient's body is anti-inflammatory.

"Hydrocortisone-Richter" must be administered intra-or periarticularly or intramuscularly.

Lidocaine is an effective pain reliever ( local anesthetic), which has an effect on the desired area of the body for an extremely short time. Also, the substance has a membrane-stabilizing effect.

In the event that this agent is administered intra-articularly or periarticularly, the active substances enter the systemic circulation within a short time. Active ingredients demonstrate high level connection with proteins (it exceeds ninety percent). In the patient's liver, the drug breaks down into the following substances: tetrahydrocortisone and tetrahydrocortisol. The latter in conjugated form are excreted from the body with the help of the kidneys.

Important! The drug freely crosses the placental barrier, so it can affect the fetus.

Lidocaine is also included in breast milk, which is dangerous for the child during breastfeeding.

The half-life is about one to two hours.

Indications

The main diseases in which the use of the drug "Hydrocortisone-Richter" is indicated are scapulohumeral periarthritis, tendovaginitis, osteoarthritis, subject to the presence of synovitis (does not apply to infectious arthritis), as well as bursitis, rheumatoid arthritis and epicondylitis.

Today, the drug in question is increasingly being used to combat various diseases respiratory tract, larynx and nasopharynx (laryngitis, asthma, bronchitis, sinusitis, runny nose, etc.), as well as ears (otitis varying degrees gravity).

Application

In order to cope with ENT diseases, Hydrocortisone-Richter is used for inhalation. Instructions for using the tool in question, therefore, is extremely simple. It is important to start by contacting a competent specialist who could appoint minimum dose drug that would be effective in this particular case. This is necessary so that the use of the drug "Hydrocortisone-Richter" for inhalation is truly safe. It would be extremely rash to make such decisions on your own. It is also important that the attending physician prescribes the proportions of the preparation of the working solution for the procedure in question. If you carefully follow the recommendations received from a specialist, then the use of the drug "Hydrocortisone-Richter" for inhalation will be truly saving in the struggle for good health.

The drug in question is also used for otitis media. In such cases, it is recommended to drip two milliliters of Hydrocortisone-Richter solution into the ear. The procedure should be repeated three to four times a day. As prescribed by the attending physician, this remedy can be combined with a solution of an antibiotic suitable for the patient.

Also contains such information) can be used directly for the treatment of diseases of the joints. In this case, the drug is administered intraarticularly or periarticularly. During the day, the "Hydrocortisone-Richter" (suspension) should not be injected into more than three joints. The next injection can be made only three weeks after the previous one.

The same joint can be exposed to the drug "Hydrocortisone-Richter" (suspension) no more than three times a year. This is due to the adverse effect of this drug on hyaline cartilage.

What doses in this case Should I use "Hydrocortisone-Richter"? Instructions for use recommend that adults inject from five to fifty milligrams of the substance, depending on how large the joint is and how severe the disease is. The pediatric dose is five to thirty milligrams. However, this amount must be divided into several injections during the day.

For the treatment of nasal diseases, special preparations should be made. Next, you should instill this solution with the drug "Hydrocortisone-Richter" into the nose (two drops three times a day).

Self-medication is not always effective and can even become dangerous. And it does not depend on what you are struggling with - otitis media, arthritis, sinusitis, or you want to use "Hydrocortisone-Richter" for inhalation. The instruction contains only average recommended dosages. Exact amount medicinal substance and the scheme of its application can be established in each individual case solely the attending physician.

Contraindications

There are some conditions under which in no case should the injection solution or Hydrocortisone-Richter drops be used. So, you will not be able to use the drug in question if you have an infected joint, problems with the Achilles tendon, a tendency to form blood clots, Itsenko-Cushing's syndrome, a systemic infection without conduction specific therapy, as well as individual intolerance to one or another constituent component of the drug.

Also, the remedy is forbidden to be taken during the period of bearing a child (in particular, in the first trimester). In the second and third trimesters, the drug should be taken only if the benefit to the mother is many times greater than the risk to the fetus. And the use of the drug "Hydrocortisone" has an extremely negative effect on the development of the fetus. In particular, it provokes a developmental delay. During the period of breastfeeding, the use of the drug is also prohibited.

It is impossible to administer the drug intra-articularly if there is pathological bleeding, infectious arthritis, bones, osteoarthritis without synovitis, bone destruction, periarticular infection, periarticular osteoporosis, joint deformity, unstable joint, previous arthroplasty.

It is important to always be under the supervision of the attending physician if the patient is elderly or has the following diseases: diabetes, duodenal or stomach ulcer, osteoporosis, herpes, tuberculosis, epilepsy, glaucoma, measles, arterial hypertension, chronic heart failure.

Side effects

What kind side effects can cause taking the drug "Hydrocortisone-Richter" (suspension)? The manual contains information about the following negative reactions that could potentially occur during therapy with the agent in question. Among them:

growth retardation;
steroid diabetes;
Itsenko-Cushing's syndrome;
decreased glucose tolerance;
suppression of adrenal function;
nausea;
hypokalemia;
hiccups
thromboembolism;
flatulence;
peptic ulcer;
heart failure;
bleeding;
peripheral vasodilation;
vomit;
increased blood pressure;
irritability;
pancreatitis;
insomnia;
esophagitis;
increased appetite;
headache;
anxiety;
weight gain;
euphoria;
mental disorders;
corneal ulceration;
excitation;
increased sweating;
hallucinations;
cataract;
damage to the optic nerve;
infections of the organs of vision;
pseudotumor of the cerebellum, glaucoma;
depression;
dizziness;
paranoia;
disorientation;
delirium;
epileptiform convulsions;
arthralgia;
myalgia;
osteoporosis;
growth retardation;
decrease in muscle mass;
muscle spasm;
fatigue;
steroid myopathy;
hypernatremia;
tendon injury;
opportunistic infections;
arrhythmia;
fluid retention;
increased weakness;
skin rash;
exacerbation of infections (including latent tuberculosis);
folliculitis;
anaphylactic shock;
ecchymosis;
steroid acne;
telangiectasia;
skin atrophy;
paresthesia;
hirsutism;
tissue swelling;
necrosis of surrounding tissues;
adrenal insufficiency;
leukocytosis;
malaise.

If the patient is elderly, then the risk of any of these side effects increases significantly.

Also, a number of the above reactions may occur due to exceeding the prescribed dosage or taking the medicine for too long. Under such conditions of use of the "Hydrocortisone-Richter" agent, the instruction advises to carry out symptomatic treatment, since there is currently no specific antidote.

Peculiarities

It is important to administer the drug in question, taking into account all the rules of antiseptics, which will help to avoid infection with any pathogenic microorganisms.

It is forbidden to vaccinate a patient during therapy with this drug. This is due to the possible inhibition of antibody synthesis.

During the use of the drug, the instructions for use recommend that you follow a certain diet. The sodium content of the food consumed should be reduced, while the potassium content should be significantly increased. It is also necessary to consume enough squirrel.

It is important to regularly monitor the following indicators: blood clotting, diuresis, blood glucose concentration, blood pressure and body weight. This will help to identify possible deviations from the norm in time and adjust the treatment regimen.

The drug in question significantly slows down the growth and development of children and adolescents. Therefore, it is important that the treatment regimen is experienced specialist. As a rule, the smallest possible doses are prescribed for the shortest possible time.

Interaction with other drugs

Cardiac glucosides, used simultaneously with the drug in question, have a much more toxic effect on the patient's body.

The drug significantly accelerates the excretion of acetylsalicylic acid.

Parallel use with live vaccines provokes the development of infections due to the activation of viruses.

Accelerates the metabolism of substances such as mexiletine and isoniazid. Consequently, their concentration in blood plasma is sharply reduced.

An increased risk of developing toxic action paracetamol on the patient's liver.

High doses of the drug in question neutralize the effect of somatropin growth hormone.

Hypoglycemic drugs while taking this tool also become less effective.

rises intraocular pressure due to simultaneous use with antihistamines and tricyclic antidepressants.

Analogues

If for any reason (for example, the presence of certain contraindications) you are not able to use the drug "Hydrocortisone-Richter", it would be wise to look for information on its substitutes in order to find the right drug for you. Yes, basically active substance analogues of the drug in question are suspensions "Cortef" and "Solu-Cortef". A similar mechanism of action has been identified in the following drugs: "Prednisolone" (ointment for external use); "Kenalog" (suspension); Dexapos, Prenacid, Maxidex, Ozurdex ( eye ointments); "Polkotrolon", "Medopred", "Megadexan", "Flosteron", "Ivapred" (suspensions). It is important to remember that each of these drugs has its own characteristics and unique cases when it should be used. Therefore, it would be most reasonable to provide an opportunity for a specialist to choose a suitable analogue of the agent in question, which would be effective in your case and would not harm your body.

One vial contains

active substances - hydrocortisone acetate 125 mg,

lidocaine hydrochloride 25 mg

excipients: propyl parahydroxybenzoate, methyl parahydroxybenzoate, sodium chloride, disodium phosphate dodecahydrate, sodium dihydrophosphate dihydrate, povidone, polysorbate 80, N,N-dimethylacetamide, water for injection.

Description

White or almost white, easily resuspendable when shaken, suspension with a characteristic odor

Pharmacotherapeutic group

Corticoids for systemic use. Glucocorticoid combination for systemic use.

ATH code H02VH

Pharmacological properties"type="checkbox">

Pharmacological properties

Pharmacokinetics

At local use, hydrocortisone can be absorbed and have a systemic effect. In the systemic circulation, 90% of hydrocortisone is in a protein-bound state. Hydrocortisone crosses the placental barrier. Hydrocortisone is metabolized in the liver to form tetrahydrocortisone and tetrahydrocortisol; these derivatives are excreted in the urine as conjugates.

In studies of reproductive toxicity, the fetotoxic effect of the drug, the development of malformations (cleft hard palate) and growth retardation. Despite the fact that no toxic effects were observed in the clinical use of drugs, long-term use corticosteroids may be associated with an increased risk of delayed prenatal development.

Lidocaine is rapidly absorbed from mucous membranes and damaged skin. In the systemic circulation, the drug actively binds to proteins; the half-life of the drug is 1 - 2 hours. Lidocaine is metabolized primarily in the liver. The drug crosses the placental and blood-brain barrier and is excreted in breast milk.

Pharmacodynamics

Hydrocortisone is steroid hormone with low glucocorticoid and anti-inflammatory action. Lidocaine is a local anesthetic with membrane stabilizing action rapid development anesthesia.

Indications for use

Osteoarthritis affecting several joints (knee, elbow, hip), monoarthrosis

Rheumatic arthritis and arthritis of other origins (except for tuberculous and gonorrheal)

Shoulder-shoulder periarthrosis

Bursitis, epicondylitis, tendovaginitis

Preoperative preparation of ankylosed joints, addition to systemic therapy corticosteroids

Dosage and administration

Adults: 5 to 50 mg intra- and periarticularly, depending on the size of the joint and the severity of the disease.

Children: 5 to 30 mg daily in divided doses.

Elderly: the use of steroids in elderly patients requires special attention, due to the increased likelihood of developing adverse reactions on the drug with age.

In one day, the drug can be administered no more than 3 joints; reintroduction the drug is possible subject to a 3-week interval. Intra-articular administration of the drug can cause damage to hyaline cartilage, the maximum frequency of administration in one joint is 3 times a year. The introduction of the drug directly into the tendon is contraindicated; with tendinitis, the drug should be injected into the tendon sheath. The drug should not be used to treat lesions of the Achilles tendon. The drug is not indicated for systemic administration.

Side effects"type="checkbox">

Side effects

Data on the incidence of adverse reactions are not available.

Pain, swelling (these reactions regress on their own within a few hours)

Slow healing of skin wounds, skin atrophy, striae, acne, flaking, folliculitis, hirsutism, hypopigmentation, irritation, dryness, thinning and hypersensitivity skin, telangiectasia

When using high doses and / or with prolonged administration, hydrocortisone and lidocaine can be absorbed in quantities sufficient to develop systemic effects.

Inhibition of the adrenal cortex (when prescribed in high doses and / or long-term use)

Eating disorders and metabolic disorders

Impaired glucose tolerance and increase the required dose of oral hypoglycemic drugs

Sodium and water retention, decreased potassium concentration, hypokalemic alkalosis, leukocytosis

Osteoporosis, growth retardation in children, development of steroid myopathy and aseptic osteonecrosis

Increased appetite, nausea, general weakness, development of peptic ulcers (in some cases with perforation and bleeding), gastric bleeding, pancreatitis, esophagitis

Increased intracranial pressure with subsequent development of papillary edema optic nerve, convulsions, dizziness, headache, insomnia, mental disorders

Corneal ulceration, increased intraocular pressure, glaucoma, exophthalmos, increased risk of cataracts in pediatric patients

Development of intracardiac conduction disorders and peripheral vasodilation, hypertension, heart failure

Thromboembolism

Opportunistic infections, exacerbation of latent tuberculosis

Hypersensitivity

After stopping the administration of steroids, withdrawal symptoms develop: fever, myalgia, arthralgia, adrenal insufficiency.

Contraindications

Hypersensitivity to the active substance or excipients of the drug

Intra-articular infections

Cushing's syndrome

Predisposition to venous thrombosis

Sepsis without adequate antibiotic therapy

Treatment of an Achilles tendon injury

Pregnancy and lactation

Drug Interactions"type="checkbox">

Drug Interactions

With Addison's disease, the simultaneous administration of hydrocortisone and barbiturates is contraindicated, since this can provoke an adrenal crisis.

Required Special attention when administered simultaneously with the following drugs:

Barbiturates, phenylbutazone, phenytoin, rifampicin - these drugs may reduce the effectiveness of corticosteroids

Oral hypoglycemic drugs (dose modification may be required to correct the hyperglycemic effect of corticosteroids)

Co-administration of corticosteroids may either increase or decrease the effectiveness of anticoagulants.

With the abolition of corticosteroids, there may be an increase in the concentration of salicylates, in some cases with the development of intoxication. Since salicylates and corticosteroids have an ulcerogenic effect, their simultaneous use increases the risk of ulceration and the development of gastrointestinal bleeding.

Combination with amphotericin, diuretics, theophylline, digoxin, cardiac glycosides - may increase the risk of hypokalemia;

Reception oral contraceptives May increase serum corticosteroid concentrations

Antihypertensive drugs - glucocorticoids reduce the effectiveness of antihypertensive therapy

Mifepristone reduces the effectiveness of corticosteroids

special instructions"type="checkbox">

special instructions

Intra-articular administration of corticosteroids is accompanied by a significant increase in the risk of an inflammatory response of joint tissues, including the development bacterial infection when infected. Therefore, especially careful observance of the rules of asepsis is required for intra-articular administration of steroid drugs.

During treatment with corticosteroids (especially at high doses), vaccination is contraindicated due to the possibility of insufficient production of antibodies and an increased risk of neurological complications. These conditions can lead to reduced immunity. The introduction of Hydrocortisone-Richter in normal or high doses can lead to an increase in blood pressure, salt and water retention, and may increase potassium excretion. All corticosteroids increase the rate of calcium excretion. With latent tuberculosis, Hydrocortisone-Richter can only be prescribed in combination with anti-tuberculosis drugs. With the development of systemic infections, Hydrocortisone-Richter can only be prescribed in combination with specific drugs (for example, antibiotics). It is necessary to adjust the dose of oral hypoglycemic drugs and anticoagulants in case of simultaneous reception with corticosteroids. When administered in combination with diuretics, control of water and electrolyte balance is required. Potassium supplements may be required to prevent hypokalemia. absolute reading is long-term therapy. Administration of corticosteroids slows growth in children and adolescents. Therefore, it is necessary to prescribe the minimum effective dose and use courses of minimum duration. Cancellation of the drug should be carried out after a gradual dose reduction. During therapy, it is necessary to monitor blood pressure, general analysis urine and perform stool tests for occult blood. The elderly are characterized by a high incidence of adverse reactions.

When prescribing corticosteroids, mandatory monitoring is required in the following cases:

Diabetes mellitus (or family history of diabetes)

osteoporosis (especially high risk disease characterized by postmenopausal women)

Instructions for use HYDROCORTISONE-RICHTER
Composition of the drug HYDROCORTISONE-RICHTER
Indications for HYDROCORTISONE-RICHTER
Storage conditions of the drug HYDROCORTISONE-RICHTER
Shelf life of the drug HYDROCORTISONE-RICHTER

ATC code: Hormones for systemic use (excluding sex hormones and insulins) (H) > Corticosteroids for systemic use (H02) > Corticosteroids for systemic use (H02A) > Glucocorticoids (H02AB) > Hydrocortisone (H02AB09)

Release form, composition and packaging

susp. microcrystalline for injections. 125 mg + 25 mg / 5 ml: vial. 1 PC.
Reg. No: 892/94/99/02/04/09/15 dated 01/14/2015 - Valid

Suspension microcrystalline for injections white or almost white color, easily shaken, with a characteristic odor.

Excipients: propyl parahydroxybenzoate, methyl parahydroxybenzoate, sodium chloride, disodium phosphate dodecahydrate, sodium dihydrogen phosphate dihydrate, povidone, polysorbate 80, N,N-dimethylacetamide, water for injection.

5 ml - colorless glass bottles (1) - cardboard boxes.

Description medicinal product HYDROCORTISONE-RICHTER was created in 2010 on the basis of instructions posted on the official website of the Ministry of Health of the Republic of Belarus.

pharmachologic effect

Hydrocortisone is a moderately active anti-inflammatory glucocorticoid. Lidocaine is a membrane stabilizing, topical pain reliever. Per a short time soothes the pain.

From the clinical point of view, there are no other important results, except for those noted in the generalized characteristics of the drug.

Pharmacokinetics

Pharmacokinetic studies have not been conducted with suspension for injection. Topically applied hydrocortisone can be absorbed and exhibit systemic effects. More than 90% of hydrocortisone binds to plasma proteins. It passes through the placental barrier. Hydrocortisone is metabolized in the liver into the forms tetrahydrocortisone and tetrahydrocortisol. These metabolites are excreted in the urine in conjugated form.

In reproductive tests on animals, the fetotoxic effect of hydrocortisone was revealed, and malformations (cleft palate), as well as a significant delay in the growth and development of offspring, were identified.

Despite the fact that in humane practice such phenomena were not found, with long-term use hydrocortisone may increase the risk of intrauterine growth retardation.

Lidocaine is rapidly absorbed from the mucous membranes and from the affected skin surface. He is in to a large extent binds to plasma proteins. The half-life is 1-2 hours. Lidocaine is metabolized mainly in the liver. It crosses the placenta, crosses the blood-brain barrier, is excreted in mother's milk.

Indications for use

Osteoarthritis affecting few joints, monoarthrosis of some joints (knee, elbow, hip), arthritis of rheumatic or other etiology (with the exception of tuberculous and gonorrheal arthritis), periarthritis (in particular of the shoulder joint), bursitis, epicondylitis, tendovaginitis. The drug is indicated for administration before surgery on ankyloid (ossified) joints, then for local supplementation of general corticosteroid therapy.

Dosing regimen

Adults: depending on the size of the joint and the severity of the disease, 5-50 mg intra- or periarticularly.

Children: 5-30 mg per day, divided into several times.

Elderly: In old age side effects corticosteroid therapy may be more intense.

No more than three joints can be injected within 24 hours. The course of therapy can be carried out at three-week intervals. When the drug is administered intra-articularly, hydrocortisone can adversely affect hyaline cartilage, therefore, within one year, one joint can be treated no more than three times. The drug should not be injected directly into the tendon, therefore, with tendonitis, the drug must be injected into the tendon sheath. The drug should not be used to treat the Achilles tendon. The drug must not be used for systemic treatment(for the treatment of the whole organism).

Side effect

Like other locally applied intra-articular steroid drugs, side effects occur in the form of swelling and pain primarily at the injection site. Usually, these phenomena spontaneously disappear within a few hours after the administration of the drug. Others may appear skin signs:

delayed wound healing, skin atrophy, stripes, acne, pruritus, folliculitis, hirsutism, hypopigmentation, irritation, drying, thinning and sensitivity of the skin, as well as the expansion of skin capillaries.

Especially when the drug is administered in a large dose, long time must be reckoned with systemic actions corticosteroid and lidocaine:

Endocrine system and metabolism. Adrenal suppression may occur, especially with prolonged use or high doses. Due to protein catabolism, a negative nitrogen balance can be observed. Carbohydrate tolerance worsens, and the need for an antidiabetic drug increases.

Exchange of water and electrolytes. Sodium and water retention, potassium loss, hypokalemic alkalosis, hypertension, and heart failure may occur.

Musculoskeletal system. Corticosteroids can cause osteoporosis and may stunt a child's growth. Steroid myopathy and aseptic necrosis may develop.

Gastrointestinal tract. A peptic ulcer of the stomach or duodenum may appear with bleeding and perforation, stomach bleeding, pancreatitis, esophagitis.

Central nervous system. There may be an increase in intracranial pressure, with swelling of the nipple of the optic nerve (a symptom of congestive nipple), convulsions, dizziness, headache, insomnia, mental disorders.

Eyes. Corneal ulcer, increased intraocular pressure, glaucoma, exophthalmos may occur. AT childhood, the possibility of cataracts is greater.

The cardiovascular system. If locally administered lidocaine is absorbed, it can cause conduction disturbances or peripheral vasodilation.

Other. Opportunistic infections, exacerbation of latent tuberculosis, leukocytosis, hypersensitivity, thromboembolism, increased appetite, nausea, and poor health may appear.

Possible signs at the end of a course of corticosteroid therapy. Fever, myalgia, arthralgia, adrenal insufficiency.

Contraindications for use

Hypersensitivity to any ingredient of the drug; infected joint; first trimester of pregnancy; the presence of Cushing's syndrome; susceptibility to thromboembolic disease, systemic infection without targeted therapy; Achilles tendon treatment.

Use during pregnancy and lactation

The use of topical corticosteroids in pregnant animals has been shown to cause fetal harm (eg:

the appearance of the cleft palate, impaired intrauterine development).

There is no data on the safety of the use of these drugs during pregnancy, therefore, in the first trimester of pregnancy, the drug can not be used, after which the drug can be used after carefully weighing the benefits / risks of taking. Available small opportunity the appearance of a cleft palate or malformation.

Lactation

Both the corticosteroid and lidocaine are excreted in the mother's milk, so the corticosteroid can interfere with the baby's adrenal glands and cause growth retardation.

special instructions

An intra-articularly administered corticosteroid may increase the chance of recovery inflammatory processes. With the introduction of the drug, bacterial infection of the joint can be caused, so the drug can only be administered under aseptic conditions.

antibiotic, antiviral agents). During the course of corticosteroid therapy, it is advisable to re-determine therapeutic dose oral antidiabetic agents and anticoagulants. With the simultaneous use of corticosteroids with diuretics, it is necessary to strictly monitor the exchange of electrolytes (potassium replacement). With prolonged use of hydrocortisone, potassium replacement may be necessary to prevent hypokalemia. Corticosteroids retard the growth of children in childhood and adolescence. It is suggested to enter the minimum effective dose, and apply the drug in the shortest possible time. The course of therapy should be completed with a gradual decrease in the dose of the drug. During the course of therapy, it is advisable to regularly measure blood pressure, and conduct a study of urine and feces. In old age, the likelihood of side effects is higher.

The course of hydrocortisone therapy should be continued with caution: diabetes mellitus or family history of diabetes mellitus, osteoporosis (higher risk among postmenopausal women), hypertension, chronic psychotic reactions, history of tuberculosis, glaucoma, steroid myopathy, gastric ulcer, or duodenum, with epilepsy, in the presence of herpes, in the presence of herpes on the eye (due to the risk of corneal perforation) and in chicken pox.

The effect of the drug on driving vehicles and on the ability to drive machines of increased injury. There is no evidence that the drug would affect the driving of vehicles and the ability to drive machines of increased injury.

Overdose

Overdose may manifest itself in local and systemic signs, depending on the amount of corticosteroid and lidocaine ingested. There is no specific antidote, symptomatic therapy is suggested.

drug interaction

Patients with Addison's disease should not be prescribed the drug together with barbiturates due to the possibility of a crisis. Corticosteroids can be taken with caution:

with barbiturates, with phenylbutazone, with phenytoin and rifampicin (the effectiveness of corticosteroids is reduced);
with oral antidiabetic agents (due to a decrease in effectiveness, it may be necessary to increase the dose of antidiabetic agents);
with anticoagulants (the anticoagulant effect may change: it may increase or decrease);
with salicylates (after completion of corticosteroid therapy, the level of salicylates in the blood may increase, causing intoxication; both drugs are ulcerogenic, therefore, when they are combined topical application may increase the risk of gastrointestinal bleeding or ulceration);
with amphotericin, with diuretics, with theophylline, with digoxin, with cardiac glycosides (the risk of hypokalemia increases);
with oral contraceptives(the concentration of corticosteroids in the blood increases);
with antihypertensive agents (corticosteroids act against antihypertensive agents);
with mifepristone (the effectiveness of corticosteroids decreases).

Hydrocortisone-Richter microcrystalline suspension for injection is a suspension, therefore, it cannot be injected into a vein; when using it, it is strictly forbidden to dilute the suspension with infusion solutions.

GEDEON RICHTER OJSC, representative office, (Hungary)

Self-medication can be harmful to your health.
It is necessary to consult a doctor, and also read the instructions before use.

Hydrocortisone-richter: instructions for use

Compound

Propyl parahydroxybenzoate, methyl parahydroxybenzoate, sodium chloride, disodium phosphate dodecahydrate, sodium dihydrogen phosphate dihydrate, povidone, polysorbate 80, N.N-dimethylacetamide, water for injection.

Description

pharmachologic effect

Hydrocortisone is a moderately active anti-inflammatory glucocorticoid. Lidocaine is a membrane stabilizing, topical pain reliever. Relieves pain in a short amount of time.

Pharmacokinetics

Despite the fact that such phenomena have not been found in humane practice, with prolonged use of hydrocortisone, the risk of intrauterine growth retardation may increase.

Lidocaine is rapidly absorbed from the mucous membranes and from the affected skin surface. It is highly bound to plasma proteins. The half-life is 1-2 hours. Lidocaine is metabolized mainly in the liver. It passes through the placenta, through the blood-brain barrier, is excreted in breast milk.

Indications for use

Contraindications

Hypersensitivity to any ingredient of the drug; infected joint; first trimester of pregnancy; the presence of Cushing's syndrome; tendency to thromboembolic diseases, systemic infectious disease without targeted therapy; Achilles tendon treatment.

Pregnancy and lactation

The use of topical corticosteroids in pregnant animals has been proven to cause fetal damage (eg, cleft palate, intrauterine development).

There is no data on the safety of the use of these drugs during pregnancy, therefore, in the first trimester of pregnancy, the drug can not be used, after which the drug can be used after carefully weighing the benefits / risks of taking. There is a small possibility of a cleft palate or malformation.

Lactation

Both the corticosteroid and lidocaine are excreted in the mother's milk, so the corticosteroid can interfere with the baby's adrenal glands and cause growth retardation.

Dosage and administration

Adults: depending on the size of the joint and the severity of the disease, 5-50 mg intra- or periarticularly.

Children: 5-30 mg per day, divided into several times.

Elderly: In the elderly, the side effects of corticosteroid therapy may be more intense.

No more than three joints can be injected within 24 hours. The course of therapy can be carried out at three-week intervals. When the drug is administered intra-articularly, hydrocortisone can adversely affect hyaline cartilage, therefore, within one year, one joint can be treated no more than three times. The drug should not be injected directly into the tendon, therefore, with tendonitis, the drug must be injected into the tendon sheath. The drug should not be used to treat the Achilles tendon. The drug can not be used for systemic treatment (for the treatment of the whole body).

Side effect

Like other locally applied intra-articular steroid drugs, side effects occur in the form of swelling and pain, primarily at the injection site. Usually, these phenomena spontaneously disappear within a few hours after the administration of the drug. Other skin signs may appear: delayed wound healing, skin atrophy, streaks, acne, pruritus, folliculitis, hirsutism, hypopigmentation, irritation, drying, thinning and sensitivity of the skin, and dilation of skin capillaries.

Especially with the introduction of the drug in a large dose, for a long time it is necessary to reckon with the systemic effects of corticosteroid and lidocaine:

Endocrine system and metabolism

Adrenal suppression may occur, especially with prolonged use or high doses. Due to protein catabolism, a negative nitrogen balance can be observed. Carbohydrate tolerance worsens, and the need for an antidiabetic drug increases.

Water and electrolyte exchange

Sodium and water retention, potassium loss, hypokalemic alkalosis, hypertension, and heart failure may occur.

Musculoskeletal system

Corticosteroids can cause osteoporosis and may stunt a child's growth. Steroid myopathy and aseptic necrosis may develop.

Gastrointestinal tract

There may be a peptic ulcer of the stomach or duodenum with bleeding and perforation, gastric bleeding, pancreatitis, esophagitis.

central nervous system

There may be an increase in intracranial pressure, with swelling of the nipple of the optic nerve (a symptom of congestive nipple), convulsions, dizziness, headache, insomnia, mental disorders.

Corneal ulcer, increased intraocular pressure, glaucoma, exophthalmos may occur. In childhood, the possibility of cataracts is greater.

The cardiovascular system

If locally administered lidocaine is absorbed, it can cause conduction disturbances or peripheral vasodilation.

Opportunistic infections, exacerbation of latent tuberculosis, leukocytosis, hypersensitivity, thromboembolism, increased appetite, nausea, and poor health may appear.

Possible signs at the end of corticosteroid therapy Fever, myalgia, arthralgia, adrenal insufficiency.

Overdose

Overdose may manifest itself in local and systemic signs, depending on the amount of corticosteroid and lidocaine ingested.

There is no specific antidote, symptomatic therapy is suggested.

Interaction with other drugs

Patients with Addison's disease should not be prescribed the drug together with barbiturates due to the possibility of a crisis.

Corticosteroids can be taken with caution:

With barbiturates, with phenylbutazone, with phenytoin and rifampicin (the effectiveness of corticosteroids is reduced);

With oral antidiabetic agents (due to a decrease in effectiveness, it may be necessary to increase the dose of antidiabetic agents);

With anticoagulants (the anticoagulant effect may change: it may increase or decrease);

With salicylates (after completion of corticosteroid therapy, the level of salicylates in the blood may increase, causing intoxication; both drugs are ulcerogenic, therefore, when they joint application may increase the risk of gastrointestinal bleeding or ulceration);

With amphotericin, with diuretics, with theophylline, with digoxin, with cardiac glycosides (the risk of hypokalemia increases);

With oral contraceptives (the concentration of corticosteroids in the blood increases);

With antihypertensive agents (corticosteroids act against antihypertensive agents);

With mifepristone (the effectiveness of corticosteroids decreases).

Application features

Intra-articularly administered corticosteroid may increase the possibility of recurrence of inflammatory processes. With the introduction of the drug, bacterial infection of the joint can be caused, so the drug can only be administered under aseptic conditions.

Active immunization should not be performed during corticosteroid therapy (especially when high doses of corticosteroids are administered), due to the increased possibility of neurological complications due to the lack of antibody production. During therapy with corticosteroids, the body's resistance may decrease, and the body's ability to localize infected areas of the body may decrease. The introduction of generally accepted and large doses of corticosteroids can cause an increase in blood pressure, can increase the retention of sodium and water in the body with a forced release of potassium from the body. All corticosteroids increase the excretion of calcium from the body. In the presence of latent tuberculosis, the drug can be administered using anti-tuberculosis drugs. In the presence of a systemic infection, the drug can be administered only with specific therapy (eg: antibiotic, antiviral agents). During the course of corticosteroid therapy, it is advisable to re-determine the therapeutic dose of oral antidiabetic agents and anticoagulants. With the simultaneous use of corticosteroids with diuretics, it is necessary to strictly monitor the exchange of electrolytes (potassium replacement). With prolonged use of hydrocortisone, potassium replacement may be necessary to prevent hypokalemia. Corticosteroids retard the growth of children in childhood and adolescence. It is proposed to administer the minimum effective dose and use the drug in the shortest possible time. The course of therapy should be completed with a gradual decrease in the dose of the drug. During the course of therapy, it is advisable to regularly measure blood pressure, and conduct a study of urine and feces. In old age, the likelihood of side effects is higher.

The course of hydrocortisone therapy should be continued with caution: in case of diabetes mellitus or in the presence of a patient with diabetes mellitus in the family, in osteoporosis (among postmenopausal women the risk is higher), in hypertension, in the presence of chronic psychotic reactions, in the presence of tuberculosis in the anamnesis of diseases, in glaucoma, with steroid myopathy, with gastric or duodenal ulcers, with epilepsy, with herpes, with herpes on the eye (due to the risk of corneal perforation) and with chickenpox.

Precautionary measures

Release form

5 ml suspension in a colorless glass vial for injection with a rim (hydrolytic class I.), with a bromobutyl rubber stopper and a FLIPP-OFF combination cap.

One bottle (5 ml) in a cardboard box with attached instructions for use.

The instruction for the preparation Hydrocortisone-Richter is included in the catalog medicines presented on our information site. If you have information about the effectiveness of this medication, please leave a review. Be healthy!

Existing release forms, price

ointment 2.5% tube 5g : 100 rub.
susp d/i 125mg/5ml fl 5ml: 120 rub.

ointment 2.5% tube 20g : price not available

Hydrocortisone
Hydrocortisone Nycomed
Hydrocortisone-AKOS
Hydrocortisone-Pos N1%
Hydrocortisone-Pos N2.5%
Hydrocortisone acetate
Hydrocortisone ointment
Cortef
Laticort
Locoid
Solu Cortef

Indications for use

Seasonal allergic rhinitis, severe attack bronchial asthma, asthmatic condition, serum sickness, hypersensitivity reactions to drug administration; emergency conditions- spontaneous and orthostatic hypotension, collapse in Addison's disease, myocardial infarction, hemorrhagic stroke, Morgagni-Adams-Stokes syndrome, coma in violation of cerebral circulation and inflammatory diseases brain, hypothyroidism and hepatic coma, acute adrenal insufficiency (Waterhouse-Frideriksen syndrome), multiple bleeding, acute liver failure in case of poisoning, laryngeal edema in allergic and inflammatory lesions, burns and injuries, poisoning with vitamin D, strong acids, organophosphates, quinine, chlorine, post-transfusion complications, Mendelssohn's syndrome, snake and scorpion stings, anaphylactic, hemorrhagic, cardiogenic and traumatic shock; endocrine diseases- primary or secondary insufficiency adrenal cortex (preferably natural cortisone and hydrocortisone, synthetic analogues should be used in combination with mineralocorticoids), adrenogenital syndrome with sodium loss, thyroiditis, hypercalcemia associated with cancer; rheumatic diseases - psoriatic, rheumatoid, juvenile rheumatoid and acute gouty arthritis, ankylosing spondylitis, acute and subacute bursitis, humeroscapular periarthritis, etc., systemic lupus erythematosus, acute rheumatic carditis, dermatomyositis; inflammatory and allergic diseases skin, incl. eczema, dermatitis: allergic and atopic, bullous herpetiform, exfoliative, seborrheic, contact; itchy dermatoses, pemphigus, Stevens-Johnson syndrome, mycosis fungoides, psoriasis; in ophthalmology: allergic conjunctivitis, blepharitis, eyelid dermatitis, keratitis, corneal ulcer, herpes zoster, iritis, iridocyclitis, chorioretinitis, anterior segment inflammation, diffuse posterior uveitis and choroiditis, optic neuritis, sympathetic ophthalmia, condition after surgical interventions; sarcoidosis, Loeffler's syndrome, berylliosis, fulminant or disseminated pulmonary tuberculosis, aspiration pneumonitis; idiopathic thrombocytopenic purpura in adults, autoimmune hemolytic and congenital hypoplastic anemia, erythroblastopenia, palliative therapy for leukemia and lymphomas in adults, acute leukemia in children; nephrotic syndrome without signs of uremia (to reduce proteinuria and induce diuresis), severe exacerbations non-specific ulcerative colitis and Crohn's disease tuberculous meningitis with subarachnoid block, trichinosis with neurological and myocardial manifestations, acute manifestations multiple sclerosis, disseminated lung cancer (adjunctive therapy). Intra-articular and periarticular administration (hydrocortisone acetate): reactive synovitis (including deforming osteoarthritis), rheumatoid arthritis, acute and subacute bursitis, acute gouty arthritis, epicondylitis, acute nonspecific tendosynovitis, syndrome carpal tunnel, post-traumatic osteoarthritis. In / to with keloids, localized hypertrophic, infiltrative, inflammatory lesions, lichen planus, psoriatic plaques, granuloma annulare, neurodermatitis, discoid lupus erythematosus, diabetic lipid necrobiosis, alopecia areata, cystic tumors of the aponeurosis and tendons; differential diagnosis idiopathic and drug-induced leukopenia.

Dosage and administration

[susp d / and 25mg + 5mg / ml 5ml] Intramuscularly, intra- and periarticularly. Adults: intramuscularly - 125-200 mg, intra- and periarticularly - 5-25 mg or more. Children: (intra- and periarticularly) - from 3 months. up to 1 year - 25 mg, 1-6 years - 25-50 mg, 6-14 years - 50-75 mg. [ointment 2.5% 20g], [ointment 2.5% 5g] Apply a thin layer on the skin to the affected areas 2-3 times a day. In chronic lichenified, hypertrophic skin manifestations used under occlusive dressings, changed every 24-48 hours.

Contraindications

Hypersensitivity, systemic fungal infections, acute psychoses, severe forms arterial hypertension, decompensated diabetes mellitus severe course, peptic ulcer of the stomach and duodenum in the acute stage, infectious (tuberculosis, mycosis, viral diseases, syphilis, etc.) and ulcerative lesions skin, wounds, neoplastic diseases skin, osteoporosis, Cushing's disease, thrombophilic conditions, kidney failure, herpetic fever, viral and fungal eye diseases, eye tuberculosis, trachoma, damage to the eye epithelium, AIDS, previous arthroplasty, conditions after intestinal anastomosis, pregnancy, breastfeeding, younger children.

Side effects

Headache, dizziness, euphoria, insomnia, depression, psychosis; allergic reactions(up to anaphylaxis); with prolonged use: edematous syndrome, pruritus, hyperpigmentation, convulsions, Cushing's syndrome, decreased glucose tolerance, hyperglycemia, steroid diabetes, adrenal insufficiency, impaired menstrual cycle, hypokalemia, hypokalemic alkalosis, hyperuricemia (especially in acute leukemia), memory impairment, increased intracranial pressure, myopathy, arthralgia, arthropathy, osteoporosis, arterial hypertension, vasculitis, exacerbation peptic ulcer stomach and duodenum, formation of posterior subcapsular cataract, glaucoma with possible damage optic nerve and increased risk viral and fungal eye infections, activation of latent foci of infection. With prolonged topical use, especially with impenetrable dressings or on large areas of the skin: systemic side effects, local irritation may occur.

Pharmacological group

Agents with glucocorticosteroid activity

pharmachologic effect

Anti-inflammatory, anti-allergic, anti-shock, desensitizing, immunosuppressive, antiexudative, antipruritic. Well absorbed after oral administration. The maximum concentration is reached in 1 hour. It penetrates well through mucous membranes and histohematic barriers. After application to the skin, it accumulates in the epidermis. Intensively metabolized in the liver. The absorbed part is metabolized in the epidermis and then in the liver. Metabolites and a small part of hydrocortisone are excreted in the urine or bile. Inhibits hypersensitivity reactions, proliferative and exudative processes in connective tissue, at the site of inflammation. Reduces local hyperemia and hyperthermia of the skin. Violates the synthesis of prostaglandin and the release of macrophage chemotactic factor, inhibits the activation of tissue kinins. Reduces the migration of macrophages and lymphocytes to the focus of inflammation. Suppresses alteration, exudation and proliferation. It inhibits the production of collagenase and activates the synthesis of protease inhibitors. Blocks synthesis and release from sensitized mast cells and basophils of histamine and other biologically active substances, suppresses various stages immunogenesis without mitosostatic effect. Increases the level of glycogen in the liver, inhibits the release of sodium and water, increases - potassium, affects protein (causes a negative nitrogen balance by increasing catabolism) and lipid metabolism. Increases the volume of circulating blood, tissue hydrophilicity, increases blood pressure. With prolonged use, atrophy of the adrenal cortex develops, the formation of ACTH and thyroid-stimulating hormone of the pituitary gland is inhibited.

Compound

Active ingredient: Hydrocortisone.

Interaction

Barbiturates, antiepileptics and antihistamines reduce efficiency. NSAIDs increase the risk of ulceration in the gastrointestinal tract, paracetamol - hepatotoxicity. Reduces the activity of salicylates, antidiabetic agents, increases - anticoagulants. Cardiac glycosides and non-potassium-sparing diuretics potentiate hypokalemia, anabolic steroid- increasing the hydrophilicity of tissues. When combined with amphotericin B, the development of dilated myocardial damage and heart failure is possible.

special instructions

During the treatment period, vaccination is not recommended. The introduction of large doses is permissible for no more than 48-72 hours. Intra-articular administration should be carried out no more than 1 time in 3 weeks. With prolonged therapy, it is recommended to monitor the content of potassium in the blood and regular ECG studies. To prevent the development of secondary hypocorticism caused by the withdrawal of treatment, the dose should be reduced gradually. Glucocorticoids may mask some manifestations infectious process, perhaps the addition of new infections due to a decrease in resistance. When treated with corticosteroids or in combination with other drugs that suppress cellular, humoral immunity or neutrophil function can be manifested by various viral, bacterial, fungal, protozoal infections and helminthic infestations that were previously latent. The risk of infection and its more severe course increases in proportion to the increase in the dose of the drug.

Storage conditions

[susp d / and 25mg + 5mg / ml 5ml] List B. In a dark place at a temperature of 15-30 ° C in a well-closed container. [ointment 2.5% 20g], [ointment 2.5% 5g] At 5-15 °C.