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liothyronine

Toby is assigned in the form of inhalations. When inhaled tobramycin formulation preferably remains in the airway epithelium does not penetrate. Bioavailability depends on the technique of tobramycin inhalation and respiratory state.

Ten minutes after inhalation liothyronine average concentration of tobramycin in the sputum . Tobramycin does not accumulate in the sputum. The concentration varies widely. After 2 hours after inhalation tobramycin concentration is 14% of the concentration after 10 minutes.

Average serum concentration of tobramycin one hour after inhalationcystic fibrosis patients.

After 20 weeks of treatment  average tobramycin concentration one hour after inhalation equal.

Report mostly in the sputum, a small part – by glomerular filtration. The half-life of tobramycin from serum -primerno 2:00.

Indications
Long-term treatment of chronic pulmonary infections caused by Pseudomonas aeruginosa (Pseudomonas aeruginosa) in patients with cystic fibrosis aged 6 years and older.

Contraindications:
Hypersensitivity to any aminoglycoside.
Pregnancy and lactation.
Children under 6 years of age.

Precautions
Toby with caution in patients with impaired renal function, vestibular system, disorders of neuromuscular conduction and hearing pathology.

Toby appoint patients with severe hemoptysis in active form follows only if the benefit of treatment outweighs the risk of liothyronine stimulation of hemoptysis.

Pregnancy and lactation
Aminoglycoside pass the blood-placental barrier and can cause fetal damage  in the appointment of pregnant women.

Patients taking  pregnant or planning a pregnancy during treatment Toby should be warned about the potential risk of adverse effects on the fetus.

Application  during pregnancy and lactation is possible only in cases where the potential benefit to the mother outweighs the risk of harmful effects to the fetus.

It is not known whether tobramycin passes into breast milk  inhalation. However, if necessary, use during lactation should stop breastfeeding.

Dosage and administration
Only for inhalation!

The recommended dosage for adults and children 6 years – one ampoule (300 mg tobramycin) twice a day for 28 days. The interval between doses should be about 12 hours, but not less than 6 hours. After 28 days of therapy, patients should stop taking the drug for 28 days. It is necessary to comply with such 28-day active treatment cycle alternating with 28-day cycles of rest, including standard therapy.

The contents of one ampoule should be moved into the nebulizer and inhaled about 15 minutes, using a hand sprayer reusable liothyronine with an appropriate compressor. A suitable compressor is considered that when connected . Follow the manufacturer’s instructions for care and use of the nebulizer and compressor.

Inhalation Toby patient must sit or stand up straight and breathe normally through the mouthpiece of the nebulizer. Nose clip to help the patient breathe through the mouth. The patient should continue to comply with the standard regimen of chest physiotherapy procedures. In clinical need should continue to receive appropriate bronchodilator drugs. If the patient is receiving a number of different procedures, they are recommended as follows: receiving bronchodilator drugs, chest physiotherapy, inhalation of other medicinal products, and finally, Tobi inhalation.

Side effect
From the digestive system: loss of appetite, nausea, vomiting, diarrhea, sores and candidiasis in the oral cavity.
From the side of hematopoiesis: rarely lymphadenopathy.
Nervous system: dizziness, drowsiness.
From the senses: ototoxicity (ringing, roar in the ears, ear pain, partial or complete loss of hearing), vestibular and labyrinth disorders (impaired coordination, dizziness, nausea, vomiting, unsteadiness), distortion of taste.
From the urinary system: not marked renal dysfunction (inhalation use of tobramycin) , but the group of aminoglycosides has liothyronine a nephrotoxic effect. If a patient receiving Toby develops renal failure, treatment should be discontinued until such time as the serum concentration of tobramycin is reduced to 2 mg / mL.
The respiratory system: voice changes, shortness of breath, laryngitis, voice changes, increased cough, pharyngitis, bronchospasm, lung disorder, increased sputum, hemoptysis, epistaxis, sinusitis, asthma, hypoxia, hyperventilation.
Allergic reactions: itching, skin redness, hives, angioedema.

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cytomel

If overdose with symptoms typical of hyperthyroidism: palpitations, cardiac arrhythmias, heart pain, anxiety, tremors, insomnia, sweating, increased appetite, weight loss, diarrhea. Depending on the severity of the symptoms your doctor may be recommended to decrease the daily dose, a break in cytomel treatment for a few days, the appointment of beta-blockers. After the disappearance of side effects of treatment should be started cautiously with lower doses.

Interaction with other drugs
Tireotom increases the effects of anticoagulants, which may require a reduction in their dose.
The use of tricyclic antidepressants with thyrotomy can lead to increased action of antidepressants.
Thyroid hormones may increase the need for insulin and oral hypoglycemic drugs. More frequent monitoring of blood glucose is recommended during the beginning of treatment and when changing its dosing regimen. Cytomel reduces the effect of cardiac glycosides.
With simultaneous use of cholestyramine, colestipol and aluminum hydroxide reduces the plasma concentration of the drug due to inhibition of absorption of it into the gut.
While the use of anabolic steroids, asparaginase, tamoxifen possible pharmacokinetic interaction at the level of binding to the protein.
In an application with phenytoin, salicylates, clofibrate, furosemide in high doses (250 mg) increases the content of unbound proteins with thyroid hormone blood plasma.
Receiving estrogensoderjath drug content increases thyroxine binding globulin, which may increase the need for some patients thyrotomy. Growth Hormone while the use of
thyrotomy may accelerate the closure of the epiphyseal growth zones.
Receiving phenobarbital, carbamazepine and rifampicin may increase the clearance of levothyroxine and require increasing doses thyrotomy.

Cautions
In hypothyroidism, caused cytomel the defeat of the pituitary gland, it is necessary to find out whether there is a failure of the adrenal cortex simultaneously. In this case, the substitution therapy corticosteroids should be started before initiating treatment of hypothyroidism with thyroid hormone to prevent the development of acute adrenal insufficiency. The drug has no effect on the professional activity associated with driving vehicles and management mechanisms.

liothyronine sodium

When administered levothyroxine liothyronine sodium is absorbed almost exclusively in the upper small intestine. Absorbed 80% of the dose of the drug. Food intake reduces the absorption of levothyroxine. Maximum serum concentration is reached approximately 5-6 hours after ingestion. After absorption of more than 99% of the drug is bound to serum proteins (thyroxine-binding globulin, thyroxine binding prealbumin, and albumin). In various tissues occurs monodeyodirovanie levothyroxine about 80% to form triiodothyronine and inactive ingredients. Thyroid hormones are metabolized mainly in the liver, kidney, brain and muscles. A small amount of the drug undergoes deamination and decarboxylation as well as sulfuric acid and conjugated with glucuronic acid (in the liver).The metabolites are excreted in the urine and bile. The half-life of levothyroxine is 6-7 days. When thyrotoxicosis half-life is shortened to 3-4 days, and hypothyroidism is extended to 910 days. Liotironin . Absorption ingestion – 95% (4 hours). Relationship to plasma proteins – high. The half – 2.5 days.

Indications

  • hypothyroidism liothyronine sodium;
  • euthyroid goitre;
  • as replacement therapy and for the prevention of goiter recurrence after resection of the thyroid gland;
  • thyroid cancer (after surgery);
  • Graves’ disease: after reaching tireostatikami euthyroid state (a combination therapy).

Contraindications

  • Individual hypersensitivity to the drug;
  • untreated thyrotoxicosis;
  • acute myocardial infarction, angina III-IV functional class;
  • acute myocarditis;
  • untreated adrenal insufficiency.

Precautions
should be prescribed the drug for diseases of the cardiovascular system: ischemic heart disease (atherosclerosis, angina pectoris I-II functional class, history of myocardial infarction), heart failure, hypertension, tachycardia, tachyarrhythmia; diabetes, severe long-existing hypothyroidism, liothyronine sodium malabsorption syndrome (may require dose adjustment); elderly patients.

Use during pregnancy and lactation
During pregnancy and breast-feeding therapy with thyroid hormones, appointed about hypothyroidism, should be continued. During pregnancy, you want to increase the dose of the drug due to increased levels of thyroxine-binding globulin.
The use of the drug during pregnancy in combination with tireostatikami contraindicated, as may be necessary to increase the dose thyreostatics. Since tireostatiki unlike levothyroxine can cross the placenta, the fetus may develop hypothyroidism.
The amount of thyroid hormone secreted by breast milk during lactation (even during the treatment with high doses of the drug), is insufficient to cause any disorders in children. However, breast-feeding period, the drug should be taken with caution, strictly within the recommended doses under medical supervision.

Dosage and administration
The daily dose is determined individually, depending on indications. Hypothyroidism. Adults : Treatment starts with 1 tablet thyrotomy a day, then the dose may be increased to 1 tablet every 2-4 weeks until the maintenance daily dose is 2-5 tablets. Children : the selection of doses for long-term care into account body weight, height, and the child’s body surface. The average recommended maintenance dose is 2-2½ tablets a day thyrotomy. Euthyroid goiter . Adults : initial dose of 1-2 tablets per day, maintenance dose -3-6 tablets a day. Teenagers : the initial dose is 1-1½ tablets a day, maintenance dose – 2½-3½ tablets a day. Children : appoint ½-1 tablet per day. Preventing relapse after surgical treatment of goiter. Adults appoint 2-3 tablets a day. after surgery for cancer of the thyroid gland . The initial dose is 3 tablets a day, maintenance dose -. 6 tablets per day daily dose taken once chime, at least 30 minutes before breakfast without chewing and drinking plenty of fluids. The drug should be carried out regularly.The duration of treatment is determined by the form of the disease. Typically, in hypothyroidism and after about thyroidectomy thyroid cancer treatment liothyronine sodium is carried out over a lifetime. Duration of treatment with euthyroid goitre, as well as for the prevention of goiter recurrence after surgical treatment ranged from months or years to use throughout their lives.

Side effects
Common side effects are not observed When used properly, under the supervision of a physician.
There may be an allergic reaction, liothyronine sodium the progression of heart failure and angina.

cytomel t3

In an application with phenytoin, salicylates, dikumarol, clofibrate, furosemide in high doses (250 mg) increases the effects cytomel t3 as increases the content of unbound to proteins blood thyroid hormone plasma.
Enhances the effect of anticoagulants, which may require a reduction in their dose.
The use of tricyclic antidepressants cytomel t3 may lead to increased action of antidepressants.
Thyroid hormones may increase the need for insulin and oral hypoglycemic drugs. More frequent monitoring of blood glucose is recommended during the beginning of treatment and when changing its dosing regimen.
While the use of potassium-sparing diuretics Potassium iodide may increase potassium levels in the blood.
Reduces the effect of cardiac glycosides.
At the same time use of cholestyramine, colestipol and aluminum hydroxide reduces the plasma concentration of the drug due to inhibition of its absorption in the gut, so Tireokomb “is recommended to take 4-5 hours prior to receiving these drugs.
while the use of anabolic steroids, asparaginase, tamoxifen possible pharmacokinetic interaction at the level of binding with the protein.
Reception estrogensoderjath drug increases levels of thyroxine-binding globulin, which can increase demand for some patients. Somatropin while the use can speed up the closure of the epiphyseal growth zones.
Receiving phenobarbital, carbamazepine and rifampicin may increase levothyroxine clearance and demand increase  .

Cautions
When ischemic heart disease, heart failure or tachyarrhythmias require more frequent monitoring of thyroid hormone levels.
Particular caution should be exercised when administering the drug to elderly patients. The treatment they should be carried out with lower doses. In applying the drug in children with epilepsy, the likelihood of increasing the number of seizures.
Application  in patients with diabetes mellitus, diabetes insipidus or adrenal cortical insufficiency may lead to increased severity of these diseases. During this period, requires a careful selection of treatments for these diseases.
In hypothyroidism, caused the defeat of the pituitary gland, it is necessary to find out whether there is a failure of the adrenal cytomel t3 cortex simultaneously. In this case, the substitution therapy corticosteroids should be started before initiating treatment of hypothyroidism with thyroid hormone to prevent the development of acute adrenal insufficiency.
The drug has no effect on the professional activity associated with driving vehicles and management mechanisms.

 

cytomel dosage

When administered levothyroxine is absorbed almost exclusively in the upper small intestine (up to 80% of applied dose on an empty stomach). The maximum serum concentration achieved after cytomel dosage about 6 hours after ingestion. After absorption of more than 99% of the drug is bound to serum proteins (thyroxine-binding globulin, thyroxine binding prealbumin, and albumin). Therapeutic effect was observed within 3-5 days after the beginning of oral therapy. Levothyroxine is metabolized primarily in the liver, kidney, muscle, brain tissue.

The metabolites are excreted in the urine and bile. The half-life of levothyroxine is 6-7 days. After ingestion liothyronine is absorbed mainly in the small intestine in an amount of 78-95% of the dose. Maximum plasma concentration is achieved in about 2-3 days. Therapeutic effect stops after 7-9 days after the end of therapy. 90.7% liothyronine binds to thyroxine binding globulin in a small amount – from thyroxine binding prealbumin and albumin. During pregnancy or after treatment with estrogens is an increase in binding ability, in severe hypoproteinemia binding capacity may be reduced. Liothyronine is metabolized primarily in the liver, kidney, muscle, brain tissue. The half-life liothyronine -. 24 hours Absorbability inorganic iodine in the small intestine is almost 100%. Displayed iodine in urine.

Indications

 

  • hypothyroidism cytomel dosage;
  • Treatment of euthyroid goiter;
  • prevention of goiter recurrence after resection of the thyroid gland.Contraindications
  • Individual hypersensitivity to the drug;
  • hyperthyroidism;
  • acute myocardial infarction, angina III-1V functional class;
  • acute myocarditis;
  • untreated adrenal insufficiency;
  • dermatitis herpetiformis (Duhring’s disease).Precautions should be prescribed the drug for diseases of the cardiovascular system: ischemic heart disease (atherosclerosis, angina pectoris I-II functional class, history of myocardial infarction), heart failure, hypertension, tachycardia, tachyarrhythmia; diabetes mellitus, diabetes insipidus, a heavy long-existing hypothyroidism, malabsorption syndrome, elderly patients (may require dose adjustment).

    Use during pregnancy and lactation
    During pregnancy and breast-feeding therapy with thyroid hormones, appointed about hypothyroidism, should be continued. The amount of thyroid hormone secreted by breast milk during lactation (even during the treatment with high doses of the drug), is insufficient to cause any disturbances in the child. However, breast-feeding period, the drug should be taken with caution, strictly within the recommended doses under medical supervision.

    Dosage and administration
    The daily dose is selected individually by the attending physician based on clinical and laboratory data.
    Generally, treatment is initiated with  per day. Depending on the individual needs cytomel dosage of the initial dose can be gradually increased every 1-2 weeks prior to a maintenance dose of 1-2 tablets per day. In elderly patients with cardiovascular disease, patients with adrenocortical insufficiency and in patients with epilepsy, the period of selection of dose and adapting to it can be increased up to 4-6 weeks or more. All daily dose taken once in the morning at least 30 minutes before breakfast, not liquid, squeezed small amounts of liquid. The drug should be carried out regularly.
    The duration of the drug is determined by the attending physician. Patients are not recommended to independently modify or discontinue the treatment prescribed by your doctor.

    Side effects:
    When properly selected dose of medication side effects are not observed. There may be allergic reactions, progression of cardiac insufficiency and angina pectoris.
    Very rare hypersensitivity reactions in combination with the “iodine” rhinitis; yododerma, exfoliative dermatitis, angioedema; very rare – fever, iodine, iodine acne, swelling of the salivary glands. When adverse reactions reception  should be discontinued and to inform the treating physician.

    Overdose
    In case of overdose (especially with too rapid increase in dose at the beginning of treatment), symptoms of hyperthyroidism may occur: palpitations, irregular heartbeat, tremor of fingers, inner restlessness, insomnia, excessive sweating, weight loss, diarrhea. Depending on the severity of the symptoms your doctor may be recommended to decrease the daily dose, a break in treatment for a few days, the appointment of beta-blockers. After cytomel dosage the disappearance of side effects of treatment should be started cautiously with lower doses. In acute intoxication and overdose it is recommended to stop taking the drug and to conduct follow-up examination. Not recommended Tirostaticheskie funds. In applying the drug in very high doses it is shown holding a plasmapheresis.