Avelox tablets 400mg, No. 5

Infectious and inflammatory diseases in adults caused by microorganisms sensitive to the drug:

acute sinusitis;

exacerbation of chronic bronchitis;

community-acquired pneumonia (including caused by strains of microorganisms with multiple antibiotic resistance *);

uncomplicated infections of the skin and soft tissues;

complicated infections of the skin and subcutaneous structures (including an infected diabetic foot);

complicated intra-abdominal infections, including polymicrobial infections, incl. intraperitoneal abscesses;

uncomplicated inflammatory diseases of the pelvic organs (including salpingitis and endometritis).

The drug is administered orally at 400 mg 1 time / day. The tablets should be taken without chewing with plenty of water, regardless of food intake. Do not exceed the recommended dose.

The duration of treatment with Avelox when taken orally is determined by the severity of the infection and the clinical effect and is: with exacerbation of chronic bronchitis - 5-10 days; with community-acquired pneumonia, the total duration of stepwise therapy (intravenous administration followed by oral administration) is 7-14 days, first intravenously, then inside, or 10 days inside; for acute sinusitis and uncomplicated infections of the skin and soft tissues - 7 days; with complicated infections of the skin and subcutaneous tissues, the total duration of stepwise therapy (intravenous administration followed by oral administration) is 7-21 days; with complicated intra-abdominal infections, the total duration of stepwise therapy (intravenous administration of the drug followed by oral administration) is 5-14 days; for uncomplicated inflammatory diseases of the pelvic organs - 14 days.

The duration of treatment with Avelox can be up to 21 days. Changes in the dosage regimen in elderly patients is not required. The efficacy and safety of using moxifloxacin in children and adolescents has not been established. Patients with impaired liver function do not need to change the dosage regimen. In patients with impaired renal function (including in severe renal failure with CC? 30 ml / min / 1.73 m2), as well as in patients on continuous hemodialysis and long-term outpatient peritoneal dialysis, no change in the dosage regimen is required. In patients of different ethnic groups, no change in dosage regimen is required.

Pink film-coated tablets, matte, oblong, biconvex, beveled, engraved with 'BAYER' on one side and 'M400' on the other.

1 tab.

moxifloxacin hydrochloride 436.8 mg,?

which corresponds to the content of moxifloxacin 400 mg

Excipients: microcrystalline cellulose - 136 mg, croscarmellose sodium - 32 mg, lactose monohydrate - 68 mg, magnesium stearate - 6 mg.

• a history of tendon pathology that developed as a result of treatment with quinolone antibiotics;

• in preclinical and clinical studies, after the introduction of moxifloxacin, a change in the electrophysiological parameters of the heart was observed, which was expressed in the prolongation of the QT interval. In this regard, the use of moxifloxacin is contraindicated in patients of the following categories: congenital or acquired documented prolongation of the QT interval, electrolyte disturbances, especially uncorrected hypokalemia;

• clinically significant bradycardia; clinically significant heart failure with reduced left ventricular ejection fraction;

• a history of rhythm disturbances accompanied by clinical symptoms;

• moxifloxacin should not be used with other drugs that prolong the QT interval;

• due to the presence of lactose in the drug, its use is contraindicated in congenital lactose intolerance, lactase deficiency, glucose-galactose malabsorption (for tablets);

• due to the limited amount of clinical data, the use of moxifloxacin is contraindicated in patients with impaired liver function (class C according to the Child-Pugh classification) and in patients with an increase in transaminases more than 5 times higher than ULN;

• pregnancy;

• lactation (breastfeeding);

• age under 18;

• hypersensitivity to moxifloxacin, other quinolones or any other component of the drug.

• With caution, the drug should be prescribed for diseases of the central nervous system (including diseases suspicious of involvement of the central nervous system), predisposing to the occurrence of seizures and lowering the threshold of convulsive readiness; in patients with a history of psychosis and / or psychiatric illness; in patients with potentially proarrhythmic conditions such as acute myocardial ischemia and cardiac arrest, especially in women and elderly patients; with myasthenia gravis; with cirrhosis of the liver; when taken simultaneously with drugs that reduce the content of potassium; in patients with a genetic predisposition or an actual deficiency of glucose-6-phosphate dehydrogenase.

pharmachologic effect

Broad-spectrum antibacterial bactericidal drug, 8-methoxyfluoroquinolone. The bactericidal effect of moxifloxacin is due to the inhibition of bacterial topoisomerases II and IV, which leads to disruption of the processes of replication, repair and transcription of DNA biosynthesis of the microbial cell and, as a consequence, to the death of microbial cells.

Pharmacokinetics

Suction

After oral administration, moxifloxacin is absorbed quickly and almost completely. The absolute bioavailability is about 91%.

The pharmacokinetics of moxifloxacin when taken in a dose of 50 to 1200 mg once, as well as 600 mg / day for 10 days, is linear. After a single dose of moxifloxacin at a dose of 400 mg, Cmax in the blood is reached within 0.5-4 hours and is 3.1 mg / l. After oral administration of moxifloxacin at a dose of 400 mg 1 time / day, Cssmax and Cssmin are 3.2 mg / l and 0.6 mg / l, respectively. When moxifloxacin is taken with food, there is a slight increase in the time to reach Cmax (by 2 hours) and a slight decrease in Cmax (by about 16%), while the duration of absorption does not change. However, these data have no clinical significance, and the drug can be used regardless of the meal

Distribution

The equilibrium state is reached within 3 days. The binding to blood proteins (mainly albumin) is about 45%. Moxifloxacin is rapidly distributed in organs and tissues. Vd is approximately 2 l / kg. High concentrations of moxifloxacin, exceeding those in plasma, are created in lung tissue (including in epithelial fluid, alveolar macrophages), in the nasal sinuses (maxillary and ethmoidal sinuses), in nasal polyps, foci of inflammation (in the contents of blisters with skin lesions ). In the interstitial fluid and in saliva, moxifloxacin is determined in a free form, not bound to proteins, in a concentration higher than in plasma. In addition, high concentrations of moxifloxacin are found in the tissues of the abdominal organs, peritoneal fluid, and also in the tissues of the female genital organs.Metabolism Moxifloxacin undergoes phase 2 biotransformation and is excreted from the body by the kidneys, as well as through the intestines, both unchanged and in the form of inactive sulfo compounds (M1) and glucuronides (M2). Moxifloxacin is not biotransformed by the cytochrome P450 microsomal system. Metabolites M1 and M2 are present in blood plasma at concentrations lower than the parent compound. According to the results of preclinical studies, it was proved that these metabolites do not have a negative effect on the body in terms of safety and tolerability. Excretion T1 / 2 is approximately 12 hours. The average total clearance after oral administration of the drug at a dose of 400 mg is 179-246 ml / min. Renal clearance is 24-53 ml / min. This indicates a partial tubular reabsorption of the drug.The mass balance of the parent compound and the phase 2 metabolites is approximately 96-98%, which indicates the absence of oxidative metabolism. About 22% of a single dose (400 mg) is excreted unchanged by the kidneys, about 26% through the intestines. Pharmacokinetics in special groups of patients When studying the pharmacokinetics of moxifloxacin in men and women, 33% differences were found in terms of AUC and Cmax. The absorption of moxifloxacin was independent of gender. The differences in AUC and Cmax were due to differences in body weight rather than gender and are not considered clinically significant. There were no clinically significant differences in the pharmacokinetics of moxifloxacin in patients of different ethnic groups and different ages. Pharmacokinetic studies of moxifloxacin in children have not been conducted.There were no significant changes in the pharmacokinetics of moxifloxacin in patients with impaired renal function (including CC <30 ml / min / 1.73 m2) and in patients on continuous hemodialysis and long-term outpatient peritoneal dialysis. There were no significant differences in the concentration of moxifloxacin in patients with impaired liver function (classes A and B on the Child-Pugh scale) compared with healthy volunteers and patients with normal liver function.There were no significant differences in the concentration of moxifloxacin in patients with impaired liver function (classes A and B on the Child-Pugh scale) compared with healthy volunteers and patients with normal liver function.There were no significant differences in the concentration of moxifloxacin in patients with impaired liver function (classes A and B on the Child-Pugh scale) compared with healthy volunteers and patients with normal liver function.

Side effect

Data on adverse reactions reported with moxifloxacin at a dose of 400 mg (by mouth, with gradual therapy [intravenous administration of the drug followed by ingestion] and only intravenous) were obtained from clinical studies and post-marketing reports (in italics). Adverse reactions listed in the 'frequent' group occurred with a frequency below 3%, with the exception of nausea and diarrhea. In each frequency group, adverse drug reactions are listed in decreasing order of importance. Determination of the frequency of adverse reactions: often (from? 1/100 to <1/10), infrequently (from? 1/1000 to <1/100), rarely (from? 1/10 000 to <1/1000), very rarely (<1/10 000). Infections: often fungal superinfections. From the hematopoietic system: infrequently - anemia, leukopenia, neutropenia, thrombocytopenia, thrombocythemia,prolongation of prothrombin time / increase in INR; rarely - a change in the concentration of thromboplastin; very rarely - an increase in the concentration of prothrombin / decrease in the INR. From the immune system: infrequently - allergic reactions, urticaria, itching, rash, eosinophilia; rarely - anaphylactic / anaphylactoid reactions, angioedema, including laryngeal edema (potentially life-threatening); very rarely - anaphylactic / anaphylactoid shock (including potentially life-threatening). From the side of metabolism: infrequently - hyperlipidemia; rarely - hyperglycemia, hyperuricemia; very rarely - hypoglycemia. Mental disorders: infrequently - anxiety, psychomotor hyperreactivity, agitation; rarely - emotional lability, depression (in very rare cases, behavior with a tendency to self-harm is possible,such as suicidal thoughts or attempts), hallucinations; very rarely - depersonalization, psychotic reactions (potentially manifested in behavior with a tendency to self-harm, such as suicidal thoughts or suicidal attempts). From the side of the nervous system: often - dizziness, headache; infrequently - paresthesia, dysesthesia, disturbances in taste sensitivity (including in very rare cases ageusia), confusion, disorientation, sleep disturbances, tremor, vertigo, drowsiness; rarely - hypesthesia, impaired sense of smell (including anosmia), atypical dreams, impaired coordination (including gait disturbances due to dizziness or vertigo, in very rare cases leading to injuries as a result of a fall, especially in elderly patients), seizures with various clinical manifestations (including h. 'grand mal'seizures), attention disorders, speech disorders, amnesia, peripheral neuropathy, polyneuropathy; very rarely - hyperesthesia. From the side of the organ of vision: infrequently - visual impairment (especially with reactions from the central nervous system); very rarely - transient loss of vision (especially with reactions from the central nervous system). From the side of the organ of hearing: rarely - tinnitus, hearing impairment, including deafness (usually reversible). From the side of the cardiovascular system: often - prolongation of the QT interval in patients with concomitant hypokalemia; infrequently - lengthening of the QT interval, palpitations, tachycardia, vasodilation; rarely - increased blood pressure, decreased blood pressure, syncope, ventricular tachyarrhythmias; very rarely - nonspecific arrhythmias, polymorphic ventricular tachycardia (like 'pirouette'), cardiac arrest (mainly in persons with conditions predisposing to arrhythmias,such as clinically significant bradycardia, acute myocardial ischemia). From the respiratory system: infrequently - shortness of breath, including an asthmatic condition. From the digestive system: often - nausea, vomiting, abdominal pain, diarrhea; infrequently - decreased appetite and reduced food intake, constipation, dyspepsia, flatulence, gastroenteritis (except for erosive gastroenteritis), increased amylase activity; rarely - dysphagia, stomatitis, pseudomembranous colitis (in very rare cases, associated with life-threatening complications). From the liver and biliary tract: often - increased activity of hepatic transaminases; infrequently - liver dysfunction (including an increase in LDH activity), an increase in the concentration of bilirubin, an increase in the activity of GGT and alkaline phosphatase; rarely - jaundice, hepatitis (mainly cholestatic); very rarely - fulminant hepatitis,potentially leading to life-threatening liver failure (including fatalities). On the part of the skin: very rarely - bullous skin reactions, for example, Stevens-Johnson syndrome or toxic epidermal necrolysis (potentially life-threatening). From the musculoskeletal system: infrequently - arthralgia, myalgia; rarely - tendonitis, increased muscle tone and cramps, muscle weakness; very rarely - arthritis, tendon ruptures, gait disturbance due to damage to the musculoskeletal system, increased symptoms of myasthenia gravis. From the urinary system: infrequently - dehydration (caused by diarrhea or decreased fluid intake); rarely - impaired renal function, renal failure as a result of dehydration, which can lead to kidney damage,especially in elderly patients with pre-existing renal impairment). From the side of the body as a whole: often - reactions at the injection / infusion site; infrequently - general malaise, nonspecific pain, sweating. The incidence of the following adverse reactions was higher in the group receiving stepwise therapy: often - increased GGT activity; infrequently - ventricular tachyarrhythmias, arterial hypotension, edema, pseudomembranous colitis (in very rare cases associated with life-threatening complications), seizures with various clinical manifestations (including 'grand mal' seizures), hallucinations, impaired renal function, renal failure (as a result of dehydration, which can lead to kidney damage, especially in elderly patients with pre-existing renal impairment).From the side of the body as a whole: often - reactions at the injection / infusion site; infrequently - general malaise, nonspecific pain, sweating. The incidence of the following adverse reactions was higher in the group receiving stepwise therapy: often - increased GGT activity; infrequently - ventricular tachyarrhythmias, arterial hypotension, edema, pseudomembranous colitis (in very rare cases associated with life-threatening complications), seizures with various clinical manifestations (including 'grand mal' seizures), hallucinations, impaired renal function, renal failure (as a result of dehydration, which can lead to kidney damage, especially in elderly patients with pre-existing renal impairment).From the side of the body as a whole: often - reactions at the injection / infusion site; infrequently - general malaise, nonspecific pain, sweating. The incidence of the following adverse reactions was higher in the group receiving stepwise therapy: often - increased GGT activity; infrequently - ventricular tachyarrhythmias, arterial hypotension, edema, pseudomembranous colitis (in very rare cases associated with life-threatening complications), seizures with various clinical manifestations (including 'grand mal' seizures), hallucinations, impaired renal function, renal failure (as a result of dehydration, which can lead to kidney damage, especially in elderly patients with pre-existing renal impairment).sweating The incidence of the following adverse reactions was higher in the group receiving stepwise therapy: often - increased GGT activity; infrequently - ventricular tachyarrhythmias, arterial hypotension, edema, pseudomembranous colitis (in very rare cases associated with life-threatening complications), seizures with various clinical manifestations (including 'grand mal' seizures), hallucinations, impaired renal function, renal failure (as a result of dehydration, which can lead to kidney damage, especially in elderly patients with pre-existing renal impairment).sweating The incidence of the following adverse reactions was higher in the group receiving stepwise therapy: often - increased GGT activity; infrequently - ventricular tachyarrhythmias, arterial hypotension, edema, pseudomembranous colitis (in very rare cases associated with life-threatening complications), seizures with various clinical manifestations (including 'grand mal' seizures), hallucinations, impaired renal function, renal failure (as a result of dehydration, which can lead to kidney damage, especially in elderly patients with pre-existing renal impairment).pseudomembranous colitis (in very rare cases associated with life-threatening complications), seizures with various clinical manifestations (including 'grand mal' seizures), hallucinations, impaired renal function, renal failure (as a result of dehydration, which can lead to damage kidney problems, especially in elderly patients with pre-existing renal impairment).pseudomembranous colitis (in very rare cases associated with life-threatening complications), seizures with various clinical manifestations (including 'grand mal' seizures), hallucinations, impaired renal function, renal failure (as a result of dehydration, which can lead to damage kidney function, especially in elderly patients with pre-existing renal impairment).

Application during pregnancy and lactation

The safety of using moxifloxacin during pregnancy has not been established and its use is contraindicated. Cases of reversible joint damage have been reported in children receiving certain quinolones, but this effect has not been reported in the fetus (when used by the mother during pregnancy). Reproductive toxicity has been shown in animal studies. The potential risk to humans is unknown. Like other quinolones, moxifloxacin causes damage to the cartilage of large joints in premature animals. In preclinical studies, it was found that a small amount of moxifloxacin is excreted in breast milk. There are no data on its use in women during lactation. Therefore, the appointment of moxifloxacin during breastfeeding is contraindicated.

Application for violations of liver function

Patients with impaired liver function do not need to change the dosage regimen. The drug should be used with caution in liver cirrhosis.

Application for impaired renal function

Patients with impaired renal function (including CC <30 ml / min / 1.73 m2), as well as patients on continuous hemodialysis and long-term outpatient peritoneal dialysis, do not need to change the dosage regimen.

Application in children

Contraindicated: children and adolescents under 18 years of age.

Use in elderly patients

Elderly patients do not need to change the dosage regimen.

special instructions

In some cases, after the first use of the drug, hypersensitivity and allergic reactions may develop, which should be immediately reported to the doctor. Very rarely, even after the first use of the drug, anaphylactic reactions can progress to life-threatening anaphylactic shock. In these cases, treatment with AveloxЃ should be discontinued and the necessary therapeutic measures (including anti-shock) should be started immediately. When using the drug AveloxЃ in some patients, there may be an increase in the QT interval. AveloxЃ should be used with caution in women and elderly patients. Because women have a longer QT interval compared to men, they may be more sensitive to drugs that prolong the QT interval. Elderly patients are also more susceptible to the effects of drugsaffecting the QT interval. The degree of lengthening of the QT interval can increase with increasing drug concentration, therefore, the recommended dose should not be exceeded. Prolongation of the QT interval is associated with an increased risk of ventricular arrhythmias, including polymorphic ventricular tachycardia. However, in patients with pneumonia, a correlation between the concentration of moxifloxacin in blood plasma and prolongation of the QT interval was noted. None of the 9000 patients who received AveloxЃ had cardiovascular complications and deaths associated with prolongation of the QT interval. When using the drug AveloxЃ, the risk of developing ventricular arrhythmias may increase in patients with conditions predisposing to arrhythmias. In this regard, AveloxЃ is contraindicated for: changes in the electrophysiological parameters of the heart,expressed in prolongation of the QT interval (congenital or acquired documented lengthening of the QT interval, electrolyte disturbances, especially uncorrected hypokalemia, clinically significant bradycardia, clinically significant heart failure with a reduced left ventricular ejection fraction, a history of indications of rhythm disturbances accompanied by clinical symptoms); use with other drugs that prolong the QT interval. AveloxЃ should be used with caution: in patients with potentially proarrhythmic conditions, such as acute myocardial ischemia; in patients with cirrhosis of the liver (because in this category of patients, the risk of developing prolongation of the QT interval cannot be excluded). When taking the drug AveloxЃ, cases of fulminant hepatitis were reported,potentially leading to the development of liver failure (including fatal cases). The patient should be informed that in the event of symptoms of hepatic failure, it is necessary to consult a doctor before continuing treatment with AveloxЃ. When taking the drug AveloxЃ, cases of development of bullous skin lesions (such as Stevens-Johnson syndrome or toxic epidermal necrolysis) have been reported. The patient should be informed that in the event of symptoms of skin or mucous membrane lesions, it is necessary to consult a doctor before continuing treatment with AveloxЃ. The use of drugs of the quinolone series is associated with a possible risk of seizures. AveloxЃ should be used with caution in patients with diseases of the central nervous system and disorders of the central nervous system,predisposing to the occurrence of seizures or lowering the threshold of seizure activity. The use of broad-spectrum antibacterial drugs, including AveloxЃ, is associated with the risk of developing pseudomembranous colitis. This diagnosis should be borne in mind in patients who have developed severe diarrhea during treatment with AveloxЃ. In this case, appropriate therapy should be prescribed immediately. Drugs that inhibit intestinal motility are contraindicated in the development of severe diarrhea. AveloxЃ should be used with caution in patients with myasthenia gravis due to a possible exacerbation of the disease. Against the background of quinolone therapy, incl. moxifloxacin, tendinitis and tendon rupture may develop, especially in the elderly and patients receiving GCS. Cases are described that occurred within a few months after the completion of treatment.At the first symptoms of pain or inflammation at the site of injury, the drug should be discontinued and the affected limb should be relieved. With the use of quinolones, photosensitivity reactions are noted. However, during preclinical and clinical studies, as well as when using AveloxЃ in practice, photosensitivity reactions were not observed. However, patients receiving AveloxЃ should avoid exposure to direct sunlight and ultraviolet radiation. The use of the drug in the form of tablets for oral administration is not recommended in patients with complicated inflammatory diseases of the pelvic organs (for example, associated with tubo-ovarian or pelvic abscesses). Moxifloxacin is not recommended for the treatment of methicillin-resistant strains of Staphylococcus aureus (MRSA).Suspected or confirmed MRSA infections should be treated with appropriate antibacterial drugs. The ability of AveloxЃ to inhibit the growth of mycobacteria may cause in vitro interaction of moxifloxacin with a test for Mycobacterium spp., Leading to false-negative results when analyzing samples of patients who are treated with AveloxЃ during this period. In patients who were treated with quinolones, including the drug AveloxЃ, cases of sensory or sensorimotor polyneuropathy have been described, leading to paresthesia, hypesthesia, dysesthesia or weakness. Patients undergoing treatment with AveloxЃ should be warned about the need to immediately consult a doctor before continuing treatment in case of symptoms of neuropathy, including pain,burning, tingling, numbness, or weakness. Mental reactions may occur even after the first administration of fluoroquinolones, including moxifloxacin. In very rare cases, depression or psychotic reactions progress to suicidal thoughts and self-harming behaviors, including suicidal attempts. If such reactions develop in patients, AveloxЃ should be discontinued and the necessary measures should be taken. Care should be taken when prescribing the drug AveloxЃ to patients with psychoses and / or psychiatric diseases in history. Due to the widespread and increasing incidence of infections caused by fluoroquinolone-resistant Neisseria gonorrhoeae, monotherapy with moxifloxacin should not be used in the treatment of patients with pelvic inflammatory disease, unlesswhen the presence of fluoroquinolone-resistant N. gonorrhoeae is excluded. If it is not possible to exclude the presence of fluoroquinolone-resistant N. gonorrhoeae, it is necessary to consider supplementing empiric therapy with moxifloxacin with an appropriate antibiotic that is active against N. gonorrhoeae (eg, cephalosporin). As with other fluoroquinolones, changes in blood glucose concentration, including hypo- and hyperglycemia, were observed with the use of AveloxЃ. During therapy with AveloxЃ, dysglycemia occurred mainly in elderly patients with diabetes mellitus receiving concomitant therapy with oral hypoglycemic drugs (for example, sulfonylureas) or insulin.When carrying out treatment in patients with diabetes mellitus, careful monitoring of the concentration of glucose in the blood is recommended.

Influence on the ability to drive vehicles and use mechanisms

Fluoroquinolones, including moxifloxacin, can interfere with the ability of patients to drive and engage in other potentially hazardous activities that require increased attention and speed of psychomotor reactions due to the effect on the central nervous system and visual impairment.

Overdose

»меютс¤ ограниченные данные о передозировке моксифлоксацина. Ќе отмечено каких-либо побочных эффектов при применении јвелокса в дозе до 1200 мг однократно и по 600 мг в течение 10 дней и более. Ћечение: в случае передозировки в соответствии с клинической ситуацией провод¤т симптоматическую и поддерживающую терапию с Ё v-мониторингом. ѕрименение активированного угл¤ сразу после перорального приема препарата может помочь предотвратить чрезмерное системное воздействие моксифлоксацина в случа¤х передозировки.

Ћекарственное взаимодействие

Ќе требуетс¤ коррекци¤ дозы при совместном применении препарата јвелоксЃ с атенололом, ранитидином, кальцийсодержащими добавками, теофиллином, циклоспорином, пероральными контрацептивными средствами, глибенкламидом, итраконазолом, дигоксином, морфином, пробенецидом (подтверждено отсутствие клинически значимого взаимодействи¤ с моксифлоксацином). —ледует учитывать возможный аддитивный эффект удлинени¤ интервала QT моксифлоксацина и других препаратов, которые вли¤ют на удлинение интервала QT. ¬следствие совместного применени¤ моксифлоксацина и препаратов, вли¤ющих на удлинение интервала QT, увеличиваетс¤ риск развити¤ желудочковой аритмии, включа¤ полиморфную желудочковую тахикардию типа 'пируэт'. ѕротивопоказано совместное применение моксифлоксацина со следующими препаратами, вли¤ющими на удлинение интервала QT: антиаритмические препараты класса IA (в т.ч. хинидин, гидрохинидин, дизопирамид); антиаритмические препараты класса III (в т.ч. амиодарон, соталол, дофетилид, ибутилид); нейролептики (в т.ч. фенотиазин, пимозид, сертиндол, галоперидол, сультоприд); трициклические антидепрессанты; противомикробные препараты (спарфлоксацин, эритромицин в/в, пентамидин, противомал¤рийные препараты, особенно галофантрин); антигистаминные препараты (терфенадин, астемизол, мизоластин); другие (цизаприд, винкамин в/в, бепридил, дифеманил). ѕрием внутрь препарата јвелоксЃ и антацидов, поливитаминов и минералов может нарушить всасывание моксифлоксацина вследствие образовани¤ хелатных комплексов с поливалентными катионами, содержащимис¤ в этих препаратах. ¬ результате концентраци¤ моксифлоксацина в плазме крови может быть значительно ниже терапевтической. ¬ св¤зи с этим антацидные, антриретровирусные (например, диданозин) и другие препараты, содержащие магний, алюминий, сукральфат, железо, цинк следует принимать как минимум за 4 ч до или через 4 ч после приема внутрь моксифлоксацина. ѕри сочетанном применении јвелокса с варфарином протромбиновое врем¤ и другие параметры свертывани¤ крови не измен¤ютс¤. ” пациентов, получавших антикоагул¤нты в сочетании с антибиотиками, в т.ч. с моксифлоксацином, отмечаютс¤ случаи повышени¤ антикоагул¤нтной активности противосвертывающих препаратов. ‘акторами риска ¤вл¤ютс¤ наличие инфекционного заболевани¤ (и сопутствующий воспалительный процесс), возраст и общее состо¤ние пациента. Ќесмотр¤ на то, что взаимодействи¤ между моксифлоксацином и варфарином не вы¤вл¤етс¤, у пациентов, получающих сочетанное лечение этими препаратами, необходимо проводить мониторирование ћЌќ и при необходимости корректировать дозу непр¤мых антикоагул¤нтов. ћоксифлоксацин и дигоксин не оказывают существенного вли¤ни¤ на фармакокинетические параметры друг друга. ѕри повторном назначении моксифлоксацина Cmax дигоксина увеличивалась приблизительно на 30%. ѕри этом значение AUC и Cmin дигоксина не измен¤ютс¤. ѕри одновременном применении активированного угл¤ и моксифлоксацина внутрь в дозе 400 мг системна¤ биодоступность препарата снижаетс¤ более чем на 80% в результате замедлени¤ его абсорбции. ¬ случае передозировки применение активированного угл¤ на ранней стадии всасывани¤ преп¤тствует дальнейшему повышению системного воздействи¤.