Coficil-plus, tablets, 10 pcs.
If it is necessary to use the drug Coficil-Plus simultaneously with other NSAIDs, use gastroprotectors.
Interaction with individual components included in the drug:
– Acetylsalicylic acid
(ASA): when interacting with antihypertensive drugs (ACE inhibitors, angiotensin II receptor antagonists, blockers of “slow” calcium channels): ASA can reduce their activity due to inhibition of prostaglandin synthesis in the kidneys. Concomitant use may lead to acute renal failure in elderly or dehydrated patients. If diuretics are used concomitantly with ASA, it is necessary to ensure adequate rehydration of the patient and control blood pressure. When used concomitantly with verapamil, bleeding time should be monitored; when interacting with sulfonylurea and insulin derivatives, ASA enhances their hypoglycemic effect, therefore, when taking a high dose of salicylates, a reduction in the dose of hypoglycemic agents may be necessary. It is recommended to monitor your blood glucose levels more frequently.
ASA increases the toxicity of methotrexate, reducing its renal clearance, valproic acid; enhances the effects of non-steroidal anti-inflammatory drugs, narcotic analgesics, oral hypoglycemic drugs, heparin, indirect anticoagulants, thrombolytics and antiplatelet agents, sulfonamides (including co-trimoxazole), T3 (triiodothyronine); reduces the effect of uricosuric drugs (benzbromarone, sulfinpyrazone), antihypertensive drugs, diuretics (spironolactone, furosemide).
Glucocorticosteroids, ethanol and ethanol-containing drugs increase the damaging effect on the mucous membrane of the gastrointestinal tract and increase the risk of gastrointestinal bleeding.
ASA increases the concentration of digoxin, barbiturates, and lithium salts in plasma.
Antacids containing magnesium ions and/or aluminum ions slow down and impair the absorption of ASA.
Myelotoxic drugs increase the manifestations of ASA hematotoxicity.
– Paracetamol:
paracetamol: when interacting with propantheline and other drugs that slow down gastric emptying, the rate of absorption of paracetamol and, accordingly, the onset of analgesic action and the degree of pain relief are reduced.
Reduces the effectiveness of uricosuric drugs.
Concomitant use of paracetamol in high doses increases the effect of anticoagulant drugs (decreased synthesis of procoagulant factors in the liver).
Inducers of microsomal liver enzymes (phenytoin, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants), ethanol and hepatotoxic drugs increase the production of hydroxylated active metabolites, which makes it possible to develop severe intoxications even with a slight overdose.
Long-term use of barbiturates reduces the effectiveness of paracetamol.
The simultaneous use of paracetamol and ethanol increases the risk of developing hepatotoxic effects.
Inhibitors of microsomal oxidation (including cimetidine) reduce the risk of hepatotoxicity.
Long-term combined use of paracetamol and other non-steroidal anti-inflammatory drugs increases the risk of developing “analgesic” nephropathy and renal papillary necrosis, and the onset of end-stage renal failure.
Simultaneous long-term administration of paracetamol in high doses and salicylates increases the risk of developing kidney or bladder cancer.
Diflunisal increases the plasma concentration of paracetamol by 50% - the risk of developing hepatotoxicity.
Myelotoxic drugs increase the manifestations of hematotoxicity of the drug.
Under the influence of paracetamol, the half-life (T1/2) of chloramphenicol increases 5 times. When taken repeatedly, paracetamol may enhance the effect of anticoagulants (coumarin derivatives).
– Caffeine:
caffeine: when interacting with ephedrine-like substances, the risk of developing drug dependence increases. Simultaneous use is not recommended.
When used together with sympathomimetics or levothyroxine, due to mutual potentiation, the chronotropic effect can be enhanced. Simultaneous use is not recommended.
Antibacterial drugs from the quinolone group, enoxacin, and pipemidic acid, terbinafine, cimetidine, fluvoxamine and oral contraceptives may increase the half-life of caffeine due to inhibition of hepatic cytochrome P450, therefore patients with impaired liver function, cardiac arrhythmias and latent epilepsy should avoid caffeine.
Nicotine, phenytoin, and phenylpropanolamine reduce the terminal half-life of caffeine.
Caffeine increases clozapine serum concentrations, likely through both pharmacokinetic and pharmacodynamic mechanisms. Monitoring of serum concentrations of clozapine is necessary. Simultaneous use is not recommended.
Caffeine is an adenosine antagonist (larger doses of adenosine may be required).
With the combined use of caffeine and barbiturates, primidone, anticonvulsants (hydantoin derivatives, especially phenytoin), it is possible to increase metabolism and increase the clearance of caffeine; cimetidine, oral contraceptive drugs, disulfiram, ciprofloxacin, norfloxacin - decreased metabolism of caffeine in the liver (slowing its excretion and increasing its concentration in the blood).
Monoamine oxidase inhibitors, furazolidone, procarbazine and selegiline - large doses of caffeine can cause the development of dangerous cardiac arrhythmias or a marked increase in blood pressure.
Caffeine reduces the absorption of calcium preparations into the gastrointestinal tract.
Reduces the effect of narcotic and sleeping pills.
Increases the excretion of lithium drugs in urine.
Accelerates absorption and enhances the effect of cardiac glycosides, increasing their toxicity.
Concomitant use of caffeine with beta-blockers may lead to mutual suppression of therapeutic effects; with adrenergic bronchodilators - to additional stimulation of the central nervous system.
Coficil-plus, 0.3 g+0.05 g+0.1 g, tablets, 10 pcs.
Are common
This medicine should not be taken at the same time as medicines containing ASA or paracetamol.
As with other migraine treatments, caution should be exercised to rule out other potentially serious neurological disorders before initiating treatment for suspected migraine in patients who have not previously been diagnosed with migraine or in those whose migraine presents with atypical symptoms.
If patients vomit during > 20% of migraine attacks or require bed rest during > 50% of migraine attacks, the drug should not be used.
If the migraine does not stop after taking the first two tablets of the drug, you should seek medical help.
The drug should not be used if the patient has had more than 10 headache attacks per month for at least the last three months. In this case, headache due to excessive use of drugs should be suspected and treatment should be discontinued. Additionally, patients should seek medical attention. Caution should be used in patients with risk factors for dehydration, such as vomiting, diarrhea, or before or after major surgery.
Due to its pharmacodynamic properties, the drug can mask the signs and symptoms of infection.
Due to the content of acetylsalicylic acid in the drug
The drug should be used with caution in patients with gout, impaired renal or hepatic function, dehydration, uncontrolled hypertension, glucose-6-phosphate dehydrogenase deficiency and diabetes mellitus.
Due to ASA inhibition of platelet aggregation, the drug may lead to an increase in bleeding time during and after surgical interventions (including minor ones, such as tooth extraction).
The drug should not be used simultaneously with anticoagulants and other drugs that interfere with blood clotting, without medical supervision (see section “Interaction with other drugs”). Patients with bleeding disorders should be closely monitored. Caution should be exercised in case of metro- or menorrhagia.
If a patient develops bleeding or ulceration of the gastrointestinal tract while taking the drug, it must be discontinued immediately. Potentially fatal bleeding, ulceration, and perforation of the gastrointestinal tract may occur at any time during treatment with any NSAID, with or without a history of precursors and severe gastrointestinal complications. These complications tend to be more severe in older patients. Alcohol, glucocorticosteroids and NSAIDs may increase the risk of gastrointestinal bleeding (see section "Interaction with other drugs").
The drug may contribute to the development of bronchospasm and the occurrence of exacerbation of bronchial asthma (including bronchial asthma caused by intolerance to analgesics) or other hypersensitivity reactions. Risk factors include bronchial asthma, seasonal allergic rhinitis, nasal polyposis, chronic obstructive pulmonary disease, chronic respiratory tract infections (especially those associated with symptoms characteristic of allergic rhinitis). Such effects may also occur in patients with allergic reactions (eg, skin reactions, including itching and urticaria) to other substances. Particular caution is recommended in such patients.
Children under 18 years of age should not be prescribed medications containing acetylsalicylic acid as an antipyretic, since in the case of a viral infection they can increase the risk of developing Reye's syndrome. Symptoms of Reye's syndrome are hyperpyrexia, prolonged vomiting, metabolic acidosis, nervous system and mental disorders, hepatomegaly and liver dysfunction, acute encephalopathy, respiratory failure, convulsions, coma.
ASA may interfere with the results of laboratory tests of thyroid function due to false-positive low concentrations of levothyroxine (T4) and triiodothyronine (T3) (see section "Interactions with other drugs").
Due to the content of paracetamol in the preparation
Caution should be exercised when prescribing the drug to patients with impaired renal or hepatic function, or alcohol dependence.
The risk of paracetamol poisoning is increased in patients taking other potentially hepatotoxic drugs or drugs that induce liver microsomal enzymes (eg, rifampicin, isoniazid, chloramphenicol, hypnotics and anticonvulsants including phenobarbital, phenytoin and carbamazepine). Patients with a history of alcoholism are at particular risk for liver damage (see section “Interaction with other drugs”).
When using the drug, serious skin reactions may develop, such as acute generalized exanthematous pustulosis, Stevens-Johnson syndrome, toxic epidermal necrolysis, which can be fatal. Patients should be informed of the signs of serious skin reactions. The drug should be discontinued at the first manifestation of skin reactions or any other signs of hypersensitivity.
Due to the caffeine content of the product
The drug should be prescribed with caution to patients with gout, hyperthyroidism and arrhythmia.
When using the drug, you should limit your consumption of products containing caffeine, since excess caffeine intake can lead to nervousness, irritability, insomnia and, in some cases, increased heart rate.
Effect on laboratory tests
High doses of ASA can distort the results of a number of clinical and biochemical laboratory studies.
The use of paracetamol may affect the results of determining uric acid using the phosphotungstic acid method and glycemia using the glucose oxidase/peroxidase method.
Caffeine may reverse the effects of dipyridamole on myocardial blood flow, thereby confounding the results of this study. During the study, it is necessary to refrain from taking caffeine for 8–12 hours.
Impact on the ability to drive vehicles and machinery
While using the drug, you should refrain from driving vehicles and operating other mechanisms, because caffeine, which is part of the drug, can cause problems with concentration and reaction speed, and acetylsalicylic acid, also included in the drug, can in rare cases cause dizziness.
