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Pharmacological properties

furamag is a complex compound of soluble furagin and magnesium hydroxycarbonate in a ratio of 1: 1, which has fundamentally different pharmacological properties than simple furagin (after taking the drug in the acidic environment of the stomach, the conversion of soluble furagin to slightly soluble furagin does not occur; therefore, the bioavailability of furamag is 3 times higher than ordinary furagin).

The drug has a wide antibacterial spectrum of action with respect to gram-positive and gram-negative microorganisms. Furamag is effective against gram-positive cocci (strepto- and staphylococci), gram-negative rods (Escherichia coli, Salmonella, Shigella, Proteus, Klebsiella, Enterobacteria), protozoa (Giardia). Furamag, in comparison with other nitrofurans, shows a higher activity to staphylococci, Escherichia coli, Aerobacter aerogenes, Bact. Citrovorum, Proteus mirabilis, Proteus morganii. Furamag is also more effective against Enterococcus faecalis, Staphylococcus spp. compared with other groups of antimicrobial agents.

The resistance of microorganisms to soluble furagin develops slowly and does not reach clinically significant indicators.

Furamag does not alter the pH of urine and in high concentrations circulates in the kidneys.

In relation to the majority of microorganisms, the bacteriostatic concentration of furagin is from 1: 100 000 to 1: 200 000. As a result of the action of nitrofurans, microorganisms release less toxins, and therefore, an improvement in the general condition of the patient is possible even before the pronounced suppression of microflora growth. The bactericidal concentration is about 2 times higher. Under the influence of nitrofurans in microorganisms, cellular respiration and the Krebs cycle are suppressed, as well as inhibition of other biochemical processes of microorganisms, which leads to the destruction of their membrane or cytoplasmic membrane. Nitrofurans, unlike many other antimicrobials, not only do not inhibit the body’s immune system, but, on the contrary, activate it (increase the complement titer and the ability of leukocytes to phagocytosis of microorganisms). Nitrofurans in therapeutic doses stimulate leukopoiesis.

Pharmacokinetics After taking Furamag capsules in the acidic environment of the stomach, the conversion of soluble furagin to furagin does not occur, thereby significantly increasing the bacteriostatic and bactericidal effect. After absorption in the digestive tract (mainly from the small intestine by passive diffusion), a bacteriostatic concentration of the drug is formed in the portal portal vein system of the liver.

Absorption of nitrofurans in the distal segment of the small intestine exceeds absorption from the proximal and middle segment, respectively, 2 and 4 times. Nitrofurans are poorly absorbed in the colon.

Clinically important is the high content of the active substance in the lymph (delays the spread of infection through the lymphatic tract). In bile, its concentration is several times higher than in blood plasma, and in cerebrospinal fluid - several times lower than in plasma. In saliva, the content of soluble furagin is 30% of its concentration in blood plasma. The concentration of furagin soluble in blood and tissues is relatively small, which is associated with its rapid release, while the concentration in urine is much higher than in blood. Cmax in the blood, it remains from 3 to 8 hours, in the urine it is detected 3-4 hours after taking the drug. Isolation of furagin, soluble by the kidneys, occurs by glomerular filtration and tubular secretion (85%), partially undergoes reverse reabsorption in the tubules, and biotransformation (less than 10%) occurs in the liver and kidneys to a lesser extent. With a decrease in excretory function of the kidneys, the metabolic rate increases. At low concentrations of furagin soluble in urine, the filtration and secretion process predominates, at high concentrations, secretion decreases and reabsorption increases.

4 hours after taking the drug, the concentration in the urine is much higher than after taking the same dose of furagin. The absorption of Furamag will noticeably improve if taken after meals.

Indications

Infections caused by sensitive furagin soluble microorganisms: urogenital infections (acute and chronic cystitis, urethritis, pyelonephritis, prostatitis), infectious diseases of the skin and soft tissues, severe infected burns, gynecological infections.

For the purpose of anti-relapse treatment of urinary tract infections.

For the prevention of infectious complications during urological operations, cystoscopy, catheterization, etc.

Application

The drug is taken after meals with a large amount of water.

Assign 50-100 mg (2-4 capsules) 3 times a day.

Children are prescribed 25-50 mg (1-2 capsules) 3 times a day, but not more than 5 mg / kg of body weight per day.

The maximum daily dose for adults is 300 mg.

The course of treatment is from 5 to 10 days. If necessary, after 10-15 days, the course can be repeated (as directed by the doctor). Children with a body weight of 30 kg or more are prescribed 50 mg capsules 3 times a day.

For the purpose of anti-relapse therapy of urinary tract infections, adults and children are prescribed 1/3–¼ daily dose of the drug at night for 3–6 months.

For the prevention of infection during urological operations, cystoscopy, catheterization, the drug is prescribed for adults - 50 mg 3 times a day, for children - 25 mg 3 times a day.

If you miss the drug, the next dose should be taken as soon as the patient remembers this.

Do not take a double dose to replace the missed dose.

Contraindications

  • Hypersensitivity to soluble furagin, derivatives of the nitrofuran group or excipients of the drug; severe renal failure (creatinine clearance 30 ml / min); severe liver failure; polyneuropathy (including diabetic); glucose-6-phosphate dehydrogenase deficiency (risk of hemolysis); porphyria (diseases caused by impaired metabolism of hemoglobin breakdown products); patients on hemodialysis or peritoneal hemodialysis.

Side effects

On the part of the blood and lymphatic system: impaired blood formation (agranulocytosis, thrombocytopenia, aplastic anemia).

On the part of the immune system: hypersensitivity reactions, including pruritus, rash, urticaria, angioedema.

From the nervous system: headache, dizziness, drowsiness, peripheral neuropathy, neuritis, polyneuritis.

From the side of the organ of vision: visual impairment.

On the part of the organ of hearing and the labyrinth: tinnitus.

From the respiratory system, chest and mediastinal organs: acute and chronic reactions of increased sensitivity of the lungs. Along with an acute pulmonary reaction, skin rash, itching, urticaria, angioedema, and myalgia have been reported. An acute pulmonary reaction is a hypersensitivity reaction that can develop within a few hours, rarely minutes, and is characterized by fever, eosinophilia, cough (with / without sputum), chest pain, severe shortness of breath. An acute pulmonary reaction usually disappears when you stop taking the drug.

Chronic pulmonary reactions can occur for a long period after discontinuation of nitrofuran therapy and are characterized by shortness of breath, which gradually intensifies, shortness of breath, fever, eosinophilia, progressive cough, interstitial pneumonia and / or pulmonary fibrosis.

Nasal disturbances, hoarseness.

From the digestive tract: nausea, flatulence, vomiting, lack of appetite, diarrhea, dyspepsia, constipation, abdominal pain, pancreatitis. The frequency of side effects decreases when taking the drug with food.

From the skin and subcutaneous tissues: papular rashes, itching, angioedema, urticaria, exfoliative dermatitis, polymorphic erythema, alopecia.

From the side of musculoskeletal and connective tissue: arthralgia, pain in the ribs, cramps.

From the vessels: mild intracranial hypertension.

From the liver and biliary tract: cholestatic jaundice, hepatitis, pain in the right hypochondrium, impaired liver function.

General disorders and disorders at the injection site: fever, weakness, sensation of a foreign body in the throat.

Research: albuminuria, erythrocyturia.

To reduce the severity of side effects, it is recommended to take B vitamins (in case of polyneuropathy), antihistamines (for manifestations of allergic reactions) and drink plenty of fluids.

With very pronounced side effects, you should reduce the dose or stop taking the drug.

Furamag stains urine in a dark yellow or brown color.

If during the period of treatment with Furamag there are adverse reactions that are not indicated in the instructions, you should inform your doctor about this.

special instructions

The drug is used with caution in the following cases:

  • impaired renal function (use is contraindicated in severe renal failure);
  • anemia;
  • deficiency of vitamins of group B and folic acid;
  • lung diseases

The use of Furamag is not recommended for urosepsis and kidney parenchyma infection.

With prolonged use of Furamag, peripheral neuropathy (pain, impaired sensitivity in the region of the corresponding nerve) may develop.

During experimental studies and clinical observations of patients, it was found that nitrofurans adversely affect testicular function, manifested by a decrease in the number of sperm and ejaculate, a decrease in sperm motility and a pathological change in their morphology.

In diabetes mellitus, the drug can cause polyneuropathy.

In case of development of symptoms of neuropathy, the use of the drug should be discontinued.

During prolonged use of Furamag in prophylactic doses, a clinically significant resistance of microorganisms does not form.

There are no reports of manifestations of pseudomembranous colitis during treatment with Furamag, although such data are available for almost all antibacterial agents, including nitrofuran derivatives. The possibility of these side effects in patients with the manifestation of diarrhea during treatment with antibacterial agents as a result of inhibition of the natural microflora of the rectum should be taken into account. Unlike antibiotics, Furamag practically does not change the intestinal microflora. With pseudomembranous colitis in a mild form, it is enough to stop taking the antibacterial agent.

A laboratory study of patients treated with Furamag showed that the drug can give a false-positive reaction to the presence of glucose in the urine, if the copper recovery method is used for determination. The results of the determination of glucose in urine, performed by the enzyme method, Furamag is not affected.

With prolonged use of the drug, monitoring of renal and hepatic function indices is necessary, as well as monitoring of pulmonary function, especially in patients over the age of 65.

For the prevention of neuritis, it is simultaneously desirable to take antihistamines and B vitamins (nicotinamide, thiamine).

Use during pregnancy and lactation. Do not use during pregnancy and lactation.

Children. Capsules of 25 mg are used in children over the age of 3 years, capsules of 50 mg can be used in children weighing more than 30 kg.

The ability to influence the reaction rate when driving vehicles or working with other mechanisms. Typically, the drug does not affect the ability to drive vehicles or work with other mechanisms, but the possibility of developing dizziness, drowsiness, or other adverse reactions from the central nervous system should be considered.

Interactions

Means alkalizing urine reduce the severity of the therapeutic effect of furamag (accelerate the excretion of furamag with urine).

Urine acidifying agents (acids, including ascorbic acid, as well as calcium chloride) increase the concentration of Furamag in urine, enhancing the therapeutic effect of the drug, but at the same time, the risk of increasing toxicity increases.

The use simultaneously with chloramphenicol, ristomycin and sulfonamides enhances the inhibition of hematopoiesis.

In vitro, nitrofurans are quinolone antagonists (nalidixic acid, oxolinic acid, norfloxacin). However, in vivo the clinical significance of this interaction has not been studied, therefore, simultaneous use with quinolones should be avoided.

The use of probenecid and sulfinpyrazone reduces the excretion of furagin, which increases the risk of unwanted side effects and toxicity.

The simultaneous use of furamag and antacids (containing magnesium trisilicate) reduces the absorption of furamag.

In renal failure, it is not recommended to use Furamag with aminoglycosides at the same time.

The antibacterial effect of Furamag is significantly enhanced with simultaneous use with antibiotics (penicillins and cephalosporins), it is well combined with tetracycline and erythromycin.

During treatment, you should not drink alcohol, since alcohol can increase the severity of side effects (tachycardia, pain in the heart, headache, nausea, vomiting, cramps, decreased blood pressure, fever, anxiety).

Overdose

Symptoms: with an overdose, symptoms of a neurotoxic nature, ataxia, tremor are observed.

Treatment: in case of poisoning, it is necessary to stop taking the drug, drink a large amount of liquid. If acute symptoms occur, antihistamines are used. For the prevention of neuritis, it is possible to prescribe B vitamins (thiamine bromide).

Storage conditions

In a dry, dark place at a temperature of no higher than 25 ° c.

Tags: Furagin soluble