Universal reference book for medicines
Product name: MAC-PAS PLUS (MAC-PAS PLUS)

Active substance: aminosalicylate sodium, isoniazid

Type: Anti-TB drug

Manufacturer: MACLEODS PHARMACEUTICALS (India)
Composition, form of production and packaging
Granules coated with enteric coating, pineapple
1 g

sodium para-aminosalicylate dihydrate 800 mg

isoniazid 23.3 mg

100 g - aluminum foil laminated packages (1) complete with measuring spoon - plastic containers.

Granules coated with enteric coating 1 g

sodium para-aminosalicylate dihydrate 800 mg

isoniazid 23.3 mg

4.3 g - aluminum foil laminated packages (25) - cardboard boxes.

4.3 g - aluminum foil laminated packages (50) - cardboard boxes.

4.3 g - bags of aluminum foil laminated (100) - cardboard boxes.

5 g - bags from aluminum foil laminated (10) - cardboard boxes.

5 g - aluminum foil laminated packages (25) - cardboard boxes.

5 g - bags of aluminum foil laminated (50) - carton boxes.

5 g - bags of aluminum foil laminated (100) - cardboard boxes.

INSTRUCTION FOR THE SPECIALIST.

Description of the drug approved by the manufacturer for the printed edition of 2010.

PHARMACHOLOGIC EFFECT

Aminosalicylic acid

It acts bacteriostatically.
Competitively suppresses the synthesis of folate in a bacterial cell. Slightly affects the pathogen, located intracellularly. Under the influence of gastric juice, aminosalicylic acid rapidly turns into an inactive metabolite. Acid-resistant shell protects the granules from the destructive effects of gastric juice. In a neutral environment, for example, in the small intestine, the granule membrane dissolves and the drug releases.
Isoniazid

Isoniazid in vivo and in vitro acts bactericidally on the process of dividing M. tuberculosis cells.
The primary mechanism is the inhibition of the synthesis of the long chain of mycolic acids, which are an integral part of the cell wall of mycobacteria. To inhibit Gram-positive and Gram-negative bacteria, an isoniazid concentration of at least 600 mg / ml is required, and the minimum concentration for inhibition of M. tuberculosis is 0.05-0.025 mg / ml. Resistance to isoniazid is manifested spontaneously and amounts to the growth of mutant bacilli, equal to 1 × 106 bacteria per generation.
PHARMACOKINETICS

Aminosalicylic acid

Characterized by high absorption;
moderately penetrates into the cerebrospinal fluid (only with inflammation of the meninges). Easily passes other histohematological barriers and is distributed in tissues. Binding to proteins - 50-60%. After a single dose of 4 g, the concentration of the drug in the plasma is 20 mg / ml (it can vary from 9 to 35 mg / ml). The average time to reach C max in plasma is 6 hours (varies from 1.5 to 24 hours). The concentration of the drug 2 mg / ml in the plasma is maintained for 7.9 hours (variability from 5 to 9 hours), and 1 mg / ml - on average, for 8.8 hours (variability from 6 to 11.5 hours).
Metabolised, half the dose is determined in the urine in the form of an acetylated derivative.
T 1/2 is 30 minutes. The total clearance depends on both the metabolic rate and the excretion of the kidneys. 80% of aminosalicylic acid is excreted by the kidneys, while 50% or more is excreted in the acetylated form.
Isoniazid

Isoniazid quickly and completely absorbed when ingested, food reduces absorption and bioavailability.
The effect of the first passage through the liver has a great influence on the bioavailability index. Time to reach C max in blood plasma - 1-2 hours C max in the blood after ingestion of a single dose of 300 mg - 3-7 μg / ml.Binding to proteins is insignificant - up to 10%. V d - 0.57-0.76 l / kg. Well distributed throughout the body, penetrating all tissues and fluids, including spinal, pleural, ascitic; high concentrations are created in the lung tissue, kidneys, liver, muscles, saliva and sputum. Penetrates through the placental barrier and into breast milk.
It is metabolized in the liver by acetylation with the formation of inactive products.
The liver is acetylated with N-acetyltransferase to form N-acetylisoiniazide, which is then converted to isonicotinic acid and monoacetylhydrazine, which has a hepatotoxic effect by forming a mixed oxidase system of cytochrome P450 upon N-hydroxylation of the active intermediate metabolite. The rate of acetylation is genetically determined; in people with slow acetylation, there is little N-acetyltransferase. It is an inhibitor of CYP2C9 and CYP2E1 isoenzymes in the liver.
T 1/2 for fast acetylators is 0.5-1.6 h;
for slow - 2-5 hours. In case of renal insufficiency, T 1/2 can increase to 6.7 hours. T 1/2 for children aged 1.5 to 15 years - 2.3-4.9 hours, and for newborns - 7.8-19.8 hours (that due to the imperfection of acetylation processes in newborns). Despite the fact that the T 1/2 index varies considerably depending on the individual intensity of the acetylation processes, the mean T 1/2 is 3 hours (ingestion 600 mg) and 5.1 h (900 mg). With repeated appointments, T 1/2 is shortened to 2-3 hours. It is excreted mainly by the kidneys: 75-95% of the drug is excreted within 24 hours, mainly in the form of inactive metabolites, N-acetylisiniazide and isonicotinic acid. In fast acetylators, the content of N-acetylisiniazide is 93%, while in slow acetylsinides it is not more than 63%. Small amounts are excreted with feces. The drug is removed from the blood during hemodialysis; hemodialysis, conducted for 5 hours, allows you to remove from the blood to 73% of the drug.
INDICATIONS

- Multidrug-resistant tuberculosis.

DOSING MODE

Assign inside as granules, which should be taken after meals, washed down with water, 2-3 times / day for 9-12 g / day or as prescribed by the doctor, at the rate of 10 mg / kg body weight / day for aminosalicylic acid (at lunch and dinner).
A measuring spoon is attached to the packing of 100.0 g for the convenience of dosing. Each measuring spoon (full 4.3 g of granules) contains sodium aminosalicylate dihydrate - 3.44 g; isoniazid - 100 mg.
It is also recommended to take isoniazid 300 mg once after breakfast.

SIDE EFFECT

Possible as a result of the action of individual components included in the drug.

Aminosalicylic acid

On the part of the digestive system: decreased appetite, nausea, vomiting, flatulence, abdominal pain, diarrhea or constipation, hepatomegaly, increased activity of hepatic transaminases, hyperbilirubinemia, partially expressed malabsorption syndrome;
rarely - drug-induced hepatitis.
From the urinary system: proteinuria, hematuria, crystalluria.

From the hemopoietic system: rarely - thrombocytopenia, leukopenia (up to agranulocytosis), B 12 - deficiency megaloblastic anemia.

Allergic reactions: fever, dermatitis (urticaria, purpura, enanthema), eosinophilia, arthralgia, bronchospasm.

With prolonged use in high doses or when exceeding the dose - hypothyroidism, goiter, myxedema.

Isoniazid

From the side of the nervous system: headache, dizziness;
rarely excessive fatigue or weakness, irritability, euphoria, insomnia, paresthesia, numbness of limbs, peripheral neuropathy, optic neuritis, polyneuritis, psychosis, mood change, depression. Seizures can occur in patients with epilepsy.
From the cardiovascular system: palpitation, angina pectoris, increased blood pressure.

On the part of the digestive system: nausea, vomiting, gastralgia, toxic hepatitis.

Allergic reactions: skin rash, itching, hyperthermia, arthralgia.

Other: very rarely - gynecomastia, menorrhagia, tendency to bleeding and hemorrhage.

CONTRAINDICATIONS

- medicinal hepatitis;

- liver failure;

- liver disease in the acute stage;

- kidney failure;

- children and adolescents under the age of 18;

- Hypersensitivity to any of the components of the drug.

With caution: convulsive seizures, concomitant diseases of the gastrointestinal tract, amyloidosis, decompensated diseases of the cardiovascular system, hypothyroidism, age over 60 years and body weight less than 50 kg, alcoholism.

PREGNANCY AND LACTATION

The use of the drug Mak-Paz plus in pregnancy is possible if the expected benefit for the mother exceeds the potential risk to the fetus.

If it is necessary to use the drug during lactation, breastfeeding should be stopped.

APPLICATION FOR FUNCTIONS OF THE LIVER

Contraindicated:

- Renal failure.

APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS

Contraindicated:

- medicinal hepatitis;

- liver failure;

- liver disease in the acute stage.

APPLICATION FOR CHILDREN

Contraindicated in children under 18 years.

APPLICATION IN ELDERLY PATIENTS

With caution: age over 60 years.

SPECIAL INSTRUCTIONS

Possible damage to the liver and kidneys due to the drug.

Careful observation of patients throughout the course of treatment is necessary.

Laboratory indicators - ALT, AST, bilirubin concentration in blood serum - can transiently increase without clinical manifestations.

When there are signs of toxic hepatitis caused by McPas Plus, the drug is canceled.

Decreased kidney function against tuberculous intoxication or specific damage is not a contraindication to the appointment.
The development of proteinuria and hematuria require a temporary discontinuation of the drug.
In connection with the different metabolic rate before the use of isoniazid, it is expedient to determine the rate of its inactivation (by the dynamics of the content in the blood and urine).
With rapid inactivation, isoniazid is used in higher doses.
At the risk of peripheral neuritis (patients over 65, patients with diabetes, pregnant women, patients with chronic renal failure at the stage of remission, alcoholics, eating disorders, concomitant anticonvulsant therapy), 10-25 mg / day of pyridoxine is recommended.

During the treatment, cheese (especially Swiss or Cheshire), fish (especially tuna, sardine) should be avoided, since with the simultaneous use of them with isoniazid may cause reactions (skin hyperemia, itching, sensation of heat or cold, palpitation, increased sweating, chills, headache, dizziness) associated with the suppression of monoamine oxidase and diaminoxidase activity and leading to a disruption of the metabolism of tyramine and histamine contained in fish and cheese.

It should be borne in mind that isoniazid can cause hyperglycemia with secondary glucosuria;
tests with the reduction of copper ions can be false positive, and the enzyme tests for glucose drug does not affect.
DRUG INTERACTION

Aminosalicylic acid

Compatible with other antituberculous drugs.

It is not recommended to have a joint reception with rifampicin.
aminosalicylic acid reduces its concentration. If it is necessary to co-therapy with rifampicin, taking medications should be divided: rifampicin before breakfast, sodium aminosalicylate after dinner and overnight.
Violates the absorption of erythromycin and lincomycin.

Disrupts the assimilation of cyanocobalamin (vitamin B 12 ) (risk of developing anemia).
Absorption of vitamin B 12 with the intake of 5 g of aminosalicylic acid is disturbed by 55%, which leads to significant changes in red blood cells. Thus, when treating patients with aminosalicylic acid for more than 1 month, vitamin B 12 isneeded.
Isoniazid

When combined with paracetamol, hepato- and nephrotoxicity increases;
isoniazid induces a cytochrome P450 system, which increases the metabolism of paracetamol to toxic products.
Ethanol increases the hepatotoxicity of isoniazid and speeds up its metabolism.

Reduces metabolic transformations and increases the concentration in the blood of alfentanil.

Cycloserine and disulfiram increase the adverse effects of the central nervous system.

Increases hepatotoxicity of rifampicin.

The combination with pyridoxine reduces the risk of peripheral neuritis and side reactions from the CNS.

Caution should be combined with potentially neuro-, hepato- and nephrotoxic drugs because of the risk of side effects.

Strengthens the action of coumarin and indanedione derivatives, benzodiazepines, carbamazepine, theophylline, as it reduces their metabolism by activating the cytochrome P450 system.

SCS accelerates metabolism in the liver and reduces the active concentration of isoniazid in the blood.

It suppresses the metabolism of phenytoin, which leads to an increase in its concentration in the blood and an increase in the toxic effect (correction of the dosing regimen of phenytoin may be necessary, especially in patients with slow acetylation of isoniazid).

Antatsida (especially aluminum-containing) slows down absorption and reduces the concentration of isoniazid in the blood (antacids should be taken no earlier than 1 hour after taking isoniazid).

When used simultaneously with enflurane, isoniazid can increase the formation of an inorganic fluoride metabolite, which has a nephrotoxic effect.

Reduces the concentration of ketoconazole in the blood.

Isoniazid - an antagonist of hypoglycemic action of insulin, it increases the level of glucose in the blood.
This is explained by the significant absorption of isoniazid by the walls of the intestine.
TERMS OF RELEASE FROM PHARMACY

The drug is released by prescription.

TERMS AND CONDITIONS OF STORAGE

The preparation should be stored in a dry, dark place at a temperature of no higher than 25 ° C.
Keep out of the reach of children. Shelf life - 1.5 years. Do not use after the expiration date.
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