Universal reference book for medicines
Product name: CEVIKAP (CEVIKAP)

Active substance: ascorbic acid

Type: Vitamin preparation

Manufacturer: MEDANA PHARMA TERPOL GROUP (Poland)
Description of the active substance:
This information is a reference and it is not enough that the drug has been prescribed by a doctor ..

PHARMACHOLOGIC EFFECT
Vitamin C. Ascorbic acid is necessary for the formation of intracellular collagen, it is required to strengthen the structure of teeth, bones and walls of capillaries.
It participates in oxidation-reduction reactions, tyrosine metabolism, conversion of folic acid into folinic, carbohydrate metabolism, synthesis of lipids and proteins, iron metabolism, cellular respiration processes. Reduces the need for vitamins B 1 , B 2 , A, E, folic acid, pantothenic acid, increases the resistance of the body to infections; improves the absorption of iron, contributing to its deposition in a reduced form. It has antioxidant properties.
With intravaginal application, ascorbic acid reduces the pH of the vagina, inhibiting the growth of bacteria and helps restore and maintain normal pH and flora of the vagina (Lactobacillus acidophilus, Lactobacillus gasseri).

PHARMACOKINETICS
After ingestion, ascorbic acid is completely absorbed from the digestive tract.
Widely distributed in the tissues of the body.
The concentration of ascorbic acid in the blood plasma is normally about 10-20 μg / ml.

The concentration of ascorbic acid in leukocytes and platelets is higher than in erythrocytes and in plasma.
With deficient states, the concentration in leukocytes decreases later and more slowly and is considered as the best criterion for assessing the deficit than the concentration in the plasma.
Binding to plasma proteins is about 25%.

Ascorbic acid reversibly oxidizes with the formation of dehydroascorbic acid, part is metabolized with the formation of ascorbate-2-sulfate, which is inactive, and oxalic acid, which is excreted in the urine.

Ascorbic acid, taken in excessive amounts, is quickly excreted unchanged in the urine, usually when the daily dose exceeds 200 mg.

INDICATIONS
For systemic use: prevention and treatment of hypo- and vitamin deficiency vitamin C;
providing increased body requirement in vitamin C during growth, during pregnancy, lactation, with heavy loads, overfatigue, in the period of convalescence after prolonged serious illnesses; in the winter, with an increased risk of developing infectious diseases.
For intravaginal application: chronic or recurrent vaginitis (bacterial vaginosis, unspecific vaginitis) due to anaerobic flora (due to altered vaginal pH);
with the purpose of normalization of the broken microflora of the vagina.
DOSING MODE
Apply inside, in / m, in / in, intravaginally.

For the prevention of deficient conditions - 25-75 mg / day, for treatment of 250 mg / day or more in divided doses.

For intravaginal use, ascorbic acid preparations are used in appropriate dosage forms.

SIDE EFFECT
From the side of the central nervous system: headache, fatigue, insomnia.

From the digestive system: stomach cramps, nausea and vomiting.

Allergic reactions: single cases of skin reactions and manifestations on the part of the respiratory system are described.

From the side of the urinary system: when used in high doses - hyperoxaluria and the formation of kidney stones from calcium oxalate.

Local reactions: with intravaginal application - burning or itching in the vagina, increased mucosal discharge, hyperemia, swelling of the vulva.

Other: a feeling of heat.

CONTRAINDICATIONS
Hypersensitivity to ascorbic acid.

PREGNANCY AND LACTATION
The minimum daily requirement for ascorbic acid in the II and III trimesters of pregnancy is about 60 mg.

Ascorbic acid penetrates the placental barrier.
It should be borne in mind that the fetus can adapt to high doses of ascorbic acid, which is taken by a pregnant woman, and then a newborn can develop ascorbic disease as a withdrawal reaction. Therefore, in pregnancy, do not take ascorbic acid in elevated doses, except when the expected benefit exceeds the potential risk.
The minimum daily requirement for lactation (breastfeeding) is 80 mg.
Ascorbic acid is excreted in breast milk. A mother's diet containing an adequate amount of ascorbic acid is sufficient to prevent a deficiency in an infant. It is not known whether it is dangerous for a child to use ascorbic acid with a mother in high doses.Theoretically, this is possible. Therefore, it is recommended not to exceed the maximum daily requirement for ascorbic acid by the nursing mother, unless the expected benefit exceeds the potential risk.
APPLICATION FOR FUNCTIONS OF THE LIVER
Use with caution in patients with hyperoxaluria, impaired renal function, indications in the history of urolithiasis.

SPECIAL INSTRUCTIONS
Use with caution in patients with hyperoxaluria, impaired renal function, indications in the history of urolithiasis.

Since ascorbic acid increases iron absorption, its use in high doses can be dangerous in patients with hemochromatosis, thalassemia, polycythemia, leukemia and sideroblastic anemia.

In patients with a high iron content in the body, ascorbic acid should be used in minimal doses.

Use with caution in patients with deficiency of glucose-6-phosphate dehydrogenase.

The use of ascorbic acid in high doses can cause an exacerbation of sickle cell anemia.

Data on the diabetic effect of ascorbic acid are contradictory.
However, prolonged use of ascorbic acid should periodically monitor blood glucose levels.
It is believed that the use of ascorbic acid in patients with rapidly proliferating and widely disseminated tumors may aggravate the course of the process.
Therefore, it is necessary to use with caution ascorbic acid in patients with progressive oncological disease.
Absorption of ascorbic acid decreases with the simultaneous use of fresh fruit or vegetable juices, alkaline drink.

DRUG INTERACTION
When used simultaneously with barbiturates, primidone, excretion of ascorbic acid with urine increases.

With the simultaneous use of oral contraceptives, the concentration of ascorbic acid in the blood plasma decreases.

With simultaneous use with iron preparations, ascorbic acid, due to its reducing properties, transfers ferric iron to bivalent iron, which improves its absorption.

Ascorbic acid in high doses can reduce the pH of the urine, which, when used at the same time, reduces the tubular reabsorption of amphetamine and tricyclic antidepressants.

With the simultaneous use of acetylsalicylic acid reduces the absorption of ascorbic acid by about a third.

With simultaneous use with warfarin, the effects of warfarin may be reduced.

With simultaneous application of ascorbic acid increases the excretion of iron in patients receiving deferoxamine.
When using ascorbic acid at a dose of 500 mg / day, there may be a disruption of left ventricular function.
With simultaneous use with tetracycline, the excretion of ascorbic acid with urine increases.

The case of a decrease in the concentration of fluphenazine in the blood plasma in a patient who received ascorbic acid 500 mg twice a day was described.

It is possible to increase the concentration of ethinyl estradiol in blood plasma when it is used simultaneously in oral contraceptives.

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