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Antibiotics for inflammation of the appendages should be given to the patient immediately after an accurate diagnosis is established. At this time, studies can be carried out to determine the type of pathogen, but this is not reflected in the initial treatment. Antibacterial drugs are relevant if the inflammatory process proceeds in an acute form. In some cases, antibiotics are given to patients with an exacerbation of a chronic disease.

  • Types of antibiotics for inflammation of the appendages;
  • Indications for the use of antibiotics;
  • Pharmacodynamics of antibiotics;
  • Pharmacokinetics of antibiotics;
  • Treatment of inflammation of the appendages during pregnancy;
  • Contraindications to the use of antibiotics;
  • Side effects of antibiotics;
  • How to take antibiotics for inflammation of the appendages;
  • Overdose of antibiotics;
  • Interactions of antibiotics with other drugs.

For the treatment of inflammation of the appendages, drugs with a wide spectrum of action are relevant, that is, they kill a number of bacteria that usually lead to diseases of the genitourinary system. Doctors need to remember that the antibiotics chosen for the treatment of the patient must be active against ureaplasma, chlamydia and mycoplasma, because most often it is these organisms that cause the inflammatory process.

The treatment is adjusted after the result of the study, if it is found that another drug is better suited to destroy the identified pathogen. The drug and / or dosage should be changed if the patient’s condition has not improved in a few days, that is, there has been no progress in symptoms and laboratory data.

Types of antibiotics for inflammation of the appendages

In recent years, a number of pathogens have acquired resistance to popular antibacterial drugs of the tetracycline series. It is also worth considering that drugs in this group have a large number of side effects. Specialists in most cases treat inflammation of the appendages with doxycycline (which has minimal side effects and is excreted by the body in a short time).

Another group of effective drugs for the problems under consideration are macrolides. They are not destroyed in the stomach, have a long half-life, therefore they accumulate in the body and thus speed up recovery. The effectiveness of sumamed and klacid has been proven in practice today. Antibacterial drugs from the macrolide group destroy, among other things, organisms that settle inside cells, leading to inflammation.

Fluoroquinolines are the next group that is relevant in the treatment of inflammation of the appendages. The “addiction” of pathogens to these drugs is very, very slow, so there will be no need to change the drug often. If the patient has no contraindications to taking fluoroquinolines, one of these drugs is prescribed:

For the treatment of diseases of the genitourinary system, two or more drugs are used, monotherapy is not indicated. The reason is that the pathogens are often two or more microorganisms, both anaerobes and aerobes. For the destruction of the latter, drugs such as metronidazole and tinidazole are relevant.

Indications for the use of antibiotics

Infectious inflammation of the ovarian appendages is known as adnexitis. For therapy, the use of antibacterial drugs of various forms of release is mandatory. Injectable forms are mostly relevant (into a muscle, into a vein, as well as drugs are available in the form of powders for dilution or ready-made solutions). After a course of injections, the doctor prescribes tablet forms of drugs. Also, in some cases, suppositories or suspensions of antibacterial agents may be prescribed.

The main antibiotics that are prescribed for the inflammatory process in the appendages:

Effective drugs from the group of nitromidazoles:

The doctor prescribes aminoglycosides only if the disease is very severe, or if the infection has spread throughout the body, moving to other organs.

Pharmacodynamics of antibiotics

Antibiotics, which are classified as tetracyclines, kill the ability of the pathogen to multiply. They are effective against such flora:

  • gonococci;
  • streptococci;
  • staphylococci;
  • enterobacteria;
  • whooping cough;
  • salmonella;
  • klebsiella;
  • spirochetes;
  • mycoplasmas;
  • chlamydia;

Antibacterial drugs from the group of fluoroquinols inhibit DNA gyrase and topoisomerase, disrupt DNA synthesis, and through these mechanisms they help to cope with the disease. If the pathogen is resistant to 1st generation quinolines (which is detected during therapy), then the doctor prescribes one of the fluoroquinolones. Kill mycobacteria, mycoplasma and pneumococci drugs of this group, but the 3rd and 4th generation, and the 2nd generation is less effective. Some enterococci can also be destroyed by fluoroquinolones.

Pharmacokinetics of antibiotics

Approximately seventy percent of the taken drug from a number of tetracyclines, which are prescribed by physicians in the diagnosis of inflammation of the appendages, is absorbed in the gastrointestinal tract. The active substance “disperses” through tissues and fluids, and during pregnancy it enters both the placenta and the fetus. Tetracycline antibiotics are excreted unchanged from the body in the urine and feces.

Absorption can be greater or lesser, depending on the type of drug and its form, as well as whether it is taken before, during or after a meal. This point should be indicated by the attending physician when developing a treatment regimen. Especially carefully you need to calculate the time of eating and taking ezithromycin. Josamycin and clarithromycin can be taken without regard to lunch/dinner hours.

Macrolides are collected in large quantities in the blood serum and tissues of the body. During inflammation in the body, macrolides spread well in the air, getting inside the cells and concentrating there. These drugs do not cross the hematoophthalmic barrier. Macrolides break down into simpler elements in the human liver, and are excreted through the gallbladder. The half-life is different for all drugs in the group, but the period is at least 1 hour, maximum 55 hours. Renal failure when taking drugs from the macrolide group does not change the above half-life figures.

The absorption of drugs from the fluoroquinolone group occurs to a large extent in the gastrointestinal tract after the patient drinks the pill. 2 hours after ingestion, the highest concentration of the drug in the patient’s blood occurs. These antibiotics can also affect the fetus, so pregnancy is a contraindication for taking. These drugs are excreted mainly by the kidneys, the gallbladder also plays a small role.

Fluoroquinolones, with the exception of norfloxacin, accumulate in the organs and tissues of the human body. Different drugs from this group have different degrees of disintegration into smaller particles, pefloxacin disintegrates the most. Drugs are excreted by 50% in 3-14 hours, the maximum half-life in some cases is twenty hours. If the patient’s kidney function is impaired, then the drugs are excreted longer, this issue should be clarified with the attending physician and be sure to inform him of all diseases, in addition to inflammation of the appendages. When determining the desired therapeutic dose, one must take into account severe renal failure, if it is present in a patient with inflammation of the appendages.

Treatment of inflammation of the appendages during pregnancy

Pregnancy is a contraindication for the appointment of tetracycline drugs, because these drugs pass through the placenta into the fetus, can be collected in its organs and tissues. Because of this, the unborn child will develop the skeleton incorrectly. Some macrolides are also not used during pregnancy. Clarithromycin has been shown to be harmful to the fetus. And the action of roxithromycin and midecamycin has not been sufficiently studied today.

Relatively safe for the treatment of inflammation of the appendages of pregnant women are such drugs:

If no other treatment is possible, and inflammation of the appendages in a pregnant woman is severe, doctors may resort to prescribing azithromycin. Preparations from the group of fluoroquinolones during pregnancy are prohibited.

Contraindications to the use of antibiotics

Contraindications to the appointment of tetracyclines are:

  • kidney failure
  • hypersensitivity to this drug
  • diagnosis of leukopenia
  • if the patient is less than 8 years old
  • when breastfeeding
  • when carrying a child

Contraindications for treatment with macrolides:

  • pregnancy (only part of the drugs)
  • breastfeeding (clarithromycin and others)

Contraindications for fluoroquinolone therapy:

  • gestation
  • lactation
  • lack of glucose-6-phosphate dehydrogenase
  • the appearance of allergic manifestations in response to taking the drug
  • not suitable for children

Side effects of antibiotics

Tetracycline antibiotics can lead to an increase in pressure inside the skull, to dizziness. In the blood, the number of neutrophils, platelets, and hemoglobin changes. Other side effects of these drugs include:

  • nausea;
  • loss of appetite;
  • inflammation in the gastrointestinal tract;
  • diarrhea or constipation;
  • violation of the functioning of the kidneys;
  • allergic manifestations;
  • anaphylactic shock.

Some of these antibiotics, prescribed for inflammation of the appendages, lead to candidiasis, the development of excessive susceptibility to ultraviolet rays. Tetracyclines in babies can disrupt the formation of bones, including teeth, the shade of enamel changes.

Macrolides can lead to such side effects:

  • allergic manifestations;
  • reinfection with pathogen resistance to erifomycin;
  • pain in the gastrointestinal tract;
  • nausea;
  • drooping of the upper eyelid;
  • vision problems;
  • a significant expansion of the pupil;
  • paralysis of the oculomotor muscles.

Fluoroquinolones also cause a number of side effects, one or some of which may be noted in the patient:

  • loss of appetite;
  • pain in the gastrointestinal tract;
  • diarrhea or constipation;
  • nausea;
  • poor sleep, or awakenings in the middle of the night;
  • headache;
  • convulsions;
  • trembling in the body;
  • decreased vision;
  • Allergy manifestations.

Rare side effects of taking fluoroquinolones include:

  • inflammation in the tendons, joints;
  • negative impact on the functioning of the kidneys;
  • tendon ruptures;
  • problems with heart rhythm;
  • diseases of the large intestine;
  • oral candidiasis;
  • thrush in female patients.

How to take antibiotics for inflammation of the appendages

Medicines classified as tetracyclines should be taken after meals or with meals. For adult patients, the doctor prescribes 100 mg of the drug, the dose is divided into three or four doses. If the child is over 8 years old, the dose for him is calculated according to the formula for a maximum of 25 mg / kg. The course of treatment with drugs of this group is 5-7 days, no more. But this should be indicated directly by your attending physician, self-medication with antibiotics is life threatening!

Treatment with tetracycline antibacterial drugs is canceled if a person develops such manifestations of allergies as burning, itching, redness of the skin. It is better not to take these drugs with milk or products based on it (kefir, fermented baked milk), otherwise the product will be absorbed much worse.

A number of macrolide antibiotics should be taken 2 hours after or 60 minutes before a meal. Erythromycin is recorded with water in an amount of more than two hundred milligrams. Suspensions for internal use must be diluted, before use, read the instructions, which indicate the features of administration and dosage. The doctor prescribes a specific treatment regimen that must be strictly followed. The medicine is taken at certain time intervals, and this plan cannot be deviated from, only in this way the desired concentration of the medicine in the blood and tissues is achieved.

Macrolides are not taken with antacids. The latter are prescribed in the presence of acid-dependent diseases of the gastrointestinal tract. Fluoroquinolones are also washed down with water in large quantities, taken 2 hours before meals. When treating with antibiotics, you need to drink one and a half liters of water or more per day.

Antibiotic overdose

If an overdose of tetracyclines occurs, the side effects of the drugs become stronger. Side effects are listed above. Treatment consists of taking medications to relieve symptoms. An overdose of antibiotics from a number of macrolides is not life-threatening. There are stool disorders, nausea, the heart rhythm changes.

Fluoroquinols in excessive dosage for the life of the patient do not pose a threat. The resulting symptoms are treated outside the hospital. Very rarely, epileptic seizures can occur. An overdose of these drugs affects the joints, liver, cardiovascular system and tendons.

Interactions of antibiotics with other drugs
Tetracyclines should not be combined with therapy with drugs containing such substances:

  • calcium;
  • magnesium;
  • iron;
  • zinc;
  • other metal ions.

The effect of tetracycline drugs is adversely affected by concurrent therapy with barbiturates and carbamazepine. It should be borne in mind that antibiotics from this series reduce the effectiveness of oral contraceptive pills. It is impossible to combine treatment with macrolides and aminoglycosides. Tetracyclines and chloramphenicol or lincomycin are not prescribed together. There are a number of other features of the interaction of antibiotics and other drugs that the attending physician should talk about, given the patient’s medical history and current diseases, in addition to inflammation of the appendages.

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Disruption of the hormonal balance in the male body, in particular, an increase in the level of the hormone dihydrotestosetron, leads to the development of prostatic hyperplasia, a concomitant manifestation of which is the difficulty of urine outflow in the acute or latent form. For inhibiting (preventing the production) of dihydrotestosterone, a synthetic substance of selective action is used – Dutasteride, which is part of preparations with various trade names.

Active ingredient and its focus
Dutasteride was developed and patented for the first time in the United States of America. It was released into mass production in 2001 as part of the drug under the trade name Avodart, which is still used today. In 2015, the term of the patent for a substance ended and it was used in the production of generic drugs.

Increasing the level of the hormone dihydrotestosterone in men leads to uncontrolled proliferation of prostate tissue, followed by possible degeneration of them into a malignant form.

In addition, the increased background of dihydrotestosterone in men is the cause of alopecia (hair loss on the head) and hirsorutism (body hair in women).

Prostate hyperplasia is considered as a precancerous condition of the body, it requires increased attention and corrective therapeutic and sometimes surgical interventions. One of the substances that selectively reduces the level of dihydrotestosterone is Dutasteride.

The substance inhibits the activity of enzymes 5-alpha-reductase of the 1st and 2nd types, acting on the hormone testosterone, preventing it from turning into an excess amount of dihydrotestosterone.

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Thanks to the action of this medication, many patients managed to avoid surgery and control the condition of the gland, restraining the progression of its growth.

In modern urology, for the treatment of prostatic hyperplasia, two active substances with similar pharmacological action are used – this is Dutasteride and its analogue – Finasteride.

They have few fundamental differences from each other, but still it is worth noting some of their differences.

Dutasterid is recognized as more effective due to the fact that it can combine with the alpha reductase enzyme of the 1st and 2nd type (which is why it is called a double inhibitor) and can reduce a high level of dihydrotestosterone by 98%, while Finasteride forms compounds only with the 1st type of enzyme and its effectiveness is slightly lower due to this – 70%.

⚠Intensive metabolism of such active ingredients occurs through the liver, so it is very important that during the course of treatment with means containing Dutasteride, the liver is healthy and able to cope with its functions.⚠

Dosage Form
Generic Avodart is made in the form of capsules-cases of white color, soluble in the stomach and containing the active substance dutasteride in the amount of 0.5 mg. Capsules are located in contour cells of 10 pieces. One pack contains 30 or 90 capsules.

Capsules are taken orally, one piece per day, washed down with water. The capsule itself can not be chewed or pour its contents into the oral cavity, since the active substance can damage the mucous membrane of the mouth and pharynx.

According to the instructions for use, the tool is recommended to take, regardless of the meal, but there is evidence that simultaneous ingestion with food reduces the absorbability and level of concentration of the active ingredient in the body.

The maximum concentration of a substance in the blood plasma is recorded already after 3 hours from the moment of use. On condition of daily ingestion of 0.5 mg of dutasterid after one month of its administration, its concentration in blood serum is 65 percent, and after 3 months it reaches a level of 90 percent.

Improving the dynamics of the urological orientation is manifested in the first month of treatment. It is necessary to take Avodart from 3 to 6 months in a mono or combination therapy format. In patients with gland hyperplasia, a decrease in the level of prostate specific antigen has been clinically proven, compared to baseline, by 50 percent after two weeks from the start of the drug.

The same indicators were observed in patients with the carcinogenic form of the disease.

With prolonged therapy to the active component does not occur addiction, and its effectiveness is not reduced. Used by adult males, including the elderly.

Contraindications and side effects

Of the contraindications for use are noted:

  • individual intolerance to the active substance;
  • From the special instructions for use it follows that dutasteride is well absorbed through the skin, therefore it is impossible to extract the contents from the capsules and to protect children and women who are at any time during pregnancy from getting it onto the mucous membranes and skin.

Scientifically based and confirmed data were obtained that Avodart, containing dutasteride, causes anomalies of the genitals in boys in the prenatal phase.

For the period of treatment, partners are recommended to refrain from unprotected sexual intercourse, since even 6 months after the end of the drug intake, sperm contains residual amounts of dutasteride, and there is no absolutely accurate evidence that sperm is not absorbed into the female genital tract during contact

reasonably apply, or completely refuse to take in case of liver diseases;
Before starting treatment, it is necessary to exclude malignant neoplasms of prostate tissue, and already in the course of treatment – to control the level of a specific prostate antigen.

Of the side effects may be the following:

    • a significant decrease in sexual desire, erectile dysfunction, impotence, impaired control over the function of ejaculation;
    • gyrsorutism, gynecomastia;
    • individual intolerance to the components in the form of allergic manifestations;
    • when taking the combined options, which contain adrenaline blockers, it is necessary to control the work of the heart, as the risk of side effects increases.

The frequency of manifestations of adverse events is directly related to the individual characteristics of each individual organism and the duration of the course of administration – the longer the application time, the more likely the risk of undesirable effects.

⚠However, it has been proven that even when the dose is exceeded many times, for those who normally tolerate Dutasterid, no side effects have occurred.⚠

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Other names for this medication:
Aciban-dsr, Adzole-dm, Agilam, Apentral, Apuldon, Arcelenan, Atidon, Avizol-d, Avomit, Benzilum, Bipéridys, Bompy, Canozol-d, Cilroton, Cinet, Cobaperidon, Costi, Cosy, Coszol-d, Dalic, Dany, Deflux, Degut, Depam, Diocid-d, Docivin, Dolium, Dombaz, Domedon, Domepraz, Domerdon, Dometa, Dometic, Domezol, Domilin, Domilux, Domin, Dominal, Dominat, Dompan, Domped, Dompel, Dompenyl, Domper, Domperdone, Domperidona, Domperidoni maleas, Domperidonmaleat, Domperidonum.

Motilium☤ is an antiemetic, which also has the ability to reduce the severity of dyspeptic symptoms (heartburn, flatulence, belching, nausea, vomiting, sensation of fullness and stomach pain after eating, etc.) due to a violation of the evacuation of the food lump from the stomach into the intestine. Therefore, Motilium☤ is used to stop vomiting, as well as to alleviate dyspeptic symptoms in reflux esophagitis, gastroesophageal reflux, GERD, esophagitis, gastric hypotension, and also against cytostatic therapy or radiotherapy of tumors.👍

Forms of release, names and composition Motilium☤ Currently, Motilium☤ is available in the following three dosage forms:
1. Tablets for resorption in the oral cavity;
2. Tablets, coated with a coating, for oral administration;
3. Suspension for oral administration.

☘ Tablets in the shell and for resorption in the oral cavity are usually called simply “Motilium☤ tablets” without specifying which particular species are involved. And the suspension often in everyday speech is called Motilium☤ syrup. However, since MotiliuⓂ☤ does not exist as a syrup, this term denotes the liquid form of the preparation, without going into the subtleties of the differences between the suspension, solution, syrup, emulsion, etc. In addition, the suspension is often called children’s Motilium☤, since this particular dosage form is used in pediatric practice.
In the composition of all dosage forms of Motilium☤, Domperidone is included as the active substance in the following different dosages:

☞☞☞Tablets for resorption in the oral cavity – 10 mg;☞ Tablets for ingestion in the shell – 10 mg; Suspension – 1 mg per 1 ml.
The auxiliary components of all three dosage forms of Motilium☤ are reflected below


☞Mint Essence
☞Poloxamer 188

Coated tablets:

☞Corn starch
☞Potato starch
☞Microcrystalline cellulose
☞Magnesium stearate
☞Hydrogenated vegetable oil
☞Lauryl sulfate

Coated tablets:

☞Saccharin sodium
☞Sodium hydroxide
☞Microcrystalline cellulose
☞Purified water
☞Carboxymethylcellulose sodium
☞Methyl parahydroxybenzoate
☞Propyl parahydroxybenzoate

☘ Tablets for resorption have a round shape and are painted white or almost white. The tablets in the shell are round in shape, painted white or white-cream color and are labeled “Janssen” and “M / 10” on flat surfaces. If the tablet is broken in a shell, then at the break it will be uniformly white, without inclusions. Both types of tablets are available in packs of 10 or 30 pieces. The suspension is a white opaque liquid of a homogeneous structure and an acidic consistency. Produced in bottles of dark glass with a volume of 100 ml.

What helps Motilium☤ (therapeutic effects)

Motilium☤ has the following pharmacological effects: Suppression of vomiting center activity in the brain; Increase in intensity and duration of contractions of the stomach and duodenum; Increased pressure in the esophagus; Acceleration of the evacuation of the food lump from the stomach into the duodenum. These pharmacological effects provide the therapeutic effect of Motilium☤, which consists in stopping the symptoms of digestive disturbances (flatulence, eructation, a feeling of heaviness and pain in the stomach after eating, nausea, vomiting, heartburn, etc.) caused by stomach diseases, which disrupt the evacuation process Its contents (gastritis, peptic ulcer, reflux esophagitis, GERD, stomach hypotension), as a result of which the food stagnates and does not pass into the duodenum in time. Motilium☤ improves the contractile activity of the muscles of the stomach, which leads to a faster evacuation of the food lump into the duodenum. ☘ And due to the fact that the food does not stagnate and does not irritate the stomach, people suffer from painful symptoms of dyspepsia (belching, heartburn, flatulence, etc.). That is, Motilium☤ helps to get rid of the symptoms of stomach diseases, in which food stagnates in it. And since these symptoms can occur in a healthy person, such as overeating, ȩating fatty or unusual food, or with other violations of a normal balanced diet, Motilium☤ will also help in this case to get rid of the unpleasant sensations associated with overcrowding. Due to increased pressure in the esophagus, MotiliuⓂ☤ prophylaxes gastroesophageal reflux, reducing heartburn and other symptoms (eructation by acid, etc.), and also contributing to the cure of GERD (gastroesophageal reflux disease). ☘ That is, Motilium☤ helps to stop the symptoms of gastroesophageal reflux and GERD. And due to the suppression of the activity of the emetic center, Motilium☤ is able to eliminate vomiting caused by an infectious disease, taking medications, various chronic pathologies of any organs and systems, and functional digestive disorders caused by the use of unknown or unusual food and other similar factors.

Motilium☤ – indications for use

Suspension and both types of Motilium☤ tablets are indicated for use in the following identical cases:

1.Coperation of the following symptoms of gastric hypotension, gastritis, GERD, reflux esophagitis, gastroesophageal reflux arising from delay in food in the stomach and its slow evacuation into the intestine:
☞Feeling of heaviness, pressure, or overcrowding in the stomach after eating;
☞Pain in the stomach after eating; Bloating; Flatulence; Belching, including sour contents;
☞Regurgitation (throwing a fairly large amount of stomach contents into the mouth).
2. Nausea or vomiting caused by infectious diseases, pathologies of any internal organs or functional disorders (for example, inaccuracies in diet, motion sickness, eating too much food at a time, etc.).
3. Nausea and vomiting, triggered by medication, as well as radiotherapy and chemotherapy of tumors.
4. Nausea and vomiting, triggered by taking Levodopa, bromocriptine or other preparations of the dopamine agonist group in Parkinsonism.
5. Stopping nausea and vomiting reflex during medical manipulations, for example, introduction of a gastric tube, production of an efGDS, etc.
6. Syndrome of regurgitation in children.
7. Cyclic vomiting in children.
8. Gastroesophageal reflux in children.
9. Violations of gastric motility in children.

Motilium☤ tablets – instructions for use
Dissolving and coated tablets should be taken 15 to 30 minutes before meals. Also, if necessary, Motilium☤ can be taken before bedtime. The tablet in the shell is simply swallowed, without cracking and chewing, with half a glass of water.☘ A tablet for resorption is put on the tongue and waiting for a few seconds, until it breaks up into small particles. After that, the formed particles are swallowed and, if necessary, washed down with several sips of water. However, if there is no water for some reason, the absorbable tablets can not be washed down after they have broken up into small pieces in the tongue and were swallowed. Tablets in the shell can be extracted from the blister, not observing any special precautions. Care should be taken with absorbable tablets, as they are quite fragile. To avoid breaking and scattering of tablets, it is recommended not to squeeze them out of the blister through the foil, but carefully cut the edge of the cell with scissors. Also, you can carefully remove the foil from one cell and take out a tablet from it. For the relief of dyspepsia (belching, heartburn, flatulence, a feȩling of fullness of the stomach, etc.) for chronic diseases of the stomach and esophagus, adults and children over 5 years should take 1 tablet 3 times daily before meals, and, if necessary, before Sleep.☘ In the absence of effect, children over 12 years and adults can increase the dosage twice, that is, take 2 tablets 3 times daily before meals. For nausea and vomiting, children over 12 years of age and adults should take 2 tablets 3 to 4 times a day before meals and before bedtime for their cupping. And children 5 – 12 years for the reduction of nausea and vomiting should be given 1 tablet 3 to 4 times a day before meals and at bedtime. For children from 5 to 12 years, the maximum allowable daily dosage of Motilium☤ is 2.4 mg (1/4 tablet) per 1 kg of body weight, but not more than 80 mg (8 tablets). For adults and teenagers over 12 years, the maximum allowable daily dosage of MotiliuⓂ☤ is 80 mg. Children under 5 years of age are given the drug as a suspension and the dosage is calculated individually by body weight, based on a ratio of 2.5 ml per 10 kg of body weight. Tablets Motilium☤ in children under 5 years old and weighing less than 35 kg are not applied.

Motilium☤ suspension (Motilium☤ for children) – instructions for use
Suspension is intended for use in children under 5 years of age and with a body weight of less than 35 kg. In children of the first year of life, the drug should be used only as directed by a doctor and under constant supervision. Suspension, as well as tablets should be given to a child 15 to 30 minutes before meals and, if necessary, before going to bed.☘  The amount of the drug, measured with a special syringe, must be poured into a spoon or in a small container (a glass, a glass, etc.) and give a drink to the child. The suspension can be washed down as desired. The dosage of the suspension for use in relation to various conditions in children is the same and depends only on body weight. Dosage is calculated individually for each 0.25-0.5 ml of the suspension for every 1 kg of the child’s body weight. ☘ The calculated amount of suspension is given to the child 3 to 4 times a day before meals and, if necessary, before going to bed. ☘ However, since a convenient measuring syringe is supplied complete with a vial, on which the variants of the child’s weight are indicated in steps of 1 kg and the corresponding amount of suspension in ml, it is possible not to calculate the dosage for the baby. It is enough to simply use the attached measuring syringe. The maximum allowable daily dosage of Motilium☤ suspension for children under 5 years is 2.4 ml per 1 kg of body weight, but not more than 80 mg (80 ml of suspension). If necessary, the suspension can be taken by adults and adolescents over 12 years in a dosage of 10 – 20 ml 3 to 4 times a day. The maximum permissible daily dose of the suspension for adults and adolescents over 12 years is 80 ml. Each time before use, shake the suspension vial

Special instructions
Do not use Motilium☤ to stop and prevent postoperative vomiting.
In renal failure, it is recommended to maximize the intervals between the two subsequent doses of the drug, but the dosage is not required to be reduced. However, if a person suffering from kidney failure should take Motilium☤ for a long time, then the entire daily dosage should be divided into 1 to 2 doses, and not 3 to 4. If the kidney function worsens during the application of the drug, it is necessary to reduce the dosage of the drug. For hepatic insufficiency, the drug in any form should be used with caution, constantly monitoring the functions and condition of the liver. When Motilium☤ is used simultaneously with antacids (Rennie, Fosfalugel, Almagel, Maalox, etc.) and H2-histaminoblockers (Ranitidine, Famotidine, etc.), their administration should be carried out in time. Optimal Motilium☤ take before meals, and antacids and H2-gistaminoblokatory – after eating. ☘ Tablets in the shell contain lactose, so they should not be taken by people suffering from intolerance to milk sugar, as well as impaired absorption of glucose and galactose. Also, resorption tablets should not be taken by people who have an increased risk of developing hyperphenylalanineemia, due to the content of aspartame in them. In children less than 1 year of age, Motilium☤ in rare cases can provoke neurologic side effects, therefore, when using the drug, you should strictly adhere to the recommended dosages without increasing them yourself.

Application in pregnancy and breastfeeding
In pregnancy, Motilium☤ can be taken only if the intended benefit to the mother exceeds the possible risks to the fetus. Breastfeeding Motilium☤ can not be taken, because in milk the drug is in a concentration of 50% of that in the blood.☘

Effect on the ability to manage mechanisms
Motilium☤ does not affect the ability of a person to control mechanisms, so against the background of the drug can be engaged in any type of activity that requires a high concentration of attention and reaction speed.

Overdose of Motilium☤ is possible and is manifested by the following symptoms:
☞Agitation (agitation);
☞Changed consciousness;
☞Extrapyramidal reactions (tremor, speech disorders, tics, myoclonus, etc.).
For the treatment of overdose, a single gastric lavage is performed followed by sorbent (activated charcoal, Polysorb, Polyphepan, etc.). In the future, if necessary, antihistamines and cholinergic drugs are used, drugs for the treatment of parkinsonism for the relief of extrapyramidal reactions.

Interaction with other drugs
Reduces the severity of the therapeutic effect of Motilium☤ anticholinergic agents (Aprofen, Atropine, Scopolamine, Dicyclomine, Cyclizine, Benaktizin, etc.), cimetidine and sodium bicarbonate. Increase the effect of Motilium☤ Fluconazole, Itraconazole, Ketoconazole, Coriconazole, Clarithromycin, Erythromycin, Amprenavir, Atazanavir, Fosamprenavir, Indinavir, Nȩlfinavir, Ritonavir, Saquinavir, Diltiazem, Verapamil, Amiodarone, Aprepitant, Nefazodone and Telithromycin.
Ketoconazole and Erythromycin, when used concomitantly with Motilium☤, cause changes in the ECG, which are normalized after drug withdrawal.

Side Effects of Motilium
Suspension and both types of Motilium☤ tablets can cause the following following side effects from different organs and systems:
1. Gastrointestinal tract:
☞Intestinal spasms;
☞Change in activity of ASAT, ALAT and APF;
☞Dry mouth;
☞Impaired appetite.

2. Nervous system:
☞Extrapyramidal syndrome (tics, tremors, speech disorders, parkinson-like movements, disorders of muscle tone, etc.);

3. Mental disorders:
☞Agitation (excitement);

4. Immune system:
☞Anaphylactic reactions (Quincke’s edema, anaphylactic shock, urticaria);
☞Allergic reactions.

5. Endocrine system:
☞Increased prolactin levels in the blood;
☞Galactorrhea (flow of milk from the chest);
☞Amenorrhea (absence of menstruation);

6. Skin:
Extrapyramidal disorders, as a rule, occur in children, but are transient, that is, they disappear on their own after the termination of Motilium☤ administration and do not require special treatment.

Contraindications for use☘
Suspension and both versions of Motilium☤ tablets are contraindicated for use in the presence of the following diseases or conditions in a person:
☞Prolactinoma (a pituitary brain tumor producing prolactin);
☞Hyperprolactinemia (increased levels of prolactin in the blood);
☞Simultaneous administration of drugs containing ketoconazole, erythromycin, fluconazole, voriconazole, clarithromycin, amiodarone or telithromycin as active substances;
☞Gastrointestinal bleeding; Mechanical obstruction of the intestine;
☞Perforation of any organ of the digestive tract;
☞Body weight less than 35 kg (for tablets);
☞Individual sensitivity or intolerance of the drug components;
☞Pregnancy and lactation.

In children younger than 1 year, Motilium☤ should be used only in the form of a suspension and with care.

Reviews on the use of Motilium☤ in adults in most cases are positive, which is due to the high effectiveness of the drug when taken on indications. However, in reviews, not all is unequivocal and there are a lot of nuances, because the spectrum of conditions under which people took Motilium☤ is quite wide and varied. So, adults took Motilium☤ in two main cases. ☘ First, the drug was taken occasionally for the relief of nausea and vomiting that arose due to existing digestive tract diseases, diet or infectious disease disorders. Secondly, adults took Motilium☤ as part of complex therapy of stomach diseases (gastritis, peptic ulcer, pyloric stenosis, etc.), refluxes and GERD with the aim of arresting flatulence, a feeling of overfilling in epigastrium, eructation, early saturation, vomiting and other symptoms of iⓂpairment Digestion of food, characteristic of these diseases. With an episodic reception of Motilium☤ for the relief of vomiting and nausea, the drug in about 2/3 cases eliminates these symptoms after the first tablet. The relief of vomiting and nausea significantly improves the overall well-being of a person, allowing him to calmly drink various solutions to compensate for fluid loss, and to take other medications that are aimed at eliminating the cause of the symptoms and treating the disease. ☘ In such situations, reviews about Motilium☤ were positive. In the remaining 1/3 cases, people had to take Motilium☤ to stop vomiting for several days in a row before each meal or liquid intake. Such a mode of application of the drug is certainly not pleasing to people, therefore they tend to leave neutral or negative feedback in such situations. And with the use of Motilium☤ for the relief of dyspeptic symptoms (eructation, nausea, vomiting, flatulence, a feeling of fullness of the stomach, pain in the epigastrium, etc.), characteristic of chronic diseases of the stomach, GERD and reflux, the drug proved to be effective in almost 100% of cases, So this category of reviews about it is almost all positive.

Motilium☤ for children – reviews
At present, a very interesting situation is observed when, in practice, Motilium☤ is used in children for a wide range of different conditions, and very often not according to the indications, but according to one’s own ideas about the physiological functions of the child’s body. Naturally, in this situation, reviews about Motilium☤ are very diverse. To navigate in them, we will consider the responses of people who gave the drug to a child for various reasons.
Comments on the use of Motilium☤ to stop vomiting in children with rotavirus infections, any other acute infectious diseases, and in response to taking medications in about 2/3 of the cases are positive. This is due to the fact that the drug stopped vomiting and improved the general condition of the child, who began to actively play, ask for drinks, eat, etc. And in some cases, a single dose of the drug was enough to stop vomiting, and in others it was necessary to give the baby syrup several times a day for 2 to 3 days.☘ When vomiting did not stop after a single dose, the parents gave Motilium☤ a child before each meal, drink or other medication.
About 1/3 – 1/4 of the reviews on Motilium☤ for the reduction of vomiting in acute conditions in children are negative, which is usually due not so much to the properties of the drug, as to the subjective attitude towards it, overestimated expectations, and also the use not according to the indications. Very often parents try to give the child Motilium☤ in case of vomiting, provoked by poisoning, and when the drug does not have the expected effect, they are disappointed and leave negative feedback. In fact, Motilium☤ will not stop vomiting during poisoning, because it is caused by the intake of toxic substances into the blood from the intestine, and not by the disorder of the stomach. In such casȩs it is necessary to take sorbents that bind toxic substances. A Motilium☤ can be drunk only before taking the sorbent so that the child does not vomit within the next 10 to 15 minutes and the main medication is not taken out.
The second part of the reviews on Motilium☤ concerns its use in infants and young children in order to reduce gassing, bloating and regurgitation. In this case, almost all reviews of the drug are positive, as the syrup effectively stopped these symptoms. ☘ The third part of the reviews on the drug concerns its use in diseases of the digestive tract in children (GERD, gastritis, gastroduodenitis, esophagitis, reflux) in order to relieve the unpleasant symptoms of slow gastric emptying (sensations of severity in the stomach, abdominal pain, belching, flatulence, nausea, vomiting and etc.). This category of reviews is in most cases positive, as the parents achieve a good therapeutic effect with the regular use of Motilium☤ syrup according to the instructions.
The fourth part of the reviews about Motilium☤ concerns its use not according to the testimony. So, many parents give syrup to children so that food from the stomach is more quickly evacuated, and they could eat more at a time. This application of the syrup is based on the fact that Motilium☤ stops the feeling of fullness of the stomach. Usually this way the drug is used when trying to get the child to “eat well” and gain weight, which in the opinion of parents and doctors is inadequate. Naturally, such a method of improving a child’s appetite and increasing the amount of food eaten by him does not work for a number of reasons, and parents leave a negative feedback about the drug.
First, Motilium☤ reduces the feeling of overcrowding and accelerates the passage of the food lump into the intestine only with diseases such as peptic ulcer, gastritis, GERD, esophagitis and reflux! And if the child does not suffer from such diseases, then his food is evacuated from the stomach to the intestine at a normal rate, and attempts to reduce this time lead only to the fact that the food lump is poorly processed and digested by gastric juice.☘ This will cause the baby colic, flatulence, bloating and other unpleasant sensations. In other words, in an attempt to speed up the evacuation of the food lump from the stomach to the intestines, to “free” space for another large portion of food, the parents only disrupt the normal process of digestion in the child, which can ultimately lead to the development of severe chronic gastrointestinal diseases.
Secondly, against the background of taking Motilium☤ the child will not be able to eat more, but, on the contrary, will be satisfied with a smaller amount of food. This is due to the fact that the food lump will quickly enter the intestine, wherece the nutrients will be absorbed into the bloodstream and give a signal to the brain about the onset of satiety. As a result, the child will be satisfied with a Ⓜuch smaller volume of food than before.
That is, the use of Motilium☤ in order to “improve” the child’s nutrition is not just irrational, inexpedient, ineffective and not according to tȩstimony, but also dangerous. That the child has typed weight, it is necessary to feed it with small portions of high-calorie and tasty food on 4 – 6 times a day. And try to feed him a large portion of low-calorie food – it’s just stretching the stomach, disrupting the normal process of digestion and creating a base for the development of digestive tract diseases.☘

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