Pharmacodynamics. Tos-Mai is a combined preparation that has an antitussive, mucolytic, expectorant, local anesthetic effect, thereby reducing cough, pain and sore throat. the effect of the preparation is due to the pharmacological properties of the components that make up its composition.
Dextromethorphan is an antitussive agent that is the D-stereoisomer of levorphanol. According to the mechanism of action, dextromethorphan, an antagonist of the NMDA receptors of the medulla oblongata, affects the central link of the cough reflex, as a result, a dry unproductive cough associated with irritation of the mucous membrane of the respiratory tract with colds decreases. Its effect on the peripheral link of the cough reflex was also noted by suppressing afferent impulses coming from the mucous membrane of the upper respiratory tract. In terms of the severity of the antitussive action, it is close to codeine, but unlike it does not cause dependence, does not inhibit the respiratory center and the activity of the ciliated epithelium of the respiratory tract, does not have an analgesic effect.
Benzocaine is a highly active surface local anesthetic derived from PABA. Does not have a resorptive effect. The mechanism of action is associated with a decrease in the ionic permeability of nerve endings. As part of combined antitussive preparations, it reduces pain and sore throat.
Potassium guayacolsulfonate is an expectorant. It helps to reduce the viscosity of bronchial mucus, depolymerize mucopolysaccharides and increases the activity of the cilia of the ciliated epithelium of the respiratory tract. Reduces the surface tension and adhesive properties of sputum, reduces its viscosity and facilitates evacuation from the respiratory tract, transforming an unproductive cough into a productive one. It has a weak antiseptic and anesthetic effect.
Sodium benzoate is a direct-acting expectorant. When taken orally, it increases the secretion of the bronchial glands, dilutes phlegm and facilitates its evacuation from the respiratory tract. It has mild antibacterial and antifungal properties.
Pharmacokinetics. After oral administration, dextromethorphan is rapidly absorbed in the gastrointestinal tract and has a high bioavailability. The antitussive effect develops within 15-30 minutes after its ingestion and lasts 5-6 hours. Cmax in blood plasma is achieved after 2 hours. It is actively metabolized in the liver by N- and O-demethylation. T½ is 6.5 hours. It is excreted mainly by the kidneys in the form of metabolites, and only a small amount is excreted unchanged.
Potassium guayacolsulfonate is rapidly absorbed in the gastrointestinal tract. Cmax in the blood is reached after 1-2 hours. Therapeutic concentration is maintained for about 6 hours. T½ is 1-2 hours. It is excreted in sputum and excreted by the kidneys in the form of metabolites and unchanged.
Symptomatic treatment of dry irritating cough with ARVI and infectious and inflammatory diseases of the upper and lower respiratory tract. when preparing a patient for bronchoscopy.
Children aged 12 years and older and adults are usually prescribed 1-2 tablets 4-6 times a day (but not more than 16 tablets a day); children aged 6-12 years - 1 tablet 4 times a day (no more than 8 tablets a day).
In order to achieve a faster action of the preparation, the tablets should be slowly dissolved in the oral cavity.
Hypersensitivity to dextromethorphan, amide anesthetics and other components of the preparation, respiratory failure, BA, pulmonary emphysema.
From the digestive system: nausea, vomiting, abdominal pain, diarrhea.
From the side of the central nervous system: general weakness, drowsiness, headache.
From the immune system: allergic reactions, including rash, itching, flushing of the skin of the face, angioedema.
Do not exceed the recommended doses of the preparation, combine the use of the preparation with the intake of alcoholic beverages, and also use the preparation for chronic cough associated with BA and pulmonary emphysema. the preparation is prescribed with caution in persons with liver disease.
Use during pregnancy and lactation. Teratogenic and embryotoxic effects of the preparation have not been registered, however, given the lack of adequate clinical trials, the preparation can be used during pregnancy only as directed by a doctor in the case when the expected benefit to the mother outweighs the potential risk to the fetus. Due to the lack of information on the use of the preparation during breastfeeding, it should not be used by women during this period.
Children. Tos-Mai is prescribed for children over the age of 6 years.
The ability to influence the reaction rate when driving or working with other mechanisms. In some patients, after using the preparation, drowsiness may occur, a decrease in the reaction rate, which should be borne in mind when driving.
Avoid the simultaneous use of the preparation with antidepressants - MAO inhibitors, furazolidone, procarbazine due to an increased risk of excitation of the central nervous system, the development of arterial hypertension and hyperthermia. preparations that depress the central nervous system, alcohol, when combined, enhance the sedative effect of the preparation. Quinidine slows down the metabolism of dextromethorphan in the liver, increasing its concentration in the blood.
With a significant overdose, symptoms caused by dextromethorphan may occur - drowsiness, dizziness, ataxia, irritability, hyperactivity, confusion, blurred vision, nystagmus, respiratory depression, nausea, vomiting; potassium guayacolsulfonate - drowsiness, nausea, vomiting; benzocaine - in very rare cases, methemoglobinemia. there is no specific antidote, symptomatic treatment.
At a temperature not exceeding 25 ° c.
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