Combined preparation containing the main trace elements necessary to support the process of hematopoiesis.
Iron is an essential component of hemoglobin, myoglobin and iron-containing enzymes, plays an important role in oxygen transport, takes part in oxidative metabolism, and stimulates erythropoiesis. Copper and manganese, which are directly involved in both the absorption of iron and the synthesis of hemoglobin, are important components of enzyme systems involved in the main redox processes in the human body.
Usually, iron salts are only partially absorbed when taken orally (10–20% of the dose taken). Absorption increases with decreasing body iron stores. Absorption occurs mainly in the duodenum and in the proximal jejunum. The simultaneous use of iron, copper and manganese in balanced amounts prevents the impairment of the absorption of iron, which can occur when used separately.
Iron-deficiency anemia; preventive treatment of iron deficiency in pregnant women, as well as premature infants, twins or children born to women with iron deficiency; if the diet does not contain enough iron.
The contents of the ampoule are dissolved in plain or sweetened water or in any other beverage other than tea, coffee, milk and alcoholic beverages.
The ampoule is opened by hand, breaking at both ends (this is possible without the use of a nail file). The ampoule should be opened directly above the container with the drink.
Apply internally. It is advisable to take it before meals, since this is how the maximum absorption of the drug's components by the body is achieved. Doses and time of administration of the Totem preparation can be adjusted taking into account the individual sensitivity of the gastrointestinal tract.
Treatment of iron deficiency anemia: adults are prescribed 100-200 mg of iron per day, that is, 2-4 ampoules of the drug; for children over the age of 1 month, the drug is prescribed at the rate of 5-10 mg of iron per 1 kg of body weight per day.
The duration of the course of treatment should be sufficient to correct anemia and restore the iron depot in the body. The duration of treatment for iron deficiency anemia is usually 3–6 months, depending on the depletion of the iron depot and can be extended, if necessary, if the causes of the anemia are not eliminated. Monitoring the effectiveness of treatment should be carried out 1 time in 3 months. Monitoring should include indicators of peripheral blood (Hb, MCV - average erythrocyte volume) and indicators of saturation of the iron depot (blood plasma iron and transferrin saturation with iron).
For the treatment of iron deficiency, a dose is used that is half that for the treatment of anemia.
Prevention of anemia and iron deficiency: for the prevention of anemia during pregnancy, the drug is prescribed to pregnant women at the rate of 50 mg of elemental iron (1 ampoule) per day in the II and III trimester of pregnancy or starting from the 4th month of pregnancy.
Excess iron in the body (especially against the background of normocytic anemia or hypersideremia, such as thalassemia). regular blood transfusions. simultaneous use of parenteral forms of iron. intestinal obstruction. iron refractory anemia. anemia associated with insufficiency of medullary hematopoiesis. hypersensitivity. hereditary fructose intolerance.
From the gastrointestinal tract: nausea, heartburn, constipation, diarrhea. temporary black staining of the stool is possible, which has no clinical significance and no health consequences.
A temporary change in the color of the tooth enamel is possible, which does not have any health consequences and disappears after the end of the treatment. To prevent such a phenomenon, it is enough to dilute the solution of the drug in an appropriate drink and, when used, do not keep it in the mouth for a long time.
Allergic reactions (itching, rash, urticaria, anaphylactic reactions), abdominal pain, vomiting are possible.
Take the drug with caution, especially in undiluted form, for patients with esophageal stenosis and / or other obstructive diseases of the digestive tract, intestinal diverticulum.
Iron deficiency associated with inflammation cannot be treated with iron supplements alone. It is necessary, if possible, to influence the cause of the disease.
Excessive consumption of tea reduces iron absorption. For patients adhering to a low-calorie diet, or patients with diabetes mellitus, it should be borne in mind that each ampoule of the drug contains 3 g of sucrose.
Due to the fact that the drug contains glucose and fructose, it is not recommended for patients with reduced fructose tolerance, glucose / galactose malabsorption syndrome, sucrose-isomaltase deficiency.
To avoid temporary darkening of the tooth enamel, you should not take the drug undiluted and retain the liquid in the mouth for a long time; after taking the drug, you should thoroughly brush your teeth. In any case, the darkening of the tooth enamel disappears after the end of the course of treatment.
The drug contains a small amount of ethanol (less than 0.1 g in an ampoule) in the fragrance composition.
Use during pregnancy and lactation. The use of the drug during pregnancy and lactation is recommended only after consulting a doctor. The available data on the observation of a limited number of pregnant women while taking the drug Totem indicate undesirable effects in pregnant women, during pregnancy, in the fetus and newborn. The drug can be used during breastfeeding and in the II and III trimester of pregnancy or starting from the 4th month of pregnancy.
Children. The drug can be administered to children over the age of 1 month.
The ability to influence the reaction rate when driving or working with other mechanisms. Does not affect.
Tetracycline: decreased absorption of tetracycline in the gastrointestinal tract (the formation of complexes).
Salts, oxides and hydroxides of magnesium, aluminum or calcium (for example, antacids): reduced absorption of iron salts in the gastrointestinal tract.
Diphosphonates: Iron salts reduce the absorption of diphosphonates.
The simultaneous use of injectable forms of iron salts with iron preparations for oral administration can cause dizziness or even shock due to the rapid release of iron from the complex and saturation / saturation of transferrin.
To avoid interaction with the above substances, the interval between taking the Totem preparation and magnesium, aluminum, calcium preparations should be as long as possible and be at least 2 hours.
Cases of overdose with iron salts were noted after using the drug in excessive doses (mainly in children under the age of 2 years).
Mostly manifestations were noted in the form of symptoms of irritation and signs of gastrointestinal necrosis, namely nausea, vomiting and shock.
In case of overdose, urgent gastric lavage with 1% sodium bicarbonate solution and seeking qualified medical help is necessary.
The use of chelates is effective (deferoxamine is the most specific), which is advisable when the level of iron in the blood plasma is 5 mg / ml.
Treatment of shock, dehydration and acid-base imbalance is carried out in accordance with generally accepted approaches.
At a temperature not higher than 25 ° C.
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