Pharmacodynamics. Iodomarin is an inorganic iodine preparation, iodine is a vital trace element that is part of the thyroid hormones - thyroxine (t4) and triiodothyronine (t3) and ensures its normal functioning.
When iodides enter the epithelial cells of the thyroid follicles under the influence of the enzyme iodide peroxidase, iodine is oxidized with the formation of elemental iodine. The substance enters into a substitution reaction with the aromatic tyrosine cycle, as a result of which thyronines are formed: the 3,5-iodine derivative (the thyroxine hormone - T4) and the 3-iodine derivative (the triiodothyronine T3 hormone). Thyronines form a complex with the protein thyroglobulin, which is deposited in the colloid of the thyroid follicle and remains in this state for several days and weeks. With iodine deficiency, this process is disrupted. Iodine entering the body in physiological quantities prevents the development of endemic goiter; normalizes the size of the thyroid gland in newborns, children, adolescents and adult patients; affects the indicators of the ratio T3 / T4, the level of TSH.
Pharmacokinetics. After oral administration, inorganic iodine is almost completely absorbed in the small intestine. Within 2 hours after absorption, iodine is distributed in the intercellular space; accumulates in the thyroid gland, kidneys, stomach, mammary and salivary glands. The volume of distribution in a healthy person averages 23 liters (38% of body weight). The concentration in blood plasma after the application of a standard dose is 10-50 ng / ml, while the iodine content in breast milk, saliva, gastric juice is 30 times higher than the concentration in blood plasma. The thyroid gland contains ¾ (10–20 mg) of all iodine in the body. Iodine is excreted mainly in urine, to a lesser extent in feces and exhaled air. When the equilibrium concentration is reached, the amount of removed iodine is proportional to the daily intake with food.
Prevention of the development of iodine deficiency, including during pregnancy or lactation.
Prevention of recurrence of iodine-deficient goiter after surgical treatment, as well as after the completion of complex treatment with thyroid hormone preparations.
Treatment of diffuse euthyroid iodine deficiency goiter in children, including newborns and infants, and young adults.
Prevention of iodine deficiency and endemic goiter in cases when the intake of iodine in the body of an adult is 150-200 mcg / day. it is necessary to additionally apply the following amount:
Prevention of recurrence of iodine deficiency goiter after surgical treatment, as well as after the completion of complex treatment with thyroid hormones: children and adults - 100-200 mcg of iodine per day (1-2 tablets Iodomarin 100 or ½ – 1 tablets Iodomarin 200).
newborns, infants and children: 100-200 mcg of iodine per day (1-2 tablets Iodomarin 100 or ½ – 1 tablets Iodomarin 200);
young adults: 300-500 micrograms of iodine per day (3-5 Iodomarin 100 tablets or 1½ – 2½ Iodomarin 200 tablets).
Mode of application. Take the tablets after meals and drink plenty of fluids, such as a glass of water. For infants and children under the age of 3 years, the preparation can be given in crushed form. The use of the preparation for prophylactic purposes is carried out, as a rule, for several months or years, and more often - for the whole life. For the treatment of goiter in newborns and infants, in most cases, 2–4 weeks are sufficient, in children and adults - 6–12 months or more. The question of the dosage and duration of use of the preparation for preventive measures or for the treatment of thyroid diseases is decided by the doctor on an individual basis.
Children. The preparation is used in children of any age if indicated.
Contraindications
Hypersensitivity to the active substance or any of the auxiliary components of the preparation. severe hyperthyroidism. in the case of latent hyperthyroidism, it is contraindicated to use the preparation in doses exceeding 150 μg of iodine per day. in the case of an autonomous adenoma, as well as focal and diffuse autonomous foci of the thyroid gland, it is contraindicated to use the preparation in a dose of 300 to 1000 mcg of iodine per day (with the exception of preoperative iodine therapy for the purpose of blocking the thyroid gland by the flame). pulmonary tuberculosis. hemorrhagic diathesis. Dühring's herpetiformis dermatitis (Dühring-brock syndrome).
Side effects
With the prophylactic use of iodide in patients of any age, as well as with therapeutic use in newborns, infants and children, side effects are usually not noted. however, in the presence of large autonomous foci of the thyroid gland and with the appointment of iodine in daily doses exceeding 150 μg, it is impossible to completely exclude the appearance of pronounced hyperthyroidism.
The following adverse reactions occurred with the following frequency: very often (≥1 / 10); often (from? 1/100 to 1/10); infrequently (from ≥1 / 1000 to 1/100); rarely (from ≥1 / 10,000 to 1/1000); very rare (1/10 000); unknown (cannot be estimated based on available data).
From the immune system: very rarely - hypersensitivity reactions (for example, rhinitis caused by iodine, bullous or tuberous iododerma, exfoliative dermatitis, angioedema, fever, acne and swelling of the salivary glands).
On the part of the endocrine system: very rarely - in the treatment of diffuse euthyroid iodine-deficient goiter in adults, in some cases, the development of hyperthyroidism caused by iodine is possible. In the overwhelming majority of cases, a prerequisite for this is the presence of diffuse or limited autonomous foci of the thyroid gland. First of all, this applies to elderly patients with long-term goiter.
Also possible: manifestations of iodism (including symptoms such as swelling of the nasal mucosa, urticaria, Quincke's edema, skin rash, itching, in rare cases - anaphylactic shock), eosinophilia, tachycardia, tremor, irritability, sleep disturbance, increased sweating, discomfort in the epigastric region, diarrhea. When using the preparation in high doses, goiter and hypothyroidism may develop in some cases.
Suspected adverse reactions reported. The reporting of suspected adverse reactions following preparation registration is important. This allows you to continue monitoring the balance of benefits and risks of the preparation. Health care workers should report any suspected adverse reactions through the national alert system.
special instructions
The preparation should not be used in hypothyroidism, unless hypothyroidism is caused by iodine deficiency. the appointment of iodine should be avoided during therapy with radioactive iodine, the presence or suspicion of thyroid cancer. it should be borne in mind that during preparation therapy in patients with renal failure, hyperkalemia may develop.
Iodomarin contains lactose. Patients with a rare hereditary form of galactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome should not take Iodomarin.
Use during pregnancy and lactation. During pregnancy and lactation, the need for iodine is increased, therefore, a sufficient intake of iodine in the body (250 μg / day) is especially important. Due to the ability of iodine to cross the placenta and the sensitivity of the fetus to pharmacologically active doses of iodine, it should be used only in recommended doses. This also applies to breastfeeding, since the concentration of iodine in breast milk is 30 times higher than in blood plasma.
The exception is high-dose iodine prophylaxis, which is carried out after nuclear technical accidents.
The ability to influence the reaction rate when driving or operating machinery. Does not affect.
Interactions
Iodine deficiency enhances the response to thyrostatic therapy, while an excess of iodine decreases it; therefore, iodine intake should be avoided if possible before or during treatment of hyperthyroidism. thyrostatic preparations, for their part, inhibit the transition of iodine to organic compounds in the thyroid gland and, thus, can cause goiter formation.
Substances that are absorbed by the thyroid gland through the same uptake mechanism as iodine can inhibit the uptake of iodine by the thyroid gland through a competitive mechanism (for example, perchlorate, which also inhibits the recirculation of iodide within the thyroid gland). Oppression is also possible from preparations that are not themselves absorbed, such as thiocyanate in concentrations exceeding 5 mg / dL.
The absorption of iodine by the thyroid gland and the metabolism of iodine in the gland are stimulated by endogenous and exogenous TSH.
Simultaneous treatment with high doses of iodine, which suppress the increment of thyroid hormones, and lithium salts can lead to the development of goiter and hypothyroidism.
High doses of potassium iodide in combination with potassium-sparing diuretics can cause hyperkalemia.
With simultaneous use, the effect of quinidine on the heart is enhanced due to an increase in the concentration of potassium in the blood plasma.
Simultaneous use with plant alkaloids and salts of heavy metals can lead to the formation of insoluble sediment and inhibition of iodine absorption.
Overdose
Symptoms of intoxication: brown color of mucous membranes, reflex vomiting (blue color in the presence of starch in food), abdominal pain, diarrhea (possibly blood in the stool), dehydration and shock. in rare cases, the formation of esophageal stenosis was observed. deaths were noted. in some cases, chronic overdose leads to the development of so-called iodism, that is, iodine intoxication: a metallic taste in the mouth, edema and inflammation of the mucous membranes (runny nose, conjunctivitis, gastroenteritis, bronchitis). iodide can activate latent inflammatory processes such as tuberculosis. development of edema, erythema, acne-like and bullous eruptions, hemorrhages, fever and nervous excitement is possible.
Treatment. Therapy for acute intoxication: gastric lavage with a solution of starch, protein or 5% solution of sodium thiosulfate until all traces of iodine are removed. Conducting symptomatic therapy in order to eliminate violations of water and electrolyte balance, and, if necessary, anti-shock therapy.
Therapy for chronic intoxication: the abolition of iodine.
Hypothyroidism caused by the intake of iodine: the abolition of iodine, the appointment of thyroid hormones in order to normalize the metabolism.
Iodine-induced hyperthyroidism: This is not an overdose in the literal sense, because hyperthyroidism can also result from an amount of iodine that is considered physiological in other countries.
Treatment according to the course: mild forms usually do not require treatment, severe forms require thyrostatic therapy (the effectiveness of which is delayed in time). In severe cases (thyrotoxic crisis), intensive care, plasmapheresis or thyroidectomy is necessary.
Storage conditions
Iodomarin 100: at a temperature not exceeding 30 ° c.
Iodomarin 200: Store the packaging containing the PVC / aluminum blister at a temperature not exceeding 25 ° C. For packaging containing an aluminum / aluminum blister, no special storage conditions are required.