INDICATIONS: Treatment of systemic fungal infections such as blastomycosis, coccidioidomycosis, histoplasmosis, chromomycosis, and paracoccidioidomycosis. Its use is restricted to cases where safer and more effective alternatives are not available, or when, after evaluating the patient, the benefits outweigh potential risks. Treatment of Cushing’s syndrome in cases where no other alternatives exist, under strict medical supervision.

DOSAGE: Administered orally, 200 mg once daily, taken with food to increase absorption and reduce gastrointestinal discomfort. The dose may be increased to 400 mg daily if an adequate response is not achieved.

Pediatric Patients: Children over 2 years: recommended 3 mg per kg of body weight per day.

CONTRAINDICATIONS: Micosin® is contraindicated in patients hypersensitive to this medication. Co-administration of ketoconazole with astemizole, cisapride, corticosteroids, triazolam, cyclosporine, oral anticoagulants, and terfenadine is contraindicated. Its use is not recommended during pregnancy and lactation.

PRECAUTIONS: Liver function tests are recommended before starting treatment and periodically during therapy. Concomitant use with hepatotoxic substances such as alcohol and paracetamol should be avoided. A disulfiram-like reaction may occur in patients taking ketoconazole after consuming alcohol. The effectiveness of oral contraceptives may be reduced.

INTERACTIONS: Ketoconazole inhibits the metabolism of a number of drugs by acting on the CYP3A4 isoenzyme of the hepatic microsomal P450 system. This leads to increased plasma levels of terfenadine, prolonging the QT interval. Similarly, it reduces the clearance of astemizole, which may cause arrhythmias, tachycardia, cardiac arrest, and death. Astemizole should be discontinued at least one week before starting ketoconazole therapy. Ketoconazole reduces the clearance of cisapride; concomitant use has been associated with QT prolongation and torsades de pointes. Ketoconazole can induce disulfiram-like reactions; alcohol should be avoided during treatment and for at least 48 hours after discontinuation. Concomitant administration of ketoconazole and indinavir increases the antiviral’s AUC by 68%. Ketoconazole dramatically inhibits the hepatic metabolism of triazolam and midazolam; simultaneous use should be avoided. Other benzodiazepines affected include alprazolam and estazolam. Ketoconazole requires an acidic gastric pH for absorption; drugs that reduce gastric acid secretion or alkalinize the stomach significantly reduce its bioavailability, including antacids, antimuscarinics, H2 antihistamines, and proton pump inhibitors. Sucralfate also reduces ketoconazole absorption by 20%. Ketoconazole may decrease the clearance of corticosteroids such as prednisolone and methylprednisolone, increasing plasma concentrations. It also increases cyclosporine plasma levels. Ketoconazole can reduce the clearance of calcium channel blockers (e.g., diltiazem, felodipine, verapamil) by inhibiting CYP3A4 metabolism. Concomitant use with tacrolimus may increase tacrolimus blood levels. Co-administration with ritonavir results in 3–4 fold increases in ketoconazole concentrations; therefore, doses >200 mg/day are not recommended with ritonavir.

PREGNANCY AND LACTATION: Preclinical data indicate that ketoconazole crosses the placenta and is teratogenic. It should only be used during pregnancy when the therapeutic need for the mother outweighs the risk to the fetus. As ketoconazole is excreted in breast milk, breastfeeding should be discontinued during treatment.

ADVERSE REACTIONS: Nausea, vomiting, and abdominal pain have been reported; these are usually mild and can be minimized if the drug is taken with food, which also improves bioavailability. Rarely, hepatotoxicity occurs. These effects are reversible upon discontinuation of treatment.

Anti-arthritis Anti-inflammatory

COMPOSITION

Meloxicam 15mg

Glucosamine sulfate 1500mg

Granules for oral solution

COMPOSITION:

Each 4g sachet of granules for oral solution contains:

Meloxicam …………………………………………. ….. 15 mg

Glucosamine Sulfate Potassium Chloride …… 1990 mg

(Equivalent to 1500 mg of Glucosamine Sulfate)

USES AND ADMINISTRATION

The pharmacological properties of glucosamine sulphate explain its beneficial activity in the degenerative and dismetabolic processes of osteoarthritis and in particular on the symptoms of the disease in different locations.

The administration of glucosamine sulfate allows to supplement the endogenous deficiencies of this substance, thus stimulating the biosynthesis and inhibiting the degradation of the proteoglycans, necessary to achieve a trophic effect in the articular facets, favor the fixation of sulfur in the synthesis of chondroitin sulphuric acid and facilitate the normal deposit of calcium in the bone tissue.

Meloxicam is a non-steroidal anti-inflammatory drug (NSAID) belonging to the group of enolcarboxamides. By inhibiting cyclooxygenase, locally prevents the conversion of arachidonic acid into cyclic endoperoxides, which are transformed into prostaglandins, thromboxanes and inflammation mediators circulating autacoids and eicosanoids. By inhibiting cyclooxygenase and the subsequent synthesis of prostaglandins, the release of proinflammatory substances and mediators is reduced, preventing the activation of the terminal nociceptors.

The chondroprotective and repairing effect of glucosamine, combined with the analgesic and anti-inflammatory action of meloxicam, significantly alleviates pain at rest and movement, improving mobility in the short and medium term.

INDICATIONS:

Symptomatic treatment of osteoarthritis (osteoarthrosis – osteoarthritis) and other articular and extra-articular rheumatic diseases.

HOW TO USE:

In a glass of boiled and cold water, pour the contents of an envelope, shake and drink once a day, preferably with breakfast

CONTRAINDICATIONS:

• Hypersensitivity to any of the formula’s components.

• Severe hypersensitivity to other NSAIDs.

• Phenylketonuria.

“Contraindicated in pregnancy or when its existence is supposed”

“Contraindicated in cases of gastritis, ulcers and / or gastroduodenal hemorrhages”

ADVERSE EFFECTS:

Meloxicam:

• Gastrointestinal: Occasionally: dyspepsia, nausea, vomiting, abdominal pain,

constipation, flatulence and diarrhea. Rarely: transient alteration of liver function parameters, (hepatic enzymes, increased bilirubin), belching, esophagitis, gastroduodenal ulcer, occult or macroscopic gastrointestinal bleeding.

• Glucosamine sulfate:

The side effects of glucosamine sulfate are uncommon and generally of a mild and transient nature. On rare occasions, the onset of nausea, heaviness, abdominal pain, bloating, constipation, diarrhea, dizziness, drowsiness and headache has been described. Hypersensitivity reactions: erythema, pruritus or bronchial asthma have been reported with low incidence