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Active substance

Paracetamol, Ascorbic acid


Active ingredients: Paracetamol; vitamin C

Mechanism of action

Paracetamol has analgesic and antipyretic effects. The drug blocks cyclooxygenase 1 and 2 mainly in the central nervous system (CNS), affecting the centers of pain and thermoregulation. In the inflamed tissues, cellular peroxidases neutralize the effect of paracetamol on cyclooxygenase, which explains the almost complete absence of its anti-inflammatory effect. The drug does not adversely affect the water-salt metabolism (sodium and water retention) and the mucous membrane of the gastrointestinal tract (GIT), due to the lack of influence on the synthesis of prostaglandins in peripheral tissues. The drug in the form of a warm drink is easy to use in patients with inflammatory diseases of the oropharynx, since the administration of drugs in solid dosage forms is difficult. The possibility of the formation of methemoglobin is unlikely.
Ascorbic acid (vitamin C) is not formed in the human body, comes only with food.
Physiological functions: it is a cofactor of some hydroxylation and amidation reactions — it transfers electrons to enzymes, providing them with a reducing equivalent. Participates in reactions hydroxylation of proline and lysine residues procollagen to form hydroxyproline and hydroxylysine (postranslyatsionnaya collagen modification), the oxidation of the side chains of lysine in proteins to form gidroksitrimetillizina (during synthesis kartinita) oxidation of folic acid to folinic, drug metabolism in liver microsomes and hydroxylation dopamine with the formation of norepinephrine.
Increases the activity of amidating enzymes involved in the processing of oxytocin, antidiuretic hormone and cholysistokinin. Participates in steroidogenesis in the adrenal glands.
The main role at the tissue level is participation in the synthesis of collagen, proteoglycans and other organic components of the intercellular substance of the teeth, bones and the endothelium of capillaries.


antipyretic in infectious and inflammatory diseases (ARVI, incl.flu); painkiller with mild and moderate pain syndrome (headache, toothache) of non-inflammatory origin, with neuralgia, pain in muscles and joints, algomenorrhea.


Deficiency of glucose-6-phosphate dehydrogenase; severe diseases of the kidneys, liver, including renal and / or liver failure; erosive and ulcerative lesions of the gastrointestinal tract (in the acute phase), Gastrointestinal bleeding; phenylketonuria; children up to 6 years; fructose intolerance, glucose-galactose malabsorption, sucrose-isomalt insufficiency; pregnancy (Ι-ΙΙΙ trimesters), lactation. With care: Erosive and ulcerative lesions of the gastrointestinal tract (in history), congenital hyperbilirubinemia (Gilbert, Dubin-Johnson and Rotor syndromes). Blood diseases (thrombocytopenia, leukopenia, agranulocytosis), sideroblastic anemia, thalassemia. Deficiency of glucose-6-phosphate dehydrogenase, hemochromatosis, hyperoxaluria, urolithiasis. Bronchial asthma. Diabetes. Alcoholism.

Side effects

Vitamin C. Allergic reactions: skin rash, skin flushing. Laboratory indicators: thrombocytosis, hyperprothrombinemia, erythropenia, neutrophilic leukocytosis, hypokalemia, glycosuria. On the part of the digestive system: rarely - nausea, very rarely - vomiting, diarrhea, pain in the epigastric region, jaundice, pancreatitis and increased activity of "liver" enzymes. Allergic reactions: rarely - skin rash, pruritus, urticaria, angioedema. On the part of the blood-forming organs and the lymphatic system: very rarely - anemia, leukopenia. Other: weakness.


If you are taking other medicines with Paracetamol Extra at the same time, you should consult with your doctor.
Paracetamol reduces the effectiveness of uricosuric drugs.
With prolonged and regular use, paracetamol potentiates the action of Warfarin and other coumarin derivatives and increases the risk of bleeding.
Simultaneous use of colestyramine leads to a decrease in the absorption of paracetamol (and the weakening of the effects of paracetamol).
Metoclopramide and Domperidone increase the absorption of paracetamol.
The simultaneous use of paracetamol and nonsteroidal anti-inflammatory drugs (metamizole sodium, Acetylsalicylic acid, Ibuprofen, etc.) increases the risk of developing "analgesic" nephropathy and renal papillary necrosis, end-stage renal failure.
The simultaneous use of paracetamol and chloramphenicol may be accompanied by an increase in T1 / 2 chloramphenicol up to 5 times.
Inductors of liver microsomal enzymes (phenytoin, ethanol, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants) increase the production of hydroxylated active metabolites, which makes it possible to develop severe intoxications even with small overdose.
Salicylamide increases T1 / 2 paracetamol, which leads to the accumulation of paracetamol and, consequently, increased formation of its toxic metabolites.
The simultaneous use of paracetamol and ethanol can enhance the hepatotoxicity of paracetamol, as well as contribute to the development of acute pancreatitis.
Diflunisal increases the plasma concentration of paracetamol by 50% - the risk of developing hepatotoxicity.
Do not simultaneously use other drugs containing paracetamol, as well as other non-narcotic analgesics. The simultaneous use of other medicines must be agreed with the doctor.
Ascorbic acid increases the concentration of benzylpenicillin and tetracyclines in the blood; at a dose of 1 g / day increases the bioavailability of ethinyl estradiol (including part of the oral contraceptives); improves the absorption in the intestines of drugs Fe (converts ferric to ferrous); may increase the excretion of iron while using with deferoxamine; reduces the effectiveness of Heparin and indirect anticoagulants.
Acetylsalicylic acid, oral contraceptives, fresh juices and alkaline drinks reduce the absorption and absorption of ascorbic acid.
With simultaneous use with acetylsalicylic acid increases the excretion of urine ascorbic acid and decreases the excretion of acetylsalicylic acid.
Acetylsalicylic acid reduces the absorption of ascorbic acid by about 30%.
Ascorbic acid increases the risk of crystalluria in the treatment of short-acting salicylates and sulfonamides, slows kidney excretion of acids, increases the excretion of drugs that have an alkaline reaction (including alkaloids), reduces the concentration of oral contraceptives in the blood.
Drugs quinoline series, CaCl2, salicylates, corticosteroids with long-term use depletes reserves of ascorbic acid.
With simultaneous use of ascorbic acid reduces the chronotropic effect of isoprenaline.
With prolonged use or use in high doses, ascorbic acid may interfere with the interaction of disulfiram and ethanol; in high doses increases the excretion of meksiletina kidneys.
Barbiturates and primidone increase the excretion of ascorbic acid in the urine.
Ascorbic acid reduces the therapeutic effect of antipsychotic drugs (neuroleptics) - phenothiazine derivatives, tubular reabsorption of amphetamine and tricyclic antidepressants.

How to take, the course of administration and dosage

Inside Single dose for adults and children (weighing more than 50 kg) - 1 pill or 10-15 mg / kg (in terms of paracetamol), the maximum daily dose - 4 tablets; Children 6-12 years old - 1/2 tablet, maximum daily dose - 2 tablets. The course of treatment is not more than 10 days.


Symptoms (caused by ascorbic acid): diarrhea, nausea, irritation of the gastrointestinal tract mucosa, flatulence, abdominal pain of a spastic nature, frequent urination, nephrolithiasis, insomnia, irritability, hypoglycemia. Symptoms (caused by paracetamol): during the first 24 hours after ingestion - pallor of the skin, nausea, vomiting; anorexia, abdominal pain; impaired glucose metabolism, metabolic acidosis, and abnormal liver function may appear 12-48 hours after overdose. In severe overdose - liver failure with progressive encephalopathy, coma, death; acute renal failure with turbulent necrosis (including in the absence of severe damage to the liver); arrhythmia, pancreatitis. Hepatotoxic effect in adults appears when taking 10 g or more. Rarely, liver failure develops with lightning speed and may be complicated by renal failure (tubular necrosis). Treatment: administration of SH-group donators and precursors of glutathione synthesis - methionine - within 8-9 hours after overdose and acetylcysteine ​​- within 8 hours. The need for additional therapeutic measures (further introduction of methionine, intravenous administration of acetylcysteine) is determined depending on the concentration paracetamol in the blood, as well as from the time elapsed after administration, symptomatic, forced diuresis.

Special instructions

Do not exceed the recommended dose of Paracetamol Extra.
With hyperthermia, lasting more than 3 days, and pain syndrome for more than 5 days, consultation of the doctor is required.
After 5 days of use of Paracetamol EXTRA, control of the picture of peripheral blood and the functional state of the liver is necessary.
Paracetamol distorts laboratory test results in the quantitative determination of plasma glucose and uric acid concentrations. In order to avoid toxic damage to the liver, paracetamol should not be combined with the intake of beverages containing alcohol, as well as being taken by persons prone to alcohol abuse.
There is evidence that the frequent use of drugs containing paracetamol, leads to worsening symptoms of bronchial asthma.
Paracetamol Extra contains sucrose, so the drug is not recommended for patients with congenital fructose intolerance, glucose-galactose malabsorption syndrome or sucrase-isomaltase deficiency.

Release form


Storage conditions

In a dry, dark place at a temperature not higher than 25 ° C.

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