Levofloxacin Ekolevid® tablets 500 mg
Ecoantibiotics are antibacterial drugs manufactured in Russia, available in the most in-demand pharmacotherapeutic classes of antibiotics: aminopenicillins, protected aminopenicillins, macrolides, and fluoroquinolones. They are used for the treatment of infectious and inflammatory diseases of various organs and systems.
Description
According to the instructions for use, Levofloxacin is a broad-spectrum antibiotic belonging to the group of new generation fluoroquinolones. The efficacy of fluoroquinolones is confirmed by twenty years of clinical experience.
Levofloxacin penetrates well into organs and tissues: lungs, bronchial mucosa, genitourinary system organs, and blood cells. It is noted that it penetrates well into lung tissue (achieving concentrations in the lungs 2-5 times higher than in plasma).
Dosage Form and Composition
Tablets are available in dosages of 250 mg and 500 mg
- Tablets 250mg #5
- Tablets 500mg #5
- Tablets 500mg #10
Indications for Use
- Exacerbation of chronic bronchitis, community-acquired pneumonia;
- Infections of the urinary tract and kidneys, including acute pyelonephritis;
- Prostatitis;
- Infections of the skin and soft tissues: suppurating atheromas, abscesses, furuncles;
- Tuberculosis;
- All Indications for Use (Instructions)
Levofloxacin. Brief Instructions for Use:
According to the instructions for use, the Levofloxacin tablet should be taken either before meals or between meals. The tablet should be swallowed whole, without chewing, with plenty of water.Instructions for Levofloxacin, optimal dosages and regimens:
For sinusitis of varying severity: 500 mg once daily for 1-2 weeks.
For community-acquired pneumonia: 500 mg 1-2 times daily for 1-2 weeks.
For various bronchial diseases: 250-500 mg once daily for 1-2 weeks.
For mild kidney infections: 250 mg once daily for 3 days.
For more complex kidney infections: 250 mg once daily (the dose should be increased in cases of high severity) for 2 weeks.
For prostatitis: 500 mg once daily; the course of treatment is 1 calendar month.
For serious skin infections: 250-500 mg 1-2 times daily for 1-2 weeks.
For gastrointestinal infections: 500 mg once daily for 1-2 weeks.
For severe tuberculosis: 500 mg 1-2 times daily; the course of treatment is up to 3 months.
The drug is often called a "respiratory" or "anti-pneumococcal" antibiotic. Which diseases are considered respiratory infections? Sinusitis, pneumonia, exacerbation of chronic bronchitis, acute bronchitis, acute tonsillopharyngitis. The instructions for Levofloxacin provide data that the resistance of pneumococci to this antibiotic is less than 1%. For example, for antibiotics from the penicillin group, this figure reaches 40%, meaning the therapy is doomed to failure. Thus, it is the excellent indicator of low resistance (resistance) of the microorganisms targeted by the therapy that makes Levofloxacin the drug of choice in this situation.
The instructions for use of Levofloxacin also indicate that the antibiotic has significant advantages in the treatment of prostatitis because it penetrates well into the secretion and tissue of the prostate gland, which are inaccessible to most antibiotics.
Levofloxacin is also effective in the therapy of kidney and urinary tract infections (acute pyelonephritis). It also has high activity against intracellular pathogens such as mycoplasma and chlamydia, which are difficult to treat.
According to the instructions for use of the tablets, Levofloxacin is no less effective in the therapy of infectious lesions of the skin and soft tissues, such as abscesses, furuncles of various locations, and suppurating atheromas.
The availability of two dosage forms for intravenous (parenteral) administration and oral administration in the form of tablets allows for step-down therapy. This means the antibiotic solution is first administered intravenously in a hospital setting, and then the patient is prescribed tablets on an outpatient basis. Few antibiotics can be used in step-down therapy.
Main Features of Levofloxacin Tablets
Levofloxacin tablets are distinguished from other antibiotic tablets by unique pharmacokinetic properties: they are well absorbed in the gastrointestinal tract, with bioavailability reaching 100%;
Levofloxacin tablets have a post-antibiotic effect, which helps reduce the number of disease relapses (recurrences);
Relatively good tolerability and low frequency of side effects.
Levofloxacin 500: Instructions for Use of Tablets for Adults and Children
The instructions for use of Levofloxacin 500 tablets clearly state that this drug is intended exclusively for the treatment of patients aged 18 years and older. Pregnant women should take the drug with caution to avoid risks to the fetus. The regimen and dosage of Levofloxacin 500 tablets according to the instructions for use are determined by a doctor.
Levofloxacin 500: Instructions and Release Features
The Levofloxacin 500 mg package includes the instructions and blisters with tablets. The drug can be purchased at many pharmacies and is dispensed with a doctor's prescription. Depending on the complexity and nature of the disease, Levofloxacin 500 mg is taken according to the instructions for use for several days. If the condition does not improve after a course of treatment lasting more than 14 days, it is necessary to consult a doctor again for therapy adjustment.
The instructions for Levofloxacin 500 contain all the information about the drug and the dosages of the active substance. Changing the administration regimen is not recommended, as it may lead to complications and the appearance of side effects. If you follow the instructions for Levofloxacin 500, the symptoms of the disease will gradually subside. However, you should not interrupt the course of treatment after the signs of the disease disappear; you need to take the tablets for as many days as prescribed by the doctor.
Levofloxacin - Contraindications:
- Intolerance to levofloxacin;
- Epileptic disorders;
- Tendon damage (occurring after treatment with quinolones);
- Pregnancy period;
- Breastfeeding period (lactation);
- Age under 18 years (due to the lack of testing of the drug on representatives of these age groups);
- Patient intolerance to lactose;
- Problems with the absorption of galactose and glucose;
- Elderly patients (especially those with impaired metabolism).
To avoid health problems, the drug Levofloxacin should be taken according to the instructions in the dosages prescribed by the doctor.
Concomitant use of Levofloxacin tablets with other drugs:
- Noticeable lowering of the seizure threshold when used concomitantly with painkillers, antipyretics, NSAIDs;
- The effect of the tablets is weakened when used with sucralfate, antacids, iron salts (therefore, Levofloxacin tablets should be taken at least 2 hours before taking the aforementioned agents);
- When combining the drug with vitamin K, it is necessary to monitor changing blood coagulation parameters;
- Cimetidine and probenecid slow down the action of the antibiotic;
- Glucocorticosteroids significantly increase the risk of tendon rupture.
A detailed review of the instructions for Levofloxacin will help avoid possible risks associated with taking the drug.
Features of treatment with Levofloxacin tablets:
Elderly patients may develop significant renal impairment during administration.
It is forbidden to sunbathe or visit a solarium.
At the slightest suspicion of acute inflammation of the large intestine (symptom: severe pain) – urgently discontinue use and initiate symptomatic treatment. In this case, it will be dangerous to use medications that complicate bowel function.
In case of genetic metabolic disorders, the drug can provoke the destruction of red blood cells, so treatment should be carried out with extreme caution.
Attacks of dizziness and severe drowsiness (as well as decreased visual acuity) are possible, which may slow reactions and complicate interaction with any machinery.
Therapy with the drug should be started only as prescribed by a doctor.
Possible side effects of Levofloxacin tablets:
- Vomiting and nausea, severe diarrhea, possible bloody diarrhea, gastrointestinal dysfunction, stomach pain, decreased appetite, increased activity of liver transaminases, acute inflammation of the colon walls, hepatitis, increased blood bilirubin levels, various forms of dysbacteriosis.
- Heart failure, decreased blood pressure, risk of ventricular tachycardia and cardiac tachycardia, heart rhythm disturbances.
- Severe dizziness, migraine, lack of concentration and weakness, limb tremor, sleep disorders, skin burning and tingling, groundless fear, anxiety, confusion, hallucinations, motor disorders, low mood, sudden muscle contractions.
- Hearing problems, distorted sense of smell, worsened vision, loss of tactile sensations, loss of taste sensitivity.
- Decreased muscle strength, joint pain, tendon ruptures, muscle pain, destruction of muscle tissue cells, inflammation of tendon tissue.
- Interstitial nephritis, bacterial inflammation of the interstitial tissue and renal tubules, acute renal failure.
- Destruction of red blood cells, increased number of eosinophils, decreased level of neutrophilic granulocytes, decreased level of leukocytes in the blood, blood cell deficiency, increased bleeding and decreased blood clotting (difficulty stopping bleeding).
- Severe increase in appetite, profuse sweating.
- Angioedema, severe itching, allergic skin redness, Lyell's syndrome, Stevens-Johnson syndrome, narrowing of the airways, impaired bronchial patency, anaphylactic shock, immunopathological vascular inflammation, allergic pneumonia.
- Pigmentation disorders, psychasthenia, persistent fever, increased body sensitivity, development of secondary infections based on an existing one.
Levofloxacin tablets are included in Russian and international clinical guidelines, such as those from the Infectious Diseases Society of America, the Russian Respiratory Society, the Alliance of Clinical Chemotherapists and Microbiologists, and others.
Prescription Status
By prescription
See also:
Our certificates:
Instructions for use of Levofloxacin Ekolevid® tablets 500 mg
Brand name of the drug: Levofloxacin Ekolevid®
International Nonproprietary Name: levofloxacin
Dosage form: film-coated tablets
Composition per one tablet:
|
Active substance, mg: |
||
|
Levofloxacin hemihydrate (calculated as levofloxacin) |
256.23 250.00 |
512.46 500.00 |
|
Excipients, mg: |
||
|
Lactitol |
300.00 |
600.00 |
|
Croscarmellose sodium |
32.50 |
65.00 |
|
Povidone K-17 |
10.00 |
20.00 |
|
Sodium stearyl fumarate |
9.75 |
19.50 |
|
Talc |
6.50 |
13.00 |
|
Microcrystalline cellulose up to a tablet mass of |
650.00 |
1300.00 |
|
Excipients of the coating, mg: |
up to a tablet mass of |
|
|
670.00 |
1340.00 |
|
|
Hypromellose |
9.52 |
19.04 |
|
Titanium dioxide |
5.22 |
10.44 |
|
Macrogol-4000 |
3.744 |
7.488 |
|
Talc |
1.10 |
2.20 |
|
Povidone K-17 |
0.416 |
0.832 |
Description
Capsule-shaped, biconvex, white or almost white film-coated tablets; a cross-section shows two layers, the inner layer is light yellow to yellow, white inclusions are allowed.
Pharmacotherapeutic group: antimicrobial agent, fluoroquinolone.
ATC code: J01MA12.
Pharmacological properties
Pharmacodynamics
Levofloxacin is a synthetic broad-spectrum antibacterial drug from the fluoroquinolone group, containing the levorotatory isomer of ofloxacin as the active substance.
Levofloxacin blocks DNA gyrase, disrupts DNA supercoiling and cross-linking of breaks, inhibits DNA synthesis, causes profound morphological changes in the cytoplasm, cell wall, and membranes of bacteria.
Levofloxacin acts bactericidally and is active against a large number of bacterial infection pathogens both in vitro and in vivo.
Susceptible microorganisms (Minimum Inhibitory Concentration (MIC) ≤ 2 mg/l):
- Aerobic Gram-positive microorganisms: Bacillus anthracis, Corynebacterium diphtheriae, Corynebacterium jeikeium, Enterococcus spp., including Enterococcus faecalis, Listeria monocytogenes, Staphylococcus spp. (coagulase-negative, methicillin-susceptible / leukotoxin-containing / moderately susceptible strains), including Staphylococcus aureus (methicillin-susceptible strains), Staphylococcus epidermidis (methicillin-susceptible strains), Streptococcus spp. groups C and G, Streptococcus agalactiae, Streptococcus pneumoniae (penicillin-susceptible / intermediately susceptible / resistant strains), Streptococcus pyogenes, Streptococcus spp. Viridans group (penicillin-susceptible / resistant strains);
- Aerobic Gram-negative microorganisms: Acinetobacter spp., including Acinetobacter baumannii, Actinobacillus actinomycetemcomitans, Citrobacter freundii, Eikenella corrodens, Enterobacter spp., including Enterobacter aerogenes, Enterobacter cloacae, Escherichia coli, Gardnerella vaginalis, Haemophilus ducreyi, Haemophilus influenzae (ampicillin-susceptible / resistant strains), Haemophilus parainfluenzae, Helicobacter pylori, Klebsiella spp., including Klebsiella oxytoca, Klebsiella pneumoniae, Moraxella catarrhalis (beta-lactamase producing and non-producing strains), Morganella morganii, Neisseria gonorrhoeae (penicillinase-producing and non-producing strains), Neisseria meningitidis, Pasteurella spp., including Pasteurella canis, Pasteurella dagmatis, Pasteurella multocida, Proteus mirabilis, Proteus vulgaris, Providencia spp., including Providencia rettgeri, Providencia stuartii, Pseudomonas spp., including Pseudomonas aeruginosa (hospital infections caused by Pseudomonas aeruginosa may require combination therapy), Serratia spp., including Serratia marcescens, Salmonella spp.;
- Anaerobic microorganisms: Bacteroides fragilis, Bifidobacterium spp., Clostridium perfringens, Fusobacterium spp., Peptostreptococcus spp., Propionibacterium spp., Veillonella spp.;
- Other microorganisms: Bartonella spp., Chlamydia pneumoniae, Chlamydia psittaci, Chlamydia trachomatis, Legionella pneumophila, Legionella spp., Mycobacterium spp., including Mycobacterium leprae, Mycobacterium tuberculosis, Mycoplasma hominis, Mycoplasma pneumoniae, Rickettsia spp., Ureaplasma urealyticum.
Moderately susceptible microorganisms (MIC = 4 mg/l):
- Aerobic Gram-positive microorganisms: Corynebacterium urealyticum, Corynebacterium xerosis, Enterococcus faecium, Staphylococcus epidermidis (methicillin-resistant strains), Staphylococcus haemolyticus (methicillin-resistant strains);
- Aerobic Gram-negative microorganisms: Campylobacter jejuni, Campylobacter coli;
- Anaerobic microorganisms: Prevotella spp., Porphyromonas spp.
Resistant microorganisms (MIC > 8 mg/l):
- Aerobic Gram-positive microorganisms: Staphylococcus aureus (methicillin-resistant strains), other Staphylococcus spp. (coagulase-negative methicillin-resistant strains);
- Aerobic Gram-negative microorganisms: Alcaligenes xylosoxidans;
- Anaerobic microorganisms: Bacteroides thetaiotaomicron
- Other microorganisms: Mycobacterium avium.
Clinical efficacy (efficacy in clinical studies for infections caused by the following microorganisms):
- Aerobic Gram-positive microorganisms: Enterococcus faecalis, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes;
- Aerobic Gram-negative microorganisms: Citrobacter freundii, Enterobacter cloacae, Escherichia coli, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Morganella morganii, Proteus mirabilis, Pseudomonas aeruginosa, Serratia marcescens;
- Other microorganisms: Chlamydia pneumoniae, Legionella pneumophila, Mycoplasma pneumoniae.
Resistance to levofloxacin develops as a result of a stepwise process of mutations in the genes encoding both type II topoisomerases: DNA gyrase and topoisomerase IV. Other resistance mechanisms, such as the mechanism affecting microbial cell penetration barriers (characteristic of Pseudomonas aeruginosa) and the efflux mechanism (active removal of the antimicrobial agent from the microbial cell), can also reduce the sensitivity of microorganisms to levofloxacin.
Due to the peculiarities of the mechanism of action of levofloxacin, cross-resistance between levofloxacin and other antimicrobial agents is usually not observed.
Pharmacokinetics
Absorption
Levofloxacin is rapidly and almost completely absorbed after oral administration; food intake has little effect on its absorption. The absolute bioavailability after oral administration is 99-100%. After a single dose of 500 mg of levofloxacin, the maximum plasma concentration (Cmax) is reached within 1-2 hours and is 5.2±1.2 μg/ml. The pharmacokinetics of levofloxacin is linear in the dose range from 50 to 1000 mg. The steady-state concentration of levofloxacin in plasma when taking 500 mg of levofloxacin once or twice daily is reached within 48 hours.
On day 10 of oral administration of Levofloxacin Ekolevid® 500 mg once daily, the Cmax of levofloxacin was 5.7±1.4 μg/ml, and the minimum concentration of levofloxacin (concentration before the next dose) (Cmin) in plasma was 0.5±0.2 μg/ml.
On day 10 of oral administration of Levofloxacin Ekolevid® 500 mg twice daily, the Cmax was 7.8±1.1 μg/ml, and the Cmin was 3.0±0.9 μg/ml.
Distribution
Binding to serum proteins is 30-40%. After single and repeated administration of 500 mg of levofloxacin, the volume of distribution of levofloxacin averages 100 L, indicating good penetration of levofloxacin into human organs and tissues.
Penetration into bronchial mucosa, epithelial lining fluid, alveolar macrophages
After a single oral dose of 500 mg of levofloxacin, maximum concentrations of levofloxacin in the bronchial mucosa and epithelial lining fluid were reached within 1 hour or 4 hours and were 8.3 μg/g and 10.8 μg/ml, respectively, with penetration coefficients into the bronchial mucosa and epithelial lining fluid, compared to plasma concentration, of 1.1-1.8 and 0.8-3, respectively.
After 5 days of oral administration of 500 mg of levofloxacin, the average concentrations of levofloxacin 4 hours after the last dose in the epithelial lining fluid were 9.94 μg/ml and in alveolar macrophages - 97.9 μg/ml.
Penetration into lung tissue
Maximum concentrations in lung tissue after a single oral dose of 500 mg of levofloxacin were approximately 11.3 μg/g and were reached 4-6 hours after administration, with penetration coefficients of 2-5 compared to plasma concentration.
Penetration into alveolar fluid
After 3 days of taking 500 mg of levofloxacin once or twice daily, the maximum concentrations of levofloxacin in the alveolar fluid were reached 2-4 hours after administration and were 4.0 and 6.7 μg/ml, respectively, with a penetration coefficient of 1 compared to plasma concentrations.
Penetration into bone tissue
Levofloxacin penetrates well into cortical and cancellous bone tissue, both in the proximal and distal parts of the femur, with a penetration coefficient (bone tissue/plasma) of 0.1-3. The maximum concentrations of levofloxacin in the cancellous bone tissue of the proximal femur after a single oral dose of 500 mg were approximately 15.1 μg/g (2 hours after administration).
Penetration into cerebrospinal fluid
Levofloxacin poorly penetrates into the cerebrospinal fluid.
Penetration into prostate tissue
After oral administration of 500 mg of levofloxacin once daily for 3 days, the average concentration of levofloxacin in prostate tissue was 8.7 μg/g, the average prostate/plasma concentration ratio was 1.84.
Concentrations in urine
Average concentrations in urine 8-12 hours after oral administration of 150, 300, and 600 mg doses of levofloxacin were 44 μg/ml, 91 μg/ml, and 162 μg/ml, respectively.
Metabolism
Levofloxacin is metabolized to a small extent (5% of the administered dose). Its metabolites are demethyllevofloxacin and levofloxacin N-oxide, which are excreted by the kidneys. Levofloxacin is stereochemically stable and does not undergo chiral transformation.
Elimination
After oral administration, levofloxacin is eliminated relatively slowly from plasma (half-life (T1/2) - 6-8 hours). Excretion is primarily renal (more than 85% of the administered dose). The total clearance of levofloxacin after a single 500 mg dose was 175±29.2 ml/min.
There are no significant differences in the pharmacokinetics of levofloxacin between its intravenous administration and oral administration, confirming that oral and intravenous administration are interchangeable.
Pharmacokinetics in specific patient groups
The pharmacokinetics of levofloxacin does not differ between men and women.
The pharmacokinetics in elderly patients does not differ from that in young patients, except for pharmacokinetic differences associated with differences in creatinine clearance (CrCl).
In renal insufficiency, the pharmacokinetics of levofloxacin change. As renal function deteriorates, renal excretion and renal clearance (CLR) decrease, and T1/2 increases.
Pharmacokinetics in renal insufficiency after a single oral dose of 500 mg of Levofloxacin Ekolevid®.
|
CrCl (ml/min) |
<20 |
20-49 |
50-80 |
|
CLR (ml/min) |
13 |
26 |
57 |
|
T1/2 (h) |
35 |
27 |
9 |
Indications for use
Treatment of infectious and inflammatory diseases caused by microorganisms sensitive to levofloxacin:
- Community-acquired pneumonia;
- Complicated urinary tract infections and pyelonephritis;
- Chronic bacterial prostatitis;
- Skin and soft tissue infections;
- For the complex treatment of drug-resistant forms of tuberculosis;
- Prevention and treatment of anthrax with airborne infection.
For the treatment of the following infectious and inflammatory diseases, levofloxacin can be used as an alternative to other antimicrobial drugs:
- Acute sinusitis;
- Exacerbation of chronic bronchitis;
- Uncomplicated cystitis.
When using Levofloxacin Ekolevid®, official national recommendations for the appropriate use of antibacterial drugs, as well as the sensitivity of pathogenic microorganisms in a particular country, should be taken into account (see section "Special Instructions").
Contraindications
Hypersensitivity to levofloxacin, other fluoroquinolones, or components of the drug; epilepsy; tendon damage during previous treatment with quinolones; pregnancy; lactation; children and adolescents (under 18 years of age); myasthenia gravis.
Lactose intolerance or lactase deficiency, as well as glucose-galactose malabsorption.
Due to the inability to split the tablet in half, the use of the drug is contraindicated in patients with impaired renal function:
- In patients with creatinine clearance less than 50 ml/min, use with an initial dosage regimen of 250 mg/24 h is impossible;
- In patients with creatinine clearance less than 20 ml/min, use with initial dosage regimens of 500 mg/24 h and 500 mg/12 h is impossible;
- With creatinine clearance less than 10 ml/min (including during hemodialysis and continuous ambulatory peritoneal dialysis), use for all dosage regimens is impossible.
With caution
- In patients predisposed to seizures [in patients with previous lesions of the central nervous system (CNS); in patients simultaneously taking drugs that lower the seizure threshold of the brain, such as fenbufen, theophylline] (see section "Drug Interactions");
- In patients with latent or manifested glucose-6-phosphate dehydrogenase deficiency (increased risk of hemolytic reactions during treatment with quinolones);
- In patients with impaired renal function (mandatory monitoring of renal function and dose adjustment are required, see section "Dosage and Administration");
- In patients with known risk factors for QT interval prolongation: elderly patients; female patients; patients with uncorrected electrolyte disturbances (with hypokalemia, hypomagnesemia); with congenital long QT syndrome; with heart disease (heart failure, myocardial infarction, bradycardia); when taking drugs that can prolong the QT interval simultaneously (class IA and III antiarrhythmics, tricyclic antidepressants, macrolides, antipsychotics) (see sections "Overdose", "Drug Interactions", "Special Instructions");
- In patients with diabetes mellitus receiving oral hypoglycemic drugs (e.g., glibenclamide) or insulin preparations (increased risk of hypoglycemia);
- In patients with severe adverse reactions to other fluoroquinolones, such as severe neurological reactions (increased risk of similar adverse reactions when using levofloxacin);
- In patients with psychoses or patients with a history of mental illness (see section "Special Instructions");
- In elderly patients, patients after transplantation, and with concomitant use of glucocorticosteroids (increased risk of tendinitis and tendon rupture) (see section "Special Instructions").
Use during pregnancy and breastfeeding
Levofloxacin is contraindicated for use in pregnant and breastfeeding women.
Dosage and administration
Orally. Once or twice daily. The tablets should be swallowed without chewing and with a sufficient amount of liquid (from 0.5 to 1 glass).
The drug can be taken before meals or at any time between meals, as food intake does not affect the absorption of the drug (see section "Pharmacokinetics").
The drug should be taken at least 2 hours before or 2 hours after taking preparations containing magnesium and/or aluminum, iron, zinc, or sucralfate (see section "Drug Interactions").
Given that the bioavailability of levofloxacin when taking Levofloxacin Ekolevid® tablets is 99-100%, in case of switching a patient from intravenous infusion with other levofloxacin preparations, Levofloxacin Ekolevid® tablets should be continued at the same dose that was used during intravenous infusion of levofloxacin preparations (see section "Pharmacokinetics").
Missing one or more doses of the drug
If a dose is accidentally missed, the next dose should be taken as soon as possible and then continue taking Levofloxacin Ekolevid® according to the recommended dosing regimen.
Dosage form
Film-coated tablets, 250 mg and 500 mg.
5, 7 or 10 tablets in a blister pack made of polyvinyl chloride film and printed lacquered aluminum foil.
1 or 2 blister packs together with the instructions for use are placed in a cardboard carton.
Storage conditions
In a place protected from moisture and light at a temperature not exceeding 25 °C. Keep out of reach of children.
Shelf life
2 years. Do not use after the expiration date.
Prescription status
Dispensed by prescription.
Name and address of the legal entity in whose name the registration certificate is issued / Organization accepting claims:
JSC "AVVA RUS",
Russia, 121614, Moscow, Krylatskie Kholmy St., 30, building 9.
Tel./Fax: +7 (495) 956-75-54.
ecoantibiotic.ru
Production site address:
JSC "AVVA RUS",
Russia, 610044, Kirov Region, Kirov, Luganskaya St., 53a.
Tel.: +7 (8332) 25-12-29; +7 (495) 956-75-54.
The full instructions can be found in the file "Instructions"
