Inside. The contents of one sachet are dissolved in 1 glass (250 ml) of hot, but not boiling water. Accepted hot. A repeated dose can be taken every 4-6 hours (no more than 3-4 doses within 24 hours). TeraFlu for flu and colds can be used at any time of the day, but the best effect is obtained by taking the drug before bedtime, at night. If there is no relief of symptoms within 3 days after starting the drug, you should see your doctor. Patients should not take TeraFlu for colds and flu for more than 5 days.

Special populations:

Hepatic impairment: patients with impaired liver function or Gilbert's syndrome need to reduce the dose or increase the interval between taking TheraFlu for influenza and colds.

Renal failure: in the presence of acute renal failure (creatinine clearance <10 ml / min), the interval between taking TheraFlu for influenza and colds should be at least 8 hours.

Elderly patients: No dose adjustment is necessary in elderly patients.

Hypersensitivity to individual components of the drug, concomitant use of tricyclic antidepressants, beta-blockers or other sympathomimetic drugs, concomitant use of monoamine oxidase (MAO) inhibitors or during the previous 2 weeks, portal hypertension, alcoholism, diabetes mellitus, sucrase / isomaltose deficiency, intolerance glucose-galactose malabsorption, pregnancy, breastfeeding period, children under 12 years of age, severe cardiovascular diseases, arterial hypertension, hyperthyroidism, angle-closure glaucoma, pheochromocytoma.

  Carefully:

With severe atherosclerosis of the coronary arteries, cardiovascular diseases, acute hepatitis, hemolytic anemia, bronchial asthma, severe liver or kidney disease, prostatic hyperplasia, difficulty urinating due to prostatic hypertrophy, blood diseases, deficiency of glucose-6-phosphate dehydrogenase, congenital Gilbert, Dubin-Johnson and Rotor syndromes), in patients suffering from exhaustion, dehydration, pyloroduodenal obstruction, stenosing gastric and / or duodenal ulcer, epilepsy, while taking drugs that can negatively affect the liver (for example, inducers of liver microsomal enzymes) ...

Caution should be exercised when treating patients with recurrent urate kidney stones

Application during pregnancy and lactation:

It is not recommended to use the drug during pregnancy and during breastfeeding.

Classification of the incidence of adverse reactions: very often (≥1 / 10); often (≥1 / 100, <1/10); infrequently (≥1 / 1000, <1/100); rarely (≥1 / 10000, <1/1000); very rare (<1/10000), including isolated messages and reactions with an unknown frequency (frequency cannot be estimated from the available data).

Blood and lymphatic system disorders:

Very rare: thrombocytopenia, agranulocytosis, leukopenia, pancytopenia.

Immune system disorders:

Rarely: hypersensitivity reactions (rash, shortness of breath, anaphylactic shock), angioedema.

Unknown: anaphylactic reaction, Stevens-Johnson syndrome, toxic

epidermal necrolysis.

Mental disorders:

Rarely: hyperexcitability, sleep disturbance.

Nervous system disorders:

Often: drowsiness.

Rarely: dizziness, headache.

Violations of the organ of vision:

Rarely: mydriasis, paresis of accommodation, increased intraocular pressure.

Heart disorders:

Rarely: tachycardia, palpitations.

Vascular disorders:

Rarely: increased blood pressure.

Gastrointestinal disorders:

Often: nausea, vomiting.

Rarely: dry mouth, constipation, abdominal pain, diarrhea.

Liver and biliary tract disorders:

Rarely: increased activity of liver enzymes.

Skin and subcutaneous tissue disorders:

Rarely: rash, pruritus, erythema, urticaria.

Kidney and urinary tract disorders:

Rarely: difficulty urinating.

General disorders and disorders at the injection site:

Rarely: malaise.

If any of the side effects indicated in the instructions are aggravated, or you notice any other side effects not listed in the instructions, inform your doctor.

Influence of paracetamol

Enhances the effects of MAO inhibitors, sedatives, ethanol.

The risk of hepatotoxic action of paracetamol increases with the simultaneous administration of barbiturates, phenytoin, phenobarbital, carbamazepine, rifampicin, isoniazid, zidovudine and other inducers of liver microsomal enzymes.

The anticoagulant properties of warfarin and other coumarins can be enhanced by long-term regular use of paracetamol, increasing the risk of bleeding.

A single dose of paracetamol does not have this effect. When paracetamol is prescribed simultaneously with metoclopramide, the rate of absorption of paracetamol increases and, accordingly, its maximum concentration in plasma is reached faster. Likewise, domperidone can increase the absorption rate of paracetamol.

With the combined use of chloramphenicol and paracetamol, the half-life of chloramphenicol may increase. Paracetamol can reduce the bioavailability of lamotrigine, with a possible decrease in its effect due to the induction of its hepatic metabolism. Absorption of paracetamol can be reduced when taken simultaneously with cholestyramine, but this can be avoided if cholestyramine is taken one hour later than paracetamol. Regular use of paracetamol along with zidovudine can cause neutropenia and increase the risk of liver damage.

Probenecid affects the metabolism of paracetamol. In patients taking probenecid at the same time, the dose of paracetamol should be reduced. The hepatotoxicity of paracetamol can be exacerbated by chronic or excessive alcohol consumption. Paracetamol may interfere with the uric acid test using the phosphotungstate precipitating reagent.

Effect of pheniramine

The effect of other substances on the central nervous system may increase (for example, MAO inhibitors, tricyclic antidepressants, alcohol, antiparkinsonian drugs, barbiturates, tranquilizers and drugs). Pheniramine can inhibit the action of anticoagulants.

Effect of phenylephrine

TeraFlu for colds and flu is contraindicated in patients who have been taking or have taken MAO inhibitors within the past two weeks. Phenylephrine can increase the effect of MAO inhibitors and cause a hypertensive crisis.

The simultaneous use of phenylephrine with other sympathomimetic drugs or tricyclic antidepressants (eg, amitriptyline) may increase the risk of cardiovascular side effects.

Phenylephrine may reduce the effectiveness of beta-blockers and other antihypertensive drugs (eg, debrisoquine, guanethidine, reserpine, methyldopa). The risk of high blood pressure and other cardiovascular side effects may be increased. The simultaneous use of phenylephrine with digoxin and other cardiac glycosides may increase the risk of developing arrhythmias or myocardial infarction. The concomitant use of phenylephrine with ergot alkaloids (ergotamine and methysergide) may increase the risk of ergotism.

Symptoms (mainly due to paracetamol, appear after taking more than 10-15 g): in severe cases of overdose, paracetamol has a hepatotoxic effect, including it can cause liver necrosis. Also, overdose can cause nephropathy and irreversible liver damage. The severity of the overdose depends on the dose, therefore it is necessary to warn patients about the prohibition of the simultaneous use of paracetamol-containing drugs. The risk of poisoning is expressed, especially in elderly patients, in children, in patients with liver diseases, in cases of chronic alcoholism, in patients suffering from exhaustion and in patients taking inducers of liver microsomal enzymes.

Paracetamol overdose can lead to liver failure, encephalopathy, coma, and death.

Symptoms of a paracetamol overdose in the first 24 hours: pallor of the skin, nausea, vomiting, anorexia, convulsions. Abdominal pain may be the first sign of liver damage and usually does not appear within 24-48 hours and may sometimes appear later, after 4-6 days. Liver damage manifests itself to the maximum extent on average after 72-96 hours after taking the drug. Disorders of glucose metabolism and metabolic acidosis may also occur. Even in the absence of liver damage, acute renal failure and acute tubular necrosis can develop. Cases of cardiac arrhythmia and the development of pancreatitis have been reported. Treatment: intravenous or oral administration of acetylcysteine ​​as an antidote, gastric lavage, ingestion of methionine may have a beneficial effect for at least 48 hours after an overdose.

The intake of activated carbon, monitoring of respiration and blood circulation is recommended.

If seizures develop, diazepam may be prescribed. Pheniramine and phenylephrine (overdose symptoms for pheniramine and phenylephrine are combined due to the risk of mutual potentiation of the parasympatholytic effect of pheniramine and the sympathomimetic effect of phenylephrine in case of drug overdose).

Overdose symptoms include: drowsiness, followed by anxiety (especially in children), visual disturbances, rash, nausea, vomiting, headache, irritability, dizziness, insomnia, circulatory disorders, coma, convulsions, changes in behavior, increase or decrease blood pressure and bradycardia. With an overdose of pheniramine, cases of atropine-like "psychosis" have been reported.

There is no specific antidote. Routine care is needed, including activated charcoal, saline laxatives, and heart and respiratory support. Psychostimulants (methylphenidate) should not be prescribed because of the risk of seizures.

With hypotension, it is possible to use vasopressor drugs.

In case of an increase in blood pressure, intravenous administration of alpha-adrenergic blockers is possible. phenylephrine is a selective agonist of alpha1-adrenergic receptors, therefore, the hypertensive effect of phenylephrine overdose should be treated by blocking alpha1-adrenergic receptors. If seizures develop, use diazepam.