20.06.2020

Mesna instructions for use. Mesna-lance, solution for intravenous administration. Side effects of Mesna

Formula: C2H6O3S2, chemical name: 2-mercaptoethanesulfonic acid (as sodium salt).
Pharmacological group: organotropic agents / respiratory agents / secretolytics and stimulants of motor function of the respiratory tract; Metabolics/detoxifiers, including antidotes.
Pharmachologic effect: mucolytic, reducing the cytotoxicity of oxazaphosphorines.

Pharmacological properties

Mesna is an antidote to acrolein, a metabolite of antitumor drugs of the oxazaphosphorine group (cyclophosphamide, ifosfamide), which irritates the mucous membrane of the bladder. Mesna in the bladder and kidneys deprives the alkylating properties of some oxazaphosphorine derivatives (ifosfamide, endoxan and others) and inactivates them. Mesna also reduces the viscosity of the discharge of the external auditory canal and paranasal sinuses, and sputum. When administered intravenously, mesna is rapidly oxidized to disulfide and reduced in the kidneys to a free thiol compound that irreversibly binds to alkylating metabolites to form non-toxic, stable thioesters. Mesna reduces the uro- and cystotoxicity of alkylating derivatives, but does not weaken the antitumor effect of the drugs. Binds to plasma proteins by 69 - 75%. Systemic clearance is 1.23 l/h/kg. With intravenous administration of 800 mg of the drug, the half-life for mesna is 0.36 hours, for disulfide it is 1.17 hours. Mesna is excreted as disulfide (33% of the dose) and thiol (32%) in the urine.

Indications

Solution for inhalation: chronic and obstructive bronchitis, bronchial asthma, bronchiectasis, atelectasis and emphysema, postoperative aspiration pneumonia during thoracic and neurosurgical operations, in intensive care units (treatment and prevention).
Nasal aerosol: rhinitis, which is accompanied by difficulty in secretion (symptomatic therapy).
Solution for injection: hemorrhagic cystitis, which is caused by alkylating agents; prevention of urotoxicity of cytostatics - oxazaphosphorine derivatives.

Method of application of mesna and dose

Injection: prevention of hemorrhagic cystitis caused by ifosfamide - administered intravenously in a slow stream of 240 mg/m2 or 20% of the cytostatic dose together with the cytostatic and 4 and 8 hours after administration of oxazaphosphorine. With continuous administration (24 hours) of a cytostatic, mesna is administered at a dose of 20% of the dose of the cytostatic at the beginning of the infusion, then at a dose of 100% during 24 hours of infusion and another 6–12 hours at the same dose after the end of the administration.
Nasal spray: injected into the nasal cavity in both nostrils, one injection (1 dose) 4 times a day.
Endotracheally, 1 - 2 ml of mesna is dissolved in 1 - 2 ml of isotonic solution or distilled water and administered using an intratracheal probe or tracheostomy tube, the procedure is repeated every hour until liquefaction and evacuation of the secretion. For sinusitis, 2–3 ml of undiluted solution is injected into the maxillary sinuses after lavage every 2–3 days.
Solution for inhalation: inhalation, 3 – 4 times a day, 1 – 2 ampoules (diluted 1:2 with water or in pure form); the course of treatment ranges from several days to several weeks.
Due to the presence of benzyl alcohol impurities in the vials, they should not be used in infants and newborns and used with caution in elderly patients.
Unused contents of ampoules must be thrown away because they quickly oxidize. Multi-dose vials can be stored for 8 days.
Mesna protects only the urinary system and does not eliminate other adverse reactions from taking cytostatics. Therefore, when using drugs from the oxazaphosphorine group, it is necessary to use a full range of symptomatic and supportive treatment.
When using mesna with oxazaphosphorines, it is necessary to test your morning urine every day for the presence of blood.
False-positive reactions to the presence of ketone bodies in the urine have been reported during the use of mesna.

Contraindications for use

Hypersensitivity (including to other thiol compounds), pregnancy, breastfeeding. Solution for inhalation: bronchial asthma without thickening of mucus in the bronchial tree, general weakness, which causes ineffective cough.

Restrictions on use

No data.

Use during pregnancy and breastfeeding

Mesna is contraindicated during pregnancy and breastfeeding.

Side effects of mesna

Digestive system: nausea, diarrhea, vomiting, constipation, flatulence, abdominal pain, anorexia, increased activity of liver function tests.
Hematopoietic organs: thrombocytopenia; leukopenia, granulocytopenia, and anemia were also noted, but the connection of these phenomena with the use of mesna has not been established, since these disorders could be caused by concomitant cytotoxic treatment.
Nervous system: drowsiness, dizziness, irritability, headache, depression.
Circulatory system:"flushes" of blood to the face, decreased blood pressure, tachycardia, increased blood pressure.
The immune system: hypersensitivity reactions (itching, skin rash, Lyell's syndrome, urticaria, anaphylactoid reactions, Stevens-Johnson syndrome).
Respiratory system: cough, tachypnea, bronchospasm.
Local reactions: phlebitis at the injection site, redness, pain.
Others: arthralgia, myalgia, burning sensation and pain in the chest, hematuria, fever, back pain, chills, conjunctivitis, pharyngitis, flu-like syndrome, pain in the limbs, fatigue, weakness, pneumonia, alopecia.

Interaction of mesna with other substances

Mesna is compatible with ifosfamide and cyclophosphamide, therefore it can be administered together with them in the same solution, while the antitumor activity of ifosfamide and cyclophosphamide does not change. Mesna is incompatible with cisplatin in the same infusion solution, as cisplatin binds and inactivates. Mesna attenuates the nephrotoxic and urotoxic effects of cisplatin. Mesna reduces the nephrotoxicity of ifosfamide. Mesna reduces the likelihood of urinary tract damage from cyclophosphamide. Mesna has no effect on the therapeutic effectiveness of carmustine, doxorubicin, cisplatin, vincristine, methotrexate, and cardiac glycosides.

Gross formula

C2H6O3S2

Pharmacological group of the substance Mesna

Nosological classification (ICD-10)

CAS code

3375-50-6

Pharmacology

pharmachologic effect- mucolytic, reducing the cytotoxicity of oxazaphosphorines.

Inactivates some oxazaphosphorine derivatives (endoxan, ifosfamide, etc.) in the kidneys and bladder, depriving them of their alkylating properties.

Reduces the viscosity of sputum, secretions of the paranasal sinuses and external auditory canal.

After intravenous injection, it is quickly oxidized to disulfide, and in the kidneys it is reduced to a free thiol compound, which irreversibly binds to alkylating derivatives, forming non-toxic stable thioesters. Reduces cysto- and urotoxicity of alkylating agents.

After intravenous administration of 800 mg T1/2 in the blood is 0.36 for mesna, 1.17 hours for disulfide. 32% of the dose is excreted in the urine as thiol and 33% as disulfide.

Application of the substance Mesna

Injection: prevention of urotoxicity of cytostatics - oxazaphosphorine derivatives, hemorrhagic cystitis caused by alkylating agents.

Solution for inhalation: bronchial asthma, chronic and obstructive bronchitis, emphysema and pulmonary atelectasis, bronchiectasis, postoperative aspiration pneumonia during neurosurgical and thoracic operations, in intensive care units (prevention and treatment).

Nasal aerosol: rhinitis, accompanied by difficulty in secretion (symptomatic treatment).

Contraindications

Hypersensitivity (including to other thiol compounds). Solution for inhalation: general weakness causing ineffective cough, bronchial asthma without thickening of mucus in the bronchial tree.

Side effects of Mesna

Dyspeptic symptoms (nausea, vomiting, diarrhea), hematuria, allergic manifestations on the skin and mucous membranes. Solution for inhalation: cough, burning sensation and pain in the chest, bronchospasm.

Interaction

Incompatible with cisplatin in the same infusion solution (binds and inactivates it).

Routes of administration

IV stream (slow), inhalation, endotracheal, instillation into the maxillary sinuses, intranasal.

Precautions for the substance Mesna

Due to the presence of benzyl alcohol impurities in the vials, they should not be used in newborns and infants, but may be used with caution in the treatment of elderly patients.

INSTRUCTIONS

on medical use of the drug

MESNA-LENS

Tradename

Mesna-LENS

International nonproprietary name

Dosage form

Solution for intravenous administration, 100 mg/ml

Compound

1 ml of the drug contains:

active substance - mesna 100 mg,

Excipients: sodium benzoate, disodium edetate, sodium hydroxide, water for injection.

Description

Transparent with slight opalescence, colorless or slightly colored liquid

Pharmacotherapeutic group

Other therapeutic products. Drugs that reduce the toxicity of cytostatic therapy. Mesna.

ATX code V03AF01

Pharmacological properties

Pharmacokinetics

When administered intravenously (i.v.), the active substance is quickly oxidized to disulfide (dimesne). In the epithelium of the renal tubules, dimesna is reduced to a free thiol compound, which irreversibly binds to oxazaphosphorine metabolites, forming non-toxic stable thioesters. The connection with blood plasma proteins is 69-75%. Systemic clearance is 1.23 l/h/kg/.

After intravenous administration at a dose of 800 mg, the half-lives of mesna and dimesna in the blood are 0.36 hours and 1.17 hours, respectively. About 32% and 33% of the administered dose were excreted by the kidneys within 24 hours, respectively, as mesna and dimesna. Most of the reconstituted dose was excreted by the kidneys within 4 hours.

Pharmacodynamics

Mesna is an antidote to acrolein, a metabolite of antitumor drugs from the oxazaphosphorine group (ifosfamide, cyclophosphamide), which has an irritating effect on the mucous membrane of the bladder. The protective properties of mesna are due to its interaction with the double bond of the acrolein molecule, which leads to the formation of a stable thioester. By reducing the urotoxic effects of oxazaphosphorines, mesna does not weaken their antitumor effect.

Indications for use

Directions for use and doses

Mesna-LENS is usually administered intravenously as a bolus (slowly). A single dose for adults is 20% of a single dose of oxazaphosphorine. The first injection is carried out simultaneously with the first administration of oxazaphosphorine, the second and third injections - 4 hours and 8 hours after the administration of oxazaphosphorine.

In children a single dose of Mesna-LENS is 60% of the cytostatic dose, administration of the drug is continued every 3 hours.

With a continuous infusion (24 hours) of ifosfamide or cyclophosphamide, the drug Mesna-LENS should be administered at a dose of 20% of the dose of the cytostatic at the beginning of the infusion, then at a dose of 100% of the dose of the cytostatic in the form of a 24-hour infusion and at the end of the administration of the cytostatic, administration of the drug Mesna -LENS is continued for another 6-12 hours at the same dose.

When oxazaphosphorines are used in very high doses, for example, before bone marrow transplantation, the total dose of Mesna-LENS can be increased to 120-160% of the oxazaphosphorine dose. After administering 20% ​​Mesna-LENS at the beginning of the administration of the cytostatic, the remaining calculated dose is recommended to be administered intravenously over a long period of 24 hours. Alternatively, a fractional bolus injection is possible: for adults 3 x 40% (time 0, 4, 8 hours) or 4 x 40 % (time 0, 3, 6, 9 hours). Instead of bolus injections, short infusions lasting 15 minutes are possible.

Side effects

Adverse reactions that occurred more often than in isolated cases are listed according to the following gradation: very often (> 10%); often (> 1%,< 10%); иногда (> 0,1%, < 1%); редко (> 0,01%, < 0,1%); крайне редко (< 0,01%).

Often:

Pneumonia and alopecia were also often observed. The causal relationship of these phenomena with the use of mesna has not been established; this could be due to concomitant cytotoxic therapy.

Rarely:

Very rarely:

Granulocytopenia, leukopenia, and anemia were also observed. The causal relationship of these phenomena with the use of mesna has not been established; this could be due to concomitant cytotoxic therapy.

Contraindications

Drug interactions

Mesna is compatible with cyclophosphamide and ifosfamide, therefore it can be administered with them in the same solution, while the antitumor activity of the latter does not change.

Pharmaceutically, the drug is incompatible with cisplatin (binding and inactivation of the latter), and therefore mesna should not be mixed in the same solution with cisplatin.

Mesna does not affect the therapeutic effectiveness of doxorubicin, carmustine, cisplatin, methotrexate, vincristine, or the activity of cardiac glycosides.

special instructions

Mesna has a protective effect only on the urinary system and does not eliminate other side effects of cytostatics, therefore, when treating with drugs from the oxazaphosphorine group, it is necessary to use a full range of supportive and symptomatic therapy.

Mesna does not prevent the development of hemorrhagic cystitis in all patients. Therefore, it is necessary to analyze the morning urine sample daily for the presence of hematuria. If hematuria occurs during the use of mesna with oxazaphosphorines according to the recommended dosage regimen, dose reduction or discontinuation of oxazaphosphorine therapy may be necessary.

Because of the potential for anaphylactic reactions, it is important to ensure that appropriate emergency medications are available.

In patients with autoimmune diseases treated with cyclophosphamide and mesna, hypersensitivity reactions are detected at a higher frequency. In such patients, urinary tract protection with mesna should only be undertaken after a careful risk-benefit analysis and under close medical supervision.

During the treatment period, false-positive reactions to the presence of ketone bodies in the urine are observed (when carrying out a color reaction to ketones, a reddish-violet color of the urine is possible, which is unstable and immediately disappears when glacial acetic acid is added to the urine).

Use in pediatrics

U In children, a single dose of Mesna-LENS is 60% of the dose of the cytostatic agent; administration of the drug is continued every 3 hours.

Use during pregnancy and breastfeeding

The drug is contraindicated during pregnancy and breastfeeding.

Features of the effect of the drug on the ability to drive a vehicle or potentially dangerous mechanisms

There have been no studies of the effects of mesna on the abilities required to operate vehicles and operate mechanical equipment.

Overdose

Symptoms: possible symptoms of overdose are nausea, flatulence, diarrhea, headache, fatigue, pain in the limbs and joints, malaise, weakness, depression, irritability, skin rash, decreased blood pressure, tachycardia.

There is no known specific antidote for mesna.

Release form and packaging

Solution for intravenous administration, 100 mg/ml

4 ml in neutral glass bottles, hermetically sealed with rubber stoppers with rolled aluminum or aluminum-plastic caps.

Solution for injection: prevention of urotoxicity of cytostatics - oxazaphosphorine derivatives, hemorrhagic cystitis caused by alkylating agents.

Solution for inhalation: bronchial asthma, chronic and obstructive bronchitis, emphysema and pulmonary atelectasis, bronchiectasis, postoperative aspiration pneumonia during neurosurgical and thoracic operations, in intensive care units (prevention and treatment).

Nasal aerosol: rhinitis, accompanied by difficulty in secretion (symptomatic treatment).

Release form of the drug Mesna

powder substance; bag (bag) double-layer polyethylene bag (bag) made of aluminum foil 1;

Pharmacodynamics of the drug Mesna

Inactivates some oxazaphosphorine derivatives (endoxan, ifosfamide, etc.) in the kidneys and bladder, depriving them of their alkylating properties.

Reduces the viscosity of sputum, secretions of the paranasal sinuses and external auditory canal.

After intravenous injection, it is quickly oxidized to disulfide, and in the kidneys it is reduced to a free thiol compound, which irreversibly binds to alkylating derivatives, forming non-toxic stable thioesters. Reduces cysto- and urotoxicity of alkylating agents.

Pharmacokinetics of the drug Mesna

After intravenous administration of 800 mg T1/2 in the blood is 0.36 for mesna, 1.17 hours for disulfide. 32% of the dose is excreted in the urine as thiol and 33% as disulfide.

Using Mesna during pregnancy

Contraindicated.

Contraindications to the use of Mesna

Hypersensitivity, pregnancy, lactation. For use as a mucolytic (optional) - asthenia, causing ineffective cough, bronchial asthma without thickening of mucus in the bronchial tree.

Side effects of Mesna

Dyspeptic symptoms (nausea, vomiting, diarrhea), hematuria, allergic manifestations on the skin and mucous membranes. Solution for inhalation: cough, burning sensation and pain in the chest, bronchospasm.

Method of administration and dosage of the drug Mesna

Prevention of ifosfamide-induced hemorrhagic cystitis - 240 mg/m2 or 20% of the cytostatic dose is administered intravenously (slowly) simultaneously with the cytostatic and 4 and 8 hours after oxazaphosphorine. For continuous infusion (24 hours), the cytostatic is administered at a dose of 20% of the dose of the cytostatic at the beginning of the infusion, then at a dose of 100% during 24 hours of infusion and another 6–12 hours at the same dose after the end of the infusion.

Interactions of Mesna with other drugs

Can be administered in the same solution with cyclophosphamide and inophosphamide. Do not mix with cisplatin in the same syringe (pharmaceutical incompatibility, binds and inactivates it). Mesna does not affect the therapeutic effectiveness of adriamycin, carmustine, cisplatin, methotrexate, vincristine, or the activity of cardiac glycosides.

Precautions when taking Mesna

Due to the presence of benzyl alcohol impurities in the vials, they should not be used in newborns and infants, but may be used with caution in the treatment of elderly patients.

Storage conditions for the drug Mesna

List B: In a dry place, protected from light, at a temperature not exceeding 25 °C. In sealed packaging

Shelf life of Mesna

The drug Mesna belongs to the ATX classification:

V Other drugs

V03 Miscellaneous other preparations

V03A Miscellaneous other preparations

V03AF Drugs that reduce the toxicity of cytostatic therapy

R No. 001945/01-221209

Tradename: Mesna-LENS ®

International nonproprietary name:

mesna

Dosage form:

solution for intravenous administration

Compound
1 ml of solution contains:
active substance: mesna - 100 mg;
Excipients: sodium benzoate, disodium edetate (Trilon B), sodium hydroxide (caustic soda), water for injection.

Description
Transparent with slight opalescence, colorless or slightly colored liquid.

Pharmacotherapeutic group:

antidote

ATX Code: V03AF01

Pharmacological properties
Pharmacodynamics
Mesna is an antidote to acrolein, a metabolite of antitumor drugs from the oxazaphosphorine group (ifosfamide, cyclophosphamide), which has an irritating effect on the mucous membrane of the bladder. The protective properties of mesna are due to its interaction with the double bond of the acrolein molecule, which leads to the formation of a stable thioester. By reducing the urotoxic effects of oxazaphosphorines, mesna does not weaken their antitumor effect.
Pharmacokinetics
When administered intravenously (i.v.), the active substance is quickly oxidized to disulfide (dimesne). In the epithelium of the renal tubules, dimesna is reduced to a free thiol compound, which irreversibly binds to oxazaphosphorine metabolites, forming non-toxic stable thioesters. The connection with blood plasma proteins is 69-75%. Systemic clearance is 1.23 l/h/kg/. After intravenous administration at a dose of 800 mg, the half-lives of mesna and dimesna in the blood are 0.36 hours and 1.17 hours, respectively. About 32% and 33% of the administered dose were excreted by the kidneys within 24 hours, respectively, as mesna and dimesna. Most of the reconstituted dose was excreted by the kidneys within 4 hours.

Indications for use
Local detoxification of the urotoxic effects of cytostatics - oxazaphosphorine derivatives, incl. in the following cases:

• when administering ifosfamide;
• when oxazaphosphorines are administered in high doses (more than 10 mg/kg);
• in patients at risk - previous radiation therapy to the pelvic area, the development of cystitis during previous therapy with oxazaphosphorines, a history of diseases of the urinary system.

Contraindications
Hypersensitivity to mesna, any other component of the drug or thiol compounds.
Pregnancy and lactation period.

Directions for use and doses
The drug Mesna-LENS ® is usually administered intravenously as a bolus (slowly). A single dose for adults is 20% of a single dose of oxazaphosphorine. The first injection is carried out simultaneously with the first administration of oxazaphosphorine, the second and third injections - 4 hours and 8 hours after the administration of oxazaphosphorine.
In children, a single dose of Mesna-LENS ® is 60% of the dose of the cytostatic agent; administration of the drug is continued every 3 hours.
During continuous infusion (24 hours) of ifosfamide or cyclophosphamide, Mesna-LENS ® should be administered at a dose of 20% of the dose of the cytostatic at the beginning of the infusion, then at a dose of 100% of the dose of the cytostatic in the form of a 24-hour infusion and at the end of the administration of the cytostatic, administration of the drug Mesna-LENS ® is continued for another 6-12 hours at the same dose. When oxazaphosphorines are used in very high doses, for example, before bone marrow transplantation, the total dose of Mesna-LENS ® can be increased to 120-160% of the oxazaphosphorine dose. After administration of 20% Mesna-LENS ® at the beginning of the administration of the cytostatic, the remaining calculated dose is recommended to be administered intravenously over a long period of 24 hours. Alternatively, a fractional bolus injection is possible: for adults 3 × 40% (time 0, 4, 8 hours) or 4 × 40% (time 0, 3, 6, 9 hours). Instead of bolus injections, short infusions lasting 15 minutes are possible.

Side effect
Adverse reactions that occurred more often than in isolated cases are listed according to the following gradation: very often (> 10%); often (> 1%, 0.1%, 0.01%, From the digestive system: often - nausea, vomiting, diarrhea, constipation, abdominal pain, flatulence, anorexia;
From the hematopoietic organs: very rarely - thrombocytopenia. Granulocytopenia, leukopenia, and anemia were also observed. The causal relationship of these phenomena with the use of mesna has not been established; this could be due to concomitant cytotoxic therapy.
From the central nervous system: often - dizziness, drowsiness, headache, irritability, depression.
From the cardiovascular system: often - a “rush” of blood to the face.
From the immune system: very rarely - hypersensitivity reactions (skin rash, itching, Lyell's syndrome, Stevens-Johnson syndrome, urticaria, conjunctivitis, anaphylactoid reactions, decreased blood pressure, increased blood pressure, tachycardia, tachypnea, myalgia, as well as increased activity of a number of liver function tests (for example , transaminases).
From the respiratory system: often - cough.
Local reactions: rarely - phlebitis at the injection site, pain and redness.
Others: often - arthralgia, back pain, fever, chills, flu-like syndrome, pharyngitis; very rarely - pain in the limbs, increased fatigue, weakness. Pneumonia and alopecia were also often observed. The causal relationship of these phenomena with the use of mesna has not been established; this could be due to concomitant cytotoxic therapy.

Interaction with other drugs
Mesna is compatible with cyclophosphamide and ifosfamide, therefore it can be administered with them in the same solution, while the antitumor activity of the latter does not change.
Pharmaceutically, the drug is incompatible with cisplatin (binding and inactivation of the latter), and therefore mesna should not be mixed in the same solution with cisplatin.
Mesna does not affect the therapeutic effectiveness of doxorubicin, carmustine, cisplatin, methotrexate, vincristine, or the activity of cardiac glycosides.

Overdose
There is no known specific antidote for mesna. Possible symptoms of overdose: nausea, flatulence, diarrhea, headache, fatigue, pain in the limbs and joints, malaise, weakness, depression, irritability, skin rash, decreased blood pressure, tachycardia. Treatment is symptomatic.

special instructions
Mesna has a protective effect only on the urinary system and does not eliminate other side effects of cytostatics, therefore, when treating with drugs from the oxazaphosphorine group, it is necessary to use a full range of supportive and symptomatic therapy.
Mesna does not prevent the development of hemorrhagic cystitis in all patients. Therefore, it is necessary to analyze the morning urine sample daily for the presence of hematuria. If hematuria occurs during the use of mesna with oxazaphosphorines according to the recommended dosage regimen, dose reduction or discontinuation of oxazaphosphorine therapy may be necessary. Because of the potential for anaphylactic reactions, it is important to ensure that appropriate emergency medications are available. In patients with autoimmune diseases treated with cyclophosphamide and mesna, hypersensitivity reactions are detected at a higher frequency. In such patients, urinary tract protection with mesna should only be undertaken after a careful risk-benefit analysis and under close medical supervision. During the treatment period, false-positive reactions to the presence of ketone bodies in the urine are observed (when carrying out a color reaction to ketones, a reddish-violet color of the urine is possible, which is unstable and immediately disappears when glacial acetic acid is added to the urine).

Release form
Solution for intravenous administration 200 mg/2 ml and 400 mg/4 ml (100 mg/ml) in vials. Each bottle with instructions for use in a pack of cardboard, or 3, 5 or 10 bottles along with instructions for use in a pack with partitions or special slots made of cardboard. 50, 85, 100 bottles with instructions for use, at the rate of one instruction per ten bottles, in a cardboard box (for hospitals).

Storage conditions
List B.
In a dry place, protected from light, at a temperature not exceeding 25°C. Keep out of the reach of children.

Best before date
2 years.
Do not use after the expiration date stated on the package.

Conditions for dispensing from pharmacies
On prescription.

Manufacturer:

LENS-Pharm LLC, a subsidiary of Veropharm OJSC
Legal address: 143033, Moscow region, Odintsovo district, pos. Gorki-Kh, village ZOa
Address for production and acceptance of claims: 601125, Vladimir region, Petushinsky district, pos. Volginsky, building 95, building 67