Mucolytic drugs. Mucolytic drugs Trypsin recipe in Latin

A proteolytic enzyme preparation that has the ability to break down molecules of predominantly denatured proteins and their breakdown products. Inactive against healthy tissues.

The drug has an anti-inflammatory effect, reduces tissue swelling.

Indications for use: locally for the breakdown of necrotic tissue and fibrinous formations in purulent wounds, bedsores, burns; in the form of inhalations for tracheitis, bronchitis, chronic pneumonia, bronchiectasis, postoperative pulmonary atelectasis; intrapleurally for exudative pleurisy and pleural empyema; intramuscularly for purulent otitis, sinusitis, iritis, iridocyclitis, osteomyelitis, thrombophlebitis, inflammatory-dystrophic forms of periodontal disease and other inflammatory diseases.

Release form: bottles of 0.01 g (10 mg).

The drug is used intramuscularly, intrapleurally, in the form of inhalations and eye drops, locally. It is unacceptable to administer the drug intravenously.

Crystalline trypsin is administered intramuscularly once a day at a dose of 0.0025-0.005 g, depending on the age of the child. 5-15 injections are prescribed for the course of treatment. Immediately before administration, the drug is dissolved in 1-2 ml of isotonic sodium chloride solution or 0.5% novocaine solution. The injection is made deep into the upper outer quadrant of the gluteal muscle. Crystalline trypsin is administered intrapleurally in a dose of 5-10 mg, dissolving this amount immediately before injection in 10-20 ml of isotonic sodium chloride solution.

For inhalation, 5-10 mg of the drug is dissolved in 2-3 ml of isotonic sodium chloride solution (antihistamines are prescribed at the same time to prevent allergic reactions). Administration of the drug into the respiratory tract must be combined with good drainage and, if necessary, with suction of liquefied mucous membranes and other masses.

Eye drops are prepared in the form of a 0.2-0.25% trypsin solution. For local use, 25-50 mg of trypsin is dissolved in 10-50 ml of 0.25% novocaine solution, sterile napkins are moistened with this solution and applied to the affected surface for 8 hours or more. Local use of trypsin can be combined with intramuscular injections of this drug.

Possible side effects: with intramuscular administration, allergic reactions may occur, increased body temperature, tachycardia, pain and hyperemia at the injection site.

Contraindications: liver dystrophy and cirrhosis, infectious hepatitis, pancreatitis, kidney damage, hemorrhagic diathesis, cardiac decompensation, pulmonary emphysema, pulmonary tuberculosis in the active phase of the disease.

S. Dilute the contents of the bottle in 2 ml of sterile isotonic sodium chloride solution. Inject 1 ml (0.005 g) deep into the muscle once a day for 6 days (child 10 years old)

Rp.: Trypsini crystallisati 0.01 D. t. d. N. 3

S. Dissolve the contents of the bottle in 3 ml of sterile isotonic sodium chloride solution. When heated, administer as an aerosol (inhalation) for 10 minutes (child 10 years old)

Rp.: Trypsini crystallisati 0.01

S. Dilute the contents of the bottle in 10 ml of 0.5% novocaine solution. Moisten a sterile gauze swab with the solution and apply it to the affected area of ​​skin for 8 hours (child 5 years old)

Active substance(international nonproprietary name)

Russian name: Trypsin
Latin name: Trypsin

Characteristic.

Endogenous proteolytic enzyme of the hydrolase class, catalyzes the breakdown, incl. proteins, peptones, low molecular weight peptides through bonds in the formation of which the carboxyl groups of L-arginine and L-lysine take part. Trypsin is a protein with a relative molecular weight of 21,000, produced and secreted by the mammalian pancreas as inactive trypsinogen, which is then converted to trypsin by the enzyme enteropeptidase in the duodenum.

Trypsin is obtained from the pancreas of cattle followed by lyophilization. In medical practice, crystalline trypsin (approved for both local and parenteral use) and amorphous trypsin (only for local use) are used.

Crystalline trypsin is a white or white powder with a slightly yellowish tint, odorless, or a porous mass (after lyophilization). Easily soluble in water, isotonic sodium chloride solution; solutions are easily destroyed in neutral and alkaline environments.

Special dosage forms of crystalline trypsin have been developed for the treatment of purulent wounds - trypsin is immobilized on special polymer bases (fabric): on dialdehyde cellulose or on activated knitted polyamide fabric; We produce pieces of fabric ranging in size from 10×7.5 cm to 30×20 cm.

Pharmacology.

When applied locally, it has anti-inflammatory, anti-burn, regenerating and necrolytic effects. Breaks down necrotic tissue and fibrinous formations, thins viscous secretions, exudates, blood clots. The enzyme is active at pH 5.0-8.0 with optimum action at pH 7.0. In relation to healthy tissues, it is inactive and safe due to the presence of trypsin inhibitors - specific and nonspecific.

Immobilized crystalline trypsin promotes the rejection of necrotic tissue, dilutes pus and facilitates its evacuation, and improves the process of wound regeneration. Unlike non-immobilized crystalline trypsin, it does not cause changes in the hemostatic system.

In inflammatory diseases of the respiratory tract, trypsin thins and facilitates the removal of viscous secretions and exudates with sputum. In these cases, it is used for inhalation and intramuscular injection. For exudative pleurisy and pleural empyema, it can be administered intrapleurally. In case of tuberculous empyema, caution should be exercised due to the fact that resorption of exudate in some cases may contribute to the development of bronchopleural fistula.

The anti-inflammatory effect determines the use of crystalline trypsin intramuscularly for thrombophlebitis (trypsin does not replace anticoagulants), inflammatory-dystrophic forms of periodontal disease, etc.

For eye diseases, it is used intramuscularly and locally (in the form of eye drops and baths).

Trypsin is used topically to treat burns, bedsores, and purulent wounds.

In dentistry, it is used for ulcerative-necrotic diseases of the oral mucosa, periodontal diseases, periodontitis, odontogenic sinusitis, etc.

Indications.

Respiratory tract diseases (including tracheitis, bronchitis, bronchiectasis, pneumonia, postoperative pulmonary atelectasis, pleural empyema, exudative pleurisy), thrombophlebitis, periodontal disease (inflammatory-dystrophic forms), osteomyelitis, sinusitis, otitis media, iritis, iridocyclitis, hemorrhage in the anterior chamber of the eye, swelling of the periorbital area after operations and injuries, burns, bedsores; purulent wounds (locally).

Contraindications.

For injection- cardiac decompensation, pulmonary emphysema with respiratory failure, decompensated forms of pulmonary tuberculosis, liver dystrophy, liver cirrhosis, infectious hepatitis, pancreatitis, hemorrhagic diathesis. Do not inject into bleeding cavities, intravenously, or apply to ulcerated surfaces of malignant tumors.

Side effects.

Allergic reactions, increased body temperature, tachycardia; with intramuscular injection - pain, hyperemia at the injection site; when administered by inhalation - irritation of the mucous membranes of the upper respiratory tract, hoarseness of the voice.

Method of administration and dose.

V/m: adults - 0.005-0.01 g 1-2 times a day; children - 0.0025 g 1 time per day; immediately before use, 0.005 g of crystalline trypsin is dissolved in 1-2 ml of a sterile 0.9% sodium chloride solution or 0.5-2% procaine solution. The course of treatment is 6-15 injections. Electrophoresis with trypsin is also used: per procedure, 10 mg of trypsin (dissolved in 15-20 ml of distilled water) is administered from the negative pole.

Inhalation: 0.005-0.01 g in 2-3 ml of 0.9% sodium chloride solution is administered as an aerosol through an inhaler or through a bronchoscope. After inhalation, rinse your mouth with warm water and rinse your nose.

In the form of eye drops: a solution (0.2-0.25%) is prepared immediately before use.

Intrapleural: 1 time per day, after dissolving 10-20 mg in 20-50 ml of 0.9% sodium chloride solution.

Locally: in the form of a powder or a solution of amorphous trypsin, compresses are applied to dry or necrotic wounds (the solution is prepared immediately before use: 50 mg of trypsin is dissolved in 5 ml of sterile water or 0.9% sodium chloride solution, when treating purulent wounds - in 5 ml of phosphate buffer solution).

A cloth soaked in trypsin is applied to the wound (after treatment), secured with a bandage and left on the wound for 24 hours. Before use, the cloth is moistened with saline solution, distilled or boiled water, or an antiseptic solution (for example, Furacilin). Keep it moist by wetting it through a bandage. A dry wipe is inactive. The time for complete cleansing of the wound from necrotic tissue and pus is 24-72 hours. If necessary, reapply.

Mucolytic drugs have secretolytic properties, dilute sputum, increase its volume, facilitate secretion and expectoration of sputum, and have an anti-inflammatory effect.

ACETYL CYSTEINE(pharmacological analogues:mucomist, mucosolvin, fluimucil ) – used for respiratory diseases; using with cautionwith bronchial asthma (there may be increased bronchospasm!), with diseases of the liver, kidneys, adrenal glands, with a tendency to pulmonary bleeding. Release form of acetylcysteine: ampoules of 5 ml and 10 ml of 20% solution - for inhalation; ampoules of 2 ml of 10% solution - for injection. List B.

Example of a recipe for acetylcysteine ​​in Latin:

Rp.: Sol. Acetylcysteini 20% pro inhalationibus 5 ml N. 20

D. S. For inhalations, 5 ml 3 times a day.

Rp.: Sol. Acetylcysteini 10% 2 ml

D.t. d. N. 10 in ampull.

S. Administer 2 ml intramuscularly 3 times a day.

BROMHEXINE(pharmacological analogues:bromhexine chloride, bisolvone, mucovin, phlegamine ) - the action is close to acetylcysteine. Contraindications to the use of bromhexine: allergic reactions. Release form of bromhexine: tablets of 0.008 g. List B.

Example of a recipe for bromhexine in Latin:

Rp.: Tab. Bromhexini 0.008 N. 20

D.S. 1 tablet 3 times a day.

TRYPSIN- proteolytic enzyme. Trypsin facilitates the removal of viscous secretions and exudates. Trypsin is prescribed for respiratory diseases by inhalation or intramuscular injection. Trypsin has an anti-inflammatory effect. Trypsin is contraindicated in pulmonary tuberculosis, emphysema, diseases of the liver, kidneys, and pancreas. Trypsin should not be administered intravenously. Trypsin release form: ampoules containing 0.01 g and 0.005 g of crystalline trypsin. List B.

Example of a trypsin recipe in Latin:

Rp.: Trypsini crystallisati 0.01

D.t. d. N. 6 in ampull.

S. For inhalation: dissolve in 1-2 ml of isotonic sodium chloride solution.

CHYMOTRYPSIN- proteolytic enzyme of the pancreas. Chymotrypsin is similar in action to trypsin and has the same indications for use and contraindications. Chymotrypsin release form: ampoules containing 0.005 and 0.01 g of crystalline chymotrypsin. List B.

Example of a chymotrypsin recipe in Latin:

Rp.: Chymotrypsini crystallisati 0.005

D.t. d. N. 6 in ampull.

S. For inhalation: dissolve in 1-2 ml of isotonic sodium chloride solution.

ELASTOLITIN- similar in action, indications for use and contraindications to chymotrypsin. Elastolitin is used (in sodium bicarbonate solution) in the form of aerosols, intratracheally, intrapleurally. Release form of elastolitin: bottles of 0.02 g and 0.03 g.

Example of a recipe for elastolitin in Latin:

Rp.: Elastolytini 0.02

D.t. d. N. 6

S. Dissolve 0.02 g of the drug in 3-5 ml of 2% sodium bicarbonate solution.

TERRILITHIN- acts like trypsin, has the same indications for use and contraindications. Terrilitin release form: bottles containing 200 PE of the drug.

Example of a terrilitine recipe in Latin:

Rp.: Terrilytini 200 PE

D.t. d. N. 6v

S. Dissolve the contents of the bottle in 5-8 ml of distilled water (or isotonic sodium chloride solution), inhale 2-3 ml of the solution 1-2 times a day.

RIBONUCLEASE, DEOXYRIBONUCLEASE - enzymes used in diseases of the upper respiratory tract and lungs, as well as in the treatment of tick-borne encephalitis, etc. Release form of ribonuclease and deoxyribonuclease: ampoules of 10, 25, 50 ml. Lysozyme is also used.

Examples of ribonuclease and deoxyribonuclease recipes in Latin:

Rp.: "Desoxyribonucleasa" 0.01

D.t. d. N. 6 in ampull.

S. Dissolve the contents of the ampoule in 5 ml of isotonic sodium chloride solution. Use for inhalation 2-3 ml 1-2 times a day.

POTASSIUM IODIDE- prescribed for diseases of the respiratory tract as a mucolytic agent, but, in addition, used for diseases of the thyroid gland, etc. Potassium iodide as a mucolytic agent is used in the form of a 1-3% aqueous solution. Potassium iodide form: powder and eye drops (3% aqueous solution).

Example recipe for potassium iodide in Latin:

Rp.: Sol. Kalii iodidi 3% 200 ml

D. S. 1 tablespoon 3-5 times a day (with warm water).

SODIUM IODIDE- also has a mucolytic effect. Indications for use of sodium iodide and doses are the same as for potassium iodide. Sodium iodide release form: powder.

Example recipe for sodium iodide in Latin:

Rp.: Sol. Natrii iodidi 1% 150 ml

D.S. 1 tablespoon 3 times a day (with warm water).

Release form, composition and packaging

pharmachologic effect

Dosage

Crystalline trypsin is used intramuscularly, intrapleurally, in the form of aerosols and electrophoresis.

V/m: adults 0.005-0.01 g 1-2 times/day, children- 0.0025 g 1 time/day. For injection, dilute, immediately before use, 0.005 g of crystalline trypsin in 1-2 ml of 0.9% sodium chloride solution or 0.5-2% procaine solution. The course of treatment is 6-15 injections. Electrophoresis with trypsin is also used: per procedure, 10 mg of trypsin (dissolved in 15-20 ml of distilled water), administered from the negative pole.

Inhalation: 0.005-0.01 g in 2-3 ml of 0.9% sodium chloride solution through an inhaler or through a bronchoscope. After inhalation, rinse your mouth with warm water and rinse your nose.

Eye drops: 0.2-0.25% solution, which is prepared immediately before use, 3-4 times a day for 1-3 days.

Intrapleural: 1 time/day 10-20 mg of the drug, dissolved in 20-50 ml of 0.9% sodium chloride solution; after administration, frequent changes in body position are desirable; On the 2nd day after installation, a liquefied exudate is usually released.

Locally: in the form of a powder or solution, compresses are applied to dry or necrotic wounds (the solution is prepared immediately before use: 50 mg of trypsin is dissolved in 5 ml of sterile water or saline, when treating purulent wounds - in 5 ml of phosphate buffer solution). A three-layer woven fabric made of dialdehyde cellulose, impregnated with trypsin, is applied to the wound (after treatment) and secured with a bandage, left on the wound for no more than 24 hours. Before use, the fabric is moistened with distilled water or furatsilin solution. The time for complete cleansing of the wound from necrotic tissue and pus is 24-72 hours. If necessary, re-apply.

Drug interactions

Only during inhalation can bronchodilators and antibiotics be added to the solution.

Pregnancy and lactation

This is only possible if the expected benefit for the woman outweighs the possible risk for both the woman and the child.

Side effects

Maybe: allergic reactions, increased body temperature, tachycardia.

Local reactions: pain and hyperemia at the injection site with intramuscular injection. Inhalation of trypsin may cause irritation of the mucous membranes of the upper respiratory tract and hoarseness of the voice.

Storage conditions and periods

Store in a dry place, protected from light, at a temperature not exceeding 10°C, out of the reach of children. Shelf life - 3 years.

Indications

- bronchiectasis;

- lung abscesses;

- exudative pleurisy;

— postoperative atelectasis;

- pleural empyema;

— treatment of purulent wounds and burns;

— chronic purulent otitis;

— purulent sinusitis (including sinusitis);

- acute thrombophlebitis;

- acute and chronic odontogenic osteomyelitis;

— inflammatory-dystrophic forms of periodontal disease;

- acute irides and iridocyclitis;

- hemorrhages in the chamber of the eye and swelling of the periorbital tissues after injuries and operations;

- obstruction of the lacrimal ducts.

Contraindications

- heart failure;

— pulmonary emphysema with respiratory failure;

Trypsin crystalline- a preparation of animal origin, a proteolytic enzyme with a molecular weight of 21,000, obtained from the pancreas of cattle.

When applied topically, trypsin breaks down necrotic tissue and fibrinous formations, dilutes viscous secretions, blood clots and exudates.

Trypsin does not affect healthy tissues, since they contain a specific trypsin inhibitor and nonspecific trypsin inhibitors.

When administered intramuscularly, trypsin has an anti-inflammatory effect.

Indications for use

• For inflammatory diseases of the respiratory tract (tracheitis, bronchitis, bronchiectasis, postoperative pulmonary atelectasis) to liquefy and facilitate the removal of viscous secretions and exudates as an adjuvant in the form of inhalations.
• For exudative pleurisy and empyema, the drug is administered intrapleurally.
• In ophthalmic practice, crystalline trypsin is used in the form of baths and eye drops for iritis, iridocyclitis, hemorrhages in the anterior chamber of the eye, swelling of the periocular tissues (after operations and injuries).
• For thrombophlebitis, osteomyelitis, sinusitis, otitis, and inflammatory-dystrophic forms of periodontal disease, intramuscular injections of crystalline trypsin are made.

Rules of application

For inhalations dissolve 0.005–0.010 g of the drug in 2–3 ml of 0.9% isotonic sodium chloride solution and inhale using an inhalation device or enter through a bronchoscope or endotracheal tube. Bronchodilators (Isadrin) and antibiotics can be added to the trypsin solution.

Intrapleural the drug is administered once a day, 0.010–0.020 g, dissolved in 20–50 ml of isotonic sodium chloride solution.

For eye baths use a 0.20% solution, for eye drops- 0.25% solution (3-4 times a day for 2-3 days).

Intramuscularly trypsin is administered to adults 0.005 g 1–2 times a day, to children 0.0025 g 1 time a day. Immediately before use, 0.005 g of crystalline trypsin is dissolved in 1–2 ml of sterile isotonic sodium chloride solution. The injection is made deep intramuscularly into the upper outer quadrant of the gluteal muscle.

The use of trypsin is one of the methods of complex treatment of diseases and does not exclude the need to use other agents (anticoagulants, antibiotics).

Local application of trypsin is combined with intramuscular administration of the drug due to its general anti-inflammatory effect.

Side effects and contraindications for use

After intramuscular injection - slight pain and hyperemia at the injection site, after intrapleural and intramuscular injection - fever, tachycardia, as well as allergic reactions associated with the absorption of proteolysis products (enzymatic breakdown of proteins into peptides and amino acids) of necrotic tissues. Allergic reactions are reduced when antihistamines - Diphenhydramine, Diprazine, Pipolfen, etc. - are used before injections of trypsin.

After inhalation of the drug, irritation of the upper respiratory tract and hoarseness may be observed.

If local irritation occurs, stop using trypsin or reduce the concentration of the drug.

Contraindications

Cardiac decompensation, decompensated forms of pulmonary tuberculosis, pulmonary emphysema with respiratory failure, hemorrhagic diathesis, cirrhosis and acute liver dystrophy, infectious hepatitis, kidney damage, pancreatitis.

Trypsin must not be administered intravenously, injected directly into areas of inflammation and into bleeding cavities, or applied to the ulcerated surfaces of malignant tumors.

special instructions

Crystalline trypsin is approved for both local and parenteral use. Amorphous trypsin and a mixture of trypsin and chymotrypsin (chymopsin) are allowed only for topical use.

Composition and release form

Trypsin crystal recipe

They produce ampoules and hermetically sealed bottles containing 0.005 g and 0.010 g of crystalline trypsin.

Shelf life and storage conditions

Store in a dry, cool, (at a temperature not exceeding 10° C) place, protected from light.

The shelf life of crystalline trypsin is 3 years.

Properties

Trypsin crystalline(Trypsinum crystallisatum) is a porous mass or white powder, easily soluble in water and isotonic sodium chloride solution.