CYNOPLUS (LEVOTHYROXINE SODIUM AND LIOTHYRONINE LIOTHYRONINE) 120/30MCG 50TAB
In stock: 817 units
THERAPEUTIC INDICATIONS: CYNOPLUS * is indicated for the treatment of hypothyroidism when there is diminished or absent thyroid function, caused by antithyroid agents, radiation therapy, primary atrophy, partial or total removal of the gland or functional alterations of the same. CYNOPLUS * is effective in the treatment of hypothyroidism of any etiology. CYNOPLUS use * as replacement therapy in simple goiter (nontoxic) produces results in a rapid reduction in the size of the thyroid gland.
CYNOPLUS * has proved useful in the maintenance treatment of hypothyroidism.
Pharmacokinetics in Humans: CYNOPLUS * contains L-triiodothyronine or liothyronine (T3) and L-tetraiodothyronine or levothyroxine (T4), synthetic forms of human thyroid hormones in a balanced proportion by weight of 1 to 4 respectively, and the hormone that each provides approximately half of the total of therapeutic activity. The proportion of active hormones that occur in CYNOPLUS * reproduces the clinical and biochemical effects of desiccated thyroid and endogenous secretion of the thyroid. CYNOPLUS * is prepared with standard synthetic hormones, so that its constant composition is safe. 95% of the liothyronine is absorbed in the gastrointestinal tract and easily reaches the tissues. Levothyroxine has an absorption in the gastrointestinal tract varies from 50 to 80%.
The maximum effect of liothyronine is apparent between 24 and 72 hours after ingestion and lasts for more than 72 hours. Levothyroxine reaches its full effect between 1 and 3 weeks, and the effect lasts for a similar period after stopping the drug.
The plasma half-life of liothyronine and levothyroxine is 1-2 days and 6-7 days respectively. Levothyroxine binds more strongly to plasma proteins liothyronine, so it has a slower onset and longer than liothyronine. In peripheral tissues levothyroxine is converted to triiodothyronine, a situation that is diminished when the hormones are associated in the same formulation, so that the hormones in CYNOPLUS * complement its effects.
CONTRAINDICATIONS: Thyrotoxicosis, unstable angina, acute myocardial infarction. CYNOPLUS * is contraindicated in patients with adrenal insufficiency irreversible, increasing demand for adrenocortical hormones and may cause an acute adrenal crisis.
PRECAUTIONS: CYNOPLUS * should be administered with caution in patients with cardiovascular diseases, including hypertension. Any cardiovascular event require a reduction in dose. Care must be taken in patients with coronary artery disease, since the possibility of cardiac arrhythmias may be greater in patients treated with thyroid hormones.
In patients in whom hypothyroidism secondary to hypopituitarism, probably coexisting adrenal insufficiency. When this happens, the latter should be corrected by corticosteroid prior to administration of thyroid hormones.
Use in Pregnancy and Lactation: Thyroid hormones do not readily cross the placental barrier. Clinical experience indicates that CYNOPLUS * no adverse effects on the fetus when administered during pregnancy. Based on this knowledge, thyroid replacement therapy to hypothyroid women should not be discontinued during pregnancy.
Thyroid hormones are excreted in small amounts in breast milk and its use has not been associated with serious adverse reactions, however, caution should be exercised when thyroid hormones are administered to nursing women.
SIDE EFFECTS: Excessive doses of thyroid hormones can lead to signs and symptoms of hyper-excitability, weight loss, palpitations, arrhythmias, tachycardia, diarrhea, sweating, tremor, headache and heat intolerance. The effects do not occur immediately and the symptoms may appear 1 to 2 weeks after the initial dose.
The medication in these cases should be discontinued until the symptoms disappear, to restart one or two days later with a smaller dose.
DRUG INTERACTIONS AND OTHER GENDER: Administration of CYNOPLUS * can produce drug interactions with various drugs. Increases the anticoagulant effects of warfarin and acenocoumarol. May cause increased requirements for insulin or oral hypoglycemic agents in diabetic patients. Cholestyramine hinders the absorption of thyroid hormones. The use of estrogen or estrogen oral contraceptives may decrease the free levothyroxine and thereby increase thyroid hormone requirements. The use of thyroid hormones with imipramine and other tricyclic antidepressants may increase the antidepressant activity, as well as the activity of thyroid hormones.
Thyroid hormones may potentiate the toxic effects of digitalis, also thyroid replacement therapy increases the metabolic rate, which may require increased doses of digitalis. It has been reported that concomitant administration of thyroid hormones and ketamine, can cause hypertension and tachycardia. Thyroid hormones increase the adrenergic effect of catecholamines such as epinephrine and norepinephrine.
CHANGES IN RESULTS OF LABORATORY TESTS: None reported with this association in Cynoplus *. When clinical and laboratory evidence show hypothyroidism and is being administered an appropriate dose, it means the patient does not follow instructions, poor absorption or excessive fecal loss. Intracellular drug resistance is very rare.
PRECAUTIONS IN RELATION TO EFFECTS OF CARCINOGENESIS, MUTAGENESIS, Impairment of Fertility: No studies have been conducted in animals over time to evaluate the potential carcinogenic, mutagenic, teratogenic or effects on fertility.
DOSAGE AND ADMINISTRATION: Oral.
CYNOPLUS * is generally administered as a single dose, preferably before breakfast.
We recommend starting with half a tablet daily for CYNOPLUS * 1 to 2 weeks. It may subsequently be increased to one tablet daily for 1 to 2 weeks. According to the clinical and laboratory data, the dose may be increased or decreased, remembering that the final dose needed varies from patient to patient individually.
In children the dose should be increased every 2 weeks. In elderly patients, CYNOPLUS * should be administered with caution since it is common to the hidden presence of cardiovascular disease. In these cases starting treatment with low dose and if symptoms develop or worsen existing dose should be decreased.
REPRESENTATIONS AND MANAGEMENT Overdosage: If overdose may present symptoms such as headache, irritability, nervousness, excessive sweating, tachycardia, increased bowel motility. It can aggravate the cases of angina pectoris or congestive heart failure and may develop a crash box. Overdose symptoms may occur over that suggested a thyroid storm, and produce manifestations of hyperthyroidism. In either case should be discontinued for several days and start it again, but with a lower dose. If overdose is acute, avoid the absorption of the drug with the induction of vomiting and gastric lavage. The treatment in cases of shock is supportive care and treatment should be considered for unrecognized adrenal insufficiency. To address the increased sympathetic activity may be included antiadrenergic drugs such as propranolol.