from the immune system: allergic reactions, acute anaphylaxis, Quincke's disease;

from skin and hypodermic cellulose: rash, itching, erythema, urticaria, dermatitis, alopecia; in the place of an injection the reddening and an itching are possible;

from a GIT: nausea, vomiting, abdominal pain, meteorism, dispeptic phenomena;

others: disturbances from organs of sight, a keratopathy, dizziness, peripheral hypostases.

Special instructions

Use during pregnancy or feeding by a breast. do not apply.

Children. Drug is not used.

Ability to influence speed of response at control of vehicles or work with other mechanisms. Does not influence.

Artiflex

As a result the glycosamine is received from an armor of mollusks, patients with an allergy on mollusks have to take Artiflex with caution.

Powder for oral administration contains sorbite. To the patients having the rare hereditary form of intolerance of fructose, it is not recommended to use medicament in this dosage form.

to the Patients who are on a diet with the controlled content of sodium needs to take into account presence of sodium in a dosage form for oral administration (151 mg in 1 daily dose on 1500 mg). it is reasonable to p to carry out by

In an initiation of treatment for patients with diabetes control of level of glucose to blood.

At patients with a heavy liver or renal failure medicament is used only under observation of the doctor.

Patient with phenylketonuria of Artiflex it is contraindicated as it contains aspartame.

Artiflex hondro

For achievement of stable clinical effect needs not less than 25 injections of drug. The effect remains within many months after the end of treatment. Apply repeated courses of treatment to prevention of aggravations. Increase in a dose under control of the doctor for patients with the excess body weight, ulcer of stomach or duodenum is recommended, at a concomitant use of diuretics and also in an initiation of treatment in need of prompt clinical reply.

At allergic reactions or hemorrhages treatment needs to be stopped.

Interaction

Artiflex

At the combined use noted strengthening of effect of coumarinic anticoagulants. In this regard it is reasonable to patients to carry out control of indicators of coagulation.

. Drug is compatible to NPVP and GKS.

Artiflex hondro

At simultaneous use with GKS and NPVP chondroitin sulfate can reduce the need for their use and also for anesthetics. Has synergy effect at simultaneous use with a glycosamine and other hondroprotektor. The efficiency of treatment increases at enrichment of a diet with vitamins A, With and salts of manganese, magnesium, copper, zinc and selenium. it is recommended to p to carry out by

At a concomitant use with acetylsalicylic acid or other anticoagulants or antiagregant control of blood clotting.

Overdose

Cases of overdose it was not noted p.

Artiflex

At accidental overdose are carried out by gastric lavage and symptomatic treatment.

Artiflex hondro

It is supposed p that when exceeding a daily dose possible increase in expressiveness of manifestations of side effect of drug. Symptomatic treatment.

to Store

in original packing at a temperature not above 25 °C.

Relevant information

Artiflex is complex medicament for treatment of pathology of the musculoskeletal system. for the purpose of the most effective use it is issued in two forms — topical administration cream and soluble powder for intake.

Main active ingredient Artiflex , powder for oral solution, is a glycosamine a hydrochloride.

Glyukozamin represents an aminosaccharide, that is on the chemical composition is to low-molecular derivatives of carbohydrates with inclusion of an amino group. It is synthesized from glucose and utilized in synthetic reactions of glikozaminoglikan and proteoglycans (Dahmer S., 2008). The glycosamine participates in many biochemical processes in an organism, including chondroitin synthesis. In modern pharmacology the glycosamine is presented in the form of two connections: glycosamine hydrochloride and glycosamine sulfate. A glycosamine sulfate demands additional components stabilizers, thus its purity makes 74%. The glycosamine of a hydrochloride has no sulphatic group that promotes achievement of 99% of purity. For this reason in recalculation on pure active ingredient of a glycosamine the hydrochloride in a dose of 1500 mg is equivalent to 2608 mg of a glycosamine to sulfate (Owens S., 2004) though the difference in bioavailability between these two forms is so insignificant that is not considered in clinical practice (Aghazadeh-Habashi A., 2011). The glycosamine is easily absorbed by a mucous membrane of a GIT and quickly is exposed to metabolism in a liver (effect of "the first passing"), is brought out of an organism with a stake or urine. Peak concentration of medicament in blood are observed during 8 h after intake. Elimination half-life of medicament rather long — 68 h. It is connected first of all with high extent of linking of a glycosamine with proteins — about 90% (Fox B.A., 2007). The bioavailability of a glycosamine is 26% (Barclay T.S., 1998).

As the glycosamine is a structural component of a cartilaginous matrix of joints, traditionally treatment of articulate pathology was associated with its additional receipt from the outside. Further researches of the biochemical principles of action of a glycosamine were conducted. The mechanism of its anti-inflammatory effect is based on inhibition of such pro-inflammatory mediators as NO, cyclooxygenase (TsOG)-2 and matriksny metalloproteinase. In addition, the same effect it is connected with a reduction of a nuclear factor κβ which is induced by interleukin-1 (Gouze J.N., 2006). In researches (Nakamura H., 2004) it is also shown that the glycosamine oppresses products of catabolic enzymes and markers of inflammation (for example prostaglandin E ₂ ) chondrocytes and synovial cells, stimulated interleukin-1.

Besides, the glycosamine is a predecessor of glikozaminoglikan (in particular hyaluronic acid and the keratansulfat) and proteoglycans which contain in an articulate cartilage, an intervertebral disk and synovial fluid (Henrotin Y., 2012). This property is used including in cosmetology — due to increase in synthesis of hyaluronic acid the glycosamine accelerates healing of wounds, moisturizes the skin and promotes reduction of quantity of wrinkles (Bissett D.L., 2006). Besides he acts as tyrosinase inhibitor, that is indirectly reduces products of melanin therefore allows to resist to development of a hyperpegmentation.

In researches (Hua J., 2005) it is proved that local use of a glycosamine considerably reduces sharpness of manifestations of adjuvant arthritis (experimental model of arthritis of any joint in an organism which on the pathogenesis is close to a pseudorheumatism).

according to the Kokranovsky overview (Towheed T., 2009), the glycosamine is choice medicament in treatment of an osteoarthrosis as promotes improvement of function of a joint, increase in volume of active and passive movements (da Camara C.C., 1998), to reduction of expressiveness of a pain syndrome and a hyperesthesia and also probably does not cause side effects. FDA carries a glycosamine to dietary additives, however this means is characterized by ability to reduce severity of pain, to slow down development of damages and even to recover a cartilage at patients with an osteoarthritis or other diseases of joints (Kirkham S.G., 2009). Researches in real time (Bruyère O., 2016) show that systematic use of a glycosamine for patients with an osteoarthritis distances need of additional intake of the anesthetizing drugs. It promotes restructuring not only cartilaginous and synovial tissue, but also and the sites of a bone subkhondralno located (Henrotin Y., 2012).

When choosing a therapeutic dose that for achievement of effect at system use (for example in the form of tablets or powder for solution preparation) the daily dose of a glycosamine has to make not less than 1500 mg. However the tablet containing 1.5 g of active ingredient can seem to the patient very big, and several tablets of the smaller size (and according to the smaller content of active ingredient) can make a subjective impression of overdose with the subsequent non-compliance with medical prescriptions by the patient (Aghazadeh-Habashi A., 2011). For this reason Artiflex is issued in the form of powder for solution preparation. One dose contains an equivalent of 1500 mg of a glycosamine. The portion of powder is dissolved in a glass of clear water and used in 1 times a day. For achievement of steady therapeutic effect it is necessary to take the medicament long courses — 4–12 weeks everyone. It is possible to repeat such courses 2–3 times a year, at the same time between courses it is necessary to maintain an interval lasting 2 months

Possible scope of medicaments on the basis of a glycosamine:

– a cervical spondylosis (Li Y., 2018);

– the osteochondrosis (localized or extended);

– an osteoarthritis (Matheson A.J., 2003), especially hip and knee joint;

– other inflammatory and degenerative diseases of the musculoskeletal system;

– after surgical interventions on joints, including plastic of meniscuses and total endoprosthesis replacement;

– thanks to the healing properties the glycosamine can be used as supportive application for treatment of inflammatory bowel diseases (for example Crohn's disease) (Bissett D.L., 2006);

– the glycosamine is applied in cosmetology to decrease in xanthopathy and reduction of quantity of wrinkles (Bissett D.L., 2006).

at use of a glycosamine inside in the form of powder for solution preparation. The maximum result in treatment of osteoarthrites requires an integrated approach which provides not only pharmacotherapy, but also remedial gymnastics, physical therapy, skeletal traction and also change of lifestyle (degrowth of a body, revision of a food allowance). It is possible to enhance therapeutic effect, in addition applying locally Artiflex cream . Cream is applied to the skin surrounding the affected joint, 2–3 times a day and rubbed within several minutes before full absorption. For achievement of steady effect the course of topical administration of Artiflex cream has to make not less than 2 weeks. Cream, except a hydrochloride glycosamine, contains the ibuprofen and allantoin enhancing its effect. Besides, for more effective penetration of medicament into fabrics the specialized carrier metilpirrolidon is used.

Metilpirrolidon represents medicament from group of ketopirrol. On the chemical structure it is close to β-lactams, but also is universal solvent. In medicine it is used as the inert universal carrier for transdermalny penetration, that is improves penetration into fabrics of substances which are applied to skin (Ameen D., 2017). Has moderate immunomodulatory activity that causes potentiation of medical effect at local inflammatory processes. This substance is non-toxic and not cancerogenic for the person (Schortt J., 2014), however if Artiflex in the form of cream to apply a long time and in large numbers, then a peculiar coloring of urine in yellow color can be observed.

Ibuprofen belongs to group of non-steroidal anti-inflammatory medicaments and is derivative propionic acid. Its anti-inflammatory and anesthetizing action is based on inhibition of synthesis of E and F prostaglandins, and action is carried out both on peripheral, and at the central level. This mechanism is implemented due to not selective blocking of TsOG-1 and TsOG-2 enzymes. Thanks to decrease in synthesis of prostaglandins the expressiveness of such manifestations of inflammatory process as hyperaemia and pain decreases. And the analgeziruyushchy effect is provided thanks to the difficult mechanism: prostaglandins increase irritability of sensitive nerve fibrils (Ershad M., 2019). Besides, the antiagregantny activity inherent in an ibuprofen allows to improve a local capillary blood stream.

Allantoin — anti-inflammatory medicament of plant or animal origin. For today most often it is received by extraction from plant roots a comfrey medicinal (Symphytum), better known in the people as zhivokost. This means is also known knitting and anesthetizing, antioxidant and cytoprotective (da Silva D.M., 2018) properties. The anesthetizing effect of allantoin is provided due to influence on peripheral opioid receptors (Florentino I.F., 2016). Besides, such effects as decrease in irritation, keratolytic activity, stimulation of a cellular mitosis are inherent to allantoin (Araujo A., 2010).

As the glycosamine is to low-molecular derivatives of carbohydrates, probably it can join in processes of carbohydrate metabolism and influence glucose level in blood. In experiments on animals it is proved that the glycosamine joins in processes of exchange of glucose by biosynthesis a hexosemine (Dostrovsky N.R., 2011). Besides, results of pilot studies on animals (Kajinuma H., 1975) show increase in blood of level of an immunoreactive glucagon (which is kontrinsulyarny hormone) at introduction to an organism of an exogenous glycosamine.

Thus, use of a glycosamine demands care from patients with diabetes (Stumph J.L., 2006). In such cases it is recommended to carry out monitoring of level of glucose and glikozilirovanny hemoglobin to blood and also dose adjustment of insulin or other glucose-lowering drugs.

Besides, as the glycosamine in modern pharmaceutical industry is made by hydrolysis of exoskeletons of Crustacea, it is necessary to appoint with care it to patients with food allergy to fish and mollusks (Dahmer S., 2008).

single messages about potentiation by a glycosamine of effect of warfarin (Dahmer S., 2008) therefore patients who receive anticoagulants need control of parameters of a coagulant system of blood Exist.

As high doses of a metilpirrolidon are characterized by teratogenic action (Shortt J., 2014), use of Artiflex cream during pregnancy contraindicated.

Thanks to local use of an ibuprofen as a part of Artiflex cream . However it is necessary to remember undesirable effects, characteristic of all non-steroidal anti-inflammatory drugs: gastropatichesky manifestations (pain in a stomach, nausea, heartburn), decrease in blood clotting and also nephrotoxicity.

As the glycosamine is non-toxic substance, is not recorded cases of overdose of the medicament Artiflex . But patients should mean that short-term exceeding the recommended dose will not lead to strengthening of therapeutic effect. It is connected with the fact that regeneration of cartilaginous and synovial tissue happens slowly — within several months.

Degenerative dystrophic diseases of the musculoskeletal system are one of the leading medico-social problems in the modern world. The osteoarthritis in the general population affects about 10% of men and 60 years (OARSI, 2016) are aged more senior than 18% of women, and 80% from them have the motive restrictions significantly worsening quality of life. It should be noted that the incidence of an osteoarthritis steadily increases in connection with aging of the population and growth of prevalence of obesity (ESCEO, 2019). Search of optimum strategy of treatment of an osteoarthritis includes reduction of expressiveness of symptomatology and, eventually, delay of progressing of pathology.

Use of medicaments on the basis of a glycosamine is of interest in connection with their effects directed to maintenance of normal structure of a cartilage and function of joints along with relief of symptoms of a disease. Two forms of the medicament Artiflex allow to make a convenient therapeutic combination which provides both system, and local impact on pathological process in musculoskeletal system diseases. And the lack of risk of overdose and a minimum of side effects do Artiflex perspective means for prolonged use.