Instruction for use: Relanium

Dosage form: Solution for intravenous and intramuscular injection

Active substance: Diazepam*

ATX

N05BA01 Diazepam

Pharmacological groups:

Anxiolytics

Antiepileptic drugs

The nosological classification (ICD-10)

A35 Other forms of tetanus: Tetanus local; Tetanus; Muscle spasms in tetanus; Clostridiosis wound; Tetanus; Hydrophobia (hydrophobia)

F10.4 Abstinent state with delirium: Alcoholic delirium; White fever alcoholic; Delirium; Delirious condition with alcoholism and drug addiction

F41.9 Anxiety disorder, unspecified: Neurotic disorders with anxiety syndrome; Severe anxiety; Neuro-like symptomatology; Neuro-like disorders; Neuro-like conditions; Neuroses with anxiety symptoms; Neuroses with a sense of anxiety; Acute situational and stress anxiety; Acute attack of anxiety; Severe Anxiety; Situational Anxiety Disorder; State of anxiety; Anxious and delusional component; Alarming state; Anxiety; Anxiety Disorders; Anxiety syndrome; Sense of anxiety; Alarm conditions; Chronic neurotic anxiety; Susto; Psychopathy with a predominance of anxiety and anxiety; Anxiety disorders in neurotic and neurosis-like states; Anxious neuroses; Anxious and delusional state; Acute situational stress alarm; Depressed mood with elements of anxiety

F48 Other neurotic disorders: Neurosis; Neurological diseases; Neurotic disorders; Neurotic condition; Psychoneurosis; Anxious-Neurotic Conditions; Chronic neurotic disorders; Emotional reactive disorders

G24.8.0 * Hypertonus muscular: Increased muscle tone; Increased muscle tone; Spasm of striated muscle due to organic diseases of the central nervous system; Spasticity of muscles; Painful spasms of muscles in diseases of the spine; Increased skeletal muscle tone

G40 Epilepsy: Atypical convulsive seizures; Atonic seizures; Great seizures; Large convulsive seizures; Generalized Absences; Jackson epilepsy; Diffuse large seizure; Diencephalic epilepsy; Cortical and non-convulsive forms of epilepsy; Primary-generalized seizures; Primary-generalized tonic-clonic seizure; Pycnoleptic absence; Repeated epileptic seizures; Attack generalized; Seizure fit; Refractory epilepsy in children; Complicated convulsive seizures; Mixed seizures; Mixed forms of epilepsy; Convulsive condition; Convulsive seizures; Convulsions; Convulsive forms of epilepsy; Epilepsy grand mal; Epileptic seizures; Great seizures in children

G45 Transient transient cerebral ischemic attacks [attacks] and related syndromes: Ischemic neurological disorders; Acute cerebrovascular insufficiency; Repeated transient cerebral ischemia; Transient ischemic attack; Transient ischemic condition; Transient ischemic attack; Transient ischemic attack; transient ischemia; Transient cerebral ischemic attack; Transient cerebral ischemia; Transient ischemic attacks; Chronic cerebral ischemia; Drop attacks; Transient ischemic attacks; Transient ischemic cerebrovascular accident; Ischemic brain damage; Subclavian steal syndrome

I10 Essential (primary) hypertension: hypertension; Arterial hypertension; Arterial hypertension crisis course; Essential Hypertension; Essential hypertension; Essential hypertension; Essential hypertension; Essential hypertension; Primary hypertension; Arterial hypertension, complications of diabetes; The sudden increase in blood pressure; Hypertensive disorders of blood circulation; hypertensive condition; hypertensive crises; arterial Hypertension; malignant Hypertension; Hypertonic disease; hypertensive crises; accelerated hypertension; malignant hypertension; The aggravation of hypertensive disease; Transient hypertension; Isolated systolic hypertension

I15 Secondary hypertension: Arterial hypertension, complications of diabetes; hypertension; The sudden increase in blood pressure; Hypertensive disorders of blood circulation; hypertensive condition; hypertensive crises; hypertension; arterial Hypertension; malignant Hypertension; hypertensive crises; accelerated hypertension; malignant hypertension; The aggravation of hypertensive disease; Transient hypertension; hypertension; Arterial hypertension; Arterial hypertension crisis course; renovascular hypertension; Hypertension symptomatic; Renal hypertension; Renovascular hypertension; renovascular hypertension; Symptomatic hypertension

I73.8 Other specified peripheral vascular disease: Syndrome of intermittent claudication; endarteritis obliterans; acrocyanosis; vasoconstriction; occlusive disease; Intermittent claudication; Disorders of vascular innervation; Spasm of peripheral arteries; Arterial angiopathy; Venous insufficiency and its complications; Spasm of peripheral vessels; The spasm of coronary vessels; endarteritis; cooling stop; Occlusal disorders of peripheral circulation; Peripheral vascular occlusion

N94.6 Unspecified Dysmenorrhea: Pain in menstruation; Functional disorders of the menstrual cycle; Functional disorders of the menstrual cycle; Menstrual cramps; Menstruation disorder; Pain during menstruation; Painful irregular menstruation; Algodismenorea; Algomenorea; Pain syndrome with smooth muscle spasms; Pain syndrome with smooth muscle spasms (renal and biliary colic, intestinal spasm, dysmenorrhea); Pain syndrome with spasms of smooth muscles of internal organs (renal and biliary colic, intestinal spasm, dysmenorrhea); Disalgomenorrhea; Dysmenorrhea; Dysmenorrhea (essential) (exfoliative); Menstrual disorder; Menstruation painful; Metrorrhagia; Violation of the menstrual cycle; Menstrual irregularities; Prolactin-dependent disorder of the menstrual cycle; Prolactin-dependent disorder of menstrual function; Pain syndrome with spasms of smooth muscles of internal organs; Spastic dysmenorrhea; Primary disalgomenorrhea

N95.1 menopausal and menopausal status of women: Atrophy of the mucosa of the lower genital tract, caused by estrogen deficiency; Vaginal dryness; Autonomic dysfunction in women; gipoestrogeniya state; Deficiency of estrogen in menopausal women; Degenerative changes of the mucous membrane in the menopause; Natural menopause; an intact uterus; climacteric; Menopause women; Menopause in women; menopausal depression; Climacteric ovarian dysfunction; Menopause; Climacteric neurosis; Menopause; Menopausal symptoms complicated psychovegetative; Climacteric syndrome; Climacteric vegetative disorders; Climacteric psychosomatic disorder; menopausal disorders; Menopausal disorders in women; menopausal condition; Climacteric vascular disorders; Menopause; Menopausal vasomotor symptoms; menopausal period; Lack of estrogen; Feeling the heat; Pathological menopause; perimenopause; menopause; postmenopausal; Premature menopause; premenopauznom period; tides; hot flashes; flushing in the Meno and postmenopausal; Hot flashes / hot flashes in menopause; Heart attack during menopause; Early menopause in women; Disorders of menopause; climacteric syndrome; Vascular complications of menopause; Physiological menopause; Estrogendefitsitnye state; premature Menopause

R25.2 Cramp and spasm: Muscle spasms in tetanus; Pain syndrome with smooth muscle spasms; Pain syndrome with smooth muscle spasms (renal and biliary colic, intestinal spasm, dysmenorrhea); Pain syndrome with spasms of smooth muscles of internal organs; Pain syndrome with spasms of smooth muscles of internal organs (renal and biliary colic, intestinal spasm, dysmenorrhea); Painful muscular spasm; Mimic spasms; Muscular spasticity; Muscle spasms; Muscular spasms of central origin; Muscular spasticity; Muscle spasm; Neurological contractures with spasms; Night cramps in the extremities; Nocturnal cramps in the legs; Night cramps calf muscles; Symptomatic convulsive state; Vesta Syndrome; Spasm of smooth muscles; Spasm of smooth vascular musculature; Spasm of muscles; Spasm of striated muscle due to organic diseases of the central nervous system; Skeletal muscle spasms; Spasms of smooth muscles of internal organs; Skeletal Muscle Cramps; Spastic states of striated musculature; Spasmodic pain syndrome; The spastic condition of smooth muscles; Spasticity of skeletal musculature; Muscle cramp; Convulsions; Cramps of the calf muscles; Convulsions of central origin; Convulsive condition; Convulsive Syndrome; Convulsive status in children; Tonic convulsions; Cerebral spasmodic syndrome; clasp knife phenomenon

R45.1 Anxiety and agitation: Agitation; Anxiety; Explosive excitability; Internal stimulation; Excitability; Excitation; Excitation acute; Psychomotor agitation; Hyperexcitability; Motor excitement; Cessation of psychomotor agitation; Nervous excitement; Restlessness; Night trouble; Acute stage of schizophrenia with excitation; Acute mental agitation; Paroxysm of excitation; Overexcitation; Increased excitability; Increased nervous excitability; Increased emotional and cardiac excitability; Increased agitation; Mental arousal; Psychomotor agitation; Psychomotor agitation in psychoses; Psychomotor agitation of an epileptic nature; Psychomotor paroxysm; Psychomotor fit; Symptoms of excitation; Symptoms of psychomotor agitation; The state of agitation; A state of anxiety; Excitation status; A state of heightened concern; The state of psychomotor agitation; Conditions of anxiety; Excitation conditions; The state of excitement in somatic diseases; Excitation level; Feelings of anxiety; Emotional arousal

Z100 * CLASS XXII Surgical practice: Abdominal surgery; adenomectomy; Amputation; Coronary angioplasty; Angioplasty of the carotid arteries; Antiseptic skin treatment for wounds; Antiseptic Hand; Appendectomy; atherectomy; Balloon coronary angioplasty; Vaginal hysterectomy; The coronary bypass; Interventions in the vagina and cervix; Interventions on the bladder; Intervention in the mouth; Restoration and reconstructive surgery; Hand hygiene of medical personnel; Gynecologic surgery; Gynecological intervention; Gynecological surgery; Hypovolemic shock during operations; Disinfection of purulent wounds; Disinfection of wounds edges; Diagnostic intervention; Diagnostic procedures; Cervical Diathermocoagulation; Long-surgery; Replacing the fistula catheters; Infection in orthopedic surgery; Artificial heart valve; cystectomy; Short-term outpatient surgery; Short-term operation; Short surgical procedures; Krikotireotomiya; Blood loss during surgery; Bleeding during surgery and in the postoperative period; Kuldotsentez; laser photocoagulation; laser coagulation; retinal laser coagulation; Laparoscopy; Laparoscopy in Gynecology; CSF fistula; Small gynecological operations; Small surgical procedures; Mastectomy and subsequent plastic; mediastinotomy; Microsurgical operations on the ear; Mukogingivalnye operation; suturing; Minor surgery; neurosurgical operation; Immobilization of the eyeball in ophthalmic surgery; testectomy; pancreatectomy; Perikardektomiya; The period of rehabilitation after surgery; The period of convalescence after surgery; Percutaneous transluminal coronary angioplasty; Pleural thoracentesis; Pneumonia postoperative and posttraumatic; Preparation for surgical procedures; Preparation for surgery; Preparation of the surgeon's hands before surgery; Preparation of the colon for surgical procedures; Postoperative aspiration pneumonia in neurosurgical and thoracic surgery; Postoperative nausea; Postoperative bleeding; postoperative granuloma; postoperative shock; The early postoperative period; myocardial revascularization; Radiectomy; gastric Resection; bowel resection; uterine Resection; liver Resection; enterectomy; Resection of part of the stomach; Reocclusion of the operated vessel; Bonding tissues during surgical procedures; Removal of sutures; Condition after eye surgery; Condition after surgery; Condition after surgery in the nasal cavity; Condition after gastrectomy; Status after resection of the small intestine; Condition after tonsillectomy; Condition after removal of the duodenum; Condition after phlebectomy; Vascular surgery; Splenectomy; Sterilization of surgical instruments; Sterilization of surgical instruments; sternotomy; Dental surgery; Dental intervention in periodontal tissues; strumectomy; Tonsillectomy; Thoracic surgery; Thoracic surgery; total gastrectomy; Transdermal intravascular coronary angioplasty; Transurethral resection; Turbinektomiya; Removal of a tooth; cataract surgery; Removal of cysts; tonsillectomy; Removal of fibroids; Removing the mobile primary teeth; Removing polyps; Removing broken tooth; Removal of the uterus body; Removal of sutures; Fistula likvoroprovodyaschih ways; Frontoetmoidogaymorotomiya; Surgical infection; Surgical treatment of chronic limb ulcers; Surgery; The surgery in the anal area; The surgery on the colon; Surgical practice; The surgical procedure; Surgical interventions; Surgery on the gastrointestinal tract; Surgical procedures on the urinary tract; Surgical procedures on the urinary system; Surgical intervention of the genitourinary system; Surgical procedures on the heart; Surgical manipulation; surgery; Surgery on the veins; Surgical intervention; Vascular surgery; Surgical treatment of thrombosis; Surgery; cholecystectomy; Partial gastric resection; hysterectomy; Percutaneous transluminal coronary angioplasty; Percutaneous transluminal angioplasty; Coronary artery bypass; tooth Extirpation; Extirpation of milk teeth; pulpectomy; pulsative cardiopulmonary bypass; tooth Extraction; teeth Extraction; cataract extraction; Electrocoagulation; endourological intervention; episiotomy; Etmoidotomiya; Complications after tooth extraction

Composition and release form

Solution for intravenous and IM administration 1 ml

Diazepam 5 mg

Auxiliary substances: propylene glycol; Ethanol; Benzyl alcohol; Sodium benzoate; Acetic acid; water for injections

In ampoules of 2 ml; In a box of 5, 10 or 50 ampoules.

Description of dosage form

Transparent colorless or yellow-green liquid.

Pharmachologic effect

Mode of action - anticonvulsant, miorelaxing, tranquilizing, sleeping, sedative.

Pharmacodynamics

Has a depressing effect on the central nervous system, which is realized mainly in the thalamus, hypothalamus and limbic system. Increases the inhibitory effect of GABA, which is one of the main mediators of pre- and postsynaptic inhibition of the transmission of nerve impulses in the central nervous system.

Stimulates the benzodiazepine receptors of the supramolecular GABA-benzodiazepine-chloronophore receptor complex, causes a decrease in the excitability of subcortical structures of the brain, inhibition of polysynaptic spinal reflexes.

Pharmacokinetics

After the IM administration, diazepam is absorbed incompletely and unevenly (depending on the site of administration); When introduced into the deltoid muscle - absorption is rapid and complete. Bioavailability is 90%. Cmax in the blood plasma after the / m administration is achieved after 0.5-1.5 h from the time of administration and within 0.25 h with IV introduction. Equilibrium concentrations are achieved with a constant intake after 1-2 weeks.

Diazepam and its metabolites pass through the BBB and placental barriers, are found in breast milk in concentrations corresponding to 1/10 of the plasma concentration. Binding to proteins - 98%.

Metabolised in the liver with the participation of the enzyme system CYP2C19, CYP3A4, CYP3A5, CYP3A7 to pharmacologically very active desmethyldiazepam and less active temazepam and oxazepam.

It is excreted by the kidneys - 70% (in the form of glucuronides), in unchanged form - 1-2% and less than 10% - with calves. T1 / 2 desmethyldiazepam - 30-100 h, temazepam - 9.5-12.4 h and oxazepam - 5-15 h. T1 / 2 may be prolonged in newborns (up to 30 h), elderly and senile patients (up to 100 h ) And in patients with hepatic-renal insufficiency (up to 4 days).

With repeated use, the accumulation of diazepam and its active metabolites is significant. Refers to benzodiazepines with long T1 / 2, excretion after cessation of treatment is slow, tk. Metabolites persist in the blood for several days or even weeks.

Indications for the Relanium

Neurotic and neurosis-like disorders with anxiety manifestation (treatment).

Coping of psychomotor agitation associated with anxiety.

Coping of epileptic seizures and convulsive conditions of various etiologies.

Conditions accompanied by increased muscle tone (tetanus, acute disorders of cerebral circulation, etc.).

Cupping of withdrawal syndrome and delirium in alcoholism.

For premedication and ataralgesia in combination with analgesics and other neurotropic drugs for various diagnostic procedures, in surgical and obstetrical practice.

In the complex therapy of essential hypertension, accompanied by anxiety, increased excitability, hypertensive crisis, vasospasms, climacteric and menstrual disorders.

Contraindications

Hypersensitivity to derivatives of benzodiazepine, severe myasthenia, coma, shock, angle-closure glaucoma, the phenomenon depending history (narcotics, alcohol, except for the treatment of alcohol withdrawal syndrome and delirium), sleep apnea, alcohol intoxication varying severity, acute intoxication drugs, have a depressing effect on the CNS (narcotics, hypnotics and psychotropic drugs), severe COPD (risk of progression of respiratory failure), acute respiratory insufficient awn infancy (up to 30 days), pregnancy (especially I and III trimester), breastfeeding.

With care - petsal (petit mal) or Lennox-Gastaut syndrome (with iv introduction can provoke the development of tonic epileptic status); epilepsy or seizures in history (the beginning of treatment with diazepam or abrupt withdrawal can accelerate the development of seizures or status epilepticus), liver and / or renal failure, cerebral or spinal ataxia, hyperkinesia, tendency to abuse of psychotropic drugs, organic brain disease (possible paradoxical Reactions), hypoproteinemia, old age, depression (see "Special instructions").

Application in pregnancy and breastfeeding

Contraindicated in pregnancy (I and III trimesters). At the time of treatment should stop breastfeeding.

Side effects

From the nervous system: especially in elderly patients - drowsiness, dizziness, increased fatigue; Violation of concentration of attention; Ataxia, disorientation, dulling of emotions, slowing of mental and motor reactions, anterograde amnesia (develops more often than with other benzodiazepines); Rarely - headache, euphoria, depression, tremor, catalepsy, confusion, dystonic extrapyramidal reactions (uncontrolled body movements), asthenia, muscle weakness, hyporeflexia, dysarthria; Extremely rare - paradoxical reactions (aggressive outbreaks, psychomotor agitation, fear, suicidal tendencies, muscle spasm, hallucinations, anxiety, sleep disturbances).

From the hemopoiesis: leukopenia, neutropenia, agranutcytosis (chills, hyperthermia, sore throat, unusual fatigue or weakness), anemia, thrombocytopenia.

On the part of the intestine: dry mouth or hypersalivation, heartburn, hiccough, gastralgia, nausea, vomiting, decreased appetite, constipation; Violations of liver function, increased activity of hepatic transaminases and alkaline phosphatase, jaundice.

From the cardiovascular system: palpitation, tachycardia, lowering blood pressure.

On the part of the genitourinary system: urinary incontinence or retention, impaired renal function, increased or decreased libido, dysmenorrhea.

Allergic reactions: skin rash, itching.

Influence on the fetus: teratogenicity (especially in the first trimester), CNS depression, respiratory failure and suppression of the sucking reflex in newborns whose mothers used the drug.

Local reactions: at the injection site - phlebitis or venous thrombosis (redness, swelling and pain at the injection site).

Other: addiction, drug dependence, rarely - respiratory center depression, visual impairment (diplopia), bulimia, weight loss.

With a sharp decrease in dose and discontinuation of reception - withdrawal syndrome (increased irritability, headache, anxiety, fear, psychomotor agitation, sleep disturbances, dysphoria, spasm of smooth muscles of the internal organs and skeletal muscles, depersonalization, increased sweating, depression, nausea, vomiting , Tremor, perception disorders, including hyperacusis, paresthesia, photophobia, tachycardia, convulsions, hallucinations, rarely - psychotic disorders). When used in obstetrics - in newborns - muscular hypotension, hypothermia, dyspnea.

Interaction

MAO inhibitors, respiratory analeptics and psychostimulants reduce the activity of Relanium ®.

With hypnotics, sedatives, narcotic analgesics, other tranquilizers, benzodiazepine derivatives, muscle relaxants, general anesthetics, antidepressants, neuroleptics, alcohol - a sharp increase in the inhibitory effect on the central nervous system.

With cimetidine, disulfiram, erythromycin, fluoxetine, as well as with oral contraceptives and estrogen-containing drugs that competitively inhibit liver metabolism (oxidation processes) - it is possible to slow the metabolism of Relanium ® and increase its plasma concentration.

Isoniazid, ketoconazole and metoprolol - slowing metabolism of Relanium ® and increasing its plasma concentration.

Propranolol and valproic acid increase the level of Relanium ® in blood plasma.

Rifampicin can enhance the metabolism of Relanium ® and as a result - reduce its concentration in the blood plasma.

Inducers of microsomal liver enzymes reduce efficacy.

Hypotensive drugs can increase the severity of blood pressure lowering.

Clozapine - may increase respiratory depression.

When used simultaneously with cardiac glycosides, it is possible to increase the concentration of the latter in the serum and the development of digitalis intoxication (as a result of competitive binding to plasma proteins).

Reduces the effectiveness of levodopa in patients with Parkinsonism.

Omeprazole prolongs the diazepam excretion time.

It is possible to increase the toxicity of zidovudine.

Theophylline (in low doses) can reduce the sedation effect of Relanium ®.

Pharmaceutically incompatible in one syringe with other drugs.

Premedication with diazepam reduces the dose of fentanyl required for an introductory general anesthetic, and shortens the time of onset of general anesthesia.

Dosing and Administration

IV, slowly, into a large vein, at a rate of 5 mg (1 ml) / min; IM.

Duplication of psychomotor agitation associated with anxiety - 10-20 mg, if necessary, repeat the dose in 3-4 hours.

In tetanus: IM or IV (jet or drip) - 10-20 mg, every 2-8 hours.

With epileptic status - 10-20 mg, if necessary, repeat the dose after 3-4 hours.

For removal of spasm of skeletal muscles: IM - 10 mg for 1-2 hours before the operation.

In obstetrics: IM - for 10-20 mg with the opening of the cervix for 2-3 fingers.

Neonatal (after the 5th week of life): IV slow - at 0.1-0.3 mg / kg to a maximum dose of 5 mg, optionally, repeat injections after 2-4 hours (depending on the clinical symptoms).

Children from 5 years and older: IV slowly - 1 mg every 2-5 minutes to a maximum dose of 10 mg; If necessary, the administration is repeated after 2-4 h.

Overdose

Symptoms: drowsiness, depression of consciousness of varying severity, paradoxical stimulation, decreased reflexes to areflexia, reduced response to painful stimuli, dysarthria, ataxia, blurred vision (nystagmus), tremor, bradycardia, decrease in blood pressure, collapse, cardiac depression, and respiratory (up to Apnea) of activity, coma.

Treatment: gastric lavage, forced diuresis, the appointment of activated charcoal, symptomatic therapy (maintenance of respiration and blood pressure), artificial ventilation. Flumazenil is used as a specific antagonist in hospital settings. Hemodialysis is ineffective.

Flumazenil is not indicated in patients with epilepsy treated with benzodiazepines. In such patients flumazenil can cause the development of epileptic seizures.

Precautionary measures

With the appointment of diazepam in severe depression requires special care - it is possible to use the drug for the implementation of suicidal intentions.

It is not recommended to carry out continuous intravenous infusion - it is possible to form sediment and adsorption of the preparation with PVC materials of infusion cylinders and tubes.

With renal / hepatic insufficiency and long-term treatment, control over the pattern of peripheral blood and liver enzymes is necessary.

The risk of forming drug dependence increases with the use of large doses, a significant duration of treatment, in patients who previously abused alcohol or drugs. Without special instructions should not be used for a long time.

Unacceptably abrupt cessation of use due to the risk of "cancellation" syndrome, but due to the slow elimination of diazepam from the body of its manifestations are less pronounced than that of other benzodiazepines.

If you have any patients with such unusual reactions, as increased aggressiveness, agitation, anxiety, anxiety, suicidal thoughts, hallucinations, increased muscle cramps, difficult to fall asleep, sleep surface - treatment should be discontinued.

The initiation of treatment with diazepam or its abrupt withdrawal in epileptic patients or with epileptic seizures in an anamnesis can accelerate the development of seizures or epileptic status.

Has a toxic effect on the fetus and increases the risk of congenital malformations when applied in the first trimester of pregnancy. Taking therapeutic doses at a later time of pregnancy can cause oppression of the fetal CNS. Continuous use during pregnancy can lead to physical dependence - there may be symptoms of "cancellation" in a newborn.

Children, especially at a young age, are very sensitive to the CNS depressing action of benzodiazepines.

Newborns is not recommended for formulations containing benzyl alcohol - may develop a toxic syndrome manifested metabolic acidosis, central nervous system depression, difficulty breathing, renal failure, hypotension, and possibly seizures and intracranial hemorrhage.

Use of at doses higher than 30 mg within 15 hours prior to delivery or during delivery may cause neonatal respiratory depression (up apnea), decreased muscle tone and blood pressure, hypothermia, weak act of sucking (the so-called "floppy baby syndrome").

Older patients Relanium ® should be administered with extreme caution and do not exceed the recommended dose.

Contraindicated the introduction of Relanium ® in the arterial channel because of the possible development of gangrene.

Careful evaluation should be made of the risk-benefit relationship for prescribing to pregnant women, as well as for patients with liver and kidney disease.

Special instructions

When using the drug should refrain from work that requires a quick psycho-emotional reaction (driving, working with mechanisms).

During treatment with Relaniumum, alcohol is prohibited.

Storage conditions of the drug Relanium

In the dark place at a temperature of 15-25 ° C.

Keep out of the reach of children.

Shelf life of the drug Relanium

5 years.

Do not use after the expiry date printed on the package.