Complete instructions for the use of retarpen, a list of analogues, reviews and prices. Retarpen: instructions for using Retarpen when you can take alcohol
The package contains 5 bottles of 1.2 IU. The active ingredient is Benzathine benzylpenicillin. Manufacturer: Pfizer (US license) India. Our experts will help you find the nearest pharmacy in Moscow, St. Petersburg, Yekaterinburg, Krasnoyarsk, Novosibirsk, Samara, Tyumen, Chelyabinsk, Saratov, Engels, Belarus (Minsk), where you can buy Penidure 1.2 million IU. If your request comes from other regions, we can help you individually.
For more than a decade, the drug Penidure (complete Retarpen) has occupied a worthy place in the arsenal of infectious disease specialists, venereologists, urologists, rheumatologists and pediatricians. Its main active ingredient, benzathine benzylpenicillin, is capable of inhibiting the growth of bacteria. The advantage of this antibiotic is its ability to accumulate in the body and have an effect on pathogens for a long time.
The recommendation to buy Retarpen (Penidure) is often heard by patients who have been diagnosed with syphilis. The drug has been successfully used to treat this "popular" sexually transmitted disease since the middle of the last century. In Europe, America and African countries, it was he who became the leading agent in the fight against this infectious and insidious disease, dangerous with serious consequences (tertiary syphilis) in the absence of adequate treatment. The cause of the disease is the bacteria pale treponema, which can enter the body through sexual contact with an already infected partner, as well as through blood transfusion. Syphilis can also be transmitted to a child during pregnancy from a sick mother.
What diseases does Penidure (a complete analogue of Retarpen) treat:
The antibiotic Penidure / Retarpen is also effective in treating scarlet fever, a disease from which thousands of people of all ages died a century ago. This drug, capable of killing streptococcal bacteria that cause scarlet fever, tonsillitis and erysipelas, is also prescribed for children.
Rheumatism is another serious consequence of the attack of the body by colonies of streptococcal bacteria. This disease, which often develops as a complication after an infectious disease, affects not only the joints, but also the heart, skin and brain. Swelling and pain in the joints are only external manifestations of rheumatism. Injections of the drug are usually prescribed to prevent recurrence of rheumatism.
Instructions for using the drug Penidure:
An objective decision on the need to use antibiotics should be made by a doctor who will determine how much Retarpen or its full analogue Penidure should be bought, and will also prescribe the dose and treatment regimen. As a rule, in the treatment of primary syphilis, 1-2 injections are prescribed, with advanced disease, at the stage of tertiary syphilis, the course of treatment can reach 5 weeks for 1-2 amp. weekly. In the treatment of scarlet fever and acute tonsillitis, adult patients are given 1-2 injections per week, children - 0.6 million IU 1 time in 3 days or daily.
💊 Penidure 1.2 million IU 5 ampoules / pack
🏥 Buy Penidure (Penidure, Retarpen 1.2 million IU No. 5 in pharmacies in Moscow, St. Petersburg, Yekaterinburg and other cities of Russia
💰 Affordable prices Penidure 1.2 million IU 5 ampoules / pack.
Before you buy Penidure 1.2 million IU at your nearest pharmacy, you should definitely consult your doctor. Self-medication is dangerous to your health.
Description
White to off-white powder with a tendency to cake.
Composition
1 bottle contains 2.0513 g of benzathine benzylpenicillin (corresponds to 2,400,000 IU).
Excipients: Simethicone, Mannitol, Povidone, Buffered Sodium Citrate, pH 7.
Pharmacotherapeutic group
Antibacterial agents for systemic use. Penicillins sensitive to beta-lactamases.
ATX code: J01CE08.
Pharmacological properties
Pharmacodynamics
Mechanism of action
The mechanism of action of benzathine benzylpenicillin is based on the inhibition of bacterial cell wall synthesis during the growth phase by blocking penicillin-binding proteins (PBPs) such as transpeptidases. This leads to bactericidal action.
The relationship between pharmacokinetics and pharmacodynamics
The effectiveness largely depends on the length of time during which the level of the active substance remains above the MIC of the pathogen.
Mechanisms of development of resistance
Resistance to benzathine benzylpenicillin may be due to the following mechanisms:
- inactivation by beta-lactamases: benzathine benzylpenicillin is not resistant to beta-lactamase and therefore does not affect bacteria that produce beta-lactamase (for example, staphylococci or gonococci);
- a decrease in the affinity of PSB for benzathine benzylpenicillin: the acquired resistance of pneumococci and some other streptococci to benzathine benzylpenicillin is due to modifications of existing PSB as a result of mutation. However, the resistance of methicillin (oxacillin) -resistant staphylococci is due to the formation of additional PSB with a reduced affinity for benzathine benzylpenicillin;
- in gram-negative bacteria, insufficient penetration of benzathine benzylpenicillin through the outer cell wall can lead to insufficient inhibition of PSB;
- benzathine benzylpenicillin can be actively transported from the cell by efflux pumps.
Benzathine benzylpenicillin is partially or completely cross-resistant to other penicillins and cephalosporins.
Boundary values
Cut-off values are based on benzylpenicillin values. For susceptible and resistant microorganisms, the following minimum inhibitory concentrations (MIC) have been established.
Minimum inhibitory concentrations (MICs) established by the European Committee for the Assessment of Antibiotic Susceptibility (EUCAST).
| Microorganism | Sensitive(mg / l) | Resistant(mg / l) |
| Staphylococcus spp. | ≤ 0,12 | > 0,12 |
| Streptococcus spp. groups A, B, C, G | ≤ 0,25 | > 0,25 |
| Streptococcus pneumoniae # | ≤ 0,06 | > 2 |
| Streptococcus of the Viridans group | ≤ 0,25 | > 2 |
| Neisseria meningitidis | ≤ 0,06 | > 0,25 |
| Neisseria gonorrhoeae | ≤ 0,06 | > 1 |
| Gram negative anaerobes | ≤ 0,25 | > 0,5 |
| Gram-positive anaerobes | ≤ 0,25 | > 0,5 |
| Limit values regardless of type * | ≤ 0,25 | > 2 |
* based on serum pharmacokinetic parameters.
Prevalence of acquired resistance
The prevalence of acquired resistance in selected species is geographically and temporally dependent, and local information on antibiotic resistance should be obtained, especially in the case of severe infections. If local antibiotic resistance values call into question the effectiveness of benzylpenicillin, you should seek the help of the appropriate expert experts. In particular, in the case of severe infection or unsuccessful therapy, it is necessary to carry out a microbiological diagnosis with the identification of the pathogen and its susceptibility to benzylpenicillin. ° Data obtained from published literature, clinical experience and therapeutic recommendations.
^ Collective name for a heterogeneous group of streptococcal species. The degree of resistance may vary depending on the presence of streptococci
Pharmacokinetics
Suction
After intramuscular administration, benzylpenicillin is absorbed very slowly. Retarpen is the longest-acting penicillin depot drug. For many indications, 1-2 injections per month are sufficient. Consequently, the frequency of injections and local reactions can be reduced.
The time to reach peak concentration after injection is 24 hours in children and 48 hours in adults.
Distribution
About 55% of the administered dose binds to plasma proteins. When using high doses of penicillin, therapeutically effective concentrations are achieved even in hard-to-reach places, such as heart valves, bone tissue, cerebrospinal fluid, empyema, etc.
Benzylpenicillin crosses the placental barrier. In fetal circulation, 10-30% of the concentration of benzylpenicillin in the mother's blood plasma was found. High concentrations are also achieved in the amniotic fluid. In contrast, transmission into breast milk is low. The volume of distribution is about 0.3-0.4 l / kg in adults and about 0.75 l / kg in children.
Biotransformation and excretion
Excretion to a large extent (50 - 80%) occurs unchanged through the kidneys (85 - 95%) and, to a lesser extent, in an active form with bile (about 5%). The half-life in adults with normal renal function is approximately 30 minutes.
Special patient groups
Premature and newborn babies: due to the immaturity of the kidneys and liver at this age, the half-life is up to 3 hours or more. Therefore, the dosing interval should be at least 8-12 hours (depending on the degree of maturity of the kidneys and liver).
Elderly patients: Elimination processes can also be slowed down. The dose should be adjusted according to the state of renal function.
Preclinical data
Reproductive studies in mice, rats and rabbits have shown no negative effects on fertility or fetus. There are no long-term studies in laboratory animals for carcinogenicity, mutagenicity and fertility.
Indications for use
Retarpen is used in adults, adolescents, children and newborns for the treatment and prevention of infections caused by pathogens susceptible to penicillin:
for treatment:
- erysipelas
- syphilis: early syphilis (primary and secondary)
- latent syphilis (exception: neurosyphilis and the presence of a detected pathology in the cerebrospinal fluid)
- yaws
- pint
for prevention:
- rheumatic fever (chorea, rheumatic carditis)
- post-streptococcal glomerulonephritis
- erysipelas
When using Retarpen, general guidelines for the proper use of antibacterial drugs should be taken into account.
Doses and method of administration
The dose depends on the severity and type of infection, age and liver and kidney function of the patient. For some specific indications (eg syphilis, prevention of rheumatic fever), international guidelines should be taken into account in addition to national or local guidelines.
Standard dose
Adults and adolescents: 1,200,000 IU once a week.
Children weighing> 30 kg: 1,200,000 IU once a week.
Children with body weight< 30 кг: 600000 МЕ один раз в неделю.
To prevent recurrence of the disease in patients with streptococcal infection, the shortest treatment period should be 10 days. This can be achieved with a single administration of 600,000 IU Retarpen, 1,200,000 IU Retarpen, or 2,400,000 IU Retarpen.
Syphilis treatment
primary and secondary stages
Adults and adolescents: 1 x 2,400,000 IU.
Treatment is repeated if clinical symptoms return or laboratory tests are consistently positive.
Duration of therapy: single dose.
the last stage (latent seropositive syphilis)
Adults and adolescents: 2,400,000 IU once a week.
Children: 50,000 IU / kg body weight, but not more than 2,400,000 IU.
Duration of therapy: 3 weeks.
congenital syphilis (no neurological symptoms)
Infants and young children: 1 x 50,000 IU / kg body weight.
Duration of therapy: single dose.
Yaws treatment, pints
Adults and adolescents: 1 x 1,200,000 IU.
Children weighing> 30 kg: 1 x 1,200,000 IU.
Children with body weight< 30 кг: 1 х 600000 МЕ.
Duration of therapy: single dose.
Prevention of rheumatic fever, post-streptococcal glomerulonephritis and erysipelas:
Adults and adolescents: 1 x 1,200,000 IU every 3-4 weeks.
Children weighing> 30 kg: 1 x 1,200,000 IU every 3-4 weeks.
Children with body weight< 30 кг: 1 х 600000 МЕ каждые 3-4 недели.
Duration of therapy:
a) in the absence of involvement of heart damage in the pathological process: at least 5 years or up to 21 years.
b) with the transient involvement of heart damage in the pathological process: at least 10 years or up to 21 years.
c) with the constant involvement of heart damage in the pathological process: at least 10 years or up to 40 years; sometimes life-long prophylaxis is needed.
Special patient groups
In case of impaired renal function
|
Retarpen dose for adults, adolescents and children based on creatinine clearance |
|||
| Creatinine clearance, ml / min | 100-60 | 50-10 | <10 |
| Serum creatinine, mg% | 0,8-1,5 | 1,5-8,0 | 15 |
| Fraction of the usual daily dose of Retarpen | 100% | 75% |
20-50% (max. 10,000,000-3,000,000 IU / day) |
| The interval between the introduction | 1 single injection | 1 single injection | 2-3 single injections |
Benzylpenicillin can be cleared by hemodialysis. There are no data on the effect of hemodialysis on plasma benzylpenicillin levels. Therefore, the question of the appointment of Retarpen to patients on hemodialysis should be considered on a case-by-case basis.
If liver function is impaired
In cases of very severe violations of liver and kidney function, there may be a delayed disintegration and excretion of penicillins.
Mode of application
For intramuscular injection only. Retarpen should not be injected into areas with poor blood supply.
Injections should be injected deep intramuscularly into the upper outer gluteal quadrant, with the needle pointing towards the iliac crest or into the ventrogluteal region according to Hochstatter. The puncture should be performed as perpendicular to the skin surface as possible, and the drug should be injected as far from large vessels as possible. A piston test should always be performed prior to injection. If blood is aspirated or pain occurs during the injection, the injection should be discontinued.
For children, it is preferable to insert into the antero-outer region of the thigh (quadriceps muscle of the thigh). With good muscle development, the deltoid muscle can be used for injection; in this case, attention should be paid to the radial nerve.
In infants and young children, to avoid damage to the sciatic nerve, the upper lateral gluteal quadrant should only be used as an injection site in exceptional cases (eg, extensive burns).
The maximum permissible injection volume for one site is 5 ml. Therefore, no more than 5 ml of a ready-made suspension for injection should be injected into one area at any time.
The drug should be administered as slowly as possible without significant effort. After injection, do not massage or rub the injection site.
With intramuscular injection, severe reactions at the injection site can be observed, especially in young children. Whenever possible, alternative therapies, such as intravenous administration of a suitable penicillin, should be considered, taking into account the therapeutic indication and regimen first, and weighing the risk-benefit ratio.
Suspension preparation
The contents of the vial of 2,400,000 IU are diluted in at least 5 ml of water for injection. Shake vigorously for 20 seconds and inject immediately using a minimum 0.9 mm needle. Only one dose is taken. Use only freshly prepared suspensions. Before administering a dose, it must be ensured that the end of the injection needle is not in a blood vessel. With repeated doses, it is necessary to change the injection site.
Side effect
Contraindications
Hypersensitivity to benzathine benzylpenicillin, to any other penicillin or to any of the excipients listed in the "Composition" section.
- A history of severe immediate hypersensitivity reactions (eg, anaphylactic) to other beta-lactam antibiotics (eg, cephalosporins, carbapenem, or monobactam).
Overdose
In very high doses, penicillins can cause nervous irritability or seizures. If overdose is suspected, clinical monitoring and symptomatic treatment are recommended. Benzylpenicillin can be cleared by hemodialysis.
Precautionary measures
Retarpen should not be injected into areas with poor blood supply.
Before starting treatment, information should be collected about the patient's history of hypersensitivity reactions to penicillins, cephalosporins or other beta-lactam antibiotics.
Serious and sometimes fatal hypersensitivity reactions have been reported in patients treated with penicillins. These reactions are more common in people with a history of penicillin hypersensitivity and in atopic individuals.
If allergic reactions occur, treatment should be canceled and appropriate treatment prescribed. If possible, a hypersensitivity test should be performed prior to starting treatment.
The patient should be aware of the possible occurrence of allergic reactions and the need to report them.
Caution should be exercised in patients suffering from:
allergic diathesis or bronchial asthma. There is an increased risk of developing a hypersensitivity reaction.
kidney failure;
impaired liver function.
Some exposed patients may experience severe immediate hypersensitivity reactions after the first administration. In this regard, the patient must remain under observation for half an hour after the injection.
In the treatment of syphilis, as a result of the bactericidal action of penicillin on pathogens, the Jarisch-Herxheimer reaction may develop.
2 - 12 hours after administration, headaches, fever, sweating, chills, myalgia, arthralgia, nausea, tachycardia, high blood pressure, followed by hypotension may appear. These symptoms disappear after 10-12 hours.
Patients should be advised that this is a common, transient complication of antibiotic therapy. To suppress or weaken the Jarisch-Herxheimer reaction, appropriate therapy should be prescribed.
For long-term treatment (more than 5 days), blood and kidney function tests are recommended.
It is necessary to monitor the growth of microbial resistance. With the development of secondary infections, appropriate measures should be taken.
It is necessary to take into account the possibility of developing severe and persistent diarrhea, pseudomembranous colitis associated with the administration of an antibiotic (bloody / mucous, watery diarrhea, dull pain, diffuse abdominal pain or colic, fever, sometimes tenesmus), such symptoms can be life-threatening. In these cases, the drug should be immediately canceled and therapy should be prescribed based on the results of the detected pathogens. Antiperistaltic drugs are contraindicated.
In patients with congenital syphilis, neurological complications cannot be ruled out, therefore, in such patients, penicillin forms that create higher concentrations in the cerebrospinal fluid should be used.
For conditions such as acute pneumonia, empyema, sepsis, meningitis, or peritonitis that require a higher serum concentration of penicillin, alternative treatment, such as with a water-soluble alkaline benzylpenicillin salt, should be considered.
Application notes
Inadvertent subcutaneous administration may result in painful lumps. In such cases, ice packs help.
In the case of unintentional intravascular injection, Hoyne's syndrome may develop (symptoms of shock with mortal fear, confusion, hallucinations, cyanosis, tachycardia and movement disorders are possible, but without the development of vascular insufficiency) caused by suspension microemboli. Symptoms subside within an hour. If the case is severe, parenteral sedation is recommended.
In the case of unintentional intra-arterial injection, especially in children, serious complications can develop, for example, vascular occlusions, thrombosis and gangrene. The initial signs are pale spots on the skin of the buttocks. As a result of the high injection pressure, retrograde flow of fluid into the common iliac artery, aorta, or spinal arteries can occur.
Repeated injections into a limited area of muscle tissue associated with long-term depot-penicillin therapy (for example, in the treatment of syphilis) can cause tissue damage and increase local vascularization.
Subsequent injections increase the likelihood of the suspension entering the bloodstream, either by direct injection into the blood vessel, either due to the pressure of the injected suspension itself, or by depot migration. Therefore, with long-term therapy, it is recommended to enter each injection at a great distance from the previous injection.
Influence on the results of diagnostic laboratory tests
- Patients receiving 10 million IU (equivalent to 6 g) of benzylpenicillin or more per day often develop a positive direct Coombs' test (≥ 1% to<10%). После отмены пенициллина, результаты прямой антиглобулиновый пробы могут оставаться положительными от 6 до 8 недель.
- Determination of protein in urine using precipitation techniques (sulfosalicylic acid, trichloroacetic acid), Folin-Cicalteu-Lowry method or biuret method may give false positive results. Therefore, the determination of protein in urine should be carried out using other methods.
- Determination of urinary amino acids using the ninhydrin method can also give false positive results.
- Penicillins bind to albumin. When using the electrophoresis method to determine albumin, false bisalbuminemia can be obtained.
- During benzylpenicillin therapy, non-enzymatic detection of glucose and urobilinogen in urine may give false positive results.
- During therapy with benzylpenicillin, the determination of 17-ketosteroids (using the Zimmermann reaction) in the urine may give increased values.
In renal dysfunction, delayed excretion of povidone must be considered.
Due to the presence of povidone in the preparation, it cannot be ruled out that after frequent or prolonged use, in very rare cases, povidone may be deposited in the reticuloendothelial system or locally, leading to the development of tumor-like granulomas.
Interaction with other medicinal products
The simultaneous administration of benzylpenicillin is not recommended with:
Based on the general principle of not combining bactericidal and bacteriostatic antibiotics, Retarpen should not be combined with bacteriostatic antibiotics.
Caution should be exercised when used together:
Probenecid
The use of probenecid leads to inhibition of the secretion of benzylpenicillin by the renal tubules, which leads to an increase in serum concentration and an extension of the half-life. Probenecid also inhibits the transport of penicillin from the cerebrospinal fluid, therefore, the simultaneous administration of probenecid reduces the further penetration of benzylpenicillin into the brain tissue.
Methotrexate
With simultaneous use with Retarpen, the excretion of methotrexate is reduced. This can lead to an increase in the toxicity of methotrexate. The combination with methotrexate is not recommended.
Anticoagulants
The simultaneous use of Retarpen with oral anticoagulants can enhance their effect and increase the risk of bleeding. It is recommended to regularly monitor the international normalized ratio (INR) and adjust the dosage of vitamin K antagonists accordingly during and after treatment with Retarpen.
Compatibility data
Compatibility data for water for injection is available.
Pregnancy and breastfeeding
Pregnancy
Benzathine benzylpenicillin crosses the placenta. Animal studies do not indicate direct or indirect harmful effects due to reproductive toxicity. Retarpen can be used during pregnancy when indicated and the benefits and risks are considered.
Breast-feeding
Benzathine benzylpenicillin passes into breast milk in small amounts. The concentration in breast milk can reach 2 to 15% of the concentration of the mother's serum.
Although to date, no adverse effects have been reported in infants who have received breast milk, nevertheless, the possibility of sensitization or harmful effects on the intestinal microflora should be considered. Breastfeeding should be discontinued if the baby has diarrhea, candidiasis, or rash.
Infants who are also receiving baby food should not be breastfed during treatment with Retarpen. Breastfeeding can be resumed after stopping treatment after 24 hours.
Fertility
No human fertility studies have been conducted. Reproductive studies in mice, rats and rabbits did not reveal any negative effects on fertility. There have been no long-term studies of fertility in laboratory animals.
50 vials with instructions for use in a cardboard box.
Manufacturer
Sandoz GmbH, Biochemistrasse 10, A-6250 Kundl, Austria.
Retarpen is an antibiotic drug from the penicillin group.
Release form and composition
The drug is produced in the form of a powder for the preparation of an injection solution.
1 bottle contains the active substance - benzathine benzylpenicillin:
- Retarpen 1.2 - 1.2 million IU (10 ml in vials, 1 or 100 vials in cardboard boxes);
- Retarpen 2.4 - 2.4 million IU (15 ml in vials, 1 or 50 vials in cardboard boxes).
Indications for use
Retarpen is prescribed for the treatment of infectious and inflammatory diseases caused by microorganisms sensitive to the action of the drug, such as:
- Pint, yaws;
- Syphilis (as monotherapy);
- Acute tonsillitis, scarlet fever.
Also, the drug is used for prophylaxis in the following cases:
- Repeated attacks after acute rheumatic fever;
- Wound infections;
- Relapses of erysipelas;
- Infections after tooth extraction or tonsillectomy.
Contraindications
The use of Retarpen is contraindicated in case of hypersensitivity to beta-lactam antibiotics (pecillins and cephalosporins).
The drug should be prescribed with caution if the patient:
- Pseudomembranous colitis;
- Tendency to allergic reactions;
- Renal failure.
Retarpen can be used in pregnant women only when the intended benefit to the mother is higher than the potential risk to the fetus.
If it is necessary to prescribe the drug to lactating women, the issue of interrupting breastfeeding should be resolved.
Method of administration and dosage
The drug is injected deeply intramuscularly (intravenous administration is prohibited).
For syphilis, Retarpen is prescribed for adults:
- For preventive treatment - a single dose of 2.4 million IU;
- With the primary - 2 injections with an interval of 7 days at a dosage of 2.4 million IU;
- With early latent and secondary - 3 injections with an interval of 7 days, 2.4 million IU.
For prophylactic therapy of a child born to a mother who has not been treated with syphilis, Retarpen is prescribed 3 injections with an interval of 7 days at a dose of 5000 IU / kg of body weight. The dosage should be halved and injected into different buttocks. For prophylactic therapy of a child due to seroresistance or insufficient treatment of the mother, 2 injections are administered with an interval of 7 days.
For the treatment of pint and yaws (endemic treponematoses), the following are prescribed:
- Children - a single dose of 1.2 million IU;
- Adults - 2.4 million IU.
For other infections (wound infections in the acute phase, erysipelas, scarlet fever, acute tonsillitis), depending on the severity of the condition, they are prescribed:
- Children under 12 years old - every 3 days for 600 thousand IU or every 2-4 weeks for 1.2 million IU;
- Adults - 1.2 million IU or 2.4 million IU once a week.
To prevent the development of repeated attacks after acute rheumatic fever, Retarpen is used once every 3 weeks:
- Children weighing less than 25 kg - 600 thousand IU each;
- Children weighing more than 25 kg - 1.2 million IU;
- Adolescents and adults - 2.4 million IU each.
The duration of prophylaxis is set by the doctor individually.
When prescribing the drug to patients with impaired renal function, the dosage regimen may be adjusted, determined by the creatinine clearance value:
- With CC 10-50 ml per minute - 75% of the recommended daily standard dose;
- With CC less than 10 ml per minute - 25-50%.
For the prevention of relapses of erysipelas with seasonal relapses, adults are prescribed 2.4 million IU once every 4 weeks for 3-4 months every year. With frequent relapses, the drug is administered once every 3-4 weeks at 2.4 million IU for 2-3 years. Children are prescribed 1 time in 2 weeks for 600 thousand IU or every 3-4 weeks for 1.2 million IU.
For the prevention of infections after tooth extraction or tonsillectomy, the drug is administered to adults every 1-2 weeks until complete recovery, 2.4 million IU, children - 600 thousand IU.
Side effects
When using Retarpen, allergic reactions may develop: difficulty breathing, urticaria, joint pain, fever, exfoliative dermatitis, angioedema, erythema multiforme, anaphylaxis.
When treating syphilis, the Jarisch-Gerskheimer reaction can develop, which is associated with the release of endotoxins.
During treatment with Retarpen, such reactions from individual systems and organs are possible:
- Hematopoietic system. Often - reversible anemia, leukopenia, thrombocytopenia;
- Digestive system. Often - stomatitis, glossitis, nausea, vomiting, diarrhea, candidiasis; rarely - a moderate increase in the activity of hepatic transaminases in the blood serum; in some cases - pseudomembranous colitis;
- Other. Rarely - acute interstitial nephritis; with prolonged use, superinfection with resistant microorganisms and fungi can develop.
The use of beta-lactam antibiotic drugs in high dosages, especially in renal failure, can cause encephalopathy (convulsions, movement disorders, impaired consciousness).
Children may develop local reactions to the administration of Retarpen.
special instructions
The drug should not be administered subcutaneously, endolumbar, intravenously and intracavitary.
In case of accidental intravascular administration of Retarpen, disturbances in the form of a transient feeling of anxiety and visual impairment (Wanier syndrome) may occur. To avoid this, before intramuscular injection, it is necessary to carry out aspiration to detect the possible penetration of the needle into the vessel.
If syphilis is suspected during the treatment of sexually transmitted diseases, microscopic and serological examinations should be carried out before starting treatment and then for 4 months.
Due to the possibility of the occurrence of fungal diseases during therapy, it is recommended to additionally take vitamins C and group B, and, if necessary, levorin and nystatin.
When prescribing the drug to patients on a diet with limited salt intake, it should be borne in mind that the sodium content per 600 thousand IU of Retarpen is 0.24 mmol or 5.5 mg.
With the development of any allergic reactions, the administration of the drug is stopped and appropriate treatment is prescribed. During therapy, severe allergic reactions (up to anaphylactic shock) may develop. If a history of hypersensitivity to penicillin is indicated, the drug is categorically contraindicated.
In 5-10% of cases, there was a cross-allergic reaction between cephalosporins and penicillins, and therefore, if an indication of an allergic reaction to cephalosporins in history, the appointment of penicillins is contraindicated.
It should be borne in mind that the use of Retarpen in insufficient doses or too early discontinuation of treatment can lead to the emergence of resistant strains of pathogens.
With the simultaneous use of Retarpen, it is noted:
- Antagonism of action - bacteriostatic antibiotics (lincosamides, chloramphenicol, macrolides, tetracyclines);
- Synergism of action - bactericidal antibiotics (cycloserine, cephalosporins, rifampicin, vancomycin, aminoglycosides).
When used simultaneously with allopurinol, the risk of developing skin rashes (allergic reactions) increases.
Analogs
The analogues of Retarpen are in the active substance - Benzicillin-1, Bicillin-1, Extensillin.
Terms and conditions of storage
Keep out of the reach of children, protected from light at temperatures up to 25 ° C.
The shelf life of the drug is 4 years.
A drug Retarpen- an antibacterial drug, the active and active ingredient of which is benzathine benzylpenicillin - these are beta-lactam antibiotics from the group of type G penicillins of prolonged action. Shows a bactericidal effect against sensitive microorganisms by suppressing the synthesis of mucopeptides of the cell wall.
Active against gram-positive pathogens: Staphylococcus spp. (penicillin-non-toxic), Streptococcus spp., including Streptococcus pneumoniae, Corynebacterium diphtheriae, anaerobic spore-forming rods, Bacillus anthracis, Clostridium spp., Actinomyces israelii; gram-negative microorganisms: Neisseria gonorrhoeae, Neisseria meningitidis, as well as Treponema spp. The drug is resistant to strains of Staphylococcus spp., Producing penicillinase, which destroys benzylpenicillin. Due to its long-term effect, the drug is intended for the treatment of infections caused by Streptococcus spp. and Treponema pallidum. Pharmacokinetics
.
When benzathine is administered, benzylpenicillin is very slowly absorbed from the injection site, providing a prolonged action.
The maximum serum concentration is reached 12-24 hours after injection. The long half-life provides a stable and long-term concentration of the drug in the blood: on the 14th day after the administration of 2,400,000 IU, the concentration in the blood serum is 0.12 μg / ml. The degree of binding to blood plasma proteins is approximately 55%.
Benzathine benzylpenicillin in small amounts crosses the placental barrier, as well as into breast milk. The metabolism of the drug is negligible. It is excreted mainly by the kidneys unchanged; for 8 days, up to 33% of the administered dose is excreted.
Indications for use
A drug Retarpen it is used to treat infections caused by microorganisms sensitive to the drug: acute tonsillitis; scarlet fever; erysipelas (chronic), erysipeloid; infected and bite wounds; syphilis and other diseases caused by treponemes (yaws, endemic syphilis, pint).Also the drug Retarpen used for the prevention of: rheumatic diseases (chorea, rheumatic heart disease); post-streptococcal glomerulonephritis; scarlet fever (after contact with a patient); faces; syphilis (after contact with a patient).
Mode of application
Before the introduction Retarpena it is necessary to collect an anamnesis of the drug's tolerance from the patient and conduct a preliminary intradermal test for its tolerance.Retarpen use only intramuscularly!
To prepare the suspension, 5 ml of water for injection should be introduced into the vial. Use only freshly prepared suspension, shake for 20 seconds and inject immediately using a needle with a minimum thickness of 0.9 mm. Retarpen should be injected into the upper quadrant of the gluteus maximus. To inject the drug, it is necessary to prick the needle perpendicularly to the surface of the skin with a sharp movement, while avoiding the proximity of large vessels. If there is aspiration of blood or pain during the administration of the drug, the injection should be discontinued. The drug should be administered as slowly as possible only under low pressure. Do not rub the injection site after injection. If repeated injections are necessary, the injection site should be changed. It is necessary to aspirate just before the injection of the drug to avoid the needle entering the blood vessels. No more than 5 ml of suspension should be injected into one place at a time.
Syphilis treatment.
Primary syphilis. Once, 2400000 MO Retarpen, distributing it into 2 injection sites.
Secondary syphilis. Retarpen 2,400,000 IU at 2 injection sites.
If clinical manifestations recur or laboratory results remain positive, the treatment should be repeated.
Late syphilis (seropositive latent syphilis). 2,400,000-4,800,000 IU weekly for 3-5 weeks.
Yaws treatment.
1,200,000 - 2,400,000 IU once. For persons who have had contact with patients or patients with a latent form of infection, inject half the dose.
Pint cure.
Treatment of other infections caused by microorganisms sensitive to the drug (acute tonsillitis, scarlet fever, erysipelas, erysipeloid, infected wounds and bite wounds).
MO Retarpen 2,400,000 weekly.
Prevention of rheumatic fever and rheumatic endocarditis, chorea, fasting glomerulonephritis and erysipelas.
1,200,000 - 2,400,000 IU of Retarpen once every 4 weeks.
The duration of prophylaxis is set individually.
Prevention of scarlet fever in persons who have had contact with patients.
2,400,000 MO Retarpen once.
With streptococcal diseases, the course of treatment should be at least 10 days to prevent complications. As a rule, one injection of Retarpen 2,400,000 MO is sufficient.
Side effects
The following adverse reactions are grouped by classes of body systems and the frequency of occurrence of reactions: very often (≥ 1/10), often (≥ 1/100,<1/10), нечасто (≥ 1/1000, <1/100), редко (≥ 1/10000, <1/1000), очень редко (<1/10000), частота неизвестна (частота не может быть оценена из-за отсутствия данных).Infections and infestations: common - resistant bacterial and fungal infections (including candidiasis).
On the part of the blood and lymphatic system: very rarely - hemolytic anemia, leukopenia, thrombocytopenia, agranulocytosis, eosinophilia.
From the immune system: rarely - hypersensitivity reactions, including rash, urticaria, Quincke's edema, erythema multiforme, exfoliative and contact dermatitis, fever, joint pain, laryngospasm, bronchospasm, anaphylactic shock sometimes with collapse and death, anaphylactoid reactions purpura, gastrointestinal symptoms); frequency unknown - serum sickness; during syphilis therapy, due to the release of endotoxins, the Jarisch-Herxheimer reaction can develop, which is characterized by the following symptoms: fever, chills, myalgia, headache, exacerbation of skin symptoms, tachycardia, vasodilation with a change in blood pressure (the reaction can be dangerous with cardiovascular - vascular syphilis or conditions in which there is a serious risk of increased local damage, for example, atrophy of the optic nerve). In patients with dermatomycosis, para-allergic reactions may develop as a result of a possible joint antigenicity between penicillins and dermatophyte metabolites. Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome).
From the nervous system: rarely - neuropathy.
On the part of the digestive tract: often - diarrhea, nausea, rarely - stomatitis, glossitis, vomiting, the frequency is unknown - pseudomembranous colitis, the tongue is black.
From the digestive system: the frequency is unknown - hepatitis, cholestasis.
From the side of the skin: frequency unknown - pemphigoid.
From the urinary system: rarely - nephropathy, interstitial nephritis.
General disorders: frequency unknown - pain, infiltration at the injection site, Wuan's syndrome, Hoigne's syndrome and Nicolau's.
Contraindications
Contraindications to the use of the drug Retarpen are: hypersensitivity to the components of the drug, beta-lactam antibiotics (penicillin and carbapenems), soy, peanuts. History of cross-sensitivity to cephalosporins (5-10% of cases). For the treatment of diseases requiring high concentrations of penicillin in blood serum and cerebrospinal fluid (severe pneumonia, empyema, sepsis, pericarditis, meningitis, peritonitis, arthritis, congenital neurosyphilis), water-soluble benzylpenicillin sodium salt should be used. Urticaria, hay fever, severe allergic reactions and a history of bronchial asthma.Pregnancy
A drug Retarpen can be used after careful assessment of the benefit / risk ratio.Benzathine benzylpenicillin passes into breast milk in small amounts. The concentration in milk can reach from 2% to 15% of the concentration in the mother's plasma. There have been no reports of adverse reactions in infants, however, possible sensitization or interference with the intestinal flora should be taken into account. Breastfeeding should be discontinued if the baby has diarrhea, candidiasis, or a rash.
Infants who are on combined feeding should be transferred to feeding with baby food during the treatment of the mother with retarpen. Breastfeeding can be resumed 24 hours after stopping treatment.
Interaction with other medicinal products
Penicillin preparations with bactericidal action should not be used in combination with bacteriostatic antibiotics.Combination with other antibiotics is only possible when a synergistic effect or any additional effect can be expected. The individual components of the therapeutic combination should be administered at the full dose (the dose of the more toxic component may be reduced if a synergistic effect is shown).
It should be borne in mind the possibility of competitive inhibition of the excretion process from the body with the simultaneous use of benzathine benzylpenicillin with anti-inflammatory, antirheumatic and antipyretic agents (indomethacin, phenylbutazone, salicylates in high doses) or probenecid.
Simultaneous use Retarpena with methotrexate reduces the excretion of the latter and may lead to increased toxicity. The combination of Retarpen and methotrexate is not recommended.
With simultaneous use, the effectiveness of indirect anticoagulants increases. When used with oral anticoagulants, the effect of antivitamins K and the risk of bleeding may increase. It is recommended to periodically determine the level of the international normalized index (MNI) and accordingly adjust the use of anti-vitamin K preparations during and after retarpen treatment.
The use of benzathine benzylpenicillin may in some cases lead to a decrease in the effectiveness of oral contraceptives.
To prevent undesirable chemical reactions, the Retarpen suspension should not be mixed with other injection solutions.
Benzathine benzylpenicillin should be used with caution in patients receiving digoxin, since with simultaneous use there is a risk of bradycardia.
Allopurinol increases the risk of developing allergic reactions (skin rashes).
Aspirin, probenecid, thiazide diuretics, furosemide, ethacrynic acid increase the half-life of benzylpenicillin, increasing its concentration in blood plasma, as a result of which the risk of developing its toxic effect by affecting renal tubular secretion increases.
Overdose
The use of high doses of beta-lactam antibiotics, especially in liver failure, can cause the development of encephalopathy (confusion, impaired movement). Penicillins in extremely high doses can cause neuromuscular excitability or epileptic-like seizures. Potentially overdose Retarpen possible gastrointestinal symptoms and electrolyte imbalance.Treatment: symptomatic and supportive therapy, hemodialysis. The specific antidote is unknown.
Storage conditions
In a dark place at temperatures below 25 ° C.Keep out of the reach of children.
Release form
Retarpen - powder for suspension for injection.Packing: powder in a bottle. 50 bottles in a cardboard box.
Composition
1 bottle Retarpen contains benzathine benzylpenicillin 2,400,000 IU.Excipients: simethicone, beckon (E 421), povidone, sodium.
Additionally
Before starting therapy, for at least 4 months, it is necessary to conduct microscopic and serological examinations. When prescribing to patients with diabetes mellitus, the long-term absorption of Retarpen from the muscle depot should be taken into account. It is prescribed with caution to patients prone to allergic reactions. With the development of such reactions, therapy is stopped (it is necessary to administer adrenaline, antihistamines and corticosteroids). With prolonged antibiotic therapy, it is necessary to pay attention to the excessive multiplication of resistant microorganisms.main parameters
| Name: | RETARPEN |
| ATX code: | J01CE08 - |
Retarpen is a prolonged antibiotic of the penicillin series, intended for the treatment of infections caused by flora sensitive to its influence. The active substance of the drug is destroyed under the influence of penicillinase secreted by some bacteria, therefore the list of indications for use is limited to rather severe diseases.
The effectiveness of Retarpen in borreliosis and syphilis has been proven. The remedy is often prescribed for the treatment and prevention of rheumatoid complications provoked by streptococcal flora.
Stable concentrations of the active ingredient are maintained for 2-4 weeks after application, which provides a pronounced therapeutic effect. But that is why the medicine is not prescribed for bacterial diseases of mild and moderate severity (lesions of the ENT organs, urinary tract, lungs, bronchi, etc.).
Information about the manufacturer of the medication
Produced by Retarpen (international name Retarpen) by the pharmaceutical company Sandoz (Austria), a division of the Novartis corporation. Sandoz is one of the world's largest manufacturers of antibiotics. The company is a leader in the production of antibacterial agents of the penicillin class, including in combination with clavulanic acid (trade name Amoxiclav).
Instructions for use
Experts categorically prohibit the independent use of any antibacterial drugs. The same applies to Retarpen. The medication is intended for use in a specially designed regimen for the treatment of serious infections. Self-medication is contraindicated, since the wrong dose and non-adherence to the therapy protocol can cause resistance of the bacterial flora. Before starting a therapeutic course, you must read the instructions for use.
Composition and dosage form
The medication is available in the form of a lyophilisate (powder) for preparing a solution for injection. Injections are given intramuscularly at the dose indicated by the doctor. The manufacturer provides a dosage of 2.4 or 1.2 IU of the active ingredient.
Description and composition
The active ingredient is benzathine benzylpenicillin in the form of a lyophilisate, packaged in vials. Additionally, the composition of the drug also includes auxiliary components that ensure the maintenance of therapeutic properties throughout the shelf life - sodium citrate, mannitol, simethicone.
Pharmacological group
In accordance with the classification system generally accepted in medicine and pharmacy, Retarpen is an antibacterial drug (antibiotic) with a prolonged action of the β-lactam penicillin class.
Pharmacodynamic aspects
The action of the active substance is associated with its effect on the outer cell membrane of bacteria. Benzathine benzylpenicillin inhibits the synthesis of structural components of the membrane during the development of a microorganism, thus causing irreversible destruction of pathogenic flora. The tool has a bactericidal effect that lasts for a long period.
The instructions for use describe the mechanisms of drug resistance development. These include the destruction of the active component of the drug by β-lactamases (this enzyme is usually produced by staphylococci). Gram-negative bacteria differ in the structure of the cell membrane, which reduces the therapeutic efficacy of Retarpen. The development of resistance as a result of mutation of pathogens has also been reported.
Pharmacokinetic parameters
Absorption... After an intramuscular injection, the absorption of the active ingredient occurs rather slowly. Therefore, for most diseases, 1-2 injections are enough for a month. Peak plasma concentrations are noted one day later in children and 48 hours later in adults.
Distribution... About 50-55% of the administered amount of the drug binds to plasma proteins. When prescribing a drug in high dosages, benzylpenicillin is found in hard-to-reach tissues - heart valves, bones, cerebrospinal and pleural fluid. Penetrates through the placental barrier and enters the fetal bloodstream, in high concentrations is found in the amniotic fluid. The volume of distribution is 0.3-0.4 l / kg in adults and 0.75 l / kg in children.
Biotransformation... The drug practically does not undergo metabolic transformations.
Elimination... Up to 80% of the total amount of the active substance is excreted in its original form, mainly by the kidneys (85-95%) with urine, the remaining dose is in a conjugated state with bile.
Pharmacokinetic parameters can change in newborns due to insufficient development of the liver and kidneys, patients with impaired functions of these organs, elderly patients.
Information about the main active ingredient
Benzathine benzylpenicillin is a natural substance with a complex chemical structure. The empirical formula is C48H56N6O8S2. ATX code J01CE08.
The compound exhibits bactericidal activity against the following representatives of the pathogenic flora:
- staphylococci (not producing penicillinase);
- streptococci;
- pneumococci;
- corynebacteria;
- clostridium;
- actinomycetes;
- causative agents of gonorrhea;
- treponem.
But taking into account the peculiarities of the application and the duration of action, benzathine benzylpenicillin is often prescribed for infections provoked by streptococci or treponema.
Indications for use
Retarpen is prescribed for the following diseases:
- erysipelas;
- acute and latent syphilis;
- Lyme disease (tick-borne borreliosis);
- tropical granuloma (sometimes the disease is called non-venereal syphilis);
- pint (Treponema carateum infection).
The drug is also prescribed for prophylactic purposes to prevent:
- rheumatic (autoimmune) complications of streptococcal infection, including damage to the kidneys, myocardium, cartilage tissue;
- syphilis, scarlet fever (after contact with a sick person);
- erysipelas.
There is evidence of the effectiveness of the drug in the treatment of angina and scarlet fever. But with an uncomplicated course of these pathologies, many doctors prefer to replace Retarpen with another broad-spectrum antibiotic in the form of tablets.
List of contraindications and restrictions for use
Not prescribed for individual hypersensitivity to antibiotics from the group of penicillins, cephalosporins and β-lactams; an allergic reaction to soy protein (contained in the auxiliary ingredients).
With caution, the medication is used for allergic diseases (rhinitis, hay fever, contact dermatitis, etc.). The use of Retarpen is inappropriate for infections caused by flora sensitive to the action of the drug, but requiring high concentrations of the antibiotic in the cerebrospinal fluid.
Dosage features
The dose and duration of therapy depends on the type and severity of the infection, the age and functional activity of the patient's liver.
- adults and adolescents: 1.2 IU of diluted medication every 7 days;
- children weighing more than 30 kg: the dose is 1.2 IU weekly;
- children weighing up to 30 kg: 600 IU per week.
The duration of treatment should be determined in such a way as to prevent recurrence of streptococcal infection. For uncomplicated diseases, a single administration of the medicinal solution is sufficient.
Retarpen is used intramuscularly. An injection is made in the upper part of the buttocks, the needle is inserted at a right angle, trying to avoid the area where large blood vessels are located. If bleeding or severe pain occurs, the injection is stopped.
Patients often ask the question of how to dilute the Retarpen lyophilisate. The drug should not be mixed with anything other than water for injection (combination in one syringe with local anesthetics, saline, etc. is contraindicated). To prepare an injection, a 5 ml ampoule of solvent is required. The result is a slurry that is used immediately. The drug is injected slowly, if necessary, two injections are made in different buttocks.
| Diagnosis | Features of dosage and use |
| Syphilis (disease manifestation or secondary stage) | Adults and adolescents: 2.4 IU once Children: 50,000 IU / kg once (but not more than 2.4 IU in total) A repeated course of therapy is necessary with further progression of the disease (laboratory and objective signs) |
| Latent seropositive syphilis | Adults and adolescents: 2.4 IU once a week Children: 50,000 IU / kg weekly Total duration of therapy: 3 weeks (3 injections) |
| Congenital syphilis (no neurological symptoms) | Infants (from the first day of life): 50,000 IU / kg once |
| Non-veneral syphilis, pint | Adults and adolescents: 1.2 IU Children over 30 kg: 1.2 IU Children weighing up to 30 kg: 600,000 IU The drug is administered once |
| Prevention of rheumatoid fever, glomerulonephritis against the background of streptococcal infection, erysipelas | Adults and adolescents: 1.2 IU every 21-28 days Children weighing up to 30 kg: 1.2 IU every 3-4 weeks Children weighing up to 30 kg: 600,000 IU every 3-4 weeks The duration of treatment is determined as follows: Without heart damage: for 5 years or until 21 years of age. For heart disease: at least 10 years old or up to 21 years old. Persistent heart disease: at least 10 years of age or until 40 years of age. Sometimes emergency prophylaxis is required |
| Dosage in certain categories of patients | |
| Creatinine clearance 100-60 ml / min Serum creatinine level 0.8-15 |
The dose is left unchanged. |
| Creatinine clearance 5-10 ml / min Serum creatinine level 1.5-8.0 |
Dosage is reduced by 25% |
| Creatinine clearance up to 10 ml / min Serum creatinine level 15 |
The dose is reduced by 50-80%, while the volume of the solution is divided into 2-3 injections |
Possible adverse reactions
The list of the most common side effects includes:
- candidiasis;
- exacerbation of bacterial infections (with incorrect selection of the dose or resistance of the pathogen);
- allergic reactions up to fatal anaphylactic shock;
- stool disorders;
- pain, swelling at the injection site.
Complications associated with the massive release of toxins as a result of the death of a large number of pathogenic flora are also possible.
Drug interactions
The simultaneous appointment of Retarpen with antibiotics is possible only to increase the results of therapy. At the same time, antibacterial agents of another group are prescribed to expand the spectrum of bactericidal action.
Parallel administration of NSAIDs slows down the elimination of benzylpenicillin from the body.
A medication with cytostatics (in particular, with methotrexate) is used with caution because of the risk of an increase in the toxic effect of the latter.
Retarpen enhances the effect of anticoagulants, which can cause uncontrolled bleeding.
When used simultaneously with hormonal contraceptives, it is necessary to use other methods of contraception.
Salicylates and diuretics increase blood levels of the antibacterial substance, which increases the likelihood of complications.
Alcohol compatibility
Alcohol is contraindicated due to the risk of side effects from the liver.
Special instructions and precautions
The medication is intended for intramuscular injection only. Before the first procedure, you must make sure that there is no allergic reaction. For patients with a history of allergies (including food), the drug is administered in a hospital in the presence of all the necessary medications to relieve anaphylaxis.
Only for health reasons, Retarpen is prescribed to patients with lesions of the hematopoietic system, the Epstein-Barr virus, impaired renal and liver function, mycoses.
Against the background of diabetes mellitus, the absorption of the drug slows down.
After injection, the patient must remain under medical supervision for 12 hours. If Retarpen is used to treat syphilis, after the first injection it is possible:
- headache;
- hot flashes of sweating;
- temperature increase;
- tremor;
- muscle and joint pain;
- nausea and vomiting;
- fluctuations in blood pressure;
- increased heart rate.
The listed symptoms go away on their own and do not require discontinuation of treatment.
With a long course of therapy, it is necessary to monitor the parameters of the kidneys and liver. On the basis of objective symptoms and a blood test, the effectiveness of the treatment is assessed.
In case of accidental injection of a medicinal solution of an antibiotic into a vein or artery, measures should be taken to prevent the risk of complications and skin reactions.
When a prolonged stool disorder occurs, pseudomembranous colitis should be excluded.
Benzathine benzylpenicillin crosses the placental barrier, therefore, the agent is prescribed only after assessing the risk / benefit ratio. Also, the active drug passes into breast milk, which requires suspension of lactation.
On the day of injection (and the next 24-48 hours), you must refrain from driving and work that requires concentration.
Overdose
Storage conditions
At room temperature.
Shelf life
Is 4 years old.
Termination of therapy
It is possible at the discretion of the doctor after receiving the results of laboratory tests and the complete elimination of the pathogenic flora.
Analogs
Analogues of Retarpen in composition and form of release are the following drugs:
- Extencillin, manufactured by Sanofi Aventis, France;
- Bitsillin 1, produced in Russia by Sintez.
Retarpen is characterized by maximum bioavailability and therapeutic efficacy. This allows you to eliminate the pathogenic flora after the first injection, prevent complications and shorten the course of treatment as much as possible. According to experts, Bitsillin 1 is several times inferior in clinical performance to its original counterparts. Therefore, it is necessary to adhere to the established therapy regimen. In any case, only the attending physician can decide what to replace Retarpen with.
Price and where to buy
There is no medication on sale in domestic pharmacies, since the antibiotic is not registered in Russia. There is an option to order from intermediaries who can buy and organize the delivery of Retarpen in the required quantity and the required dosage from Europe.
Given the long shelf life and storage conditions, the medicine is often already available in warehouses in Moscow or St. Petersburg. In this case, the product will be sent shortly after placing the order via the Internet or by phone. In most cases, the drug is purchased directly in Germany, very rarely in Poland. The approximate price of one bottle of Retarpen is 60 euros. The cost will be lower if you order several packages at the same time.
