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רישכתה םש תוליתפ לאסאפר אפר ט"קמ
194057
הרודהמ 'סמ
057004
הסירפ 'ד / 3 חפסנ יפל מ"ס
21X16
עבצ רוחש תופש )תיברעו תילגנא ,תירבע(
סופד לאידיא םילופיק 'סמ
מ"ס 16
3.5-4 )תינדי הזירא( לופיק רחאל יפוס לדוג ריינ גוס םרג 60 ע"נ דוקהמרפ )תולע אלל דוקמרפה תא שיבלי סופדה תיב( 697 דוקהמרפ יוקל תודימ ;מ"מ 1 םיווקה ןיב חוור ;מ"מ 1.5 הבע וק ;מ"מ 0.5 קד וק תופידע - מ"מ 8 םומינימ( מ"מ 10 םומיסקמ וטנ ךרוא )תילמיסקמ הדימל י"ע ןכוה םייטבצמרפ םיתוריש ואלב ךיראת
22.01.2012
Patient Leaflet According to the
Pharmacists’ Regulations
(Preparations) - 1986
This medicine requires a doctor’s
prescription
Please read the entire leaflet carefully
before using this medicine
RAFASSAL SUPPOSITORIES
500 mg
RAFASSAL SUPPOSITORIES
1 gram
Composition
:
Active ingredient
Each suppository of Rafassal 500 mg contains:
5-aminosalicylic acid 500 mg
Each suppository of Rafassal 1 gram contains:
5-aminosalicylic acid 1 gram
The active ingredient is also named mesalazine
or mesalamine.
Inactive ingredients
Hard fat W-45
Therapeutic group:
Salicylates
Therapeutic activity:
Anti-inflammatory medicine which is intended
for the treatment and prevention of ulcerative
colitis and Crohn’s disease.
When
should
this
medicine
not
be
used?
Do not use this medicine if you are
hypersensitive to any of its ingredients or to
other salicylates.
Do
not
take
this
medicine
without
consulting
a
doctor
before
starting
treatment, in the following cases:
If you are pregnant or breastfeeding.
If you suffer or have suffered in the past from
impaired function of the: liver, kidneys/urinary
tract, digestive system (such as peptic ulcer),
blood system (such as coagulation etc.).
Warnings:
sensitive
type
food
medicine
(especially
sulfasalazine),
inform
your doctor before starting treatment with this
medication.
During treatment with this medicine blood, urine
and kidney function tests should be performed.
Drug Interactions:
taking
other
medications
including non-prescription drugs and nutrition
supplements, or if you have recently finished
treatment with another drug, please notify your
doctor in order to prevent any potential risks or
a potential reduction in efficacy that may result
from drug interactions. In particular, medicines
of the following therapeutic groups may interact
with
your
medicine:
aspirin,
anticoagulants,
laxatives, other drugs for the treatment of large
intestine diseases.
Side effects:
In addition to the desired effect of the medicine,
side effects may also appear during the course
taking
this
medicine.
These
include:
diarrhea,
nausea,
vomiting,
abdominal
pain,
headache, weakness.
these
side
effects
persist
and/or
bothersome, please consult your doctor.
The
following
side
effects
require
special attention:
Signs
hypersensitivity
including
bloody
diarrhea,
severe
abdominal
pain,
fever,
skin
rash (rare): Stop the treatment and refer to your
doctor immediately!
Irritation of the anus: Continue the treatment and
refer to your doctor immediately!
If at any time you experience side effects that
are not mentioned in this leaflet or if you feel an
adverse change in your general health, consult
your doctor immediately!
Dosage:
Administer according to the doctor’s instructions
only. Do not exceed the recommended dose.
This medicine is usually not intended for children,
unless instructed by the doctor.
This medicine should be administered at set
intervals according to your doctor’s instructions.
If you forget to take your medicine at the proper
time, take the missed dose as soon as you
remember, but never take two doses at the same
time!
Attention:
Do not swallow! This medicine is intended for
use through the anus.
Wait
least
hours
between
using
this
medicine
inserting
other
medicine
through the anus.
Directions for use:
Remove the wrapper from the suppository. The
suppository may be moistened with some water
to ease its insertion. Lie down on your side and
insert the suppository deep into the anus using
your finger. Wash your hands thoroughly.
Notes:
If the suppository is too soft, it may be
chilled in a refrigerator for approximately
30 minutes or under a stream of cold water
before removing the wrapper.
It is advisable to empty your bowel before
inserting the suppository.
If the suppository comes out within the first
10 minutes, a new suppository should be
inserted.
Do not halve the suppository.
How can you contribute to the success
of the treatment?
Complete
entire
course
treatment
instructed by your doctor.
Even if your condition improves do not stop
taking this drug without consulting your doctor.
Avoid poisoning!
This medicine, and all other medicines, must be
stored in a safe place out of the reach of children
and/or infants, to avoid poisoning.
If you have taken an overdose, or if a child has
accidentally swallowed the medicine, proceed
immediately to a hospital emergency room and
bring the package of the medicine with you.
induce
vomiting
unless
explicitly
instructed to do so by a doctor!
This medicine was prescribed for the treatment
of your ailment; in another patient it may cause
harm. Do not give this medicine to your relatives,
neighbours, or acquaintances.
take
medicines
dark!
Carefully check the label and dose each time
you take the medicine.
Wear your glasses if you need them.
Storage:
This medicine should be stored below 25
Even
stored
properly
according
manufacturer’s recommendations, all medicines
have a limited shelf life. Please pay attention to
the expiry date of your medicine! If you have
doubts,
please
consult
dispensing
pharmacist.
Do not store different medicines in the same
container.
Drug registration number:
Rafassal Suppositories 500 mg: 0511226439
Rafassal Suppositories 1 gram: 0695028345
Rafa Laboratories Ltd.,
P.O.Box 405, Jerusalem 91003
The format of this leaflet was determined by the Ministry
of Health that checked and approved its content in
January 2012.
Rafassal suppositories 500mg & 1gram PIL PB0112-04
رشعلا قئاقدلا ءانثأ ةليمحتلا جورخ لاح في .٣ .ةديدج ةليمتح لاخدإ بجيف ,لىولأا .ةليمحتلا فيصنت زويج لا ؟جلاعلا حاجنب ةدعاسلما كناكمإب فيك .بيبطلا لبق نم هب ىصولما جلاعلا لامكإ كيلع ةراشتسا نودب ءاودلاب جلاعلا نع فقوتلا زويج لا .ةيحصلا كتلاح ىلع نستح أرط اذإ تىح بيبطلا !ممستلا بنتج ناكم في رخآ ءاود لكو ءاودلا اذه ظفح بيج كلذبو عضرلا وأ/و لافطلأا يديأ نع اديعب قلغم .ممستلا عنيم علب اذإ وأ ةيئاودلا ةعرلجا لوانت في تطرفأ اذإ في ئراوطلا ةفرغ لىإ هجوت ,أطلخاب ءاودلا نم دلو .ءاودلا ةوبع ا
بحطصم ,لااح ىفشتسلما !بيبطلا نم ةيحرص تاميلعت نود ؤيقتلا ببست لا ببسي دقو ;كضرم جلاعل فصو ءاودلا اذه ,كبراقأ لىإ ءاود اذه طعت لا .رخآ ضيرلم ررضلا .كفراعم وأ كنايرج ققتح !ملاظلا في ةيودأ لوانت وأ لامعتسا زويج لا ةيئاودلا ةعرلجاو ءاودلا ىلع دوجولما قصللما نم .ءاودلا اهيف لوانتت ةرم لك في .كلذ رملأا مزل اذإ ةيبطلا تاراظنلا عض :نيزختلا .ةيوئم ةجرد ٢٥ تتح نيزختلا بيج تىح ,طقف ةدودم تاترفل ةلحاص ةيودلأا ىقبت ىجري .اهب ىصولما نيزختلا/بيلعتلا فورظ في
ِّ
يأ في !رضحتسلما ة
يحلاص ءاهتنا خيراتل هابتنلاا فرص يذلا ليديصلا ةراشتسا كيلع ,كش ةلاح .ءاودلا اذه كل .ةوبعلا سفن في ةفلتم ةيودأ نزخ زويج لا :ءاودلا ليجست مقر ٠٥١١٢٢٦٤٣٩ :مغلم ٥٠٠ ليماتح لاسافر ٠٦٩٥٠٢٨٣٤٥
:مارغ ١ ليماتح لاسافر ,٤٠٥ .ب.ص ,.ض.م افار تابرتم ٩١٠٠٣سدقلا صح
فو ةرشنلا هذه ةغيص ةحصلا ةرازو ترقأ .٢٠١٢ نياثلا نوناك في اهلبق نم صخ
رو اهاوتم
Rafassal
caplets, supp, enema -DL-May 2015-02
Doctor leaflet
Rafassal
Caplets, Suppositories, Enemas
Composition
Rafassal Caplets:
Active ingredient:
Rafassal 500 mg Caplets: Each caplet contains mesalazine (5-aminosalicylic acid) 500 mg.
Rafassal 1 gram Caplets: Each caplet contains mesalazine (5-aminosalicylic acid) 1000 mg
Inactive ingredients:
Sodium carbonate anhydrous, Glycine, Povidone K25, Cellulose microcrystalline, Sodium
carboxyl methyl cellulose, Silicon dioxide colloidal 200, Calcium stearate, Hydroxypropyl
methyl cellulose, Methacrilic acid copolymer (Eudragit L), Talc (micronized), Titanium dioxide,
Ferric oxide brown, Polyethylene glycol 6000, Simethicone emulsion, Sodium hydroxide
Rafassal Suppositories:
Active ingredient:
Rafassal 500 mg Suppositories :Each suppository contains mesalazine (5-aminosalicylic acid) 500 mg.
Rafassal 1 gram Suppositories :Each suppository contains mesalazine (5-aminosalicylic acid) 1000 mg.
Inactive ingredients:
Hard Fat W-45.
Rafassal Enemas:
Active ingredient:
Rafassal 1 gram Enema: Each enema (60 gram bottle) contains mesalazine (5-aminosalicylic acid) 1 gram.
Rafassal Enema 4 gram: Each enema (60 gram bottle) contains mesalazine (5-aminosalicylic acid ) 4 gram.
Inactive ingredients: Sodium benzoate, Carbomer 934P, Disodium edetate, Potassium
metabisulfite, Potassium acetate, Xanthan gum, Purified water.
Action
Pharmacotherapeutic group: Intestinal antiinflammatory agents; aminosalicylic acid and similar agents.
ATC code: A07EC02
Mechanism of action
The mechanism of the anti-inflammatory action is unknown. The results of in-vitro studies
indicate that inhibition of lipoxygenase may play a role.
Effects on prostaglandin concentrations in the intestinal mucosa have also been
demonstrated. Mesalazine (5-Aminosalicylic acid / 5-ASA) may also function as a radical
scavenger of reactive oxygen compounds.
Pharmacodynamic effects
Mesalazine, orally administered, acts predominantly locally at the gut mucosa and in the
submucous tissue from the luminal side of the intestine. It is important, therefore, that
mesalazine is available at the regions of inflammation. Systemic bioavailability / plasma
concentrations of mesalazine therefore are of no relevance for therapeutic efficacy, but
rather a factor for safety. In order to fulfil these criteria, Rafassal are coated with Eudragit
L; they are thus gastro-resistant and release of mesalazine is pH-dependent.
Rectally administered mesalazine:
On reaching the intestinal lumen, rectally administered mesalazine has largely local effects on
the intestinal mucosaand submucosal tissue.
Pharmacokinetic properties
General considerations of mesalazine:
Absorption:
Mesalazine absorption is highest in proximal gut regions and lowest in distal gut areas.
Biotransformation:
Mesalazine is metabolised both pre-systemically by the intestinal mucosa and the liver to the
pharmacologically inactive N-acetyl-5-aminosalicylic acid (N-Ac-5-ASA). The acetylation
seems to be independent of the acetylator phenotype of the patient. Some acetylation also
occurs through the action of colonic bacteria. Protein binding of mesalazine and N-Ac-5-ASA
is 43% and 78%, respectively.
Elimination:
Mesalazine and its metabolite N-Ac-5-ASA are eliminated via the faeces (major part), renally
(varies between 20 and 50%, dependent on kind of application, pharmaceutical preparation
and route of mesalazine release, respectively), and biliary (minor part). Renal excretion
predominantly occurs as N-Ac-5-ASA.
About 1% of total orally administered mesalazine dose is excreted into the breast milk mainly
as N-Ac-5-ASA.
Orally administerd mesalazine:
Distribution:
Tablets reach the ileocoecal region after approximately 3-4 hours in fasting subjects and
reach the ascending colon within approximately 4–5 hours. The total transit time in the colon
is approximately 17 hours.
Absorption:
The release of mesalazine from caplets begins after a lag-phase of approximately 3–4 hours.
Peak plasma concentrations are reached after approximately 5 hours (ileocoecal region) and,
at 3 x 500 mg mesalazine/ day under steady-state conditions, are 3.0±1.6 µg/ml for
mesalazine and 3.4±1.6 µg/ml for the metabolite, N-Ac-5-ASA.
Elimination:
The total renal elimination rate for mesalazine and N-Ac-5-ASA over 24 hours during multiple
intake (3 x 500mg tablets, for 2 days; 1 tablet on the third day=examination day) was
approximately 60%. The non-metabolised mesalazine fraction after oral administration was
approximately 10%.
Indications
Treatment and prevention of ulcerative colitis and Crohn's disease.
Contraindications
Hypersensitivity to the active substance, salicylates or any of the excipients.
Severe impairment of liver and kidney function.
Warnings and Precautions
Mesalazine has occasionally been implicated in an acute intolerance syndrome. This
syndrome is characterized by abdominal cramps , acute abdominal pain and bloody diarrhea,
fever, severe headache and a rash. In such cases, prompt withdrawal is required. It is
important to be aware of this syndrome in patients who have already displayed intolerance to
sulfasalazine.
Patients with a history of adverse drug reactions to preparations containing
sulphasalazine should be kept under close medical surveillance on commencement of a
course of treatment with mesalazine.
Blood tests (differential blood count; liver function parameters such as ALT or AST; serum
creatinine) and urinary status (dip sticks) should be determined prior to and during treatment,
at the discretion of the treating physician. As a guideline, follow-up tests are recommended 14
days after commencement of treatment, then a further two to three tests at intervals of
4 weeks.
If the findings are normal, follow-up tests should be carried out every 3 months. If additional
symptoms occur, these tests should be performed immediately.
Caution is recommended in patients with impaired liver function.
Mesalazine is not recommended for use in patients with renal impairment. The renal function
should be monitored regularly (e.g. serum creatinine), especially during the initial phase of
treatment. Mesalazine induced nephrotoxicity should be suspected in patients developing
renal dysfunction during treatment.
Caution should be exercised in patients with elevated blood urea or proteinuria.
Patients with pulmonary disease, in particular asthma, should be very carefully monitored
during a course of treatment with mesalazine.
Mesalazine-induced cardiac hypersensitivity reactions (myo-and pericarditis) have rarely been
reported. Serious blood dyscrasias have very rarely been reported with mesalazine.
Haematological investigations should be performed if the patient develops unexplained
bleeding, bruising, purpura, anaemia, fever or sore throat.
In rare cases, in patients who have undergone bowel resection/bowel surgery in the
ileocoecal region with removal of the ileocoecal valve, it has been observed that tablets
contain mesalasine were excreted undissolved in the stool, due to an excessively rapid
intestinal passage.
Rafassal Enemas contain sodium benzoate, which may be mildly irritant to the skin, eyes
and mucous membranes.
Use in Pregnancy
There are no adequate and well-controlled studies in pregnant women.
However, data on a limited number of exposed pregnancies indicate no adverse effect of
mesalazine on pregnancy or on the health of the fetus/newborn child. To date no other
relevant epidemiologic data are available. In one single case after long-term use of a high
dose mesalazine (2-4 g, orally) during pregnancy, renal failure in a neonate was reported.
Animal studies on oral mesalazine do not indicate direct or indirect harmful effects with
respect to pregnancy, embryonic/ fetal development, parturition or postnatal development.
Therefore mesalazine should only be used during pregnancy if the potential benefit outweighs
the possible risk.
Use in Breastfeeding
N-acetyl-5-aminosalicylic acid and to a lesser degree mesalazine are excreted in breast milk.
Only limited experience during lactation in women is available to date. Hypersensitivity
reactions such as diarrhoea in the infant cannot be excluded. Therefore mesalazine should
only be used during breast-feeding if the potential benefit outweighs the possible risk. If the
infant develops diarrhoea, the breast-feeding should be discontinued
Use in Pediatrics
Infants and young children should not be treated with mesalazine unless it is strictly indicated,
or when alternative treatment is ineffective or unavailable.
Interference with Laboratory Tests
Use of mesalamine may lead to spuriously elevated test results when measuring urinary
normetanephrine by liquid chromatography with electrochemical detection, because of the
similarity in the chromatograms of normetanephrine and mesalamine’s main metabolite,
Nacetylaminosalicylic acid (N-Ac-5-ASA). An alternative, selective assay for normetanephrine
should be considered.
Drug Interactions
The concurrent use of mesalazine with other known nephrotoxic agents may increase the risk
of renal reaction
In patients who are concomitantly treated with azathioprine, 6-mercaptopurine or thioguanine,
a possible increase in the myelosuppressive effects of azathioprine, 6-mercaptopurine or
thioguanine should be taken into account.
There is weak evidence that mesalazine might decrease the anticoagulant effect of warfarin.
Effects on ability to drive and use machines
No or negligible effects on the ability to drive and use machines have been observed.
Adverse Reactions
Mesalazine may be associated with an exacerbation of the symptoms of colitis in those
patients who have previously had such problems with sulphasalazine.
Undesirable effects are as follows:
Common
Gastrointestinal disorders:
1% and <10%)
Nausea, vomiting, diarrhoea, abdominal pain
Skin disorders:
Rash (including urticaria and erythematous rash)
General:
Headache
Rare
Blood and lymphatic system disorders:
0.01% and < 0.1%)
Altered blood counts (aplastic anaemia, agranulocytosis,
granulocytopenia, neutropenia, leukopenia, thrombocytopenia)
Nervous system disorders:
Peripheral neuropathy, dizziness
Cardiac disorders:
Myocarditis, pericarditis
Respiratory , thoracic and mediastinal disorders:
Allergic and fibrotic lung reactions (including dyspnoea, cough,
bronchospasm, alveolitis, pulmonary eosinophilia, pulmonary
infiltration, pneumonitis)
Gastrointestinal disorders:
Pancreatitis, increased amylase, flatulence
Liver:
Abnormalities of hepatic function and hepatotoxicity (including,
hepatitis, cirrhosis, hepatic failure)
Renal and urinary disorders :
Impairment of renal function (including acute and chronic
interstitial nephritis,
renal insufficiency, nephrotic syndrome),
urine discolouration (*see additional text)
Collagen disorders:
Lupus erythematosus
syndrome
Very rare
Blood disorders:
(<0.01% )
Anaemia, eosinophilia (as part of an systemic allergic reaction)
and pancytopenia
Hepatobiliary disorders :
Increased bilirubin.
Changes in liver function parameters (increase in
transaminases and parameters of cholestasis), cholestatic
hepatitis
Skin and subcutaneous tissue
disorders:
Alopecia, bullous skin reactions including erythema multiforme
and Stevens-Johnson syndrome
Musculoskeletal and connective tissue disorders:
Myalgia, arthralgia
Immune system disorders:
Hypersensitivity reactions
such as allergic exanthema
anaphylactic reaction, angioedema, drug fever,
pancolitis.
Reproductive system and breast disorders:
Oligospermia (reversible)
*Renal failure has been reported. Mesalazine-induced nephrotoxicity should be suspected in
patients developing renal dysfunction during treatment.
The mechanism of mesalazine-induced myocarditis, pericarditis, pancreatitis, nephritis and
hepatitis is unknown, but it might be of allergic origin.
Hypersensitivity reactions (which are not dose-related) such as allergic skin eruptions,
hyperpyrexia, bronchospasm and lupus erythematosus-like syndrome, cannot be excluded.
Theoretically, elevated methemoglobin levels may occur.
Mesalazine may be associated with the exacerbation of the symptoms of colitis in patients
who have previously had such problems when treated with sulfasalazine.
Following rectal administration local reactions such as pruritus, rectal discomfort and urge
may occur.
Dosage and Administration
During the acute inflammatory stage and in long-term maintenance therapy, Rafassal must be
taken reliably and consistently by the patient. This is essential in order to attain the desired
therapeutic success.
Rafassal Caplets
For acute inflammatory symptoms:
Individual dosage up to 4 gram/day, divided into 2 or 3 doses.
Rafassal caplets should be taken with an ample amount of fluid.
As soon as remission occurs, the dose should be reduced (to 2 g divided into 2 or 3 doses, to
avoid recurrence.
Children
There is only limited documentation for an effect in children (age 6-18 years).
Children 6 years of age and older
Active disease: To be determined individually, starting with 30-50 mg/kg/day in divided
doses. Maximum dose: 75 mg/kg/day. The total dose should not exceed the maximum adult
dose (4 grams).
Maintenance treatment (ulcerative colitis): To be determined individually, starting with
15-30 mg/kg/day in divided doses. The total dose should not exceed the recommended adult
dose (2 grams).
It is generally recommended that half the adult dose may be given to children up to a body
weight of 40 kg; and the normal adult dose to those above 40 kg.
Rafassal Suppositories
For acute inflammatory symptoms: 1 suppository of 500 mg 3 times daily. The suppositories
should be inserted deeply.
As soon as remission occurs, the dose should be reduced.
Rafassal Enemas
Dosage should be adjusted to the individual response to each patient.
Higher daily doses are recommended for acute disease episodes, with dose strength tapering
as disease remits.
Rectal suspensions of 5-aminosalicylic acid are best retained if administered at bedtime.
Optimal results are expected for those individuals retaining the medication during the entire
rest period.
Initiate therapy with bedtime administration of a 4 gram enema.
Response to therapy and adjustment of dosage should be determined by periodic
examination, including endoscopy and assessment of symptomatology, i.e. frequency of
bowel movements and rectal bleeding. The daily dosage should be tapered when a
significant response (improvement) or remission is attained. Abrupt withdrawal of therapy
without tapering to lower daily doses is not recommended.
Maintenance therapy is indicated to assure continued remission. The dosing schedule may be
every other day, every third day, or as required. The optimum maintenance dose should be
determined for each patient. If symptoms recur, dosage should be increased to the
previously effective level.
The 1 gram enema provides flexibility in dosing.
Overdose
There are rare data on overdosage (e.g. intended suicide with high oral doses of
mesalazine), which do not indicate renal or hepatic toxicity. There is no specific antidote
and treatment is symptomatic and supportive.
Storage condition: Store below 25ºC.
Presentations and Registration Numbers:
Rafassal Caplets 500 mg:
0511126440
Rafassal Caplets 1 g:
0678028346
Rafassal 500 mg Suppositories: 0511226439
Rafassal Suppositories 1 g:
0695028345
Rafassal Enema 1 g:
1203926001
Rafassal Enema 4 g:
0295825321
Rafa Laboratories Ltd., P O Box 405, Jerusalem 9100301
The format and content of this document have been approved by the Ministry of Health in
May 2015.
לע העדוה לע העדוה ( הרמחה ( הרמחה עדימ עדימ )תוחיטב )תוחיטב :ךיראת
10
יאמב
2015
תילגנאב רישכת םש
:םושיר רפסמו
RAFASSAL CAPLETS 500MG
(
051 11 26440 00
),
RAFASSAL CAPLETS 1G
067 80
28346 00
RAFASSAL ENEMA 1G
120 39 26001 00),
RAFASSAL ENEMA 4G
(029 58 25321 00
RAFASSAL SUPPOSITORIES 500MG (
051 12 26439 00
),
RAFASSAL SUPPOSITORIES 1G
069 50 28345 00)
מ"עב אפר תודבעמ :םושירה לעב םש .עבצב םינמוסמ (הרמחה םג םיווהמ בור יפ לעש) םיייתועמשמה םייונישה
בוהצ ,הפסוה=
קורי .הקיחמ= אפורל ןולעב אפורל ןולעב ןולעב קרפ יחכונ טסקט שדח טסקט
Product Name
Rafassal
Tablets, Suppositories, Enemas
Rafassal
TabletsCaplets, Suppositories, Enemas
Composition
(inactives)
Rafassal Caplets
Inactive ingredients:
Sodium carbonate anhydrous, Glycine, Povidone
K25, Cellulose microcrystalline, Sodium carboxyl
methyl cellulose, Silicon dioxide colloidal 200,
Calcium stearate, Hydroxypropyl methyl cellulose,
Methacrilic acid copolymer (Eudragit L), Talc
(micronized), Titanium dioxide, Ferric oxide
brown, Polyethylene glycol 6000, Simethicone
emulsion, Sodium hydroxide
Rafassal Suppositories:
Inactive ingredients:
Hard Fat W-45
Rafassal Enemas
Inactive ingredients: Sodium benzoate,
Carbomer 934P, Disodium edentate, Potassium
metabisulfite, Potassium acetate, Xanthan gum,
Purified water
Contra-
indications
Known hypersensitivity to salicylates or
any of the excipients.
Severe disorders of liver and kidney
function, and in the presence of gastric
or duodenal ulcers.
Not to be used in patients where there
is a pathologically elevated tendency
to hemorrhage.
Hypersensitivity to the active substance, salicylates
or any of the excipients.
Severe disorders impairment of liver and kidney
function, and in the presence of gastric or duodenal
ulcers.
Not to be used in patients where there is a
pathologically elevated tendency to hemorrhage.
Warnings and
Precautions
Mesalazine has occasionally been
implicated in an acute intolerance
syndrome. This syndrome is
characterized by cramping, acute
abdominal pain and bloody diarrhea,
and sometimes, fever, headache and
a rash. In such cases, prompt
withdrawal is required. It is important
to be aware of this syndrome in
patients who have already displayed
intolerance to sulfasalazine
Caution is recommended in patients
with impaired liver function.
The drug is not recommended for use
Mesalazine has occasionally been implicated in an
acute intolerance syndrome. This syndrome is
characterized by cramping
abdominal cramps ,
acute abdominal pain and bloody diarrhea, and
sometimes, fever, severe headache and a rash. In
such cases, prompt withdrawal is required. It is
important to be aware of this syndrome in patients
who have already displayed intolerance to
sulfasalazine.
Patients with a history of adverse
drug reactions to preparations containing
sulphasalazine should be kept under close medical
surveillance on commencement of a course of
treatment with mesalazine.
Blood tests (differential blood count; liver function
parameters such as ALT or AST; serum creatinine)
in patients with renal impairment. The
renal function should be monitored
regularly (e.g. serum creatinine),
especially during the initial phase of
treatment. Mesalazine induced
nephrotoxicity should be suspected in
patients developing renal dysfunction
during treatment.
Caution should be exercised in
patients with elevated blood urea or
proteinuria.
Mesalazine-induced cardiac
hypersensitivity reactions (myo-and
pericarditis) have rarely been
reported. Serious blood dyscrasias
have very rarely been reported with
mesalazine. Haematological
investigations should be performed if
the patient develops unexplained
bleeding, bruising, purpura, anaemia,
fever or sore throat
Use in Pregnancy
There are no adequate and well-
controlled studies in pregnant
women. Therefore Rafassal should
be used during pregnancy only if
clearly needed
Use in Breastfeeding
Low concentrations of mesalamine and
higher concentrations of its N-acetyl
metabolite have been detected in
human breast milk. While the clinical
significance of this has not been
determined, caution should be
exercised when mesalamine is
administered to a nursing woman.
Use in Pediatrics
Infants and young children should not
be treated with this drug unless it is
strictly indicated, or when alternative
treatment is ineffective or unavailable.
and urinary status (dip sticks) should be determined
prior to and during treatment, at the discretion of the
treating physician. As a guideline, follow-up tests
are recommended 14 days after commencement of
treatment, then a further two to three tests at
intervals of 4 weeks.
If the findings are normal, follow-up tests should
be carried out every 3 months. If additional
symptoms occur, these tests should be performed
immediately.
Caution is recommended in patients with impaired
liver function.
Mesalazine is not recommended for use in patients
with renal impairment. The renal function should be
monitored regularly (e.g. serum creatinine),
especially during the initial phase of treatment.
Mesalazine induced nephrotoxicity should be
suspected in patients developing renal dysfunction
during treatment.
Caution should be exercised in patients with
elevated blood urea or proteinuria.
Patients with pulmonary disease, in particular
asthma, should be very carefully monitored during a
course of treatment with mesalazine.
Mesalazine-induced cardiac hypersensitivity
reactions (myo-and pericarditis) have rarely been
reported. Serious blood dyscrasias have very rarely
been reported with mesalazine. Haematological
investigations should be performed if the patient
develops unexplained bleeding, bruising, purpura,
anaemia, fever or sore throat.
In rare cases, in patients who have undergone
bowel resection/bowel surgery in the ileocoecal
region with removal of the ileocoecal valve, it has
been observed that tablets contain mesalasine
were excreted undissolved in the stool, due to an
excessively rapid intestinal passage.
Rafassal Enemas contain sodium benzoate, which
may be mildly irritant to the skin, eyes and mucous
membranes.
Use in Pregnancy
There are no adequate and well-controlled studies
in pregnant women.
However, data on a limited number of exposed
pregnancies indicate no adverse effect of
mesalazine on pregnancy or on the health of the
fetus/newborn child. To date no other relevant
epidemiologic data are available. In one single case
after long-term use of a high dose mesalazine (2-4
g, orally) during pregnancy, renal failure in a
neonate was reported.
Animal studies on oral mesalazine do not indicate
direct or indirect harmful effects with respect to
pregnancy, embryonic/ fetal development,
parturition or postnatal development.
Therefore mesalazine should be used during
pregnancy only if clearly needed should only be
used during pregnancy if the potential benefit
outweighs the possible risk.
Use in Breastfeeding
Low concentrations of mesalamine and higher
concentrations of its N-acetyl metabolite have been
detected in human breast milk. While the clinical
significance of this has not been determined,
caution should be exercised when mesalamine is
administered to a nursing woman.
N-acetyl-5-aminosalicylic acid and to a lesser
degree mesalazine are excreted in breast milk. Only
limited experience during lactation in women is
available to date. Hypersensitivity reactions such as
diarrhoea in the infant cannot be excluded.
Therefore mesalazine should only be used during
breast-feeding if the potential benefit outweighs the
possible risk. If the infant develops diarrhoea, the
breast-feeding should be discontinued
Use in Pediatrics
Infants and young children should not be treated
with mesalazine unless it is strictly indicated, or
when alternative treatment is ineffective or
unavailable.
Interference with Laboratory Tests
Use of mesalamine may lead to spuriously elevated
test results when measuring urinary
normetanephrine by liquid chromatography with
electrochemical detection, because of the similarity
in the chromatograms of normetanephrine and
mesalamine’s main metabolite,
Nacetylaminosalicylic acid (N-Ac-5-ASA). An
alternative, selective assay for normetanephrine
should be considered.
Drug
Interactions
The hypoglycemic effect of
sulfonylureas may be enhanced.
Interaction may occur with coumarin
derivatives.
Rafassal tablets may intensify the
undesirable effects of glucocorticoids
on the stomach.
Concurrent administration of lactulose
and products which may decrease
stool pH may prevent release of the
drug.
The concurrent use of mesalazine with
other known nephrotoxic agents, such
as NSAIDs and azathioprine, may
increase the risk of renal reaction
Concomitant treatment with
mesalazine can increase the risk of
blood dyscrasia in patients receiving
azathioprine or 6-mercaptopurine.
Treatment should be discontinued on
suspicion or evidence of these adverse
reactions.
Concurrent administration with other
The hypoglycemic effect of sulfonylureas may be
enhanced.
Interaction may occur with coumarin derivatives.
Rafassal tablets may intensify the undesirable
effects of glucocorticoids on the stomach.
Concurrent administration of lactulose and products
which may decrease stool pH may prevent release
of the drug.
The concurrent use of mesalazine with other known
nephrotoxic agents, such as NSAIDs and
azathioprine, may increase the risk of renal reaction
Concomitant treatment with mesalazine can
increase the risk of blood dyscrasia in patients
receiving azathioprine or 6-mercaptopurine.
Treatment should be discontinued on suspicion or
evidence of these adverse reactions.
Concurrent administration with other inflammatory
bowel disease products may intensify undesirable
effects.
In patients who are concomitantly treated with
azathioprine, 6-mercaptopurine or thioguanine, a
possible increase in the myelosuppressive effects of
inflammatory bowel disease products
may intensify undesirable effects.
azathioprine, 6-mercaptopurine or thioguanine
should be taken into account.
There is weak evidence that mesalazine might
decrease the anticoagulant effect of warfarin.
Effects on
ability to
drive and use
machines
Effects on ability to drive and use machines
No or negligible effects on the ability to drive and
use machines have been observed.
Adverse
Reactions
Rare (
0.01% and < 0.1%)
Blood disorders:
Aplastic anaemia, agranulocytosis,
granulocytopenia, neutropenia,
leukopenia, thrombocytopenia
Nervous system disorders:
Peripheral neuropathy
Cardiac disorders:
Myocarditis, pericarditis
Respiratory disorders:
Allergic lung reactions (including
dyspnoea, cough, allergic alveolitis,
pulmonary eosinophilia, pulmonary
infiltration, pneumonitis)
Gastrointestinal disorders:
Pancreatitis, increased amylase,
Liver:
Abnormalities of hepatic function and
hepatotoxicity (including, hepatitis,
cirrhosis, hepatic failure)
Urogenital:
Abnormal
renal function (including
interstitial nephritis, nephrotic
syndrome), urine discolouration (*see
additional text)
Collagen disorders:
Lupus erythematosus-like reactions
Very rare (<0.01% )
Blood disorders:
Anaemia, eosinophilia (as part of an
allergic reaction**) and pancytopenia
Rare (
0.01% and < 0.1%)
Blood and lymphatic system disorders:
Altered blood counts (aplastic anaemia,
agranulocytosis, granulocytopenia, neutropenia,
leukopenia, thrombocytopenia)
Nervous system disorders:
Peripheral neuropathy, dizziness
Cardiac disorders:
Myocarditis, pericarditis
Respiratory , thoracic and mediastinal disorders:
Allergic and fibrotic lung reactions (including
dyspnoea, cough,
bronchospasm, allergic alveolitis,
pulmonary eosinophilia, pulmonary infiltration,
pneumonitis)
Gastrointestinal disorders:
Pancreatitis, increased amylase, flatulence
Liver:
Abnormalities of hepatic function and hepatotoxicity
(including, hepatitis, cirrhosis, hepatic failure)
Renal and urinary disorders Urogenital:
Abnormal
Impairment of renal function (including
acute and chronic interstitial nephritis,
renal
insufficiency, nephrotic syndrome), urine
discolouration (*see additional text)
Collagen disorders:
Lupus erythematosus-like reactions
syndrome
Very rare (<0.01% )
Blood disorders:
Anaemia, eosinophilia (as part of an systemic
allergic reaction) and pancytopenia
Liver
Hepatobiliary disorders :
Liver :
Increased liver enzymes and bilirubin.
Skin disorders:
Reversible Alopecia, bullous skin
reactions including erythema
multiforme and Stevens-Johnson
syndrome**
Musculoskeletal disorders:
Myalgia, arthralgia
Allergic reactions:
Hypersensitivity reactions
drug fever,.
Hypersensitivity reactions (which are
not dose-related) such as allergic skin
eruptions, hyperpyrexia,
bronchospasm and lupus
erythematosus-like syndrome, cannot
be excluded.
Increased liver enzymes and bilirubin.
Changes in liver function parameters (increase in
transaminases and parameters of cholestasis),
cholestatic hepatitis
Skin and subcutaneous tissue
disorders:
Reversible Alopecia, bullous skin reactions
including erythema multiforme and Stevens-
Johnson syndrome
Musculoskeletal and connective tissue disorders:
Myalgia, arthralgia
Immune system disorders Allergic reactions:
Hypersensitivity reactions
such as allergic
exanthema, anaphylactic reaction, angiedema, drug
fever,
pancolitis.
Reproductive system and breast disorders:
Oligospermia (reversible)
…
Hypersensitivity reactions (which are not dose-
related) such as allergic skin eruptions,
hyperpyrexia, bronchospasm and lupus
erythematosus-like syndrome, cannot be excluded.
Theoretically, elevated methemoglobin levels may
occur.
Mesalazine May be associated with the
exacerbation of the symptoms of colitis in patients
who have previously had such problems when
treated with sulfasalazine.
Following rectal administration local reactions such
as pruritus, rectal discomfort and urge may occur.
Dosage and
Administra-
tion
…
Rafassal Caplets
For acute inflammatory symptoms:
Individual dosage up to 4 gram/day,
divided into 3 doses..
Rafassal tablets should be taken with
food or after meals with an ample
amount of fluid.
As soon as remission occurs, the dose
should be reduced (to 1.5g into 3
doses, to avoid recurrence.
The patient should wait at least 2
hours between taking this drug and
other drugs that may affect
gastrointestinal acidity (e.g.omeprazole
and antacids)
Children: Individual dosage, starting
with 50 mg/kg bodyweight daily in
divided doses.
Rafassal Suppositories
For acute inflammatory symptoms: 1
suppository of 500 mg 3 times daily.
The suppositories should be inserted
deeply.
As soon as remission occurs, the dose
should be reduced to 1 suppository of
Rafassal 250 mg 3 times daily to avoid
recurrence.
Rafassal Enemas…
…
Rafassal Caplets
For acute inflammatory symptoms:
Individual dosage up to 4 gram/day, divided into 2
3 doses.
Rafassal caplets should be taken with food or after
meals with an ample amount of fluid.
As soon as remission occurs, the dose should be
reduced (to 1.5g 2 g divided into 2 or
3 doses, to
avoid recurrence.
The patient should wait at least 2 hours between
taking this drug and other drugs that may affect
gastrointestinal acidity (e.g.omeprazole and
antacids)
Children: Individual dosage, starting with 50 mg/kg
bodyweight daily in divided doses.
Children
There is only limited documentation for an effect in
children (age 6-18 years).
Children 6 years of age and older
Active disease: To be determined individually,
starting with 30-50 mg/kg/day in divided doses.
Maximum dose: 75 mg/kg/day. The total dose
should not exceed the maximum adult dose.
Maintenance treatment (ulcerative colitis): To be
determined individually, starting with 15-30
mg/kg/day in divided doses. The total dose should
not exceed the recommended adult dose.
It is generally recommended that half the adult dose
may be given to children up to a body weight of 40
kg; and the normal adult dose to those above 40 kg.
Rafassal Suppositories
For acute inflammatory symptoms: 1 suppository of
500 mg 3 times daily. The suppositories should be
inserted deeply.
As soon as remission occurs, the dose should be
reduced to 1 suppository of Rafassal 250 mg 3
times daily to avoid recurrence.
Rafassal Enemas…
Overdose
Acute experience in animals:
Single oral doses of
mesalazine up to 5 g/kg in pigs
or single intravenous dose of
mesalazine at 920 mg/kg in
rats were not lethal.
Human experience: No cases
of overdose have been
reported.
Management of overdose in
man: Symptomatic treatment
(at hospital). . Close
monitoring of renal function.
There are rare data on overdosage (e.g.
intended suicide with high oral doses of
mesalazine), which do not indicate renal or
hepatic toxicity. There is no specific antidote and
treatment is symptomatic and supportive.
Acute experience in animals: Single oral
doses of mesalazine up to 5 g/kg in pigs or
single intravenous dose of mesalazine at
920 mg/kg in rats were not lethal.
Human experience: No cases of overdose
have been reported.
Management of overdose in man:
Symptomatic treatment (at hospital). . Close
monitoring of renal function.
ןכרצל ןולעב ןכרצל ןולעב
–
דבלב ןקוח לאסאפר רובע ןולעב קרפ יחכונ טסקט שדח טסקט תדעוימ המל הפורתה
תיתקלד-יטנא הפורת
תדעוימ הפורתה יעמב תיביכ תקלד לש העינמלו לופיטל ) סגה
ulcerative colitis
.ןהורק תלחמ לשו תיביכ תקלד לש העינמלו לופיטל תדעוימ הפורתה ) סגה יעמב
ulcerative colitis
ןהורק תלחמ לשו שמתשהל ןיא םא הפורתב תושיגר העודי םא רישכתב שמתשהל ןיא וא ,םירחא םיטליצילסל ,ויביכרממ דחאל םויסטופ ליכמ הז רישכתש ןוויכמ טיפלוסל טיפלוסיב הטמ
םיטליצילסל ,ליעפה רמוחל (יגרלא) שיגר התא ,ןיריפסא תמגודכ הז רישכתש ןוויכמ) טיפלוסל דחא לכל וא ,(טיפלוסיב הטמ םויסטופ ליכמ רישכתה ליכמ רשא םיפסונה םיביכרמהמ ףיעס האר ,םיליעפ יתלבה םיביכרמה תמישרל)
דוקפתב רומח יוקלמ לבוס התא םא שמתשהל ןיא .תוילכה וא דבכה תורהזא תודחוימ תועגונה שומישל הפורתב הפורתל וא והשלכ ןוזמל שיגר ךניה םא ךילע ,(ןיזאלסאפלוסל דחוימב) יהשלכ .הפורתה תליטנ ינפל אפורל ךכ-לע עידוהל ךורעל שי
הפורתב לופיטה תפוקתב .תוילכ ידוקפתו ןתש ,םד תוקידב
לע טילחי אפורהו ןכתיי ,הפורתב לופיטה ךלהמב ףיעסב 'בקעמו תוקידב' םג האר) דומצ יאופר בקעמ
,יהשלכ הפורתל וא והשלכ ןוזמל שיגר התא םא הפורתה תליטנ ינפל אפורל ךכ-לע עידוהל ךילע תלחתה ינפל רפס לופיטה ךלש אפורל .הקינימ וא ןוירהב ךניה םא יוקילמ רבעב תלבס וא לבוס ךניה םא ,ןתשה תכרעמ/הילכה ,דבכה :דוקפתב תכרעמ ,(יטפפ ביכ ןוגכ) לוכיעה תכרעמ ('וכו השירק ןוגכ) םדה
.
דחוימב ,תואיר תויעבמ רבעב תלבס וא לבוס התא םא .המטסאמ לבוס התא םא
םשב רמוחל היגרלאמ רבעב תלבס וא לבוס התא םא ) ןיזלאסאפלוס
sulphasalazine
שרדת ,הזכ הרקמב םינימסת םיעיפומו הדימב) .הדומצ תיאופר החגשה ,ןטבב תותיווע וא םיבאכ :ןוגכ ,תוליבס יא לש םיטוקא תא קיספהל שי - החירפ ,שאר באכ ,םוח ,ימד לושלש .(דימ לופיטה
.דבכה דוקפתב תויעבמ רבעב תלבס וא לבוס התא םא
דוקפתב תויעבמ רבעב תלבס וא לבוס התא םא .ןתשה תכרעמ/הילכה תכרעמ:דוקפתב יוקילמ רבעב תלבס וא לבוס ךניה םא השירק ןוגכ) םדה תכרעמ ,(יטפפ ביכ ןוגכ) לוכיעה ('וכו
.
התא םא םא וא חקול תחקל תופורת תורחא :תויתפורת ןיב תובוגת ללוכ ,תופסונ תופורת לטונ ךניה םא יפסותו םשרמ אלל תורכמנה תופורת לופיט התע הז תמייס םא וא ,הנוזת אפורל חוודל ךילע ,תרחא הפורתב תוליעי-יא וא םינוכיס עונמל ידכ לפטמה דחוימב ,תויתפורת-ןיב תובוגתמ םיעבונה ,ןיריפסא :תואבה תוצובקהמ תופורת יבגל תולשלשמ תופורת ,םד תשירק דגנ תופורת יעמה תולחמב לופיטל תופסונ תופורתו .סגה ,תורחא תופורת הנורחאל תחקל םא וא חקול התא םא ךכ לע רפס ,הנוזת יפסותו םשרמ אלל תופורת ללוכ .חקורל וא אפורל חקורה וא אפורה תא עדייל שי דחוימב המישרה יכ ןייצל שי) תואבה תופורתה תא חקול התא םא ךניא םא .תופורתב םיליעפה םירמוחה תא תנייצמ ןלהלש אנא וללה תופורתהמ תחאב שמתשמ התא םאה חוטב :(חקורה וא אפורה םע ץעייתה
םד תשירק דגנ תומיוסמ תופורת .(ןירפרו ןוגכ)
.ןיריפסא
,ןירפויתזא
תופורת) ןינאוגוית ,ןירוטפקרמ- .(תינוסיחה תכרעמב תוערפהב לופיטל תושמשמה וא םינוכיס עונמל ידכ לפטמה אפורל חוודל ךילע יבגל דחוימב ,תויתפורת-ןיב תובוגתמ םיעבונה תוליעי-יא :תואבה תוצובקהמ תופורת
תופורתו תולשלשמ תופורת
.סגה יעמה תולחמב לופיטל תופסונ הקינמו ןוירה ץעוויהל ילבמ רישכתב שמתשהל ןיא םירקמב לופיטה תלחתה ינפל אפורב :םיאבה
הקינימ וא ןוירהב ךניה םא
הקנהו ןוירה
.ןוירהב תא םא אפורה םע ץעייתהל ילבמ הפורתב שמתשהל ןיא
הקינמ תא םא אפורה םע ץעייתהל ילבמ הפורתב שמתשהל ןיא .(םא בלחב תרבוע הפורתה) :הפורתה לש םיביכרמהמ קלח לע בושח עדימ םורגל לולעה ,טאוזנב םוידוס רמשמה תא ליכמ ןקוחה .תוירירה תונרבממבו םייניעב ,רועב לק יוריגל שומיש םידליב :ןונימ רובעל ןיא .דבלב אפורה תוארוה יפל ןונימ .תצלמומה הנמה לע םידליל ללכ ךרדב תדעוימ הניא וז הפורת .אפור תארוה יפ לע אלא
:םידליב שומיש
שומישה .םידליב שומישב בר ןויסינ ןיא יאליגב םירגבתמו םידליב
דע
תוארוה יפל אוה .םפוג לקשמל םאתהבו אפורה
תדעוימ הניא וז הפורת .אפור תארוה יפ לע אלא םידליל ללכ ךרדב דציכ שמתשת ?הפורתב :ןונימ רובעל ןיא .דבלב אפורה תוארוה יפל ןונימ .תצלמומה הנמה לע :תורהזא הפורתל וא והשלכ ןוזמל שיגר ךניה םא ךילע ,(ןיזאלסאפלוסל דחוימב) יהשלכ .הפורתה תליטנ ינפל אפורל ךכ-לע עידוהל ךורעל שי
הפורתב לופיטה תפוקתב .תוילכ ידוקפתו ןתש ,םד תוקידב
,ןונימה לופיטה ךשמו לופיטה ןפוא אפורה ידי לע ועבקיי .דבלב
בקעמו תוקידב
לופיטה תליחת ינפל ןכתיי וכלהמבו ןתש ,םד תוקידב רובעל ךרטצתו
ידוקפתו דבכ ו .תוילכ יאוול תועפות ןמזב ,הפורתה לש היוצרה תוליעפל ףסונב יאוול תועפות עיפוהל תולולע הב שומישה ,ןטב יבאכ ,האקה ,הליחב ,לושלש :ןוגכ .השלוח ,שאר באכ ןהש וא תופלוח ןניא יאוולה תועפות םא .אפורה םע ץעייתהל שי ,תודירטמ תדחוימ תוסחייתה תובייחמה תועפות
:
לושלש ללוכ ,רתי תושיגר ינמיס עיפוהב םיקזח ןטב יבאכ ,רועב החירפ ,םוח ,ימד אפורל הנפו לופיטה קספה - (רידנ) דואמ !דימ הנפו לופיטה ךשמה – תעבטה יפב יוריג !דימ אפורל יאוול תועפות שיגרמ ךניה ובש הרקמ לכב יוניש לח םא וא ,הז ןולעב וניוצ אלש םע ץעייתהל ךילע תיללכה ךתשגרהב !דימ אפורה הב שומישה ןמזב ,הפורתה לש היוצרה תוליעפל ףסונב :ןוגכ יאוול תועפות עיפוהל תולולע
השלוח
םורגל לולע לאסאפר ןקוחב שומישה ,הפורת לכב ומכ יאוולה תועפות םא .םישמתשמהמ קלחב יאוול תועפותל שי ,תורימחמ ןהש וא תודירטמ ןהש וא תופלוח ןניא תועפות תמישר ארקמל להבית לא .אפורה םע ץעייתהל .ןהמ תחא ףאמ לובסת אלו ןכתי ,יאוולה :םיאבה םירקמב דימ אפורל הנפו לופיטה קספה
עיפוהב וא המדאויגנא
רתי תושיגר ינמיס (היגרלא)
ןוגכ
דואמ םיקזח ןטב יבאכ ,רועב החירפ ,םוח
יישק וא .המישנ
הוולמה וזכ דחוימב ,הער תיללכ השגרהמ לבוס התא םא הלא םינימסת תורידנ םיתעל .ןורגב וא הפב םיבאכ וא/ו םוחב םינבלה םדה יאת רפסמב הדירי לע דיעהל םילולע רתוי שיגר תויהל ךל םורגל לולעה בצמ ,(סיזוטיצולונרגא) .רומח םוהיז חתפל עיפוהב דימ אפורל הנפו לופיטה ךשמה יפב יוריג .תעבטה :תופסונ יאוול תועפות -ב תועיפומ( תוחיכש יאוול תועפות
1-10
םישמתשמ ךותמ
100
:)
.תואקה ,תוליחב ,םילושלש ,ןטב באכ
תקלדו םדוא ,הירקיטרוא ללוכ) תוירוע תובוגתו החירפ .(רועב
.שאר באכ -ב תועיפומ( תורידנ יאוול תועפות
1-10
םישמתשמ ךותמ
10,000
:)
.תרוחרחס ,םיזג
האצותכ םייפגה תוחפנתה וא המישנ רצוק ,הזחב באכ םורקב וא בלה רירשב תקלד ללוכ) בלה לע העפשהמ .(בלה
.םד תריפסב םייוניש
היתפוריונ) םילגרבו םיידיב ץוצקעו השוחת רסוח .(תיפקיה
,תואירה לש םירחא םייתקלד םיבצמ וא/ו תיגרלא תקלד
,לועיש ,המישנ רצוקב ראשה ןיב אטבתהל םילוכיש .ןגטנרב הארנה תואירב לצ ,המישנב םיפוצפיצ
.רומח ןטב באכב אטבתהל הלוכיש בלבלב תקלד
תבהצ (ןיעה ןבולו רועה לש הבהצהב אטבתהל הלוכיש) תמירזב וא/ו דבכב םייוקילמ האצותכ ןטב באכ וא/ו .(םד תוקידבב םג םיאטבתמש) הרמה
.זלימע םיזנאה לש הילע
םיוולמה ,תוילכה ידוקפתב םייוניש ,ןתשה עבצב יוניש .םיינתומב באכ וא םייפגה תוחפנתהב םיתיעל
.(סופול) תיתנמדא תבאז תיומד תנומסת שמתשממ תוחפב תועיפומ( דואמ תורידנ יאוול תועפות ךותמ דחא
10,000
:)
.הימנא ןוגכ םדה תכרעמב תוערפה
.ןיבוריליב לש הילע
וא תקלדמ האצותכ רומח ןטב באכ וא/ו רומח לושלש .יעמה לש תיגרלא הבוגת
ןוגכ הרומח תירוע הבוגת
Erythema multiforme
תנומסת
Steven-Johnson
.םיקרפמ וא/ו םירירש יבאכ
.תוחרקתה ,רעיש תרישנ
.ערזה רוצייב הכיפה הדירי תועפות
יאוול
ןתוחיכשש
הניא
העודי
)
תועפות
ןתוחיכשש םרט
העבקנ
(:
.תיטקליפאנא הבוגת ,ןיבולגומהתמב הילע
יא ,דרג ןוגכ תעבטה יפב תוימוקמ תובוגת ונכתיי .האיציל תופיחדו תעבטה יפב תוחונ וניוצ אלש יאוול תועפות שיגרמ ךניה ובש הרקמ לכב ךילע תיללכה ךתשגרהב יוניש לח םא וא ,הז ןולעב דימ אפורה םע ץעייתהל