Efferalgan Children's: instructions for use. A drug with an analgesic effect - children's syrup Efferalgan: instructions for use and general recommendations for use Efferalgan powder instructions for use

Unfortunately, all children suffer from respiratory ailments, due to the characteristics of their body, weak immunity. Most diseases are accompanied by an increase in body temperature, which is an absolutely normal reaction of the body to pathogenic microorganisms.

You can cope with a fever in a child with the help of various medicines, one of the most effective is Efferalgan syrup. The product has a pleasant taste and aroma, quickly lowers the baby's body temperature, has an analgesic effect, and is absolutely safe for the child's body.

Pharmacological properties

Efferalgan syrup is a quality medicinal product with analgesic, antipyretic effect, it is often used in pediatrics. The active substance of the drug - paracetamol, is a non-narcotic analgesic, perfectly copes with the task, does not harm the child's body.

The analgesic effect is achieved by affecting the amount of prostaglandins in the nervous tissue, as a result - a decrease in the pain impulse. The elimination of heat is carried out by getting paracetamol into the thermoregulation center located in the hypothalamus. The drug does not have an anti-inflammatory effect, it is necessarily used in combination with other drugs aimed at the destruction of pathogens.

After application, the drug is well absorbed into gastrointestinal tract, the maximum concentration of the active substance is reached after half an hour. The medicinal product is excreted along with the kidneys. The half-life of the drug is about 4 hours. If a small patient suffers from kidney disease, this period is significantly increased.

Release form and composition of the drug

Efferalgan is produced in the form of a viscous liquid (syrup) with a pleasant caramel-vanilla smell. The main active ingredient is paracetamol. Additionally, the medication includes: citric acid, macrogol 6000, potassium sorbate, caramel-vanilla flavors, others. Auxiliary components provide the desired consistency to the drug, give the syrup a pleasant taste and aroma.

Efferalgan is produced in bottles of 90, 150 ml. Means is packed into plastic bottles, cardboard packaging. The kit necessarily includes a measuring spoon that helps to measure the right amount of the drug, this aspect helps to avoid overdose, the occurrence of undesirable effects.

Indications for use

Efferalgan syrup is actively used to solve the following problems in pediatrics:

as an anesthetic, antipyretic during the course, including influenza;
with infectious diseases, which are accompanied by an increase in body temperature;
in the period after vaccination, if there is an increased body temperature, other unpleasant symptoms;
as an anesthetic medicinal product with an average level of pain (muscle pain, neuralgia).

Note! The drug is potent, be sure to consult a doctor before use. It is strictly forbidden to fight fever, other unpleasant symptoms in a child on your own.

Contraindications and possible side effects

Efferalgan syrup is forbidden to use in the following cases:

with hypersensitivity to paracetamol or another component of the drug;
if serious pathologies of the liver, kidneys are found;
the presence of diseases of the circulatory system;
for children up to the first month of life;
in the presence of serious chronic diseases internal organs and systems.

In most cases, the medication is well tolerated by the child's body. It is not excluded the possibility of negative effects arising against the background of individual intolerance to the components of the drug, other features of the child's body.

Possible side effects:

, nausea, irritation of the rectum, serious problems with the digestive system;
allergic reaction (, Quincke's edema, rash on the skin, itching);
prolonged use of the syrup can cause regular abdominal pain, increased blood pressure, anaphylactic shock, diarrhea and other unpleasant symptoms;
uncontrolled long-term use leads to changes in the composition of the blood, problems with the mental health of the child.

Overdose in children is manifested by pallor of the skin, low body temperature, anorexia, abdominal pain. Absence medical care leads to irreversible consequences in blood liver cells, acidosis, liver failure, sometimes to lethal outcome. Treatment of pathology consists in stopping the medication, hospitalizing a small patient, gastric lavage, symptomatic treatment.

Strictly follow the instructions given by the doctor. Exceeding the dosage, uncontrolled intake is fraught with sharply negative complications.

Instructions for use and dosage

Efferalgan syrup is indicated for oral administration, it is allowed to dilute it with juice, milk, water. In most cases, children do not refuse delicious syrup without other additives. A single dosage is determined taking into account the weight of the baby, the syrup is allowed to be taken up to four times a day. The break between doses should be at least four hours. Uncontrolled use of the drug is fraught with sharply negative consequences.

The daily dosage should not exceed 60 mg per kilogram of body weight. little patient. If this rule is violated, there is a high risk of side effects.

Cost and storage conditions

The drug is characterized by low cost and high efficiency, the average price of Efferalgan syrup in Russia is 100 rubles per 90 ml bottle. The specific amount may vary depending on the city of purchase, a specific pharmacy chain.

The medication is stored in a dark place, completely protected from children. Little Patients Love to Treat tasty medicines, which sometimes leads to an overdose, sharply negative consequences. The temperature regime should not exceed 30 degrees, the duration of the drug's shelf life is 3 years. After opening the bottle - six months. It is forbidden to use the product after the expiration date.

Effective analogues

The pharmaceutical industry produces a mass similar drugs, the main component is paracetamol, it differs by the country of origin, auxiliary components. Only a pediatrician will help you choose a specific medication, It is strictly forbidden to replace the prescribed medicine on your own:

Pharmacitron;
Flukold;
BOL-Run;
Spazmoleks and others.

Efferalgan syrup - effective medicine actively used in pediatrics. Judging by the reviews, the drug quickly copes with fever in children from one month to 12 years old, has a pleasant taste and aroma, shows excellent results without being addictive. If you stick to the dosage, method of application, side effects are extremely rare.

Efferalgan syrup must be taken according to the instructions, without exceeding the dosage. The remedy can cause a number of side effects, if the fact of an overdose does occur, immediately contact your doctor for help.

The article will be presented to the children's syrup "Efferalgan" instructions for use and reviews.

It is a universal drug that has an antipyretic effect, and acts quite quickly. It is often prescribed to reduce high fever in the acute stage of a respiratory or infectious disease. Also, the syrup is sometimes prescribed as an analgesic for intense toothache, headache or muscle pain.

What does the instruction for Efferalgan children's syrup tell us?

Description and indications

The syrup is based on paracetamol, which has analgesic and antipyretic properties. For children, the concentration of paracetamol is strictly verified, which makes it safe even for small children. At the same time, the syrup has a pleasant taste, which makes it easier to take. The package with syrup is equipped with a special measuring spoon, which is convenient to measure the required amount of the drug.

According to the instructions, Efferalgan children's syrup is prescribed to reduce high body temperature during diseases such as influenza and acute respiratory infections. In addition, it is valued as an anti-inflammatory and analgesic drug that quickly and effectively relieves headache or toothache, and also helps to cope with pain in the postoperative period or as a result of burns and other skin lesions.

Contraindications

So that the treatment does not harm the child, you should carefully study the instructions before using Efferalgan children's syrup, especially contraindications. So, the drug can not be prescribed in the following situations:

Individual intolerance to paracetamol, which is the active substance of the drug.
Pathological disorders in the work of the kidneys and liver.
Diseases that affect the process of hematopoiesis.
The child is under 1 month of age.
Gilbert's disease.

Instructions for children's syrup "Efferalgan"

It must be remembered that the drug should not be given to a child whose age is less than one month. The dosage of the drug is selected individually, taking into account the age of the child. The main recommendation on the use of the drug is to prevent taking more than the norm prescribed by the instructions. The standard dosage of the drug is 10-15 mg per kilogram of the child's body weight.

The drug should be given to the child one and a half hours after eating. The break between two doses of syrup should be at least five hours. The maximum number of doses per day should not exceed four times.

On the measuring spoon that comes with the syrup, convenient divisions are applied, which make the procedure for taking the drug as simple and convenient as possible. The numbers on the spoon indicate the estimated weight of the child, which must be known for the accuracy of dosing the drug. For example, if the child's body weight is 6.5 kg, then the spoon should be filled to the mark with the number 6. The maximum divisions are calculated for 16 kilograms. If the child weighs more, then the drug is taken in a spoon twice.

As mentioned above, the syrup has a pleasant taste, so there are no problems when it is taken by a child. However, there are times when children refuse to take the drug in the form of a syrup. In such a situation, it is permissible to mix it with any liquid and give it to the child.

According to the instructions for children's syrup "Efferalgan", the duration of the drug depends on the reason for which it is taken. If the syrup is taken as an antipyretic drug, then it should be drunk for up to three days. If the goal is to relieve pain and relieve inflammation, the duration of the course will be five days. If the effect of the reception has not come, then you need to consult a doctor for advice.

Side effects

As the instructions and reviews confirm, Efferalgan children's syrup is well tolerated.

He is recognized as effective drug at the right price. In this regard, it is often chosen by parents as an antipyretic drug for children. However, it should be borne in mind that uncontrolled intake of the drug in excess of the dosage indicated in the instructions can lead to serious consequences and complications. Side effects from taking "Efferalgan" can be:

Painful sensations in the abdomen.
Nausea accompanied by vomiting.
Allergic reaction to the components of the drug. It manifests itself in varying degrees of severity, ranging from rashes, ending with Quincke's edema and anaphylactic shock.
Thrombocytopenia, anemia, agranulocytosis, leukopenia and other diseases that change the composition of the blood.

The latter diseases pose a threat to the health of the child, therefore, at the first sign of side effects or an overdose, it is necessary to show the child to the doctor.

Overdose

Do not exceed the dosage indicated in the instructions for Efferalgan syrup. The dose should be carefully calculated taking into account the exact weight of the child. Exceeding the indicated dose may cause the following symptoms:

Cutting pains in the abdomen.
Nausea and frequent urge to vomit.
Painful appearance and pallor skin.
Increased sweating.

If timely measures are not taken to eliminate the symptoms of an overdose, such serious complications as disruption of the kidneys and liver are possible. In especially severe cases, an overdose can lead the child into a coma.

If you find signs of an overdose in a child while taking Efferalgan syrup, you should immediately contact a specialist and take all necessary measures. Most often, in case of an overdose, the first thing to do is gastric lavage, it is prescribed Activated carbon or other enterosorbents that will remove signs of intoxication. In some cases, an antidote may be used.

special instructions

The main active ingredient of the drug is paracetamol. Its excess in the body can cause side effects. For this reason, it is impossible to combine the drug with other drugs, which also include paracetamol.

You can not independently prolong the course of taking "Efferalgan". If you neglect the dosages and duration prescribed by the instructions and the specialist, this can adversely affect the hematopoietic system of the body, as well as the condition of the liver. If a specialist prescribes a long-term use of this drug, then it is necessary to monitor the condition of the blood and liver in order to avoid unwanted complications.

The composition includes sugar, so its intake should be limited for children with diabetes or observing special medical nutrition, providing for a reduced amount of this substance. This is confirmed by the instructions for use for Efferalgan syrup.

During the period of drug therapy, a blood test should not be performed, since the drug tends to change the level of glucose and uric acid, which affects the reliability of the results of the tests. The syrup is prescribed by a pediatrician, he also determines the duration of admission. If after the course of taking the child's condition has not improved, you should also consult a doctor for advice.

Cost and storage

Syrup for children is dispensed without a doctor's prescription and is freely available in almost every pharmacy. The cost of the drug is quite low, a 90 ml bottle will cost about one hundred rubles. This price is low compared to other similar drugs.

There are such antipyretic drugs that, after a short period of time after opening the package, lose their properties. "Efferalgan" remains effective after opening throughout the entire shelf life, which is three years. However, for this, the storage conditions of the drug must be observed. It should be in a dark, cool place, at an air temperature of no more than 30 degrees.

The most common analogues of Efferalgan are preparations in the form of syrups such as Panadol, Nurofen, etc. These drugs are also effective in high temperature in infectious and viral diseases, and also have anti-inflammatory and analgesic effects. Their cost, however, is much higher.

The drug is administered orally 1-2 hours after a meal.

The average single dose depends on the body weight of the child and is 10-15 mg / kg body weight 3-4 times / day. The maximum daily dose is 60 mg/kg. The interval between doses is 4-6 hours.

For convenience and accuracy of dosing, use a measuring spoon. The measuring spoon is marked with divisions indicating a single dose (15 mg / kg) for children with body weight 4, 8, 12 or 16 kg respectively. Unmarked divisions correspond body weight 6, 10 or 14 kg.

Child's age	Child's body weight (kg)	The mark on the measuring spoon (paracetamol content/ solution volume)
1-3 months	On the recommendation of a doctor.
3-5 months	6-8	6 (90 mg/3 ml)
5 months-1 year	8-10	8 (120 mg/4 ml)
1-2 years	10-12	10 (150 mg/5 ml)
2-3 years	12-14	12 (180 mg/6 ml)
3-4 years	14-16	14 (210 mg/7 ml)
4-6 years old	16-20	16 (240 mg/8 ml)
6-7 years old	20-22	16+4 (300 mg/10 ml)
7-8 years old	22-24	16+6 (330 mg/11 ml)
8-9 years old	24-26	16+8 (360 mg/12 ml)
9-10 years old	26-28	16+10 (390 mg/13 ml)
10-11 years old	28-30	16+12 (420 mg/14 ml)
11-12 years old	30-32	16+14 (450 mg/15 ml)

The ratio of the age and body weight of the child is given approximately.

Children aged 3 months to 6 years (body weight 6-20 kg): fill the measuring spoon to the mark in accordance with the table. For example, if the child's body weight is from 6 to 8 kg, then the measuring spoon should be filled up to the mark corresponding to 6 kg.

Children aged 6 to 12 years (body weight 20-32 kg): fill the measuring spoon to the mark corresponding to 16 kg, then refill the measuring spoon to the mark according to the table. For example, if the child's body weight is between 20 and 22 kg, then fill the measuring spoon to the mark corresponding to 16 kg, then refill the measuring spoon to the mark of 4 kg.

The drug can be given to a child without dilution or after dilution with water or milk.

The duration of treatment is 3 days when used as an antipyretic and up to 5 days as an analgesic. If you need a longer dose of the drug, you need to consult a doctor.

On our website you will find detailed information about the drug EFFERALGAN (syrup) and its instructions for use in Russian. Instructions for use contain information about the composition, indications for use, contraindications, dosage, features of admission in children, during pregnancy and lactation, interaction with other drugs, about side effects and an overdose of EFFERALGAN. You can also get acquainted with the conditions and shelf life of the drug EFFERALGAN and its analogues.

◊ Syrup (for children) in the form of a slightly viscous solution of yellow-brown color, with a caramel-vanilla smell.

Excipients: macrogol 6000, sugar syrup (sucrose, water), sodium saccharinate, potassium sorbate, citric acid, caramel-vanilla flavor (butanedione, acetylmethylcarbinol, benzaldehyde, propylene glycol, gamma-heptalactone, benzyl alcohol, triacetin, piperonal, amyl cinnamate, vanillin, acetylvanillin) , purified water.

90 ml - plastic bottles (1) complete with measuring spoon - cardboard boxes.

Clinical and pharmacological group

Analgesic-antipyretic

pharmachologic effect

Analgesic-antipyretic. It has an analgesic and antipyretic effect. Inhibits COX-1 and COX-2 mainly in the central nervous system, affecting the centers of pain and thermoregulation. In inflamed tissues, cellular peroxidases neutralize the effect of paracetamol on COX, which explains practically complete absence it has an anti-inflammatory effect.

It does not adversely affect the water-salt metabolism (sodium and water retention) and the gastrointestinal mucosa due to the lack of influence on the synthesis of prostaglandins in peripheral tissues.

Pharmacokinetics

Suction and distribution

Absorption of paracetamol is complete and rapid. C max in plasma is achieved 30-60 minutes after ingestion. Distribution of paracetamol in tissues occurs quickly. Comparable drug concentrations in blood, saliva and plasma are achieved. Communication with plasma proteins is low (10-25%). Penetrates through the BBB.

Metabolism and excretion

Metabolism occurs in the liver, 80% enters into conjugation reactions with glucuronic acid and sulfates to form inactive metabolites; 17% undergoes hydroxylation with the formation of 8 active metabolites, which are conjugated with glutathione to form already inactive metabolites. With a lack of glutathione, these metabolites can block the enzyme systems of hepatocytes and cause their necrosis. The CYP2E1 isoenzyme is also involved in the metabolism of the drug.

T 1/2 is about 2 hours (1-4 hours). It is excreted by the kidneys in the form of metabolites, mainly conjugates. Less than 5% is excreted unchanged.

Indications for the use of the drug

For children aged 1 month to 12 years (weighing 4 to 32 kg):

- as an antipyretic for acute respiratory infections, influenza, childhood infections, post-vaccination reactions and other conditions accompanied by fever;

- as a pain reliever pain syndrome weak or moderate intensity, incl. headache and toothache, muscle pain, neuralgia, pain from injuries and burns.

Dosing regimen

The average single dose depends on the body weight of the child and is 10-15 mg / kg body weight 3-4 times / day. The maximum daily dose should not exceed 60 mg/kg body weight. The interval between doses of the drug should be 4-6 hours. Regular time intervals between taking the drug should be followed.

For convenience and accuracy of dosing, use a measuring spoon. On the measuring spoon, divisions indicating the body weight of the child are applied: 4, 6, 8, 10, 12, 14 or 16 kg. Unmarked divisions correspond to intermediate body weight: 5, 7, 9, 11, 13 or 15 kg.

Children weighing 4 to 16 kg

Fill the measuring spoon to the mark corresponding to the child's body weight, or to the mark closest in value to the child's body weight. For example, if the child's body weight is 4 to 5 kg, fill the measuring spoon to the mark corresponding to 4 kg. If necessary, the drug should be taken every 4-6 hours.

Children weighing 16 to 32 kg

Fill the measuring spoon to the mark corresponding to 10 kg, then refill the measuring spoon to the mark so that the total body weight of the child is obtained. For example, if the child weighs between 18 and 19 kg, fill the measuring spoon to the 10 kg mark, then refill the measuring spoon to the 8 kg mark. If necessary, the drug should be taken every 4-6 hours.

At impaired renal function (CC less than 10 ml / min) the time interval between doses of the drug should be at least 8 hours.

The drug can be given to a child both without dilution and after dilution (with water, milk or juice).

The duration of treatment is 3 days as an antipyretic and up to 5 days as an analgesic. If you need to continue taking the drug, you need to consult a doctor.

Side effect

From the digestive system: possible - diarrhea, abdominal pain, nausea, vomiting, tenesmus; with prolonged use in high doses, a hepatotoxic effect is possible.

Allergic reactions: possible - skin rash, itching, urticaria, Quincke's edema, anaphylactic shock, lowering blood pressure (as a symptom of anaphylaxis).

From the hematopoietic system: rarely - anemia, thrombocytopenia, leukopenia, neutropenia.

Others: decrease or increase in the prothrombin index; with prolonged use in high doses, a nephrotoxic effect is possible.

Contraindications to the use of the drug

- severe liver dysfunction;

- severe renal dysfunction;

- blood diseases;

- deficiency of glucose-6-phosphate dehydrogenase;

— childhood up to 1 month;

- hypersensitivity to the components of the drug

WITH caution the drug should be used for mild to moderate liver or kidney dysfunction, with Gilbert's syndrome.

special instructions

To avoid exceeding the maximum daily dose, Efferalgan should not be used simultaneously with other drugs containing paracetamol.

When using the drug for more than 5-7 days, it is necessary to control the pattern of peripheral blood and the functional state of the liver.

Paracetamol skews results laboratory research plasma glucose and uric acid levels.

If it is necessary to prescribe the drug to patients with diabetes mellitus or patients on a diet with a low sugar content, it should be borne in mind that 1 ml of the drug contains 0.335 g of sugar (0.67 g of sugar per graduation division of a measuring spoon / marked with marks in kg /).

Persons caring for a sick child should be warned about the need to discontinue the drug and consult a doctor in case of adverse reactions. A doctor's consultation is also required in the absence of a therapeutic effect: continued fever for more than 3 days and pain for more than 5 days.

Overdose

Symptoms acute poisoning with paracetamol are nausea, vomiting, anorexia, pain in the epigastric region, sweating, pallor of the skin, appearing in the first 24 hours after ingestion. Taking paracetamol at a dose of 140 mg / kg of body weight in children causes destruction of liver cells, leading to complete and irreversible hepatonecrosis, liver failure, metabolic acidosis, encephalopathy, which, in turn, can lead to the development of coma and death.

12-48 hours after administration, an increase in the level of liver transaminases, LDH and bilirubin may be observed with a simultaneous decrease in the level of prothrombin. Clinical picture liver damage is usually detected after 1 or 2 days and reaches a maximum after 3-4 days.

Treatment: when symptoms of poisoning appear, it is recommended to stop taking the drug and immediate hospitalization. Blood samples should be taken for the initial determination of the level of paracetamol in the blood plasma. Gastric lavage is performed, enterosorbents are taken (activated charcoal, hydrolytic lignin), the antidote acetylcysteine is administered (in / in or orally) up to 10 hours after taking the drug. Acetylcysteine may be effective 16 hours after an overdose. Symptomatic treatment is also carried out.

drug interaction

With the simultaneous use of Efferalgan with barbiturates, tricyclic antidepressants, anticonvulsants (phenytoin), flumecinol, phenylbutazone, rifampicin, ethanol, the risk of developing a hepatotoxic effect is significantly increased.

When taken together with salicylates, the risk of nephrotoxicity increases significantly.

Salicylamide can prolong T 1/2 of paracetamol.

With simultaneous use with chloramphenicol, the toxicity of the latter increases.

Probenecid leads to an almost two-fold decrease in the clearance of paracetamol due to the suppression of binding to glucuronic acid.

Paracetamol enhances the effect of indirect anticoagulants.

Paracetamol reduces the effectiveness of uricosuric drugs.

Terms of dispensing from pharmacies

The drug is approved for use as a means of OTC.

Terms and conditions of storage

The drug should be stored out of the reach of children at a temperature not exceeding 30°C. Shelf life - 3 years.

Unfortunately, almost all children suffer from various acute respiratory and infectious diseases, and not just once. But with every illness of a child, parents worry, especially if a small patient develops a temperature. Of course, the phenomenon itself - an increase in body temperature - is normal. In this way, the body produces interferon, a substance that helps fight the pathogen. But with a fever in a beloved child, the mother still has a state close to panic. Antipyretics will come to the rescue, for example, Efferalgan for children.

Indications for the use of Efferalgan

Efferalgan is medicinal product whose active ingredient is paracetamol. The latter has an analgesic, antipyretic and weak anti-inflammatory effect. Efferalgan is used for children's fever of various origins, including acute respiratory infections, infections. In addition, the medicine is also prescribed for pain in children, for example, with tonsillitis, headache, myalgia.

How to use Efferalgan

Antipyretic for children is available in several forms. Moreover, the choice of dosage form depends on the age of the patient. So, for example, Efferalgan antipyretic suppositories for children are convenient to use for babies who do not yet know how to drink from a spoon, and babies under 3 years old. By the way, such dosage form rectally. The dosage of Efferalgan suppositories is calculated according to the formula of 60 mg of a substance per kilogram of a child's body weight.

Children from the age of 1 month to 5 months (weighing 4-7 kg) are prescribed 1 suppository 80 mg three to four times a day. Moreover, the time interval between doses should be at least 6 hours. Children's suppositories from temperature Efferalgan at a dosage of 150 mg are used for patients aged from 5 months to three years with a body weight of 8-14 kg. It is necessary to apply 1 suppository two to four times a day.

Another form of antipyretic - syrup for children Efferalgan - is prescribed from the first month of life. A measuring spoon is attached to the bottle, making it easy to calculate the dosage of Efferalgan for children:

An infant aged 1-3 months can only be prescribed by a doctor.
A baby aged 3-5 months with a body weight of 6-8 kg needs 3 ml (90 mg) of medication.
From 5 months to 1 year with a body weight of 8-10 kg, 4 ml (120 mg) is indicated.

for a child 1-2 years old 10-12 kg, the dosage is 5 ml (150 mg);
for a patient 2-3 years old weighing 12-14 kg 6 ml (18 mg);
a peanut 3-4 years old with a body weight of 14-16 kg is prescribed 7 ml (210 mg);
the dosage of Efferalgan syrup for children for a child 4-6 years old weighing 16-20 kg is 8 ml (240 mg);
for 6-7 years old with a weight of 20-22 kg - 10 ml (300 mg);
from 7-8 years old and with a weight of 22-24 kg, 11 ml (330 mg) is indicated;
8-9 years old with a weight of 24-26 kg - 12 ml (360 mg);
9-10 years old with a weight of 26-28 kg - 13 ml (390 mg);
10-11 years old with a body weight of 28-30 kg - 14 ml (420 mg);
11-12 years old with a body weight of 30-32 - 15 ml (450 mg).

When calculating the dosage, the body weight of the child should be taken into account first of all.

Efferalgan - contraindications and side effects

In general, Efferalgan is well tolerated by children, but in rare cases individual intolerance to the components of the antipyretic is possible. It is expressed in the appearance of urticaria, skin rash or itching, even angioedema. In rare cases, taking the drug accompanied by such side effects like vomiting, nausea, abdominal pain, thrombocytopenia, epistaxis, or bleeding gums.