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Описание

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Гептразан таб. кш/раств., 400 мг, 20 шт.

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4.9
(9)
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Коротко о товаре

Артикул Маркета
326464798
Тип препарата
Назначение
Действующее вещество
Возраст
от 18 лет
Инструкция
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противоопухолевые, противотуберкулезные и противовирусные препараты, трициклические антидепрессанты, пероральные контрацептивы);\u003Cbr /\u003E\n- хронический бескаменный холецистит;\u003Cbr /\u003E\n- холангит;\u003Cbr /\u003E\n- цирроз печени;\u003Cbr /\u003E\n- энцефалопатия, в т. ч. ассоциированная с печеночной недостаточностью (алкогольная и др.).\u003Cbr /\u003E\nВнутрипеченочный холестаз у беременных.\u003Cbr /\u003E\nСимптомы депрессии."},{"name":"Противопоказания","value":"- Генетические нарушения, влияющие на метиониновый цикл, и/или вызывающие гомоцистинурию и/или гипергомоцистеинемию (дефицит цистатионин бета-синтазы, нарушения метаболизма В12). \u003Cbr /\u003E\n- Гиперчувствительность к любому из компонентов препарата. \u003Cbr /\u003E\n- Возраст до 18 лет (опыт медицинского применения у детей ограничен)."},{"name":"Состав","value":"1 таблетка содержит: \u003Cbr /\u003E\nДействующее вещество: адеметионина 1.4-бутандисульфонат 760 мг (в пересчете на адеметионин-ион 400 мг). \u003Cbr /\u003E\nВспомогательные вещества: целлюлоза микрокристаллическая 93,60 мг; карбоксиметилкрахмал натрия 17,60 мг; кремния диоксид коллоидный 4,40 мг; магния стеарат 4,40 мг. \u003Cbr /\u003E\nВспомогательные вещества (оболочка): 88,0 мг (метакриловой кислоты и этилакрилата сополимер [1:1] - 52,8 мг, тальк - 28,336 мг, макрогол - 4,4 мг, кремния диоксид коллоидный - 1,1 мг, натрия бикарбонат - 0,924 мг, натрия лаурилсульфат - 0,44 мг, симетикон эмульсия 30 % (в пересчете на симетикон) - 0,202 мг)"},{"name":"Действующее вещество","value":"Адеметионин","transition":{"type":"catalog","params":{"categorySlug":"sredstva-dlia-pishchevareniia","categoryId":"15756506","navnodeId":"72470","glfilters":["27144131:28710768"]}}},{"name":"Способ применения и дозы","value":"Внутрь. Таблетки следует принимать целиком, не разжевывая, желательно в первой половине дня между приемами пищи. \u003Cbr /\u003E\nТаблетки препарата Гептразан следует вынимать из блистера непосредственно перед приемом внутрь. В случае если таблетки имеют цвет, отличный от белого до белого с желтоватым оттенком (вследствие негерметичности алюминиевой фольги), препарат Гептразан не применять.\u003Cbr\u003E\nНачальная терапия. Рекомендуемая доза составляет 10-25 мг/кг/сут. \u003Cbr /\u003E\nВнутрипеченочный холестаз. Доза составляет от 800 мг/сут до 1600 мг/сут. \u003Cbr /\u003E\nДепрессия. Доза составляет от 800 мг/сут до 1600 мг/сут. \u003Cbr /\u003E\nДлительность терапии определяется врачом. Терапия может быть начата с внутривенного или внутримышечного введения препаратов адеметионина других производителей с последующим применением препарата Гептразан в виде таблеток или сразу с применения препарата Гептразан в виде таблеток. \u003Cbr /\u003E\nПациенты пожилого возраста. Клинический опыт применения препарата Гептразан не выявил каких-либо различий в его эффективности у пациентов пожилого возраста и пациентов более молодого возраста. Однако учитывая высокую вероятность имеющихся нарушений функции печени, почек или сердца, другой сопутствующей патологии или одновременной терапии с другими лекарственными средствами, дозу препарата Гептразан пожилым пациентам следует подбирать с осторожностью, начиная применение препарата с нижнего предела диапазона доз. \u003Cbr /\u003E\nПочечная недостаточность. Имеются ограниченные данные о применении препарата Гептразан у пациентов с почечной недостаточностью, в связи с этим рекомендуется соблюдать осторожность при применении препарата Гептразан у таких пациентов. \u003Cbr /\u003E\nПеченочная недостаточность. Параметры фармакокинетики адеметионина сходны у здоровых добровольцев и у пациентов с хроническими заболеваниями печени. \u003Cbr /\u003E\nДети. Применение препарата Гептразан у детей противопоказано (эффективность и безопасность не установлены)."},{"name":"Побочные действия","value":"Инфекционные и паразитарные заболевания.Нечасто.Инфекции мочевыводящих путей.\u003Cbr\u003E\nНарушения со стороны иммунной системы.Нечасто.Реакции гиперчувствительности Анафилактоидные или анафилактические реакции (в том числе гиперемия кожных покровов, одышка, бронхоспазм, боль в спине, ощущение дискомфорта в области грудной клетки, изменение артериального давления (артериальная гипотензия, артериальная гипертензия) или частоты пульса (тахикардия брадикардия)).\u003Cbr\u003E\nНарушения психики.Часто.Тревога, бессонница.Нечасто.Ажитация, спутанность сознания.\u003Cbr\u003E\nНарушения со стороны нервной системы.Часто.Головная боль.Нечасто.Головокружение, парастезия.\u003Cbr\u003E\nНарушения со стороны сосудов.Нечасто.\"Приливы\", артериальная гипотензия, флебит.\u003Cbr\u003E\nНарушения со стороны дыхательной системы, органов грудной клетки, средостения.Нечасто.Отек гортани.\u003Cbr\u003E\nНарушения со стороны желудочно-кишечного тракта.Часто.Боль в животе, диарея, сухость во рту, тошнота.\u003Cbr\u003E\nНечасто.Сухость во рту, диспепсия, метеоризм, желудочно-кишечная боль, желудочно-кишечное кровотечение, желудочно-кишечные расстройства, рвота.Редко.Вздутие живота, эзофагит.\u003Cbr\u003E\nНарушения со стороны кожи и подкожных тканей. Часто.Кожный зуд. Нечасто. Повышенное потоотделение, ангионевротический отек, кожно-аллергические реакции (в том числе кожная сыпь, кожный зуд, крапивница, эритема).\u003Cbr\u003E\nНарушения со стороны скелетно-мышечной и соединительной ткани.Нечасто.Артралгия, мышечные спазмы.\u003Cbr\u003E\nОбщие расстройства и нарушения в месте введения.Нечасто.Астения, отек, лихорадка, озноб, реакция в месте введения, некроз кожи в месте введения. Редко. Недомогание."},{"name":"Фармакологическое действие","value":"Адеметионин относится к группе гепатопротекторов, обладает также антидепрессивной активностью. Оказывает холеретическое и холекинетическое действие, обладает детоксикационными, регенерирующими, антиоксидантными, антифиброзирующими и нейропротективными свойствами. \u003Cbr\u003E\nВосполняет дефицит S-аденозил-L-метионина (адеметионина) и стимулирует его выработку в организме, содержится во всех средах организма. Наибольшая концентрация адеметионина отмечена в печени и мозге. Выполняет ключевую роль в метаболических процессах организма, принимает участие в важных биохимических реакциях: трансметилировании, транссульфурировании, трансаминировании. В реакциях трансметилирования адеметионин донирует метальную группу для синтеза фосфолипидов клеточных мембран, нейротрансмиттеров, нуклеиновых кислот, белков, гормонов и др. В реакциях транссульфурирования адеметионин является предшественником цистеина, таурина, глютатиона (обеспечивая окислительно-восстановительный механизм клеточной детоксикации), коэнзима А (включается в биохимические реакции цикла трикарбоновых кислот и восполняет энергетический потенциал клетки). Повышает содержание глутамина в печени, цистеина и таурина в плазме; снижает содержание метионина в сыворотке, нормализуя метаболические реакции в печени. После декарбоксилирования участвует в реакциях аминопропилирования, как предшественник полиаминов - путресцина (стимулятор регенерации клеток и пролиферации гепатоцитов), спермидина и спермина, входящих в структуру рибосом, что уменьшает риск фиброзирования.\u003Cbr\u003E\nОказывает холеретическое действие. Адеметионин нормализует синтез эндогенного фосфатидилхолина в гепатоцитах, что повышает текучесть и поляризацию мембран. Это улучшает функцию ассоциированных с мембранами гепатоцитов транспортных систем желчных кислот и способствует пассажу желчных кислот в желчевыводящие пути. Эффективен при внутридольковом варианте холестаза (нарушение синтеза и тока желчи). Адеметионин снижает токсичность желчных кислот в гепатоците, осуществляя их конъюгирование и сульфатирование. Конъюгация с таурином повышает растворимость желчных кислот и выведение их из гепатоцита. \u003Cbr\u003E\nПроцесс сульфатирования желчных кислот способствует возможности их элиминации почками, облегчает прохождение через мембрану гепатоцита и выведение с желчью. Кроме этого, сами сульфатированные желчные кислоты дополнительно защищают мембраны клеток печени от токсического действия несульфатированных желчных кислот (в высоких концентрациях присутствующих в гепатоцитах при внутрипеченочном холестазе). У пациентов с диффузными заболеваниями печени (цирроз, гепатит) с синдромом внутрипеченочного холестаза адеметионин снижает выраженность кожного зуда и изменений биохимических показателей, в т. ч. концентрации прямого билирубина, активности щелочной фосфатазы, аминотрансфераз и др. Холеретический и гепатопротективный эффект сохраняется до 3 месяцев после прекращения лечения. \u003Cbr\u003E\nПоказана эффективность при гепатопатиях, обусловленных различными гепатотоксичными препаратами. Назначение пациентам с опиоидной наркоманией, сопровождающейся поражением печени, приводит к регрессии клинических проявлений абстиненции, улучшению функционального состояния печени и процессов микросомального окисления. Антидепрессивная активность проявляется постепенно, начиная с конца первой недели лечения и стабилизируется в течение 2 недель лечения. Эффективен при рекуррентных эндогенной и невротической депрессиях, резистентных к амитриптилину. Обладает способностью прерывать рецидивы депрессии. Адеметионин повышает синтез протеогликанов и приводит к частичной регенерации хрящевой ткани."},{"name":"Фармакологическая группа","value":"гепатопротекторы"},{"name":"Форма выпуска","value":"таблетки, покрытые кишечнорастворимой оболочкой"},{"name":"Способ применения/введения","value":"пероральный","transition":{"type":"catalog","params":{"categorySlug":"sredstva-dlia-pishchevareniia","categoryId":"15756506","navnodeId":"72470","glfilters":["35947170:36763744"]}}},{"name":"Минимальный возраст применения","value":"от 18 лет"},{"name":"Условия хранения","value":"При температуре не выше 25 °С.\u003Cbr\u003E\nХранить в недоступном для детей месте."},{"name":"Передозировка","value":"Передозировка препарата Гептразан маловероятна. В случае передозировки рекомендуется наблюдение за пациентом и проведение симптоматической терапии."},{"name":"Применение при беременности и кормлении грудью","value":"В клинических исследованиях было показано, что применение адеметионина в III триместре беременности не вызывало никаких нежелательных эффектов. Применение препарата Гептразан у беременных в I или II триместре и в период грудного вскармливания возможно, только если потенциальная польза для матери превышает возможный риск для плода или ребенка."},{"name":"Влияние на способность управлять транспортом и механизмами","value":"У некоторых пациентов при приеме препарата Гептразан может возникнуть головокружение. Не рекомендуется водить автомобиль и работать с механизмами во время приема препарата до тех пор, пока пациенты не будут уверены, что терапия не влияет на способность заниматься подобного вида деятельностью."},{"name":"Особые указания","value":"Учитывая тонизирующий эффект препарата, не рекомендуется принимать его перед сном. При назначении препарата Гептразан пациентам с циррозом печени на фоне гиперазотемии необходим систематический контроль содержания азота в крови. Во время длительной терапии необходимо определять содержание мочевины и креатинина в сыворотке крови. Не рекомендуется применять адеметионин пациентам с биполярными расстройствами. Есть сообщения о переходе депрессии в гипоманию или манию у пациентов, принимавших адеметионин. \u003Cbr /\u003E\nУ пациентов с депрессией имеется повышенный риск суицида и других серьезных нежелательных явлений, поэтому во время лечения адеметионином такие пациенты должны находиться под постоянным наблюдением врача для оценки и лечения симптомов депрессии. Пациенты должны информировать врача в случае, если отмечающиеся у них симптомы депрессии не уменьшаются или усугубляются при терапии адеметионином. \u003Cbr /\u003E\nТак же имеются сообщения о внезапном появлении или нарастании тревоги у пациентов, принимающих адеметионин. В большинстве случаев отмена терапии не требуется, в нескольких случаях тревога исчезала после снижения дозы или отмены препарата. Поскольку дефицит цианокобаламина и фолиевой кислоты может снизить содержание адеметионина у пациентов группы риска (с анемией, заболеваниями печени, при беременности или с вероятностью витаминной недостаточности, в связи с другими заболеваниями или диетой, например, у вегетарианцев), следует контролировать содержание витаминов в плазме крови. Если недостаточность обнаружена, рекомендован прием цианокобаламина и фолиевой кислоты до начала лечения адеметионином или одновременный прием с адеметионином. \u003Cbr /\u003E\nПри иммунологическом анализе применение адеметионина может способствовать ложному определению показателя высокого уровня гомоцистеина в крови. \u003Cbr /\u003E\nДля пациентов, принимающих адеметионин, рекомендовано использовать не иммунологические методы анализа для определения уровня гомоцистеина.\u003Cbr /\nС осторожностью: Биполярные расстройства (см. раздел \"Особые указания\").\u003Cbr /\u003E\nБеременность (I, II триместр) и период грудного вскармливания (применение возможно, только если потенциальная польза для матери превышает возможный риск для плода и ребенка). \u003Cbr /\u003E\nОдновременный прием с селективными ингибиторами обратного захвата серотонина (СИОЗС), трициклическими антидепрессантами (такими как кломипрамин), а также препаратами растительного происхождения и препаратами, содержащими триптофан. Пожилой возраст. Почечная недостаточность."},{"name":"Взаимодействие","value":"Известных взаимодействий с другими лекарственными средствами не наблюдалось. \u003Cbr /\u003E\nЕсть сообщение о синдроме избытка серотонина у пациента, принимавшего адеметионин и кломипрамин. Считается, что такое взаимодействие возможно, и следует с осторожностью назначать адеметионин вместе с селективными ингибиторами обратного захвата серотонина, трициклическими антидепрессантами (такими как кломипрамин), а также препаратами растительного происхождения и препаратами, содержащими триптофан."},{"name":"Регистрационный номер","value":"ЛП-004430"},{"name":"Дата государственной регистрации","value":"05.02.2019"},{"name":"Владелец регистрационного удостоверения","value":"Ирвин 2","transition":{"type":"catalog","params":{"categorySlug":"sredstva-dlia-pishchevareniia","categoryId":"15756506","navnodeId":"72470","glfilters":["34324371:35649313","7893318:35762710"]}}},{"name":"Изготовитель","value":"ЗиО-Здоровье"},{"name":"Фасовщик","value":"ЗиО-Здоровье"},{"name":"Страна бренда","value":"Россия"},{"name":"Страна-производитель","value":"Россия"}]}},"fullSpecsGrouped":{"4676037718518942139":{"groups":[{"name":"Общие характеристики","items":[{"name":"Тип препарата","value":"лекарственный препарат"},{"name":"Рецептурный препарат","value":"да"},{"name":"Органы и системы","value":"печень"},{"name":"Назначение","value":"внутрипеченочный холестаз, жировая дистрофия печени, печеночная недостаточность, печеночная энцефалопатия, токсические поражения печени, холангит, холецистит, хронические гепатиты, цирроз печени"},{"name":"Показания к применению","value":"Внутрипеченочный холестаз при прецирротических и цирротических состояниях, который может наблюдаться при следующих заболеваниях:\u003Cbr /\u003E\n- жировая дистрофия печени;\u003Cbr /\u003E\n- хронический гепатит;\u003Cbr /\u003E\n- токсические поражения печени различной этиологии, включая алкогольные, вирусные, лекарственные (антибиотики; противоопухолевые, противотуберкулезные и противовирусные препараты, трициклические антидепрессанты, пероральные контрацептивы);\u003Cbr /\u003E\n- хронический бескаменный холецистит;\u003Cbr /\u003E\n- холангит;\u003Cbr /\u003E\n- цирроз печени;\u003Cbr /\u003E\n- энцефалопатия, в т. ч. ассоциированная с печеночной недостаточностью (алкогольная и др.).\u003Cbr /\u003E\nВнутрипеченочный холестаз у беременных.\u003Cbr /\u003E\nСимптомы депрессии."},{"name":"Противопоказания","value":"- Генетические нарушения, влияющие на метиониновый цикл, и/или вызывающие гомоцистинурию и/или гипергомоцистеинемию (дефицит цистатионин бета-синтазы, нарушения метаболизма В12). \u003Cbr /\u003E\n- Гиперчувствительность к любому из компонентов препарата. \u003Cbr /\u003E\n- Возраст до 18 лет (опыт медицинского применения у детей ограничен)."},{"name":"Состав","value":"1 таблетка содержит: \u003Cbr /\u003E\nДействующее вещество: адеметионина 1.4-бутандисульфонат 760 мг (в пересчете на адеметионин-ион 400 мг). \u003Cbr /\u003E\nВспомогательные вещества: целлюлоза микрокристаллическая 93,60 мг; карбоксиметилкрахмал натрия 17,60 мг; кремния диоксид коллоидный 4,40 мг; магния стеарат 4,40 мг. \u003Cbr /\u003E\nВспомогательные вещества (оболочка): 88,0 мг (метакриловой кислоты и этилакрилата сополимер [1:1] - 52,8 мг, тальк - 28,336 мг, макрогол - 4,4 мг, кремния диоксид коллоидный - 1,1 мг, натрия бикарбонат - 0,924 мг, натрия лаурилсульфат - 0,44 мг, симетикон эмульсия 30 % (в пересчете на симетикон) - 0,202 мг)"},{"name":"Действующее вещество","value":"Адеметионин"},{"name":"Способ применения и дозы","value":"Внутрь. Таблетки следует принимать целиком, не разжевывая, желательно в первой половине дня между приемами пищи. \u003Cbr /\u003E\nТаблетки препарата Гептразан следует вынимать из блистера непосредственно перед приемом внутрь. В случае если таблетки имеют цвет, отличный от белого до белого с желтоватым оттенком (вследствие негерметичности алюминиевой фольги), препарат Гептразан не применять.\u003Cbr\u003E\nНачальная терапия. Рекомендуемая доза составляет 10-25 мг/кг/сут. \u003Cbr /\u003E\nВнутрипеченочный холестаз. Доза составляет от 800 мг/сут до 1600 мг/сут. \u003Cbr /\u003E\nДепрессия. Доза составляет от 800 мг/сут до 1600 мг/сут. \u003Cbr /\u003E\nДлительность терапии определяется врачом. Терапия может быть начата с внутривенного или внутримышечного введения препаратов адеметионина других производителей с последующим применением препарата Гептразан в виде таблеток или сразу с применения препарата Гептразан в виде таблеток. \u003Cbr /\u003E\nПациенты пожилого возраста. Клинический опыт применения препарата Гептразан не выявил каких-либо различий в его эффективности у пациентов пожилого возраста и пациентов более молодого возраста. Однако учитывая высокую вероятность имеющихся нарушений функции печени, почек или сердца, другой сопутствующей патологии или одновременной терапии с другими лекарственными средствами, дозу препарата Гептразан пожилым пациентам следует подбирать с осторожностью, начиная применение препарата с нижнего предела диапазона доз. \u003Cbr /\u003E\nПочечная недостаточность. Имеются ограниченные данные о применении препарата Гептразан у пациентов с почечной недостаточностью, в связи с этим рекомендуется соблюдать осторожность при применении препарата Гептразан у таких пациентов. \u003Cbr /\u003E\nПеченочная недостаточность. Параметры фармакокинетики адеметионина сходны у здоровых добровольцев и у пациентов с хроническими заболеваниями печени. \u003Cbr /\u003E\nДети. Применение препарата Гептразан у детей противопоказано (эффективность и безопасность не установлены)."},{"name":"Побочные действия","value":"Инфекционные и паразитарные заболевания.Нечасто.Инфекции мочевыводящих путей.\u003Cbr\u003E\nНарушения со стороны иммунной системы.Нечасто.Реакции гиперчувствительности Анафилактоидные или анафилактические реакции (в том числе гиперемия кожных покровов, одышка, бронхоспазм, боль в спине, ощущение дискомфорта в области грудной клетки, изменение артериального давления (артериальная гипотензия, артериальная гипертензия) или частоты пульса (тахикардия брадикардия)).\u003Cbr\u003E\nНарушения психики.Часто.Тревога, бессонница.Нечасто.Ажитация, спутанность сознания.\u003Cbr\u003E\nНарушения со стороны нервной системы.Часто.Головная боль.Нечасто.Головокружение, парастезия.\u003Cbr\u003E\nНарушения со стороны сосудов.Нечасто.\"Приливы\", артериальная гипотензия, флебит.\u003Cbr\u003E\nНарушения со стороны дыхательной системы, органов грудной клетки, средостения.Нечасто.Отек гортани.\u003Cbr\u003E\nНарушения со стороны желудочно-кишечного тракта.Часто.Боль в животе, диарея, сухость во рту, тошнота.\u003Cbr\u003E\nНечасто.Сухость во рту, диспепсия, метеоризм, желудочно-кишечная боль, желудочно-кишечное кровотечение, желудочно-кишечные расстройства, рвота.Редко.Вздутие живота, эзофагит.\u003Cbr\u003E\nНарушения со стороны кожи и подкожных тканей. Часто.Кожный зуд. Нечасто. Повышенное потоотделение, ангионевротический отек, кожно-аллергические реакции (в том числе кожная сыпь, кожный зуд, крапивница, эритема).\u003Cbr\u003E\nНарушения со стороны скелетно-мышечной и соединительной ткани.Нечасто.Артралгия, мышечные спазмы.\u003Cbr\u003E\nОбщие расстройства и нарушения в месте введения.Нечасто.Астения, отек, лихорадка, озноб, реакция в месте введения, некроз кожи в месте введения. Редко. Недомогание."},{"name":"Фармакологическое действие","value":"Адеметионин относится к группе гепатопротекторов, обладает также антидепрессивной активностью. Оказывает холеретическое и холекинетическое действие, обладает детоксикационными, регенерирующими, антиоксидантными, антифиброзирующими и нейропротективными свойствами. \u003Cbr\u003E\nВосполняет дефицит S-аденозил-L-метионина (адеметионина) и стимулирует его выработку в организме, содержится во всех средах организма. Наибольшая концентрация адеметионина отмечена в печени и мозге. Выполняет ключевую роль в метаболических процессах организма, принимает участие в важных биохимических реакциях: трансметилировании, транссульфурировании, трансаминировании. В реакциях трансметилирования адеметионин донирует метальную группу для синтеза фосфолипидов клеточных мембран, нейротрансмиттеров, нуклеиновых кислот, белков, гормонов и др. В реакциях транссульфурирования адеметионин является предшественником цистеина, таурина, глютатиона (обеспечивая окислительно-восстановительный механизм клеточной детоксикации), коэнзима А (включается в биохимические реакции цикла трикарбоновых кислот и восполняет энергетический потенциал клетки). Повышает содержание глутамина в печени, цистеина и таурина в плазме; снижает содержание метионина в сыворотке, нормализуя метаболические реакции в печени. После декарбоксилирования участвует в реакциях аминопропилирования, как предшественник полиаминов - путресцина (стимулятор регенерации клеток и пролиферации гепатоцитов), спермидина и спермина, входящих в структуру рибосом, что уменьшает риск фиброзирования.\u003Cbr\u003E\nОказывает холеретическое действие. Адеметионин нормализует синтез эндогенного фосфатидилхолина в гепатоцитах, что повышает текучесть и поляризацию мембран. Это улучшает функцию ассоциированных с мембранами гепатоцитов транспортных систем желчных кислот и способствует пассажу желчных кислот в желчевыводящие пути. Эффективен при внутридольковом варианте холестаза (нарушение синтеза и тока желчи). Адеметионин снижает токсичность желчных кислот в гепатоците, осуществляя их конъюгирование и сульфатирование. Конъюгация с таурином повышает растворимость желчных кислот и выведение их из гепатоцита. \u003Cbr\u003E\nПроцесс сульфатирования желчных кислот способствует возможности их элиминации почками, облегчает прохождение через мембрану гепатоцита и выведение с желчью. Кроме этого, сами сульфатированные желчные кислоты дополнительно защищают мембраны клеток печени от токсического действия несульфатированных желчных кислот (в высоких концентрациях присутствующих в гепатоцитах при внутрипеченочном холестазе). У пациентов с диффузными заболеваниями печени (цирроз, гепатит) с синдромом внутрипеченочного холестаза адеметионин снижает выраженность кожного зуда и изменений биохимических показателей, в т. ч. концентрации прямого билирубина, активности щелочной фосфатазы, аминотрансфераз и др. Холеретический и гепатопротективный эффект сохраняется до 3 месяцев после прекращения лечения. \u003Cbr\u003E\nПоказана эффективность при гепатопатиях, обусловленных различными гепатотоксичными препаратами. Назначение пациентам с опиоидной наркоманией, сопровождающейся поражением печени, приводит к регрессии клинических проявлений абстиненции, улучшению функционального состояния печени и процессов микросомального окисления. Антидепрессивная активность проявляется постепенно, начиная с конца первой недели лечения и стабилизируется в течение 2 недель лечения. Эффективен при рекуррентных эндогенной и невротической депрессиях, резистентных к амитриптилину. Обладает способностью прерывать рецидивы депрессии. Адеметионин повышает синтез протеогликанов и приводит к частичной регенерации хрящевой ткани."},{"name":"Фармакологическая группа","value":"гепатопротекторы"},{"name":"Форма выпуска","value":"таблетки, покрытые кишечнорастворимой оболочкой"},{"name":"Способ применения/введения","value":"пероральный"},{"name":"Минимальный возраст применения","value":"от 18 лет"}]},{"name":"Дополнительно","items":[{"name":"Условия хранения","value":"При температуре не выше 25 °С.\u003Cbr\u003E\nХранить в недоступном для детей месте."},{"name":"Передозировка","value":"Передозировка препарата Гептразан маловероятна. В случае передозировки рекомендуется наблюдение за пациентом и проведение симптоматической терапии."},{"name":"Применение при беременности и кормлении грудью","value":"В клинических исследованиях было показано, что применение адеметионина в III триместре беременности не вызывало никаких нежелательных эффектов. Применение препарата Гептразан у беременных в I или II триместре и в период грудного вскармливания возможно, только если потенциальная польза для матери превышает возможный риск для плода или ребенка."},{"name":"Влияние на способность управлять транспортом и механизмами","value":"У некоторых пациентов при приеме препарата Гептразан может возникнуть головокружение. Не рекомендуется водить автомобиль и работать с механизмами во время приема препарата до тех пор, пока пациенты не будут уверены, что терапия не влияет на способность заниматься подобного вида деятельностью."},{"name":"Особые указания","value":"Учитывая тонизирующий эффект препарата, не рекомендуется принимать его перед сном. При назначении препарата Гептразан пациентам с циррозом печени на фоне гиперазотемии необходим систематический контроль содержания азота в крови. Во время длительной терапии необходимо определять содержание мочевины и креатинина в сыворотке крови. Не рекомендуется применять адеметионин пациентам с биполярными расстройствами. Есть сообщения о переходе депрессии в гипоманию или манию у пациентов, принимавших адеметионин. \u003Cbr /\u003E\nУ пациентов с депрессией имеется повышенный риск суицида и других серьезных нежелательных явлений, поэтому во время лечения адеметионином такие пациенты должны находиться под постоянным наблюдением врача для оценки и лечения симптомов депрессии. Пациенты должны информировать врача в случае, если отмечающиеся у них симптомы депрессии не уменьшаются или усугубляются при терапии адеметионином. \u003Cbr /\u003E\nТак же имеются сообщения о внезапном появлении или нарастании тревоги у пациентов, принимающих адеметионин. В большинстве случаев отмена терапии не требуется, в нескольких случаях тревога исчезала после снижения дозы или отмены препарата. Поскольку дефицит цианокобаламина и фолиевой кислоты может снизить содержание адеметионина у пациентов группы риска (с анемией, заболеваниями печени, при беременности или с вероятностью витаминной недостаточности, в связи с другими заболеваниями или диетой, например, у вегетарианцев), следует контролировать содержание витаминов в плазме крови. Если недостаточность обнаружена, рекомендован прием цианокобаламина и фолиевой кислоты до начала лечения адеметионином или одновременный прием с адеметионином. \u003Cbr /\u003E\nПри иммунологическом анализе применение адеметионина может способствовать ложному определению показателя высокого уровня гомоцистеина в крови. \u003Cbr /\u003E\nДля пациентов, принимающих адеметионин, рекомендовано использовать не иммунологические методы анализа для определения уровня гомоцистеина.\u003Cbr /\nС осторожностью: Биполярные расстройства (см. раздел \"Особые указания\").\u003Cbr /\u003E\nБеременность (I, II триместр) и период грудного вскармливания (применение возможно, только если потенциальная польза для матери превышает возможный риск для плода и ребенка). \u003Cbr /\u003E\nОдновременный прием с селективными ингибиторами обратного захвата серотонина (СИОЗС), трициклическими антидепрессантами (такими как кломипрамин), а также препаратами растительного происхождения и препаратами, содержащими триптофан. Пожилой возраст. Почечная недостаточность."},{"name":"Взаимодействие","value":"Известных взаимодействий с другими лекарственными средствами не наблюдалось. \u003Cbr /\u003E\nЕсть сообщение о синдроме избытка серотонина у пациента, принимавшего адеметионин и кломипрамин. Считается, что такое взаимодействие возможно, и следует с осторожностью назначать адеметионин вместе с селективными ингибиторами обратного захвата серотонина, трициклическими антидепрессантами (такими как кломипрамин), а также препаратами растительного происхождения и препаратами, содержащими триптофан."},{"name":"Регистрационный номер","value":"ЛП-004430"},{"name":"Дата государственной регистрации","value":"05.02.2019"},{"name":"Владелец регистрационного удостоверения","value":"Ирвин 2"},{"name":"Изготовитель","value":"ЗиО-Здоровье"},{"name":"Фасовщик","value":"ЗиО-Здоровье"},{"name":"Страна бренда","value":"Россия"},{"name":"Страна-производитель","value":"Россия"}]}],"transitionId":"tr_6"}}}}
Внешний вид товаров и/или упаковки может быть изменён изготовителем и отличаться от изображенных на Яндекс Маркете.
Есть противопоказания, посоветуйтесь с врачом. Отпускается по рецепту врача. Приобретение лекарственных препаратов осуществляется только в торговом зале аптеки

Где купить

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1 058 ₽

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лекарственные (антибиотики; противоопухолевые, противотуберкулезные и противовирусные препараты, трициклические антидепрессанты, пероральные контрацептивы);\u003Cbr /\u003E\n- хронический бескаменный холецистит;\u003Cbr /\u003E\n- холангит;\u003Cbr /\u003E\n- цирроз печени;\u003Cbr /\u003E\n- энцефалопатия, в т. ч. ассоциированная с печеночной недостаточностью (алкогольная и др.).\u003Cbr /\u003E\nВнутрипеченочный холестаз у беременных.\u003Cbr /\u003E\nСимптомы депрессии."},{"description":"","filters":[{"id":15768002,"name":"Противопоказания"}],"isMainProperty":false,"name":"Противопоказания","value":"- Генетические нарушения, влияющие на метиониновый цикл, и/или вызывающие гомоцистинурию и/или гипергомоцистеинемию (дефицит цистатионин бета-синтазы, нарушения метаболизма В12). \u003Cbr /\u003E\n- Гиперчувствительность к любому из компонентов препарата. \u003Cbr /\u003E\n- Возраст до 18 лет (опыт медицинского применения у детей ограничен)."},{"description":"","filters":[{"id":15768292,"name":"Состав"}],"isMainProperty":false,"name":"Состав","value":"1 таблетка содержит: \u003Cbr /\u003E\nДействующее вещество: адеметионина 1.4-бутандисульфонат 760 мг (в пересчете на адеметионин-ион 400 мг). \u003Cbr /\u003E\nВспомогательные вещества: целлюлоза микрокристаллическая 93,60 мг; карбоксиметилкрахмал натрия 17,60 мг; кремния диоксид коллоидный 4,40 мг; магния стеарат 4,40 мг. \u003Cbr /\u003E\nВспомогательные вещества (оболочка): 88,0 мг (метакриловой кислоты и этилакрилата сополимер [1:1] - 52,8 мг, тальк - 28,336 мг, макрогол - 4,4 мг, кремния диоксид коллоидный - 1,1 мг, натрия бикарбонат - 0,924 мг, натрия лаурилсульфат - 0,44 мг, симетикон эмульсия 30 % (в пересчете на симетикон) - 0,202 мг)"},{"description":"","filters":[{"id":27144131,"name":"Действующее вещество"}],"isMainProperty":false,"name":"Действующее вещество","value":"Адеметионин"},{"description":"","filters":[{"id":15768000,"name":"Способ применения и дозы"}],"isMainProperty":false,"name":"Способ применения и дозы","value":"Внутрь. Таблетки следует принимать целиком, не разжевывая, желательно в первой половине дня между приемами пищи. \u003Cbr /\u003E\nТаблетки препарата Гептразан следует вынимать из блистера непосредственно перед приемом внутрь. В случае если таблетки имеют цвет, отличный от белого до белого с желтоватым оттенком (вследствие негерметичности алюминиевой фольги), препарат Гептразан не применять.\u003Cbr\u003E\nНачальная терапия. Рекомендуемая доза составляет 10-25 мг/кг/сут. \u003Cbr /\u003E\nВнутрипеченочный холестаз. Доза составляет от 800 мг/сут до 1600 мг/сут. \u003Cbr /\u003E\nДепрессия. Доза составляет от 800 мг/сут до 1600 мг/сут. \u003Cbr /\u003E\nДлительность терапии определяется врачом. Терапия может быть начата с внутривенного или внутримышечного введения препаратов адеметионина других производителей с последующим применением препарата Гептразан в виде таблеток или сразу с применения препарата Гептразан в виде таблеток. \u003Cbr /\u003E\nПациенты пожилого возраста. Клинический опыт применения препарата Гептразан не выявил каких-либо различий в его эффективности у пациентов пожилого возраста и пациентов более молодого возраста. Однако учитывая высокую вероятность имеющихся нарушений функции печени, почек или сердца, другой сопутствующей патологии или одновременной терапии с другими лекарственными средствами, дозу препарата Гептразан пожилым пациентам следует подбирать с осторожностью, начиная применение препарата с нижнего предела диапазона доз. \u003Cbr /\u003E\nПочечная недостаточность. Имеются ограниченные данные о применении препарата Гептразан у пациентов с почечной недостаточностью, в связи с этим рекомендуется соблюдать осторожность при применении препарата Гептразан у таких пациентов. \u003Cbr /\u003E\nПеченочная недостаточность. Параметры фармакокинетики адеметионина сходны у здоровых добровольцев и у пациентов с хроническими заболеваниями печени. \u003Cbr /\u003E\nДети. Применение препарата Гептразан у детей противопоказано (эффективность и безопасность не установлены)."},{"description":"","filters":[{"id":15767998,"name":"Побочные действия"}],"isMainProperty":false,"name":"Побочные действия","value":"Инфекционные и паразитарные заболевания.Нечасто.Инфекции мочевыводящих путей.\u003Cbr\u003E\nНарушения со стороны иммунной системы.Нечасто.Реакции гиперчувствительности Анафилактоидные или анафилактические реакции (в том числе гиперемия кожных покровов, одышка, бронхоспазм, боль в спине, ощущение дискомфорта в области грудной клетки, изменение артериального давления (артериальная гипотензия, артериальная гипертензия) или частоты пульса (тахикардия брадикардия)).\u003Cbr\u003E\nНарушения психики.Часто.Тревога, бессонница.Нечасто.Ажитация, спутанность сознания.\u003Cbr\u003E\nНарушения со стороны нервной системы.Часто.Головная боль.Нечасто.Головокружение, парастезия.\u003Cbr\u003E\nНарушения со стороны сосудов.Нечасто.\"Приливы\", артериальная гипотензия, флебит.\u003Cbr\u003E\nНарушения со стороны дыхательной системы, органов грудной клетки, средостения.Нечасто.Отек гортани.\u003Cbr\u003E\nНарушения со стороны желудочно-кишечного тракта.Часто.Боль в животе, диарея, сухость во рту, тошнота.\u003Cbr\u003E\nНечасто.Сухость во рту, диспепсия, метеоризм, желудочно-кишечная боль, желудочно-кишечное кровотечение, желудочно-кишечные расстройства, рвота.Редко.Вздутие живота, эзофагит.\u003Cbr\u003E\nНарушения со стороны кожи и подкожных тканей. Часто.Кожный зуд. Нечасто. Повышенное потоотделение, ангионевротический отек, кожно-аллергические реакции (в том числе кожная сыпь, кожный зуд, крапивница, эритема).\u003Cbr\u003E\nНарушения со стороны скелетно-мышечной и соединительной ткани.Нечасто.Артралгия, мышечные спазмы.\u003Cbr\u003E\nОбщие расстройства и нарушения в месте введения.Нечасто.Астения, отек, лихорадка, озноб, реакция в месте введения, некроз кожи в месте введения. Редко. Недомогание."},{"description":"","filters":[{"id":15768001,"name":"Фармакологическое действие"}],"isMainProperty":false,"name":"Фармакологическое действие","value":"Адеметионин относится к группе гепатопротекторов, обладает также антидепрессивной активностью. Оказывает холеретическое и холекинетическое действие, обладает детоксикационными, регенерирующими, антиоксидантными, антифиброзирующими и нейропротективными свойствами. \u003Cbr\u003E\nВосполняет дефицит S-аденозил-L-метионина (адеметионина) и стимулирует его выработку в организме, содержится во всех средах организма. Наибольшая концентрация адеметионина отмечена в печени и мозге. Выполняет ключевую роль в метаболических процессах организма, принимает участие в важных биохимических реакциях: трансметилировании, транссульфурировании, трансаминировании. В реакциях трансметилирования адеметионин донирует метальную группу для синтеза фосфолипидов клеточных мембран, нейротрансмиттеров, нуклеиновых кислот, белков, гормонов и др. В реакциях транссульфурирования адеметионин является предшественником цистеина, таурина, глютатиона (обеспечивая окислительно-восстановительный механизм клеточной детоксикации), коэнзима А (включается в биохимические реакции цикла трикарбоновых кислот и восполняет энергетический потенциал клетки). Повышает содержание глутамина в печени, цистеина и таурина в плазме; снижает содержание метионина в сыворотке, нормализуя метаболические реакции в печени. После декарбоксилирования участвует в реакциях аминопропилирования, как предшественник полиаминов - путресцина (стимулятор регенерации клеток и пролиферации гепатоцитов), спермидина и спермина, входящих в структуру рибосом, что уменьшает риск фиброзирования.\u003Cbr\u003E\nОказывает холеретическое действие. Адеметионин нормализует синтез эндогенного фосфатидилхолина в гепатоцитах, что повышает текучесть и поляризацию мембран. Это улучшает функцию ассоциированных с мембранами гепатоцитов транспортных систем желчных кислот и способствует пассажу желчных кислот в желчевыводящие пути. Эффективен при внутридольковом варианте холестаза (нарушение синтеза и тока желчи). Адеметионин снижает токсичность желчных кислот в гепатоците, осуществляя их конъюгирование и сульфатирование. Конъюгация с таурином повышает растворимость желчных кислот и выведение их из гепатоцита. \u003Cbr\u003E\nПроцесс сульфатирования желчных кислот способствует возможности их элиминации почками, облегчает прохождение через мембрану гепатоцита и выведение с желчью. Кроме этого, сами сульфатированные желчные кислоты дополнительно защищают мембраны клеток печени от токсического действия несульфатированных желчных кислот (в высоких концентрациях присутствующих в гепатоцитах при внутрипеченочном холестазе). У пациентов с диффузными заболеваниями печени (цирроз, гепатит) с синдромом внутрипеченочного холестаза адеметионин снижает выраженность кожного зуда и изменений биохимических показателей, в т. ч. концентрации прямого билирубина, активности щелочной фосфатазы, аминотрансфераз и др. Холеретический и гепатопротективный эффект сохраняется до 3 месяцев после прекращения лечения. \u003Cbr\u003E\nПоказана эффективность при гепатопатиях, обусловленных различными гепатотоксичными препаратами. Назначение пациентам с опиоидной наркоманией, сопровождающейся поражением печени, приводит к регрессии клинических проявлений абстиненции, улучшению функционального состояния печени и процессов микросомального окисления. Антидепрессивная активность проявляется постепенно, начиная с конца первой недели лечения и стабилизируется в течение 2 недель лечения. Эффективен при рекуррентных эндогенной и невротической депрессиях, резистентных к амитриптилину. Обладает способностью прерывать рецидивы депрессии. 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Еще может подойти

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Инструкция

Показания к применению

Внутрипеченочный холестаз при прецирротических и цирротических состояниях, который может наблюдаться при следующих заболеваниях:
- жировая дистрофия печени;
- хронический гепатит;
- токсические поражения печени различной этиологии, включая алкогольные, вирусные, лекарственные (антибиотики; противоопухолевые, противотуберкулезные и противовирусные препараты, трициклические антидепрессанты, пероральные контрацептивы);
- хронический бескаменный холецистит;
- холангит;
- цирроз печени;
- энцефалопатия, в т. ч. ассоциированная с печеночной недостаточностью (алкогольная и др.).
Внутрипеченочный холестаз у беременных.
Симптомы депрессии.

Противопоказания

- Генетические нарушения, влияющие на метиониновый цикл, и/или вызывающие гомоцистинурию и/или гипергомоцистеинемию (дефицит цистатионин бета-синтазы, нарушения метаболизма В12).
- Гиперчувствительность к любому из компонентов препарата.
- Возраст до 18 лет (опыт медицинского применения у детей ограничен).

Способ применения и дозы

Внутрь. Таблетки следует принимать целиком, не разжевывая, желательно в первой половине дня между приемами пищи.
Таблетки препарата Гептразан следует вынимать из блистера непосредственно перед приемом внутрь. В случае если таблетки имеют цвет, отличный от белого до белого с желтоватым оттенком (вследствие негерметичности алюминиевой фольги), препарат Гептразан не применять.
Начальная терапия. Рекомендуемая доза составляет 10-25 мг/кг/сут.
Внутрипеченочный холестаз. Доза составляет от 800 мг/сут до 1600 мг/сут.
Депрессия. Доза составляет от 800 мг/сут до 1600 мг/сут.
Длительность терапии определяется врачом. Терапия может быть начата с внутривенного или внутримышечного введения препаратов адеметионина других производителей с последующим применением препарата Гептразан в виде таблеток или сразу с применения препарата Гептразан в виде таблеток.
Пациенты пожилого возраста. Клинический опыт применения препарата Гептразан не выявил каких-либо различий в его эффективности у пациентов пожилого возраста и пациентов более молодого возраста. Однако учитывая высокую вероятность имеющихся нарушений функции печени, почек или сердца, другой сопутствующей патологии или одновременной терапии с другими лекарственными средствами, дозу препарата Гептразан пожилым пациентам следует подбирать с осторожностью, начиная применение препарата с нижнего предела диапазона доз.
Почечная недостаточность. Имеются ограниченные данные о применении препарата Гептразан у пациентов с почечной недостаточностью, в связи с этим рекомендуется соблюдать осторожность при применении препарата Гептразан у таких пациентов.
Печеночная недостаточность. Параметры фармакокинетики адеметионина сходны у здоровых добровольцев и у пациентов с хроническими заболеваниями печени.
Дети. Применение препарата Гептразан у детей противопоказано (эффективность и безопасность не установлены).
Полная инструкция
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Гептразан таб. кш/раств.
Гептразан таб. кш/раств., 400 мг, 20 шт.
4.9
(9)
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1 вопрос
Инструкция

1 058 ₽

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4.9
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У продавца:9 оценок·2 отзыва
У всех продавцов:10 оценок·3 отзыва
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user avatar
2 недели назад • Сергей Сурин • Куплен на Маркете
Достоинства: В два раза дешевле Гептрала, действующее вещество то же
Комментарий: Неприятных побочных эффектов от этого дженерика пока не заметил.
user avatar
Месяц назад • Сергей У. • Куплен на Маркете
Комментарий: все отлично
Посмотреть все отзывы на Маркете
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  • Таблетница из 14 секций на семь дней Утро-вечер
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    Таблетница из 14 секций на семь дней Утро-вечер

    Цена 166 ₽ вместо 190
  • Таблетница на день, контейнер для таблеток, 4 секции (зеленый)
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    Таблетница на день, контейнер для таблеток, 4 секции (зеленый)

    Цена 195 ₽ вместо 499
  • Гептрал таб. п/о кш/раств., 400 мг, 20 шт.
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    Гептрал таб. п/о кш/раств., 400 мг, 20 шт.

    Цена 2 001 ₽ вместо 2 264
  • Таблетница с делителем, 2 секции
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    Таблетница с делителем, 2 секции

    Цена 182 ₽
  • Гептор таб. п/о кш/раств., 400 мг, 20 шт.
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    Гептор таб. п/о кш/раств., 400 мг, 20 шт.

    Цена 1 234 ₽
  • Таблетница - брелок на день, 1 раздел, контейнер для таблеток металлический маленький (черный матовый)
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    Таблетница - брелок на день, 1 раздел, контейнер для таблеток металлический маленький (черный матовый)

    Цена 223 ₽ вместо 599
  • Таблетница на 7 дней / органайзер / бокс / контейнер на неделю для хранения таблеток и лекарств 4 приема Clear Daswerk
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    Таблетница на 7 дней / органайзер / бокс / контейнер на неделю для хранения таблеток и лекарств 4 приема Clear Daswerk

    Цена 405 ₽ вместо 637
  • Таблетница/контейнер-органайзер для лекарств и витаминов 7 дней/2 приема Maxi, Daswerk, 631025
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    Таблетница/контейнер-органайзер для лекарств и витаминов 7 дней/2 приема Maxi, Daswerk, 631025

    Цена 417 ₽ вместо 750
  • Реклама
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  • Таблетница компактная /органайзер аптечка/ контейнер для таблеток БАД Panda_Home (синего цвета)
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    Таблетница компактная /органайзер аптечка/ контейнер для таблеток БАД Panda_Home (синего цвета)

    Цена 245 ₽ вместо 263
  • Контейнер для хранения/таблетница/кейс для таблеток
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    Контейнер для хранения/таблетница/кейс для таблеток

    Цена 377 ₽ вместо 699
  • Адеметионин таб. кш/раств., 400 мг, 20 шт.
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    Адеметионин таб. кш/раств., 400 мг, 20 шт.

    Цена 1 413 ₽ вместо 1 580
  • Самеликс таб. п/о плен. кш/раств., 400 мг, 20 шт.
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    Самеликс таб. п/о плен. кш/раств., 400 мг, 20 шт.

    Цена 1 315 ₽
  • Таблетница на день 3 ячейки Oxitab синяя
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    Таблетница на день 3 ячейки Oxitab синяя

    Цена 241 ₽ вместо 520
  • Таблетница органайзер на неделю утро / день / вечер; Органайзер для таблеток на 7 дней; Карманная аптечка
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    Таблетница органайзер на неделю утро / день / вечер; Органайзер для таблеток на 7 дней; Карманная аптечка

    Цена 781 ₽ вместо 1 890
  • Таблетница органайзер на неделю утро / день / вечер; Органайзер для таблеток на 7 дней; Карманная аптечка полностью черная
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    Таблетница органайзер на неделю утро / день / вечер; Органайзер для таблеток на 7 дней; Карманная аптечка полностью черная

    Цена 812 ₽ вместо 1 300
  • Таблетница пенал - органайзер ABORNS на неделю 7 ячеек 7 дней
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    Таблетница пенал - органайзер ABORNS на неделю 7 ячеек 7 дней

    Цена 173 ₽ вместо 350
  • Таблетница с зеркальной поверхностью, 3 секции, d 5см, цвет серебристый
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    Таблетница с зеркальной поверхностью, 3 секции, d 5см, цвет серебристый

    Цена 413 ₽ вместо 417
  • Таблетница, 4 секции
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    Таблетница, 4 секции

    Цена 97 ₽ вместо 400
  • Таблетница с делителем таблеток
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    Таблетница с делителем таблеток

    Цена 513 ₽ вместо 1 625
  • Таблетница на 7 дней прозрачная, органайзер для хранения лекарств
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    Таблетница на 7 дней прозрачная, органайзер для хранения лекарств

    Цена 346 ₽ вместо 1 290
  • Реклама
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  • Таблетница-органайзер «Неделька», английские буквы, утро/день/вечер/ночь, 10 × 7,5 × 4 см, 7 контейнеров по 4 секции, разноцветный
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    Таблетница-органайзер «Неделька», английские буквы, утро/день/вечер/ночь, 10 × 7,5 × 4 см, 7 контейнеров по 4 секции, разноцветный

    Цена 484 ₽ вместо 494
  • Гепатрин капс., 44 г, 30 шт., 1 уп.
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    Гепатрин капс., 44 г, 30 шт., 1 уп.

    Цена 536 ₽ вместо 541
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