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Описание

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Риолма таб. п/о плен., 25 мг, 30 шт.

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4.8
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Коротко о товаре

Артикул Маркета
3413164629
Тип препарата
Назначение
Действующее вещество
Возраст
от 18 лет
Инструкция
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применение у пациентов пожилого возраста; нарушение функции почек (КК \u003C 50 мл/мин); одновременное применение эплеренона и ингибиторов АПФ или антагонистов рецепторов ангиотензина II (АРА II), мощных индукторов изофермента СYР3А4, препаратов, содержащих литий, циклоспорина или такролимуса, дигоксина и варфарина в дозах, близких к максимальным терапевтическим.\u003Cbr\u003E\u003Cbr\u003EНе следует применять тройную комбинацию: ингибитор АПФ, АРА II и эплеренон.\u003Cbr\u003E"},{"name":"Состав","value":"1 таблетка, покрытая пленочной оболочкой, 25 мг/50 мг содержит:\u003Cbr\u003Eядро:\u003Cbr\u003EДействующее вещество: эплеренон 25,000 мг/50,000 мг\u003Cbr\u003E\tВспомогательные\tвещества:\tлактозы\tмоногидрат, целлюлоза\u003Cbr\u003Eмикрокристаллическая, РН 101, кроскармеллоза натрия, гипромеллоза, магния стеарат, натрия лаурилсульфат\u003Cbr\u003EОболочка пленочная: пленкообразующая смесь (гипромеллоза, титана диоксид (Т 71), макрогол-4()0, полисорбат-80, краситель железа оксид желтый (Е172))\u003Cbr\u003E"},{"name":"Действующее вещество","value":"Эплеренон","transition":{"type":"catalog","params":{"categorySlug":"sredstva-dlia-serdtsa-i-sosudov","categoryId":"15756887","navnodeId":"72494","glfilters":["27144131:28709355"]}}},{"name":"Способ применения и дозы","value":"Внутрь, независимо от времени приема пищи.\u003Cbr\u003E\u003Cbr\u003EПрием пищи не влияет на всасывание препарата Риолма®. Для индивидуального подбора дозы можно применять дозировки 25 мг и 50 мг.\u003Cbr\u003E\u003Cbr\u003EДо начала терапии препаратом Риолма®, в течение первой недели и через 1 месяц после начала терапии или при изменении дозы препарата следует определить содержание калия в сыворотке крови пациента. В дальнейшем необходимо периодически контролировать содержание калия в сыворотке крови.\u003Cbr\u003E\u003Cbr\u003EИМ\u003Cbr\u003E\u003Cbr\u003EЛечение следует начинать с дозы 25 мг 1 раз в сутки и увеличивать ее до 50 мг 1 раз в сутки через 4 недели с учетом содержания калия в сыворотке крови (см. таблицу 1). Рекомендуемая поддерживающая доза препарата составляет 50 мг 1 раз в сутки.\u003Cbr\u003E\u003Cbr\u003EХСН II ФК по классификации NYНА\u003Cbr\u003E\u003Cbr\u003EЛечение также следует начинать с дозы 25 мг 1 раз в сутки, далее дозу подбирают индивидуально, увеличивая ее до 50 мг 1 раз в сутки, предпочтительно в течение 4 недель с учетом содержания калия в сыворотке крови (см. таблицу 1).\u003Cbr\u003E\u003Cbr\u003EЛечение эплереноном не следует начинать у пациентов с содержанием калия в сыворотке крови \u003E 5,0 ммоль/л.\nПосле временного прекращения приема препарата в связи с повышением содержания калия в сыворотке крови до или более 6,0 ммоль/л, терапию препаратом можно возобновить в дозе 25 мг через день, когда содержание калия в сыворотке крови составит \u003C 5,0 ммоль/л.\u003Cbr\u003E\u003Cbr\u003EОсобые группы пациентов\u003Cbr\u003E\u003Cbr\u003EПациенты пожилого возраста\u003Cbr\u003E\u003Cbr\u003EКоррекции начальной дозы у пациентов пожилого возраста не требуется. В связи с возрастным снижением функции почек у пациентов пожилого возраста повышается риск развития гиперкалиемии, особенно при наличии сопутствующих заболеваний, способствующих увеличению концентрации эплеренона в сыворотке крови, в частности при нарушении функции печени от легкой до средней степени тяжести. Рекомендуется периодически определять содержание калия в сыворотке крови (раздел «Особые указания»).\u003Cbr\u003E\u003Cbr\u003EПациенты с нарушением функции почек\u003Cbr\u003E\u003Cbr\u003EУ пациентов с легкой степенью нарушения функции почек коррекции начальной дозы не требуется. Рекомендуется периодически определять содержание калия в сыворотке крови (см. таблицу 1).\u003Cbr\u003E\u003Cbr\u003EУ пациентов с нарушением функции почек средней степени тяжести (КК 30-60 мл/мин) следует начинать терапию с дозы 25 мг через день с последующей коррекцией дозы в зависимости от содержания калия в сыворотке крови (см. таблицу 1).\u003Cbr\u003E\u003Cbr\u003EПациенты с сердечной недостаточностью\u003Cbr\u003E\u003Cbr\u003EОтсутствует опыт применения эплеренона у пациентов с ХСН, после перенесенного ИМ и КК \u003C 50 мл/мин. Поэтому у таких пациентов препарат следует применять с осторожностью.\u003Cbr\u003E\u003Cbr\u003EУ пациентов с КК \u003C 50 мл/мин применение эплеренона в дозе выше 25 мг 1 раз в сутки не исследовалось (также см. разделы «Противопоказания» и «Особые указания»).\u003Cbr\u003E\u003Cbr\u003EПациенты с нарушением функции печени\u003Cbr\u003E\u003Cbr\u003EУ пациентов с нарушениями функции печени от легкой до средней степени тяжести коррекции начальной дозы не требуется. Учитывая увеличение сывороточной концентрации эплеренона у таких пациентов, рекомендуется регулярно контролировать содержание калия в сыворотке крови, особенно у пациентов пожилого возраста (см. раздел «Особые указания»),\u003Cbr\u003E\u003Cbr\u003EУ пациентов с нарушением функции печени тяжелой степени применение препарата Риолма® противопоказано.\u003Cbr\u003E\u003Cbr\u003EСопутствующая терапия\u003Cbr\u003E\u003Cbr\u003EПри одновременном применении препаратов, оказывающих слабое или умеренно выраженное ингибирующее действие на изофермент СYР3А4, например, эритромицина, саквинавира, амиодарона, дилтиазема, верапамила, лечение препаратом Риолма® следует проводить в дозе 25 мг 1 раз в сутки, при этом доза последнего не должна превышать 25 мг 1 раз в сутки (см. раздел «Взаимодействие с другими лекарственными средствами»).\n\u003Cbr\u003E"},{"name":"Побочные действия","value":"Ниже перечислены нежелательные явления, которые могли быть связаны с лечением, а также серьезные нежелательные явления, частота которых сопоставима с частотой нежелательных и серьезных нежелательных явлений в группе плацебо. Нежелательные явления перечислены в соответствии с системно-органным классом и абсолютной частотой их возникновения.\u003Cbr\u003E\u003Cbr\u003EЧастота определяется следующим образом: очень часто (\u003E 1/10), часто (от \u003E1/100 до \u003C 1/10), нечасто (от \u003E 1/1000 до \u003C 1/100), редко (от \u003E 1/10000 до \u003C 1000), очень редко (\u003C 1/10000), частота неизвестна (не может быть оценена по имеющимся данным).\u003Cbr\u003E"},{"name":"Фармакологическое действие","value":"Эплеренон обладает высокой селективностью в отношении минералокортикоидных рецепторов у человека в отличие от глюкокортикоидных, прогестероновых и андрогенных рецепторов и препятствует связыванию минералокортикоидных рецепторов с альдостероном - ключевым гормоном ренин-ангиотензин-альдостероновой системы (РААС), который участвует в регуляции артериального давления (АД) и патогенезе сердечно-сосудистых заболеваний.\u003Cbr\u003E\u003Cbr\u003EЭплеренон вызывает стойкое увеличение активности ренина в плазме крови и альдостерона в сыворотке крови. Впоследствии секреция ренина подавляется альдостероном по механизму обратной связи. При этом повышение активности ренина или концентрации циркулирующего альдостерона не влияет на эффекты эплеренона.\u003Cbr\u003E\u003Cbr\u003EПрименение эплеренона у пациентов после инфаркта миокарда (ИМ) с признаками сердечной недостаточности\u003Cbr\u003E\u003Cbr\u003EЭффективность эплеренона изучали в двойном слепом плацебо-контролируемом исследовании у 6632 пациентов с острым ИМ, дисфункцией левого желудочка (ЛЖ) (фракция выброса (ФВ) \u003C 40 %) и с клиническими признаками сердечной недостаточности. В течение 3-14 дней (в среднем 7 дней) после острого ИМ пациентам назначали эплеренон или плацебо в дополнение к стандартной терапии. Лечение начинали с дозы 25 мг 1 раз в сутки и к концу 4 недели увеличивали до 50 мг 1 раз в сутки, если содержание калия в сыворотке крови оставалось менее 5,0 ммоль/л. Во время исследования пациенты получали стандартную терапию с применением ацетилсалициловой кислоты (92 %), ингибиторов ангиотензинпревращающего фермента (АПФ) (90 %), бета-адреноблокаторов (83 %), нитратов (72 %), «петлевых» диуретиков (66 %) или ингибиторов З-гидрокси-З-метилглутарил-кофермент А редуктазы (ГМГ-КоА- редуктазы) (60 %). Первичной конечной точкой в исследовании была общая смертность, а комбинированной конечной точкой - смертность или госпитализация по поводу сердечнососудистых заболеваний.\u003Cbr\u003E\u003Cbr\u003EОбщая смертность в группах эплеренона и плацебо составила соответственно 14,4 % и 16,7 %, а комбинированную конечную точку смертности или госпитализации по поводу сердечно-сосудистых заболеваний отмечали соответственно у 26,7 % и 30,0 % пациентов. Таким образом по данным исследования в результате терапии эплереноном риск общей смертности был снижен на 15 % (относительный риск 0,85; 95 % доверительный интервал (ДИ), 0,75-0,96; р = 0,008) по сравнению с плацебо, главным образом за счет снижения смертности в результате сердечно-сосудистых заболеваний. Риск летального исхода или госпитализации по поводу сердечно-сосудистых заболеваний при применении эплеренона был снижен на 13 % (относительный риск 0,87; 95 % ДИ, 0,79-0,95; р = 0,002). Снижение абсолютного риска для двух конечных точек - общая смертность и смертность/госпитализации по поводу сердечно-сосудистых заболеваний - составило 2,3 % и 3,3 % соответственно. Клиническая эффективность была продемонстрирована главным образом при применении эплеренона у пациентов в возрасте до 75 лет. Эффективность терапии у пациентов в возрасте старше 75 лет не изучалась. Снижение или стабилизацию функционального класса (ФК) хронической сердечной недостаточности (ХСН) в группе эплеренона отмечали значительно чаще, чем в группе плацебо. Частота гиперкалиемии в группах эплеренона и плацебо составила 3,4 % и 2,0 % (р \u003C 0,001), гипокалиемии - 0,5 % и 1,5 % (р \u003C 0,001) соответственно.\u003Cbr\u003E\u003Cbr\u003EЭлектрокардиография\u003Cbr\u003E\u003Cbr\u003EВ исследованиях по изучению динамики электрокардиограммы (ЭКГ) у здоровых добровольцев существенного влияния эплеренона на частоту сердечных сокращений (ЧСС), длительность интервалов QRS, PR или QT не выявлено."},{"name":"Фармакологическая группа","value":"диуретическое калийсберегающее средство"},{"name":"Форма выпуска","value":"таблетки, покрытые пленочной оболочкой"},{"name":"Способ применения/введения","value":"пероральный","transition":{"type":"catalog","params":{"categorySlug":"sredstva-dlia-serdtsa-i-sosudov","categoryId":"15756887","navnodeId":"72494","glfilters":["35947170:36763744"]}}},{"name":"Минимальный возраст применения","value":"от 18 лет"},{"name":"Условия хранения","value":"При температуре не выше 25 °С, в оригинальном блистере.\u003Cbr\u003E\u003Cbr\u003EХранить в недоступном для детей месте.\u003Cbr\u003E"},{"name":"Передозировка","value":"Случаев передозировки эплеренона у человека не описано. Наиболее вероятными проявлениями передозировки могут быть выраженное снижение АД и/или гиперкалиемия. Эплеренон не удаляется при гемодиализе.\u003Cbr\u003E\u003Cbr\u003EУстановлено, что эплеренон активно связывается с активированным углем. При появлении симптоматической гипотензии необходимо назначить поддерживающую терапию. В случае развития гиперкалиемии показана стандартная терапия.\u003Cbr\u003E"},{"name":"Применение при беременности и кормлении грудью","value":"Беременность\u003Cbr\u003E\u003Cbr\u003EСведений о применении препарата у беременных нет. Препарат Риолма® следует применять с осторожностью и только в тех случаях, когда ожидаемая польза для матери значительно превышает возможный риск для плода/ребенка.\u003Cbr\u003E\u003Cbr\u003EПериод грудного вскармливания\u003Cbr\u003E\u003Cbr\u003EСведений о выведении эплеренона после приема внутрь с грудным молоком нет. Однако в доклинических исследованиях показано, что эплеренон и/или его метаболиты присутствуют в грудном молоке крыс.\u003Cbr\u003E\u003Cbr\u003EПоскольку нежелательные эффекты эплеренона у новорожденных, находящихся на грудном вскармливании, не изучены, решение о прекращении грудного вскармливания или отмене лекарственного препарата должно быть принято в зависимости от важности этого препарата для матери.\u003Cbr\u003E\u003Cbr\u003EРепродуктивная функция\u003Cbr\u003E\u003Cbr\u003EВ доклинических исследованиях также было показано, что в дозах до 300 мг/кг воздействия эплеренона на фертильность половозрелых особей крыс не обнаружено. Клинические данные о воздействии на репродуктивную функцию у человека отсутствуют.\u003Cbr\u003E"},{"name":"Влияние на способность управлять транспортом и механизмами","value":"Эффекты эплеренона на способность управлять транспортными средствами, механизмами не изучались. В рекомендуемых дозах 25 мг и 50 мг эплеренон не вызывает головокружения, обморочных состояний и нарушений когнитивной функции, но при управлении транспортными средствами, механизмами или использовании другой техники следует принимать во внимание, что во время лечения может развиться головокружение.\u003Cbr\u003E"},{"name":"Особые указания","value":"Гиперкалиемия\u003Cbr\u003E\u003Cbr\u003EПри применении эплеренона может развиться гиперкалиемия, которая обусловлена его механизмом действия. В начале лечения и при изменении дозы препарата у всех пациентов следует контролировать содержание калия в сыворотке крови.\u003Cbr\u003E\u003Cbr\u003EВ дальнейшем периодический контроль содержания калия рекомендуется проводить пациентам с повышенным риском развития гиперкалиемии, например, пациентам пожилого возраста, пациентам с почечной недостаточностью (см. раздел «Способ применения и дозы») и сахарным диабетом. Учитывая повышенный риск развития гиперкалиемии, назначение препаратов калия после начала лечения эплереноном не рекомендуется. Снижение дозы препарата Риолма® приводит к снижению содержания калия в сыворотке крови. В одном исследовании добавление гидрохлоротиазида к эплеренону препятствовало увеличению содержания калия в сыворотке крови. Риск развития гиперкалиемии может увеличиться, если эплеренон применяется в комбинации с ингибитором АПФ и/или АРА II.\u003Cbr\u003E\u003Cbr\u003EНарушение функции почек\u003Cbr\u003E\u003Cbr\u003EУ пациентов с нарушениями функции почек, в том числе диабетической микроальбуминурией, рекомендуется регулярно контролировать содержание калия в сыворотке крови. Риск развития гиперкалиемии увеличивается при снижении функции почек. Хотя число пациентов с сахарным диабетом 2 типа и микроальбуминурией в исследованиях было ограниченным, тем не менее, в этой небольшой выборке было отмечено увеличение частоты гиперкалиемии. В связи с этим у таких пациентов лечение следует проводить с осторожностью. Эплеренон не удаляется при гемодиализе.\u003Cbr\u003E\u003Cbr\u003EНарушение функции печени\u003Cbr\u003E\u003Cbr\u003EУ пациентов с нарушениями функции печени легкой или средней степени (класс А и В по классификации Чайлд-Пью) увеличения содержания калия в сыворотке крови более 5,5 ммоль/л выявлено не было. У таких пациентов следует контролировать содержание электролитов в плазме крови. У пациентов с нарушением функции печени тяжелой степени оценка применения эплеренона не проводилась, поэтому его применение у таких пациентов противопоказано.\u003Cbr\u003E\u003Cbr\u003EИндукторы изофермента СYР3А4\u003Cbr\u003E\u003Cbr\u003EОдновременное применение эплеренона с мощными индукторами изофермента СYРЗА4 не рекомендуется (см. раздел «Взаимодействие с другими лекарственными средствами»).\u003Cbr\u003E\u003Cbr\u003EЦиклоспорин, такролимус, препараты, содержащие литий\u003Cbr\u003E\u003Cbr\u003EВо время лечения эплереноном следует избегать назначения этих средств (см. раздел «Взаимодействие с другими лекарственными средствами»).\u003Cbr\u003E\u003Cbr\u003EСпециальная информация о вспомогательных веществах\u003Cbr\u003E\u003Cbr\u003EПрепарат Риолма® содержит лактозу, поэтому не следует применять при следующих состояниях: непереносимость лактозы, дефицит лактазы, синдром глюкозо-галактозной мальабсорбции.\u003Cbr\u003E"},{"name":"Взаимодействие","value":"Фармакодинамические взаимодействия\u003Cbr\u003E\u003Cbr\u003EКалийсберегающие диуретики и препараты калия\u003Cbr\u003E\u003Cbr\u003EУчитывая повышенный риск развития гиперкалиемии, эплеренон не следует назначать пациентам, получающим калийсберегающие диуретики и препараты калия (см. раздел «Противопоказания»). Калийсберегающие диуретики могут усиливать эффекты гипотензивных средств и других диуретиков.\u003Cbr\u003E\u003Cbr\u003EПрепараты, содержащие литий\u003Cbr\u003E\u003Cbr\u003EВзаимодействие эплеренона с препаратами лития не изучалось. Однако у пациентов, получавших препараты лития в сочетании с диуретиками и ингибиторами АПФ, описаны случаи повышения концентрации и интоксикации литием. Следует избегать одновременного назначения эплеренона и препаратов лития. Если подобная комбинация необходима, целесообразно контролировать концентрации лития в плазме крови.\u003Cbr\u003E\u003Cbr\u003EЦиклоспорин, такролимус\u003Cbr\u003E\u003Cbr\u003EЦиклоспорин и такролимус могут вызывать нарушение функции почек и повышать риск развития гиперкалиемии. Следует избегать одновременного применения эплеренона и циклоспорина или такролимуса. Если во время лечения эплереноном потребуется назначение циклоспорина или такролимуса, рекомендуется тщательно контролировать содержание калия в сыворотке крови и функцию почек.\u003Cbr\u003E\u003Cbr\u003EНестероидные противовоспалительные препараты (НПВП)\u003Cbr\u003E\u003Cbr\u003EЛечение НПВП может привести к острой почечной недостаточности за счет прямого подавления клубочковой фильтрации, особенно у пациентов группы риска (пациенты пожилого возраста и/или пациенты с дегидратацией). При одновременном применении этих средств до начала и во время лечения необходимо обеспечивать адекватный водный режим и контролировать функцию почек.\u003Cbr\u003E\u003Cbr\u003EТриметоприм\u003Cbr\u003E\u003Cbr\u003EОдновременное применение триметоприма с эплереноном повышает риск развития гиперкалиемии. Рекомендуется контролировать содержание калия в сыворотке крови и функцию почек, особенно у пациентов с почечной недостаточностью и у пациентов пожилого возраста.\u003Cbr\u003E\u003Cbr\u003EИнгибиторы АПФ и АРА II\u003Cbr\u003E\u003Cbr\u003EПри применении эплеренона с ингибиторами АПФ или АРА II следует тщательно контролировать содержание калия сыворотки крови. Подобная комбинация может привести к увеличению риска развития гиперкалиемии, особенно у пациентов с нарушением функции почек, в т. ч. у пациентов пожилого возраста. Не следует применять тройную комбинацию: ингибитор АПФ, АРА II и эплеренон.\u003Cbr\u003E\u003Cbr\u003EАльфа1-адреноблокаторы (празозин, альфузозин)\u003Cbr\u003E\u003Cbr\u003EПри одновременном применении альфа1-адреноблокаторов с эплереноном может усиливаться антигипертензивное действие и/или увеличиваться риск развития ортостатической гипотензии, в связи с чем рекомендуется контролировать АД при изменении положения тела.\u003Cbr\u003E\u003Cbr\u003EТрициклические антидепрессанты, нейролептики, амифостин, баклофен\u003Cbr\u003E\u003Cbr\u003EПри одновременном применении этих средств с эплереноном может усиливаться антигипертензивный эффект или увеличиваться риск развития ортостатической гипотензии.\u003Cbr\u003E\u003Cbr\u003EГлюкокортикоиды, тетракозактид\u003Cbr\u003E\u003Cbr\u003EОдновременное применение этих средств с эплереноном может привести к задержке ионов натрия и жидкости.\u003Cbr\u003E\u003Cbr\u003EФармакокинетические взаимодействия\u003Cbr\u003E\u003Cbr\u003EИсследования in vitro свидетельствуют о том, что эплеренон не ингибирует изоферменты CYP1A2, CYP2C19, CYP2C9, CYP2D6 или CYP3A4. Эплеренон не является субстратом или ингибитором гликопротеина Р.\u003Cbr\u003E\u003Cbr\u003EДигоксин\u003Cbr\u003E\u003Cbr\u003EAUC дигоксина при одновременном применении с эплереноном увеличивается на 16% (90 % ДИ: 4-30 %). Необходимо соблюдать осторожность, если дигоксин применяется в дозах, близких к максимальным терапевтическим.\u003Cbr\u003E\u003Cbr\u003EВарфарин\u003Cbr\u003E\u003Cbr\u003EКлинически значимого фармакокинетического взаимодействия с варфарином не выявлено. Необходимо соблюдать осторожность, если варфарин применяется в дозах, близких к максимальным терапевтическим.\u003Cbr\u003E\u003Cbr\u003EСубстраты изофермента CYP3A4\u003Cbr\u003E\u003Cbr\u003EВ специальных исследованиях признаков фармакокинетического взаимодействия эплеренона с субстратами изофермента CYP3A4, например, мидазоламом и цизапридом, выявлено не было.\u003Cbr\u003E\u003Cbr\u003EИнгибиторы изофермента CYP3A4\u003Cbr\u003E\u003Cbr\u003EМощные ингибиторы изофермента CYP3A4\u003Cbr\u003E\u003Cbr\u003EПри применении эплеренона со средствами, ингибирующими изофермент CYP3A4, возможно значимое фармакокинетическое взаимодействие. Мощный ингибитор изофермента CYP3A4 (кетоконазол 200 мг 2 раза в сутки) вызывал увеличение AUC эплеренона на 441 %. Одновременное применение эплеренона с мощными ингибиторами изофермента CYP3A4, такими как кетоконазол, итраконазол, ритонавир, нелфинавир, кларитромицин, телитромицин и нефазадон, противопоказано (см. раздел «Противопоказания»).\u003Cbr\u003E\u003Cbr\u003EСлабые и умеренные ингибиторы изофермента CYP3A4\u003Cbr\u003E\u003Cbr\u003EОдновременное применение с эритромицином, саквинавиром, амиодароном, дилтиаземом, верапамилом и флуконазолом сопровождалось значимым фармакокинетическим взаимодействием (степень увеличения AUC варьировала от 98% до 187%). При одновременном применении этих средств с эплереноном доза последнего не должна превышать 25 мг в сутки (см. раздел «Способ применения и дозы»).\u003Cbr\u003E\u003Cbr\u003EИндукторы изофермента CYP3A4\u003Cbr\u003E\u003Cbr\u003EОдновременный прием препаратов, содержащих Зверобой продырявленный (мощный индуктор изофермента CYP3A4) с эплереноном вызывал снижение AUC последнего на 30 %. При применении более мощных индукторов изофермента CYP3A4, таких как рифампицин, возможно более выраженное снижение AUC эплеренона. Учитывая возможное снижение эффективности эплеренона, одновременное применение мощных индукторов изофермента CYP3A4 (рифампицина, карбамазепина, фенитоина, фенобарбитала, препаратов, содержащих Зверобой продырявленный) не рекомендуется (см. раздел «Особые указания»),\u003Cbr\u003E\u003Cbr\u003EАнтациды\u003Cbr\u003E\u003Cbr\u003EНа основании фармакокинетического клинического исследования значительного взаимодействия антацидов с эплереноном при их одновременном применении не предполагается.\u003Cbr\u003E"},{"name":"Регистрационный номер","value":"ЛП-006425"},{"name":"Дата государственной регистрации","value":"25.08.2020"},{"name":"Владелец регистрационного удостоверения","value":"KRKA","transition":{"type":"catalog","params":{"categorySlug":"sredstva-dlia-serdtsa-i-sosudov","categoryId":"15756887","navnodeId":"72494","glfilters":["34324371:35649313","7893318:8514230"]}}},{"name":"Изготовитель","value":"КРКА"},{"name":"Страна бренда","value":"Словения"},{"name":"Страна-производитель","value":"Словения"},{"name":"Срок годности","value":"930 дн."}]}},"fullSpecsGrouped":{"4076086678011107058":{"groups":[{"name":"Общие характеристики","items":[{"name":"Тип препарата","value":"лекарственный препарат"},{"name":"Рецептурный препарат","value":"да"},{"name":"Органы и системы","value":"кровеносные сосуды, сердце"},{"name":"Назначение","value":"инфаркт миокарда, сердечная недостаточность"},{"name":"Показания к применению","value":"Инфаркт миокарда: в дополнение к стандартной терапии с целью снижения риска сердечно-сосудистой смертности и заболеваемости у пациентов со стабильной дисфункцией левого желудочка (ФВ \u003C 40 %) и клиническими признаками сердечной недостаточности после перенесенного инфаркта миокарда.\u003Cbr\u003E\u003Cbr\u003EХроническая сердечная недостаточность: в дополнение к стандартной терапии с целью снижения риска сердечно-сосудистой смертности и заболеваемости у пациентов с хронической сердечной недостаточностью II ФК по классификации NYНА, при дисфункции левого желудочка (ФВ \u003C 35 %).\u003Cbr\u003E"},{"name":"Противопоказания","value":"Повышенная чувствительность к эплеренону или другим компонентам препарата.\u003Cbr\u003EКлинически значимая гиперкалиемия.\u003Cbr\u003EСодержание калия в сыворотке крови в начале лечения \u003E 5,0 ммоль/л.\u003Cbr\u003EПочечная недостаточность тяжелой степени (клиренс креатинина (КК) \u003C 30 мл/мин) у пациентов с хронической сердечной недостаточностью II функционального класса по классификации NYНА).\u003Cbr\u003EПеченочная недостаточность тяжелой степени (класс С по классификации Чайлд-Пью).\u003Cbr\u003EОдновременный прием калийсберегающих диуретиков, препаратов калия или мощных ингибиторов изофермента СYР3А4, например, итраконазола, кетоконазола, ритонавира, нелфинавира, кларитромицина, телитромицина и нефазодона.\u003Cbr\u003EДефицит лактазы, непереносимость лактозы и синдром глюкозо-галактозной мальабсорбции.\u003Cbr\u003EДетский возраст до 18 лет (эффективность и безопасность не установлены).\u003Cbr\u003EС осторожностью:\u003Cbr\u003EСахарный диабет 2 типа и микроальбуминурия; применение у пациентов пожилого возраста; нарушение функции почек (КК \u003C 50 мл/мин); одновременное применение эплеренона и ингибиторов АПФ или антагонистов рецепторов ангиотензина II (АРА II), мощных индукторов изофермента СYР3А4, препаратов, содержащих литий, циклоспорина или такролимуса, дигоксина и варфарина в дозах, близких к максимальным терапевтическим.\u003Cbr\u003E\u003Cbr\u003EНе следует применять тройную комбинацию: ингибитор АПФ, АРА II и эплеренон.\u003Cbr\u003E"},{"name":"Состав","value":"1 таблетка, покрытая пленочной оболочкой, 25 мг/50 мг содержит:\u003Cbr\u003Eядро:\u003Cbr\u003EДействующее вещество: эплеренон 25,000 мг/50,000 мг\u003Cbr\u003E\tВспомогательные\tвещества:\tлактозы\tмоногидрат, целлюлоза\u003Cbr\u003Eмикрокристаллическая, РН 101, кроскармеллоза натрия, гипромеллоза, магния стеарат, натрия лаурилсульфат\u003Cbr\u003EОболочка пленочная: пленкообразующая смесь (гипромеллоза, титана диоксид (Т 71), макрогол-4()0, полисорбат-80, краситель железа оксид желтый (Е172))\u003Cbr\u003E"},{"name":"Действующее вещество","value":"Эплеренон"},{"name":"Способ применения и дозы","value":"Внутрь, независимо от времени приема пищи.\u003Cbr\u003E\u003Cbr\u003EПрием пищи не влияет на всасывание препарата Риолма®. Для индивидуального подбора дозы можно применять дозировки 25 мг и 50 мг.\u003Cbr\u003E\u003Cbr\u003EДо начала терапии препаратом Риолма®, в течение первой недели и через 1 месяц после начала терапии или при изменении дозы препарата следует определить содержание калия в сыворотке крови пациента. В дальнейшем необходимо периодически контролировать содержание калия в сыворотке крови.\u003Cbr\u003E\u003Cbr\u003EИМ\u003Cbr\u003E\u003Cbr\u003EЛечение следует начинать с дозы 25 мг 1 раз в сутки и увеличивать ее до 50 мг 1 раз в сутки через 4 недели с учетом содержания калия в сыворотке крови (см. таблицу 1). Рекомендуемая поддерживающая доза препарата составляет 50 мг 1 раз в сутки.\u003Cbr\u003E\u003Cbr\u003EХСН II ФК по классификации NYНА\u003Cbr\u003E\u003Cbr\u003EЛечение также следует начинать с дозы 25 мг 1 раз в сутки, далее дозу подбирают индивидуально, увеличивая ее до 50 мг 1 раз в сутки, предпочтительно в течение 4 недель с учетом содержания калия в сыворотке крови (см. таблицу 1).\u003Cbr\u003E\u003Cbr\u003EЛечение эплереноном не следует начинать у пациентов с содержанием калия в сыворотке крови \u003E 5,0 ммоль/л.\nПосле временного прекращения приема препарата в связи с повышением содержания калия в сыворотке крови до или более 6,0 ммоль/л, терапию препаратом можно возобновить в дозе 25 мг через день, когда содержание калия в сыворотке крови составит \u003C 5,0 ммоль/л.\u003Cbr\u003E\u003Cbr\u003EОсобые группы пациентов\u003Cbr\u003E\u003Cbr\u003EПациенты пожилого возраста\u003Cbr\u003E\u003Cbr\u003EКоррекции начальной дозы у пациентов пожилого возраста не требуется. В связи с возрастным снижением функции почек у пациентов пожилого возраста повышается риск развития гиперкалиемии, особенно при наличии сопутствующих заболеваний, способствующих увеличению концентрации эплеренона в сыворотке крови, в частности при нарушении функции печени от легкой до средней степени тяжести. Рекомендуется периодически определять содержание калия в сыворотке крови (раздел «Особые указания»).\u003Cbr\u003E\u003Cbr\u003EПациенты с нарушением функции почек\u003Cbr\u003E\u003Cbr\u003EУ пациентов с легкой степенью нарушения функции почек коррекции начальной дозы не требуется. Рекомендуется периодически определять содержание калия в сыворотке крови (см. таблицу 1).\u003Cbr\u003E\u003Cbr\u003EУ пациентов с нарушением функции почек средней степени тяжести (КК 30-60 мл/мин) следует начинать терапию с дозы 25 мг через день с последующей коррекцией дозы в зависимости от содержания калия в сыворотке крови (см. таблицу 1).\u003Cbr\u003E\u003Cbr\u003EПациенты с сердечной недостаточностью\u003Cbr\u003E\u003Cbr\u003EОтсутствует опыт применения эплеренона у пациентов с ХСН, после перенесенного ИМ и КК \u003C 50 мл/мин. Поэтому у таких пациентов препарат следует применять с осторожностью.\u003Cbr\u003E\u003Cbr\u003EУ пациентов с КК \u003C 50 мл/мин применение эплеренона в дозе выше 25 мг 1 раз в сутки не исследовалось (также см. разделы «Противопоказания» и «Особые указания»).\u003Cbr\u003E\u003Cbr\u003EПациенты с нарушением функции печени\u003Cbr\u003E\u003Cbr\u003EУ пациентов с нарушениями функции печени от легкой до средней степени тяжести коррекции начальной дозы не требуется. Учитывая увеличение сывороточной концентрации эплеренона у таких пациентов, рекомендуется регулярно контролировать содержание калия в сыворотке крови, особенно у пациентов пожилого возраста (см. раздел «Особые указания»),\u003Cbr\u003E\u003Cbr\u003EУ пациентов с нарушением функции печени тяжелой степени применение препарата Риолма® противопоказано.\u003Cbr\u003E\u003Cbr\u003EСопутствующая терапия\u003Cbr\u003E\u003Cbr\u003EПри одновременном применении препаратов, оказывающих слабое или умеренно выраженное ингибирующее действие на изофермент СYР3А4, например, эритромицина, саквинавира, амиодарона, дилтиазема, верапамила, лечение препаратом Риолма® следует проводить в дозе 25 мг 1 раз в сутки, при этом доза последнего не должна превышать 25 мг 1 раз в сутки (см. раздел «Взаимодействие с другими лекарственными средствами»).\n\u003Cbr\u003E"},{"name":"Побочные действия","value":"Ниже перечислены нежелательные явления, которые могли быть связаны с лечением, а также серьезные нежелательные явления, частота которых сопоставима с частотой нежелательных и серьезных нежелательных явлений в группе плацебо. Нежелательные явления перечислены в соответствии с системно-органным классом и абсолютной частотой их возникновения.\u003Cbr\u003E\u003Cbr\u003EЧастота определяется следующим образом: очень часто (\u003E 1/10), часто (от \u003E1/100 до \u003C 1/10), нечасто (от \u003E 1/1000 до \u003C 1/100), редко (от \u003E 1/10000 до \u003C 1000), очень редко (\u003C 1/10000), частота неизвестна (не может быть оценена по имеющимся данным).\u003Cbr\u003E"},{"name":"Фармакологическое действие","value":"Эплеренон обладает высокой селективностью в отношении минералокортикоидных рецепторов у человека в отличие от глюкокортикоидных, прогестероновых и андрогенных рецепторов и препятствует связыванию минералокортикоидных рецепторов с альдостероном - ключевым гормоном ренин-ангиотензин-альдостероновой системы (РААС), который участвует в регуляции артериального давления (АД) и патогенезе сердечно-сосудистых заболеваний.\u003Cbr\u003E\u003Cbr\u003EЭплеренон вызывает стойкое увеличение активности ренина в плазме крови и альдостерона в сыворотке крови. Впоследствии секреция ренина подавляется альдостероном по механизму обратной связи. При этом повышение активности ренина или концентрации циркулирующего альдостерона не влияет на эффекты эплеренона.\u003Cbr\u003E\u003Cbr\u003EПрименение эплеренона у пациентов после инфаркта миокарда (ИМ) с признаками сердечной недостаточности\u003Cbr\u003E\u003Cbr\u003EЭффективность эплеренона изучали в двойном слепом плацебо-контролируемом исследовании у 6632 пациентов с острым ИМ, дисфункцией левого желудочка (ЛЖ) (фракция выброса (ФВ) \u003C 40 %) и с клиническими признаками сердечной недостаточности. В течение 3-14 дней (в среднем 7 дней) после острого ИМ пациентам назначали эплеренон или плацебо в дополнение к стандартной терапии. Лечение начинали с дозы 25 мг 1 раз в сутки и к концу 4 недели увеличивали до 50 мг 1 раз в сутки, если содержание калия в сыворотке крови оставалось менее 5,0 ммоль/л. Во время исследования пациенты получали стандартную терапию с применением ацетилсалициловой кислоты (92 %), ингибиторов ангиотензинпревращающего фермента (АПФ) (90 %), бета-адреноблокаторов (83 %), нитратов (72 %), «петлевых» диуретиков (66 %) или ингибиторов З-гидрокси-З-метилглутарил-кофермент А редуктазы (ГМГ-КоА- редуктазы) (60 %). Первичной конечной точкой в исследовании была общая смертность, а комбинированной конечной точкой - смертность или госпитализация по поводу сердечнососудистых заболеваний.\u003Cbr\u003E\u003Cbr\u003EОбщая смертность в группах эплеренона и плацебо составила соответственно 14,4 % и 16,7 %, а комбинированную конечную точку смертности или госпитализации по поводу сердечно-сосудистых заболеваний отмечали соответственно у 26,7 % и 30,0 % пациентов. Таким образом по данным исследования в результате терапии эплереноном риск общей смертности был снижен на 15 % (относительный риск 0,85; 95 % доверительный интервал (ДИ), 0,75-0,96; р = 0,008) по сравнению с плацебо, главным образом за счет снижения смертности в результате сердечно-сосудистых заболеваний. Риск летального исхода или госпитализации по поводу сердечно-сосудистых заболеваний при применении эплеренона был снижен на 13 % (относительный риск 0,87; 95 % ДИ, 0,79-0,95; р = 0,002). Снижение абсолютного риска для двух конечных точек - общая смертность и смертность/госпитализации по поводу сердечно-сосудистых заболеваний - составило 2,3 % и 3,3 % соответственно. Клиническая эффективность была продемонстрирована главным образом при применении эплеренона у пациентов в возрасте до 75 лет. Эффективность терапии у пациентов в возрасте старше 75 лет не изучалась. Снижение или стабилизацию функционального класса (ФК) хронической сердечной недостаточности (ХСН) в группе эплеренона отмечали значительно чаще, чем в группе плацебо. Частота гиперкалиемии в группах эплеренона и плацебо составила 3,4 % и 2,0 % (р \u003C 0,001), гипокалиемии - 0,5 % и 1,5 % (р \u003C 0,001) соответственно.\u003Cbr\u003E\u003Cbr\u003EЭлектрокардиография\u003Cbr\u003E\u003Cbr\u003EВ исследованиях по изучению динамики электрокардиограммы (ЭКГ) у здоровых добровольцев существенного влияния эплеренона на частоту сердечных сокращений (ЧСС), длительность интервалов QRS, PR или QT не выявлено."},{"name":"Фармакологическая группа","value":"диуретическое калийсберегающее средство"},{"name":"Форма выпуска","value":"таблетки, покрытые пленочной 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, в оригинальном блистере.\u003Cbr\u003E\u003Cbr\u003EХранить в недоступном для детей месте.\u003Cbr\u003E"},{"name":"Передозировка","value":"Случаев передозировки эплеренона у человека не описано. Наиболее вероятными проявлениями передозировки могут быть выраженное снижение АД и/или гиперкалиемия. Эплеренон не удаляется при гемодиализе.\u003Cbr\u003E\u003Cbr\u003EУстановлено, что эплеренон активно связывается с активированным углем. При появлении симптоматической гипотензии необходимо назначить поддерживающую терапию. В случае развития гиперкалиемии показана стандартная терапия.\u003Cbr\u003E"},{"name":"Применение при беременности и кормлении грудью","value":"Беременность\u003Cbr\u003E\u003Cbr\u003EСведений о применении препарата у беременных нет. Препарат Риолма® следует применять с осторожностью и только в тех случаях, когда ожидаемая польза для матери значительно превышает возможный риск для плода/ребенка.\u003Cbr\u003E\u003Cbr\u003EПериод грудного вскармливания\u003Cbr\u003E\u003Cbr\u003EСведений о выведении эплеренона после приема внутрь с грудным молоком нет. Однако в доклинических исследованиях показано, что эплеренон и/или его метаболиты присутствуют в грудном молоке крыс.\u003Cbr\u003E\u003Cbr\u003EПоскольку нежелательные эффекты эплеренона у новорожденных, находящихся на грудном вскармливании, не изучены, решение о прекращении грудного вскармливания или отмене лекарственного препарата должно быть принято в зависимости от важности этого препарата для матери.\u003Cbr\u003E\u003Cbr\u003EРепродуктивная функция\u003Cbr\u003E\u003Cbr\u003EВ доклинических исследованиях также было показано, что в дозах до 300 мг/кг воздействия эплеренона на фертильность половозрелых особей крыс не обнаружено. Клинические данные о воздействии на репродуктивную функцию у человека отсутствуют.\u003Cbr\u003E"},{"name":"Влияние на способность управлять транспортом и механизмами","value":"Эффекты эплеренона на способность управлять транспортными средствами, механизмами не изучались. В рекомендуемых дозах 25 мг и 50 мг эплеренон не вызывает головокружения, обморочных состояний и нарушений когнитивной функции, но при управлении транспортными средствами, механизмами или использовании другой техники следует принимать во внимание, что во время лечения может развиться головокружение.\u003Cbr\u003E"},{"name":"Особые указания","value":"Гиперкалиемия\u003Cbr\u003E\u003Cbr\u003EПри применении эплеренона может развиться гиперкалиемия, которая обусловлена его механизмом действия. В начале лечения и при изменении дозы препарата у всех пациентов следует контролировать содержание калия в сыворотке крови.\u003Cbr\u003E\u003Cbr\u003EВ дальнейшем периодический контроль содержания калия рекомендуется проводить пациентам с повышенным риском развития гиперкалиемии, например, пациентам пожилого возраста, пациентам с почечной недостаточностью (см. раздел «Способ применения и дозы») и сахарным диабетом. Учитывая повышенный риск развития гиперкалиемии, назначение препаратов калия после начала лечения эплереноном не рекомендуется. Снижение дозы препарата Риолма® приводит к снижению содержания калия в сыворотке крови. В одном исследовании добавление гидрохлоротиазида к эплеренону препятствовало увеличению содержания калия в сыворотке крови. Риск развития гиперкалиемии может увеличиться, если эплеренон применяется в комбинации с ингибитором АПФ и/или АРА II.\u003Cbr\u003E\u003Cbr\u003EНарушение функции почек\u003Cbr\u003E\u003Cbr\u003EУ пациентов с нарушениями функции почек, в том числе диабетической микроальбуминурией, рекомендуется регулярно контролировать содержание калия в сыворотке крови. Риск развития гиперкалиемии увеличивается при снижении функции почек. Хотя число пациентов с сахарным диабетом 2 типа и микроальбуминурией в исследованиях было ограниченным, тем не менее, в этой небольшой выборке было отмечено увеличение частоты гиперкалиемии. В связи с этим у таких пациентов лечение следует проводить с осторожностью. Эплеренон не удаляется при гемодиализе.\u003Cbr\u003E\u003Cbr\u003EНарушение функции печени\u003Cbr\u003E\u003Cbr\u003EУ пациентов с нарушениями функции печени легкой или средней степени (класс А и В по классификации Чайлд-Пью) увеличения содержания калия в сыворотке крови более 5,5 ммоль/л выявлено не было. У таких пациентов следует контролировать содержание электролитов в плазме крови. У пациентов с нарушением функции печени тяжелой степени оценка применения эплеренона не проводилась, поэтому его применение у таких пациентов противопоказано.\u003Cbr\u003E\u003Cbr\u003EИндукторы изофермента СYР3А4\u003Cbr\u003E\u003Cbr\u003EОдновременное применение эплеренона с мощными индукторами изофермента СYРЗА4 не рекомендуется (см. раздел «Взаимодействие с другими лекарственными средствами»).\u003Cbr\u003E\u003Cbr\u003EЦиклоспорин, такролимус, препараты, содержащие литий\u003Cbr\u003E\u003Cbr\u003EВо время лечения эплереноном следует избегать назначения этих средств (см. раздел «Взаимодействие с другими лекарственными средствами»).\u003Cbr\u003E\u003Cbr\u003EСпециальная информация о вспомогательных веществах\u003Cbr\u003E\u003Cbr\u003EПрепарат Риолма® содержит лактозу, поэтому не следует применять при следующих состояниях: непереносимость лактозы, дефицит лактазы, синдром глюкозо-галактозной мальабсорбции.\u003Cbr\u003E"},{"name":"Взаимодействие","value":"Фармакодинамические взаимодействия\u003Cbr\u003E\u003Cbr\u003EКалийсберегающие диуретики и препараты калия\u003Cbr\u003E\u003Cbr\u003EУчитывая повышенный риск развития гиперкалиемии, эплеренон не следует назначать пациентам, получающим калийсберегающие диуретики и препараты калия (см. раздел «Противопоказания»). Калийсберегающие диуретики могут усиливать эффекты гипотензивных средств и других диуретиков.\u003Cbr\u003E\u003Cbr\u003EПрепараты, содержащие литий\u003Cbr\u003E\u003Cbr\u003EВзаимодействие эплеренона с препаратами лития не изучалось. Однако у пациентов, получавших препараты лития в сочетании с диуретиками и ингибиторами АПФ, описаны случаи повышения концентрации и интоксикации литием. Следует избегать одновременного назначения эплеренона и препаратов лития. Если подобная комбинация необходима, целесообразно контролировать концентрации лития в плазме крови.\u003Cbr\u003E\u003Cbr\u003EЦиклоспорин, такролимус\u003Cbr\u003E\u003Cbr\u003EЦиклоспорин и такролимус могут вызывать нарушение функции почек и повышать риск развития гиперкалиемии. Следует избегать одновременного применения эплеренона и циклоспорина или такролимуса. Если во время лечения эплереноном потребуется назначение циклоспорина или такролимуса, рекомендуется тщательно контролировать содержание калия в сыворотке крови и функцию почек.\u003Cbr\u003E\u003Cbr\u003EНестероидные противовоспалительные препараты (НПВП)\u003Cbr\u003E\u003Cbr\u003EЛечение НПВП может привести к острой почечной недостаточности за счет прямого подавления клубочковой фильтрации, особенно у пациентов группы риска (пациенты пожилого возраста и/или пациенты с дегидратацией). При одновременном применении этих средств до начала и во время лечения необходимо обеспечивать адекватный водный режим и контролировать функцию почек.\u003Cbr\u003E\u003Cbr\u003EТриметоприм\u003Cbr\u003E\u003Cbr\u003EОдновременное применение триметоприма с эплереноном повышает риск развития гиперкалиемии. Рекомендуется контролировать содержание калия в сыворотке крови и функцию почек, особенно у пациентов с почечной недостаточностью и у пациентов пожилого возраста.\u003Cbr\u003E\u003Cbr\u003EИнгибиторы АПФ и АРА II\u003Cbr\u003E\u003Cbr\u003EПри применении эплеренона с ингибиторами АПФ или АРА II следует тщательно контролировать содержание калия сыворотки крови. Подобная комбинация может привести к увеличению риска развития гиперкалиемии, особенно у пациентов с нарушением функции почек, в т. ч. у пациентов пожилого возраста. Не следует применять тройную комбинацию: ингибитор АПФ, АРА II и эплеренон.\u003Cbr\u003E\u003Cbr\u003EАльфа1-адреноблокаторы (празозин, альфузозин)\u003Cbr\u003E\u003Cbr\u003EПри одновременном применении альфа1-адреноблокаторов с эплереноном может усиливаться антигипертензивное действие и/или увеличиваться риск развития ортостатической гипотензии, в связи с чем рекомендуется контролировать АД при изменении положения тела.\u003Cbr\u003E\u003Cbr\u003EТрициклические антидепрессанты, нейролептики, амифостин, баклофен\u003Cbr\u003E\u003Cbr\u003EПри одновременном применении этих средств с эплереноном может усиливаться антигипертензивный эффект или увеличиваться риск развития ортостатической гипотензии.\u003Cbr\u003E\u003Cbr\u003EГлюкокортикоиды, тетракозактид\u003Cbr\u003E\u003Cbr\u003EОдновременное применение этих средств с эплереноном может привести к задержке ионов натрия и жидкости.\u003Cbr\u003E\u003Cbr\u003EФармакокинетические взаимодействия\u003Cbr\u003E\u003Cbr\u003EИсследования in vitro свидетельствуют о том, что эплеренон не ингибирует изоферменты CYP1A2, CYP2C19, CYP2C9, CYP2D6 или CYP3A4. Эплеренон не является субстратом или ингибитором гликопротеина Р.\u003Cbr\u003E\u003Cbr\u003EДигоксин\u003Cbr\u003E\u003Cbr\u003EAUC дигоксина при одновременном применении с эплереноном увеличивается на 16% (90 % ДИ: 4-30 %). Необходимо соблюдать осторожность, если дигоксин применяется в дозах, близких к максимальным терапевтическим.\u003Cbr\u003E\u003Cbr\u003EВарфарин\u003Cbr\u003E\u003Cbr\u003EКлинически значимого фармакокинетического взаимодействия с варфарином не выявлено. Необходимо соблюдать осторожность, если варфарин применяется в дозах, близких к максимальным терапевтическим.\u003Cbr\u003E\u003Cbr\u003EСубстраты изофермента CYP3A4\u003Cbr\u003E\u003Cbr\u003EВ специальных исследованиях признаков фармакокинетического взаимодействия эплеренона с субстратами изофермента CYP3A4, например, мидазоламом и цизапридом, выявлено не было.\u003Cbr\u003E\u003Cbr\u003EИнгибиторы изофермента CYP3A4\u003Cbr\u003E\u003Cbr\u003EМощные ингибиторы изофермента CYP3A4\u003Cbr\u003E\u003Cbr\u003EПри применении эплеренона со средствами, ингибирующими изофермент CYP3A4, возможно значимое фармакокинетическое взаимодействие. Мощный ингибитор изофермента CYP3A4 (кетоконазол 200 мг 2 раза в сутки) вызывал увеличение AUC эплеренона на 441 %. Одновременное применение эплеренона с мощными ингибиторами изофермента CYP3A4, такими как кетоконазол, итраконазол, ритонавир, нелфинавир, кларитромицин, телитромицин и нефазадон, противопоказано (см. раздел «Противопоказания»).\u003Cbr\u003E\u003Cbr\u003EСлабые и умеренные ингибиторы изофермента CYP3A4\u003Cbr\u003E\u003Cbr\u003EОдновременное применение с эритромицином, саквинавиром, амиодароном, дилтиаземом, верапамилом и флуконазолом сопровождалось значимым фармакокинетическим взаимодействием (степень увеличения AUC варьировала от 98% до 187%). При одновременном применении этих средств с эплереноном доза последнего не должна превышать 25 мг в сутки (см. раздел «Способ применения и дозы»).\u003Cbr\u003E\u003Cbr\u003EИндукторы изофермента CYP3A4\u003Cbr\u003E\u003Cbr\u003EОдновременный прием препаратов, содержащих Зверобой продырявленный (мощный индуктор изофермента CYP3A4) с эплереноном вызывал снижение AUC последнего на 30 %. При применении более мощных индукторов изофермента CYP3A4, таких как рифампицин, возможно более выраженное снижение AUC эплеренона. Учитывая возможное снижение эффективности эплеренона, одновременное применение мощных индукторов изофермента CYP3A4 (рифампицина, карбамазепина, фенитоина, фенобарбитала, препаратов, содержащих Зверобой продырявленный) не рекомендуется (см. раздел «Особые указания»),\u003Cbr\u003E\u003Cbr\u003EАнтациды\u003Cbr\u003E\u003Cbr\u003EНа основании фармакокинетического клинического исследования значительного взаимодействия антацидов с эплереноном при их одновременном применении не предполагается.\u003Cbr\u003E"},{"name":"Регистрационный номер","value":"ЛП-006425"},{"name":"Дата государственной регистрации","value":"25.08.2020"},{"name":"Владелец регистрационного удостоверения","value":"KRKA"},{"name":"Изготовитель","value":"КРКА"},{"name":"Страна бренда","value":"Словения"},{"name":"Страна-производитель","value":"Словения"},{"name":"Срок годности","value":"930 дн."}]}],"transitionId":"tr_9182095494054480970"}}}}
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    Эспиро таб. п/о плен., 25 мг, 30 шт.

    Рейтинг товара: 4.9 из 5
    на основе 28 оценок
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  • Амприлан НД таб, 25 мг+5 мг, 30 шт.
    {"widgets":{"@marketfront/SnippetConstructor/ToggleWishlist":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-ghmgrek0vij/toggleWishlist":{"skuId":"186847736","productId":1778173756,"offerId":"H8nCOzU00RLduvb61xlTFQ","size":24,"color":"#BDBDBC","wishlistLink":"/my/wishlist","baobabRealTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEjEKL0NvbXBldGl0aXZlQW5hbG9nc19NYXJrZXRNb2RlbENhcmRfRnJvbnRTbmlwcGV0MhUIvI7zzwYQ+KOMWRi21YcEINfcwQc=","sign":"NZnk9udiAHXal1yV+E25Smcw/EBKqnOrGTv47l9SRtI="},"waitWishlistCollections":false,"place":{"page":"product","widget":"scrollbox"}}}},"meta":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-ghmgrek0vij/toggleWishlist":{"name":"@marketfront/SnippetConstructor/ToggleWishlist"}}}

    Амприлан НД таб, 25 мг+5 мг, 30 шт.

    Рейтинг товара: 4.8 из 5
    на основе 13 оценок
    Цена 674 ₽
    {"widgets":{"@light/AddToCartButtonSnippet":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-ghmgrek0vij/addToCartButton":{"offerId":"H8nCOzU00RLduvb61xlTFQ","skuId":"186847736","pendingCartItem":{"productId":1778173756,"offerId":"H8nCOzU00RLduvb61xlTFQ","showPlaceId":"OTNDnItfwRMjN9MRHuEMMv0MphsmScLfEyTUimrC379QQfFzksVfu9AFQAAiHSD2R1zs-Lfm50M9Uh-imgvVSMkBaPQ8iv-I39Yq_QwKjMQJBR3d8Sdd_4u3gKTi8ago4g-SHXxSOXIEp06oEj9XjgJwWvkm6a7MsDZMlPmRQK3aZmVZDKcwxP_n3SdTOMZlvsckrlDHp3PvfBo82hvL4A,,","feeShow":"OTNDnItfwRMjN9MRHuEMMv0MphsmScLfEyTUimrC379QQfFzksVfu9AFQAAiHSD2R1zs-Lfm50M9Uh-imgvVSMkBaPQ8iv-I39Yq_QwKjMQJBR3d8Sdd_4u3gKTi8ago4g-SHXxSOXIEp06oEj9XjgJwWvkm6a7MsDZMlPmRQK3aZmVZDKcwxP_n3SdTOMZlvsckrlDHp3PvfBo82hvL4A,,","skuId":"186847736","shopId":55106433,"price":{"applicablePriceDiscounts":[],"value":"674","currency":"RUR"},"hid":"15756887","name":"Амприлан НД таб, 25 мг+5 мг, 30 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  • Аторис таб. п/о плен., 10 мг, 30 шт.
    {"widgets":{"@marketfront/SnippetConstructor/ToggleWishlist":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-tvbdj9msy9/toggleWishlist":{"skuId":"187406844","productId":1401075514,"offerId":"fFz0Ys4GDh87FVgFS1UqyA","size":24,"color":"#BDBDBC","wishlistLink":"/my/wishlist","baobabRealTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEjEKL0NvbXBldGl0aXZlQW5hbG9nc19NYXJrZXRNb2RlbENhcmRfRnJvbnRTbmlwcGV0MhUIuu6KnAUQ/LOuWRi21YcEINfcwQc=","sign":"ZnHT6zBh7+HVHq9Kmx2N9eWZWMnbJonhDVVfDGt6+T8="},"waitWishlistCollections":false,"place":{"page":"product","widget":"scrollbox"}}}},"meta":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-tvbdj9msy9/toggleWishlist":{"name":"@marketfront/SnippetConstructor/ToggleWishlist"}}}

    Аторис таб. п/о плен., 10 мг, 30 шт.

    Рейтинг товара: 4.8 из 5
    на основе 9 оценок
    Цена 197 ₽
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  • Лориста НД таб. п/о плен., 100 мг+25 мг, 30 шт.
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    Лориста НД таб. п/о плен., 100 мг+25 мг, 30 шт.

    Рейтинг товара: 4.7 из 5
    на основе 11 оценок
    Цена 660 ₽
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  • Карведилол таб., 12.5 мг, 30 шт.
    {"widgets":{"@marketfront/SnippetConstructor/ToggleWishlist":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-aylmfsg604h/toggleWishlist":{"skuId":"187574911","productId":1401075571,"offerId":"IZEzZMraijR1RQ9bzE_pDw","size":24,"color":"#BDBDBC","wishlistLink":"/my/wishlist","baobabRealTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEjEKL0NvbXBldGl0aXZlQW5hbG9nc19NYXJrZXRNb2RlbENhcmRfRnJvbnRTbmlwcGV0MhUI8+6KnAUQ/9S4WRi01YcEINfcwQc=","sign":"pmIiQCgrrZ8LAwb4CQMhrUGD/Mqn/3SaJYF7eMmLpns="},"waitWishlistCollections":false,"place":{"page":"product","widget":"scrollbox"}}}},"meta":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-aylmfsg604h/toggleWishlist":{"name":"@marketfront/SnippetConstructor/ToggleWishlist"}}}

    Карведилол таб., 12.5 мг, 30 шт.

    Рейтинг товара: 5 из 5
    на основе 1 оценка
    Цена 271 ₽
    {"widgets":{"@light/AddToCartButtonSnippet":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-aylmfsg604h/addToCartButton":{"offerId":"IZEzZMraijR1RQ9bzE_pDw","skuId":"187574911","pendingCartItem":{"productId":1401075571,"offerId":"IZEzZMraijR1RQ9bzE_pDw","showPlaceId":"OTNDnItfwRMjN9MRHuEMMv0MphsmScLfy-dcJjNNWHipHEp8HlvCLNbvzrg3DWBZBxcpvWU_s0TbltxJftP75A1ViYPPS4SusGi8_2F_O7QNZe0UtSwmMsobIDlLr0E3xqGcq2FS9TDWeYH-jvUMOdSOfEguBV88R81calwqbPgkyMUCDaJJKoJx-3H8F_ZhPOOf3ZhR-jND4pNDbpESGw,,","feeShow":"OTNDnItfwRMjN9MRHuEMMv0MphsmScLfy-dcJjNNWHipHEp8HlvCLNbvzrg3DWBZBxcpvWU_s0TbltxJftP75A1ViYPPS4SusGi8_2F_O7QNZe0UtSwmMsobIDlLr0E3xqGcq2FS9TDWeYH-jvUMOdSOfEguBV88R81calwqbPgkyMUCDaJJKoJx-3H8F_ZhPOOf3ZhR-jND4pNDbpESGw,,","skuId":"187574911","shopId":55106433,"price":{"applicablePriceDiscounts":[],"value":"271","currency":"RUR"},"hid":"15756887","name":"Карведилол таб., 12.5 мг, 30 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  • Роксера Плюс таб. п/о плен., 10 мг+10 мг, 30 шт.
    {"widgets":{"@marketfront/SnippetConstructor/ToggleWishlist":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-rfkise5dqxg/toggleWishlist":{"skuId":"101801583739","productId":1765197186,"offerId":"ltSDnOWGgMru4BpIgMRBgA","size":24,"color":"#BDBDBC","wishlistLink":"/my/wishlist","baobabRealTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEjEKL0NvbXBldGl0aXZlQW5hbG9nc19NYXJrZXRNb2RlbENhcmRfRnJvbnRTbmlwcGV0MhcIgovbyQYQ+8jjnvsCGLbVhwQg19zBBw==","sign":"Ov0ajUAFJvl3fgc1E0Whx51ZnEvhMm+w7u3n6M2x37A="},"waitWishlistCollections":false,"place":{"page":"product","widget":"scrollbox"}}}},"meta":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-rfkise5dqxg/toggleWishlist":{"name":"@marketfront/SnippetConstructor/ToggleWishlist"}}}

    Роксера Плюс таб. п/о плен., 10 мг+10 мг, 30 шт.

    Рейтинг товара: 4.7 из 5
    на основе 3 оценки
    Цена 981 ₽
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  • Лориста Н 100 таб. п/о плен., 12.5 мг+100 мг, 30 шт.
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    Лориста Н 100 таб. п/о плен., 12.5 мг+100 мг, 30 шт.

    Рейтинг товара: 5 из 5
    на основе 4 оценки
    Цена 541 ₽
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  • Лортенза таб. п/о плен., 5 мг + 50 мг, 30 шт.
    {"widgets":{"@marketfront/SnippetConstructor/ToggleWishlist":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-q38oaea19jh/toggleWishlist":{"skuId":"227814271","productId":1401075611,"offerId":"C3RY_T4cjAKGUqE81OEaOw","size":24,"color":"#BDBDBC","wishlistLink":"/my/wishlist","baobabRealTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEjEKL0NvbXBldGl0aXZlQW5hbG9nc19NYXJrZXRNb2RlbENhcmRfRnJvbnRTbmlwcGV0MhUIm++KnAUQ/9bQbBigxN4HINfcwQc=","sign":"kY9tL2ptFQdo/xnKi2NsX4XA15+sBR5wMf1RGl+DEvM="},"waitWishlistCollections":false,"place":{"page":"product","widget":"scrollbox"}}}},"meta":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-q38oaea19jh/toggleWishlist":{"name":"@marketfront/SnippetConstructor/ToggleWishlist"}}}

    Лортенза таб. п/о плен., 5 мг + 50 мг, 30 шт.

    Рейтинг товара: 4.6 из 5
    на основе 110 оценок
    Цена 454 ₽
    {"widgets":{"@light/AddToCartButtonSnippet":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-q38oaea19jh/addToCartButton":{"offerId":"C3RY_T4cjAKGUqE81OEaOw","skuId":"227814271","pendingCartItem":{"productId":1401075611,"offerId":"C3RY_T4cjAKGUqE81OEaOw","showPlaceId":"OTNDnItfwRMjN9MRHuEMMv0MphsmScLfgmkHYOZFGH0bE3nIqbjmiJQNi8MGAiX-C4RdqTbXo5tNsyaOiQxa-FXDqKoBmdl88FH55x7JkxutNAtSSWnPrdCv--Q15YrqvN5O7eZ0NEvP2JDihzbkhIRSjn6RLRvnkiW2lDdGtwmoyVd5rSm5qqCD2zRnC7clNw9LgDezO_ePBIb17EW_Qg,,","feeShow":"OTNDnItfwRMjN9MRHuEMMv0MphsmScLfgmkHYOZFGH0bE3nIqbjmiJQNi8MGAiX-C4RdqTbXo5tNsyaOiQxa-FXDqKoBmdl88FH55x7JkxutNAtSSWnPrdCv--Q15YrqvN5O7eZ0NEvP2JDihzbkhIRSjn6RLRvnkiW2lDdGtwmoyVd5rSm5qqCD2zRnC7clNw9LgDezO_ePBIb17EW_Qg,,","skuId":"227814271","shopId":55106433,"price":{"applicablePriceDiscounts":[],"value":"454","currency":"RUR"},"hid":"15756887","name":"Лортенза таб. п/о плен., 5 мг + 50 мг, 30 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  • Доксазозин-ФПО таб., 2 мг, 30 шт.
    {"widgets":{"@marketfront/SnippetConstructor/ToggleWishlist":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-hgsk78hknnb/toggleWishlist":{"skuId":"101392339200","productId":1401319529,"offerId":"P5c1WkRWhsB4wJp3fn8OWg","size":24,"color":"#BDBDBC","wishlistLink":"/my/wishlist","baobabRealTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEjEKL0NvbXBldGl0aXZlQW5hbG9nc19NYXJrZXRNb2RlbENhcmRfRnJvbnRTbmlwcGV0MhcI6eCZnAUQgKLR2/kCGOvc0Acg19zBBw==","sign":"G8LPy28tQpsj2P3mM7afxcGLYomlN6vfMBne2WF0vBw="},"waitWishlistCollections":false,"place":{"page":"product","widget":"scrollbox"}}}},"meta":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-hgsk78hknnb/toggleWishlist":{"name":"@marketfront/SnippetConstructor/ToggleWishlist"}}}

    Доксазозин-ФПО таб., 2 мг, 30 шт.

    Рейтинг товара: 5 из 5
    на основе 1 оценка
    Цена 200 ₽
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  • Ко-Дальнева таб., 5 мг+0.625 мг+2 мг, 30 шт.
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    Ко-Дальнева таб., 5 мг+0.625 мг+2 мг, 30 шт.

    Рейтинг товара: 4.9 из 5
    на основе 22 оценки
    Цена 493 ₽
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  • Эпленор таб. п/о плен., 25 мг, 30 шт.
    {"widgets":{"@marketfront/SnippetConstructor/ToggleWishlist":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-1k293903tsp/toggleWishlist":{"skuId":"101637721215","productId":1484168648,"offerId":"XEsp5AZebW1r0qZ3M3BLvQ","size":24,"color":"#BDBDBC","wishlistLink":"/my/wishlist","baobabRealTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEjEKL0NvbXBldGl0aXZlQW5hbG9nc19NYXJrZXRNb2RlbENhcmRfRnJvbnRTbmlwcGV0MhcIyLvawwUQ/5jS0PoCGNb9jQcg19zBBw==","sign":"KkGs3JUR5ZIVTrPIbG2YdnWILYOqXQAVf8/OgURUDes="},"waitWishlistCollections":false,"place":{"page":"product","widget":"scrollbox"}}}},"meta":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-1k293903tsp/toggleWishlist":{"name":"@marketfront/SnippetConstructor/ToggleWishlist"}}}

    Эпленор таб. п/о плен., 25 мг, 30 шт.

    Рейтинг товара: 5 из 5
    на основе 2 оценки
    Цена 840 ₽
    {"widgets":{"@light/AddToCartButtonSnippet":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-1k293903tsp/addToCartButton":{"offerId":"XEsp5AZebW1r0qZ3M3BLvQ","skuId":"101637721215","pendingCartItem":{"productId":1484168648,"offerId":"XEsp5AZebW1r0qZ3M3BLvQ","showPlaceId":"OTNDnItfwRMjN9MRHuEMMv0MphsmScLfH-dn6EfgApVlgQ1f-LGxq5vC22uZwzyuTjC-FjaYKPdgCT5-G5a2ZKJuMhRhNSqDQslGGLM4UsubXFpELGNQQODi1UUjItZQUGgB7X-3Ts3cFYTR8F-lTylbtIljlcXhu41SmMlOBAcga3oVj-YOyHbVp50YALpj_4PQgrbaZUtuLgNxzGoDwA,,","feeShow":"OTNDnItfwRMjN9MRHuEMMv0MphsmScLfH-dn6EfgApVlgQ1f-LGxq5vC22uZwzyuTjC-FjaYKPdgCT5-G5a2ZKJuMhRhNSqDQslGGLM4UsubXFpELGNQQODi1UUjItZQUGgB7X-3Ts3cFYTR8F-lTylbtIljlcXhu41SmMlOBAcga3oVj-YOyHbVp50YALpj_4PQgrbaZUtuLgNxzGoDwA,,","skuId":"101637721215","shopId":77075781,"price":{"applicablePriceDiscounts":[],"value":"840","currency":"RUR"},"hid":"15756887","name":"Эпленор таб. п/о плен., 25 мг, 30 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  • Фенофибрат Канон таб. п/о плен., 145 мг, 30 шт.
    {"widgets":{"@marketfront/SnippetConstructor/ToggleWishlist":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-mnz80qun9ya/toggleWishlist":{"skuId":"186989656","productId":1778173785,"offerId":"aFU7NcPxjHK9gBiym6GKiw","size":24,"color":"#BDBDBC","wishlistLink":"/my/wishlist","baobabRealTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEjEKL0NvbXBldGl0aXZlQW5hbG9nc19NYXJrZXRNb2RlbENhcmRfRnJvbnRTbmlwcGV0MhUI2Y7zzwYQ2PiUWRjOwtkHINfcwQc=","sign":"LV7S/i9lpWPDn8m7hBdLsKCEXzKsNu+h+2oKB/vk0iA="},"waitWishlistCollections":false,"place":{"page":"product","widget":"scrollbox"}}}},"meta":{"/content/page/fancyPage/kkmCarousel/kkmCarousel/content/content/slot-mnz80qun9ya/toggleWishlist":{"name":"@marketfront/SnippetConstructor/ToggleWishlist"}}}

    Фенофибрат Канон таб. п/о плен., 145 мг, 30 шт.

    Рейтинг товара: 5 из 5
    на основе 8 оценок
    Цена 571 ₽
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Инструкция

Показания к применению

Инфаркт миокарда: в дополнение к стандартной терапии с целью снижения риска сердечно-сосудистой смертности и заболеваемости у пациентов со стабильной дисфункцией левого желудочка (ФВ < 40 %) и клиническими признаками сердечной недостаточности после перенесенного инфаркта миокарда.

Хроническая сердечная недостаточность: в дополнение к стандартной терапии с целью снижения риска сердечно-сосудистой смертности и заболеваемости у пациентов с хронической сердечной недостаточностью II ФК по классификации NYНА, при дисфункции левого желудочка (ФВ < 35 %).

Противопоказания

Повышенная чувствительность к эплеренону или другим компонентам препарата.
Клинически значимая гиперкалиемия.
Содержание калия в сыворотке крови в начале лечения > 5,0 ммоль/л.
Почечная недостаточность тяжелой степени (клиренс креатинина (КК) < 30 мл/мин) у пациентов с хронической сердечной недостаточностью II функционального класса по классификации NYНА).
Печеночная недостаточность тяжелой степени (класс С по классификации Чайлд-Пью).
Одновременный прием калийсберегающих диуретиков, препаратов калия или мощных ингибиторов изофермента СYР3А4, например, итраконазола, кетоконазола, ритонавира, нелфинавира, кларитромицина, телитромицина и нефазодона.
Дефицит лактазы, непереносимость лактозы и синдром глюкозо-галактозной мальабсорбции.
Детский возраст до 18 лет (эффективность и безопасность не установлены).
С осторожностью:
Сахарный диабет 2 типа и микроальбуминурия; применение у пациентов пожилого возраста; нарушение функции почек (КК < 50 мл/мин); одновременное применение эплеренона и ингибиторов АПФ или антагонистов рецепторов ангиотензина II (АРА II), мощных индукторов изофермента СYР3А4, препаратов, содержащих литий, циклоспорина или такролимуса, дигоксина и варфарина в дозах, близких к максимальным терапевтическим.

Не следует применять тройную комбинацию: ингибитор АПФ, АРА II и эплеренон.

Способ применения и дозы

Внутрь, независимо от времени приема пищи.

Прием пищи не влияет на всасывание препарата Риолма®. Для индивидуального подбора дозы можно применять дозировки 25 мг и 50 мг.

До начала терапии препаратом Риолма®, в течение первой недели и через 1 месяц после начала терапии или при изменении дозы препарата следует определить содержание калия в сыворотке крови пациента. В дальнейшем необходимо периодически контролировать содержание калия в сыворотке крови.

ИМ

Лечение следует начинать с дозы 25 мг 1 раз в сутки и увеличивать ее до 50 мг 1 раз в сутки через 4 недели с учетом содержания калия в сыворотке крови (см. таблицу 1). Рекомендуемая поддерживающая доза препарата составляет 50 мг 1 раз в сутки.

ХСН II ФК по классификации NYНА

Лечение также следует начинать с дозы 25 мг 1 раз в сутки, далее дозу подбирают индивидуально, увеличивая ее до 50 мг 1 раз в сутки, предпочтительно в течение 4 недель с учетом содержания калия в сыворотке крови (см. таблицу 1).

Лечение эплереноном не следует начинать у пациентов с содержанием калия в сыворотке крови > 5,0 ммоль/л. После временного прекращения приема препарата в связи с повышением содержания калия в сыворотке крови до или более 6,0 ммоль/л, терапию препаратом можно возобновить в дозе 25 мг через день, когда содержание калия в сыворотке крови составит < 5,0 ммоль/л.

Особые группы пациентов

Пациенты пожилого возраста

Коррекции начальной дозы у пациентов пожилого возраста не требуется. В связи с возрастным снижением функции почек у пациентов пожилого возраста повышается риск развития гиперкалиемии, особенно при наличии сопутствующих заболеваний, способствующих увеличению концентрации эплеренона в сыворотке крови, в частности при нарушении функции печени от легкой до средней степени тяжести. Рекомендуется периодически определять содержание калия в сыворотке крови (раздел «Особые указания»).

Пациенты с нарушением функции почек

У пациентов с легкой степенью нарушения функции почек коррекции начальной дозы не требуется. Рекомендуется периодически определять содержание калия в сыворотке крови (см. таблицу 1).

У пациентов с нарушением функции почек средней степени тяжести (КК 30-60 мл/мин) следует начинать терапию с дозы 25 мг через день с последующей коррекцией дозы в зависимости от содержания калия в сыворотке крови (см. таблицу 1).

Пациенты с сердечной недостаточностью

Отсутствует опыт применения эплеренона у пациентов с ХСН, после перенесенного ИМ и КК < 50 мл/мин. Поэтому у таких пациентов препарат следует применять с осторожностью.

У пациентов с КК < 50 мл/мин применение эплеренона в дозе выше 25 мг 1 раз в сутки не исследовалось (также см. разделы «Противопоказания» и «Особые указания»).

Пациенты с нарушением функции печени

У пациентов с нарушениями функции печени от легкой до средней степени тяжести коррекции начальной дозы не требуется. Учитывая увеличение сывороточной концентрации эплеренона у таких пациентов, рекомендуется регулярно контролировать содержание калия в сыворотке крови, особенно у пациентов пожилого возраста (см. раздел «Особые указания»),

У пациентов с нарушением функции печени тяжелой степени применение препарата Риолма® противопоказано.

Сопутствующая терапия

При одновременном применении препаратов, оказывающих слабое или умеренно выраженное ингибирующее действие на изофермент СYР3А4, например, эритромицина, саквинавира, амиодарона, дилтиазема, верапамила, лечение препаратом Риолма® следует проводить в дозе 25 мг 1 раз в сутки, при этом доза последнего не должна превышать 25 мг 1 раз в сутки (см. раздел «Взаимодействие с другими лекарственными средствами»).
Полная инструкция
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Риолма таб. п/о плен.
Риолма таб. п/о плен., 25 мг, 30 шт.
4.8
(5)
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–21 %
Вместо:1 042 ₽
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4.8
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Рекомендуем

  • Эспиро таб. п/о плен., 25 мг, 30 шт.
    {"widgets":{"@marketfront/SnippetConstructor/Gallery":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1401075455_0/content/content/gallery":{"title":"Эспиро таб. п/о плен., 25 мг, 30 шт.","images":[{"src":"https://avatars.mds.yandex.net/get-mpic/5387588/img_id515719452517411483.jpeg/orig","srcSet":"https://avatars.mds.yandex.net/get-mpic/5387588/img_id515719452517411483.jpeg/120x160 120w, https://avatars.mds.yandex.net/get-mpic/5387588/img_id515719452517411483.jpeg/180x240 180w, https://avatars.mds.yandex.net/get-mpic/5387588/img_id515719452517411483.jpeg/240x320 240w, https://avatars.mds.yandex.net/get-mpic/5387588/img_id515719452517411483.jpeg/300x400 300w, https://avatars.mds.yandex.net/get-mpic/5387588/img_id515719452517411483.jpeg/600x800 600w","sizes":"(max-width: 1456px) 15vw, 217px"},{"src":"https://avatars.mds.yandex.net/get-mpic/4408567/img_id2913924667987604478.png/orig","srcSet":"https://avatars.mds.yandex.net/get-mpic/4408567/img_id2913924667987604478.png/120x160 120w, https://avatars.mds.yandex.net/get-mpic/4408567/img_id2913924667987604478.png/180x240 180w, https://avatars.mds.yandex.net/get-mpic/4408567/img_id2913924667987604478.png/240x320 240w, https://avatars.mds.yandex.net/get-mpic/4408567/img_id2913924667987604478.png/300x400 300w, https://avatars.mds.yandex.net/get-mpic/4408567/img_id2913924667987604478.png/600x800 600w","sizes":"(max-width: 1456px) 15vw, 217px"}],"firstImageLazyLoading":false,"baobabClientData":{"realTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEhoKGHJlbWl4X2Rlc2t0b3BfbW9kZWxfY2FyZDIVCP/tipwFEOnz+FgYud3QByDX3MEH","sign":"T8QgkZh1vDUiyT4xxhTmBkWxv8jQmzai0zddIYqBBWY="},"target":"model_card"},"isNoPicturePadding":true}}},"meta":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1401075455_0/content/content/gallery":{"name":"@marketfront/SnippetConstructor/Gallery"}}}
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    Эспиро таб. п/о плен., 25 мг, 30 шт.

    Цена 1 006 ₽
  • Амприлан НД таб, 25 мг+5 мг, 30 шт.
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    Амприлан НД таб, 25 мг+5 мг, 30 шт.

    Цена 674 ₽
  • Таблетница с делителем, 2 секции
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    Таблетница с делителем, 2 секции

    Цена 182 ₽
  • Таблетница на 7 дней 3 приема черная
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    Таблетница на 7 дней 3 приема черная

    Цена 733 ₽ вместо 1 000
  • Таблетница органайзер на неделю, контейнер для таблеток, бокс, на 7 дней, 4 приема, 28 ячеек
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    Таблетница органайзер на неделю, контейнер для таблеток, бокс, на 7 дней, 4 приема, 28 ячеек

    Цена 361 ₽ вместо 690
  • 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 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
  • Аторис таб. п/о плен., 10 мг, 30 шт.
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    Аторис таб. п/о плен., 10 мг, 30 шт.

    Цена 197 ₽
  • Реклама
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  • Лориста НД таб. п/о плен., 100 мг+25 мг, 30 шт.
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    Лориста НД таб. п/о плен., 100 мг+25 мг, 30 шт.

    Цена 660 ₽
  • Пилюля Таблетница на неделю Дорожная ( 7 дней по 4 отделения)
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    Пилюля Таблетница на неделю Дорожная ( 7 дней по 4 отделения)

    Цена 587 ₽ вместо 799
  • 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 418 ₽ вместо 637
  • 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
  • Карведилол таб., 12.5 мг, 30 шт.
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    Карведилол таб., 12.5 мг, 30 шт.

    Цена 271 ₽
  • Таблетница - брелок на день, 1 раздел, контейнер для таблеток металлический маленький (черный матовый)
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    {"widgets":{"@marketfront/SnippetConstructor/ToggleWishlist":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1880169529_14/content/content/toggleWishlist":{"skuId":"102051429199","productId":1880169529,"offerId":"-MwEvv2E5Jlb4ajTA7yX-A","size":24,"color":"#BDBDBC","wishlistLink":"/my/wishlist","baobabRealTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEhoKGHJlbWl4X2Rlc2t0b3BfbW9kZWxfY2FyZDIWCLm4xIAHEM/29JX8AhjUn98ZIM3OPQ==","sign":"C6M/nH+kef0HXuYSmxBBY5k12PjtThzh3rhA2ts+QmI="},"waitWishlistCollections":false,"place":{"page":"product","widget":"feed"}}}},"meta":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1880169529_14/content/content/toggleWishlist":{"name":"@marketfront/SnippetConstructor/ToggleWishlist"}}}

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

    Цена 209 ₽ вместо 599
  • Роксера Плюс таб. п/о плен., 10 мг+10 мг, 30 шт.
    {"widgets":{"@marketfront/SnippetConstructor/Gallery":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1765197186_15/content/content/gallery":{"title":"Роксера Плюс таб. п/о плен., 10 мг+10 мг, 30 шт.","images":[{"src":"https://avatars.mds.yandex.net/get-mpic/6236983/img_id1848165720284908607.jpeg/orig","srcSet":"https://avatars.mds.yandex.net/get-mpic/6236983/img_id1848165720284908607.jpeg/120x160 120w, https://avatars.mds.yandex.net/get-mpic/6236983/img_id1848165720284908607.jpeg/180x240 180w, https://avatars.mds.yandex.net/get-mpic/6236983/img_id1848165720284908607.jpeg/240x320 240w, https://avatars.mds.yandex.net/get-mpic/6236983/img_id1848165720284908607.jpeg/300x400 300w, https://avatars.mds.yandex.net/get-mpic/6236983/img_id1848165720284908607.jpeg/600x800 600w","sizes":"(max-width: 1456px) 15vw, 217px"},{"src":"https://avatars.mds.yandex.net/get-mpic/6259567/img_id1989983454184316411.png/orig","srcSet":"https://avatars.mds.yandex.net/get-mpic/6259567/img_id1989983454184316411.png/120x160 120w, https://avatars.mds.yandex.net/get-mpic/6259567/img_id1989983454184316411.png/180x240 180w, https://avatars.mds.yandex.net/get-mpic/6259567/img_id1989983454184316411.png/240x320 240w, https://avatars.mds.yandex.net/get-mpic/6259567/img_id1989983454184316411.png/300x400 300w, https://avatars.mds.yandex.net/get-mpic/6259567/img_id1989983454184316411.png/600x800 600w","sizes":"(max-width: 1456px) 15vw, 217px"}],"firstImageLazyLoading":false,"baobabClientData":{"realTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEhoKGHJlbWl4X2Rlc2t0b3BfbW9kZWxfY2FyZDIXCIKL28kGEPvI4577Ahi21YcEINfcwQc=","sign":"RYC1/QhhW0/DQWusrb6imsQoBbmWgsXI5y9EpHw1uAA="},"target":"model_card"},"isNoPicturePadding":true}}},"meta":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1765197186_15/content/content/gallery":{"name":"@marketfront/SnippetConstructor/Gallery"}}}
    {"widgets":{"@marketfront/SnippetConstructor/ToggleWishlist":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1765197186_15/content/content/toggleWishlist":{"skuId":"101801583739","productId":1765197186,"offerId":"ltSDnOWGgMru4BpIgMRBgA","size":24,"color":"#BDBDBC","wishlistLink":"/my/wishlist","baobabRealTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEhoKGHJlbWl4X2Rlc2t0b3BfbW9kZWxfY2FyZDIXCIKL28kGEPvI4577Ahi21YcEINfcwQc=","sign":"RYC1/QhhW0/DQWusrb6imsQoBbmWgsXI5y9EpHw1uAA="},"waitWishlistCollections":false,"place":{"page":"product","widget":"feed"}}}},"meta":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1765197186_15/content/content/toggleWishlist":{"name":"@marketfront/SnippetConstructor/ToggleWishlist"}}}

    Роксера Плюс таб. п/о плен., 10 мг+10 мг, 30 шт.

    Цена 981 ₽
  • Лориста Н 100 таб. п/о плен., 12.5 мг+100 мг, 30 шт.
    {"widgets":{"@marketfront/SnippetConstructor/Gallery":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1401075458_16/content/content/gallery":{"title":"Лориста Н 100 таб. п/о плен., 12.5 мг+100 мг, 30 шт.","images":[{"src":"https://avatars.mds.yandex.net/get-mpic/5346847/img_id1510814656463414636.jpeg/orig","srcSet":"https://avatars.mds.yandex.net/get-mpic/5346847/img_id1510814656463414636.jpeg/120x160 120w, https://avatars.mds.yandex.net/get-mpic/5346847/img_id1510814656463414636.jpeg/180x240 180w, https://avatars.mds.yandex.net/get-mpic/5346847/img_id1510814656463414636.jpeg/240x320 240w, https://avatars.mds.yandex.net/get-mpic/5346847/img_id1510814656463414636.jpeg/300x400 300w, https://avatars.mds.yandex.net/get-mpic/5346847/img_id1510814656463414636.jpeg/600x800 600w","sizes":"(max-width: 1456px) 15vw, 217px"},{"src":"https://avatars.mds.yandex.net/get-mpic/4519356/img_id4880937033387248390.jpeg/orig","srcSet":"https://avatars.mds.yandex.net/get-mpic/4519356/img_id4880937033387248390.jpeg/120x160 120w, https://avatars.mds.yandex.net/get-mpic/4519356/img_id4880937033387248390.jpeg/180x240 180w, https://avatars.mds.yandex.net/get-mpic/4519356/img_id4880937033387248390.jpeg/240x320 240w, https://avatars.mds.yandex.net/get-mpic/4519356/img_id4880937033387248390.jpeg/300x400 300w, https://avatars.mds.yandex.net/get-mpic/4519356/img_id4880937033387248390.jpeg/600x800 600w","sizes":"(max-width: 1456px) 15vw, 217px"}],"firstImageLazyLoading":false,"baobabClientData":{"realTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEhoKGHJlbWl4X2Rlc2t0b3BfbW9kZWxfY2FyZDIVCILuipwFEMas+VgYttWHBCDX3MEH","sign":"yDmTLWO+5cBj0xHqS+nc8L3n7CjVREoQUh1+CWD1vb0="},"target":"model_card"},"isNoPicturePadding":true}}},"meta":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1401075458_16/content/content/gallery":{"name":"@marketfront/SnippetConstructor/Gallery"}}}
    {"widgets":{"@marketfront/SnippetConstructor/ToggleWishlist":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1401075458_16/content/content/toggleWishlist":{"skuId":"186537542","productId":1401075458,"offerId":"8yg-xDAq9WlIzsSb_Pu2wQ","size":24,"color":"#BDBDBC","wishlistLink":"/my/wishlist","baobabRealTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEhoKGHJlbWl4X2Rlc2t0b3BfbW9kZWxfY2FyZDIVCILuipwFEMas+VgYttWHBCDX3MEH","sign":"yDmTLWO+5cBj0xHqS+nc8L3n7CjVREoQUh1+CWD1vb0="},"waitWishlistCollections":false,"place":{"page":"product","widget":"feed"}}}},"meta":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1401075458_16/content/content/toggleWishlist":{"name":"@marketfront/SnippetConstructor/ToggleWishlist"}}}

    Лориста Н 100 таб. п/о плен., 12.5 мг+100 мг, 30 шт.

    Цена 541 ₽
  • Лортенза таб. п/о плен., 5 мг + 50 мг, 30 шт.
    {"widgets":{"@marketfront/SnippetConstructor/ToggleWishlist":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1401075611_17/content/content/toggleWishlist":{"skuId":"227814271","productId":1401075611,"offerId":"C3RY_T4cjAKGUqE81OEaOw","size":24,"color":"#BDBDBC","wishlistLink":"/my/wishlist","baobabRealTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEhoKGHJlbWl4X2Rlc2t0b3BfbW9kZWxfY2FyZDIVCJvvipwFEP/W0GwYoMTeByDX3MEH","sign":"YIC6Y44qvkBYinKpp4qpIVjh8GGP+9RjVXD1DvfTeQ8="},"waitWishlistCollections":false,"place":{"page":"product","widget":"feed"}}}},"meta":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1401075611_17/content/content/toggleWishlist":{"name":"@marketfront/SnippetConstructor/ToggleWishlist"}}}

    Лортенза таб. п/о плен., 5 мг + 50 мг, 30 шт.

    Цена 454 ₽
  • Доксазозин-ФПО таб., 2 мг, 30 шт.
    {"widgets":{"@marketfront/SnippetConstructor/ToggleWishlist":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1401319529_18/content/content/toggleWishlist":{"skuId":"101392339200","productId":1401319529,"offerId":"P5c1WkRWhsB4wJp3fn8OWg","size":24,"color":"#BDBDBC","wishlistLink":"/my/wishlist","baobabRealTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEhoKGHJlbWl4X2Rlc2t0b3BfbW9kZWxfY2FyZDIXCOngmZwFEICi0dv5Ahjr3NAHINfcwQc=","sign":"S9yHxYmJYqjI4XB3Wt0Oh3vorGdA6JUV48lNlcqb5hc="},"waitWishlistCollections":false,"place":{"page":"product","widget":"feed"}}}},"meta":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1401319529_18/content/content/toggleWishlist":{"name":"@marketfront/SnippetConstructor/ToggleWishlist"}}}

    Доксазозин-ФПО таб., 2 мг, 30 шт.

    Цена 200 ₽
  • Ко-Дальнева таб., 5 мг+0.625 мг+2 мг, 30 шт.
    {"widgets":{"@marketfront/SnippetConstructor/ToggleWishlist":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1401075825_19/content/content/toggleWishlist":{"skuId":"265134745","productId":1401075825,"offerId":"uc9RA0gDWwfL0D9qhLt66w","size":24,"color":"#BDBDBC","wishlistLink":"/my/wishlist","baobabRealTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEhoKGHJlbWl4X2Rlc2t0b3BfbW9kZWxfY2FyZDIVCPHwipwFEJnFtn4YoMTeByDX3MEH","sign":"+CVtvZPUxKEuUBCgSlIL08VB4xQ856cUbnZVNXyQllU="},"waitWishlistCollections":false,"place":{"page":"product","widget":"feed"}}}},"meta":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1401075825_19/content/content/toggleWishlist":{"name":"@marketfront/SnippetConstructor/ToggleWishlist"}}}

    Ко-Дальнева таб., 5 мг+0.625 мг+2 мг, 30 шт.

    Цена 493 ₽
  • Эпленор таб. п/о плен., 25 мг, 30 шт.
    {"widgets":{"@marketfront/SnippetConstructor/ToggleWishlist":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1484168648_20/content/content/toggleWishlist":{"skuId":"101637721215","productId":1484168648,"offerId":"XEsp5AZebW1r0qZ3M3BLvQ","size":24,"color":"#BDBDBC","wishlistLink":"/my/wishlist","baobabRealTimeEventPayload":{"version":"EPV_BRT_V1","payload":"CgoQ5ZqG26rX6ZIYEhoKGHJlbWl4X2Rlc2t0b3BfbW9kZWxfY2FyZDIXCMi72sMFEP+Y0tD6AhjW/Y0HINfcwQc=","sign":"LZJW4WeGp4vjJMxyW03GYZkCB1JXfFuuWKVh3l8EQyQ="},"waitWishlistCollections":false,"place":{"page":"product","widget":"feed"}}}},"meta":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_21#1:1484168648_20/content/content/toggleWishlist":{"name":"@marketfront/SnippetConstructor/ToggleWishlist"}}}

    Эпленор таб. п/о плен., 25 мг, 30 шт.

    Цена 840 ₽
  • Реклама
    {"widgets":{"@light/AdLabel":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_102_21/content/content/content/adLabel":{"adLabel":{"adLabelText":"Реклама","advertizer":"Общество с ограниченной ответственностью «Азимут», ИНН 7805797800, ID #e-1g-107382-VND-ADV","adLabel":1},"advertisementId":1943501,"allowDebug":false,"borderRadius":5,"indents":6}}},"meta":{"/content/page/fancyPage/recommendationRoll/content/lazyGenerator/initialContent/recomLayoutItem_102_21/content/content/content/adLabel":{"name":"@light/AdLabel"}}}
    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  • Фенофибрат Канон таб. п/о плен., 145 мг, 30 шт.
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    Фенофибрат Канон таб. п/о плен., 145 мг, 30 шт.

    Цена 571 ₽
  • Контейнер для хранения/таблетница/кейс для таблеток
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    Контейнер для хранения/таблетница/кейс для таблеток

    Цена 365 ₽ вместо 699
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