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7 достижений
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Очень хорошая кружка. Держит хорошо тепло . Утром ребенку наливаю горячий чай ,к обеду хорошая температура ,можно пить ,теплый. Очень удобная,неубиваемая ,хотя пластик от 2-х летнего использования в некоторых местах откололся ,от бросания рюкзаках по коридорам.рекомендую
Хорошая паста ,посоветовал стоматолог для укрепления зубов и пятен на них . Расход экономичный ,хватает на 6-7 месяцев .
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системы"}],"isMainProperty":false,"name":"Органы и системы","value":"щитовидная железа"},{"description":"","filters":[{"id":36476390,"name":"Назначение"}],"isMainProperty":false,"name":"Назначение","value":"гипотиреоз, гипофункция щитовидной железы, диффузный токсический зоб, заместительная терапия после оперативных вмешательств на щитовидной железе, подготовка к обследованию или операции, профилактика развития эндемического зоба, рак щитовидной железы, супрессивная и заместительная терапия при злокачественных новообразованиях щитовидной железы, эутиреоидный зоб"},{"description":"","filters":[{"id":15768013,"name":"Показания к применению"}],"isMainProperty":false,"name":"Показания к применению","value":"- гипотиреоз;\u003Cbr\u003E- эутиреоидный зоб;\u003Cbr\u003E- в качестве заместительной терапии и для профилактики рецидива зоба после оперативных вмешательств на щитовидной железе;\u003Cbr\u003E- в качестве супрессивной и заместительной терапии при злокачественных новообразованиях щитовидной железы, в основном после оперативного лечения;\u003Cbr\u003E- диффузный токсический зоб: после достижения эутиреоидного состояния антитиреоидными средствами (в виде комбинированной или монотерапии);\u003Cbr\u003E- в качестве диагностического средства при проведении теста тиреоидной супрессии."},{"description":"","filters":[{"id":15768002,"name":"Противопоказания"}],"isMainProperty":false,"name":"Противопоказания","value":"- повышенная индивидуальная чувствительность к любому из компонентов препарата;\u003Cbr\u003E- нелеченный тиреотоксикоз;\u003Cbr\u003E- нелеченная недостаточность надпочечников;\u003Cbr\u003E- нелеченная гипофизарная недостаточность;\u003Cbr\u003E- применение в период беременности в комбинации с антитиреоидными средствами.\u003Cbr\u003EНе следует начинать лечение препаратом при наличии острого инфаркта миокарда, острого миокардита, острого панкардита."},{"description":"","filters":[{"id":15768292,"name":"Состав"}],"isMainProperty":false,"name":"Состав","value":"Для дозировки 75 мкг: в одной таблетке содержится:\u003Cbr\u003EДействующее вещество: левотироксин натрия - 0,075 мг\u003Cbr\u003EВспомогательные вещества:\u003Cbr\u003Eкальция гидрофосфат 2-водный - 23,925 мг, целлюлоза микрокристаллическая - 24,00 мг, карбоксиметилкрахмала натриевая соль, тип А - 18,00 мг, декстрин - 10,20 мг, глицериды длинноцепные парциальные - 1,80 мг.\u003Cbr\u003E\u003Cbr\u003EДля дозировки 50 мкг:\u003Cbr\u003EДействующее вещество: левотироксин натрия - 0,05 мг.\u003Cbr\u003EВспомогательные вещества: кальция гидрофосфата дигидрат, целлюлоза микрокристаллическая, карбоксиметилкрахмал натрия (тип А), декстрин, глицериды длинноцепочечные парциальные.\u003Cbr\u003EДля дозировки 100 мкг: \u003Cbr\u003EДействующее вещество: левотироксин натрия - 0,100 мг.\u003Cbr\u003EВспомогательные вещества: кальция гидрофосфата дигидрат - 31,90 мг, целлюлоза микрокристаллическая 32,00 мг, карбоксиметилкрахмал натрия (тип А) - 24,00 мг, декстрин - 13,60 мг, длинноцепочечные неполные глицериды - 2,40 мг.\u003Cbr\u003EДля дозировки 125 мкг:\u003Cbr\u003EДействующее вещество: левотироксин натрия - 0,125 мг.\u003Cbr\u003EВспомогательные вещества: кальция гидрофосфата дигидрат, целлюлоза микрокристаллическая, карбоксиметилкрахмал натрия (тип А), декстрин, глицериды длинноцепочечные парциальные.\u003Cbr\u003EДля дозировки 150 мкг:\u003Cbr\u003EДействующее вещество: левотироксин натрия - 0,15 мг.\u003Cbr\u003EВспомогательные вещества: кальция гидрофосфата дигидрат, целлюлоза микрокристаллическая, карбоксиметилкрахмал натрия (тип А), декстрин, глицериды длинноцепочечные парциальные."},{"description":"","filters":[{"id":27144131,"name":"Действующее вещество"}],"isMainProperty":false,"name":"Действующее вещество","value":"Левотироксин натрия"},{"description":"","filters":[{"id":15768000,"name":"Способ применения и дозы"}],"isMainProperty":false,"name":"Способ применения и дозы","value":"Суточная доза определяется индивидуально в зависимости от показаний, клинического состояния пациента и данных лабораторного обследования.\u003Cbr\u003EСуточную дозу левотироксина натрия принимают внутрь утром натощак, по крайней мере, за 30 минут до приема пищи, запивая таблетку небольшим количеством жидкости (полстакана воды) и не разжевывая. Таблетку можно делить на две равные части.\u003Cbr\u003EПри проведении заместительной терапии гипотиреоза у пациентов моложе 55 лет при отсутствии сердечно-сосудистых заболеваний левотироксин натрия применяют в суточной дозе 1.6-1.8 мкг на 1 кг массы тела; у пациентов старше 55 лет или с сердечно-сосудистыми заболеваниями - 0.9 мкг на 1 кг массы тела.\u003Cbr\u003EГрудным детям и детям до 3 лет суточную дозу левотироксина натрия дают в один прием за 30 минут до первого кормления. Таблетку растворяют в воде (10-15 мл) до тонкой взвеси, которую готовят непосредственно перед приемом препарата и дают запивать дополнительно небольшим количеством жидкости (5-10 мл).\u003Cbr\u003EУ пациентов с тяжелым длительно существующим гипотиреозом лечение следует начинать с особой осторожностью, с малых доз - с 12,5 мкг/сут, дозу увеличивают до поддерживающей через более продолжительные интервалы времени - на 12,5 мкг/сут каждые 2 недели и чаще определяют концентрацию ТТГ в крови.\u003Cbr\u003EПри гипотиреозе левотироксин натрия принимают, как правило, в течение всей жизни. При тиреотоксикозе левотироксин натрия применяют в комплексной терапии с антитиреоидными препаратами после достижения эутиреоидного состояния. Во всех случаях длительность лечения препаратом определяет врач.\u003Cbr\u003EДля точного дозирования необходимо использовать наиболее подходящую дозировку левотироксина натрия."},{"description":"","filters":[{"id":15767998,"name":"Побочные действия"}],"isMainProperty":false,"name":"Побочные действия","value":"При правильном применении левотироксина натрия под контролем врача побочные эффекты не наблюдаются. В случае передозировки, или при превышении индивидуального порога переносимости левотироксина натрия или, если дозу препарата с момента начала терапии увеличивают слишком быстро, у пациента могут появиться симптомы, характерные для гипертиреоза (см. раздел \"Передозировка\").\u003Cbr\u003EПри повышенной чувствительности к компонентам препарата возможно возникновение аллергических реакций со стороны кожных покровов (например, кожная сыпь, крапивница) и органов дыхания; ангионевротического отека; были зарегистрированы единичные случаи развития анафилактического шока. В случае возникновения указанных симптомов применение препарата следует немедленно прекратить."},{"description":"","filters":[{"id":15768001,"name":"Фармакологическое действие"}],"isMainProperty":false,"name":"Фармакологическое действие","value":"Действующее вещество препарата L-Тироксин 75 Берлин-Хеми левотироксин натрия является синтетическим левовращающим изомером тироксина, который по своему действию идентичен природному тиреоидному гормону, синтезируемому щитовидной железой человека. Для организма человека не существует отличий между эндогенным и экзогенным левотироксинами. После частичного превращения в трийодтиронин (Тз) в печени и почках и перехода в клетки организма, левотироксин натрия оказывает влияние на развитие и рост тканей, обмен веществ. В малых дозах обладает анаболическим действием на белковый и жировой обмены. В средних суточных дозах стимулирует рост и развитие, повышает потребность тканей в кислороде, стимулирует метаболизм белков, жиров и углеводов, повышает функциональную активность сердечно-сосудистой системы и центральной нервной системы.\u003Cbr\u003EВ больших дозах левотироксин натрия угнетает выработку тиротропин-рилизинг гормона гипоталамуса и тиреотропного гормона (ТТГ) гипофиза.\u003Cbr\u003EТерапевтический эффект наблюдается через 7-12 дней после начала применения, в течение такого же времени сохраняется действие левотироксина натрия после его отмены. Клинический эффект при гипотиреозе проявляется через 3-5 сут. Проявления диффузного эутиреоидного зоба уменьшаются или исчезают в течение 3-6 мес применения препарата."},{"description":"","filters":[{"id":34045110,"name":"Фармакологическая группа"}],"isMainProperty":false,"name":"Фармакологическая группа","value":"тиреоидное средство"},{"description":"","filters":[{"id":27141511,"name":"Форма выпуска для карточки"}],"isMainProperty":false,"name":"Форма выпуска","value":"таблетки"},{"description":"","filters":[{"id":35947170,"name":"Способ применения/введения"}],"isMainProperty":false,"name":"Способ применения/введения","value":"пероральный"}]},{"name":"Дополнительно","specs":[{"description":"","filters":[{"id":15767999,"name":"Условия хранения"}],"isMainProperty":false,"name":"Условия хранения","value":"Хранить при температуре не выше 25 °С.\u003Cbr\u003EХранить в недоступном для детей месте!"},{"description":"","filters":[{"id":15768014,"name":"Передозировка"}],"isMainProperty":false,"name":"Передозировка","value":"Симптомы\u003Cbr\u003EПри передозировке препарата наблюдается значительное увеличение скорости обмена веществ. Клинические признаки гипертиреоза могут возникать в случае передозировки, если превышен индивидуальный порог переносимости левотироксина натрия, или если доза препарата с момента начала терапии увеличивается слишком быстро. Симптомы, характерные для гипертиреоза: нарушения ритма сердца, тахикардия, ощущение сердцебиения, стенокардия, головная боль, мышечная слабость и мышечные подергивания, гиперемия (особенно лица), лихорадка, рвота, нарушение менструального цикла, доброкачественная внутричерепная гипертензия, тремор, беспокойство, бессонница, гипергидроз, снижение массы тела, диарея.\u003Cbr\u003EПередозировка левотироксина натрия может привести к появлению симптомов острого психоза, особенно у пациентов с предрасположенностью к психотическим расстройствам. Были зарегистрированы случаи внезапной остановки сердечной деятельности у пациентов, которые принимали чрезмерно высокие дозы левотироксина натрия в течение многих лет. У предрасположенных пациентов были отмечены отдельные случаи возникновения судорог при превышении индивидуального порога переносимости.\u003Cbr\u003EЛечение\u003Cbr\u003EВ зависимости от выраженности симптомов врачом может быть рекомендовано уменьшение суточной дозы левотироксина натрия, перерыв в лечении на несколько дней, назначение бета-адреноблокаторов. В случае острой передозировки абсорбция препарата в желудочно-кишечном тракте может быть снижена путем применения активированного угля. При приеме предельно высоких доз может быть назначен плазмаферез. После исчезновения побочных эффектов лечение следует начинать с осторожностью с более низкой дозы. Передозировка левотироксина натрия требует длительного периода наблюдения. Из-за постепенного превращения левотироксина в лиотиронин симптомы могут возникать с задержкой до 6 дней."},{"description":"","filters":[{"id":15768015,"name":"Применение при беременности и кормлении грудью"}],"isMainProperty":false,"name":"Применение при беременности и кормлении грудью","value":"В период беременности терапия левотироксином натрия, назначенная по поводу гипотиреоза, должна продолжаться.\u003Cbr\u003EВ период беременности может потребоваться увеличение дозы левотироксина натрия из-за повышения содержания тироксин-связывающего глобулина. Нет данных о возникновении тератогенных и фетотоксичных эффектов при приеме левотироксина натрия в рекомендуемых терапевтических дозах. Прием левотироксина натрия в период беременности в чрезмерно высоких дозах может негативно влиять на плод и постнатальное развитие. Применение при беременности левотироксина натрия в комбинации с антитиреоидными средствами противопоказано, так как прием левотироксина натрия может потребовать увеличения доз антитиреоидных средств. Поскольку антитиреоидные средства, в отличие от левотироксина натрия, могут проникать через плаценту, то у плода может развиться гипотиреоз. Проведение теста тиреоидной супрессии во время беременности противопоказано.\u003Cbr\u003EПериод грудного вскармливания\u003Cbr\u003EВ период грудного вскармливания левотироксин натрия следует принимать строго в рекомендованных дозах, под наблюдением врача. При приеме в рекомендованных терапевтических дозах концентрация тиреоидного гормона, секретируемого с грудным молоком при лактации, недостаточна для того, чтобы вызвать гипертиреоз и подавить секрецию ТТГ у ребенка.\u003Cbr\u003EПроведение теста тиреоидной супрессии во время грудного вскармливания противопоказано."},{"description":"","filters":[{"id":17360993,"name":"Влияние на способность управлять транспортом и механизмами"}],"isMainProperty":false,"name":"Влияние на способность управлять транспортом и механизмами","value":"Исследований влияния левотироксина натрия на способность к управлению транспортными средствами и механизмами не проводилось. Тем не менее, так как левотироксин натрия идентичен природному тиреоидному гормону, влияния на способность управлять транспортными средствами и другими механизмами не ожидается."},{"description":"","filters":[{"id":15771167,"name":"Особые указания"}],"isMainProperty":false,"name":"Особые указания","value":"С осторожностью:\u003Cbr\u003EЛевотироксин натрия следует назначать с осторожностью при заболеваниях сердечно¬сосудистой системы:ишемической болезни сердца (ИБС) (атеросклероз, стенокардия, ин¬фаркт миокарда в анамнезе), артериальной гипертензии, нарушениях ритма сердца;при гипофизарной и/или надпочечниковой недостаточности, при сахарном диабете, тяжелом длительно существующем гипотиреозе, тиреоидной автономии, синдроме мальабсорбции (может потребоваться коррекция дозы);у пациентов с предрасположенностью к психоти¬ческим реакциям.\u003Cbr\u003E"},{"description":"","filters":[{"id":15768012,"name":"Взаимодействие"}],"isMainProperty":false,"name":"Взаимодействие","value":"Применение трициклических антидепрессантов с левотироксином натрия может привести к усилению действия антидепрессантов.\u003Cbr\u003EЛевотироксин натрия снижает действие сердечных гликозидов.\u003Cbr\u003EПри одновременном применении колестирамин и колестипол (ионообменные смолы) уменьшают плазменную концентрацию левотироксина натрия за счет торможения его всасывания в кишечнике. В связи с этим левотироксин натрия необходимо принимать за 4-5 ч до приема указанных препаратов.\u003Cbr\u003EКолесевелам связывает левотироксин натрия и, таким образом, уменьшает абсорбцию левотироксина натрия из желудочно-кишечного тракта. Хотя не было установлено никаких взаимодействий при применении левотироксина натрия как минимум за 4 ч до приема колесевелама, левотироксин натрия следует принимать как минимум за 4 ч до приема колесевелама.\u003Cbr\u003EПри одновременном применении с анаболическими стероидами, аспарагиназой, тамоксифеном возможно фармакокинетическое взаимодействие на уровне связывания с белками плазмы крови.\u003Cbr\u003EИнгибиторы протеазы (например, ритонавир, индинавир, лопинавир) могут оказывать влияние на эффективность левотироксина натрия. Рекомендуется тщательный мониторинг концентрации тиреоидных гормонов. Тиреотропный гормон (ТТГ) следует контролировать у пациентов, принимающих левотироксин натрия, по крайней мере, в течение первого месяца после начала и/или прекращения лечения ритонавиром. При необходимости следует скорректировать дозу левотироксина натрия.\u003Cbr\u003EФенитоин может оказывать влияние на эффективность левотироксина натрия вследствие вытеснения левотироксина натрия из связи с белками плазмы, что может привести к повышению концентрации свободного Т4 и Т3. С другой стороны фенитоин повышает интенсивность метаболизма левотироксина натрия в печени. Рекомендуется тщательный мониторинг концентрации тиреоидных гормонов.\u003Cbr\u003EЛевотироксин натрия может способствовать снижению эффективности гипогликемических препаратов. Поэтому необходим частый мониторинг концентрации глюкозы в крови с момента начала заместительной терапии гормоном щитовидной железы. При необходимости дозу гипогликемического препарата следует скорректировать.\u003Cbr\u003EЛевотироксин натрия может усиливать эффект антикоагулянтов (производных кумарина) путем вытеснения их из связи с белками плазмы, что может повысить риск развития кровотечения, например, кровоизлияния в головной мозг или желудочно-кишечного кровотечения, особенно у пожилых пациентов. Поэтому необходим регулярный мониторинг параметров коагуляции как в начале, так и в ходе сочетанной терапии указанными препаратами. При необходимости дозу антикоагулянта следует скорректировать.\u003Cbr\u003EСалицилаты, дикумарол, фуросемид в высоких дозах (250 мг), клофибрат и другие препараты могут вытеснять левотироксин натрия из связи с белками плазмы, что приводит к повышению концентрации свободного Т4.\u003Cbr\u003EСевеламер и карбонат лантана могут уменьшать всасывание левотироксина натрия. Ингибиторы тирозинкиназы (например, иматиниб, сунитиниб) могут снижать эффективность левотироксина натрия. Поэтому в начале или в конце курса одновременной терапии указанными препаратами рекомендуется мониторинг изменения функции щитовидной железы у пациентов. При необходимости дозу левотироксина натрия корректируют. Алюминийсодержащие лекарственные препараты (антациды, сукральфат) в литературе описаны как потенциально снижающие эффективность левотироксина натрия. Поэтому\u003Cbr\u003Eприем левотироксина натрия рекомендуется осуществлять, по меньшей мере, за 2 ч до применения данных лекарственных препаратов. Данная рекомендация также относится к применению лекарственных препаратов, содержащих соли железа и кальция.\u003Cbr\u003EСоматропин при одновременном применении с левотироксином натрия может ускорить закрытие эпифизарных зон роста.\u003Cbr\u003EПропилтиоурацил, глюкокортикостероиды, бета-симпатолитики, йодсодержащие контрастные препараты и амиодарон ингибируют превращение Т4 в Т3. Ввиду высокого содержания йода применение амиодарона может сопровождаться развитием как гипертиреоза, так и гипотиреоза. Особое внимание следует уделять узловому зобу с возможным развитием нераспознанной функциональной автономии.\u003Cbr\u003EСертралин, хлорохин/прогуанил снижают эффективность левотироксина натрия и повышают концентрацию ТТГ в плазме крови.\u003Cbr\u003EЛекарственные препараты, способствующие индукции печеночных ферментов (например, барбитураты, карбамазепин), могут способствовать печеночному клиренсу левотироксина натрия.\u003Cbr\u003EУ женщин, применяющих эстрогенсодержащие контрацептивы, или у женщин в постменопаузе, получающих заместительную гормональную терапию, может возрастать потребность в левотироксине натрия.\u003Cbr\u003EУпотребление соесодержащих продуктов может способствовать снижению всасывания в кишечнике левотироксина натрия. Поэтому может потребоваться коррекция дозы, особенно в начале или после прекращения употребления продуктов, содержащих сою.\u003Cbr\u003EПри одновременном применении орлистата и левотироксина натрия может развиться гипотиреоз и/или произойти снижение контроля гипотиреоза. Причиной этого может быть снижение всасывания солей йода и/или левотироксина натрия. Пациенты, принимающие лево- тироксин натрия, должны проконсультироваться с врачом до начала применения орлистата, так как, возможно, потребуется принимать орлистат и левотироксин натрия в разное время суток, и скорректировать дозу левотироксина натрия. В дальнейшем рекомендуется проводить мониторинг функции щитовидной железы."},{"description":"","filters":[{"id":16435314,"name":"Регистрационный номер"}],"isMainProperty":false,"name":"Регистрационный номер","value":"П N008963, П N008964, ЛСР-001294/08, ЛСР-001484/08, ЛСР-001807/08"},{"description":"","filters":[{"id":16435315,"name":"Дата государственной регистрации"}],"isMainProperty":false,"name":"Дата государственной регистрации","value":"22.01.2021, 05.11.2019, 31.10.2019, 11.11.2019, 11.11.2019"},{"description":"","filters":[{"id":34324371,"name":"Тип препарата"},{"id":7893318,"name":"Производитель"}],"isMainProperty":false,"name":"Владелец регистрационного 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лактации","filterIds":["36476390"],"filters":[{"id":36476390,"name":"","values":[{"value":"36617923","isFilterable":true,"text":""},{"value":"36618070","isFilterable":true,"text":""},{"value":"36618406","isFilterable":true,"text":""}],"type":"","subType":"","unit":""}]},{"value":"действующее вещество: Каберголин","filterIds":["27144131"],"filters":[{"id":27144131,"name":"","values":[{"value":"28708898","isFilterable":true,"text":""}],"type":"","subType":"","unit":""}]},{"value":"возраст: от 16 лет","filterIds":["23679511","16082123"],"filters":[{"id":23679511,"name":"","values":[{"value":"192","isFilterable":true,"text":""}],"type":"","subType":"","unit":""},{"id":16082123,"name":"","values":[{"value":"0","isFilterable":true,"text":""}],"type":"","subType":"","unit":""}]},{"value":"форма выпуска: таблетки","filterIds":["27141511"],"filters":[{"id":27141511,"name":"","values":[{"value":"28706582","isFilterable":true,"text":""}],"type":"","subType":"","unit":""}]},{"value":"способ применения/введения: пероральный","filterIds":["35947170"],"filters":[{"id":35947170,"name":"","values":[{"value":"36763744","isFilterable":true,"text":""}],"type":"","subType":"","unit":""}]},{"value":"страна-производитель: Италия","filterIds":["16064056"],"filters":[{"id":16064056,"name":"","values":[{"value":"16064144","isFilterable":true,"text":""}],"type":"","subType":"","unit":""}]}],"full":[{"name":"Общие характеристики","specs":[{"description":"","filters":[{"id":34324371,"name":"Тип препарата"}],"isMainProperty":false,"name":"Тип препарата","value":"лекарственный препарат"},{"description":"","filters":[{"id":27272850,"name":"Рецептурный препарат"}],"isMainProperty":false,"name":"Рецептурный препарат","value":"да"},{"description":"","filters":[{"id":34045610,"name":"Органы и системы"}],"isMainProperty":false,"name":"Органы и системы","value":"гипофиз, половая система, эндокринная система"},{"description":"","filters":[{"id":36476390,"name":"Назначение"}],"isMainProperty":false,"name":"Назначение","value":"аденома гипофиза, лечение нарушений, связанных с гиперпролактинемией, подавление лактации"},{"description":"","filters":[{"id":15768013,"name":"Показания к применению"}],"isMainProperty":false,"name":"Показания к применению","value":"- Предотвращение физиологической лактации после родов.\u003Cbr\u003E\n- Подавление уже установившейся послеродовой лактации.\u003Cbr\u003E\n- Лечение нарушений, связанных с гиперпролактинемией, включая аменорею, олигоменорею, ановуляцию, галакторею.\u003Cbr\u003E\n- Пролактинсекретирующие аденомы гипофиза (микро- и макропролактиномы); идиопатическая гиперпролактинемия; синдром \"пустого\" турецкого седла в сочетании с гиперпролактинемией."},{"description":"","filters":[{"id":15768002,"name":"Противопоказания"}],"isMainProperty":false,"name":"Противопоказания","value":"- Гиперчувствительность к каберголину и/или любому вспомогательному веществу в составе препарата, а также к любым алкалоидам спорыньи.\u003Cbr\u003E\n- Фиброзные изменения в легких, перикарде или забрюшинном пространстве в анамнезе.\u003Cbr\u003E\n- При длительной терапии: анатомические признаки патологии клапанного аппарата сердца (такие как, утолщение створки клапана, сужение просвета клапана, смешанная патология сужение и стеноз клапана), подтвержденные эхокардиографическим исследованием (ЭхоКГ), проведенным до начала терапии.\u003Cbr\u003E\n- Применение у детей и подростков в возрасте до 16 лет (безопасность и эффективность препарата не установлены).\u003Cbr\u003E\n- Непереносимость лактозы, дефицит лактазы, глюкозо-галактозная мальабсорбция.\u003Cbr\u003E\n- Беременность и период грудного вскармливания (в связи с отсутствием клинических данных по эффективности и безопасности применения каберголина).\u003Cbr\u003E"},{"description":"","filters":[{"id":15768292,"name":"Состав"}],"isMainProperty":false,"name":"Состав","value":"Каждая таблетка содержит:\u003Cbr\u003E\nДействующее вещество: каберголин 0,50 мг;\u003Cbr\u003E\nВспомогательные вещества: лактоза 75,90 мг, лейцин 3,60 мг.\u003Cbr\u003E"},{"description":"","filters":[{"id":27144131,"name":"Действующее вещество"}],"isMainProperty":false,"name":"Действующее вещество","value":"Каберголин"},{"description":"","filters":[{"id":15768000,"name":"Способ применения и дозы"}],"isMainProperty":false,"name":"Способ применения и дозы","value":"Внутрь, во время еды.\u003Cbr\u003E\nПредотвращение лактации: 1 мг однократно (2 таблетки по 0,5 мг), в первый день после родов (предпочтительно с первым приемом пищи после родов).\u003Cbr\u003E\nПодавление установившейся лактации: по 0,25 мг (1/2 таблетки) 2 раза в сутки через каждые 12 часов в течение двух дней (общая доза равна 1 мг). С целью снижения риска ортостатической артериальной гипотензии у женщины, однократная доза каберголина не должна превышать 0,25 мг.\u003Cbr\u003E\nЛечение нарушений, связанных с гиперпролактинемией: рекомендуемая начальная доза составляет 0,5 мг в неделю в один прием (1 таблетка 0,5 мг) или в два приема (по 1/2 таблетки 0,5 мг, например, в понедельник и четверг). Повышение недельной дозы должно проводиться постепенно — на 0,5 мг с месячным интервалом до достижения оптимального терапевтического эффекта. Терапевтическая доза обычно составляет 1 мг в неделю, но может колебаться от 0,25 до 2 мг в неделю. Максимальная доза для пациенток с гиперпролактинемией не должна превышать 4,5 мг в неделю.\u003Cbr\u003E\nВ зависимости от переносимости, недельную дозу можно принимать однократно или разделить на 2 и более приемов в неделю. Разделение недельной дозы на несколько приемов рекомендуется при назначении препарата в дозе более 1 мг в неделю.\u003Cbr\u003E\nУ пациентов с повышенной чувствительностью к дофаминергическим препаратам вероятность развития нежелательных реакций можно уменьшить, начав терапию каберголином в более низкой дозе (например, по 0,25 мг один раз в неделю), с последующим постепенным ее увеличением до достижения терапевтической дозы. Для улучшения переносимости препарата при возникновении выраженных нежелательных реакций возможно временное снижение дозы с последующим более постепенным ее увеличением (например, увеличение на 0,25 мг в неделю или каждые 2 недели).\u003Cbr\u003E\nПри увеличении дозы пациенты должны проходить регулярное обследование для установления наименьшей эффективной дозы каберголина. Рекомендуется, как минимум 1 раз в месяц, определение концентрации пролактина в плазме крови, так как нормализация его концентрации обычно наступает в течение 2-4 недель после подбора эффективной дозы каберголина.\u003Cbr\u003E\nПосле отмены каберголина обычно наблюдается рецидив гиперпролактинемии. Однако у некоторых пациенток наблюдается стойкое снижение концентрации пролактина в плазме крови в течение нескольких месяцев. У большинства женщин овуляторные циклы сохраняются в течение, по меньшей мере, 6 месяцев после прекращения терапии.\u003Cbr\u003E\nПрименение препарата в особых кинических группах пациентов\u003Cbr\u003E\nУ детей и подростков\u003Cbr\u003E\nЭффективность и безопасность применения каберголина у детей и подростков в возрасте 16 лет не установлены.\u003Cbr\u003E\nУ пожилых пациентов\u003Cbr\u003E\nВ связи с показаниями к применению каберголина, опыт его применения у пациентов пожилого возраста крайне ограничен. Имеющиеся данные не указывают на наличие особого риска.\u003Cbr\u003E\nУ пациентов с нарушением функции печени\u003Cbr\u003E\nУ пациентов с печеночной недостаточностью тяжелой степени следует применять более низкие дозы каберголина (см. раздел «Особые указания»)."},{"description":"","filters":[{"id":15767998,"name":"Побочные действия"}],"isMainProperty":false,"name":"Побочные действия","value":"В ходе клинических исследований с применением каберголина для предотвращения физиологической лактации (1 мг однократно) и для подавления лактации (по 0,25 мг каждые 12 часов в течение 2 дней) нежелательные реакции отмечались приблизительно у 14% женщин. При применении каберголина в течение 6 месяцев в дозе 1-2 мг в неделю, разделенной на 2 приема, для лечения нарушений, связанных с гиперпролактинемией, частота нежелательных реакций составляла 68%. Нежелательные реакции возникали, в основном, в течение первых 2 недель терапии и в большинстве случаев исчезали по мере продолжения терапии или через несколько дней после отмены каберголина. Нежелательные реакции обычно были преходящими, по степени тяжести - слабо или умеренно выражены и носили дозозависимый характер. По крайней мере, однократно в ходе терапии тяжелые нежелательные реакции отмечались у 14% пациентов; из-за нежелательных реакций лечение было прекращено примерно у З% пациентов.\u003Cbr\u003E\nВозможные нежелательные реакции при применении каберголина распределены по системно-органным классам с указанием частоты их возникновения согласно рекомендациям ВОЗ (очень часто (≥1/10); часто (≥1/100 до \u003C1/10); нечасто (≥1/1,000 до \u003C1/100); редко (≥1/10,000 до \u003C1/1,000); очень редко (\u003C1/10,000), неизвестно (невозможно определить на основе имеющихся данных): \u003Cbr\u003E\nНарушения со стороны иммунной системы: нечасто - реакции гиперчувствительности;\u003Cbr\u003E\nНарушения психики: часто - депрессия; нечасто - повышение либидо, частота неизвестна - агрессивность, бред, гиперсексуальность, игровая зависимость / патологическая склонность к азартным играм, психотические расстройства, галлюцинации.\u003Cbr\u003E\nНарушения со стороны органа зрения: частота неизвестна - нарушения зрения.\u003Cbr\u003E\nНарушения со стороны сердца: очень часто - поражение клапанов сердца (вальвулопатия), в том числе регургитация, и сопутствующие нарушения (перикардит и выпот в перикард); нечасто - ощущение сердцебиения; частота неизвестна - стенокардия.\u003Cbr\u003E\nНарушения со стороны сосудов: часто - при длительном применении каберголин обычно оказывает гипотензивное действие, в некоторых случаях может иметь месть ортостатическая артериальная гипотензия, «приливы»; нечасто - спазм сосудов верхних и нижних конечностей, обморок.\u003Cbr\u003E\nНарушения со стороны дыхательной системы, органов грудной клетки и средостения: нечасто - одышка, плевральный выпот, фиброз (фиброз легких), носовое кровотечение; очень редко - плевральный фиброз; частота неизвестна - нарушения дыхания, дыхательная недостаточность, плеврит и боль в грудной клетке.\u003Cbr\u003E\nНарушения со стороны желудочно-кишечного такта: очень часто - тошнота, диспепсия, гастрит, боль в животе; часто - запор, рвота; редко - боль в эпигастральной области.\u003Cbr\u003E\nНарушения со стороны печени и желчевыводящих путей: частота неизвестна - нарушение функции печени.\u003Cbr\u003E\nНарушения со стороны кожи и подкожных тканей: нечасто - сыпь, алопеция.\u003Cbr\u003E\nНарушения со стороны скелетно-мышечной и соединительной ткани: нечасто - судороги нижних конечностей.\u003Cbr\u003E\nНарушения со стороны половых органов и молочной железы: часто - мастодиния.\u003Cbr\u003E\nОбщие расстройства и нарушения в месте введения: очень часто - астения, повышенная утомляемость; нечасто - отеки, периферические отеки.\u003Cbr\u003E\nЛабораторные и инструментальные данные: часто - бессимптомное снижение артериального давления (систолического — не мене чем на 20 мм рт. ст.; диастолического — не мене чем на 10 мм рт.ст.); нечасто - возможно уменьшение содержания гемоглобина у женщин с аменореей в первые месяцы после возобновления менструаций; редко - отклонение от нормы стандартных лабораторных показате лей при длительной терапии с применением каберголина; частота неизвестна - увеличение активности креатинфосфокиназы, отклонения от нормы показателей функции печени.\u003Cbr\u003E\nРасстройства импульсного контроля: патологическое пристрастие к азартным играм, повышенное либидо, гиперсексуальность, склонность к неадекватным тратам или компульсивным покупкам, булимическое переедание и булимия могут возникать у пациентов, получающих терапию агонистами дофаминергических рецепторов, включая каберголин."},{"description":"","filters":[{"id":15768001,"name":"Фармакологическое действие"}],"isMainProperty":false,"name":"Фармакологическое действие","value":"Каберголин является дофаминергическим производным эрголина и характеризуется выраженным и длительным пролактинснижающим действием, обусловленным прямой стимуляцией D2-дофаминовых рецепторов лактотропных клеток гипофиза. Кроме того, при приеме более высоких доз по сравнению с таковыми для снижения концентрации пролактина в плазме крови, каберголин обладает центральным дофаминергическим эффектом вследствие стимуляции D2-рецепторов.\u003Cbr\u003E\nСнижение концентрации пролактина в плазме крови отмечается в течение З ч после приема препарата и сохраняется в течение 7-28 дней у здоровых добровольцев и пациенток с гиперпролактинемией, и до 14-21 дней — у женщин в послеродовом периоде.\u003Cbr\u003E\nКаберголин обладает строго избирательным действием, не оказывает влияния на базальную секрецию других гормонов гипофиза и кортизола. Пролактинснижающее действие каберголина является дозозависимым как в отношении выраженности, так и длительности действия.\u003Cbr\u003E\nК фармакодинамическим воздействиям каберголина, не связанным с терапевтическим эффектом, относится только снижение артериального давления (АД). При однократном приеме препарата максимальный гипотензивный эффект отмечается в течение первых 6 часов и является дозозависимым."},{"description":"","filters":[{"id":34045110,"name":"Фармакологическая группа"}],"isMainProperty":false,"name":"Фармакологическая группа","value":"дофаминовых рецепторов агонист"},{"description":"","filters":[{"id":27141511,"name":"Форма выпуска для карточки"}],"isMainProperty":false,"name":"Форма выпуска","value":"таблетки"},{"description":"","filters":[{"id":35947170,"name":"Способ применения/введения"}],"isMainProperty":false,"name":"Способ применения/введения","value":"пероральный"},{"description":"","filters":[{"id":14805991,"name":"Пол"}],"isMainProperty":false,"name":"Пол","value":"для женщин"},{"description":"","filters":[{"id":23679511,"name":"Минимальный возраст применения"},{"id":16082123,"name":"С рождения"}],"isMainProperty":false,"name":"Минимальный возраст применения","value":"от 16 лет"}]},{"name":"Дополнительно","specs":[{"description":"","filters":[{"id":15767999,"name":"Условия хранения"}],"isMainProperty":false,"name":"Условия хранения","value":"Препарат следует хранить в недоступном для детей месте при температуре не выше 25°C."},{"description":"","filters":[{"id":15768014,"name":"Передозировка"}],"isMainProperty":false,"name":"Передозировка","value":"Симптомы (вероятнее, симптомы гиперстимуляции допаминовых рецепторов): тошнота, рвота, диспептические симптомы, ортостатическая артериальная гипотензия, спутанность сознания, психоз, галлюцинации.\u003Cbr\u003EЛечение: следует проводить мероприятия, направленные на выведение препарата (промывание желудка) и на поддержание АД. Рекомендуется назначение антагонистов допамина."},{"description":"","filters":[{"id":15768015,"name":"Применение при беременности и кормлении грудью"}],"isMainProperty":false,"name":"Применение при беременности и кормлении грудью","value":"Беременность\u003Cbr\u003E\nАдекватных контролируемых клинических исследований по применению каберголина у беременных не проводилось. Исследования на животных не продемонстрировали тератогенного действия каберголина, но были выявлены снижение фертильности и эмбриотоксичность. Результаты 12-летнего обсервационного исследования влияния каберголина на исходы беременности показали, что в 6,6% (17 беременностей из 256) привели к серьезным врожденным порокам развития или преждевременному прерыванию беременности (наиболее частыми были пороки развития костно-мышечной системы, сердца и легких). Информации в отношении перинатальных расстройств или долгосрочных наблюдений развития новорожденных, матери которых принимали каберголин во время беременности, нет. В связи с чем, терапия каберголином в период беременности возможна только в случаях крайней необходимости, с учетом тщательной оценки соотношения ”пользы-риска” для женщины и плода. Учитывая длительный период полувыведения каберголина и ограниченные данные о действии каберголина на плод, пациентки, планирующие беременность, должны прекратить его прием за месяц до планируемой даты беременности. В случае наступления беременности на фоне терапии каберголином, прием препарата следует прекратить после подтверждения беременности.\u003Cbr\u003E\nПериод грудного вскармливания\u003Cbr\u003E\nКаберголин проникает в молоко лактирующих крыс, сведений о проникновении каберголина в грудное молоко человека нет. Тем не менее, при отсутствии достаточного эффекта применения каберголина для предотвращения или подавления лактации от грудного вскармливания следует отказаться.\u003Cbr\u003E\nТак как каберголин предотвращает лактацию, прием препарата пациенткам с гиперпролактинемией, планирующим грудное вскармливание, противопоказан.\u003Cbr\u003E"},{"description":"","filters":[{"id":17360993,"name":"Влияние на способность управлять транспортом и механизмами"}],"isMainProperty":false,"name":"Влияние на способность управлять транспортом и механизмами","value":"Пациенты, принимающие препарат Достинекс, должны воздержаться от управления транспортными средствами и механизмами и другой потенциально опасной деятельности, требующей концентрации внимания и быстроты психомоторных реакций."},{"description":"","filters":[{"id":15771167,"name":"Особые указания"}],"isMainProperty":false,"name":"Особые указания","value":"Как и другие производные спорыньи, каберголин следует назначать с осторожностью при следующих состояниях и/или заболеваниях:\u003Cbr\u003E\n- артериальная гипертензия, развившаяся на фоне беременности, например, преэклампсия или послеродовая артериальная гипертензия (каберголин назначается только в тех случаях, когда потенциальная польза от применения препарата значительно превышает возможный риск);\u003Cbr\u003E\n- тяжелые сердечно-сосудистые заболевания, синдром Рейно;\u003Cbr\u003E\n- пептическая язва, желудочно-кишечные кровотечения;\u003Cbr\u003E\n- печеночная недостаточность тяжелой степени (рекомендуется применение более низких доз);\u003Cbr\u003E\n- тяжелые психотические или когнитивные нарушения (в т.ч. в анамнезе);\u003Cbr\u003E\n- одновременное применение с препаратами, оказывающими гипотензивное действие (из-за риска развития ортостатической артериальной гипотензии).\u003Cbr\u003E\nОсобые указания:\u003Cbr\u003E\nПеред началом терапии каберголином с целью лечения нарушений, связанных с гиперпролактинемией, необходимо провести полное обследование гипофиза.\u003Cbr\u003E\nПеред началом длительной терапии каберголином все пациенты должны пройти обследование сердечно-сосудистой системы, включая эхокардиограмму (с целью исключения бессимптомно протекающих пороков сердца). Кроме того, целесообразно определение СРБ или других маркеров воспаления, рентгенография грудной клетки, исследование функции легких и функции почек.\u003Cbr\u003E\nКак и при применении других производных спорыньи, после длительного приема каберголина у пациентов наблюдались плевральный выпот/плевральный фиброз и вальвулопатия. В некоторых случаях пациенты получали предшествующую терапию эрготониновыми агонистами дофамина. Поэтому каберголин не следует применять у пациентов с имеющимися признаками и/или клиническими симптомами нарушения функции сердца или дыхания, связанными с фиброзными изменениями или с такими состояниями в анамнезе. Следует отменить прием препарата в случае обнаружения признаков появления или ухудшения регургитации крови, сужения просвета клапанов или утолщения створок клапанов (см. раздел «Противопоказания»).\u003Cbr\u003E\nБыло установлено, что скорость оседания эритроцитов возрастает при развитии плеврального выпота или фиброза. В случае обнаружения необъяснимого увеличения скорости оседания эритроцитов, рекомендуется выполнить рентгенографическое исследование грудной клетки. В постановке диагноза может помочь определение концентрации креатинина в плазме крови и оценка функции почек. После прекращения приема каберголина у пациентов с наличием плеврального выпота/плеврального фиброза или вальвулопатии отмечалось улучшение симптомов.\u003Cbr\u003E\nНеизвестно может ли каберголин ухудшать состояние пациентов с признаками регургитации крови. Каберголин не следует применять при выявлении фиброзных поражений клапанного аппарата сердца (см. раздел «Противопоказания»).\u003Cbr\u003E\nФибротические нарушения могут развиваться бессимптомно. В связи с этим следует регулярно контролировать состояние пациентов, получающих длительную терапию каберголином и обращать особое внимание, на следующие симптомы:\u003Cbr\u003E\n- плевро-легочные нарушения: такие, как одышка, затруднение дыхания, непроходящий кашель или боль в грудной клетке;\u003Cbr\u003E\n- почечная недостаточность или обструкция сосудов мочеточников или органов брюшной полости, которые могут сопровождаться болью в боку или в области поясницы и отеками нижних конечностей, любые припухлости или болезненность при дотрагивании в области живота, что может свидетельствовать о развитии ретроперитонеального фиброза;\u003Cbr\u003E\n- перикардиальный фиброз и фиброз створок клапанов сердца часто манифестируют сердечной недостаточностью. В связи с этим необходимо исключить фиброз створок клапанов сердца (и констриктивный перикардит) при появлении симптомов сердечной недостаточности.\u003Cbr\u003E\nСледует регулярно проводить мониторинг состояния пациента на предмет развития фибротических нарушений. Первый раз ЭхоКГ должна быть проведена через 3-6 месяцев после начала терапии. Затем данное исследование необходимо проводить в зависимости от клинической оценки состояния пациента, уделяя особое внимание симптомам, описанным выше, как минимум каждые 6-12 месяцев терапии.\u003Cbr\u003E\nНеобходимость других методов мониторинга (например, физикальное обследование, включая аускультацию сердца, рентгенографию, компьютерную томографию) оценивается индивидуально для каждого пациента.\u003Cbr\u003E\nКаберголин восстанавливает овуляцию и фертильность у женщин с гиперпролактинемическим гипогонадизмом. До начала применения каберголина следует исключить беременность. Поскольку беременность может наступить до восстановления менструации, рекомендуется проводить тесты на беременность не реже одного раза в 4 недели в течение периода аменореи, а после восстановления менструации - каждый раз, когда отмечается задержка менструации более чем на З дня. Женщинам, желающим избежать беременности, следует использовать барьерные методы контрацепции во время лечения каберголином, а также после отмены препарата до повторения ановуляции. Женщины, у которых наступила беременность, должны находиться под наблюдением врача для своевременного выявления симптомов увеличения гипофиза, поскольку во время беременности возможно увеличение размеров уже существовавших опухолей гипофиза. У пациентов с печеночной недостаточностью тяжелой степени для длительной терапии следует применять низкие дозы каберголина.\u003Cbr\u003E\nУ пациентов с печеночной недостаточностью тяжелой степени (класс С по шкале Чайлд-Пью) после однократного приема каберголина в дозе 1 мг значение AUC было выше, чем у здоровых добровольцев или пациентов с меньшей выраженностью печеночной недостаточности.\u003Cbr\u003E\nПрименение каберголина вызывает сонливость. У пациентов с болезнью Паркинсона применение агонистов дофаминовых рецепторов может вызвать внезапное засыпание. В подобных случаях рекомендуется снизить дозу каберголина или прекратить терапию.\u003Cbr\u003E\nНе рекомендуется применение каберголина у пациентов с нарушением функции почек, в связи с отсутствием клинических данных по эффективности и безопасности каберголина в данной популяции пациентов.\u003Cbr\u003E\nС целью выявления признаков расстройств импульсного контроля при длительной терапии каберголином пациенты должны находиться под регулярным наблюдением, пациенты и/или осуществляющие за ними уход люди должны быть проинформированы о возможных расстройствах поведения на фоне терапии. Расстройства импульсного контроля, такие как патологическое пристрастие к азартным играм, повышенное либидо и гиперсексуальность были зарегистрированы у пациентов, получающих терапию агонистами дофаминергических рецепторов, включая каберголин. Эти явления были обычно обратимы после уменьшения дозы или отмены препарата.\u003Cbr\u003E"},{"description":"","filters":[{"id":15768012,"name":"Взаимодействие"}],"isMainProperty":false,"name":"Взаимодействие","value":"Информация о взаимодействии каберголина и других алкалоидов спорыньи отсутствует, поэтому одновременное применение этих лекарственных средств во время длительной терапии препаратом Достинекс не рекомендуется.\u003Cbr\u003EПоскольку каберголин оказывает терапевтическое действие путем прямой стимуляции допаминовых рецепторов, препарат нельзя назначать одновременно с препаратами, действующими как антагонисты допамина (в т.ч. фенотиазины, бутирофеноны, тиоксантены, метоклопрамид), т.к. они могут ослабить действие каберголина, направленное на снижение концентрации пролактина.\u003Cbr\u003EКак и другие производные спорыньи, каберголин нельзя применять одновременно с антибиотиками группы макролидов (например, с эритромицином), поскольку это может привести к увеличению системной 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