Противосудорожный препарат. Натрия вальпроат повышает содержание гамма-аминобутировой кислоты (GABA) в головном мозге, что соответственно увеличивает содержание GABA в постсинаптических нейронах. Кроме того, натрия вальпроат влияет на перенос ионов калия через мембраны нейронов. В результате происходит подавление развития, а также распространения эпилептического возбуждения по нейронам.; Натрия вальпроат обладает противосудорожной активностью при различных типах эпилепсии у людей. Препарат не обладает выраженным снотворными и седативным эффектами, а также не оказывает угнетающего действия на дыхательный центр. Натрия вальпроат не оказывает отрицательного действия на АД, ЧСС, функцию почек и температуру тела.
Показания к применению
Лечение генерализованной или парциальной эпилепсии, особенно при следующих типах припадков:
Абсансы
Миоклонические
Тонико-клонические
Атонические
Парциальная эпилепсия:
Простые или комбинированные припадки
Вторичные генерализованные припадки
Специфические синдромы (Веста, Леннокса-Гасто).
Противопоказания
Тяжелые нарушения функции поджелудочной железы
Острый или хронический гепатит, случаи активного гепатита в семейном анамнезе (прежде всего лекарственного генеза)
Порфирия
Тромбоцитопения
Беременность
Лактация (грудное вскармливание)
Детский возраст до 3 лет
Повышенная чувствительность к вальпроевой кислоте и другим компонентам препарата
Применение при беременности и в период грудного вскармливания
Назначение препарата при беременности возможно только в случае, когда предполагаемая польза для матери превышает потенциальный риск для плода. В случае приема препарата при беременности обязательно проведение специализированного предродового наблюдения за плодом.; Применение препарата в период грудного вскармливания не рекомендуется.
Способ применения и дозы
Режим дозирования подбирают индивидуально в зависимости от возраста и массы тела пациента.; Для взрослых начальная доза составляет 600 мг/сут с последующим увеличением дозы на 200 мг каждые 3 дня до достижения оптимального эффекта. Кратность приема - 1-2 раза/сут. Максимально рекомендуемая доза 1-2 г/сут.; Таблетки следует проглатывать целиком, запивая небольшим количеством воды.; У пациентов пожилого возраста режим дозирования Вальпарина ХР сходен с режимом дозирования у взрослых и подбирается индивидуально.; Для детей с массой тела более 20 кг начальная доза - 400 мг/сут. Дозу следует повышать постепенно до достижения оптимальных значений - обычно 20-30 мг/кг/сут в 1 или 2 приема.; У детей массой тела до 20 кг не следует применять Вальпарин ХР.
Побочное действие
Со стороны системы пищеварения: редко - тошнота, рвота, диарея и/или запор, гепатит, панкреатит.; Аллергические реакции: редко - кожная сыпь, зуд, фотосенсибилизация, мультиформная эритема, синдром Стивенса-Джонсона.; Со стороны ЦНС: редко - атаксия, тремор, нарушение сознания, кома.; Со стороны половой системы: редко - нарушение менструального цикла, вторичная аменорея.; Со стороны системы кроветворения: редко - анемия, тромбоцитопения, нейтропения, лейкопения, снижение содержания фибриногена, торможение агрегации тромбоцитов.; Прочие: 2-12% - выпадение волос; редко - увеличение массы тела, гипераммониемия, креатининемия.
Передозировка
Сообщалось о редких случаях случайной или преднамеренной передозировки препарата.; Симптомы: тошнота, рвота, головокружение, диарея, угнетение дыхания, гипорефлексия, коматозное состояние.; Лечение: промывание желудка, прием активированного угля. При необходимости - стационарное лечение с проведением симптоматической терапии, гемодиализа.
Особые указания
Необходимо регулярное проведение контроля активности трансаминаз, содержания билирубина, тромбоцитов крови, амилазы (каждые 3 месяца).; Вальпроевая кислота ингибирует агрегацию тромбоцитов, что повышает риск увеличения времени свертывания крови при кровотечениях. Следует учитывать возможность развития осложнений, связанных с кровотечением в послеоперационном периоде у пациентов, получающих натрия вальпроат. При длительном приеме натрия вальпроата возможно развитие спонтанных гематом и кровотечений. В таком случае следует немедленно прекратить прием препарата.; Натрия вальпроат может вызвать лекарственный панкреатит и нарушение функции печени (обычно в первые 6 мес применения). В связи с этим необходимо в течение первых 23 мес лечения контролировать состояние поджелудочной железы, проводить печеночные пробы, следить за уровнем протромбина. Нарушение функции печени, печеночная недостаточность на фоне терапии натрия вальпроатом иногда наблюдаются у детей с эпилепсией и сочетанными метаболическими и дегенеративными заболеваниями, органической патологией мозговой ткани и замедленным умственным развитием. При возникновении таких симптомов, как выраженная слабость, летаргическое состояние, отечность, рвота и желтуха, следует немедленно прекратить применение препарата.; Влияние на способность к вождению автотранспорта и управлению механизмами; Пациенту следует соблюдать осторожность при работе с механизмами, т.к. препарат снижает способность к концентрации внимания.
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