Немелкоклеточный рак легкого, рак молочной железы, рак предстательной железы, резистентный к гормонотерапии (в комбинации с малыми дозами пероральных кортикостероидов).
Противопоказания
Гиперчувствительность к винка-алкалоидам или другим составным частям препарата; содержание нейтрофилов менее 1500 клеток/мкл крови; содержание тромбоцитов менее 75000 клеток/мкл крови (при в/в введении) и менее 100000 клеток/мкл (при приеме внутрь); тяжелая инфекция (сопутствующая назначению препарата или перенесенная в течение 2 нед); выраженная недостаточность ...
Немелкоклеточный рак легкого, рак молочной железы, рак предстательной железы, резистентный к гормонотерапии (в комбинации с малыми дозами пероральных кортикостероидов).
Противопоказания
Гиперчувствительность к винка-алкалоидам или другим составным частям препарата; содержание нейтрофилов менее 1500 клеток/мкл крови; содержание тромбоцитов менее 75000 клеток/мкл крови (при в/в введении) и менее 100000 клеток/мкл (при приеме внутрь); тяжелая инфекция (сопутствующая назначению препарата или перенесенная в течение 2 нед); выраженная недостаточность функции печени, не связанная с опухолевым процессом; потребность в постоянной оксигенотерапии (у больных с опухолью легкого); заболевания и состояния, приводящие к снижению всасывания в ЖКТ (для капсул); беременность, период кормления грудью. С осторожностью использовать при дыхательной недостаточности, угнетении костномозгового кроветворения (в т.ч. после предыдущей химиотерапии или лучевого лечения), запорах или явлениях кишечной непроходимости в анамнезе, нейропатии в анамнезе.
Применение при беременности и в период грудного вскармливания
Противопоказано при беременности. На время лечения следует прекратить грудное вскармливание.
Способ применения и дозы
Навельбин применяется как в виде монотерапии, так и в комбинации с другими противоопухолевыми препаратами. При выборе дозы и режима введения в каждом индивидуальном случае следует обращаться к специальной литературе. Капсулы. Внутрь, целиком, не разжевывая и не рассасывая во рту, запивая водой. При монотерапии рекомендуемая доза составляет 60 мг/м2 1 раз в неделю. После третьего приема дозу увеличивают до 80 мг/м2 1 раз в неделю. Увеличение дозы с 60 до 80 мг/м2 может быть осуществлено, если на протяжении 3 нед приема Навельбина не отмечено нейтропении 4 степени (<500 клеток/мкл), или был 1 эпизод нейтропении 3 степени (<1000 – ≥500 клеток/мкл), и содержание нейтрофилов перед очередным приемом не ниже 1500 клеток/мкл. В случае, если перед приемом препарата в дозе 80 мг/м2 отмечена нейтропения 4 степени (<500 клеток/мкл3) или 2 случая нейтропении 3 степени (<1000 – ≥500 клеток/мкл), то в последующие 3 приема следует снизить дозу с 80 до 60 мг/м2 в неделю. В том случае, если содержание нейтрофилов не снижалось менее 500 клеток/мкл или не наблюдалось более 1 снижения содержания нейтрофилов в диапазоне 500–1000 клеток/мкл в течение 3 нед приема Навельбина в дозе 60 мг/м2 (согласно вышеприведенным рекомендациям), то можно снова увеличить дозу препарата с 60 до 80 мг/м2 в неделю. Для пациентов с BSA≥2 м2 общая разовая доза Навельбина, принимаемого внутрь, не должна превышать 120 мг в неделю при назначении препарата в дозе 60 мг/м2 и 160 мг в неделю при назначении препарата в дозе 80 мг/м2. Применение Навельбина внутрь в дозах 60 и 80 мг/м2 соответствует в/в введению препарата в дозах 25 и 30 мг/м2. При полихимиотерапии доза и частота приема препарата (как в/в, так и внутрь) зависят от конкретной программы противоопухолевой терапии. При снижении содержания нейтрофилов <1500 клеток/мкл крови или тромбоцитопении <75000 клеток/мкл крови (при в/в введении) или <100000 (при приеме внутрь) очередное введение или прием препарата внутрь откладывают на 1 нед. Если из-за гематологической токсичности пришлось воздержаться от 3 еженедельных введений или приемов препарата, применение Навельбина рекомендуется прекратить. Коррекция режима дозирования Навельбина при печеночной недостаточности: у больных с выраженной печеночной недостаточностью Навельбин должен назначаться с осторожностью, в дозе, сниженной на 33%. Дети: безопасность и эффективность Навельбина у детей не изучена. Пожилые люди: какие-либо специальные инструкции по применению отсутствуют.
Побочное действие
Со стороны органов кроветворения: очень часто - нейтропения, анемия, тромбоцитопения, присоединение вторичных инфекций на фоне угнетения костномозгового кроветворения; часто - лихорадка (>38 °C) на фоне нейтропении; иногда - сепсис, септицемия; крайне редко - осложненная септицемия, в некоторых случаях приводящая к летальному исходу. Наименьшее число нейтрофилов наблюдается на 7–10 день от начала терапии, восстановление происходит в последующие 5–7 дней. Кумулирования гематотоксичности не отмечено. Со стороны иммунной системы: редко - анафилактический шок или ангионевротический отек. Со стороны нервной системы: очень часто - парестезии, гиперестезии, снижение или выпадение глубоких сухожильных рефлексов; часто - слабость в ногах; иногда - тяжелые парестезии с сенсорными и моторными симптомами, как правило, обратимого характера. Со стороны сердечно-сосудистой системы: иногда - повышение или снижение АД, приливы жара и похолодание конечностей; редко - ИБС (стенокардия, инфаркт миокарда), выраженная гипотония, коллапс; крайне редко - тахикардия, сердцебиение, нарушение сердечного ритма. Со стороны респираторной системы: иногда - одышка, бронхоспазм; редко - интерстициальная пневмония (при комбинированной терапии с митомицином), острый респираторный дистресс-синдром. Со стороны системы пищеварения: очень часто - тошнота, рвота, стоматит, запор, диарея, преходящее повышение функциональных проб печени (АЛТ, АСТ); редко - панкреатит, повышение уровня билирубина, парез кишечника. Со стороны кожи и кожных придатков: часто - алопеция, редко - кожные высыпания. Местные нарушения: часто - боль/жжение или покраснение в месте инъекции, изменение окраски вены, флебит; при экстравазации - целлюлит, возможен некроз окружающих тканей. Прочие: часто - повышенная утомляемость, миалгия, артралгия, лихорадка, боли различной локализации, включая боль в грудной клетке, боль в нижней челюсти и в области опухолевых образований; редко - гипонатриемия; очень редко - геморрагический цистит и синдром неадекватной секреции антидиуретического гормона.
Передозировка
Основные ожидаемые проявления передозировки включают в себя подавление функции костного мозга и проявление нейротоксичности. Специфический антидот неизвестен. Лечение: госпитализация больного, проведение тщательного контроля за функциями жизненно важных органов. Симптоматическая терапия.
Особые указания
Лечение Навельбином следует проводить под наблюдением врача, имеющего опыт работы с противоопухолевыми препаратами. При выраженном нарушении функции печени дозы Навельбина следует снизить на 33%. При нарушении функции почек необходимо контролировать состояние пациента. При появлении признаков нейротоксичности 2 и более степени применение Навельбина следует прекратить. При появлении одышки, кашля или гипоксии невыясненной этиологии следует обследовать пациента для исключения легочной токсичности. При экстравазации инфузию препарата следует немедленно прекратить, оставшуюся дозу вводят в другую вену. В случае появления тошноты или рвоты после приема капсул Навельбина повторно ту же дозу принимать не следует. Во время и в течение, по крайней мере, трех месяцев после прекращения терапии, необходимо использовать надежные методы контрацепции. При попадании действующего вещества в ротовую полость рекомендуется прополоскать рот водой или любым солевым раствором. При попадании Навельбина в глаза их следует обильно и тщательно промыть водой. Т.к. в состав препарата входит сорбитол, Навельбин не следует использовать у пациентов с наследственной непереносимостью фруктозы. Контроль лабораторных показателейЛечение препаратом проводят под строгим гематологическим контролем, определяя число лейкоцитов, нейтрофилов, тромбоцитов и уровень гемоглобина перед каждой очередной инъекцией или приемом внутрь. При снижении числа нейтрофилов менее 1500/мкл и/или тромбоцитов менее 75 000/мкл (для в/в введения) или менее 100 000/мкл (для приема внутрь) применение очередной дозы препарата откладывают до нормализации показателей, одновременно осуществляют контроль состояния пациента.
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С осторожностью использовать при дыхательной недостаточности, угнетении костномозгового кроветворения (в т.ч. после предыдущей химиотерапии или лучевого лечения), запорах или явлениях кишечной непроходимости в анамнезе, нейропатии в анамнезе."}}]},{"id":5,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Противопоказано при беременности. На время лечения следует прекратить грудное вскармливание."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Навельбин применяется как в виде монотерапии, так и в комбинации с другими противоопухолевыми препаратами. При выборе дозы и режима введения в каждом индивидуальном случае следует обращаться к специальной литературе. Капсулы. Внутрь, целиком, не разжевывая и не рассасывая во рту, запивая водой. При монотерапии рекомендуемая доза составляет 60 мг/м2 1 раз в неделю. После третьего приема дозу увеличивают до 80 мг/м2 1 раз в неделю. Увеличение дозы с 60 до 80 мг/м2 может быть осуществлено, если на протяжении 3 нед приема Навельбина не отмечено нейтропении 4 степени (\u003c500 клеток/мкл), или был 1 эпизод нейтропении 3 степени (\u003c1000 – ≥500 клеток/мкл), и содержание нейтрофилов перед очередным приемом не ниже 1500 клеток/мкл. В случае, если перед приемом препарата в дозе 80 мг/м2 отмечена нейтропения 4 степени (\u003c500 клеток/мкл3) или 2 случая нейтропении 3 степени (\u003c1000 – ≥500 клеток/мкл), то в последующие 3 приема следует снизить дозу с 80 до 60 мг/м2 в неделю. В том случае, если содержание нейтрофилов не снижалось менее 500 клеток/мкл или не наблюдалось более 1 снижения содержания нейтрофилов в диапазоне 500–1000 клеток/мкл в течение 3 нед приема Навельбина в дозе 60 мг/м2 (согласно вышеприведенным рекомендациям), то можно снова увеличить дозу препарата с 60 до 80 мг/м2 в неделю. Для пациентов с BSA≥2 м2 общая разовая доза Навельбина, принимаемого внутрь, не должна превышать 120 мг в неделю при назначении препарата в дозе 60 мг/м2 и 160 мг в неделю при назначении препарата в дозе 80 мг/м2. Применение Навельбина внутрь в дозах 60 и 80 мг/м2 соответствует в/в введению препарата в дозах 25 и 30 мг/м2. При полихимиотерапии доза и частота приема препарата (как в/в, так и внутрь) зависят от конкретной программы противоопухолевой терапии. При снижении содержания нейтрофилов \u003c1500 клеток/мкл крови или тромбоцитопении \u003c75000 клеток/мкл крови (при в/в введении) или \u003c100000 (при приеме внутрь) очередное введение или прием препарата внутрь откладывают на 1 нед. Если из-за гематологической токсичности пришлось воздержаться от 3 еженедельных введений или приемов препарата, применение Навельбина рекомендуется прекратить. Коррекция режима дозирования Навельбина при печеночной недостаточности: у больных с выраженной печеночной недостаточностью Навельбин должен назначаться с осторожностью, в дозе, сниженной на 33%. Дети: безопасность и эффективность Навельбина у детей не изучена. Пожилые люди: какие-либо специальные инструкции по применению отсутствуют."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Со стороны органов кроветворения: очень часто - нейтропения, анемия, тромбоцитопения, присоединение вторичных инфекций на фоне угнетения костномозгового кроветворения; часто - лихорадка (\u003e38 °C) на фоне нейтропении; иногда - сепсис, септицемия; крайне редко - осложненная септицемия, в некоторых случаях приводящая к летальному исходу. Наименьшее число нейтрофилов наблюдается на 7–10 день от начала терапии, восстановление происходит в последующие 5–7 дней. Кумулирования гематотоксичности не отмечено. Со стороны иммунной системы: редко - анафилактический шок или ангионевротический отек. Со стороны нервной системы: очень часто - парестезии, гиперестезии, снижение или выпадение глубоких сухожильных рефлексов; часто - слабость в ногах; иногда - тяжелые парестезии с сенсорными и моторными симптомами, как правило, обратимого характера. Со стороны сердечно-сосудистой системы: иногда - повышение или снижение АД, приливы жара и похолодание конечностей; редко - ИБС (стенокардия, инфаркт миокарда), выраженная гипотония, коллапс; крайне редко - тахикардия, сердцебиение, нарушение сердечного ритма. Со стороны респираторной системы: иногда - одышка, бронхоспазм; редко - интерстициальная пневмония (при комбинированной терапии с митомицином), острый респираторный дистресс-синдром. Со стороны системы пищеварения: очень часто - тошнота, рвота, стоматит, запор, диарея, преходящее повышение функциональных проб печени (АЛТ, АСТ); редко - панкреатит, повышение уровня билирубина, парез кишечника. Со стороны кожи и кожных придатков: часто - алопеция, редко - кожные высыпания. 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При попадании действующего вещества в ротовую полость рекомендуется прополоскать рот водой или любым солевым раствором. При попадании Навельбина в глаза их следует обильно и тщательно промыть водой. Т.к. в состав препарата входит сорбитол, Навельбин не следует использовать у пациентов с наследственной непереносимостью фруктозы. Контроль лабораторных показателейЛечение препаратом проводят под строгим гематологическим контролем, определяя число лейкоцитов, нейтрофилов, тромбоцитов и уровень гемоглобина перед каждой очередной инъекцией или приемом внутрь. 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