Выраженная артериальная гипотензия (систолическое АД ниже 90 мм рт. ст., диастолическое АД - ниже 60 мм рт.ст.)
Кардиогенный шок, если невозможна коррекция конечного диастолического давления левого желудочка с помощью внутриаортальной контрпульсации или препаратов с положительным инотропным действием
Периферический вазодилататор с преимущественным влиянием на венозные сосуды. Стимулирует образование оксида азота (эндотелиального релаксирующего фактора) в эндотелии сосудов, вызывающего активацию внутриклеточной гуанилатциклазы, следствием чего является увеличение цГМФ (медиатор вазодилатации). Уменьшает потребность миокарда в кислороде за счет снижения преднагрузки (уменьшает КДО левого желудочка и снижает систолическое напряжение его стенок). Обладает коронарорасширяющим действием. Снижает приток крови к правому предсердию, способствует снижению давления в малом круге кровообращения и регрессии симптомов при отеке легких. Способствует перераспределению коронарного кровотока в области со сниженным кровообращением. Повышает толерантность к физической нагрузке у больных с ишемической болезнью сердца, стенокардией. Расширяет сосуды головного мозга, твердой мозговой оболочки, что может сопровождаться головной болью. Как и к другим нитратам, развивается перекрестная толерантность. После отмены (перерыва в лечении) чувствительность к нему быстро восстанавливается. После распыления на слизистую оболочку полости рта эффект проявляется через 30 сек и продолжается 15 - 120 мин.
Показания к применению
Купирование приступов стенокардии
Профилактика приступов стенокардии
Острый инфаркт миокарда (в том числе осложненный острой левожелудочковой недостаточностью)
Состояние после перенесенного инфаркта миокарда
Противопоказания
Повышенная чувствительность к нитратным соединениям или другим компонентам препарата
Выраженная артериальная гипотензия (систолическое АД ниже 90 мм рт. ст., диастолическое АД - ниже 60 мм рт.ст.)
Кардиогенный шок, если невозможна коррекция конечного диастолического давления левого желудочка с помощью внутриаортальной контрпульсации или препаратов с положительным инотропным действием
Дефицит глюкозо-6-фосфатдегидрогеназы
Закрытоугольная форма глаукомы
Гипертиреоз
Пациенты до 18 лет (эффективность и безопасность не установлены). Нельзя одновременно применять Изокет спрей и ингибиторы фосфодиэстеразы, так как в этом случае возможно усиление гипотензивного эффекта препарата. Особенно тщательное врачебное наблюдение необходимо при остром инфаркте миокарда со сниженным давлением наполнения желудочков. С осторожностью: гипертрофическая обструктивная кардиомиопатия, констриктивный перикардит и тампонада сердца; аортальный и/или митральный стеноз; склонности к ортостатическим реакциям (резкое снижение АД при изменении положения тела); заболевания, которые сопровождаются повышением внутричерепного давления (в том числе, геморрагический инсульт, черепно-мозговая травма); пожилой возраст; тяжелая почечная недостаточности, печеночная недостаточность (риск развития метгемоглобинемии)
Применение при беременности и в период грудного вскармливания
Применение препарата при беременности и в период грудного вскармливания возможно только в том случае, когда предполагаемая польза для матери превосходит потенциальный риск для плода.
Способ применения и дозы
Изокет спрей используется для разбрызгивания на слизистую полости рта. Раствор не следует вдыхать. Поднести спрей вплотную ко рту и, нажав на распылитель, впрыснуть раствор в полость рта: сделайте глубокий вдох; задержите дыхание; впрысните раствор в рот (при этом может появиться легкое жжение языка); закройте рот и около 30 сек дышите через нос. Пользуйтесь приведенной выше информацией в том случае, если Ваш врач не дал Вам других рекомендаций. Пожалуйста, придерживайтесь описанных условий применения, так как в противном случае Изокет спрей может не оказать желаемого действия. Для купирования приступа стенокардии или перед физической или эмоциональной нагрузкой, которая может вызвать приступ, нужно впрыснуть спрей в рот 1-3 раза с интервалом в 30 сек между впрыскиваниями на фоне задержки дыхания. Разовую дозу из 3 впрыскиваний для купирования приступа можно увеличивать только по настоятельной рекомендации врача. При остром инфаркте миокарда и острой сердечной недостаточности начинают с 1-3 впрыскиваний под строгим контролем АД и ЧСС. При отсутствии эффекта в течение 5 мин можно повторить впрыскивание под контролем врача. Если улучшение не наступает в течение 10 мин, контролируя АД, можно повторить применение Изокета спрея. При каждом нажатии на распылитель равное количество раствора разбрызгивается в виде мельчайших капелек. Он легко проникает сквозь слизистую оболочку рта и в считанные секунды попадает в кровоток. Изокет спрей не содержит фреона, безвреден для окружающей среды. Еще одним преимуществом является прозрачность флакончика, позволяющая вовремя заметить необходимость замены.
Побочное действие
При первом применении или при увеличении дозы возможно снижение АД, ортостатическая гипотензия, что может сопровождаться рефлекторным повышением ЧСС, заторможенностью, а также головокружением и чувством слабости. В начале лечения также могут появляться головные боли (нитратные головные боли), которые, как правило, исчезают при дальнейшем применении препарата, возможно появление ощущения легкого жжения языка, сухость во рту. Редко могут появляться тошнота, рвота, а также покраснение кожи лица, ощущение жара и аллергические кожные реакции. В редких случаях при сильном снижении АД может наблюдаться усиление симптомов стенокардии («парадоксальное» усиление приступов стенокардии) и коллапс. Крайне редко наблюдаются коллаптоидные состояния, иногда с брадикардией (замедление ЧСС) и синкопэ (приступы с нарушением сознания, головокружением, связанные с расстройством мозгового кровообращения в результате нарушений ритма сердца, прежде всего обусловленные значительным урежением ритма сердца). В отдельных случаях может возникнуть эксфолиативный дерматит (кожное воспалительное заболевание), развитие толерантности (в том числе перекрестной к другим нитратам). Со стороны нервной системы: скованность, сонливость, нечеткость зрения, снижение способности к быстрым психическим и двигательным реакциям (особенно в начале лечения). В редких случаях - ишемия мозга.
Передозировка
Симптомы: коллапс, обморок, головная боль, головокружение, сердцебиение, зрительные расстройства, гипертермия, судороги, гиперемия кожи, повышенная потливость, тошнота, рвота, диарея, метгемоглобинемия (цианоз, диспноэ), брадикардия, повышение внутричерепного давления, паралич, кома. Лечение: при метгемоглобинемии – в/в введение 1% метиленового синего, 1-2 мг/кг. Симптоматическая терапия: при тяжелой артериальной гипотензии – в/в фенилэфрин (мезатон), эпинефрин (адреналин) и родственные ему соединения противопоказаны.
Особые указания
При первом применении и в том случае, когда после последнего использования Изокета спрея прошло больше сут, следует при первом нажатии на распылитель направить брызги в воздух, поскольку они могут не содержать полную дозу. Для гарантии безупречного действия необходимо непрерывно и до конца нажать на распылитель и снова отпустить. При применении флакончик спрея нужно держать вертикально распылителем вверх. Избегайте попадания раствора в глаза. В период терапии необходим контроль АД и ЧСС. Избегать резкой отмены препарата. Частое назначение и высокие дозы могут вызывать развитие толерантности, в этом случае рекомендуется отмена на 24-48 ч, или после 3-6 недель регулярного приема делать перерыв на 3-5 дней, заменив на это время Изокет спрей другими антиангинальными средствами. Раствор содержит около 85% алкоголя. В период лечения Изокетом следует исключить употребление этанола. Избегать резкой отмены препарата, дозу снижать постепенно. Влияние на способность к вождению автотранспорта и управлению механизмамиОсобенности индивидуальной реакции на препарат могут привести к нарушению способности управлять автотранспортными средствами или другими механизмами. Этот эффект в значительной мере усиливается в начале лечения, при увеличении дозы и смене препарата, а также при сочетании с приемом алкоголя. Пожалуйста, храните спрей при комнатной температуре и проверяйте время от времени работу распылителя. Это особенно необходимо при длительном перерыве в его использовании. На этикетке флакончика спрея, внизу, нанесена стрелка. Когда уровень жидкости во флакончике достигает верхнего края стрелки, необходимо приобрести следующий флакончик спрея. Дальнейшее использование такого флакончика тоже возможно, до тех пор, пока при легком наклоне кончик засасывающей трубки еще погружен в жидкость.
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Вспомогательные вещества: макрогол 400, этанол 100%."}}]},{"id":2,"name":"Фармакологические свойства","slug":"pharmacologic_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Периферический вазодилататор с преимущественным влиянием на венозные сосуды. Стимулирует образование оксида азота (эндотелиального релаксирующего фактора) в эндотелии сосудов, вызывающего активацию внутриклеточной гуанилатциклазы, следствием чего является увеличение цГМФ (медиатор вазодилатации). Уменьшает потребность миокарда в кислороде за счет снижения преднагрузки (уменьшает КДО левого желудочка и снижает систолическое напряжение его стенок). Обладает коронарорасширяющим действием. Снижает приток крови к правому предсердию, способствует снижению давления в малом круге кровообращения и регрессии симптомов при отеке легких. Способствует перераспределению коронарного кровотока в области со сниженным кровообращением. Повышает толерантность к физической нагрузке у больных с ишемической болезнью сердца, стенокардией. Расширяет сосуды головного мозга, твердой мозговой оболочки, что может сопровождаться головной болью. Как и к другим нитратам, развивается перекрестная толерантность. После отмены (перерыва в лечении) чувствительность к нему быстро восстанавливается. После распыления на слизистую оболочку полости рта эффект проявляется через 30 сек и продолжается 15 - 120 мин."}}]},{"id":3,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"list","data":{"style":"unordered","items":["Купирование приступов стенокардии","Профилактика приступов стенокардии","Острый инфаркт миокарда (в том числе осложненный острой левожелудочковой недостаточностью)","Состояние после перенесенного инфаркта миокарда"]}}]},{"id":4,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"list","data":{"style":"unordered","items":["Повышенная чувствительность к нитратным соединениям или другим компонентам препарата","Острая сосудистая недостаточность (сосудистый коллапс)","Выраженная артериальная гипотензия (систолическое АД ниже 90 мм рт. ст., диастолическое АД - ниже 60 мм рт.ст.)","Кардиогенный шок, если невозможна коррекция конечного диастолического давления левого желудочка с помощью внутриаортальной контрпульсации или препаратов с положительным инотропным действием","Дефицит глюкозо-6-фосфатдегидрогеназы","Закрытоугольная форма глаукомы","Гипертиреоз","Пациенты до 18 лет (эффективность и безопасность не установлены). Нельзя одновременно применять Изокет спрей и ингибиторы фосфодиэстеразы, так как в этом случае возможно усиление гипотензивного эффекта препарата. Особенно тщательное врачебное наблюдение необходимо при остром инфаркте миокарда со сниженным давлением наполнения желудочков. С осторожностью: гипертрофическая обструктивная кардиомиопатия, констриктивный перикардит и тампонада сердца; аортальный и/или митральный стеноз; склонности к ортостатическим реакциям (резкое снижение АД при изменении положения тела); заболевания, которые сопровождаются повышением внутричерепного давления (в том числе, геморрагический инсульт, черепно-мозговая травма); пожилой возраст; тяжелая почечная недостаточности, печеночная недостаточность (риск развития метгемоглобинемии)"]}}]},{"id":5,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Применение препарата при беременности и в период грудного вскармливания возможно только в том случае, когда предполагаемая польза для матери превосходит потенциальный риск для плода."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Изокет спрей используется для разбрызгивания на слизистую полости рта. Раствор не следует вдыхать. Поднести спрей вплотную ко рту и, нажав на распылитель, впрыснуть раствор в полость рта: сделайте глубокий вдох; задержите дыхание; впрысните раствор в рот (при этом может появиться легкое жжение языка); закройте рот и около 30 сек дышите через нос. Пользуйтесь приведенной выше информацией в том случае, если Ваш врач не дал Вам других рекомендаций. Пожалуйста, придерживайтесь описанных условий применения, так как в противном случае Изокет спрей может не оказать желаемого действия. Для купирования приступа стенокардии или перед физической или эмоциональной нагрузкой, которая может вызвать приступ, нужно впрыснуть спрей в рот 1-3 раза с интервалом в 30 сек между впрыскиваниями на фоне задержки дыхания. Разовую дозу из 3 впрыскиваний для купирования приступа можно увеличивать только по настоятельной рекомендации врача. При остром инфаркте миокарда и острой сердечной недостаточности начинают с 1-3 впрыскиваний под строгим контролем АД и ЧСС. При отсутствии эффекта в течение 5 мин можно повторить впрыскивание под контролем врача. Если улучшение не наступает в течение 10 мин, контролируя АД, можно повторить применение Изокета спрея. При каждом нажатии на распылитель равное количество раствора разбрызгивается в виде мельчайших капелек. Он легко проникает сквозь слизистую оболочку рта и в считанные секунды попадает в кровоток. Изокет спрей не содержит фреона, безвреден для окружающей среды. Еще одним преимуществом является прозрачность флакончика, позволяющая вовремя заметить необходимость замены."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"При первом применении или при увеличении дозы возможно снижение АД, ортостатическая гипотензия, что может сопровождаться рефлекторным повышением ЧСС, заторможенностью, а также головокружением и чувством слабости. В начале лечения также могут появляться головные боли (нитратные головные боли), которые, как правило, исчезают при дальнейшем применении препарата, возможно появление ощущения легкого жжения языка, сухость во рту. Редко могут появляться тошнота, рвота, а также покраснение кожи лица, ощущение жара и аллергические кожные реакции. В редких случаях при сильном снижении АД может наблюдаться усиление симптомов стенокардии («парадоксальное» усиление приступов стенокардии) и коллапс. Крайне редко наблюдаются коллаптоидные состояния, иногда с брадикардией (замедление ЧСС) и синкопэ (приступы с нарушением сознания, головокружением, связанные с расстройством мозгового кровообращения в результате нарушений ритма сердца, прежде всего обусловленные значительным урежением ритма сердца). В отдельных случаях может возникнуть эксфолиативный дерматит (кожное воспалительное заболевание), развитие толерантности (в том числе перекрестной к другим нитратам). Со стороны нервной системы: скованность, сонливость, нечеткость зрения, снижение способности к быстрым психическим и двигательным реакциям (особенно в начале лечения). В редких случаях - ишемия мозга."}}]},{"id":8,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Симптомы: коллапс, обморок, головная боль, головокружение, сердцебиение, зрительные расстройства, гипертермия, судороги, гиперемия кожи, повышенная потливость, тошнота, рвота, диарея, метгемоглобинемия (цианоз, диспноэ), брадикардия, повышение внутричерепного давления, паралич, кома. Лечение: при метгемоглобинемии – в/в введение 1% метиленового синего, 1-2 мг/кг. Симптоматическая терапия: при тяжелой артериальной гипотензии – в/в фенилэфрин (мезатон), эпинефрин (адреналин) и родственные ему соединения противопоказаны."}}]},{"id":9,"name":"Особые указания","slug":"cautions","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"При первом применении и в том случае, когда после последнего использования Изокета спрея прошло больше сут, следует при первом нажатии на распылитель направить брызги в воздух, поскольку они могут не содержать полную дозу. Для гарантии безупречного действия необходимо непрерывно и до конца нажать на распылитель и снова отпустить. При применении флакончик спрея нужно держать вертикально распылителем вверх. Избегайте попадания раствора в глаза. В период терапии необходим контроль АД и ЧСС. Избегать резкой отмены препарата. Частое назначение и высокие дозы могут вызывать развитие толерантности, в этом случае рекомендуется отмена на 24-48 ч, или после 3-6 недель регулярного приема делать перерыв на 3-5 дней, заменив на это время Изокет спрей другими антиангинальными средствами. Раствор содержит около 85% алкоголя. В период лечения Изокетом следует исключить употребление этанола. Избегать резкой отмены препарата, дозу снижать постепенно. Влияние на способность к вождению автотранспорта и управлению механизмамиОсобенности индивидуальной реакции на препарат могут привести к нарушению способности управлять автотранспортными средствами или другими механизмами. Этот эффект в значительной мере усиливается в начале лечения, при увеличении дозы и смене препарата, а также при сочетании с приемом алкоголя. Пожалуйста, храните спрей при комнатной температуре и проверяйте время от времени работу распылителя. Это особенно необходимо при длительном перерыве в его использовании. 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