Профилактика и лечение гипо- и авитаминоза витамина С.
В качестве вспомогательного средства: гемморагический диатез, носовые, маточные, легочные и другие кровотечения, в том числе вызванные лучевой болезнью, передозировка антикоагулянтов, заболевания желудочно-кишечного тракта, сопровождающиеся нарушением всасывания витамина С, травмы.
гиперчувствительность; детский возраст (до 3 лет). C осторожностью: сахарный диабет, дефицит глюкозо-6-фосфатдегидрогеназы; для применения в больших дозах - гемохроматоз, сидеробластная анемия, талассемия, гипероксалурия, нефроуролитиаз.
1 таблетка содержит аскорбиновая кислота 100 мг; декстроза 877 мг.
Описание
БАД. Не является лекарственным средством
Фармакотерапевтическая группа
витамин
Фармакологические свойства
Фармакодинамика
Аскорбиновая кислота (витамин C) не образуется в организме человека, а поступает только с пищей.
Фармакологические эффекты: в количествах, значительно превышающих суточную потребность (90 мг), почти не оказывает действия, за исключением быстрого устранения симптомов гипо- и авитаминоза (цинги).
Физиологические функции: является кофактором некоторых реакций гидроксилирования и амидирования — переносит электроны на ферменты, снабжая их восстановительным эквивалентом. Участвует в реакциях гидроксилирования пролиновых и лизиновых остатков проколлагена с образованием гидроксипролина и гидроксилизина (пострансляционная модификация коллагена), окислении боковых цепей лизина в белках с образованием гидрокситриметиллизина (в процессе синтеза картинита), окислении фолиевой кислоты до фолиновой, метаболизме лекарственных средств в микросомах печени и гидроксилировании дофамина с образованием норадреналина. Повышает активность амидирующих ферментов, участвующих в процессинге окситоцина, антидиуретического гормона и холицистокинина. Участвует в стероидогенезе в надпочечниках.
Восстанавливает ионы железа трехвалентного до ионов железа двухвалентного в кишечнике, способствуя его всасыванию. Основная роль в тканях — участие в синтезе коллагена, протеогликанов и других органических компонентов межклеточного вещества зубов, костей и эндотелия межклеточного капилляров. В низких дозах (150-250 мг/сут внутрь) улучшает комплексообразующую функцию дефероксамина при хронической интоксикации препаратами железа, что ведет к усилению экскреции последнего.
Фармакокинетика
Абсорбируется в желудочно-кишечном тракте (преимущественно в тощей кишке). С увеличением дозы до 200 мг всасывается до 140 мг (70%); при дальнейшем повышении дозы всасывание уменьшается (50-20%). Связь с белками плазмы — 25%. Заболевания желудочно-кишечного тракта (язвенная болезнь желудка и 12-перстной кишки, запор или диарея, глистная инвазия, лямблиоз), употребление свежих фруктовых и овощных соков, щелочного питья уменьшают всасывание аскорбиновой кислоты в кишечнике. Концентрация аскорбиновой кислоты в плазме в норме составляет приблизительно 10-20 мкг/мл, запасы в организме — около 1.5 г при приеме ежедневных рекомендуемых доз и 2.5 г при приеме 200 мг/сут. Время достижения максимальной концентрации (TCmax) после приема внутрь — 4 ч.
Легко проникает в лейкоциты, тромбоциты, а затем — во все ткани; наибольшая концентрация достигается в железистых органах, лейкоцитах, печени и хрусталике глаза; проникает через плаценту. Концентрация аскорбиновой кислоты в лейкоцитах и тромбоцитах выше, чем в эритроцитах и в плазме. При дефицитных состояниях концентрация в лейкоцитах снижается позднее и более медленно и рассматривается как лучший критерий оценки дефицита, чем концентрация в плазме.
Метаболизируется преимущественно в печени в дезоксиаскорбиновую и далее в щавелевоуксусную кислоту и аскорбат-2-сульфат.
Выводится почками, через кишечник, с потом, грудным молоком в неизмененном виде и в виде метаболитов.
При назначении высоких доз скорость выведения резко усиливается. Курение и употребление этанола ускоряют разрушение аскорбиновой кислоты (превращение в неактивные метаболиты), резко снижая запасы в организме.
Выводится при гемодиализе.
Показания к применению
Профилактика и лечение гипо- и авитаминоза витамина С.
В качестве вспомогательного средства: гемморагический диатез, носовые, маточные, легочные и другие кровотечения, в том числе вызванные лучевой болезнью, передозировка антикоагулянтов, заболевания желудочно-кишечного тракта, сопровождающиеся нарушением всасывания витамина С, травмы.
Состояния, сопровождающиеся повышенной потребностью в витамине С: повышенные физические и умственные нагрузки, период беременности и грудного вскармливания, период выздоровления после длительных заболеваний.
Противопоказания
гиперчувствительность; детский возраст (до 3 лет). C осторожностью: сахарный диабет, дефицит глюкозо-6-фосфатдегидрогеназы; для применения в больших дозах - гемохроматоз, сидеробластная анемия, талассемия, гипероксалурия, нефроуролитиаз.
Применение при беременности и в период грудного вскармливания
В связи со стимулирующим действием аскорбиновой кислоты на синтез кортикостероидных гормонов необходимо следить за функцией почек и АД. При длительном применении больших доз возможно угнетение функции инсулярного аппарата поджелудочной железы, поэтому в процессе лечения ее необходимо регулярно контролировать. У пациентов с повышенным содержанием железа в организме следует применять аскорбиновую кислоту в минимальных дозах. Назначение аскорбиновой кислоты пациентам с быстро пролиферирующими и интенсивно метастазирующими опухолями может усугубить течение процесса. Аскорбиновая кислота как восстановитель может искажать результаты различных лабораторных тестов (содержание в крови глюкозы, билирубина, активности печеночных трансаминаз и ЛДГ).
Способ применения и дозы
Аскорбиновую кислоту приниают внутрь. Дозы приведены в пересчете на аскорбиновую кислоту. Взрослым с профилактической целью - 50-100 мг/сут., детям - 25 мг/сут. Взрослым с лечебной целью - 50-100 3-5 раз/сут., детям - 50-100 мг 2-3 В период беременности и лактации - 300 мг/сут. в течение 15 дней, затем - по 100 мг сут.
Побочное действие
Со стороны центральной нервной системы (ЦНС): головная боль, чувство усталости, при длительном применении больших доз (более 1000 мг) — повышение возбудимости ЦНС, нарушение сна.
Со стороны пищеварительной системы: раздражение слизистой желудочно-кишечного тракта, при длительном применении больших доз — тошнота, рвота, диарея, гиперацидный гастрит, ульцерация слизистой оболочки желудочно-кишечного тракта.
Со стороны эндокринной системы: угнетение функции инсулярного аппарата поджелудочной железы (гипергликемия, глюкозурия).
Со стороны мочевыделительной системы: умеренная поллакиурия (при приеме дозы более 600 мг/сут), при длительном применении больших доз — гипероксалурия, образование мочевых камней из кальция оксалата, повреждение гломерулярного аппарата почек.
Со стороны сердечнососудистой системы: при длительном применении больших доз — снижение проницаемости капилляров (возможно ухудшение трофики тканей, повышение артериального давления, гиперкоагуляция, развитие микроангиопатий).
Аллергические реакции: кожная сыпь, анафилактический шок.
Прочие: гипервитаминоз, ощущение жара, при длительном применении больших доз — задержка натрия и жидкости, нарушение обмена цинка, меди.
При появлении любых побочных эффектов следует прекратить прием препарата и обратиться к врачу.
Передозировка
Аллергические реакции, раздражение слизистой оболочки ЖКТ (тошнота, рвота, диарея, спазм ЖКТ); угнетение функции инсулярного аппарата поджелудочной железы (гипергликемия, глюкозурия); при применении в высоких дозах - гипероксалурия и нефрокальциноз (оксалатный). Изменение лабораторных показателей: тромбоцитоз, гиперпротромбинемия, эритропения, нейтрофильный лейкоцитоз, гипокалиемия.
Взаимодействие с другими лекарственными средствами
Повышает концентрацию в крови бензилпенициллина и тетрациклинов; в дозе 1 г/сут повышает биодоступность этинилэстрадиола (в т.ч. входящего в состав пероральных контрацептивов). Улучшает всасывание в кишечнике препаратов железа (переводит трехвалентное железо в двухвалентное); может повышать экскрецию железа при одновременном применении с дефероксамином.
Ацетилсалициловая кислота (АСК), пероральные контрацептивы, свежие соки и щелочное питье снижают всасывание и усвоение. При одновременном применении с АСК повышается выведение с мочой аскорбиновой кислоты и снижается экскреция АСК. АСК снижает абсорбцию аскорбиновой кислоты примерно на 30 %. Увеличивает риск развития кристаллурии при лечении салицилатами и сульфаниламидами короткого действия, замедляет выведение почками кислот, увеличивает выведение лекарственных средств, имеющих щелочную реакцию (в т.ч. алкалоидов), снижает концентрацию в крови пероральных контрацептивов. Повышает общий клиренс этанола, который, в свою очередь, снижает концентрацию аскорбиновой кислоты в организме. Лекарственные средства хинолинового ряда (фторхинолоны и др.), кальция хлорид, салицилаты, глюкокортикостероиды при длительном применении истощают запасы аскорбиновой кислоты. При одновременном применении уменьшает хронотропное действие изопреналина. При длительном применении или применении в высоких дозах может нарушать взаимодействие дисульфирама и этанола. В высоких дозах повышает почечную экскрецию мексилетина.
Барбитураты и примидон повышают выведение аскорбиновой кислоты с мочой. Уменьшает терапевтическое действие антипсихотических лекарственных средств (производных фенотиазина), канальцевую реабсорбцию амфетамина и трициклических антидепрессантов.
Снижает эффективность гепарина и непрямых антикоагулянтов.
Особые указания
В связи со стимулирующим действием аскорбиновой кислоты на синтез глюкокортикостероидных гормонов, необходимо следить за функцией почек и артериальным давлением. При длительном применении больших доз возможно угнетение функции инсулярного аппарата поджелудочной железы, поэтому в процессе лечения ее необходимо регулярно контролировать. У пациентов с повышенным содержанием железа в организме следует применять аскорбиновую кислоту в минимальных дозах.
Назначение аскорбиновой кислоты пациентам с быстро пролиферирующими и интенсивно метастазирующими опухолями может усугубить течение процесса.
Аскорбиновая кислота, как восстановитель, может искажать результаты различных лабораторных тестов (содержание в крови и мочи глюкозы, билирубина, активности трансаминаз, ЛДГ).
Высокие дозы аскорбиновой кислоты усиливают экскрецию оксалатов, способствуя образованию камней в почках.
Влияние на способность к вождению автотранспорта и управлению механизмами
Аскорбиновая кислота не влияет на способность к вождению автотранспорта и выполнению работ, требующих повышенной скорости психомоторных реакций.
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Участвует в реакциях гидроксилирования пролиновых и лизиновых остатков проколлагена с образованием гидроксипролина и гидроксилизина (пострансляционная модификация коллагена), окислении боковых цепей лизина в белках с образованием гидрокситриметиллизина (в процессе синтеза картинита), окислении фолиевой кислоты до фолиновой, метаболизме лекарственных средств в микросомах печени и гидроксилировании дофамина с образованием норадреналина. Повышает активность амидирующих ферментов, участвующих в процессинге окситоцина, антидиуретического гормона и холицистокинина. Участвует в стероидогенезе в надпочечниках."}},{"type":"paragraph","data":{"text":"Восстанавливает ионы железа трехвалентного до ионов железа двухвалентного в кишечнике, способствуя его всасыванию. Основная роль в тканях — участие в синтезе коллагена, протеогликанов и других органических компонентов межклеточного вещества зубов, костей и эндотелия межклеточного капилляров. 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C осторожностью: сахарный диабет, дефицит глюкозо-6-фосфатдегидрогеназы; для применения в больших дозах - гемохроматоз, сидеробластная анемия, талассемия, гипероксалурия, нефроуролитиаз."}}]},{"id":4,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"В связи со стимулирующим действием аскорбиновой кислоты на синтез кортикостероидных гормонов необходимо следить за функцией почек и АД. При длительном применении больших доз возможно угнетение функции инсулярного аппарата поджелудочной железы, поэтому в процессе лечения ее необходимо регулярно контролировать. У пациентов с повышенным содержанием железа в организме следует применять аскорбиновую кислоту в минимальных дозах. Назначение аскорбиновой кислоты пациентам с быстро пролиферирующими и интенсивно метастазирующими опухолями может усугубить течение процесса. Аскорбиновая кислота как восстановитель может искажать результаты различных лабораторных тестов (содержание в крови глюкозы, билирубина, активности печеночных трансаминаз и ЛДГ)."}}]},{"id":5,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Аскорбиновую кислоту приниают внутрь. Дозы приведены в пересчете на аскорбиновую кислоту. Взрослым с профилактической целью - 50-100 мг/сут., детям - 25 мг/сут. Взрослым с лечебной целью - 50-100 3-5 раз/сут., детям - 50-100 мг 2-3 В период беременности и лактации - 300 мг/сут. в течение 15 дней, затем - по 100 мг сут."}}]},{"id":6,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Со стороны центральной нервной системы (ЦНС): головная боль, чувство усталости, при длительном применении больших доз (более 1000 мг) — повышение возбудимости ЦНС, нарушение сна."}},{"type":"paragraph","data":{"text":"Со стороны пищеварительной системы: раздражение слизистой желудочно-кишечного тракта, при длительном применении больших доз — тошнота, рвота, диарея, гиперацидный гастрит, ульцерация слизистой оболочки желудочно-кишечного тракта."}},{"type":"paragraph","data":{"text":"Со стороны эндокринной системы: угнетение функции инсулярного аппарата поджелудочной железы (гипергликемия, глюкозурия)."}},{"type":"paragraph","data":{"text":"Со стороны мочевыделительной системы: умеренная поллакиурия (при приеме дозы более 600 мг/сут), при длительном применении больших доз — гипероксалурия, образование мочевых камней из кальция оксалата, повреждение гломерулярного аппарата почек."}},{"type":"paragraph","data":{"text":"Со стороны сердечнососудистой системы: при длительном применении больших доз — снижение проницаемости капилляров (возможно ухудшение трофики тканей, повышение артериального давления, гиперкоагуляция, развитие микроангиопатий)."}},{"type":"paragraph","data":{"text":"Аллергические реакции: кожная сыпь, анафилактический шок."}},{"type":"paragraph","data":{"text":"Лабораторные показатели: тромбоцитоз, гиперпротромбинемия, эритропения, нейтрофильный лейкоцитоз, гипокалиемия, глюкозурия."}},{"type":"paragraph","data":{"text":"Прочие: гипервитаминоз, ощущение жара, при длительном применении больших доз — задержка натрия и жидкости, нарушение обмена цинка, меди."}},{"type":"paragraph","data":{"text":"При появлении любых побочных эффектов следует прекратить прием препарата и обратиться к врачу."}}]},{"id":7,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Аллергические реакции, раздражение слизистой оболочки ЖКТ (тошнота, рвота, диарея, спазм ЖКТ); угнетение функции инсулярного аппарата поджелудочной железы (гипергликемия, глюкозурия); при применении в высоких дозах - гипероксалурия и нефрокальциноз (оксалатный). Изменение лабораторных показателей: тромбоцитоз, гиперпротромбинемия, эритропения, нейтрофильный лейкоцитоз, гипокалиемия."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Повышает концентрацию в крови бензилпенициллина и тетрациклинов; в дозе 1 г/сут повышает биодоступность этинилэстрадиола (в т.ч. входящего в состав пероральных контрацептивов). Улучшает всасывание в кишечнике препаратов железа (переводит трехвалентное железо в двухвалентное); может повышать экскрецию железа при одновременном применении с дефероксамином."}},{"type":"paragraph","data":{"text":"Ацетилсалициловая кислота (АСК), пероральные контрацептивы, свежие соки и щелочное питье снижают всасывание и усвоение. При одновременном применении с АСК повышается выведение с мочой аскорбиновой кислоты и снижается экскреция АСК. АСК снижает абсорбцию аскорбиновой кислоты примерно на 30 %. Увеличивает риск развития кристаллурии при лечении салицилатами и сульфаниламидами короткого действия, замедляет выведение почками кислот, увеличивает выведение лекарственных средств, имеющих щелочную реакцию (в т.ч. алкалоидов), снижает концентрацию в крови пероральных контрацептивов. Повышает общий клиренс этанола, который, в свою очередь, снижает концентрацию аскорбиновой кислоты в организме. Лекарственные средства хинолинового ряда (фторхинолоны и др.), кальция хлорид, салицилаты, глюкокортикостероиды при длительном применении истощают запасы аскорбиновой кислоты. При одновременном применении уменьшает хронотропное действие изопреналина. При длительном применении или применении в высоких дозах может нарушать взаимодействие дисульфирама и этанола. В высоких дозах повышает почечную экскрецию мексилетина."}},{"type":"paragraph","data":{"text":"Барбитураты и примидон повышают выведение аскорбиновой кислоты с мочой. Уменьшает терапевтическое действие антипсихотических лекарственных средств (производных фенотиазина), канальцевую реабсорбцию амфетамина и трициклических антидепрессантов."}},{"type":"paragraph","data":{"text":"Снижает эффективность гепарина и непрямых антикоагулянтов."}}]},{"id":8,"name":"Особые указания","slug":"","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"\n\nВ связи со стимулирующим действием аскорбиновой кислоты на синтез глюкокортикостероидных гормонов, необходимо следить за функцией почек и артериальным давлением. При длительном применении больших доз возможно угнетение функции инсулярного аппарата поджелудочной железы, поэтому в процессе лечения ее необходимо регулярно контролировать. У пациентов с повышенным содержанием железа в организме следует применять аскорбиновую кислоту в минимальных дозах."}},{"type":"paragraph","data":{"text":"Назначение аскорбиновой кислоты пациентам с быстро пролиферирующими и интенсивно метастазирующими опухолями может усугубить течение процесса."}},{"type":"paragraph","data":{"text":"Аскорбиновая кислота, как восстановитель, может искажать результаты различных лабораторных тестов (содержание в крови и мочи глюкозы, билирубина, активности трансаминаз, ЛДГ)."}},{"type":"paragraph","data":{"text":"Высокие дозы аскорбиновой кислоты усиливают экскрецию оксалатов, способствуя образованию камней в почках."}},{"type":"paragraph","data":{"text":"Влияние на способность к вождению автотранспорта и управлению механизмами "}},{"type":"paragraph","data":{"text":"Аскорбиновая кислота не влияет на способность к вождению автотранспорта и выполнению работ, требующих повышенной скорости психомоторных реакций.\n\n"}}]},{"id":20,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"Без рецепта"}}]},{"id":21,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"\u003ca href=\"https://www.eapteka.ru/goods/manufacturer/kvadrat_s/\"\u003eКвадрат-С, Россия\u003c/a\u003e"}}]}],"source":{"title":"36.6","url":"https://366.ru"}},"description_toggle":false,"short_description":"Фармакодинамика Аскорбиновая кислота (витамин C) не образуется в организме человека, а поступает только с пищей. Фармакологические эффекты: в количествах, значительно превышающих суточную потребность (90 мг), почти не оказывает действия, за исключением быстрого устранения симптомов гипо- и авитаминоза (цинги). Физиологические функции: является кофактором некоторых реакций гидроксилирования и амидирования — переносит электроны на ферменты, снабжая их восстановительным эквивалентом. Участвует в реакциях гидроксилирования пролиновых и лизиновых остатков проколлагена с образованием гидроксипролина и гидроксилизина (пострансляционная модификация коллагена), окислении боковых цепей лизина в белках с образованием гидрокситриметиллизина (в процессе синтеза картинита), окислении фолиевой кислоты до фолиновой, метаболизме лекарственных средств в микросомах печени и гидроксилировании дофамина с образованием норадреналина. Повышает активность амидирующих ферментов, участвующих в процессинге окситоцина, антидиуретического гормона и холицистокинина. Участвует в стероидогенезе в надпочечниках. Восстанавливает ионы железа трехвалентного до ионов железа двухвалентного в кишечнике, способствуя его всасыванию. Основная роль в тканях — участие в синтезе коллагена, протеогликанов и других органических компонентов межклеточного вещества зубов, костей и эндотелия межклеточного капилляров. В низких дозах (150-250 мг/сут внутрь) улучшает комплексообразующую функцию дефероксамина при хронической интоксикации препаратами железа, что ведет к усилению экскреции последнего. Фармакокинетика Абсорбируется в желудочно-кишечном тракте (преимущественно в тощей кишке). С увеличением дозы до 200 мг всасывается до 140 мг (70%); при дальнейшем повышении дозы всасывание уменьшается (50-20%). Связь с белками плазмы — 25%. Заболевания желудочно-кишечного тракта (язвенная болезнь желудка и 12-перстной кишки, запор или диарея, глистная инвазия, лямблиоз), употребление свежих фруктовых и овощных соков, щелочного питья уменьшают всасывание аскорбиновой кислоты в кишечнике. Концентрация аскорбиновой кислоты в плазме в норме составляет приблизительно 10-20 мкг/мл, запасы в организме — около 1.5 г при приеме ежедневных рекомендуемых доз и 2.5 г при приеме 200 мг/сут. Время достижения максимальной концентрации (TCmax) после приема внутрь — 4 ч. Легко проникает в лейкоциты, тромбоциты, а затем — во все ткани; наибольшая концентрация достигается в железистых органах, лейкоцитах, печени и хрусталике глаза; проникает через плаценту. Концентрация аскорбиновой кислоты в лейкоцитах и тромбоцитах выше, чем в эритроцитах и в плазме. При дефицитных состояниях концентрация в лейкоцитах снижается позднее и более медленно и рассматривается как лучший критерий оценки дефицита, чем концентрация в плазме. Метаболизируется преимущественно в печени в дезоксиаскорбиновую и далее в щавелевоуксусную кислоту и аскорбат-2-сульфат. Выводится почками, через кишечник, с потом, грудным молоком в неизмененном виде и в виде метаболитов. При назначении высоких доз скорость выведения резко усиливается. Курение и употребление этанола ускоряют разрушение аскорбиновой кислоты (превращение в неактивные метаболиты), резко снижая запасы в организме. 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