Блокатор кальциевых каналов. Нимодипин обладает высокоселект... Инструкция
Показания к применению
профилактика и лечение ишемических неврологических расстройств, вызванных спазмом сосудов головного мозга на фоне субарахноидального кровоизлияния, вызванного разрывом аневризмы (применяется после предшествующего проведения в/в терапии раствором для инфузий) . - выраженные нарушения функций мозга у пациентов пожилого возраста (снижение памяти и концентрации внимания, эмоциональная неустойчивость).
Противопоказания
тяжелые нарушения функций печени (например, цирроз печени) . - одновременное назначение с рифампицином или противоэпилептическими препаратами (фенобарбитал, фенитоин, карбамазепин) . - беременность . - период лактации . - возраст до 18 лет . - повышенная чувствительность к любому из компонентов препарата. С осторожностью следует назначать при артериальной гипотензии (систолическое давление менее 100 мл рт.ст). У пациентов с нестабильной стенокардией или в течение первых 4 недель после острого инфаркта миокарда необходима оценка соотношения потенциального риска (снижение перфузии коронарных артерий и ишемия миокарда) и преимуществ (улучшение перфузии головного мозга). С осторожностью следует назначать препарат пожилым пациентам с сочетанной патологией с тяжелыми нарушениями функции почек (гломерулярная фильтрация менее 20 мл/мин). Пациенты пожилого возраста с тяжелой сердечной недостаточностью, получающие препарат для лечения нарушений функции мозга, нуждаются в регулярном обследовании.
Блокатор кальциевых каналов. Нимодипин обладает высокоселективным спазмолитическим действием в отношении сосудов головного мозга. Нимодипин предотвращает или устраняет сужение сосудов, спровоцированное различными вазоактивными веществами (например, серотонином, простагландинами). У пациентов с острыми нарушениями мозгового кровообращения нимодипин расширяет мозговые сосуды и способствует улучшению мозгового кровотока. Увеличение перфузии, как правило, более выражено в областях мозга, которые получали недостаточное кровоснабжение, чем в неповрежденных тканях. Нимодипин значительно снижает частоту ишемических повреждений головного мозга и уровень смертности у пациентов с субарахноидальным кровоизлиянием. Нимодипин, действуя на связанные с кальциевыми каналами рецепторы кровеносных сосудов головного мозга, оказывает защитное действие на нервные клетки, стабилизирует их функцию, улучшает кровоснабжение головного мозга, улучшает переносимость ишемии нервными клетками, при этом не развивается "синдром обкрадывания". Нимодипин оказывает благоприятное воздействие при расстройствах памяти и концентрации внимания у пациентов с нарушением мозговых функций. При этом улучшаются личностные, поведенческие реакции и результаты психометрических функциональных тестов.
Показания к применению
профилактика и лечение ишемических неврологических расстройств, вызванных спазмом сосудов головного мозга на фоне субарахноидального кровоизлияния, вызванного разрывом аневризмы (применяется после предшествующего проведения в/в терапии раствором для инфузий) . - выраженные нарушения функций мозга у пациентов пожилого возраста (снижение памяти и концентрации внимания, эмоциональная неустойчивость).
Противопоказания
тяжелые нарушения функций печени (например, цирроз печени) . - одновременное назначение с рифампицином или противоэпилептическими препаратами (фенобарбитал, фенитоин, карбамазепин) . - беременность . - период лактации . - возраст до 18 лет . - повышенная чувствительность к любому из компонентов препарата. С осторожностью следует назначать при артериальной гипотензии (систолическое давление менее 100 мл рт.ст). У пациентов с нестабильной стенокардией или в течение первых 4 недель после острого инфаркта миокарда необходима оценка соотношения потенциального риска (снижение перфузии коронарных артерий и ишемия миокарда) и преимуществ (улучшение перфузии головного мозга). С осторожностью следует назначать препарат пожилым пациентам с сочетанной патологией с тяжелыми нарушениями функции почек (гломерулярная фильтрация менее 20 мл/мин). Пациенты пожилого возраста с тяжелой сердечной недостаточностью, получающие препарат для лечения нарушений функции мозга, нуждаются в регулярном обследовании.
Применение при беременности и в период грудного вскармливания
Применение Нимотопа при беременности всегда требует тщательной оценки соотношения факторов пользы и риска с учетом тяжести клинической картины.
Способ применения и дозы
Таблетки следует проглатывать целиком, запивая небольшим количеством жидкости, независимо от приема пищи. Интервалы между приемами должны составлять не менее 4 ч. При субарахноидальном кровоизлиянии, вызванном разрывом аневризмы, прием таблеток следует начинать после 5-14 дней в/в терапии инфузионным раствором Нимотоп. Рекомендуемая доза - 2 таб. 6 раз/сут (60 мг нимодипина 6 раз/сут) в течение 7 дней. При нарушениях мозговых функций у пациентов пожилого возраста рекомендуемая доза - 1 таб. 3 раза/сут (30 мг нимодипина 3 раза/сут).
Побочное действие
В каждой группе нежелательные реакции представлены в порядке уменьшения их тяжести. Частота определена как очень часто (≥ . 1/10), часто (от ≥ . 1/100 до <1/10), нечасто (от ≥ . 1/1 000 до <1/100), редко (от ≥ . 1/10 000 до <1/1000), очень редко (<1/10 000). Ниже представлены нежелательные реакции, о которых сообщалось в связи с применением препарата при ишемических неврологических расстройствах. Со стороны сердечно-сосудистой системы: нечасто - тахикардия, снижение АД, вазодилатация . редко - брадикардия. Со стороны пищеварительной системы: нечасто - тошнота . редко - кишечная непроходимость. Со стороны гепатобилиарной системы: редко - транзиторное повышение уровня печеночных ферментов. Со стороны нервной системы: нечасто - головная боль. Со стороны системы кроветворения: нечасто - тромбоцитопения. Со стороны иммунной системы: нечасто - аллергические реакции, сыпь. Ниже представлены нежелательные реакции, о которых сообщалось в связи с применением препарата при выраженных нарушениях функции мозга у пациентов пожилого возраста. Со стороны сердечно-сосудистой системы: нечасто - снижение АД, вазодилатация . редко - ощущение сердцебиения, тахикардия, обморок, отеки. Со стороны пищеварительной системы: редко - запор, диарея, метеоризм. Со стороны нервной системы: редко - головная боль, вертиго, головокружение, гиперкинезия, тремор. Со стороны иммунной системы: редко - аллергические реакции, сыпь.
Особые указания
В каждой группе нежелательные реакции представлены в порядке уменьшения их тяжести. Частота определена как очень часто (≥ . 1/10), часто (от ≥ . 1/100 до <1/10), нечасто (от ≥ . 1/1 000 до <1/100), редко (от ≥ . 1/10 000 до <1/1000), очень редко (<1/10 000). Ниже представлены нежелательные реакции, о которых сообщалось в связи с применением препарата при ишемических неврологических расстройствах. Со стороны сердечно-сосудистой системы: нечасто - тахикардия, снижение АД, вазодилатация . редко - брадикардия. Со стороны пищеварительной системы: нечасто - тошнота . редко - кишечная непроходимость. Со стороны гепатобилиарной системы: редко - транзиторное повышение уровня печеночных ферментов. Со стороны нервной системы: нечасто - головная боль. Со стороны системы кроветворения: нечасто - тромбоцитопения. Со стороны иммунной системы: нечасто - аллергические реакции, сыпь. Ниже представлены нежелательные реакции, о которых сообщалось в связи с применением препарата при выраженных нарушениях функции мозга у пациентов пожилого возраста. Со стороны сердечно-сосудистой системы: нечасто - снижение АД, вазодилатация . редко - ощущение сердцебиения, тахикардия, обморок, отеки. Со стороны пищеварительной системы: редко - запор, диарея, метеоризм. Со стороны нервной системы: редко - головная боль, вертиго, головокружение, гиперкинезия, тремор. Со стороны иммунной системы: редко - аллергические реакции, сыпь.
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