Ранитидин блокирует гистаминовые Н2-рецепторы париетальных клеток слизистой оболочки желудка, снижает базальную и стимулированную секрецию соляной кислоты, вызванную раздражением барорецепторов, пищевой нагрузкой, действием гормонов и биогенных стимуляторов (гастрин, гистамин, пентагастрин). Ранитидин уменьшает объем желудочного сока и содержание соляной кислоты в нем, повышает рН содержимого желудка, что приводит к снижению активности пепсина. После перорального приема в терапевтических дозах не влияет на уровень пролактина. Ингибирует микросомальные ферменты.
Продолжительность действия после однократного приема до 12 ч.
Показания к применению
Лечение и профилактика— язвенная болезнь желудка и двенадцатиперстной кишки, НПВС-гастропатия, изжога (связанная с гиперхлоргидрией), гиперсекреция желудочного сока, симптоматические язвы ЖКТ, эрозивный эзофагит, рефлюкс-эзофагит, синдром Золлингера-Эллисона, системный мастоцитоз, полиэндокринный аденоматоз; хроническая диспепсия, характеризующаяся эпигастральными или загрудинными болями, связанными с приемом пищи или нарушающими сон; лечение кровотечения из верхних отделов ЖКТ, профилактика рецидивов желудочных кровотечений в послеоперационном периоде, профилактика аспирации желудочного сока у пациентов, которым проводятся операции под общей анестезией (синдрома Мендельсона), аспирационный пневмонит (профилактика).
Противопоказания
беременность;
лактация;
детский возраст до 12 лет;
повышенная чувствительность к ранитидину или другим компонентам препарата.
С осторожностью - почечная и/или печеночная недостаточность, цирроз печени с портосистемной энцефалопатией в анамнезе, острая порфирия (в т.ч. в анамнезе).
Применение при беременности и в период грудного вскармливания
В опытах у крыс и кроликов, получавших ранитидин в дозах, до 160 раз превышающих дозу для человека, неблагоприятного действия на плод не выявлено.Ранитидин проходит через плаценту. Применение при беременности возможно только в случае, если ожидаемый эффект терапии превышает потенциальный риск для плода (адекватных и строго контролируемых исследований безопасности применения у беременных женщин не проведено).Категория действия на плод по FDA— B.Ранитидин проникает в грудное молоко и, возможно, создает там более высокие концентрации, чем в плазме крови. Не рекомендуется принимать в период кормления грудью. При необходимости назначения следует решить вопрос о прекращении грудного вскармливания.
Способ применения и дозы
Ранитидин принимают независимо от приема пищи, не разжевывая, запивая небольшим количеством жидкости.
Взрослые и дети старше 12 лет:
Язвенная болезнь желудка и 12-перстной кишки. Для лечения обострений назначают по 150 мг 2 раза/сут (утром и вечером) или 300 мг на ночь. При необходимости - по 300 мг 2 раза/сут. Продолжительность курса лечения - 4-8 недель. Для профилактики обострений назначают по 150 мг на ночь, для курящих пациентов - 300 мг на ночь.
Язвы, связанные с приемом НПВП. Назначают по 150 мг 2 раза/сут или 300 мг на ночь в течение 8-12 недель. Профилактика образования язв при приеме НПВП - по 150 мг 2 раза/сут.
Послеоперационные и "стрессовые" язвы. Назначают по 150 мг 2 раза/сут в течение 4-8 недель.
Эрозивный рефлюкс-эзофагит. Назначают по 150 мг 2 раза/сут или 300 мг на ночь. При необходимости доза может быть увеличена до 150 мг 4 раза/сут. Курс лечения 8-12 недель. Длительная профилактическая терапия - 150 мг 2 раза/сут.
Синдром Золлингера-Эллисона. Начальная доза составляет 150 мг 3 раза/сут, при необходимости доза может быть увеличена.
Профилактика рецидивирующих кровотечений. По 150 мг 2 раза/сут.
Профилактика развития синдрома Мендельсона. Назначают в дозе 150 мг за 2 ч до наркоза, а также желательно 150 мг накануне вечером.
При наличии сопутствующего нарушения функции печени может потребоваться снижение дозы.
Больным с почечной недостаточностью при КК менее 50 мл/мин рекомендуемая доза составляет 150 мг/сут.
Побочное действие
Со стороны нервной системы и органов чувств: головная боль, чувство усталости, головокружение, сонливость, инсомния, вертиго, тревога, депрессия; редко— спутанность сознания, галлюцинации (особенно у пожилых и ослабленных пациентов), обратимая нечеткость зрения, нарушение аккомодации глаза.Со стороны сердечно-сосудистой системы и крови (кроветворение, гемостаз): аритмия, тахикардия/брадикардия, AV-блокада, снижение АД; обратимые лейкопения, тромбоцитопения, гранулоцитопения; редко— агранулоцитоз, панцитопения, иногда с гипоплазией костного мозга, апластическая анемия; иногда— иммунная гемолитическая анемия.Со стороны органов ЖКТ: тошнота, рвота, запор/диарея, абдоминальный дискомфорт/боль; редко— панкреатит. Иногда— гепатоцеллюлярный, холестатический или смешанный гепатит с/без желтухи (в таких случаях прием ранитидина необходимо немедленно прекратить). Эти эффекты обычно обратимы, но в редких случаях возможен летальный исход. Также отмечались редкие случаи развития печеночной недостаточности. У здоровых добровольцев концентрация АСТ была повышена, по крайней мере, в 2 раза по отношению к уровню до лечения у 6 из 12 человек, получавших 100 мг 4 раза в/в в течение 7 дней, и у 4 из 24 людей, получавших 50 мг 4 раза в/в в течение 5 дней.Со стороны опорно-двигательного аппарата: редко— артралгия, миалгия.Аллергические реакции: кожная сыпь, бронхоспазм, лихорадка, эозинофилия; редко— многоформная эритема, анафилактический шок, ангионевротический отек.Прочие: редко— алопеция, васкулит; в отдельных случаях— гинекомастия, снижение потенции и/или либидо. При длительном применении возможно развитие В12-дефицитной анемии.
Лечение: симптоматическое. При развитии судорог - диазепам в/в, при брадикардии или желудочковых аритмиях - атропин, лидокаин. Гемодиализ - эффективен.
Взаимодействие с другими лекарственными средствами
Курение снижает эффективность ранитидина.
Увеличивает концентрацию метопролола в сыворотке крови (соответственно на 80% и 50%), при этом период полувыведения метопролола увеличивается с 4.4 до 6.5 ч.
Вследствие повышения рН содержимого желудка при одновременном приеме может уменьшиться всасывание итраконазола и кетоконазола.
При одновременном применении с антацидами, сукральфатом в высоких дозах возможно замедление абсорбции ранитидина, поэтому перерыв между приемом этих препаратов должен быть не менее 2 ч.
Особые указания
Лечение ранитидином может маскировать симптомы, связанные с карциномой желудка, поэтому перед началом лечения необходимо исключить наличие рака-язвы.
Ранитидин, как и все Н2-гистаминоблокаторы, нежелательно резко отменять (синдром "рикошета").
При длительном лечении ослабленных больных в условиях стресса возможны бактериальные поражения желудка с последующим распространением инфекции.
Имеются сведения о том, что ранитидин может вызвать острые приступы порфирии.
Блокаторы Н2-гистаминовых рецепторов следует принимать через 2 часа после приема итраконазола или кетоконазола во избежание значительного уменьшения их всасывания.
Может повышать активность глутаматтранспептидазы.
Может быть причиной ложноположительной реакции на проведение пробы на белок в моче.
Блокаторы Н2-гистаминовых рецепторов могут противодействовать влиянию пентагастрина и гистамина на кислоторбразующую функцию желудка, поэтому в течение 24 ч, предшествующему тесту, применять блокаторы Н2- гистаминорецепторов не рекомендуется.
Блокаторы Н2-гистаминовых рецепторов могут подавлять кожную реакцию на гистамин, приводя таким образом к ложноположительным результатам (перед проведением диагностических кожкых проб для выявления аллергической кожной реакции немедленного типа использование блокаторов Н2-гистаминовых рецепторов рекомендуется прекратить).
Во время лечения следует избегать употребления продуктов питания, напитков и других лекарственных средств, которые могут вызвать раздражение слизистой оболочки желудка.
Использование в педиатрии
Безопасность и эффективность ранитидина у детей младше 12 лет не установлены.
Влияние на способность к управлению транспортными средствами и механизмами
В период лечения необходимо воздерживаться от занятий потенциально опасными видами деятельности, требующими повышенной концентрации внимания и быстроты психомоторных реакций.
Форма выпуска
Таблетки.
Условия хранения
В сухом, защищенном от света месте, при температуре не выше 25°C. Хранить в недоступном для детей месте.
Срок годности
3 года. Не применять по истечении срока годности, указанного на упаковке.
Условия отпуска
По рецепту.
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Противоязвенный препарат\u003c/a\u003e."}}]},{"name":"Фармакологические свойства","slug":"pharmacologic_effects","id":13,"body":[{"type":"paragraph","data":{"text":"Ранитидин блокирует гистаминовые Н\u003csub\u003e2\u003c/sub\u003e-рецепторы париетальных клеток слизистой оболочки желудка, снижает базальную и стимулированную секрецию соляной кислоты, вызванную раздражением барорецепторов, пищевой нагрузкой, действием гормонов и биогенных стимуляторов (гастрин, гистамин, пентагастрин). Ранитидин уменьшает объем желудочного сока и содержание соляной кислоты в нем, повышает рН содержимого желудка, что приводит к снижению активности пепсина. После перорального приема в терапевтических дозах не влияет на уровень пролактина. Ингибирует микросомальные ферменты."}},{"type":"paragraph","data":{"text":"Продолжительность действия после однократного приема до 12 ч."}}]},{"id":1,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Лечение и профилактика— язвенная болезнь желудка и двенадцатиперстной кишки, НПВС-гастропатия, изжога (связанная с гиперхлоргидрией), гиперсекреция желудочного сока, симптоматические язвы ЖКТ, эрозивный эзофагит, рефлюкс-эзофагит, синдром Золлингера-Эллисона, системный мастоцитоз, полиэндокринный аденоматоз; хроническая диспепсия, характеризующаяся эпигастральными или загрудинными болями, связанными с приемом пищи или нарушающими сон; лечение кровотечения из верхних отделов ЖКТ, профилактика рецидивов желудочных кровотечений в послеоперационном периоде, профилактика аспирации желудочного сока у пациентов, которым проводятся операции под общей анестезией (синдрома Мендельсона), аспирационный пневмонит (профилактика)."}}]},{"id":2,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"list","data":{"style":"ordered","items":["беременность;","лактация;","детский возраст до 12 лет;","повышенная чувствительность к ранитидину или другим компонентам препарата."]}},{"type":"paragraph","data":{"text":"\u003ci\u003eС осторожностью\u003c/i\u003e - почечная и/или печеночная недостаточность, цирроз печени с портосистемной энцефалопатией в анамнезе, острая порфирия (в т.ч. в анамнезе)."}}]},{"id":3,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"В опытах у крыс и кроликов, получавших ранитидин в дозах, до 160 раз превышающих дозу для человека, неблагоприятного действия на плод не выявлено.Ранитидин проходит через плаценту. Применение при беременности возможно только в случае, если ожидаемый эффект терапии превышает потенциальный риск для плода (адекватных и строго контролируемых исследований безопасности применения у беременных женщин не проведено).Категория действия на плод по FDA— B.Ранитидин проникает в грудное молоко и, возможно, создает там более высокие концентрации, чем в плазме крови. Не рекомендуется принимать в период кормления грудью. При необходимости назначения следует решить вопрос о прекращении грудного вскармливания."}}]},{"name":"Способ применения и дозы","slug":"dosage","id":15,"body":[{"type":"paragraph","data":{"text":"Ранитидин принимают независимо от приема пищи, не разжевывая, запивая небольшим количеством жидкости."}},{"type":"paragraph","data":{"text":"\u003cb\u003eВзрослые и дети старше 12 лет:\u003c/b\u003e"}},{"type":"paragraph","data":{"text":"\u003ci\u003eЯзвенная болезнь желудка и 12-перстной кишки. \u003c/i\u003eДля лечения обострений назначают по 150 мг 2 раза/сут (утром и вечером) или 300 мг на ночь. При необходимости - по 300 мг 2 раза/сут. Продолжительность курса лечения - 4-8 недель. Для профилактики обострений назначают по 150 мг на ночь, для курящих пациентов - 300 мг на ночь."}},{"type":"paragraph","data":{"text":"\u003ci\u003eЯзвы, связанные с приемом НПВП. \u003c/i\u003eНазначают по 150 мг 2 раза/сут или 300 мг на ночь в течение 8-12 недель. Профилактика образования язв при приеме НПВП - по 150 мг 2 раза/сут."}},{"type":"paragraph","data":{"text":"\u003ci\u003eПослеоперационные и \"стрессовые\" язвы. \u003c/i\u003eНазначают по 150 мг 2 раза/сут в течение 4-8 недель."}},{"type":"paragraph","data":{"text":"\u003ci\u003eЭрозивный рефлюкс-эзофагит. \u003c/i\u003eНазначают по 150 мг 2 раза/сут или 300 мг на ночь. При необходимости доза может быть увеличена до 150 мг 4 раза/сут. Курс лечения 8-12 недель. Длительная профилактическая терапия - 150 мг 2 раза/сут."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСиндром Золлингера-Эллисона. \u003c/i\u003eНачальная доза составляет 150 мг 3 раза/сут, при необходимости доза может быть увеличена."}},{"type":"paragraph","data":{"text":"\u003ci\u003eПрофилактика рецидивирующих кровотечений. \u003c/i\u003eПо 150 мг 2 раза/сут."}},{"type":"paragraph","data":{"text":"\u003ci\u003eПрофилактика развития синдрома Мендельсона. \u003c/i\u003eНазначают в дозе 150 мг за 2 ч до наркоза, а также желательно 150 мг накануне вечером."}},{"type":"paragraph","data":{"text":"При наличии сопутствующего \u003cb\u003eнарушения функции печени\u003c/b\u003e может потребоваться снижение дозы."}},{"type":"paragraph","data":{"text":"Больным с \u003cb\u003eпочечной недостаточностью при КК менее 50 мл/мин\u003c/b\u003e рекомендуемая доза составляет 150 мг/сут."}}]},{"id":4,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Со стороны нервной системы и органов чувств: головная боль, чувство усталости, головокружение, сонливость, инсомния, вертиго, тревога, депрессия; редко— спутанность сознания, галлюцинации (особенно у пожилых и ослабленных пациентов), обратимая нечеткость зрения, нарушение аккомодации глаза.Со стороны сердечно-сосудистой системы и крови (кроветворение, гемостаз): аритмия, тахикардия/брадикардия, AV-блокада, снижение АД; обратимые лейкопения, тромбоцитопения, гранулоцитопения; редко— агранулоцитоз, панцитопения, иногда с гипоплазией костного мозга, апластическая анемия; иногда— иммунная гемолитическая анемия.Со стороны органов ЖКТ: тошнота, рвота, запор/диарея, абдоминальный дискомфорт/боль; редко— панкреатит. Иногда— гепатоцеллюлярный, холестатический или смешанный гепатит с/без желтухи (в таких случаях прием ранитидина необходимо немедленно прекратить). Эти эффекты обычно обратимы, но в редких случаях возможен летальный исход. Также отмечались редкие случаи развития печеночной недостаточности. У здоровых добровольцев концентрация АСТ была повышена, по крайней мере, в 2 раза по отношению к уровню до лечения у 6 из 12 человек, получавших 100 мг 4 раза в/в в течение 7 дней, и у 4 из 24 людей, получавших 50 мг 4 раза в/в в течение 5 дней.Со стороны опорно-двигательного аппарата: редко— артралгия, миалгия.Аллергические реакции: кожная сыпь, бронхоспазм, лихорадка, эозинофилия; редко— многоформная эритема, анафилактический шок, ангионевротический отек.Прочие: редко— алопеция, васкулит; в отдельных случаях— гинекомастия, снижение потенции и/или либидо. При длительном применении возможно развитие В12-дефицитной анемии."}}]},{"name":"Передозировка","slug":"overdose","id":16,"body":[{"type":"paragraph","data":{"text":"\u003ci\u003eСимптомы\u003c/i\u003e: судороги, брадикардия, желудочковые аритмии."}},{"type":"paragraph","data":{"text":"\u003ci\u003eЛечение:\u003c/i\u003e симптоматическое. При развитии судорог - диазепам в/в, при брадикардии или желудочковых аритмиях - атропин, лидокаин. Гемодиализ - эффективен."}}]},{"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","id":17,"body":[{"type":"paragraph","data":{"text":"Курение снижает эффективность ранитидина."}},{"type":"paragraph","data":{"text":"Увеличивает концентрацию метопролола в сыворотке крови (соответственно на 80% и 50%), при этом период полувыведения метопролола увеличивается с 4.4 до 6.5 ч."}},{"type":"paragraph","data":{"text":"Вследствие повышения рН содержимого желудка при одновременном приеме может уменьшиться всасывание итраконазола и кетоконазола."}},{"type":"paragraph","data":{"text":"Угнетает метаболизм в печени феназона, аминофеназона, диазепама, гексобарбитала, пропраколола, диазепама, лидокаика, фенитоина, теофиллина, аминофиллина, непрямых антикоагулянтов, глипизида, буформина, метронидазола, антагонистов кальция."}},{"type":"paragraph","data":{"text":"Лекарственные средства, угнетающие костный мозг, увеличивают риск нейтропении."}},{"type":"paragraph","data":{"text":"При одновременном применении с антацидами, сукральфатом в высоких дозах возможно замедление абсорбции ранитидина, поэтому перерыв между приемом этих препаратов должен быть не менее 2 ч."}}]},{"id":5,"name":"Особые указания","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Лечение ранитидином может маскировать симптомы, связанные с карциномой желудка, поэтому перед началом лечения необходимо исключить наличие рака-язвы."}},{"type":"paragraph","data":{"text":"Ранитидин, как и все Н\u003csub\u003e2\u003c/sub\u003e-гистаминоблокаторы, нежелательно резко отменять (синдром \"рикошета\")."}},{"type":"paragraph","data":{"text":"При длительном лечении ослабленных больных в условиях стресса возможны бактериальные поражения желудка с последующим распространением инфекции."}},{"type":"paragraph","data":{"text":"Имеются сведения о том, что ранитидин может вызвать острые приступы порфирии."}},{"type":"paragraph","data":{"text":"Блокаторы Н\u003csub\u003e2\u003c/sub\u003e-гистаминовых рецепторов следует принимать через 2 часа после приема итраконазола или кетоконазола во избежание значительного уменьшения их всасывания."}},{"type":"paragraph","data":{"text":"Может повышать активность глутаматтранспептидазы."}},{"type":"paragraph","data":{"text":"Может быть причиной ложноположительной реакции на проведение пробы на белок в моче."}},{"type":"paragraph","data":{"text":"Блокаторы Н\u003csub\u003e2\u003c/sub\u003e-гистаминовых рецепторов могут противодействовать влиянию пентагастрина и гистамина на кислоторбразующую функцию желудка, поэтому в течение 24 ч, предшествующему тесту, применять блокаторы Н2- гистаминорецепторов не рекомендуется."}},{"type":"paragraph","data":{"text":"Блокаторы Н\u003csub\u003e2\u003c/sub\u003e-гистаминовых рецепторов могут подавлять кожную реакцию на гистамин, приводя таким образом к ложноположительным результатам (перед проведением диагностических кожкых проб для выявления аллергической кожной реакции немедленного типа использование блокаторов Н\u003csub\u003e2\u003c/sub\u003e-гистаминовых рецепторов рекомендуется прекратить)."}},{"type":"paragraph","data":{"text":"Во время лечения следует избегать употребления продуктов питания, напитков и других лекарственных средств, которые могут вызвать раздражение слизистой оболочки желудка."}},{"type":"paragraph","data":{"text":"\u003ci\u003eИспользование в педиатрии\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Безопасность и эффективность ранитидина у \u003cb\u003eдетей младше 12 лет\u003c/b\u003e не установлены."}},{"type":"paragraph","data":{"text":"\u003ci\u003eВлияние на способность к управлению транспортными средствами и механизмами\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"В период лечения необходимо воздерживаться от занятий потенциально опасными видами деятельности, требующими повышенной концентрации внимания и быстроты психомоторных реакций."}}],"slug":""},{"id":19,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Таблетки."}}]},{"id":6,"name":"Условия хранения","slug":"storage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"В сухом, защищенном от света месте, при температуре не выше 25°C. 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После перорального приема в терапевтических дозах не влияет на уровень пролактина. Ингибирует микросомальные ферменты. 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