при лечении кларитромицином запрещается принимать цизаприд, пимозид, астемизол и терфенадин; у больных, принимающих эти препараты одновременно с кларитромицином, отмечается повышение их концентрации в крови. При этом возможно удлинение интервала QT и развитие сердечных аритмий, включая желудочковую пароксизмальную тахикардию, фибрилляцию желудочков и трепетание или мерцание желудочков;
тяжелые нарушения функции печени и/или почек;
повышенная чувствительность к антибиотикам из группы макролидов.
инфекции нижнего отдела дыхательных путей (бронхиты, пневмония);
инфекции верхнего отдела дыхательных путей (фарингиты, синуситы, отиты);
инфекции кожи и мягких тканей (фолликулиты, рожистое воспаление);
распространенные или локализованные микобактериальные инфекции, вызванные Mycobacterium avium и Mycobacterium intracellulare;
локализованные инфекции, вызванные Mycobacterium chelonae, Mycobacterium fortuitum и Mycobacterium kansasii;
ликвидация Helicobacter pylori и снижения частоты рецидивов язвы двенадцатиперстной кишки.
Противопоказания
одновременный прием дериватов спорыньи;
при лечении кларитромицином запрещается принимать цизаприд, пимозид, астемизол и терфенадин; у больных, принимающих эти препараты одновременно с кларитромицином, отмечается повышение их концентрации в крови. При этом возможно удлинение интервала QT и развитие сердечных аритмий, включая желудочковую пароксизмальную тахикардию, фибрилляцию желудочков и трепетание или мерцание желудочков;
тяжелые нарушения функции печени и/или почек;
повышенная чувствительность к антибиотикам из группы макролидов.
Способ применения и дозы
Для взрослых средняя доза для приема внутрь составляет 250 мг 2 раза/сут. При необходимости можно назначать по 500 мг 2 раза/сут. Длительность курса лечения - 6-14 дней.
Детям препарат назначают в дозе 7.5 мг/кг массы тела/сут. Максимальная суточная доза - 500 мг. Длительность курса лечения - 7-10 дней.
Для лечения инфекций, вызванных Mycobacterium avium, кларитромицин назначают внутрь - по 1 г 2 раза/сут. Длительность лечения может составлять 6 мес и более.
У больных с почечной недостаточностью, при КК менее 30 мл/мин, дозу препарата следует снизить в 2 раза. Максимальная длительность курса у пациентов этой группы должна составлять не более14 дней.
Побочное действие
Наиболее часто отмечаются жалобы со стороны пищеварительной системы: тошнота, диспепсия, боли в животе, рвота и диарея. Имеются сообщения о развитии псевдомембранозного колита от среднего до угрожающего жизни. К другим побочным реакциям относятся головные боли, нарушения вкуса и преходящее повышение активности ферментов печени.
Имеются сообщения о редких случаях развития парастезии.
Имеются сообщения о редких случаях гепатита с повышением уровня ферментов печени в крови и развитием холестаза и желтухи. Эти повреждения печени в некоторых случаях были тяжелыми и, как правило, обратимыми. В исключительных случаях наблюдалась печеночная недостаточность с летальным исходом.
Имеются сообщения о редких случаях увеличения концентрации креатинина в сыворотке, развитии интерстициальных нефритов, развитии почечной недостаточности.
При приеме кларитромицина перорально наблюдались аллергические реакции, интенсивность которых варьировала от крапивницы и кожной сыпи, до анафилаксии и синдрома Стивенса-Джонсона.
Имеются сообщения о потере слуха в период лечения кларитромицином, который в большинстве случаев восстанавливался после отмены препарата. Также сообщается об изменениях восприятия вкуса, как правило, возникающих вместе с нарушением вкуса.
Имеются сообщения о развитии глосситов, стоматитов, кандидоза слизистой оболочки полости рта и изменении цвета языка в период лечения кларитромицином. Сообщается также об изменении цвета зубов у получавших кларитромицин больных. Изменение цвета зубов в большинстве случаев было обратимым.
В редких случаях отмечалась гипогликемия; в ряде этих случаев гипогликемия развивалась у больных, принимавших в период лечения кларитромицином гипогликемические средства для перорального приема или инсулин.
Сообщается об отдельных случаях тромбоцитопении и лейкопении.
При приеме кларитромицина наблюдалось транзиторное побочное действие на центральную нервную систему: головокружение, тревога, страх, боязнь, бессонница, ночные кошмары, шум в ушах, спутанность сознания, дезориентация, галлюцинации, психозы и деперсонализация.
При лечении кларитромицином, как и при использовании других макролидов, крайне редко наблюдалось удлинение интервала QT, желудочковая аритмия, в т.ч. желудочковая пароксизмальная тахикардия и трепетание или мерцание желудочков.
Взаимодействие с другими лекарственными средствами
При одновременном приеме увеличивает концентрацию в крови препаратов, метаболизирующихся в печени с помощью ферментов цитохрома Р450, непрямых антикоагулянтов, карбамазепина, теофиллина, астемизола, цизаприда, терфенадина (в 2-3 раза), триазолама, мидазолама, циклоспорина, дизопирамида, фенитоина, рифабутина, ловастатина, дигоксина, алколоидов спорыньи.
Сообщалось о редких случаях острого некроза скелетных мышц, совпадающих по времени с одновременным назначением кларитромицина и ингибиторов ГМК-КоА-редуктазы - ловастатина и симвастатина.
Имеются сообщения о повышении концентрации дигоксина в плазме больных, получавших одновременно дигоксин и кларитромицин. У таких пациентов необходимо постоянно контролировать содержание дигоксина в сыворотке, чтобы избежать дигиталисной интоксикации.
Кларитромицин может уменьшать клиренс триазолама и, таким образом, повышать его фармакологические эффекты с развитием сонливости и спутанности сознания.
Одновременное применение кларитромицина и эрготамина (дериваты спорыньи) может привести к острой эрготоминовой интоксикации, проявляющейся тяжелым периферическим вазоспазмом и извращенной чувствительностью.
Одновременное назначение ВИЧ-инфицированным взрослым зидовудина перорально и кларитромицина в таблетках может привести к уменьшению Css зидовудина. Учитывая то, что кларитромицин, вероятно, изменяет всасывание назначаемого одновременно перорально зидовудина, этого взаимодействия в значительной степени удается избежать при приеме кларитромицина и зидовудина в различные часы суток (с интервалом не менее 4 ч).
При одновременном назначении кларитромицина и ритонавира возрастают значения сывороточной концентрации кларитромицина. Коррекция дозы кларитромицина в этих случаях для больных с нормальной функцией почек не требуется. Однако у больных с КК от 30 до 60 мл/мин дозу кларитромицина следует снизить на 50%. При КК менее 30 мл/мин дозу кларитромицина следует снизить на 75%. При одновременном лечении ритонавиром не следует назначать кларитромицин в дозах свыше 1 г/сут.
Особые указания
При наличии хронических заболеваний печени необходимо проводить регулярный контроль ферментов сыворотки крови.
С осторожностью назначают на фоне препаратов, метаболизирующихся печенью (рекомендуется измерять их концентрацию в крови).
В случае совместного назначения с варфарином или другими непрямыми антикоагулянтами необходимо контролировать протромбиновое время.
При заболеваниях сердца в анамнезе не рекомендуется одновременный прием с терфенадином, цизапридом, астемизолом.
Необходимо обратить внимание на возможность перекрестной устойчивости между кларитромицином и другими антибиотиками из группы макролидов, а также линкомицином и клиндамицином.
При длительном или повторном применении препарата возможно развитие суперинфекции (рост нечувствительных бактерий и грибов).
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крови. 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Длительность лечения может составлять 6 мес и более."}},{"type":"paragraph","data":{"text":"У \u003cb\u003eбольных с почечной недостаточностью\u003c/b\u003e, при КК менее 30 мл/мин, дозу препарата следует снизить в 2 раза. Максимальная длительность курса у пациентов этой группы должна составлять не более14 дней."}}]},{"id":12,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Наиболее часто отмечаются жалобы \u003ci\u003eсо стороны пищеварительной системы:\u003c/i\u003e тошнота, диспепсия, боли в животе, рвота и диарея. Имеются сообщения о развитии псевдомембранозного колита от среднего до угрожающего жизни. К другим побочным реакциям относятся головные боли, нарушения вкуса и преходящее повышение активности ферментов печени."}},{"type":"paragraph","data":{"text":"Имеются сообщения о редких случаях развития парастезии."}},{"type":"paragraph","data":{"text":"Имеются сообщения о редких случаях гепатита с повышением уровня ферментов печени в крови и развитием холестаза и желтухи. Эти повреждения печени в некоторых случаях были тяжелыми и, как правило, обратимыми. В исключительных случаях наблюдалась печеночная недостаточность с летальным исходом."}},{"type":"paragraph","data":{"text":"Имеются сообщения о редких случаях увеличения концентрации креатинина в сыворотке, развитии интерстициальных нефритов, развитии почечной недостаточности."}},{"type":"paragraph","data":{"text":"При приеме кларитромицина перорально наблюдались аллергические реакции, интенсивность которых варьировала от крапивницы и кожной сыпи, до анафилаксии и синдрома Стивенса-Джонсона."}},{"type":"paragraph","data":{"text":"Имеются сообщения о потере слуха в период лечения кларитромицином, который в большинстве случаев восстанавливался после отмены препарата. Также сообщается об изменениях восприятия вкуса, как правило, возникающих вместе с нарушением вкуса."}},{"type":"paragraph","data":{"text":"Имеются сообщения о развитии глосситов, стоматитов, кандидоза слизистой оболочки полости рта и изменении цвета языка в период лечения кларитромицином. Сообщается также об изменении цвета зубов у получавших кларитромицин больных. Изменение цвета зубов в большинстве случаев было обратимым."}},{"type":"paragraph","data":{"text":"В редких случаях отмечалась гипогликемия; в ряде этих случаев гипогликемия развивалась у больных, принимавших в период лечения кларитромицином гипогликемические средства для перорального приема или инсулин."}},{"type":"paragraph","data":{"text":"Сообщается об отдельных случаях тромбоцитопении и лейкопении."}},{"type":"paragraph","data":{"text":"При приеме кларитромицина наблюдалось транзиторное побочное действие на центральную нервную систему: головокружение, тревога, страх, боязнь, бессонница, ночные кошмары, шум в ушах, спутанность сознания, дезориентация, галлюцинации, психозы и деперсонализация."}},{"type":"paragraph","data":{"text":"При лечении кларитромицином, как и при использовании других макролидов, крайне редко наблюдалось удлинение интервала QT, желудочковая аритмия, в т.ч. желудочковая пароксизмальная тахикардия и трепетание или мерцание желудочков."}}]},{"id":14,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"При одновременном приеме увеличивает концентрацию в крови препаратов, метаболизирующихся в печени с помощью ферментов цитохрома Р450, непрямых антикоагулянтов, карбамазепина, теофиллина, астемизола, цизаприда, терфенадина (в 2-3 раза), триазолама, мидазолама, циклоспорина, дизопирамида, фенитоина, рифабутина, ловастатина, дигоксина, алколоидов спорыньи."}},{"type":"paragraph","data":{"text":"Сообщалось о редких случаях острого некроза скелетных мышц, совпадающих по времени с одновременным назначением кларитромицина и ингибиторов ГМК-КоА-редуктазы - ловастатина и симвастатина."}},{"type":"paragraph","data":{"text":"Имеются сообщения о повышении концентрации дигоксина в плазме больных, получавших одновременно дигоксин и кларитромицин. У таких пациентов необходимо постоянно контролировать содержание дигоксина в сыворотке, чтобы избежать дигиталисной интоксикации."}},{"type":"paragraph","data":{"text":"Кларитромицин может уменьшать клиренс триазолама и, таким образом, повышать его фармакологические эффекты с развитием сонливости и спутанности сознания."}},{"type":"paragraph","data":{"text":"Одновременное применение кларитромицина и эрготамина (дериваты спорыньи) может привести к острой эрготоминовой интоксикации, проявляющейся тяжелым периферическим вазоспазмом и извращенной чувствительностью."}},{"type":"paragraph","data":{"text":"Одновременное назначение ВИЧ-инфицированным взрослым зидовудина перорально и кларитромицина в таблетках может привести к уменьшению C\u003csub\u003ess\u003c/sub\u003e зидовудина. Учитывая то, что кларитромицин, вероятно, изменяет всасывание назначаемого одновременно перорально зидовудина, этого взаимодействия в значительной степени удается избежать при приеме кларитромицина и зидовудина в различные часы суток (с интервалом не менее 4 ч)."}},{"type":"paragraph","data":{"text":"При одновременном назначении кларитромицина и ритонавира возрастают значения сывороточной концентрации кларитромицина. Коррекция дозы кларитромицина в этих случаях для больных с нормальной функцией почек не требуется. Однако у больных с КК от 30 до 60 мл/мин дозу кларитромицина следует снизить на 50%. При КК менее 30 мл/мин дозу кларитромицина следует снизить на 75%. При одновременном лечении ритонавиром не следует назначать кларитромицин в дозах свыше 1 г/сут."}}]},{"id":15,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"При наличии хронических заболеваний печени необходимо проводить регулярный контроль ферментов сыворотки крови."}},{"type":"paragraph","data":{"text":"С осторожностью назначают на фоне препаратов, метаболизирующихся печенью (рекомендуется измерять их концентрацию в крови)."}},{"type":"paragraph","data":{"text":"В случае совместного назначения с варфарином или другими непрямыми антикоагулянтами необходимо контролировать протромбиновое время."}},{"type":"paragraph","data":{"text":"При заболеваниях сердца в анамнезе не рекомендуется одновременный прием с терфенадином, цизапридом, астемизолом."}},{"type":"paragraph","data":{"text":"Необходимо обратить внимание на возможность перекрестной устойчивости между кларитромицином и другими антибиотиками из группы макролидов, а также линкомицином и клиндамицином."}},{"type":"paragraph","data":{"text":"При длительном или повторном применении препарата возможно развитие суперинфекции (рост нечувствительных бактерий и грибов)."}}]}],"source":{"title":"ЗдравСити","url":"https://zdravcity.ru"}},"description_toggle":false,"short_description":"","substance":[],"branding":null,"valid_for_quick_buy":true,"is_available_to_delivery":false,"comments":{"count":31,"url":"/review/21012-clarithromycin/"},"image_alt":"Кларитромицин - фото упаковки","image_share":{"isTouch":{"default":"https://vseapteki.ru/cropping/thumbnails/101/24821/share_default/"},"isFromTablet":{"default":"https://vseapteki.ru/cropping/thumbnails/101/24821/share_default/"}},"diseases":[{"id":"35","title":"Легочная инфекция, вызванная Mycobacterium","slug":"35-legochnaya_infektsiya_vyzvannaya_mycobacterium"},{"id":"50","title":"Болезнь легионеров","slug":"50-bolezn_legionerov"},{"id":"59","title":"Хламидийные инфекции нижних отделов мочеполового 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