Артериальная гипертензия (монотерапия и в комбинации с другими антигипертензивными средствами: тиазидными диуретиками, бета-адреноблокаторами, блокаторами кальциевых каналов или ингибиторами АПФ), доброкачественная гиперплазия предстательной железы (при наличии артериальной гипертензии и при нормальном АД).
Противопоказания
Гиперчувствительность, беременность, кормление грудью, возраст до 18 лет.
Сосудорасширяющее, спазмолитическое, гипотензивное, гиполипидемическое. Селективно блокирует постсинаптические альфа1-адренорецепторы. За счет снижения тонуса мышц сосудов уменьшает ОПСС и понижает АД. Уменьшает концентрации триглицеридов, общего холестерина и ЛПВП в плазме. Одновременно отмечается некоторое увеличение коэффициента ЛПВП по отношению к общему холестерину (на 4–13%). Подавляет агрегацию тромбоцитов и увеличивает содержание активного плазминогена в тканях. Уменьшает тонус гладкомышечных клеток стромы и капсулы предстательной железы, а также шейки мочевого пузыря. Понижает сопротивление и давление в мочеиспускательном канале, уменьшает сопротивление внутреннего сфинктера.
Показания к применению
Артериальная гипертензия (монотерапия и в комбинации с другими антигипертензивными средствами: тиазидными диуретиками, бета-адреноблокаторами, блокаторами кальциевых каналов или ингибиторами АПФ), доброкачественная гиперплазия предстательной железы (при наличии артериальной гипертензии и при нормальном АД).
Противопоказания
Гиперчувствительность, беременность, кормление грудью, возраст до 18 лет.
Применение при беременности и в период грудного вскармливания
Противопоказано. На время лечения следует прекратить грудное вскармливание.
Способ применения и дозы
Внутрь, независимо от приема пищи, не разжевывая и запивая достаточным количеством воды, 1 раз в сутки (утром или вечером). При артериальной гипертензии: дозы варьируются от 1 до 16 мг/сут (максимально); начальная доза - 1 мг 1 раз в сутки (перед сном), после этого больной должен находиться в постели в течение 6–8 ч (возможно развитие феномена «первой дозы», особенно выраженного на фоне предшествующего приема диуретиков). При недостаточности терапевтического эффекта суточную дозу увеличивают до 2 мг только через 1–2 нед непрерывного лечения, затем с интервалом 1–2 нед дозу увеличивают на 2 мг до достижения оптимального терапевтического эффекта. После достижения стойкого терапевтического эффекта дозу обычно уменьшают (средняя терапевтическая доза при поддерживающей терапии - 2–4 мг/сут). При доброкачественной гиперплазии предстательной железы без артериальной гипертензии: обычно - 2–4 мг/сут, максимальная доза - 8 мг/сут.
Побочное действие
При применении доксазозина, особенно в начале лечения, наиболее часто наблюдается ортостатическая гипотензия, которая в редких случаях может приводить к обморокам. С целью предотвращения ортостатической гипотензии больные должны избегать неожиданных и резких смен положения тела (переход из положения лежа в положение стоя). Могут отмечаться: головная боль, головокружение, общее чувство слабости, повышенная утомляемость, сонливость, ринит, тошнота. У больных артериальной гипертензией редко отмечаются: тахикардия, аритмия, боль в груди, приступы стенокардии, инфаркт миокарда, цереброваскулярные нарушения. Отмечались единичные случаи аллергических реакций (кожная сыпь, желтуха, тромбоцитопеническая пурпура, повышение уровня трансаминаз), сухости во рту, носовых кровотечений, приапизма, недержания мочи, повышения аппетита, запора, повышения диуреза, миалгий, артралгий.
Передозировка
Симптомы: выраженное понижение АД, иногда сопровождающееся обмороками. Лечение: необходимо перевести пациента в горизонтальное положение (опустить голову вниз, приподнять ноги), симптоматическая терапия.
Особые указания
С особой осторожностью следует назначать препарат пациентам с нарушением функции печени, особенно в тех случаях, когда одновременно применяются препараты, способные отрицательно повлиять на функцию печени. В случаях ухудшения показателей функционального состояния печени препарат немедленно отменяют. С целью предотвращения ортостатических реакций пациенты должны избегать неожиданных и резких смен положения тела (переход из положения лежа в положение стоя). При одновременном употреблении алкоголя возможно усиление нежелательных реакций. Эффект первого приема препарата особенно выражен на фоне предшествующей диуретической терапии и соблюдения диеты с ограничением потребления натрия. Перед началом терапии необходимо исключить злокачественное перерождение предстательной железы. Влияние на способность к вождению автотранспорта и управлению механизмамиВ период лечения пациентам следует соблюдать осторожность при управлении транспортными средствами и занятиях другими потенциально опасными видами деятельности, требующими повышенной концентрации внимания и быстроты психомоторных реакций (риск развития головокружения, слабости). В связи с тем, что доксазозин способен вызывать ортостатические реакции в начале лечения или в период повышения доз, пациентам целесообразно воздерживаться от всех потенциально опасных видов деятельности, в частности от управления автотранспортом и другими транспортными средствами и механизмами.
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