Пентоксифиллин Концентрат, ампулы, 10 шт, 5 мл, 2 %, для инфузий

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При внутривенном введении приводит к усилению коллатерального кровообращения, увеличению объема протекающей крови через единицу сечения."}},{"type":"paragraph","data":{"text":"Снижает вязкость крови, вызывает дезагрегацию тромбоцитов, повышает эластичность эритроцитов (за счет воздействия на патологически измененную деформируемость эритроцитов). Улучшает микроциркуляцию в зонах нарушенного кровообращения. При окклюзионном поражении периферических артерий (перемежающейся хромоте), приводит к удлинению дистанции ходьбы, устранению ночных судорог икроножных мышц и болей в покое. "}},{"type":"paragraph","data":{"text":"Фармакокинетика "}},{"type":"paragraph","data":{"text":"Препарат после введения быстро метаболизируется в печени. В процессе метаболизма происходит образование двух основных метаболитов: 1-(5-гидроксигексил)-3,7-диметилксантин (метаболит I) и 1-(3-карбоксипропил)-3,7-диметилксантина (метаболит V), которые обладают аналогичной пентоксифиллину активностью. "}},{"type":"paragraph","data":{"text":"Через 1,5-2 часа после инфузии концентрация метаболитов I и V в плазме крови соответственно в 5 и 8 раз выше концентрации исходного вещества. К 8-му часу концентрация пентоксифиллина и его метаболитов в крови значительно снижается (до 10% от начальной). Период полувыведения от 30 минут до 1,5 часов. "}},{"type":"paragraph","data":{"text":"Экскретируется преимущественно почками (94%) в виде метаболитов (преимущественно метаболита V), кишечником (4%), за первые 4 часа выводится до 90% дозы. В неизмененном виде выводится 2% препарата. Пентоксифиллин и его метаболиты не связываются с белками плазмы крови. Выделяется с грудным молоком."}},{"type":"paragraph","data":{"text":"При тяжелых нарушениях функции почек выведение метаболитов замедлено. При нарушении функции печени отмечается удлинение периода полувыведения и повышение биодоступности."}}]},{"id":7,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"- Нарушения периферического кровообращения на фоне атеросклеротических, диабетических и воспалительных процессов (в т. ч. при перемежающейся хромоте, обусловленной атеросклерозом, диабетической ангиопатией, облитерирующим эндартериитом);"}},{"type":"paragraph","data":{"text":"- трофические нарушения тканей вследствие нарушения артериальной и венозной микроциркуляции (варикозные язвы, гангрена, отморожения); "}},{"type":"paragraph","data":{"text":"- ангионейропатии (парестезии, акроцианоз, болезнь Рейно); - острые и хронические нарушения мозгового кровообращения ишемического типа (в т.ч. при церебральном атеросклерозе); "}},{"type":"paragraph","data":{"text":"- состояния после геморрагического или ишемического инсульта; "}},{"type":"paragraph","data":{"text":"- нарушения кровообращения в сосудах глаза (острая и хроническая недостаточность кровоснабжения сетчатой и сосудистой оболочек глаза); - нарушения функции среднего уха сосудистого генеза, сопровождающиеся тугоухостью."}}]},{"id":8,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"- Повышенная чувствительность к пентоксифиллину или другим производным ксантина, а также к любому вспомогательному веществу препарата;"}},{"type":"paragraph","data":{"text":"- выраженный коронарный или церебральный атеросклероз; "}},{"type":"paragraph","data":{"text":"- недавно перенесенный инфаркт миокарда; "}},{"type":"paragraph","data":{"text":"- гемодинамически значимые нарушения ритма сердца; "}},{"type":"paragraph","data":{"text":"- неконтролируемая артериальная гипотензия; "}},{"type":"paragraph","data":{"text":"- массивные кровотечения (риск усиления кровотечения); "}},{"type":"paragraph","data":{"text":"- обширные кровоизлияния в сетчатую оболочку глаза (риск усиления кровотечения); "}},{"type":"paragraph","data":{"text":"- кровоизлияния в головной мозг; "}},{"type":"paragraph","data":{"text":"- язвенная болезнь желудка и двенадцатиперстной кишки; "}},{"type":"paragraph","data":{"text":"- нарушение показателей свертывающей системы крови; "}},{"type":"paragraph","data":{"text":"- возраст до 18 лет (эффективность и безопасность не установлены). "}},{"type":"paragraph","data":{"text":"С осторожностью: "}},{"type":"paragraph","data":{"text":"Пациентам с лабильным артериальным давлением, склонностью к артериальной гипотензии, хронической сердечной недостаточностью, геморрагическим диатезом, склонностью к кровотечениям (в т.ч. при язвенной болезни желудка и двенадцатиперстной кишки), при состоянии после недавно перенесенных оперативных вмешательств, при тяжелой печеночной и/или почечной (клиренс креатинина менее 10 мл/мин) недостаточности. Пациент Пентоксифиллин необходимо назначать с осторожностью совместно с прямыми и непрямыми антикоагулянтами в связи с усилением действия последних. Беременность и лактация: Пентоксифиллин противопоказан при беременности, потому что опыт применения препарата у беременных ограничен. При необходимости назначения пентоксифиллина в период лактации грудное вскармливание необходимо прекратить в связи с тем, что пентоксифиллин проникает в грудное молоко."}}]},{"id":11,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Внутривенно и внутриартериально. "}},{"type":"paragraph","data":{"text":"При проведении инфузии пациент должен находиться в положении \"лежа\". Препарат вводят внутривенно капельно медленно в дозе 100 мг в 250-500 мл 0,9% раствора натрия хлорида или раствора Рингера (длительность введения - 90-180 минут). 100 мг пентоксифиллина должны вводиться внутривенно в течение как минимум 60 минут. "}},{"type":"paragraph","data":{"text":"Суточная доза при внутривенном введении может быть увеличена до максимальной - 300 мг/сут. Внутриартериально - сначала в дозе 100 мг в 20-50 мл 0,9% раствора натрия хлорида, а в последующие дни - по 200-300 мг в 30-50 мл 0,9% раствора натрия хлорида (скорость введения -10 мг/мин). "}},{"type":"paragraph","data":{"text":"При выраженном атеросклерозе сосудов головного мозга препарат нельзя вводить в сонную артерию. Пациентам с хронической почечной недостаточностью (клиренс креатинина менее 30 мл/мин) назначают 50-70% обычной дозы. У пожилых пациентов может потребоваться уменьшение дозы (повышение биодоступности и снижение скорости выведения). "}},{"type":"paragraph","data":{"text":"Уменьшение дозы, с учетом индивидуальной переносимости, необходимо у пациентов с тяжелым нарушением функции печени. Вводимая доза должна быть уменьшена у пациентов с низким и нестабильным артериальным давлением. "}},{"type":"paragraph","data":{"text":"Порядок работы с полимерной ампулой: "}},{"type":"paragraph","data":{"text":"1. Взять ампулу и встряхнуть ее, удерживая за горлышко. "}},{"type":"paragraph","data":{"text":"2. Сдавить ампулу рукой, при этом не должно происходить выделение препарата, и вращающими движениями повернуть и отделить клапан. "}},{"type":"paragraph","data":{"text":"3. Через образовавшееся отверстие немедленно соединить шприц с ампулой. "}},{"type":"paragraph","data":{"text":"4. Перевернуть ампулу и медленно набрать в шприц ее содержимое. "}},{"type":"paragraph","data":{"text":"5. Надеть иглу на шприц."}}]},{"id":12,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Частота возможных побочных эффектов, перечисленных ниже, определяется следующим образом: очень часто (1/10); часто (1/100 до < 1/10); нечасто (1/1000 до < 1/100); редко (1/10000 до < 1/1000); очень редко (< 1/10000); "}},{"type":"paragraph","data":{"text":"частота неизвестна (не может быть оценена по имеющимся данным). "}},{"type":"paragraph","data":{"text":"Нарушения со стороны крови и лимфатической системы: "}},{"type":"paragraph","data":{"text":"Очень редко: тромбоцитопения, тромбоцитопеническая пурпура, апластическая анемия, панцитопения. "}},{"type":"paragraph","data":{"text":"Редко: кровотечения (в т. ч. носовые кровотечения, желудочно-кишечные кровотечения, кровотечения из мочевыводящих путей и др.). "}},{"type":"paragraph","data":{"text":"Нарушения со стороны иммунной системы: Нечасто: реакции гиперчувствительности. "}},{"type":"paragraph","data":{"text":"Очень редко: тяжелые, происходящие в течение нескольких минут после введения пентоксифиллина анафилактические или анафилактоидные реакции, отек Квинке, бронхоспазм, анафилактический шок. "}},{"type":"paragraph","data":{"text":"Нарушения психики: "}},{"type":"paragraph","data":{"text":"Нечасто: повышенная возбудимость, бессонница. "}},{"type":"paragraph","data":{"text":"Нарушения со стороны нервной системы: "}},{"type":"paragraph","data":{"text":"Нечасто: головокружение, тремор, головная боль. "}},{"type":"paragraph","data":{"text":"Очень редко: парестезия, судороги, внутричерепное кровоизлияние, асептический менингит. Нарушения со стороны органа зрения: "}},{"type":"paragraph","data":{"text":"Нечасто: нарушение зрения, конъюнктивит. "}},{"type":"paragraph","data":{"text":"Очень редко: кровоизлияние в сетчатую оболочку глаза, отслоение сетчатой оболочки глаза. "}},{"type":"paragraph","data":{"text":"Нарушения со стороны сердца: "}},{"type":"paragraph","data":{"text":"Нечасто: нарушение ритма сердца, тахикардия. "}},{"type":"paragraph","data":{"text":"Редко: стенокардия, одышка. "}},{"type":"paragraph","data":{"text":"Нарушения со стороны сосудов: "}},{"type":"paragraph","data":{"text":"Часто: гиперемия кожи лица. "}},{"type":"paragraph","data":{"text":"Редко: снижение артериального давления, периферические отеки. "}},{"type":"paragraph","data":{"text":"Очень редко: повышение артериального давления. "}},{"type":"paragraph","data":{"text":"Нарушения со стороны желудочно-кишечного тракта: Часто: тошнота, рвота, вздутие живота, чувство тяжести в желудке, диарея. "}},{"type":"paragraph","data":{"text":"Нарушения со стороны печени и желчевыводящих путей: "}},{"type":"paragraph","data":{"text":"Очень редко: внутрипеченочный холестаз, повышение активности \"печеночных\" трансаминаз. "}},{"type":"paragraph","data":{"text":"Нарушения со стороны кожи и подкожных тканей: "}},{"type":"paragraph","data":{"text":"Нечасто: кожный зуд, эритема, крапивница. "}},{"type":"paragraph","data":{"text":"Очень редко: токсический эпидермальный некролиз, синдром Стивенса-Джонсона, повышенное потоотделение. "}},{"type":"paragraph","data":{"text":"Общие расстройства и нарушения в месте введения: "}},{"type":"paragraph","data":{"text":"Нечасто: повышение температуры тела."}}]},{"id":13,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Симптомы: слабость, головокружение, выраженное снижение артериального давления, тахикардия, сонливость, потеря сознания, тонико-клонические судороги, повышенная нервная возбудимость, гипертермия, арефлексия, признаки желудочно-кишечного кровотечения (рвота типа \"кофейной гущи\"). "}},{"type":"paragraph","data":{"text":"Лечение: симптоматическое, направленное на поддержание функции дыхания и артериального давления."}}]},{"id":14,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Пентоксифиллин может усиливать действие лекарственных средств, влияющих на свертывающую систему крови (непрямые и прямые антикоагулянты, тромболитики), антибиотиков (в т.ч. цефаллоспоринов - цефамандола, цефоперазона, цефотетана), вальпроевой кислоты. "}},{"type":"paragraph","data":{"text":"При одновременном применении пентоксифиллина с кеторолаком повышается риск кровотечений и/или удлинения протромбинового времени. Совместное назначение данных препаратов нежелательно. Увеличивает эффективность гипотензивных препаратов, инсулина, гипогликемических средств для приема внутрь."}},{"type":"paragraph","data":{"text":"Циметидин повышает концентрацию пентоксифиллина в плазме крови (риск возникновения побочных эффектов). Совместное назначение с другими ксантинами может приводить к чрезмерному нервному возбуждению. "}},{"type":"paragraph","data":{"text":"У некоторых пациентов при одновременном применении пентоксифиллина и теофиллина отмечается увеличение концентрации теофиллина в крови. В дальнейшем это может приводить к увеличению или усилению побочных действий, связанных с теофиллином. "}},{"type":"paragraph","data":{"text":"У некоторых пациентов при одновременном применении пентоксифиллина и ципрофлоксацина отмечается увеличение концентрации пентоксифиллина в плазме крови. В дальнейшем это может приводить к увеличению или усилению побочных действий, связанных с применением данной комбинации."}}]},{"id":15,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Лечение следует проводить под контролем артериального давления. У пациентов с хронической сердечной недостаточностью следует достичь компенсации кровообращения. "}},{"type":"paragraph","data":{"text":"У пациентов с сахарным диабетом, принимающих гипогликемические средства, назначение больших доз пентоксифиллина может вызвать выраженную гипогликемию (может потребоваться коррекция доз гипогликемических средств и проведение гликемического контроля)."}},{"type":"paragraph","data":{"text":"При назначении одновременно с антикоагулянтами необходим контроль показателей свертывания крови. У пациентов, перенесших недавно оперативное вмешательство, необходим регулярный контроль гемоглобина и гематокрита. "}},{"type":"paragraph","data":{"text":"Вводимая доза должна быть уменьшена у пациентов с низким и нестабильным артериальным давлением, а также у пациентов с выраженным атеросклерозом коронарных и/или церебральных артерий, т.к. в последнем случае дополнительное снижение артериального давления может приводить к ухудшению кровоснабжения сердца и/или мозга. "}},{"type":"paragraph","data":{"text":"У пожилых пациентов может потребоваться уменьшение дозы (повышение биодоступности и снижение скорости выведения). Курение может снижать терапевтическую эффективность препарата. "}},{"type":"paragraph","data":{"text":"Совместимость раствора пентоксифиллина с другими инфузионными растворами следует проверять в каждом конкретном случае. Во время терапии требуется контроль содержания натрия в плазме крови, особенно у пациентов, соблюдающих диету с ограничением поваренной соли (общее содержание натрия в ампуле объемом 5 мл - 11,8 мг)."}},{"type":"paragraph","data":{"text":"Влияние на способность управлять транспортными средствами и механизмами: "}},{"type":"paragraph","data":{"text":"Учитывая возможные побочные эффекты (например, головокружение), следует соблюдать осторожность при управлении транспортными средствами и занятиях потенциально опасными видами деятельности, требующими повышенной концентрации внимания и быстроты психомоторных реакций."}}]}],"source":{"title":"ЗдравСити","url":"https://zdravcity.ru"}},"description_toggle":false,"short_description":"Пентоксифиллин является производным ксантина. Улучшает микроциркуляцию и реологические свойства крови. Механизм действия связан с угнетением фосфодиэстеразы и повышением содержания циклического 3,5-аденозинмонофосфата (3,5-АМФ) в тромбоцитах и аденозинтрифосфата (АТФ) в эритроцитах с одновременным насыщением энергетического потенциала, что в свою очередь приводит к вазодилатации, снижению общего периферического сосудистого сопротивления, возрастанию систолического и минутного объема крови без значительного изменения частоты сердечных сокращений. Расширяя коронарные артерии, увеличивает доставку кислорода к миокарду (незначительный антиангинальный эффект), сосуды легких - улучшает оксигенацию крови. При внутривенном введении приводит к усилению коллатерального кровообращения, увеличению объема протекающей крови через единицу сечения. Снижает вязкость крови, вызывает дезагрегацию тромбоцитов, повышает эластичность эритроцитов (за счет воздействия на патологически измененную деформируемость эритроцитов). Улучшает микроциркуляцию в зонах нарушенного кровообращения. При окклюзионном поражении периферических артерий (перемежающейся хромоте), приводит к удлинению дистанции ходьбы, устранению ночных судорог икроножных мышц и болей в покое. Фармакокинетика Препарат после введения быстро метаболизируется в печени. В процессе метаболизма происходит образование двух основных метаболитов: 1-(5-гидроксигексил)-3,7-диметилксантин (метаболит I) и 1-(3-карбоксипропил)-3,7-диметилксантина (метаболит V), которые обладают аналогичной пентоксифиллину активностью. Через 1,5-2 часа после инфузии концентрация метаболитов I и V в плазме крови соответственно в 5 и 8 раз выше концентрации исходного вещества. К 8-му часу концентрация пентоксифиллина и его метаболитов в крови значительно снижается (до 10% от начальной). Период полувыведения от 30 минут до 1,5 часов. Экскретируется преимущественно почками (94%) в виде метаболитов (преимущественно метаболита V), кишечником (4%), за первые 4 часа выводится до 90% дозы. В неизмененном виде выводится 2% препарата. Пентоксифиллин и его метаболиты не связываются с белками плазмы крови. Выделяется с грудным молоком. При тяжелых нарушениях функции почек выведение метаболитов замедлено. 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