Симптоматическое лечение: остеоартроз (артроз, дегенеративные заболевания суставов), в т.ч. с болевым компонентом; ревматоидный артрит; анкилозирующий спондилит (болезнь Бехтерева).
Препарат предназначен для симптоматической терапии, уменьшения боли и воспаления на момент использования, на прогрессирование заболевания не влияет.
Противопоказания
гиперчувствительность к активному веществу или вспомогательным компонентам препарата, другим НПВП; полное или неполное сочетание бронхиальной астмы, ангионевротического отека или крапивницы, рецидивирующего полипоза носа и околоносовых пазух и непереносимости ацетилсалициловой кислоты и других НПВП (в т.ч. в анамнезе); эрозивно-язвенные поражения слизистой ...
Симптоматическое лечение: остеоартроз (артроз, дегенеративные заболевания суставов), в т.ч. с болевым компонентом; ревматоидный артрит; анкилозирующий спондилит (болезнь Бехтерева).
Препарат предназначен для симптоматической терапии, уменьшения боли и воспаления на момент использования, на прогрессирование заболевания не влияет.
Противопоказания
гиперчувствительность к активному веществу или вспомогательным компонентам препарата, другим НПВП; полное или неполное сочетание бронхиальной астмы, ангионевротического отека или крапивницы, рецидивирующего полипоза носа и околоносовых пазух и непереносимости ацетилсалициловой кислоты и других НПВП (в т.ч. в анамнезе); эрозивно-язвенные поражения слизистой оболочки желудка и двенадцатиперстной кишки в стадии обострения или недавно перенесенные; воспалительные заболевания кишечника — болезнь Крона или язвенный колит в стадии обострения; тяжелая печеночная недостаточность или активное заболевание печени; тяжелая почечная недостаточность с Cl креатинина менее 30 мл/мин (пациенты, не подвергающиеся гемодиализу, с подтвержденной гиперкалиемией), прогрессирующие заболевания почек; активное желудочно-кишечное кровотечение, недавно перенесенные цереброваскулярные кровотечения или подтвержденный диагноз заболевания свертывающей системы крови, заболевания щитовидной железы; декомпенсированная сердечная недостаточность, острый инфаркт миокарда; период после проведения аортокоронарного шунтирования; наследственная непереносимость лактозы, нарушение всасывания глюкозы и галактозы, недостаточность лактазы; беременность; грудное вскармливание; детский возраст до 12 лет.
С осторожностью
заболевания ЖКТ в анамнезе (язвенная болезнь желудка и двенадцатиперстной кишки, заболевания печени); наличие инфекции Helicobacter pylori; ишемическая болезнь сердца; хроническая сердечная недостаточность; цереброваскулярные заболевания; почечная недостаточность (Cl креатинина 30–60 мл/мин); дислипидемия/гиперлипидемия; сахарный диабет; одновременный прием пероральных ГКС (в т.ч. преднизолон), антикоагулянтов (в т.ч. варфарин), антиагрегантов (в т.ч. клопидогрел), СИОЗС (в т.ч. циталопрам, флуоксетин, пароксетин, сертралин); тяжелые соматические заболевания; заболевания периферических артерий; пожилой возраст; длительное использование НПВП; курение; частое употребление алкоголя; бронхиальная астма. Для снижения риска развития нежелательных явлений со стороны ЖКТ следует использовать минимальную эффективную дозу минимально возможным коротким курсом.
Применение при беременности и в период грудного вскармливания
Противопоказан к применению при беременности.
При необходимости применения в период лактации следует решить вопрос о прекращении грудного вскармливания.
В экспериментальных исследованиях не выявлено тератогенного действия мелоксикама.
Способ применения и дозы
Внутрь, во время еды, не разжевывая.
Остеоартроз.
Суточная доза составляет 7,5 мг, при необходимости может быть увеличена до 15 мг/сут.
Ревматоидный артрит.
Препарат назначают по 15 мг/сут, при достижении положительного терапевтического эффекта доза может быть снижена до 7,5 мг/сут.
Анкилозирующий спондилит.
Препарат назначают по 15 мг/сут, при достижении положительного терапевтического эффекта доза может быть снижена до 7,5 мг/сут.
У пациентов с повышенным риском побочных реакций начальная лечебная доза составляет 7,5 мг/сут. У больных с тяжелой почечной недостаточностью, находящихся на гемодиализе, доза не должна превышать 7,5 мг/сут.
Побочное действие
Нежелательные явления, представленные ниже, перечислены в зависимости от анатомо-физиологической классификации и частоты встречаемости. Частота встречаемости определяется по ВОЗ и имеет следующую градацию: очень часто — более 10%; часто — более 1%; нечасто — 0,1–1%; редко — 0,01–0,1%; очень редко — менее 0,01%, включая отдельные случаи.
Со стороны системы кроветворения и лимфатической системы: нечасто — анемия; редко — изменение числа клеток крови, включая изменения лейкоцитарной формулы, лейкопения, тромбоцитопения.
Со стороны иммунной системы: не установлено — анафилактический шок, анафилактоидные/анафилактические реакции; нечасто — другие реакции гиперчувствительности немедленного типа.
Со стороны нервной системы: часто — головная боль; нечасто — головокружение, сонливость.
Нарушения психики: не установлено — спутанность сознания, дезориентация; часто — эмоциональная лабильность.
Со стороны органов чувств: нечасто — вертиго; редко — конъюнктивит, нарушения зрения, включая нечеткость зрения, шум в ушах.
Со стороны ЖКТ: часто — боль в животе, диспепсия, диарея, тошнота, рвота; нечасто — скрытое или явное желудочно-кишечное кровотечение, гастрит, стоматит, запор, вздутие живота, отрыжка; редко — гастродуоденальные язвы, колит, эзофагит; очень редко — перфорация ЖКТ.
Со стороны печени: нечасто — транзиторные изменения показателей функции печени (в т.ч. повышение активности трансаминаз или билирубина) очень редко — гепатит.
Со стороны кожи и подкожных тканей: не установлено — фотосенсибилизация; нечасто — ангионевротический отек, зуд, кожная сыпь; редко — токсический эпидермальный некролиз, синдром Стивенса-Джонсона, крапивница; очень редко — буллезный дерматит, мультиформная эритема.
Со стороны дыхательной системы: редко — бронхиальная астма у пациентов с аллергией к ацетилсалициловой кислоте или другим НПВП.
Со стороны ССС: нечасто — повышение АД, чувство прилива крови к лицу; редко — ощущение сердцебиения.
Со стороны мочеполовой системы: нечасто — изменение показателей функций почек (повышение концентрации креатинина и/или мочевины в сыворотке крови), нарушения мочеиспускания, включая острую задержку мочи; очень редко — острая почечная недостаточность.
Желудочно-кишечное кровотечение, язва или перфорация могут приводить к летальному исходу. Как и для других НПВП, не исключают возможность появления интерстициального нефрита, гломерулонефрита, почечного медуллярного некроза, нефротического синдрома.
Передозировка
Симптомы: нарушение сознания, тошнота, рвота, боль в эпигастрии, желудочно-кишечное кровотечение, острая почечная недостаточность, печеночная недостаточность, остановка дыхания, асистолия.
Лечение: симптоматическая терапия, промывание желудка, назначение активированного угля. Форсированный диурез, защелачивание мочи, гемодиализ — малоэффективны из-за высокой связи препарата с белками крови. Специфического антидота нет.
Взаимодействие с другими лекарственными средствами
Мелоксикам вместе с другими ингибиторами синтеза ПГ, включая ГКС и салицилаты, может увеличивать риск возникновения язв слизистой оболочки ЖКТ и желудочно-кишечных кровотечений вследствие их синергизма. Совместное назначение мелоксикама и других НПВП не рекомендуется.
Вместе с антикоагулянтами, гепарином для системного применения, тромболитическими средствами мелоксикам повышает риск развития кровотечений. Если невозможно избежать их одновременного применения, необходимо контролировать показатели свертывающей системы крови. Одновременный прием антитромбоцитарных препаратов, СИОЗС с мелоксикамом повышает риск кровотечения вследствие ингибирования тромбоцитарной функции. В случае одновременного применения необходим тщательный контроль за свертывающей системой крови.
Мелоксикам может снижать почечную экскрецию лития, что приводит к увеличению его концентрации в плазме крови до токсического уровня. Одновременное применение мелоксикама с препаратами лития не рекомендуется. В случае необходимости одновременного применения рекомендуется тщательный контроль за концентрацией лития в плазме в течение всего курса применения препаратов лития. НПВП снижают экскрецию метотрексата почками, тем самым повышая его концентрацию в плазме.
Одновременное применение мелоксикама и метотрексата (доза более 15 мг/нед) не рекомендуется. В случае одновременного применения необходим тщательный контроль за функцией почек и формулой крови. Мелоксикам может усилить гематологическую токсичность метотрексата, особенно у пациентов с нарушением функции почек. При совместном применении мелоксикама и метотрексата в течение 3 дней возрастает риск повышения токсичности последнего. Контрацепция. Есть данные, что мелоксикам может снижать эффективность внутриматочных контрацептивных устройств, однако это не доказано.
При применении мелоксикама вместе с диуретиками может возникнуть риск развития острой почечной недостаточности, поэтому следует контролировать функцию почек и поддерживать адекватный уровень гидратации. Гипотензивные средства (бета-адреноблокаторы, ингибиторы АПФ, вазодилататоры, диуретики).
Мелоксикам снижает эффект гипотензивных средств вследствие ингибирования ПГ, обладающих вазодилатирующими свойствами. Мелоксикам и АРА II, а также ингибиторы АПФ оказывают синергический эффект на уменьшение КФ. У пациентов с существующим нарушением почечной функции это может привести к острой почечной недостаточности. Колестирамин, связывая мелоксикам в ЖКТ, приводит к его более быстрому выведению. Мелоксикам, влияя на почечные ПГ, усиливает нефротоксичность циклоспорина, что требует усиленного контроля функции почек при одновременном применении препаратов.
Совместное применение с ЛС, угнетающими костный мозг (в т.ч. метотрексат), может спровоцировать цитопению. Мелоксикам почти полностью разрушается путем печеночного метаболизма, приблизительно 2/3 которого проходят при участии цитохрома Р450 и 1/3 — путем пероксидазного окисления.
Возможно ФКВ мелоксикама и других препаратов на этапе метаболизма за счет влияния их на CYP2С9 и/или CYPЗА4. При одновременном применении с гипогликемическими средствами для приема внутрь мелоксикам может усиливать их действие, тем самым способствуя риску возникновения гипогликемии.
При одновременном приеме мелоксикама с антацидами, циметидином, дигоксином и фуросемидом взаимодействия на фармакокинетическом уровне не выявлено. Мелоксикам может ослабить действие дигоксина, кортизона, диуретиков.
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или подтвержденный диагноз заболевания свертывающей системы крови, заболевания щитовидной железы; декомпенсированная сердечная недостаточность, острый инфаркт миокарда; период после проведения аортокоронарного шунтирования; наследственная непереносимость лактозы, нарушение всасывания глюкозы и галактозы, недостаточность лактазы; беременность; грудное вскармливание; детский возраст до 12 лет."}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"заболевания ЖКТ в анамнезе (язвенная болезнь желудка и двенадцатиперстной кишки, заболевания печени); наличие инфекции Helicobacter pylori; ишемическая болезнь сердца; хроническая сердечная недостаточность; цереброваскулярные заболевания; почечная недостаточность (Cl креатинина 30–60 мл/мин); дислипидемия/гиперлипидемия; сахарный диабет; одновременный прием пероральных ГКС (в т.ч. преднизолон), антикоагулянтов (в т.ч. варфарин), антиагрегантов (в т.ч. клопидогрел), СИОЗС (в т.ч. циталопрам, флуоксетин, пароксетин, сертралин); тяжелые соматические заболевания; заболевания периферических артерий; пожилой возраст; длительное использование НПВП; курение; частое употребление алкоголя; бронхиальная астма. Для снижения риска развития нежелательных явлений со стороны ЖКТ следует использовать минимальную эффективную дозу минимально возможным коротким курсом."}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"Противопоказан к применению при беременности."}},{"type":"paragraph","data":{"text":"При необходимости применения в период лактации следует решить вопрос о прекращении грудного вскармливания."}},{"type":"paragraph","data":{"text":"В экспериментальных исследованиях не выявлено тератогенного действия мелоксикама."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Внутрь, во время еды, не разжевывая."}},{"type":"paragraph","data":{"text":"Остеоартроз."}},{"type":"paragraph","data":{"text":"Суточная доза составляет 7,5 мг, при необходимости может быть увеличена до 15 мг/сут."}},{"type":"paragraph","data":{"text":"Ревматоидный артрит."}},{"type":"paragraph","data":{"text":"Препарат назначают по 15 мг/сут, при достижении положительного терапевтического эффекта доза может быть снижена до 7,5 мг/сут."}},{"type":"paragraph","data":{"text":"Анкилозирующий спондилит."}},{"type":"paragraph","data":{"text":"Препарат назначают по 15 мг/сут, при достижении положительного терапевтического эффекта доза может быть снижена до 7,5 мг/сут."}},{"type":"paragraph","data":{"text":"У пациентов с повышенным риском побочных реакций начальная лечебная доза составляет 7,5 мг/сут. У больных с тяжелой почечной недостаточностью, находящихся на гемодиализе, доза не должна превышать 7,5 мг/сут."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Нежелательные явления, представленные ниже, перечислены в зависимости от анатомо-физиологической классификации и частоты встречаемости. Частота встречаемости определяется по ВОЗ и имеет следующую градацию: очень часто — более 10%; часто — более 1%; нечасто — 0,1–1%; редко — 0,01–0,1%; очень редко — менее 0,01%, включая отдельные случаи."}},{"type":"paragraph","data":{"text":"Со стороны системы кроветворения и лимфатической системы: нечасто — анемия; редко — изменение числа клеток крови, включая изменения лейкоцитарной формулы, лейкопения, тромбоцитопения."}},{"type":"paragraph","data":{"text":"Со стороны иммунной системы: не установлено — анафилактический шок, анафилактоидные/анафилактические реакции; нечасто — другие реакции гиперчувствительности немедленного типа."}},{"type":"paragraph","data":{"text":"Со стороны нервной системы: часто — головная боль; нечасто — головокружение, сонливость."}},{"type":"paragraph","data":{"text":"Нарушения психики: не установлено — спутанность сознания, дезориентация; часто — эмоциональная лабильность."}},{"type":"paragraph","data":{"text":"Со стороны органов чувств: нечасто — вертиго; редко — конъюнктивит, нарушения зрения, включая нечеткость зрения, шум в ушах."}},{"type":"paragraph","data":{"text":"Со стороны ЖКТ: часто — боль в животе, диспепсия, диарея, тошнота, рвота; нечасто — скрытое или явное желудочно-кишечное кровотечение, гастрит, стоматит, запор, вздутие живота, отрыжка; редко — гастродуоденальные язвы, колит, эзофагит; очень редко — перфорация ЖКТ."}},{"type":"paragraph","data":{"text":"Со стороны печени: нечасто — транзиторные изменения показателей функции печени (в т.ч. повышение активности трансаминаз или билирубина) очень редко — гепатит."}},{"type":"paragraph","data":{"text":"Со стороны кожи и подкожных тканей: не установлено — фотосенсибилизация; нечасто — ангионевротический отек, зуд, кожная сыпь; редко — токсический эпидермальный некролиз, синдром Стивенса-Джонсона, крапивница; очень редко — буллезный дерматит, мультиформная эритема."}},{"type":"paragraph","data":{"text":"Со стороны дыхательной системы: редко — бронхиальная астма у пациентов с аллергией к ацетилсалициловой кислоте или другим НПВП."}},{"type":"paragraph","data":{"text":"Со стороны ССС: нечасто — повышение АД, чувство прилива крови к лицу; редко — ощущение сердцебиения."}},{"type":"paragraph","data":{"text":"Со стороны мочеполовой системы: нечасто — изменение показателей функций почек (повышение концентрации креатинина и/или мочевины в сыворотке крови), нарушения мочеиспускания, включая острую задержку мочи; очень редко — острая почечная недостаточность."}},{"type":"paragraph","data":{"text":"Желудочно-кишечное кровотечение, язва или перфорация могут приводить к летальному исходу. Как и для других НПВП, не исключают возможность появления интерстициального нефрита, гломерулонефрита, почечного медуллярного некроза, нефротического синдрома."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Симптомы: нарушение сознания, тошнота, рвота, боль в эпигастрии, желудочно-кишечное кровотечение, острая почечная недостаточность, печеночная недостаточность, остановка дыхания, асистолия."}},{"type":"paragraph","data":{"text":"Лечение: симптоматическая терапия, промывание желудка, назначение активированного угля. Форсированный диурез, защелачивание мочи, гемодиализ — малоэффективны из-за высокой связи препарата с белками крови. Специфического антидота нет."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Мелоксикам вместе с другими ингибиторами синтеза ПГ, включая ГКС и салицилаты, может увеличивать риск возникновения язв слизистой оболочки ЖКТ и желудочно-кишечных кровотечений вследствие их синергизма. Совместное назначение мелоксикама и других НПВП не рекомендуется."}},{"type":"paragraph","data":{"text":"Вместе с антикоагулянтами, гепарином для системного применения, тромболитическими средствами мелоксикам повышает риск развития кровотечений. Если невозможно избежать их одновременного применения, необходимо контролировать показатели свертывающей системы крови. Одновременный прием антитромбоцитарных препаратов, СИОЗС с мелоксикамом повышает риск кровотечения вследствие ингибирования тромбоцитарной функции. В случае одновременного применения необходим тщательный контроль за свертывающей системой крови."}},{"type":"paragraph","data":{"text":"Мелоксикам может снижать почечную экскрецию лития, что приводит к увеличению его концентрации в плазме крови до токсического уровня. Одновременное применение мелоксикама с препаратами лития не рекомендуется. В случае необходимости одновременного применения рекомендуется тщательный контроль за концентрацией лития в плазме в течение всего курса применения препаратов лития. НПВП снижают экскрецию метотрексата почками, тем самым повышая его концентрацию в плазме."}},{"type":"paragraph","data":{"text":"Одновременное применение мелоксикама и метотрексата (доза более 15 мг/нед) не рекомендуется. В случае одновременного применения необходим тщательный контроль за функцией почек и формулой крови. Мелоксикам может усилить гематологическую токсичность метотрексата, особенно у пациентов с нарушением функции почек. При совместном применении мелоксикама и метотрексата в течение 3 дней возрастает риск повышения токсичности последнего. Контрацепция. Есть данные, что мелоксикам может снижать эффективность внутриматочных контрацептивных устройств, однако это не доказано."}},{"type":"paragraph","data":{"text":"При применении мелоксикама вместе с диуретиками может возникнуть риск развития острой почечной недостаточности, поэтому следует контролировать функцию почек и поддерживать адекватный уровень гидратации. Гипотензивные средства (бета-адреноблокаторы, ингибиторы АПФ, вазодилататоры, диуретики)."}},{"type":"paragraph","data":{"text":"Мелоксикам снижает эффект гипотензивных средств вследствие ингибирования ПГ, обладающих вазодилатирующими свойствами. Мелоксикам и АРА II, а также ингибиторы АПФ оказывают синергический эффект на уменьшение КФ. У пациентов с существующим нарушением почечной функции это может привести к острой почечной недостаточности. Колестирамин, связывая мелоксикам в ЖКТ, приводит к его более быстрому выведению. Мелоксикам, влияя на почечные ПГ, усиливает нефротоксичность циклоспорина, что требует усиленного контроля функции почек при одновременном применении препаратов."}},{"type":"paragraph","data":{"text":"Совместное применение с ЛС, угнетающими костный мозг (в т.ч. метотрексат), может спровоцировать цитопению. Мелоксикам почти полностью разрушается путем печеночного метаболизма, приблизительно 2/3 которого проходят при участии цитохрома Р450 и 1/3 — путем пероксидазного окисления."}},{"type":"paragraph","data":{"text":"Возможно ФКВ мелоксикама и других препаратов на этапе метаболизма за счет влияния их на CYP2С9 и/или CYPЗА4. При одновременном применении с гипогликемическими средствами для приема внутрь мелоксикам может усиливать их действие, тем самым способствуя риску возникновения гипогликемии."}},{"type":"paragraph","data":{"text":"При одновременном приеме мелоксикама с антацидами, циметидином, дигоксином и фуросемидом взаимодействия на фармакокинетическом уровне не выявлено. Мелоксикам может ослабить действие дигоксина, кортизона, диуретиков."}}]}],"source":null},"description_toggle":false,"short_description":"","substance":[{"id":126,"title":"Мелоксикам","title_latin":"Meloxicamum","slug":"meloksikam_126"}],"branding":null,"valid_for_quick_buy":false,"is_available_to_delivery":false,"comments":null,"image_alt":"Генитрон - фото упаковки","image_share":{"isTouch":{"default":null},"isFromTablet":{"default":null}},"diseases":[{"id":"1012","title":"Серопозитивный ревматоидный артрит","slug":"1012-seropozitivnyy_revmatoidnyy_artrit"},{"id":"1016","title":"Полиартроз","slug":"1016-poliartroz"},{"id":"1020","title":"Боль в суставе","slug":"1020-bol_v_sustave"},{"id":"1035","title":"Анкилозирующий спондилит","slug":"1035-ankiloziruyuschiy_spondilit"}],"other_packages":[],"other_product_forms":[{"id":182859,"title":"Генитрон","subtitle":{"full":"Раствор, 5 шт, 1.5 мл, 10 мг / мл, для внутримышечного введения","short":"Раствор, 5 шт, 1.5 мл, 10 мг / мл","package":"5 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