Фармакологическое действие — антиангинальное, антигипертензи... Инструкция
Показания к применению
артериальная гипертензия;профилактика приступов стенокардии (за исключением стенокардии Принцметала);нарушения сердечного ритма (синусовая тахикардия, профилактика наджелудочковых тахиаритмий);нейроциркуляторная дистония по гипертоническому типу.
Противопоказания
повышенная чувствительность к препарату;AV-блокада II–III степени;синдром слабости синусного узла;кардиогенный шок;острая сердечная недостаточность;выраженная брадикардия;артериальная гипотензия при инфаркте (сАД <100 мм рт. ст.);хроническая сердечная недостаточность IIБ–III стадии;синоаурикулярная блокада;метаболический ацидоз;бронхиальная астма;сочетание ...
Оказывает антиангинальное, антигипертензивное и антиаритмическое действие
Фармакотерапевтическая группа
Оказывает антиангинальное, антигипертензивное и антиаритмическое действие. Не обладает мембраностабилизирующей и внутренней симпатомиметической активностью. Уменьшает стимулированное катехоламинами образование цАМФ из АТФ.
В первые 24 ч после перорального приема на фоне снижения сердечного выброса отмечается реактивное повышение общего периферического сопротивления сосудов, выраженность которого в течение 1-3 суток постепенно снижается.
Гипотензивный эффект связан с уменьшением сердечного выброса, снижением активности ренин-ангиотензиновой системы, чувствительности барорецепторов и влиянием на центральную нервную систему. Гипотензивное действие проявляется как снижением систолического, так и диастолического артериального давления (АД), уменьшением ударного и минутного объемов.
В средних терапевтических дозах не оказывает влияния на тонус периферических артерий. Гипотензивный эффект продолжается 24 ч, при регулярном применении стабилизируется к концу второй недели лечения.
Антиангинальный эффект определяется снижением потребности миокарда в кислороде в результате уменьшения частоты сердечных сокращений (удлинение диастолы и улучшение перфузии миокарда) и сократимости, а также снижением чувствительности миокарда к воздействию симпатической стимуляции. Урежает частоту сердечных сокращений (ЧСС) в покое и при физической нагрузке.
За счет повышения конечного диастолического давления в левом желудочке и увеличения растяжения мышечных волокон желудочков может повышать потребность в кислороде, особенно у больных с хронической сердечной недостаточностью.
Антиаритмическое действие проявляется подавлением синусовой тахикардии и связано с устранением аритмогенных симпатических влияний на проводящую систему сердца, уменьшением скорости распространения возбуждения через синоатриальный узел и удлинением рефрактерного периода.
Угнетает проведение импульсов в антеградном и в меньшей степени в ретроградном направлениях через АV (атриовентрикулярный) узел и по дополнительным путям проведения.
Отрицательный хронотропный эффект проявляется через 1 ч после приема, достигает максимума спустя 2-4 ч, продолжается до 24 ч.
Уменьшает автоматизм синусового узла, урежает ЧСС, замедляет АV проводимость, снижает сократимость миокарда, снижает потребность миокарда в кислороде. Уменьшает возбудимость миокарда. При применении в средних терапевтических дозах оказывает менее выраженное влияние на гладкую мускулатуру бронхов и периферических артерий, чем неселективные
бета-адреноблокаторы.
Фармакологические свойства
Фармакологическое действие — антиангинальное, антигипертензивное, антиаритмическое.
Показания к применению
артериальная гипертензия;профилактика приступов стенокардии (за исключением стенокардии Принцметала);нарушения сердечного ритма (синусовая тахикардия, профилактика наджелудочковых тахиаритмий);нейроциркуляторная дистония по гипертоническому типу.
Противопоказания
повышенная чувствительность к препарату;AV-блокада II–III степени;синдром слабости синусного узла;кардиогенный шок;острая сердечная недостаточность;выраженная брадикардия;артериальная гипотензия при инфаркте (сАД <100 мм рт. ст.);хроническая сердечная недостаточность IIБ–III стадии;синоаурикулярная блокада;метаболический ацидоз;бронхиальная астма;сочетание с ингибиторами МАО;детский возраст до 18 лет.
Применение при беременности и в период грудного вскармливания
Беременным следует назначать Атенолол только в тех случаях, когда польза для матери превышает потенциальный риск для плода.Атенолол выделяется с грудным молоком, поэтому в период кормления его следует принимать только в исключительных случаях с большой осторожностью.
Способ применения и дозы
Внутрь, перед едой, не разжевывают, запивают небольшим количеством жидкости. Режим дозирования устанавливается индивидуально.Артериальная гипертензияЛечение начинают с 25–50 мг Атенолола 1 раз в сутки. Для достижения стабильного гипотензивного эффекта требуется 1–2 недели приема. При недостаточной выраженности гипотензивного эффекта дозу повышают до 100 мг на один прием. Дальнейшее увеличение дозы не рекомендуется, т.к. не сопровождается усилением клинического эффекта.СтенокардияНачальная доза— 25–50 мг в сутки. Если в течение недели не достигается оптимальный терапевтический эффект, увеличивают дозу до 100 мг/сут за 1 или 2 приема.Пациентам пожилого возраста и больным с нарушениями выделительной функции почек необходима коррекция режима дозирования.При наличии почечной недостаточности рекомендуют коррекцию дозы в зависимости от клиренса креатинина.При значениях Cl креатинина выше 35 мл/мин/1,73 м2 (нормальные значения составляют 100–150 мл/мин/1,73 м2) значительной кумуляции Атенолола не происходит.В таблице указаны рекомендуемые максимальные дозы для больных с почечной недостаточностью.Таблица Клиренс креатинина, мл/мин/1,73м2 Время полувыведения, ч Максимальная доза 15–35 16–27 50 мг в сутки <15 >27 50 мг через день Больным, находящимся на гемодиализе, Атенолол назначают по 50 мг/сутки сразу после проведения каждого диализа. Прием необходимо проводить в стационарных условиях, т.к. может иметь место падение артериального давления.Для вторичной профилактики инфаркта миокарда— 100 мг 1 раз в день или по 50 мг 2 раза в день в течение 6–9 дней или до выписки из стационара.При функциональных нарушениях сердечно-сосудистой системы рекомендуется применять Атенолол в дозе 25 мг в день.
Побочное действие
Наиболее часто встречающиеся побочные явления связаны с основным фармакологическим действием препарата и выражаются следующим образом.Со стороны сердечно-сосудистой системы: появление симптомов сердечной недостаточности, нарушение AV проводимости, брадикардия, артериальная гипотензия, ощущение холода и парестезии в конечностях.Со стороны ЦНС: головокружение, нарушение сна, снижение способности к концентрации внимания, сонливость, депрессия, галлюцинации, вялость, чувство усталости, головная боль.Со стороны органов ЖКТ: сухость во рту, тошнота, рвота, понос, боли в животе, запор;Со стороны дыхательной системы: диспноэ, бронхоспазм, апноэ.Гематологические реакции: тромбоцитопеническая пурпура, анемия (апластическая), тромбоз.Со стороны эндокринной системы: гинекомастия, снижение потенции, снижение либидо;Метаболические реакции: гиперлипидемия, гипогликемия;Со стороны кожных покровов: крапивница, дерматиты, зуд, фоточувствительность.
Передозировка
Симптомы: брадикардия, атриовентрикулярная блокада II и III степени, нарастание симптомов сердечной недостаточности, артериальная гипотензия, бронхоспазм, гипогликемия.При появлении симптомов передозировки немедленно обратиться к врачу.Лечение: При выраженной брадикардии показано внутривенное введение 1 мл 0,1 % раствора атропина сульфата.При AV блокаде II и III степени возможно назначение изопреналина в таблетках по 5 мг под язык (при необходимости— повторный прием через 2–4 ч) или в/в капельное или медленное струйное введение препарата в дозе 0,5–1 мг. При возникновении бронхоспазма показаны бета2-адреномиметики.
Взаимодействие с другими лекарственными средствами
При совместном применении с эуфиллином и теофиллином, возможно взаимное подавление терапевтических эффектов.При одновременном применении Атенолола с инсулином, противодиабетическими средствами их гипогликемизирующее действие усиливается.При совместном применении с антигипертензивными средствами разных групп или нитратами происходит усиление гипотензивного действия. Одновременное применение Атенолола и верапамила (или дилтиазема) может вызвать взаимное усиление кардиодепрессивного действия.При одновременном применении Атенолола и сердечных гликозидов повышается риск развития брадикардии и нарушения AV проводимости.При одновременном назначении Атенолола с резерпином, метилдопой, клонидином, верапамилом возможно возникновение выраженной брадикардии.При одновременном приеме Атенолола с производными эрготамина, ксантина, НПВС эффективность их снижается.При прекращении комбинированного применения Атенолола и клонидина лечение клонидином продолжают еще несколько дней после отмены Атенолола.Одновременное применение с лидокаином может уменьшить его выведение и повысить риск токсического действия лидокаина.Применение совместно с производными фенотиазина, способствует повышению концентрации каждого из препаратов в сыворотке крови.Противопоказано одновременное применение с ингибиторами МАО.
Форма выпуска
Таблетки.
Условия хранения
В сухом месте, при температуре не выше 30°C. Хранить в недоступном для детей месте.
Срок годности
3 года. Не применять по истечении срока годности, указанного на упаковке.2000-2017. Регистр лекарственных средств России.
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Не обладает мембраностабилизирующей и внутренней симпатомиметической активностью. Уменьшает стимулированное катехоламинами образование цАМФ из АТФ. "}},{"type":"paragraph","data":{"text":"В первые 24 ч после перорального приема на фоне снижения сердечного выброса отмечается реактивное повышение общего периферического сопротивления сосудов, выраженность которого в течение 1-3 суток постепенно снижается. "}},{"type":"paragraph","data":{"text":"Гипотензивный эффект связан с уменьшением сердечного выброса, снижением активности ренин-ангиотензиновой системы, чувствительности барорецепторов и влиянием на центральную нервную систему. Гипотензивное действие проявляется как снижением систолического, так и диастолического артериального давления (АД), уменьшением ударного и минутного объемов. "}},{"type":"paragraph","data":{"text":"В средних терапевтических дозах не оказывает влияния на тонус периферических артерий. Гипотензивный эффект продолжается 24 ч, при регулярном применении стабилизируется к концу второй недели лечения. "}},{"type":"paragraph","data":{"text":"Антиангинальный эффект определяется снижением потребности миокарда в кислороде в результате уменьшения частоты сердечных сокращений (удлинение диастолы и улучшение перфузии миокарда) и сократимости, а также снижением чувствительности миокарда к воздействию симпатической стимуляции. Урежает частоту сердечных сокращений (ЧСС) в покое и при физической нагрузке. "}},{"type":"paragraph","data":{"text":"За счет повышения конечного диастолического давления в левом желудочке и увеличения растяжения мышечных волокон желудочков может повышать потребность в кислороде, особенно у больных с хронической сердечной недостаточностью."}},{"type":"paragraph","data":{"text":"Антиаритмическое действие проявляется подавлением синусовой тахикардии и связано с устранением аритмогенных симпатических влияний на проводящую систему сердца, уменьшением скорости распространения возбуждения через синоатриальный узел и удлинением рефрактерного периода. "}},{"type":"paragraph","data":{"text":"Угнетает проведение импульсов в антеградном и в меньшей степени в ретроградном направлениях через АV (атриовентрикулярный) узел и по дополнительным путям проведения."}},{"type":"paragraph","data":{"text":"Отрицательный хронотропный эффект проявляется через 1 ч после приема, достигает максимума спустя 2-4 ч, продолжается до 24 ч."}},{"type":"paragraph","data":{"text":"Уменьшает автоматизм синусового узла, урежает ЧСС, замедляет АV проводимость, снижает сократимость миокарда, снижает потребность миокарда в кислороде. Уменьшает возбудимость миокарда. При применении в средних терапевтических дозах оказывает менее выраженное влияние на гладкую мускулатуру бронхов и периферических артерий, чем неселективные"}},{"type":"paragraph","data":{"text":"бета-адреноблокаторы."}}]},{"id":1,"name":"Фармакологические свойства","slug":"pharmacologic_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Фармакологическое действие — антиангинальное, антигипертензивное, антиаритмическое."}}]},{"id":2,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"артериальная гипертензия;профилактика приступов стенокардии (за исключением стенокардии Принцметала);нарушения сердечного ритма (синусовая тахикардия, профилактика наджелудочковых тахиаритмий);нейроциркуляторная дистония по гипертоническому типу."}}]},{"id":3,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"повышенная чувствительность к препарату;AV-блокада II–III степени;синдром слабости синусного узла;кардиогенный шок;острая сердечная недостаточность;выраженная брадикардия;артериальная гипотензия при инфаркте (сАД \u003c100 мм рт. ст.);хроническая сердечная недостаточность IIБ–III стадии;синоаурикулярная блокада;метаболический ацидоз;бронхиальная астма;сочетание с ингибиторами МАО;детский возраст до 18 лет."}}]},{"id":4,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Беременным следует назначать Атенолол только в тех случаях, когда польза для матери превышает потенциальный риск для плода.Атенолол выделяется с грудным молоком, поэтому в период кормления его следует принимать только в исключительных случаях с большой осторожностью."}}]},{"id":5,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Внутрь, перед едой, не разжевывают, запивают небольшим количеством жидкости. Режим дозирования устанавливается индивидуально.Артериальная гипертензияЛечение начинают с 25–50 мг Атенолола 1 раз в сутки. Для достижения стабильного гипотензивного эффекта требуется 1–2 недели приема. При недостаточной выраженности гипотензивного эффекта дозу повышают до 100 мг на один прием. Дальнейшее увеличение дозы не рекомендуется, т.к. не сопровождается усилением клинического эффекта.СтенокардияНачальная доза— 25–50 мг в сутки. Если в течение недели не достигается оптимальный терапевтический эффект, увеличивают дозу до 100 мг/сут за 1 или 2 приема.Пациентам пожилого возраста и больным с нарушениями выделительной функции почек необходима коррекция режима дозирования.При наличии почечной недостаточности рекомендуют коррекцию дозы в зависимости от клиренса креатинина.При значениях Cl креатинина выше 35 мл/мин/1,73 м2 (нормальные значения составляют 100–150 мл/мин/1,73 м2) значительной кумуляции Атенолола не происходит.В таблице указаны рекомендуемые максимальные дозы для больных с почечной недостаточностью.Таблица Клиренс креатинина, мл/мин/1,73м2 Время полувыведения, ч Максимальная доза 15–35 16–27 50 мг в сутки \u003c15 \u003e27 50 мг через день Больным, находящимся на гемодиализе, Атенолол назначают по 50 мг/сутки сразу после проведения каждого диализа. Прием необходимо проводить в стационарных условиях, т.к. может иметь место падение артериального давления.Для вторичной профилактики инфаркта миокарда— 100 мг 1 раз в день или по 50 мг 2 раза в день в течение 6–9 дней или до выписки из стационара.При функциональных нарушениях сердечно-сосудистой системы рекомендуется применять Атенолол в дозе 25 мг в день."}}]},{"id":6,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Наиболее часто встречающиеся побочные явления связаны с основным фармакологическим действием препарата и выражаются следующим образом.Со стороны сердечно-сосудистой системы: появление симптомов сердечной недостаточности, нарушение AV проводимости, брадикардия, артериальная гипотензия, ощущение холода и парестезии в конечностях.Со стороны ЦНС: головокружение, нарушение сна, снижение способности к концентрации внимания, сонливость, депрессия, галлюцинации, вялость, чувство усталости, головная боль.Со стороны органов ЖКТ: сухость во рту, тошнота, рвота, понос, боли в животе, запор;Со стороны дыхательной системы: диспноэ, бронхоспазм, апноэ.Гематологические реакции: тромбоцитопеническая пурпура, анемия (апластическая), тромбоз.Со стороны эндокринной системы: гинекомастия, снижение потенции, снижение либидо;Метаболические реакции: гиперлипидемия, гипогликемия;Со стороны кожных покровов: крапивница, дерматиты, зуд, фоточувствительность."}}]},{"id":7,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Симптомы: брадикардия, атриовентрикулярная блокада II и III степени, нарастание симптомов сердечной недостаточности, артериальная гипотензия, бронхоспазм, гипогликемия.При появлении симптомов передозировки немедленно обратиться к врачу.Лечение: При выраженной брадикардии показано внутривенное введение 1 мл 0,1 % раствора атропина сульфата.При AV блокаде II и III степени возможно назначение изопреналина в таблетках по 5 мг под язык (при необходимости— повторный прием через 2–4 ч) или в/в капельное или медленное струйное введение препарата в дозе 0,5–1 мг. При возникновении бронхоспазма показаны бета2-адреномиметики."}}]},{"id":8,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"При совместном применении с эуфиллином и теофиллином, возможно взаимное подавление терапевтических эффектов.При одновременном применении Атенолола с инсулином, противодиабетическими средствами их гипогликемизирующее действие усиливается.При совместном применении с антигипертензивными средствами разных групп или нитратами происходит усиление гипотензивного действия. Одновременное применение Атенолола и верапамила (или дилтиазема) может вызвать взаимное усиление кардиодепрессивного действия.При одновременном применении Атенолола и сердечных гликозидов повышается риск развития брадикардии и нарушения AV проводимости.При одновременном назначении Атенолола с резерпином, метилдопой, клонидином, верапамилом возможно возникновение выраженной брадикардии.При одновременном приеме Атенолола с производными эрготамина, ксантина, НПВС эффективность их снижается.При прекращении комбинированного применения Атенолола и клонидина лечение клонидином продолжают еще несколько дней после отмены Атенолола.Одновременное применение с лидокаином может уменьшить его выведение и повысить риск токсического действия лидокаина.Применение совместно с производными фенотиазина, способствует повышению концентрации каждого из препаратов в сыворотке крови.Противопоказано одновременное применение с ингибиторами МАО."}}]},{"id":19,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Таблетки."}}]},{"id":9,"name":"Условия хранения","slug":"storage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"В сухом месте, при температуре не выше 30°C. 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