НОРФЛОКСАЦИН Таблетки, 10 шт, 400 мг, для взрослых, в пленочной оболочке

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Низкая величина связывания норфлоксацина с белками плазмы (10-15 %) и высокая растворимость в липидах обусловливают большой объем распределения препарата и хорошее проникновение в органы и ткани (паренхима почек яичники жидкость семенных канальцев предстательная железа матка органы брюшной полости и малого таза желчь материнское молоко). Проникает через гематоэнцефалический барьер и плаценту. Метаболизируется в печени. Почечный клиренс - 275 мл/мин. В течение 24 ч 26-32% выводится почками в неизмененном виде 5-8% в виде слабоактивного метаболита. В последующем почками выводится менее 1% принятой дозы. 30% выводится кишечником. У пожилых пациентов почками выводится 22% норфлоксацина (почечный клиренс - 154 мл/мин)."}},{"type":"paragraph","data":{"text":"Через 2-3 ч после приема 400 мг внутрь концентрация в моче превышает 200 мкг/мл в течение 12 ч она поддерживается выше 30 мкг/мл. При pH 75 растворимость норфлоксацина снижается."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Инфекционно-воспалительные заболевания вызванные чувствительными к норфлоксацину микроорганизмами: инфекции мочевыводящих путей (кроме острого и хронического осложненного пиелонефрита) хронический бактериальный простатит неосложненная гонорея сальмонеллез шигеллез."}},{"type":"paragraph","data":{"text":"Профилактика диареи путешественников профилактика сепсиса у пациентов с нейтропенией"}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"- повышенная чувствительность к норфлоксацину компонентам препарата и другим хинолонам;"}},{"type":"paragraph","data":{"text":"- дефицит глюкозо-6-фосфатдегидрогеназы;"}},{"type":"paragraph","data":{"text":"- тендинит разрыв сухожилия вызванные приемом фторхинолонов (в т.ч. в анамнезе);"}},{"type":"paragraph","data":{"text":"- наследственная непереносимость лактозы дефицит лактазы или глюкозо-галактозная мальабсорбция;"}},{"type":"paragraph","data":{"text":"- детский и подростковый возраст (до 18 лет);"}},{"type":"paragraph","data":{"text":"- беременность и период лактации."}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"Атеросклероз сосудов головного мозга нарушение мозгового кровообращения (в анамнезе) эпилепсия органические заболевания центральной нервной системы предрасположенность к судорожным реакциям психозы и другие психические нарушения в анамнезе почечная/печеночная недостаточность миастения gravis печеночная порфирия сахарный диабет синдром врожденного удлинения интервала QT заболевания сердца (сердечная недостаточность инфаркт миокарда брадикардия) электролитный дисбаланс (например при гипокалиемии гипомагниемии) пожилой возраст у женщин одновременный прием лекарственных средств удлиняющих интервал QT (антиаритмические средства IA и III классов трициклические и тетрациклические антидепрессанты нейролептики макролиды противогрибковые производные имидазола некоторые антигистаминные в т.ч. астемизол терфенадин эбастин) средств для общей анестезии из группы барбитуратов; лекарственных средств снижающих артериальное давление."}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"Безопасность применения во время беременности и в период лактации не изучена. Препарат противопоказан в период беременности. При необходимости назначения препарата в период лактации следует прекратить грудное вскармливание"}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Внутрь натощак (не менее чем за 1 час до или через 2 часа после еды) и запивают достаточным количеством жидкости."}},{"type":"paragraph","data":{"text":"При отсутствии особых предписаний врача рекомендуются следующие дозы: по 1 таблетке (400 мг) 2 раза в день. Продолжительность лечения от 7 до 14 дней при необходимости проводят более длительное лечение."}},{"type":"paragraph","data":{"text":"При инфекциях мочевыводящих путей - по 400 мг 2 раза в день в течение 7-10 дней; при неосложненном цистите - 3-7 дней; при хронической рецидивирующей инфекции мочевыводящих путей - до 12 недель; при остром бактериальном гастроэнтерите (шигеллез сальмонеллез) - 5 дней; при остром гонококковом уретрите фарингите проктите цервиците - однократно 800 мг. Для профилактики инфекций (у пациентов с нейтропенией) - по 400 мг 2 раза в сутки; для профилактики бактериальных гастроэнтеритов - по 400 мг/сут. Для профилактики диареи путешественников - по 400 мг/сут за 1 день до отъезда и в течение всего периода пути (не более 21 дня). Для профилактики рецидивов инфекций мочевыводящих путей - по 200 мг/сут. При бактериальном простатите (остром и хроническом) - по 400 мг 2 раза в день 28 дней."}},{"type":"paragraph","data":{"text":"У пациентов с нарушениями функции почек при клиренсе креатинина (КК) более 30 мл/мин коррекции режима дозирования не требуется. При КК ниже 30 мл/мин и пациентам находящимся на гемодиализе назначают 1/2 терапевтической дозы 2 раза в сутки или полную дозу 1 раз в сутки."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Со стороны нервной системы: головокружение головная боль беспокойство покалывание в пальцах рук сонливость тревога депрессия бессонница нарушение сна."}},{"type":"paragraph","data":{"text":"Со стороны пищеварительной системы: тошнота боль в животе анорексия диарея боль в прямой кишке или анусе запор диспепсия метеоризм рвота сухость слизистой оболочки полости рта изжога неоформленный стул горький привкус во рту изъязвление слизистой оболочки полости рта зуд ануса."}},{"type":"paragraph","data":{"text":"Со стороны органов кроветворения: лейкопения тромбоцитопения эозинофилия нейтропения."}},{"type":"paragraph","data":{"text":"Со стороны кожных покровов: зуд сыпь эритема крапивница."}},{"type":"paragraph","data":{"text":"Со стороны органов чувств: нечеткость зрительного восприятия."}},{"type":"paragraph","data":{"text":"Со стороны опорно-двигательного аппарата: бурсит отечность кистей и стоп."}},{"type":"paragraph","data":{"text":"Со стороны сердечно-сосудистой системы: инфаркт миокарда ощущение сердцебиения."}},{"type":"paragraph","data":{"text":"Со стороны мочевыделительной системы:почечная колика."}},{"type":"paragraph","data":{"text":"Лабораторные показатели: повышение активности \"печеночных\" трансаминаз (аланинаминотрансферазы аспартатаминотрансферазы щелочной фосфатазы лактадегидрогеназы) протеинурия снижение гематокрита и гемоглобина повышение концентрации мочевины в крови гиперкреатининемия глюкозурия."}},{"type":"paragraph","data":{"text":"Прочие: гипергидроз астения боль в спине лихорадка озноб боль в груди дисменорея отеки аллергические реакции усталость."}},{"type":"paragraph","data":{"text":"Постмаркетинговый опыт."}},{"type":"paragraph","data":{"text":"Со стороны нервной системы: судороги миоклония тремор периферическая нейропатия синдром Гийена-Барре атаксия парестезия гипестезия психические нарушения (в т.ч. спутанность сознания) раздражительность чувство страха."}},{"type":"paragraph","data":{"text":"Аллергические реакции: анафилактические/анафилактоидные реакции ангионевротический отек одышка васкулит крапивница."}},{"type":"paragraph","data":{"text":"Со стороны кожных покровов: токсический эпидермальный некролиз синдром Стивенса-Джонсона многоформная эритема эксфолиативный дерматит фотосенсибилизация лейкоцитокластический васкулит лекарственная сыпь с эозинофилией и системной симптоматикой (DRESS-синдром)."}},{"type":"paragraph","data":{"text":"Со стороны пищеварительной системы: псевдомембранозный колит гепатит холестатическая желтуха панкреатит стоматит печеночная недостаточность (в т.ч. с летальным исходом)."}},{"type":"paragraph","data":{"text":"Со стороны сердечно-сосудистой системы: удлинение интервала QT желудочковая аритмия в т.ч. тахикардия типа \"пируэт\"."}},{"type":"paragraph","data":{"text":"Со стороны мочевыделительной системы: повышение содержания мочевины в плазме интерстициальный нефрит почечная недостаточность."}},{"type":"paragraph","data":{"text":"Со стороны опорно-двигательного аппарата: артрит артралгия миалгия тендинит разрыв сухожилия обострение миастении gravis повышение активности креатинфосфокиназы мышечные спазмы."}},{"type":"paragraph","data":{"text":"Со стороны органов кроветворения: агранулоцитоз гемолитическая анемия."}},{"type":"paragraph","data":{"text":"Со стороны органов чувств: снижение слуха шум в ушах диплопия дисгевзия."}},{"type":"paragraph","data":{"text":"Прочие побочные эффекты при приеме хинолонов: агранулоцитоз альбуминурия кандидурия кристаллурия цилиндрурия дисфагия гипергликемия гиперхолестеринемия гиперкалиемия гипертриглицеридемия гематурия некроз печени гипогликемия нистагм постуральная гипотензия удлинение протромбинового времени кандидоз влагалища."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Симптомы: тошнота рвота диарея головокружение сонливость \"холодный\" пот судороги одутловатое лицо."}},{"type":"paragraph","data":{"text":"Лечение: промывание желудка адекватная гирдатационная терапия с форсированным диурезом и симптоматическая терапия. Требуется обследование и наблюдение в стационаре в течение нескольких дней. Специфического антидота нет."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"При одновременном применении норфлоксацина и теофиллина следует контролировать концентрацию теофиллина в плазме крови и корректировать его дозу так как норфлоксацин снижает клиренс теофиллина на 25%."}},{"type":"paragraph","data":{"text":"Снижает эффект нитрофуранов."}},{"type":"paragraph","data":{"text":"Норфлоксацин может усиливать терапевтическое действие циклоспорина и непрямых антикоагулянтов в отдельных случаях при применении норфлоксацина с циклоспорином наблюдалось увеличение концентрации креатинина в плазме крови поэтому у таких пациентов необходим контроль этого показателя а так же плазменной концентрации циклоспорина."}},{"type":"paragraph","data":{"text":"Одновременное применение норфлоксацина и антацидных средств содержащих гидроксид алюминия или магния а также препаратов содержащих ионы железа цинка сукральфат приводит к снижению всасывания норфлоксацина (интервал между их приемом должен быть не менее 2 часов)."}},{"type":"paragraph","data":{"text":"Одновременное применение с лекарственными препаратами (в т.ч. с нестероидными противовоспалительными препаратами) снижающими судорожный порог может привести к развитию судорог."}},{"type":"paragraph","data":{"text":"Одновременное применение с глюкокортикостероидами может способствовать увеличению риска развития тендинитов или случаев разрыва сухожилий."}},{"type":"paragraph","data":{"text":"Норфлоксацин может усиливать терапевтическое действие гипогликемических препаратов (производные сульфонилмочевины) в связи с чем необходимо контролировать концентрацию глюкозы в плазме крови."}},{"type":"paragraph","data":{"text":"Одновременное применение норфлоксацина с препаратами обладающими потенциальной способностью понижать артериальное давление может вызвать резкое его снижение. В связи с этим в таких случаях а также при одновременном введении с барбитуратами и другими лекарственными средствами для общей анестезии следует контролировать частоту сердечных сокращений артериальное давление и показатели ЭКГ."}},{"type":"paragraph","data":{"text":"Норфлоксацин in vitro ингибирует изофермент CYP1A2 что может привести к повышению концентрации его субстратов в плазме крови (в т.ч. кофеина клозапина ропинирола такрина теофиллина тизанидина) в связи с чем необходимо наблюдение за пациентами принимающими одновременно с норфлоксацином эти препараты."}},{"type":"paragraph","data":{"text":"Пробенецид может снижать экскрецию норфлоксацина."}},{"type":"paragraph","data":{"text":"При одновременном применение с препаратами удлиняющими интервал QT возможно более выраженное удлинение последнего."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"В некоторых случаях уже после первого применения препарата могут развиться реакции гиперчувствительности (анафилактичесие/анафилактоидные реакции) о чем следует немедленно информировать врача. Очень редко даже после первого применения препарата анафилактические реакции могут прогрессировать до угрожающего жизни анафилактического шока. В этих случаях лечение норфлоксацином следует прекратить и немедленно начать проводить необходимые лечебные мероприятия (в т.ч. противошоковые)."}},{"type":"paragraph","data":{"text":"В период лечения норфлоксацином пациенты должны получать достаточное количество жидкости (под контролем диуреза)."}},{"type":"paragraph","data":{"text":"В период терапии возможно увеличение протромбинового индекса (при проведении хирургических вмешательств следует контролировать состояние системы свертывания крови)."}},{"type":"paragraph","data":{"text":"Во время лечения норфлоксацином следует избегать воздействия ультрафиолетовых лучей в т.ч. прямого солнечного света."}},{"type":"paragraph","data":{"text":"Норфлоксацин как и другие фторхинолоны может вызывать тендинит и разрыв сухожилий. Факторы риска: возраст старше 60 лет прием глюкокортикостероидов трансплантация почки сердца или легкого повышенная физическая активность хроническая почечная недостаточность поражение сухожилий в анамнезе (в т.ч. ревматоидный артрит). Данные явления могут возникать и через несколько месяцев после завершения приема препарата. При появлении болей в сухожилиях или при первых признаках тендовагинита необходимо отменить препарат и обратиться к врачу. Во время терапии норфлоксацином рекомендуется избегать чрезмерных физических нагрузок. Норфлоксацин может снижать порог судорожной готовности и вызывать судороги; фторхинолоны могут также стимулировать центральную нервную систему вызывая тремор токсические психозы беспокойство спутанность сознания и галлюцинации; повышение внутричерепного давления. В случае развития судорог применение препарата следует прекратить."}},{"type":"paragraph","data":{"text":"Норфлоксацин может приводить к развитию псевдомембранозного колита вызванного Clostridium difficile. В этом случае необходимо отменить препарат и назначитьсоответствующее лечение (в том числе применение ванкомицина внутрь или метронидазола). Препараты тормозящие перистальтику кишечника противопоказаны."}},{"type":"paragraph","data":{"text":"При применении норфлоксацина сообщалось о случаях развития холестатического гепатита. Пациента следует информировать о том что в случае появления симптомов нарушения функции печени (анорексия желтуха потемнение мочи зуд боль в животе) необходимо обратиться к врачу прежде чем продолжить лечение норфлоксацином."}},{"type":"paragraph","data":{"text":"Не эффективен при сифилисе."}},{"type":"paragraph","data":{"text":"У пациентов которым проводилось лечение хинолонами включая норфлоксацин описаны случаи сенсорной или сенсомоторной аксональной полинейропатии поражающей мелкие и/или крупные аксоны и приводящей к парестезии гипостезии дизестезии и слабости. Симптомы могут проявиться вскоре после начала применения и быть необратимыми. Пациентов которым проводится лечение норфлоксацином следует предупредить о необходимости немедленного обращения к врачу в случае возникновения симптомов нейропатии включающих боль жжение покалывание онемение слабость или другие нарушения чувствительности включая тактильную болевую температурную вибрационную чувствительность и чувство положения (см. раздел \"Побочное действие\") Норфлоксацин необходимо немедленно отменить."}},{"type":"paragraph","data":{"text":"Во избежание образования кристаллов норфлоксацина в почках не следует превышать рекомендованных доз; необходимо запивать таблетки достаточным количеством жидкости."}}]},{"id":17,"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","body":[{"type":"paragraph","data":{"text":"Необходимо соблюдать осторожность при вождении автомобиля и занятиях другими потенциально опасными видами деятельности требующими повышенной концентрации внимания и быстроты психомоторных реакций."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Таблетки покрытые пленочной оболочкой 400 мг."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"В защищенном от света месте при температуре не выше 25 °С. Хранить в недоступном для детей месте."}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"3 года. Не использовать препарат после истечения срока годности."}}]},{"id":21,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"По рецепту"}}]},{"id":22,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"Общество с ограниченной ответственностью \"Озон\" (ООО \"Озон\"), 445351, Самарская, обл., г. Жигулевск, ул. Гидростроителей, д. 6; д. 6, стр. 1; д. 6-А; д. 6-А, стр. 1, Россия"}}]},{"id":23,"name":"Организация, принимающая претензии потребителей","body":[{"type":"paragraph","data":{"text":"ООО \"Атолл\""}}]}],"source":null},"description_toggle":false,"short_description":"Противомикробное средство из группы фторхинолонов. Оказывает бактерицидное действие. Воздействует на бактериальный фермент ДНК-гиразу обеспечивающую сверхспирализацию и таким образом стабильность ДНК бактерий. Дестабилизация цепи ДНК приводит к гибели бактерий. Обладает широким спектром антибактериального действия и активен в отношении большинства штаммов микроорганизмов как в условиях in vitro так и in vivo. Чувствительны in vivo: грамположительные аэробы - Enterococcus faecalis Staphylococcus aureus Staphylococcus epidermidis Staphylococcus saprophyticus Streptococcus agalactiae; грамотрицательные аэробы - Citrobacter freundii Enterobacter aerogenes Enterobacter cloacae Escherichia coli Klebsiella pneumoniae Neisseria gonorrhoeae Proteus mirabilis Proteus vulgaris Pseudomonas aeruginosa Serratia marcescens Salmonella spp. Shigella spp. Чувствительны in vitro: грамотрицательные аэробы - Citrobacter diversus Edwardsiella tarda Enterobacter agglomerans Haemophilus ducreyi Klebsiella oxytoca Morganella morganii Providencia alcalifaciens Providencia rettgeri Providencia stuartii Pseudomonas fluorescens Pseudomonas stutzeri; прочие - Ureaplasma urealyticum. Неактивен в отношении облигатных анаэробов Абсорбция норфлоксацина при приеме внутрь - быстрая; биодоступность - 30-40%; пища замедляет абсорбцию препарата но не изменяет максимальную концентрацию и биодоступность. Максимальные концентрации в плазме крови достигаются через 1 -2 ч и составляют от 08 до 24 мкг/мл в зависимости от дозы (200-800 мг). Низкая величина связывания норфлоксацина с белками плазмы (10-15 %) и высокая растворимость в липидах обусловливают большой объем распределения препарата и хорошее проникновение в органы и ткани (паренхима почек яичники жидкость семенных канальцев предстательная железа матка органы брюшной полости и малого таза желчь материнское молоко). Проникает через гематоэнцефалический барьер и плаценту. Метаболизируется в печени. Почечный клиренс - 275 мл/мин. В течение 24 ч 26-32% выводится почками в неизмененном виде 5-8% в виде слабоактивного метаболита. В последующем почками выводится менее 1% принятой дозы. 30% выводится кишечником. У пожилых пациентов почками выводится 22% норфлоксацина (почечный клиренс - 154 мл/мин). Через 2-3 ч после приема 400 мг внутрь концентрация в моче превышает 200 мкг/мл в течение 12 ч она поддерживается выше 30 мкг/мл. 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