- Острые и хронические церебральные метаболические и сосудистые нарушения (вследствие атеросклероза артериальной гипертензии тромбоза и эмболии сосудов головного мозга) в том числе транзиторная ишемическая атака сосудистая дементация и головная боль вызванная вазоспазмом;
- Острые и хронические периферические метаболические и сосудистые нарушения (органические ...
Недавно перенесенный инфаркт миокарда острое кровотечение выраженная брадикардия нарушение ортостатической регуляции повышенная чувствительность к ницерголину или другим компонентам препарата
Круглые, двояковыпуклые таблетки, покрытые оболочкой белого или почти белого цвета. На поперечном разрезе видны два слоя.
Фармакотерапевтическая группа
Альфа-адреноблокатор
Фармакологические свойства
Фармакодинамика:
Ницерголин - производное эрголина улучшает метаболические и гемодинамические процессы в головном мозге снижает агрегацию тромбоцитов и улучшает гемореологические показатели крови повышает скорость кровотока в верхних и нижних конечностях проявляет альфа-1-адреноблокирующее действие.
Фармакокинетика:
После приема внутрь ницерголин быстро и практически полностью абсорбируется. Основные продукты метаболизма ницерголина: 16-диметил-8ß-гидроксиметил-10α-метоксиэрголин (MMDL продукт гидролиза) и 6-метил-8ß- гидроксиметил-10α-метоксиэрголин (MDL продукт диметилирования под действием изофермента CYP2D6). Соотношение значений площади пол кривой "концентрация- время" (AUC) для MMDL и MDL при приеме внутрь и внутривенном введении ницерголина указывает на выраженный метаболизм при первом прохождении. После приема 30 мг ницерголина внутрь максимальные концентрации MMDL (21 ±14 мг/мл) и MDL (41 ±14 мг/мл) достигались примерно через 1 и 4 часа соответственно затем концентрация MDL снижается с периодом полувыведения 13 - 20 ч. Прием пищи не оказывает существенного влияния на степень и скорость всасывания ницерголина. Ницерголин активно (> 90 %) связывается с белками плазмы причем степень его сродства к а-кислоте гликопротеина больше чем к сывороточному альбумину. Показано что ницерголин и его метаболиты могут распределяться в клетках крови. Фармакокинетика ницерголина при применении доз до 60 мг носит линейный характер и не меняется в зависимости от возраста пациента.
Ницерголин выводится в форме метаболитов в основном с мочой (примерно 80 % от общей дозы) и в небольшом количестве (10-29 %) - с калом. У больных тяжелой почечной недостаточностью наблюдается значительное снижение степени выведения продуктов метаболизма с мочой по сравнению с пациентами с нормальной функцией почек.
Показания к применению
- Острые и хронические церебральные метаболические и сосудистые нарушения (вследствие атеросклероза артериальной гипертензии тромбоза и эмболии сосудов головного мозга) в том числе транзиторная ишемическая атака сосудистая дементация и головная боль вызванная вазоспазмом;
- Острые и хронические периферические метаболические и сосудистые нарушения (органические и функциональные артериопатии конечностей болезнь Рейно синдромы обусловленные нарушением периферического кровотока.
Противопоказания
Недавно перенесенный инфаркт миокарда острое кровотечение выраженная брадикардия нарушение ортостатической регуляции повышенная чувствительность к ницерголину или другим компонентам препарата
С осторожностью
Гиперурикемия или подагра в анамнезе и/или в сочетании с лекарственными средствами которые нарушают метаболизм или выведение мочевой кислоты.
Применение при беременности и в период грудного вскармливания
В связи с отсутствием специальных исследований в период беременности ницерголин следует применять только при наличии явной необходимости и под непосредственным контролем врача. На время приема препарата необходимо отказаться от грудного вскармливания т.к. ницерголин и продукты его метаболизма проникают в молоко матери.
Способ применения и дозы
Внутрь по 5 - 10 мг три раза в сутки с одинаковыми интервалами в течение длительного периода времени (до нескольких месяцев). При сосудистой деменции показано применение 30 мг 2 раза в сутки (при этом каждые 6 месяцев рекомендуется консультироваться с врачом о целесообразности продолжения терапии).
Доза и длительность терапии зависят от характера заболевания. В некоторых случая предпочтительнее начать терапию с парентерального введения а затем перейти на прием препарата внутрь для поддерживающего лечения.
Больным с нарушением функции почек (сывороточный креатинин > 2 мг/дл) ницерголин рекомендуется применять в более низких терапевтических дозах.
Побочное действие
Снижение артериального давления (АД) головокружение диспептические явления ощущение жара аллергические реакции сонливость или бессонница Возможно повышение концентрации мочевой кислоты в крови причем этот эффект не зависит от дозы и длительности терапии. Побочные эффекты обычно легко или умеренно выражены.
Передозировка
Симптомы: преходящее выраженное снижение АД. Специального лечения обычно не требуется больному достаточно на несколько минут принять горизонтальное положение. В исключительных случаях при резком нарушении кровоснабжения головного мозга и сердца рекомендуется введение симпатомиметических средств под постоянным контролем артериального давления.
Взаимодействие с другими лекарственными средствами
Может усиливать действие антигипертензивных средств. Ницерголин метаболизируется под действием цитохрома CYP450 2D6 поэтому нельзя исключить возможность его взаимодействия с препаратами которые метаболизируются при участии этого же фермента.
Особые указания
В терапевтических дозах Ницерголин как правило не влияет на артериальное давление однако у больных артериальной гипертонией он может вызвать его постепенное снижение.
Препарат действует постепенно поэтому его следует принимать в течение длительного времени при этом врач периодически (по крайней мере каждые 6 месяцев)оценивать эффект лечения и целесообразность его продолжения.
Влияние на способность управлять автомобилем и движущимися механизмами
Несмотря на то что ницерголин улучшает реакцию и концентрацию внимания его воздействие на способность управлять автомобилем и пользоваться сложной техникой специально не изучалось. В любом случае следует соблюдать осторожность учитывая характер основного заболевания.
Форма выпуска
Таблетки покрытые оболочкой 10 мг.
Условия хранения
В сухом защищенном от света месте при температуре не выше 25 °С.
Хранить в недоступном для детей месте
Срок годности
2 года. Не использовать позже срока указанного на упаковке.
Условия отпуска
По рецепту
Производитель
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На поперечном разрезе видны два слоя."}}]},{"id":6,"name":"Фармакотерапевтическая группа","slug":"","body":[{"type":"paragraph","data":{"text":"Альфа-адреноблокатор"}}]},{"id":7,"name":"Фармакологические свойства","slug":"pharmacologic_effects","body":[{"type":"header","data":{"text":"Фармакодинамика:","level":3}},{"type":"paragraph","data":{"text":"Ницерголин - производное эрголина улучшает метаболические и гемодинамические процессы в головном мозге снижает агрегацию тромбоцитов и улучшает гемореологические показатели крови повышает скорость кровотока в верхних и нижних конечностях проявляет альфа-1-адреноблокирующее действие."}},{"type":"header","data":{"text":"Фармакокинетика:","level":3}},{"type":"paragraph","data":{"text":"После приема внутрь ницерголин быстро и практически полностью абсорбируется. Основные продукты метаболизма ницерголина: 16-диметил-8ß-гидроксиметил-10α-метоксиэрголин (MMDL продукт гидролиза) и 6-метил-8ß- гидроксиметил-10α-метоксиэрголин (MDL продукт диметилирования под действием изофермента CYP2D6). Соотношение значений площади пол кривой \"концентрация- время\" (AUC) для MMDL и MDL при приеме внутрь и внутривенном введении ницерголина указывает на выраженный метаболизм при первом прохождении. После приема 30 мг ницерголина внутрь максимальные концентрации MMDL (21 ±14 мг/мл) и MDL (41 ±14 мг/мл) достигались примерно через 1 и 4 часа соответственно затем концентрация MDL снижается с периодом полувыведения 13 - 20 ч. Прием пищи не оказывает существенного влияния на степень и скорость всасывания ницерголина. Ницерголин активно (> 90 %) связывается с белками плазмы причем степень его сродства к а-кислоте гликопротеина больше чем к сывороточному альбумину. Показано что ницерголин и его метаболиты могут распределяться в клетках крови. Фармакокинетика ницерголина при применении доз до 60 мг носит линейный характер и не меняется в зависимости от возраста пациента."}},{"type":"paragraph","data":{"text":"Ницерголин выводится в форме метаболитов в основном с мочой (примерно 80 % от общей дозы) и в небольшом количестве (10-29 %) - с калом. У больных тяжелой почечной недостаточностью наблюдается значительное снижение степени выведения продуктов метаболизма с мочой по сравнению с пациентами с нормальной функцией почек."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"- Острые и хронические церебральные метаболические и сосудистые нарушения (вследствие атеросклероза артериальной гипертензии тромбоза и эмболии сосудов головного мозга) в том числе транзиторная ишемическая атака сосудистая дементация и головная боль вызванная вазоспазмом;"}},{"type":"paragraph","data":{"text":"- Острые и хронические периферические метаболические и сосудистые нарушения (органические и функциональные артериопатии конечностей болезнь Рейно синдромы обусловленные нарушением периферического кровотока."}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"Недавно перенесенный инфаркт миокарда острое кровотечение выраженная брадикардия нарушение ортостатической регуляции повышенная чувствительность к ницерголину или другим компонентам препарата"}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"Гиперурикемия или подагра в анамнезе и/или в сочетании с лекарственными средствами которые нарушают метаболизм или выведение мочевой кислоты."}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"В связи с отсутствием специальных исследований в период беременности ницерголин следует применять только при наличии явной необходимости и под непосредственным контролем врача. На время приема препарата необходимо отказаться от грудного вскармливания т.к. ницерголин и продукты его метаболизма проникают в молоко матери."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Внутрь по 5 - 10 мг три раза в сутки с одинаковыми интервалами в течение длительного периода времени (до нескольких месяцев). При сосудистой деменции показано применение 30 мг 2 раза в сутки (при этом каждые 6 месяцев рекомендуется консультироваться с врачом о целесообразности продолжения терапии)."}},{"type":"paragraph","data":{"text":"Доза и длительность терапии зависят от характера заболевания. В некоторых случая предпочтительнее начать терапию с парентерального введения а затем перейти на прием препарата внутрь для поддерживающего лечения."}},{"type":"paragraph","data":{"text":"Больным с нарушением функции почек (сывороточный креатинин > 2 мг/дл) ницерголин рекомендуется применять в более низких терапевтических дозах."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Снижение артериального давления (АД) головокружение диспептические явления ощущение жара аллергические реакции сонливость или бессонница Возможно повышение концентрации мочевой кислоты в крови причем этот эффект не зависит от дозы и длительности терапии. Побочные эффекты обычно легко или умеренно выражены."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Симптомы: преходящее выраженное снижение АД. Специального лечения обычно не требуется больному достаточно на несколько минут принять горизонтальное положение. В исключительных случаях при резком нарушении кровоснабжения головного мозга и сердца рекомендуется введение симпатомиметических средств под постоянным контролем артериального давления."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Может усиливать действие антигипертензивных средств. Ницерголин метаболизируется под действием цитохрома CYP450 2D6 поэтому нельзя исключить возможность его взаимодействия с препаратами которые метаболизируются при участии этого же фермента."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"В терапевтических дозах Ницерголин как правило не влияет на артериальное давление однако у больных артериальной гипертонией он может вызвать его постепенное снижение."}},{"type":"paragraph","data":{"text":"Препарат действует постепенно поэтому его следует принимать в течение длительного времени при этом врач периодически (по крайней мере каждые 6 месяцев)оценивать эффект лечения и целесообразность его продолжения."}}]},{"id":17,"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","body":[{"type":"paragraph","data":{"text":"Несмотря на то что ницерголин улучшает реакцию и концентрацию внимания его воздействие на способность управлять автомобилем и пользоваться сложной техникой специально не изучалось. В любом случае следует соблюдать осторожность учитывая характер основного заболевания."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Таблетки покрытые оболочкой 10 мг."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"В сухом защищенном от света месте при температуре не выше 25 °С."}},{"type":"paragraph","data":{"text":"Хранить в недоступном для детей месте"}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"2 года. Не использовать позже срока указанного на упаковке."}}]},{"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":"ОАО \"АВВА РУС\", 610044, Кировская обл., г. Киров, ул. 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Соотношение значений площади пол кривой \"концентрация- время\" (AUC) для MMDL и MDL при приеме внутрь и внутривенном введении ницерголина указывает на выраженный метаболизм при первом прохождении. После приема 30 мг ницерголина внутрь максимальные концентрации MMDL (21 ±14 мг/мл) и MDL (41 ±14 мг/мл) достигались примерно через 1 и 4 часа соответственно затем концентрация MDL снижается с периодом полувыведения 13 - 20 ч. Прием пищи не оказывает существенного влияния на степень и скорость всасывания ницерголина. Ницерголин активно (\u003e 90 %) связывается с белками плазмы причем степень его сродства к а-кислоте гликопротеина больше чем к сывороточному альбумину. Показано что ницерголин и его метаболиты могут распределяться в клетках крови. Фармакокинетика ницерголина при применении доз до 60 мг носит линейный характер и не меняется в зависимости от возраста пациента. 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