Рабепразол-СЗ Капсулы, 30 шт, 20 мг, кишечнорастворимые

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При прекращении приема секреторная активность восстанавливается в течение 1-2 дней."}},{"type":"paragraph","data":{"text":"В течение первых 2-8 недель терапии рабепразолом концентрация гастрина в плазме крови увеличивается (что является отражением ингибирующего влияния на секрецию соляной кислоты) и возвращается к исходным уровням через 1-2 недели после его отмены."}},{"type":"paragraph","data":{"text":"Рабепразол не обладает антихолинергическими свойствами не влияет на центральную нервную систему (ЦНС) сердечно-сосудистую и дыхательную системы."}},{"type":"paragraph","data":{"text":"На фоне приема рабепразола устойчивые изменения в морфологической структуре энтерохромафинноподобных клеток в степени выраженности гастрита в частоте атрофического гастрита кишечной метаплазии или распространении инфекции Helicobacter pylori не обнаружены."}},{"type":"header","data":{"text":"Фармакокинетика:","level":3}},{"type":"paragraph","data":{"text":"Абсорбция"}},{"type":"paragraph","data":{"text":"Рабепразол быстро абсорбируется из кишечника и его максимальные концентрации в плазме достигаются примерно через 35 ч после приема дозы в 20 мг. 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Прием препарата с жирной пищей замедляет абсорбцию рабепразола на 4 часа и более однако ни С\u003csub\u003emах\u003c/sub\u003e ни степень абсорбции не изменяются."}},{"type":"paragraph","data":{"text":"Распределение"}},{"type":"paragraph","data":{"text":"У человека степень связывания рабепразола с белками плазмы составляет около 97%."}},{"type":"paragraph","data":{"text":"Метаболизм и выведение"}},{"type":"paragraph","data":{"text":"У здоровых людей"}},{"type":"paragraph","data":{"text":"После приема однократной пероральной дозы 20 мг \u003csup\u003e14\u003c/sup\u003eС-меченного рабепразола неизмененного препарата в моче найдено не было. Около 90% рабепразола выводится с мочой главным образом в виде двух метаболитов: конъюгата меркаптуровой кислоты (М5) и карбоновой кислоты (М6) а также в форме двух неизвестных метаболитов выявленных в ходе токсикологического анализа."}},{"type":"paragraph","data":{"text":"Оставшаяся часть принятого рабепразола выводится с калом."}},{"type":"paragraph","data":{"text":"Суммарное выведение составляет 998%. Эти данные свидетельствуют о небольшом выведении метаболитов рабепразола с желчью. Основным метаболитом является тиоэфир (M1). Единственным активным метаболитом является десметил (М3) однако он наблюдался в низкой концентрации только у одного участника исследования после приема 80 мг рабепразола."}},{"type":"paragraph","data":{"text":"Терминальная стадия почечной недостаточности"}},{"type":"paragraph","data":{"text":"У пациентов со стабильной почечной недостаточностью в терминальной стадии которым необходим поддерживающий гемодиализ (клиренс креатинина < 5 мл/мин/173м\u003csup\u003e2\u003c/sup\u003e) выведение рабепразола схоже с таковым для здоровых добровольцев. AUC и С\u003csub\u003emах \u003c/sub\u003eу этих пациентов были примерно на 35% ниже чем у здоровых добровольцев. В среднем период полувыведения рабепразола составлял 082 ч у здоровых добровольцев 095 ч у пациентов во время гемодиализа и 36 ч после гемодиализа. Клиренс препарата у пациентов с заболеваниями почек нуждающихся в гемодиализе был приблизительно в два раза выше чем у здоровых добровольцев."}},{"type":"paragraph","data":{"text":"Хронический компенсированный цирроз"}},{"type":"paragraph","data":{"text":"Пациенты с хроническим компенсированным циррозом печени переносят рабепразол в дозе 20 мг 1 раз в день хотя AUC удвоена и С\u003csub\u003emах\u003c/sub\u003e увеличена на 50% по сравнению со здоровыми добровольцами соответствующего пола."}},{"type":"paragraph","data":{"text":"Пожилые пациенты"}},{"type":"paragraph","data":{"text":"У пожилых пациентов элиминация рабепразола несколько замедлена. После 7 дней приема рабепразола по 20 мг в сутки у пожилых пациентов AUC была примерно вдвое больше а С\u003csub\u003emах\u003c/sub\u003e повышена на 60% по сравнению с молодыми здоровыми добровольцами. Однако признаков кумуляции рабепразола не отмечалось."}},{"type":"paragraph","data":{"text":"CYP2C19 полиморфизм"}},{"type":"paragraph","data":{"text":"У пациентов с замедленным метаболизмом CYP2C19 после 7 дней приема рабепразола в дозе 20 мг в сутки AUC увеличивается в 19 раза а период полувыведения в 16 раза по сравнению с теми же параметрами у \"быстрых метаболизаторов\" в то время как С\u003csub\u003emах\u003c/sub\u003e увеличивается на 40%."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"- Язвенная болезнь желудка в стадии обострения и язва анастомоза;"}},{"type":"paragraph","data":{"text":"- язвенная болезнь двенадцатиперстной кишки в стадии обострения;"}},{"type":"paragraph","data":{"text":"- эрозивная и язвенная гастроэзофагеальная рефлюксная болезнь (ГЭРБ) - взрослые и дети с 12 лет или рефлюкс-эзофагит;"}},{"type":"paragraph","data":{"text":"- поддерживающая терапия гастроэзофагеальной рефлюксной болезни;"}},{"type":"paragraph","data":{"text":"- неэрозивная гастроэзофагеальная рефлюксная болезнь;"}},{"type":"paragraph","data":{"text":"- синдром Золлингера-Эллисона и другие состояния характеризующиеся патологической гиперсекрецией;"}},{"type":"paragraph","data":{"text":"- в комбинации с соответствующей антибактериальной терапией для эрадикации Helicobacter pylori у пациентов с язвенной болезнью."}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"- Гиперчувствительность к рабепразолу замещенным бензимидазолам или к вспомогательным компонентам препарата;"}},{"type":"paragraph","data":{"text":"- дефицит сахаразы/изомальтазы непереносимость фруктозы глюкозо- галактозная недостаточность;"}},{"type":"paragraph","data":{"text":"- беременность;"}},{"type":"paragraph","data":{"text":"- период грудного вскармливания;"}},{"type":"paragraph","data":{"text":"- детский возраст до 18 лет за исключением ГЭРБ (детский возраст до 12 лет)."}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"- Тяжелая почечная недостаточность;"}},{"type":"paragraph","data":{"text":"- тяжелая печеночная недостаточность."}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"Данных по безопасности применения рабепразола во время беременности нет."}},{"type":"paragraph","data":{"text":"Исследования репродуктивности на крысах и кроликах не выявили признаков нарушения фертильности или дефектов развития плода обусловленных рабепразолом; однако у крыс в небольших количествах препарат проникает через плацентарный барьер. Рабепразол не следует применять при беременности."}},{"type":"paragraph","data":{"text":"Неизвестно выделяется ли рабепразол с грудным молоком. Соответствующие исследования по применению препарата в период грудного вскармливания не проводились. Вместе с тем рабепразол обнаружен в молоке лактирующих крыс и поэтому Рабепразол нельзя применять женщинам в период грудного вскармливания."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Капсулы препарата Рабепразол-СЗ следует глотать целиком. Установлено что ни время суток ни прием пищи не влияют на активность рабепразола."}},{"type":"paragraph","data":{"text":"При язвенной болезни желудка в стадии обострения и язве анастомоза рекомендуется принимать внутрь по 10 мг или по 20 мг один раз в день. Обычно излечение наступает после 6 недель терапии однако в некоторых случаях длительность лечения может быть увеличена еще на 6 недель."}},{"type":"paragraph","data":{"text":"При язвенной болезни двенадцатиперстной кишки в стадии обострения рекомендуется принимать внутрь по 20 мг один раз в день. В некоторых случаях лечебный эффект наступает при приеме 10 мг один раз в день. Длительность лечения составляет от 2 до 4 недель. В случае необходимости длительность лечения может быть увеличена еще на 4 недели."}},{"type":"paragraph","data":{"text":"При лечении эрозивной гастроэзофагеальной рефлюксной болезни (ГЭРБ) или рефлюкс-эзофагите рекомендуется принимать внутрь по 10 мг или 20 мг один раз в день. Длительность лечения составляет от 4 до 8 недель. В случае необходимости длительность лечения может быть увеличена еще на 8 недель."}},{"type":"paragraph","data":{"text":"При поддерживающей терапии гастроэзофагеальной рефлюксной болезни (ГЭРБ) рекомендуется принимать внутрь по 10 мг или 20 мг один раз в день. Длительность лечения зависит от состояния пациента."}},{"type":"paragraph","data":{"text":"При неэрозивной гастроэзофагеальной рефлюксной болезни (НЭРБ) без эзофагита рекомендуется принимать внутрь по 10 мг или 20 мг один раз в день."}},{"type":"paragraph","data":{"text":"Если после четырех недель лечения симптомы не исчезают следует провести дополнительное исследование пациента. После купирования симптомов для предупреждения их последующего возникновения следует принимать препарат внутрь в дозе 10 мг один раз в день по требованию."}},{"type":"paragraph","data":{"text":"Для лечения синдрома Золлингера-Эллисона и других состояний характеризующихся патологической гиперсекрецией дозу подбирают индивидуально. Начальная доза - 60 мг в день затем дозу повышают и назначают препарат в дозе до 100 мг в день при однократном приеме или по 60 мг два раза в день. Для некоторых пациентов дробное дозирование препарата является предпочтительным. Лечение должно продолжаться по мере клинической необходимости. У некоторых пациентов с синдромом Золлингера-Эллисона длительность лечения рабепразолом составляла до одного года."}},{"type":"paragraph","data":{"text":"Для эрадикации Helicobacter pylori рекомендуется принимать внутрь 20 мг 2 раза в день по определенной схеме с соответствующей комбинаций антибиотиков. Длительность лечения составляет 7 дней."}},{"type":"paragraph","data":{"text":"Пациенты с почечной и печеночной недостаточностью"}},{"type":"paragraph","data":{"text":"Коррекции дозы пациентам с почечной недостаточностью не требуется."}},{"type":"paragraph","data":{"text":"У пациентов с печеночной недостаточностью легкой и средней степени тяжести концентрация рабепразола в крови обычно выше чем у здоровых добровольцев."}},{"type":"paragraph","data":{"text":"При назначении препарата Рабепразол-СЗ пациентам с тяжелой степенью тяжести печеночной недостаточности следует соблюдать осторожность."}},{"type":"paragraph","data":{"text":"Пожилые пациенты"}},{"type":"paragraph","data":{"text":"Коррекции дозы не требуется."}},{"type":"paragraph","data":{"text":"Дети"}},{"type":"paragraph","data":{"text":"Безопасность и эффективность рабепразола 20 мг для краткосрочного (до 8 недель) лечения ГЭРБ у детей в возрасте 12 лет и более подтверждена экстраполяцией результатов адекватных и хорошо контролируемых исследований подкрепляющих эффективность рабепразола для взрослых и исследованиями безопасности и фармакокинетики для пациентов детского возраста. Рекомендуемая доза для детей в возрасте 12 лет и более составляет 20 мг 1 раз в день продолжительностью до 8 недель."}},{"type":"paragraph","data":{"text":"Безопасность и эффективность рабепразола для лечения ГЭРБ у детей в возрасте младше 12 лет не установлена. Безопасность и эффективность рабепразола для применения по другим показаниям не установлена для пациентов детского возраста."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"В ходе клинических исследований отмечались следующие нежелательные реакции при приеме рабепразола: головная боль головокружение астения боль в животе диарея метеоризм сухость во рту сыпь."}},{"type":"paragraph","data":{"text":"Нежелательные реакции систематизированы в соответствии с Классификацией ВОЗ:"}},{"type":"paragraph","data":{"text":"Очень часто (> 1/10);"}},{"type":"paragraph","data":{"text":"Часто (> 1/100 < 1/10);"}},{"type":"paragraph","data":{"text":"Нечасто (> 1/1000 < 1/100);"}},{"type":"paragraph","data":{"text":"Редко (> 1/10000 < 1/1000);"}},{"type":"paragraph","data":{"text":"Очень редко (< 1/10000);"}},{"type":"paragraph","data":{"text":"Частота неизвестна (невозможно определить исходя из доступных данных)."}},{"type":"paragraph","data":{"text":"Со стороны иммунной системы: редко - острые системные аллергические реакции (включая отек лица гипотонию одышку)."}},{"type":"paragraph","data":{"text":"Со стороны крови и лимфатической системы: редко - тромбоцитопения нейтропения лейкопения."}},{"type":"paragraph","data":{"text":"Со стороны обмена веществ и питания: редко - анорексия; частота неизвестна - гипонатриемия гипомагниемия."}},{"type":"paragraph","data":{"text":"Со стороны нервной системы: часто - бессонница головная боль головокружение; нечасто - сонливость нервозность; редко - депрессия; частота неизвестна - спутанность сознания."}},{"type":"paragraph","data":{"text":"Со стороны органа зрения: редко - нарушение зрения."}},{"type":"paragraph","data":{"text":"Со стороны сосудов: частота неизвестна - периферический отек."}},{"type":"paragraph","data":{"text":"Со стороны дыхательной системы: часто - кашель фарингит ринит; нечасто - синусит бронхит."}},{"type":"paragraph","data":{"text":"Со стороны пищеварительной системы: часто - боль в животе диарея метеоризм тошнота рвота запор; нечасто - диспепсия отрыжка сухость во рту; редко - стоматит гастрит нарушение вкуса."}},{"type":"paragraph","data":{"text":"Со стороны гепатобилиарной системы: редко - гепатит желтуха печеночная энцефалопатия."}},{"type":"paragraph","data":{"text":"Со стороны почек и мочевыводящих путей: нечасто - инфекция мочевыводящих путей; редко - интерстициальный нефрит."}},{"type":"paragraph","data":{"text":"Со стороны кожи и подкожных тканей: редко - буллезные высыпания крапивница; очень редко - мультиформная эритема токсический эпидермальный некролиз синдром Стивенса-Джонсона."}},{"type":"paragraph","data":{"text":"Со стороны костно-мышечной системы: часто - боль в спине; нечасто - миалгия артралгия судорога мышц ног перелом костей бедра запястья или позвоночника."}},{"type":"paragraph","data":{"text":"Со стороны репродуктивной системы: частота неизвестна - гинекомастия."}},{"type":"paragraph","data":{"text":"Со стороны лабораторных и инструментальных исследований: редко - повышение активности \"печеночных\" трансаминаз увеличение массы тела."}},{"type":"paragraph","data":{"text":"Прочие: часто - инфекции."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Симптомы"}},{"type":"paragraph","data":{"text":"Данные о намеренной или случайной передозировке минимальны."}},{"type":"paragraph","data":{"text":"Лечение"}},{"type":"paragraph","data":{"text":"Специфический антидот для рабепразола неизвестен. Рабепразол хорошо связывается с белками плазмы и поэтому слабо выводится при диализе. При передозировке необходимо проводить симптоматическое и поддерживающее лечение."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Замедляет выведение некоторых лекарственных средств метаболизирующихся в печени путем микросомального окисления (диазепам фенитоин непрямые антикоагулянты)."}},{"type":"paragraph","data":{"text":"Совместное применение рабепразола с кетоконазолом или итраконазолом может привести к значительному снижению концентрации противогрибковых препаратов в плазме крови."}},{"type":"paragraph","data":{"text":"Не рекомендуется совместное применение ингибиторов протонной помпы (ИПП) с атаназавиром так как значительно снижаются эффекты атаназавира."}},{"type":"paragraph","data":{"text":"Рабепразол ингибирует метаболизм циклоспорина."}},{"type":"paragraph","data":{"text":"При одновременном приеме ИПП и метотрексата можно предположить повышение концентрации последнего и/или его метаболита гидроксиметотрексата и увеличение периода полувыведения."}},{"type":"paragraph","data":{"text":"При одновременном применении рабепразола амоксициллина и кларитромицина показатели AUC и С\u003csub\u003emах\u003c/sub\u003e для кларитромицина и амоксициллина были схожими при сравнении комбинированной терапии с монотерапией. Показатели AUC и С\u003csub\u003emах\u003c/sub\u003e рабепразола увеличивались на 11% и 34% соответственно a AUC и С\u003csub\u003emах\u003c/sub\u003e 14-гидроксикларитромицина (активного метаболита кларитромицина) увеличивались на 42% и 46% соответственно. Данное увеличение показателей не было признано клинически значимым."}},{"type":"paragraph","data":{"text":"Одновременное применение рабепразола и суспензий антацидов содержащих алюминия и/или магния гидроксид не приводит к клинически значимому взаимодействию."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Ответ пациента на терапию рабепразолом не исключает наличие злокачественных новообразований в желудке."}},{"type":"paragraph","data":{"text":"Капсулы препарата Рабепразол-СЗ следует глотать целиком. Установлено что ни время суток ни прием пищи не влияют на активность рабепразола."}},{"type":"paragraph","data":{"text":"В специальном исследовании у пациентов с легкими или умеренными нарушениями функции печени не было обнаружено значимого отличия частоты побочных эффектов препарата Рабепразол-СЗ от таковой у подобранных по полу и возрасту здоровых лиц но несмотря на это рекомендуется соблюдать осторожность при первом назначении препарата Рабепразол-СЗ пациентам с тяжелыми нарушениями функции печени."}},{"type":"paragraph","data":{"text":"Пациентам с нарушениями функции почек или печени корректировка дозы препарата Рабепразол-СЗ не требуется. AUC рабепразола у пациентов с тяжелым нарушением функции печени примерно в два раза выше чем у здоровых пациентов."}},{"type":"paragraph","data":{"text":"Гипомагниемия"}},{"type":"paragraph","data":{"text":"При лечении ИПП на протяжении по крайней мере 3 месяцев в редких случаях были отмечены случаи симптоматической или асимптоматической гипомагниемии. В большинстве случаев эти сообщения поступали через год после проведения терапии. Серьезными побочными явлениями были тетания аритмия и судороги. Большинству пациентов требовалось лечение гипомагниемии включающей замещение магния и отмены терапии ИПП. У пациентов которые будут получать длительное лечение или которые принимают ИПП с препаратами такими как дигоксин или препаратами которые могут вызвать гипомагниемию (например диуретики) медицинские работники должны контролировать содержание магния до начала лечения ИПП и в период лечения."}},{"type":"paragraph","data":{"text":"Переломы"}},{"type":"paragraph","data":{"text":"Терапия ИПП может привести к возрастанию риска связанных с остеопорозом переломов бедра запястья или позвоночника. Риск переломов был увеличен у пациентов получавших высокие дозы ИПП длительно (год и более)."}},{"type":"paragraph","data":{"text":"Одновременное применение рабепразола с метотрексатом"}},{"type":"paragraph","data":{"text":"Согласно литературным данным одновременный прием ИПП с метотрексатом (прежде всего в высоких дозах) может привести к повышению концентрации метотрексата и/или его метаболита гидроксиметотрексата и увеличить период полувыведения что может привести к проявлению токсичности метотрексата. При необходимости применения высоких доз метотрексата может быть рассмотрена возможность временного прекращения терапии ИПП."}},{"type":"paragraph","data":{"text":"Инфекции вызванные Salmonella Campylobacter и Clostridium difficile"}},{"type":"paragraph","data":{"text":"Терапия ИПП может приводить к возрастанию риска желудочно-кишечных инфекций таких как инфекции вызванные Salmonella Campylobacter и Clostridium difficile."}}]},{"id":17,"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","body":[{"type":"paragraph","data":{"text":"Исходя из особенностей фармакодинамики рабепразола и его профиля нежелательных эффектов маловероятно что Рабепразол-СЗ оказывает влияние на способность к вождению автотранспорта и управлению механизмами. Однако в случае появления сонливости следует избегать этих видов деятельности."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Капсулы кишечнорастворимые 10 мг и 20 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":"3 года."}},{"type":"paragraph","data":{"text":"Не использовать по истечении срока годности 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":"Непубличное акционерное общество \"Северная звезда\" (НАО \"Северная звезда\"), Ленинградская обл., Всеволожский муниципальный район, Кузьмоловское городское поселение, г.п. Кузьмоловский, ул. Заводская, д. 4, Россия"}}]},{"id":23,"name":"Организация, принимающая претензии потребителей","body":[{"type":"paragraph","data":{"text":"НАО \"Северная звезда\""}}]}],"source":null},"description_toggle":false,"short_description":"Рабепразол относится к классу антисекреторных веществ производных бензимидазола. Подавляет секрецию желудочного сока путем специфического ингибирования Н+/К+-АТФ-азы на секреторной поверхности париетальных клеток желудка. Блокирует заключительную стадию секреции соляной кислоты снижая содержание базальной и стимулированной секреции независимо от природы раздражителя. Обладая высокой липофильностью легко проникает в париетальные клетки желудка концентрируется в них оказывая цитопротекторное действие и увеличивая секрецию гидрокарбоната. Антисекреторное действие после перорального приема 20 мг рабепразола наступает в течение 1 часа и достигает максимума через 2-4 часа; угнетение базальной и стимулированной пищей секреции кислоты через 23 часа после приема первой дозы составляет 62 и 82% соответственно и продолжается до 48 часов. При прекращении приема секреторная активность восстанавливается в течение 1-2 дней. В течение первых 2-8 недель терапии рабепразолом концентрация гастрина в плазме крови увеличивается (что является отражением ингибирующего влияния на секрецию соляной кислоты) и возвращается к исходным уровням через 1-2 недели после его отмены. Рабепразол не обладает антихолинергическими свойствами не влияет на центральную нервную систему (ЦНС) сердечно-сосудистую и дыхательную системы. На фоне приема рабепразола устойчивые изменения в морфологической структуре энтерохромафинноподобных клеток в степени выраженности гастрита в частоте атрофического гастрита кишечной метаплазии или распространении инфекции Helicobacter pylori не обнаружены. Абсорбция Рабепразол быстро абсорбируется из кишечника и его максимальные концентрации в плазме достигаются примерно через 35 ч после приема дозы в 20 мг. Изменение максимальных концентраций в плазме (Сmах) и значений площади под кривой \"концентрация-время\" (AUC) рабепразола носят линейный характер в диапазоне доз от 10 до 40 мг. Абсолютная биодоступность после перорального приема 20 мг (по сравнению с внутривенным введением) составляет около 52%. Кроме того биодоступность не изменяется при многократном приеме рабепразола. У здоровых добровольцев период полувыведения из плазмы составляет около 1 ч (варьируя от 07 до 15 ч) а суммарный клиренс составляет 38 мл/мин/кг. У пациентов с хроническим поражением печени AUC увеличена вдвое по сравнению со здоровыми добровольцами что свидетельствует о снижении метаболизма первого прохождения а период полувыведения из плазмы увеличен в 2-3 раза. Ни время приема препарата в течение суток ни антациды не влияют на абсорбцию рабепразола. Прием препарата с жирной пищей замедляет абсорбцию рабепразола на 4 часа и более однако ни Сmахни степень абсорбции не изменяются. Распределение У человека степень связывания рабепразола с белками плазмы составляет около 97%. Метаболизм и выведение У здоровых людей После приема однократной пероральной дозы 20 мг14С-меченного рабепразола неизмененного препарата в моче найдено не было. Около 90% рабепразола выводится с мочой главным образом в виде двух метаболитов: конъюгата меркаптуровой кислоты (М5) и карбоновой кислоты (М6) а также в форме двух неизвестных метаболитов выявленных в ходе токсикологического анализа. Оставшаяся часть принятого рабепразола выводится с калом. Суммарное выведение составляет 998%. Эти данные свидетельствуют о небольшом выведении метаболитов рабепразола с желчью. Основным метаболитом является тиоэфир (M1). Единственным активным метаболитом является десметил (М3) однако он наблюдался в низкой концентрации только у одного участника исследования после приема 80 мг рабепразола. Терминальная стадия почечной недостаточности У пациентов со стабильной почечной недостаточностью в терминальной стадии которым необходим поддерживающий гемодиализ (клиренс креатинина\u003c5 мл/мин/173м2) выведение рабепразола схоже с таковым для здоровых добровольцев. AUC и Сmаху этих пациентов были примерно на 35% ниже чем у здоровых добровольцев. В среднем период полувыведения рабепразола составлял 082 ч у здоровых добровольцев 095 ч у пациентов во время гемодиализа и 36 ч после гемодиализа. Клиренс препарата у пациентов с заболеваниями почек нуждающихся в гемодиализе был приблизительно в два раза выше чем у здоровых добровольцев. Хронический компенсированный цирроз Пациенты с хроническим компенсированным циррозом печени переносят рабепразол в дозе 20 мг 1 раз в день хотя AUC удвоена и Сmахувеличена на 50% по сравнению со здоровыми добровольцами соответствующего пола. Пожилые пациенты У пожилых пациентов элиминация рабепразола несколько замедлена. После 7 дней приема рабепразола по 20 мг в сутки у пожилых пациентов AUC была примерно вдвое больше а Сmахповышена на 60% по сравнению с молодыми здоровыми добровольцами. Однако признаков кумуляции рабепразола не отмечалось. 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