ФортеДетрим Капсулы, 30 шт, 10000 МЕ, для приема внутрь, витамин D3

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По сравнению с витамином D2 характеризуется на 25 % более высокой активностью."}},{"type":"paragraph","data":{"text":"Витамин D связывается со специфическим рецептором витамина D (VDR), который регулирует экспрессию многих генов, включая гены ионного канала TRPV6 (обеспечивает абсорбцию кальция в кишечнике), CALB1 (кальбиндин; обеспечивает транспорт кальция в кровеносное русло), BGLAP (остеокальцин; обеспечивает минерализацию костной ткани и гомеостаз кальция), SPP1 (остеопонтин; регулирует миграцию остеокластов), REN (ренин; обеспечивает регуляцию артериального давления, являясь ключевым элементом ренин-ангиотензин-альдостероновой системы регуляции), IGFBP (связывающий белок инсулинподобного фактора роста; усиливает действие инсулинподобного фактора роста), FGF23 и FGFR23 (фактор роста фибробластов 23; регулируют уровни кальция, фосфат-аниона, процессы клеточного деления фибробластов), TGFB1 (трансформирующий фактор роста бета-1; регулирует процессы клеточного деления и дифференцировки остеоцитов, хондроцитов, фибробластов и кератиноцитов), LRP2 (ЛПНП-рецептор-связанный белок 2; является посредником эндоцитоза липопротеинов низкой плотности), INSR (рецептор инсулина; обеспечивает эффекты инсулина на любые типы клеток)."}},{"type":"paragraph","data":{"text":"Витамин D3 является активным антирахитическим фактором. Самой важной функцией витамина D3 является регулирование метаболизма кальция и фосфатов, что способствует правильной минерализации и росту скелета."}},{"type":"paragraph","data":{"text":"Колекальциферол играет существенную роль в абсорбции кальция и фосфатов в кишечнике, в транспорте минеральных солей и в процессе кальцификации костей, регулирует также выведение кальция и фосфатов почками."}},{"type":"paragraph","data":{"text":"Концентрация ионов кальция в крови обуславливает поддержание тонуса мышц скелетной мускулатуры, функцию миокарда, способствует проведению нервного возбуждения, регулирует процесс свертывания крови."}},{"type":"paragraph","data":{"text":"Недостаток витамина D в пище, нарушение его всасывания, дефицит кальция, а также недостаточное пребывание на солнце в период быстрого роста ребенка приводит к рахиту, у взрослых - к остеомаляции, у беременных могут возникнуть симптомы тетании, нарушение процессов обызвествления костей новорожденных."}},{"type":"paragraph","data":{"text":"Повышенная потребность в витамине D возникает у женщин в период менопаузы, поскольку у них часто развивается остеопороз в связи с гормональными нарушениями. Витамин D обладает рядом т. н. внескелетных эффектов."}},{"type":"paragraph","data":{"text":"Витамин D участвует в функционировании иммунной системы путем модуляции уровней цитокинов и регулирует деление лимфоцитов Т-хелперов и дифференцировку В-лимфоцитов. В ряде исследований отмечено снижение заболеваемости инфекциями дыхательных путей на фоне приема витамина D."}},{"type":"paragraph","data":{"text":"Показано, что витамин D является важным звеном гомеостаза иммунной системы: предотвращает аутоиммунные заболевания (сахарный диабет 1 типа, рассеянный склероз,"}},{"type":"paragraph","data":{"text":"ревматоидный артрит, воспалительные болезни кишечника и др.)."}},{"type":"paragraph","data":{"text":"Витамин D обладает антипролиферативным и продифференцирующим эффектами, которые обуславливают онкопротективное действие витамина D. Отмечено, что частота некоторых опухолей (рак молочной железы, рак толстого кишечника) повышается на фоне низкого уровня витамина D в крови."}},{"type":"paragraph","data":{"text":"Витамин D участвует в регуляции углеводного и жирового метаболизма путем влияния на синтез IRS1 (субстрат рецептора инсулина 1; участвует во внутриклеточных путях проведения сигнала рецептора инсулина), IGF (инсулинподобный фактор роста; регулирует баланс жировой и мышечной ткани), PPAR- ? (активированный рецептор пролифераторов пероксисом, тип ?; способствует переработке избыточного холестерина)."}},{"type":"paragraph","data":{"text":"По данным эпидемиологических исследований дефицит витамина D ассоциирован с риском метаболических нарушений (метаболический синдром и сахарный диабет 2 типа). Рецепторы и метаболизирующие ферменты витамина D экспрессируются в артериальных сосудах, сердце и практически всех клетках и тканях, имеющих отношение к патогенезу сердечно-сосудистых заболеваний. На животных моделях показаны антиатеросклеротическое действие, супрессия ренина и предупреждение повреждения миокарда и др. Низкие уровни витамина D у человека связаны с неблагоприятными факторами риска сердечно-сосудистой патологии, такими как сахарный диабет, дислипидемия, артериальная гипертензия, и ассоциированы с риском сердечно-сосудистых катастроф, в т. ч. инсультов. В исследованиях на экспериментальных моделях болезни Альцгеймера показано, что витамин D3 снижал накопление амилоида в мозге и улучшал когнитивную функцию. В неитервенционных исследованиях у человека показано, что частота развития деменции и болезни Альцгеймера увеличивается на фоне низкого уровня витамина D и низкого диетарного потребления витамина D. Отмечалось ухудшение когнитивной функции и заболеваемости болезнью Альцгеймера при низких уровнях витамина D."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Лечение и профилактика дефицита и недостаточности витамина D и состояний, вызванных дефицитом витамина D у взрослых."}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"Повышенная чувствительность к действующему веществу или любому из вспомогательных веществ, перечисленных в разделе «Состав»;"}},{"type":"paragraph","data":{"text":"• Гиперкальциемия и (или) гиперкальциурия;"}},{"type":"paragraph","data":{"text":"• Мочекаменная болезнь (образование кальциевых оксалатных камней);"}},{"type":"paragraph","data":{"text":"• Гипервитаминоз D;"}},{"type":"paragraph","data":{"text":"• Псевдогипопаратиреоз;"}},{"type":"paragraph","data":{"text":"• Саркоидоз;"}},{"type":"paragraph","data":{"text":"• Активная форма туберкулеза легких;"}},{"type":"paragraph","data":{"text":"• Тяжелая почечная недостаточность;"}},{"type":"paragraph","data":{"text":"• Беременность и период грудного вскармливания (в данных дозировках);"}},{"type":"paragraph","data":{"text":"• Детский возраст до 18 лет."}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"Прием дополнительных количеств колекальциферола и кальция (например, в составе других препаратов), при нарушениях экскреции кальция и фосфатов с мочой, при лечении иммобилизованных пациентов, при одновременном приеме тиазидов, сердечных гликозидов (особенно гликозидов наперстянки), производных бензотиадиазина, у пациентов с атеросклерозом."}},{"type":"paragraph","data":{"text":"Применение при беременности и в период грудного вскармливания"}},{"type":"paragraph","data":{"text":"Применение препарата Фортедетрим в период беременности и грудного вскармливания не рекомендуется в данных дозировках в связи с превышением рекомендуемой суточной дозой 1000 МЕ. Во время беременности и в период грудного вскармливания рекомендуется применение препаратов колекальциферола в более низких дозах, например, Аквадетрим."}}]},{"id":28,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"Применение препарата Фортедетрим в период беременности и грудного вскармливания не рекомендуется в данных дозировках в связи с превышением рекомендуемой суточной дозой 1000 МЕ. Во время беременности и в период грудного вскармливания рекомендуется применение препаратов колекальциферола в более низких дозах, например, Аквадетрим."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Капсулы следует принимать внутрь, проглатывая целиком и запивая водой, желательно во время основного приема пищи."}},{"type":"paragraph","data":{"text":"Капсулы 10000 МЕ"}},{"type":"paragraph","data":{"text":"- Лечение дефицита витамина D (уровень 25(ОН)D ?20 нг/мл) у взрослых- 50 000 МЕ (5 капсул 10000 МЕ) 1 раз в неделю в течение 8 недель,"}},{"type":"paragraph","data":{"text":"- Лечение недостаточности витамина D (уровень 25(ОН)D - 20-29 нг/мл) у взрослых - 50 000 МЕ (5 капсул 10000 МЕ) 1 раз в неделю в течение 4 недель,"}},{"type":"paragraph","data":{"text":"- Поддержание нормального уровня витамина D (уровень 25(ОН)D ?30 нг/мл) у взрослых- 10000 МЕ (1 капсула) 1 раз в неделю."}},{"type":"paragraph","data":{"text":"При длительном лечении следует регулярно определять концентрацию кальция в крови и моче, а также определять функцию почек путем измерения сывороточной концентрации креатинина. При необходимости доза должна быть скорректирована с учетом концентрации кальция в сыворотке крови."}},{"type":"paragraph","data":{"text":"Заболевания печени"}},{"type":"paragraph","data":{"text":"Коррекция дозы не требуется."}},{"type":"paragraph","data":{"text":"Нарушение функции почек"}},{"type":"paragraph","data":{"text":"Препарат не должен назначаться пациентам с тяжелой почечной недостаточностью."}}]},{"id":29,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Классификация частоты нежелательных реакций: нечасто (≥1/1000 –"}},{"type":"paragraph","data":{"text":"Нарушения со стороны иммунной системы: Неизвестно - Реакции гиперчувствительности, такие как ангионевротический отек или отек гортани."}},{"type":"paragraph","data":{"text":"Нарушения со стороны обмена веществ и питания: Нечасто - Гиперкальциемия или гиперкальциурия."}},{"type":"paragraph","data":{"text":"Нарушения со стороны желудочно-кишечного тракта: Неизвестно - Запор, вздутие живота, тошнота, абдоминальная боль, диарея."}},{"type":"paragraph","data":{"text":"Нарушения со стороны кожи и подкожной клетчатки: Редко - Зуд, сыпь, крапивница."}}]},{"id":30,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"\u003ci\u003eСимптомы\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Порог интоксикации для колекальциферола варьирует между 40000 и 100000 МЕ/сут в течение 1-2 месяцев у взрослых с нормальной функцией паращитовидных желез. У новорожденных и маленьких детей может отмечаться чувствительность к гораздо более низким концентрациям."}},{"type":"paragraph","data":{"text":"Острая и хроническая передозировка может привести к увеличению уровней фосфора в сыворотке крови и моче и гиперкальциемии, которая может иметь персистирующий характер и потенциально угрожать жизни."}},{"type":"paragraph","data":{"text":"Типичные изменения биохимических показателей включают гиперкальциемию, гиперкальциурию, а также повышение в сыворотке крови уровня 25-гидроксикальциферола (25(OH)D\u003csub\u003e3\u003c/sub\u003e, кальцидиол). Хроническая передозировка колекальциферола может привести к отложению кальция в тканях и паренхиматозных органах, прежде всего в почках (мочекаменная болезнь, нефрокальциноз) и сосудах."}},{"type":"paragraph","data":{"text":"Симптомы носят общий характер и проявляются в виде тошноты, рвоты, также первоначально в виде диареи, позже – в виде запора, потери аппетита, слабости, головной боли, боли в мышцах и суставах, мышечной слабости, азотемии, постоянной сонливости, полидипсии и полиурии и, на завершающей стадии, в виде обезвоживания организма. Передозировка колекальциферола может вызывать изменения ЭКГ, нарушения ритма сердца, панкреатит, почечную недостаточность."}},{"type":"paragraph","data":{"text":"\u003ci\u003eЛечение\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Прежде всего необходимо прекратить прием колекальциферола. Для устранения гиперкальциемии, вызванной передозировкой колекальциферола, требуется несколько недель. В зависимости от степени гиперкальциемии в качестве мер лечения назначают диету с низким содержанием кальция или полностью без кальция, потребление большого количества жидкости, форсированный диурез с применением фуросемида, а также ГКС и кальцитонин. При сохранной функции почек концентрация кальция может быть значительно снижена путем инфузии изотонического раствора хлорида натрия (3-6 л в течение 24 ч) с добавлением фуросемида и, в некоторых случаях, также натрия эдетата в дозе 15 мг/кг/ч, при одновременном мониторинге уровня кальция и данных ЭКГ. Не следует применять инфузию фосфатов для уменьшения гиперкальциемии, вызванной передозировкой колекальциферола, в связи с опасностью развития метастатической кальцификации. При олиго-, анурии следует провести гемодиализ (диализат без кальция)."}},{"type":"paragraph","data":{"text":"Специфического антидота не существует."}},{"type":"paragraph","data":{"text":"Рекомендуется обращать внимание пациентов на симптомы возможной передозировки при длительном приеме препарата в высоких дозах (тошнота, рвота, первоначально – диарея, позже – запор, потеря аппетита, слабость, головная боль, боль в мышцах и суставах, мышечная слабость, постоянная сонливость, полидипсия и полиурия)."}}]},{"id":31,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Одновременный прием противосудорожных лекарственных препаратов (таких как фенитоин) или барбитуратов (и, возможно, других лекарственных средств, индуцирующих ферменты печени) может снизить эффективность колекальциферола за счет увеличения скорости биотрансформации колекальциферола в неактивные метаболиты."}},{"type":"paragraph","data":{"text":"Сопутствующая терапия препаратами ГКС может снижать эффективность колекальциферола."}},{"type":"paragraph","data":{"text":"Пероральный прием колекальциферола может усилить терапевтический эффект и токсический потенциал наперстянки и других сердечных гликозидов (риск развития аритмии) за счет развития гиперкальциемии. Требуется тщательное медицинское наблюдение, контроль показателей ЭКГ и уровней кальция в плазме крови и моче, и, при необходимости, коррекция дозы сердечных гликозидов."}},{"type":"paragraph","data":{"text":"В случае сопутствующей терапии тиазидными диуретиками, которые уменьшают экскрецию кальция с мочой, рекомендуется контролировать содержание кальция в сыворотке крови и моче."}},{"type":"paragraph","data":{"text":"Одновременное лечение ионообменными смолами (такими как колестирамин), препаратами орлистата или слабительными средствами (такими как парафиновое масло) может уменьшать всасывание колекальциферола в пищеварительном тракте."}},{"type":"paragraph","data":{"text":"Одновременный прием рифампицина и изониазида может снизить эффективность препарата из-за увеличения скорости биотрансформации колекальциферола."}},{"type":"paragraph","data":{"text":"На фоне одновременного приема антацидов, содержащих магний, и колекальциферола может повышаться концентрация магния в крови."}},{"type":"paragraph","data":{"text":"На фоне одновременного приема антацидов, содержащих алюминий, и колекальциферола может повышаться концентрация алюминия в крови, что увеличивает риск токсического воздействия алюминия."}}]},{"id":34,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Капсулы."}}]},{"id":35,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"Препарат следует хранить в оригинальной упаковке (блистер в пачке) в недоступном для детей месте при температуре не выше 30°C."}}]},{"id":36,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"3 года. Не применять по истечении срока годности."}}]},{"id":37,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"По рецепту."}}]}],"source":null},"description_toggle":false,"short_description":"Витамин D3 является естественной формой витамина D, которая образуется у человека в коже под действием солнечных лучей. По сравнению с витамином D2 характеризуется на 25 % более высокой активностью. Витамин D связывается со специфическим рецептором витамина D (VDR), который регулирует экспрессию многих генов, включая гены ионного канала TRPV6 (обеспечивает абсорбцию кальция в кишечнике), CALB1 (кальбиндин; обеспечивает транспорт кальция в кровеносное русло), BGLAP (остеокальцин; обеспечивает минерализацию костной ткани и гомеостаз кальция), SPP1 (остеопонтин; регулирует миграцию остеокластов), REN (ренин; обеспечивает регуляцию артериального давления, являясь ключевым элементом ренин-ангиотензин-альдостероновой системы регуляции), IGFBP (связывающий белок инсулинподобного фактора роста; усиливает действие инсулинподобного фактора роста), FGF23 и FGFR23 (фактор роста фибробластов 23; регулируют уровни кальция, фосфат-аниона, процессы клеточного деления фибробластов), TGFB1 (трансформирующий фактор роста бета-1; регулирует процессы клеточного деления и дифференцировки остеоцитов, хондроцитов, фибробластов и кератиноцитов), LRP2 (ЛПНП-рецептор-связанный белок 2; является посредником эндоцитоза липопротеинов низкой плотности), INSR (рецептор инсулина; обеспечивает эффекты инсулина на любые типы клеток). Витамин D3 является активным антирахитическим фактором. Самой важной функцией витамина D3 является регулирование метаболизма кальция и фосфатов, что способствует правильной минерализации и росту скелета. Колекальциферол играет существенную роль в абсорбции кальция и фосфатов в кишечнике, в транспорте минеральных солей и в процессе кальцификации костей, регулирует также выведение кальция и фосфатов почками. Концентрация ионов кальция в крови обуславливает поддержание тонуса мышц скелетной мускулатуры, функцию миокарда, способствует проведению нервного возбуждения, регулирует процесс свертывания крови. Недостаток витамина D в пище, нарушение его всасывания, дефицит кальция, а также недостаточное пребывание на солнце в период быстрого роста ребенка приводит к рахиту, у взрослых - к остеомаляции, у беременных могут возникнуть симптомы тетании, нарушение процессов обызвествления костей новорожденных. Повышенная потребность в витамине D возникает у женщин в период менопаузы, поскольку у них часто развивается остеопороз в связи с гормональными нарушениями. Витамин D обладает рядом т. н. внескелетных эффектов. Витамин D участвует в функционировании иммунной системы путем модуляции уровней цитокинов и регулирует деление лимфоцитов Т-хелперов и дифференцировку В-лимфоцитов. В ряде исследований отмечено снижение заболеваемости инфекциями дыхательных путей на фоне приема витамина D. Показано, что витамин D является важным звеном гомеостаза иммунной системы: предотвращает аутоиммунные заболевания (сахарный диабет 1 типа, рассеянный склероз, ревматоидный артрит, воспалительные болезни кишечника и др.). Витамин D обладает антипролиферативным и продифференцирующим эффектами, которые обуславливают онкопротективное действие витамина D. Отмечено, что частота некоторых опухолей (рак молочной железы, рак толстого кишечника) повышается на фоне низкого уровня витамина D в крови. Витамин D участвует в регуляции углеводного и жирового метаболизма путем влияния на синтез IRS1 (субстрат рецептора инсулина 1; участвует во внутриклеточных путях проведения сигнала рецептора инсулина), IGF (инсулинподобный фактор роста; регулирует баланс жировой и мышечной ткани), PPAR- ? (активированный рецептор пролифераторов пероксисом, тип ?; способствует переработке избыточного холестерина). По данным эпидемиологических исследований дефицит витамина D ассоциирован с риском метаболических нарушений (метаболический синдром и сахарный диабет 2 типа). Рецепторы и метаболизирующие ферменты витамина D экспрессируются в артериальных сосудах, сердце и практически всех клетках и тканях, имеющих отношение к патогенезу сердечно-сосудистых заболеваний. На животных моделях показаны антиатеросклеротическое действие, супрессия ренина и предупреждение повреждения миокарда и др. Низкие уровни витамина D у человека связаны с неблагоприятными факторами риска сердечно-сосудистой патологии, такими как сахарный диабет, дислипидемия, артериальная гипертензия, и ассоциированы с риском сердечно-сосудистых катастроф, в т. ч. инсультов. В исследованиях на экспериментальных моделях болезни Альцгеймера показано, что витамин D3 снижал накопление амилоида в мозге и улучшал когнитивную функцию. В неитервенционных исследованиях у человека показано, что частота развития деменции и болезни Альцгеймера увеличивается на фоне низкого уровня витамина D и низкого диетарного потребления витамина D. 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