Бинафин Нео Таблетки, 14 шт, 250 мг

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дозировки 125 мг "}},{"type":"paragraph","data":{"text":"Тербинафина гидрохлорид 141,27 мг, эквивалентно  тербинафину 125,00 мг "}},{"type":"paragraph","data":{"text":"Для дозировки 250 мг "}},{"type":"paragraph","data":{"text":"Тербинафина гидрохлорид 282,54 мг, эквивалентно\nтербинафину 250,00 мг"}},{"type":"paragraph","data":{"text":"\u003ci\u003eВспомогательные\nвещества:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Целлюлоза микрокристаллическая Miccel 101,\nкрахмал кукурузный, Повидон К-30, метилпарагидроксибензоат натрия,\nлаурилсульфат натрия, кремния диоксид коллоидный, магния стеарат, карбоксиметилкрахмал натрия, тальк."}}]},{"id":7,"name":"Фармакологические свойства","slug":"pharmacologic_effects","body":[{"type":"paragraph","data":{"text":"\u003cb\u003e\u003ci\u003eФармакодинамика\u003c/i\u003e\u003c/b\u003e"}},{"type":"paragraph","data":{"text":"Тербинафин представляет собой аллиламин, который\nобладает широким спектром действия в отношении грибов, вызывающих заболевания\nкожи, волос и ногтей, в том числе дерматофитов, таких как Trichophyton (например, Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton verrucosum, Trichophyton tonsurans, Trichophyton violaceum), Microsporum (например, Microsporum canis), Epidermophyton floccosum, а также дрожжевых\nгрибов рода Candida\n(например, Candida\nalbicans)\nи Malassezia\n(ранее Pityrosporum).\nВ низких концентрациях тербинафин оказывает фунгицидное действие в отношении\nдерматофитов, плесневых и некоторых диморфных грибов. Активность в отношении\nдрожжевых грибов, в зависимости от их вида, может быть фунгицидной или\nфунгистатической. Тербинафин специфически подавляет ранний этап биосинтеза стеринов\nв клетке гриба. Это ведет к дефициту эргостерина и к внутриклеточному\nнакоплению сквалена, что вызывает гибель клетки гриба. Действие тербинафина\nосуществляется путем ингибирования фермента скваленэпоксидазы в клеточной\nмембране гриба. Этот фермент не относится к системе цитохрома Р450. При\nприменении тербинафина внутрь в коже, волосах и ногтях создаются его\nконцентрации, обеспечивающие фунгицидное действие. "}},{"type":"paragraph","data":{"text":"\u003cb\u003e\u003ci\u003eФармакокинетика\n\u003c/i\u003e\u003c/b\u003e"}},{"type":"paragraph","data":{"text":"После приема внутрь тербинафин хорошо абсорбируется\n(> 70 %), абсолютная биодоступность тербинафина вследствие эффекта\n«первичного прохождения» через печень составляет примерно 50 %. После\nоднократного приема тербинафина внутрь в дозе 250 мг его максимальная\nконцентрация (С\u003csub\u003emax\u003c/sub\u003e)\nв плазме крови достигается через 1,5 ч и составляет 1,3 мкг/мл. С\u003csub\u003emax\u003c/sub\u003e тербинафина в плазме\nкрови при постоянном его применении в среднем увеличилась на 25 % по\nсравнению с однократным приемом, значение площади под кривой\n«концентрация-время» (AUC)\nувеличилось в 2,3 раза. Исходя из увеличения AUC, можно рассчитать эффективный период\nполувыведения (30 ч). Прием пищи в умеренной степени влияет на биодоступность препарата\n(значение AUC\nувеличивается менее чем на 20 %), но коррекции дозы тербинафина при\nодновременном приеме с пищей не требуется."}},{"type":"paragraph","data":{"text":"Тербинафин в значительной степени связывается с\nбелками плазмы крови (99 %). Он быстро проникает через дермальный слой\nкожи и накапливается в липофильном роговом слое эпидермиса. Тербинафин также\nпроникает в секрет сальных желез, что обеспечивает высокую концентрацию в\nволосяных фолликулах, волосах и в коже, богатой сальными железами. Показано\nтакже, что тербинафин проникает в ногтевые пластинки в первые несколько недель\nпосле начала терапии. "}},{"type":"paragraph","data":{"text":"Метаболизируется быстро и в существенной степени при\nучастии, как минимум, семи изоферментов системы цитохрома Р450. Основную роль\nиграют изоферменты CYP2C9, CYP1A2, CYP3A4, CYP2C8 и CYP2C19. В результате биотрансформации\nтербинафина образуются метаболиты, не обладающие противогрибковой активностью и\nвыводящиеся преимущественно почками."}},{"type":"paragraph","data":{"text":"Не выявлено изменений равновесной концентрации\nтербинафина в плазме крови в зависимости от возраста."}},{"type":"paragraph","data":{"text":"У пациентов с сопутствующими нарушениями функции почек\n(клиренс креатинина [КК] < 50 мл/мин) и с заболеваниями печени возможно\nснижение клиренса тербинафина на 50 %. "}},{"type":"paragraph","data":{"text":"Выделяется с грудным молоком."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Поверхностные микозы, вызванные чувствительными к\nтербинафину микроорганизмами: онихомикоз, вызванный грибами дерматофитами;\nмикоз волосистой части головы; дерматомикоз туловища, голеней, стоп; а также\nдрожжевые инфекции кожи, вызываемые грибами рода Candida (например, Candida albicans) – в тех случаях, когда\nлокализация, выраженность или распространенность инфекции обуславливают\nцелесообразность пероральной терапии. "}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"§  Повышенная\nчувствительность к тербинафину и другим компонентам препарата."}},{"type":"paragraph","data":{"text":"§  Детский\nвозраст до 3 лет и/или дети с массой тела менее 20 кг (нет данных о применении)."}},{"type":"paragraph","data":{"text":"§  Хроническое\nили активное заболевание печени."}},{"type":"paragraph","data":{"text":"§  Не\nрекомендуется применять препарат Бинафин Нео\u003csup\u003e®\u003c/sup\u003e у пациентов с\nнарушениями функции почек (КК менее 50 мл/мин или концентрация креатинина в\nсыворотке крови более 300 мкмоль/л), поскольку применение препарата у данной\nкатегории пациентов недостаточно изучено."}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"Угнетение костномозгового кроветворения, псориаз,\nкожная красная волчанка, системная красная волчанка, беременность."}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"Данные экспериментальных исследований не дают\nоснований предполагать наличие нежелательных явлений в отношении фертильности и\nтоксического действия на плод. Поскольку клинический опыт применения\nтербинафина у беременных очень ограничен, не следует применять препарат Бинафин\nНео\u003csup\u003e®\u003c/sup\u003e во время беременности, за исключением тех случаев, когда\nожидаемая польза от проведения терапии для матери превышает потенциальный риск\nдля плода."}},{"type":"paragraph","data":{"text":"Тербинафин выделяется с грудным молоком, поэтому при\nнеобходимости применения препарата Бинафин Нео\u003csup\u003e®\u003c/sup\u003e следует прекратить\nгрудное вскармливание. "}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Для приема внутрь. "}},{"type":"paragraph","data":{"text":"Вне зависимости от времени приема пищи, запивать\nводой. Желательно применять препарат Бинафин Нео\u003csup\u003e®\u003c/sup\u003e в одно и то же\nвремя суток. Длительность курса лечения и режим дозирования устанавливается в\nиндивидуальном порядке, зависит от локализации процесса и тяжести заболевания."}},{"type":"paragraph","data":{"text":"\u003ci\u003eВзрослые:\u003c/i\u003e\n250 мг (1 таблетка) 1 раз в сутки."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Тербинафин в целом переносится хорошо. Побочные\nэффекты обычно слабо или умеренно выражены и носят преходящий характер. Ниже\nприведены нежелательные явления, которые наблюдались в ходе клинических\nисследований или в пострегистрационный период."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны крови и лимфатической системы: \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"нечасто: анемия;"}},{"type":"paragraph","data":{"text":"очень редко: нейтропения, агранулоцитоз, панцитопения,\nтромбоцитопения. В случае развития качественных или количественных изменений со\nстороны форменных элементов крови следует установить причину нарушений и\nрассмотреть вопрос о снижении дозы препарата или при необходимости о\nпрекращении терапии препаратом Бинафин Нео\u003csup\u003e®\u003c/sup\u003e."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны иммунной системы:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"очень редко: анафилактоидные реакции (включая\nангионевротический отек), кожная и системная красная волчанка (или их\nобострение)."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nпсихики:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"часто: депрессия;"}},{"type":"paragraph","data":{"text":"нечасто: тревога."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны нервной системы: \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"очень часто: головная боль;"}},{"type":"paragraph","data":{"text":"часто: головокружение, нарушение вкусовых ощущений,\nвключая их утрату вплоть до их потери (обычно восстановление происходит в\nпределах нескольких недель после прекращения лечения). Имеются отдельные\nсообщения о случаях длительных нарушений вкусовых ощущений. В отдельных случаях\nна фоне приема препарата отмечалось снижение потребления пищи, которое\nприводило к значительному снижению массы тела;"}},{"type":"paragraph","data":{"text":"нечасто: парестезия, гипестезия."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны органа зрения: \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"нечасто: нарушение зрения."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны органа слуха и лабиринтные нарушения:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"нечасто: шум в ушах."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны пищеварительной системы:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"очень часто: вздутие живота, снижение аппетита,\nдиспепсия, тошнота, слабо выраженная боль в животе, диарея."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны печени и желчевыводящих путей:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"редко: гепатобилиарная дисфункция (преимущественно\nхолестатической природы), в том числе печеночная недостаточность, включая очень\nредкие случаи развития тяжелой печеночной недостаточности (некоторые со\nсмертельным исходом или требующие трансплантации печени; в большинстве случаев,\nкогда развивалась печеночная недостаточность, пациенты имели серьезные\nсопутствующие системные заболевания, и причинно-следственная связь печеночной недостаточности\nс приемом тербинафина была сомнительной), гепатит, желтуха, холестаз, повышение\nсывороточной активности «печеночных» ферментов."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны кожи и подкожных тканей: \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"очень часто: кожная сыпь, крапивница;"}},{"type":"paragraph","data":{"text":"нечасто: реакции фоточувствительности;"}},{"type":"paragraph","data":{"text":"очень редко: синдром Стивенса-Джонсона, токсический\nэпидермальный некролиз, острый генерализованный экзентематозный пустулез,\nмультиформная эритема, токсическая кожная сыпь, эксфолиативный дерматит,\nбуллезный дерматит, псориазоподобные высыпания на коже или обострения на коже\nили обострения псориаза, алопеция. "}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны скелетно-мышечной и соединительной ткани:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"очень часто: артралгия, миалгия."}},{"type":"paragraph","data":{"text":"\u003ci\u003eОбщие\nрасстройства и нарушения в месте введения: \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"часто: чувство усталости;"}},{"type":"paragraph","data":{"text":"нечасто: повышение температуры тела."}},{"type":"paragraph","data":{"text":"\u003ci\u003eЛабораторные\nи инструментальные данные: \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"нечасто: снижение массы тела (вторично по отношению к\nнарушению вкусовых ощущений)."}},{"type":"paragraph","data":{"text":"На основе спонтанных сообщений, получаемых в\nпострегистрационный период, и литературных данных выявлены следующие\nнежелательные явления, частота которых вследствие неточного количества\nпациентов не может быть установлена."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны иммунной системы: \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"анафилактические реакции, синдром подобный\nсывороточной болезни."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны нервной системы:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"потеря обоняния, в том числе на длительный период\nвремени, снижение обоняния. "}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны органа зрения: \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"затуманивание зрения, снижение остроты зрения."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны кожи и подкожных тканей:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"лекарственная реакция с эозинофилией и системными\nпроявлениями (DRESS-синдром)\n(кожная сыпь, отеки, лихорадка и увеличение лимфатических узлов)."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны органа слуха и лабиринтные нарушения: \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"тугоухость, нарушение слуха."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны сосудов: \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"васкулит."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны пищеварительной системы:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"панкреатит."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения\nсо стороны скелетно-мышечной и соединительной ткани:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"рабдомиолиз."}},{"type":"paragraph","data":{"text":"\u003ci\u003eОбщие\nрасстройства и нарушения в месте введения: \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"гриппоподобный синдром."}},{"type":"paragraph","data":{"text":"\u003ci\u003eЛабораторные\nи инструментальные данные:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"повышение активности креатинфосфокиназы (КФК) в\nсыворотке крови."}},{"type":"paragraph","data":{"text":"\u003ci\u003eЕсли\nлюбые из указанных в инструкции побочных эффектов усугубляются, или Вы заметили\nлюбые другие побочные эффекты, не указанные в инструкции, сообщите об этом\nврачу.\u003c/i\u003e"}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"\u003ci\u003eСимптомы:\u003c/i\u003e\nимеются сообщения о некоторых случаях передозировки (принятая доза тербинафина\nдо 5 г), при которых отмечались головная боль, тошнота, боль в эпигастрии и\nголовокружение."}},{"type":"paragraph","data":{"text":"\u003ci\u003eЛечение:\u003c/i\u003e\nпромывание желудка с последующим применением активированного угля, при\nнеобходимости – симптоматическая и поддерживающая терапия. "}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"\u003ci\u003eВлияние\nдругих лекарственных средств на тербинафин\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Плазменный клиренс тербинафина может ускоряться под\nвлиянием препаратов – индукторов метаболизма и подавляться под влиянием\nингибиторов системы цитохрома Р450. При необходимости одновременного применения\nвышеуказанных препаратов и препарата Бинафин Нео\u003csup\u003e®\u003c/sup\u003e может\nпотребоваться соответствующая коррекция режима дозирования последнего. "}},{"type":"paragraph","data":{"text":"Циметидин может усиливать действие тербинафина или\nувеличивать его концентрацию в плазме крови. Циметидин снижает клиренс\nтербинафина на 33 %. "}},{"type":"paragraph","data":{"text":"Флуконазол увеличивает С\u003csub\u003emax\u003c/sub\u003e и AUC тербинафина на 52 % и\n69 %, соответственно, в связи с угнетением изоферментов CYP2C9 и CYP3А4. Подобное увеличение экспозиции\nтербинафина может возникать при применении других препаратов, ингибирующих\nизоферменты CYP2C9 и CYP3A4, \nнапример, кетоконазола и амиодарона."}},{"type":"paragraph","data":{"text":"Рифампицин может ослаблять действие тербинафина или\nуменьшать его концентрацию в плазме крови. Рифампицин увеличивает клиренс\nтербинафина на 100 %."}},{"type":"paragraph","data":{"text":"\u003ci\u003eВлияние\nтербинафина на другие лекарственные средства\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Результаты исследований, проведенных в условиях in vitro и у здоровых добровольцев,\nпоказывают, что тербинафин обладает незначительным потенциалом для подавления\nили усиления клиренса большинства препаратов, которые метаболизируются при\nучастии системы цитохрома Р450 (например, тербинафина, триазолама, толбутамина\nили контрацептивов для приема внутрь), за исключением тех, которые\nметаболизируются с участием изофермента CYP2D6. "}},{"type":"paragraph","data":{"text":"Тербинафин не влияет на клиренс феназона или\nдигоксина."}},{"type":"paragraph","data":{"text":"Тербинафин не оказывает существенного влияния на\nфармакокинетику флуконазола. Не было выявлено клинически значимых\nвзаимодействий между тербинафином и компонентами ко-тримоксазола (триметопримом\nи сульфаметоксазолом), зидовудином или теофиллином.   "}},{"type":"paragraph","data":{"text":"Имеются сообщения о нескольких случаях нарушения\nменструального цикла у пациенток, принимающих препарат Бинафин Нео\u003csup\u003e®\u003c/sup\u003e\nодновременно с контрацептивами для приема внутрь. При этом частота этих\nнарушений не превышает среднюю частоту у пациенток, принимающих только\nконтрацептивы для приема внутрь."}},{"type":"paragraph","data":{"text":"Тербинафин может усиливать действие кофеина или\nувеличивать его концентрацию в плазме крови. Тербинафин снижает клиренс кофеина\nпри внутривенном введении на 19 %."}},{"type":"paragraph","data":{"text":"В исследованиях in vivo и in vitro было показано, что тербинафин\nподавляет метаболизм, опосредуемый изоферментом CYP2D6. Эти данные могут оказаться\nклинически значимыми для тех препаратов, которые метаболизируются  преимущественно этим изоферментом:\nтрициклические антидепрессанты, бета-адреноблокаторы, селективные ингибиторы\nобратного захвата серотонина, антиаритмические препараты IA, IB, IC класса и ингибиторы\nмоноаминооксидазы типа В, в том случае, если применяемый одновременно препарат\nимеет малый диапазон терапевтической концентрации."}},{"type":"paragraph","data":{"text":"Тербинафин снижает клиренс дезипрамина на 82 %."}},{"type":"paragraph","data":{"text":"В исследованиях на здоровых добровольцах с активным\nметаболизмом декстрометорфана (противокашлевое средство и субстрат изофермента CYP2D6) тербинафин увеличил метаболический\nкоэффициент декстрометорфан/декстрорфан в моче в 16-97 раз. Таким образом,\nтербинафин у лиц с высокой активностью изофермента CYP2D6 может снизить активность\nпоследнего."}},{"type":"paragraph","data":{"text":"Тербинафин может ослаблять действие циклоспорина и\nуменьшать его концентрацию в плазме крови. Тербинафин повышает клиренс\nциклоспорина на 15 %. "}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Нерегулярное применение или досрочное окончание\nлечения повышает риск развития рецидива. Если через 2 недели лечения не\nотмечается улучшение состояния, необходимо повторно определить возбудителя\nзаболевания  и его чувствительность к\nпрепарату. До начала применения тербинафина необходимо провести исследованием\nфункции печени. Гепатотоксичность может возникнуть как у пациентов с\nпредшествующими заболеваниями печени, так и без них. В течение терапии\nрекомендовано периодическое исследование функции печени (через 4-6 недель после\nначала лечения). Лечение тербинафином должно быть немедленно прекращено в\nслучае повышения сывороточной активности «печеночных» проб. Пациенты, которым\nназначают тербинафин, должны быть предупреждены о том, что необходимо\nнемедленно информировать лечащего врача о возникновении на фоне приема\nтербинафина таких симптомов, как стойкая тошнота, снижение аппетита, чувство\nусталости, рвота, боли в правом подреберье, желтуха, темная моча или светлый\nкал. В случае появления подобных симптомов необходимо немедленно прекратить\nприем тербинафина и провести исследование функции печени. Не рекомендуется\nназначать тербинафин пациентам с хроническими заболеваниями печени. Тербинафин\nследует применять с осторожностью у пациентов с псориазом, так как были\nзарегистрированы очень редкие случаи обострения псориаза. Серьезные кожные\nреакции (в том числе синдром Стивенса-Джонсона, токсический эпидермальный\nнекролиз, DRESS-синдром)\nкрайне редко отмечались на фоне применения тербинфина. При применении\nтербинафина в таблетках отмечались крайне редкие случаи изменения клеточного\nсостава крови (нейтропения, агранулоцитоз, тромбоцитопения, панцитопения). В\nслучае развития качественных или количественных изменений со стороны форменных\nэлементов крови следует установить причину нарушений и рассмотреть вопрос о\nснижении дозы тербинафина или, при необходимости, о прекращении терапии\nтербинафином. Было показано, что тербинафин подавляет метаболизм, опосредуемый\nизоферментом CYP2D6. Поэтому необходимо осуществлять\nпостоянное наблюдение за пациентами, получающими одновременно с тербинафином\nлечение препаратами, преимущественно метаболизирующимися с участием этого\nфермента (такими как трициклические антидепрессанты, бета-адреноблокаторы,\nселективные ингибиторы обратного захвата серотонина, антиаритмические препараты\nIC\nкласса и ингибиторы моноаминоксидазы типа B) в случае, если применяемый\nодновременно препарат имеет малый диапазон терапевтической концентрации."}},{"type":"paragraph","data":{"text":"Специальных мер предосторожности при утилизации\nнеиспользованного препарата не предусмотрено. Если лекарственное средство\nпришло в негодность или истек срок годности – не выбрасывайте его в сточные\nводы или на улицу. Поместите лекарственное средство в пакет и положите в\nмусорный контейнер. Эти меры помогут защитить окружающую среду."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"При температуре не выше 25 \u003csup\u003eо\u003c/sup\u003eС, в\nоригинальной упаковке (блистер в пачке)."}},{"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 применять препарат по истечении срока годности."}}]}],"source":null},"description_toggle":false,"short_description":"ФармакодинамикаТербинафин представляет собой аллиламин, который обладает широким спектром действия в отношении грибов, вызывающих заболевания кожи, волос и ногтей, в том числе дерматофитов, таких как Trichophyton (например, Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton verrucosum, Trichophyton tonsurans, Trichophyton violaceum), Microsporum (например, Microsporum canis), Epidermophyton floccosum, а также дрожжевых грибов рода Candida (например, Candida albicans) и Malassezia (ранее Pityrosporum). В низких концентрациях тербинафин оказывает фунгицидное действие в отношении дерматофитов, плесневых и некоторых диморфных грибов. Активность в отношении дрожжевых грибов, в зависимости от их вида, может быть фунгицидной или фунгистатической. Тербинафин специфически подавляет ранний этап биосинтеза стеринов в клетке гриба. Это ведет к дефициту эргостерина и к внутриклеточному накоплению сквалена, что вызывает гибель клетки гриба. Действие тербинафина осуществляется путем ингибирования фермента скваленэпоксидазы в клеточной мембране гриба. Этот фермент не относится к системе цитохрома Р450. При применении тербинафина внутрь в коже, волосах и ногтях создаются его концентрации, обеспечивающие фунгицидное действие.ФармакокинетикаПосле приема внутрь тербинафин хорошо абсорбируется (\u003e 70 %), абсолютная биодоступность тербинафина вследствие эффекта «первичного прохождения» через печень составляет примерно 50 %. После однократного приема тербинафина внутрь в дозе 250 мг его максимальная концентрация (Сmax) в плазме крови достигается через 1,5 ч и составляет 1,3 мкг/мл. Сmaxтербинафина в плазме крови при постоянном его применении в среднем увеличилась на 25 % по сравнению с однократным приемом, значение площади под кривой «концентрация-время» (AUC) увеличилось в 2,3 раза. Исходя из увеличения AUC, можно рассчитать эффективный период полувыведения (30 ч). Прием пищи в умеренной степени влияет на биодоступность препарата (значение AUC увеличивается менее чем на 20 %), но коррекции дозы тербинафина при одновременном приеме с пищей не требуется. Тербинафин в значительной степени связывается с белками плазмы крови (99 %). Он быстро проникает через дермальный слой кожи и накапливается в липофильном роговом слое эпидермиса. Тербинафин также проникает в секрет сальных желез, что обеспечивает высокую концентрацию в волосяных фолликулах, волосах и в коже, богатой сальными железами. Показано также, что тербинафин проникает в ногтевые пластинки в первые несколько недель после начала терапии. Метаболизируется быстро и в существенной степени при участии, как минимум, семи изоферментов системы цитохрома Р450. Основную роль играют изоферменты CYP2C9, CYP1A2, CYP3A4, CYP2C8 и CYP2C19. В результате биотрансформации тербинафина образуются метаболиты, не обладающие противогрибковой активностью и выводящиеся преимущественно почками. Не выявлено изменений равновесной концентрации тербинафина в плазме крови в зависимости от возраста. У пациентов с сопутствующими нарушениями функции почек (клиренс креатинина [КК]\u003c50 мл/мин) и с заболеваниями печени возможно снижение клиренса тербинафина на 50 %. 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