Арифон Ретард Таблетки, коробка, 30 шт, 1,5 мг, для приема внутрь, для взрослых

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В связи с тем, что в состав препарата входит лактоза, Арифон ретард не рекомендуется больным с непереносимостью лактозы, галактоземией, глюкозо-галактозной мальабсорбцией. С осторожностью следует назначать препарат при нарушениях функции печени и почек, нарушениях водно-электролитного баланса, ослабленным больные или пациентам, получающим сочетанную терапию с другими антиаритмическими препаратами, при сахарном диабете, повышенном уровне мочевой кислоты, гиперпаратиреозе, пациентам с удлиненным интервалом QT. Из-за отсутствия достаточного количества клинических данных препарат не рекомендуется применять у детей и подростков в возрасте до 18 лет."]}}]},{"id":14,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"\n\n(Подробно см. «Особые указания»)"}},{"type":"paragraph","data":{"text":"Нарушения функции печени и почек, нарушения водно-электролитного баланса, ослабленные больные или пациенты, получающие сочетанную терапию с другими антиаритмическими препаратами (см. «Взаимодействие с другими лекарственными средствами»), сахарный диабет, повышенный уровень мочевой кислоты, пациенты с удлиненным QT- интервалом, гиперпаратиреоз."}},{"type":"paragraph","data":{"text":"Из-за отсутствия достаточного количества клинических данных препарат не рекомендуется применять у детей до 18 лет.\n\n"}}]},{"id":5,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Как правило, при беременности не следует назначать диуретические препараты. Не следует использовать эти препараты для лечения физиологических отеков при беременности. Диуретические препараты могут вызывать фетоплацентарную ишемию и приводить к нарушению развития плода. В связи с тем, что индапамид выделяется с грудным молоком, не рекомендуется назначение препарата в период грудного вскармливания."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Назначают внутрь по 1 таб./сут, желательно утром. Таблетку следует проглатывать целиком, не разжевывая, запивая водой. При лечении больных артериальной гипертензией увеличение дозы препарата не приводит к увеличению антигипертензивного действия, но усиливает диуретический эффект. У пациентов пожилого возраста следует контролировать плазменный уровень креатинина с учетом возраста, массы тела и пола. Арифон ретард в дозе 1.5 мг/сут (1 таб.) можно назначать пациентам пожилого возраста с нормальной или незначительно нарушенной функцией почек."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Большинство побочных реакций (лабораторные и клинические показатели) носят дозозависимый характер."}},{"type":"paragraph","data":{"text":"Частота побочных реакций, которые могут быть вызваны тиазидоподобными диуретиками, включая индапамид, приведена в виде следующей градации: очень часто (≥1/10); часто (≥1/100, Со стороны кровеносной и лимфатической системы"}},{"type":"paragraph","data":{"text":"Очень редко: тромбоцитопения, лейкопения, агранулоцитоз, апластическая анемия, гемолитическая анемия."}},{"type":"paragraph","data":{"text":"Со стороны центральной нервной системы"}},{"type":"paragraph","data":{"text":"Редко: астения, головная боль, парестезии, вертиго."}},{"type":"paragraph","data":{"text":"Неуточненной частоты: обморок."}},{"type":"paragraph","data":{"text":"Со стороны сердечно-сосудистой системы"}},{"type":"paragraph","data":{"text":"Очень редко: аритмия, выраженное снижение АД."}},{"type":"paragraph","data":{"text":"Неуточненной частоты: аритмия типа «пируэт» (возможно со смертельным исходом) (см. разделы «Взаимодействие с другими лекарственными препаратами» и «Особые указания»)."}},{"type":"paragraph","data":{"text":"Со стороны пищеварительной системы"}},{"type":"paragraph","data":{"text":"Нечасто: рвота."}},{"type":"paragraph","data":{"text":"Редко: тошнота, запор, сухость слизистой оболочки полости рта."}},{"type":"paragraph","data":{"text":"Очень редко: панкреатит."}},{"type":"paragraph","data":{"text":"Со стороны мочевыделительной системы"}},{"type":"paragraph","data":{"text":"Очень редко: почечная недостаточность."}},{"type":"paragraph","data":{"text":"Со стороны печени и желчевыводящих путей"}},{"type":"paragraph","data":{"text":"Очень редко: нарушение функции печени."}},{"type":"paragraph","data":{"text":"Неуточненной частоты: возможность развития печеночной энцефалопатии в случае печеночной недостаточности (см. разделы «Противопоказания» и «Особые указания»); гепатит."}},{"type":"paragraph","data":{"text":"Со стороны кожных покровов и подкожно-жировой клетчатки"}},{"type":"paragraph","data":{"text":"Реакции повышенной чувствительности, в основном дерматологические, у пациентов с предрасположенностью к аллергическим и астматическим реакциям:"}},{"type":"list","data":{"style":"ordered","items":["Часто: макулопапулезная сыпь;","Нечасто: геморрагический васкулит;","Очень редко: ангионевротический отек и/или крапивница, токсический эпидермальный некролиз, синдром Стивенса-Джонсона;","Неуточненной частоты: у пациентов с острой формой системной красной волчанки возможно ухудшение течения заболевания."]}},{"type":"paragraph","data":{"text":"Описаны случаи реакций фоточувствительности (см. разделы «Особые указания» и «Взаимодействие с другими лекарственными препаратами»)."}},{"type":"paragraph","data":{"text":"Лабораторные показатели"}},{"type":"paragraph","data":{"text":"Неуточненной частоты:"}},{"type":"list","data":{"style":"ordered","items":["Увеличение QT интервала на ЭКГ (см. раздел «Особые указания»).","Повышение концентрации мочевой кислоты и глюкозы в крови: тиазидные и тиазидоподобные диуретики следует с осторожностью применять у пациентов с подагрой и сахарным диабетом.","Повышение активности «печеночных» трансаминаз."]}},{"type":"paragraph","data":{"text":"В клинических исследованиях гипокалиемия (содержание калия в плазме крови менее 3,4 ммоль/л) наблюдалась у 10 % пациентов и менее 3,2 ммоль/л - у 4 % пациентов после 4 - 6 недель лечения. После 12 недель терапии содержание калия в плазме крови снизилось, в среднем, на 0,23 ммоль/л."}},{"type":"paragraph","data":{"text":"Очень редко: гиперкальциемия."}},{"type":"paragraph","data":{"text":"Неуточненной частоты:"}},{"type":"list","data":{"style":"ordered","items":["снижение содержания калия и развитие гипокалиемии, особенно значимое для пациентов, относящихся к группе риска (см. раздел «Особые указания»);","гипонатриемия, сопровождающаяся гиповолемией, дегидратацией и ортостатической гипотензией. Одновременная гипохлоремия может привести к метаболическому алкалозу компенсаторного характера (вероятность и тяжесть данного эффекта низка)."]}}]},{"id":8,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Индапамид даже в очень высоких концентрациях (до 40 мг, т.е. в 27 раз больше терапевтической дозы) не оказывает токсического действия. Симптомы острого отравления препаратом в первую очередь связаны с нарушением водно-электролитного баланса (гипонатриемия, гипокалиемия). Также могут отмечаться тошнота, рвота, снижение АД, судороги, головокружение, сонливость, спутанность сознания, полиурия или олигурия, приводящая к анурии (вследствие гиповолемии). Лечение: неотложные меры, направленные на удаление препарата из организма: промывание желудка и/или назначение активированного угля с последующим восстановлением нормального водно-электролитного баланса."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"НЕЖЕЛАТЕЛЬНОЕ СОЧЕТАНИЕ ЛЕКАРСТВЕННЫХ ВЕЩЕСТВ"}},{"type":"paragraph","data":{"text":"- Препараты лития:"}},{"type":"paragraph","data":{"text":"СОЧЕТАНИЕ ПРЕПАРАТОВ, ТРЕБУЮЩЕЕ ОСОБОГО ВНИМАНИЯ"}},{"type":"paragraph","data":{"text":"Препараты, способные вызывать аритмию типа “пируэт”:"}},{"type":"list","data":{"style":"ordered","items":["антиаритмические препараты IА класса (хинидин, гидрохинидин, дизопирамид);","антиаритмические препараты III класса (амиодарон, соталол, дофетилид, ибутилид);","некоторые нейролептики: фенотиазины (хлорпромазин, циамемазин, левомепромазин, тиоридазин, трифторперазин), бензамиды (амисульприд, сульпирид, сультоприд, тиаприд), бутирофеноны (дроперидол, галоперидол);","другие: бепридил, цизаприд, дифеманил, эритромицин (в/в), галофантрин, мизоластин, пентамидин, спарфлоксацин, моксифлоксацин, астемизол, винкамин (в/в)."]}},{"type":"paragraph","data":{"text":"Увеличение риска желудочковых аритмий, особенно аритмии типа “пируэт” (фактор риска - гипокалиемия)."}},{"type":"paragraph","data":{"text":"Следует определить уровень калия в плазме крови и, при необходимости, корректировать его до начала комбинированной терапии индапамидом и указанными выше препаратами."}},{"type":"paragraph","data":{"text":"Необходим контроль клинического состояния пациента, контроль уровня электролитов плазмы крови, показателей ЭКГ."}},{"type":"paragraph","data":{"text":"У пациентов с гипокалиемией необходимо использовать препараты, не вызывающие аритмию типа “пируэт”."}},{"type":"paragraph","data":{"text":"- Нестероидные противовоспалительные препараты (при системном назначении), включая селективные ингибиторы ЦОГ-2, высокие дозы салицилатов (≥ 3 г/сутки):"}},{"type":"paragraph","data":{"text":"Возможно снижение антигипертензивного эффекта индапамида."}},{"type":"paragraph","data":{"text":"- Ингибиторы ангиотензин-превращающего фермента (АПФ):"}},{"type":"paragraph","data":{"text":"Назначение ингибиторов АПФ пациентам со сниженной концентрацией ионов натрия в крови (особенно пациентам со стенозом почечной артерии) сопровождается риском внезапной артериальной гипотензии и/или острой почечной недостаточности. Пациентам с артериальной гипертензией и возможно сниженным, вследствие приема диуретиков, содержанием ионов натрия в плазме крови необходимо:"}},{"type":"list","data":{"style":"ordered","items":["за 3 дня до начала лечения ингибитором АПФ прекратить прием диуретиков. В дальнейшем, при необходимости, прием диуретиков можно возобновить;","или начинать терапию ингибитором АПФ с низких доз, с последующим постепенным увеличением дозы в случае необходимости."]}},{"type":"paragraph","data":{"text":"При хронической сердечной недостаточности лечение ингибиторами АПФ следует начинать с низких доз с возможным предварительным снижением доз диуретиков."}},{"type":"paragraph","data":{"text":"- Другие препараты, способные вызывать гипокалиемию: амфотерицин В (в/в), глюко- и минералокортикостероиды (при системном назначении), тетракозактид, слабительные средства, стимулирующие моторику кишечника:"}},{"type":"paragraph","data":{"text":"Увеличение риска развития гипокалиемии (аддитивный эффект)."}},{"type":"paragraph","data":{"text":"- Баклофен:"}},{"type":"paragraph","data":{"text":"Отмечается усиление гипотензивного эффекта."}},{"type":"paragraph","data":{"text":"- Сердечные гликозиды:"}},{"type":"paragraph","data":{"text":"Гипокалиемия усиливает токсическое действие сердечных гликозидов."}},{"type":"paragraph","data":{"text":"При одновременном применении индапамида и сердечных гликозидов следует контролировать уровень калия в плазме крови, показатели ЭКГ, и, при необходимости, корректировать терапию."}},{"type":"paragraph","data":{"text":"СОЧЕТАНИЕ ПРЕПАРАТОВ, ТРЕБУЮЩЕЕ ВНИМАНИЯ"}},{"type":"paragraph","data":{"text":"- Калийсберегающие диуретики (амилорид, спиронолактон, триамтерен):"}},{"type":"paragraph","data":{"text":"Комбинированная терапия индапамидом и калийсберегающими диуретиками целесообразна у некоторых пациентов, однако при этом не исключается возможность развития гипокалиемии (особенно у больных сахарным диабетом и пациентов с почечной недостаточностью) или гиперкалиемии."}},{"type":"paragraph","data":{"text":"- Метформин"}},{"type":"paragraph","data":{"text":"Функциональная почечная недостаточность, которая может возникать на фоне диуретиков, особенно петлевых, при одновременном назначении метформина повышает риск развития молочнокислого ацидоза."}},{"type":"paragraph","data":{"text":"- Йодсодержащие контрастные вещества:"}},{"type":"paragraph","data":{"text":"Обезвоживание организма на фоне приема диуретических препаратов увеличивает риск развития острой почечной недостаточности, особенно при использовании высоких доз йодсодержащих контрастных веществ."}},{"type":"paragraph","data":{"text":"- Трициклические антидепрессанты, антипсихотические средства (нейролептики):"}},{"type":"paragraph","data":{"text":"- Соли кальция:"}},{"type":"paragraph","data":{"text":"- Циклоспорин, такролимус:"}},{"type":"paragraph","data":{"text":"- Кортикостероидные препараты, тетракозактид (при системном назначении):"}},{"type":"paragraph","data":{"text":"Снижение гипотензивного действия (задержка жидкости и ионов натрия в результате действия кортикостероидов)."}}]},{"id":9,"name":"Особые указания","slug":"","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Нарушения функции печени"}},{"type":"paragraph","data":{"text":"Фоточувствительность"}},{"type":"paragraph","data":{"text":"Водно-электролитный баланс:"}},{"type":"paragraph","data":{"text":"- Содержание ионов натрия в плазме крови:"}},{"type":"paragraph","data":{"text":"- Содержание ионов калия в плазме крови:"}},{"type":"paragraph","data":{"text":"При терапии тиазидными и тиазидоподобными диуретиками основной риск заключается в резком снижении уровня калия в плазме крови и развитии гипокалиемии. Необходимо избегать риска развития гипокалиемии ( Кроме того, к группе повышенного риска относятся больные с увеличенным интервалом QT, при этом не имеет значения, вызвано это увеличение врожденными причинами или действием лекарственных средств."}},{"type":"paragraph","data":{"text":"Гипокалиемия, так же как и брадикардия, является состоянием, способствующим развитию тяжелых аритмий и, особенно, аритмий типа “пируэт“, которые могут приводить к летальному исходу. Во всех описанных выше случаях необходимо регулярно контролировать содержание калия в плазме крови. Первое измерение концентрации ионов калия в крови необходимо провести в течение первой недели от начала лечения."}},{"type":"paragraph","data":{"text":"- Содержание кальция в плазме крови:"}},{"type":"paragraph","data":{"text":"Следует иметь в виду, что тиазидные и тиазидоподобные диуретики могут уменьшать выведение ионов кальция почками, приводя к незначительному и временному повышению концентрации кальция в плазме крови. Выраженная гиперкальциемия может быть следствием ранее не диагностированного гиперпаратиреоза."}},{"type":"paragraph","data":{"text":"Содержание глюкозы в плазме крови:"}},{"type":"paragraph","data":{"text":"Мочевая кислота:"}},{"type":"paragraph","data":{"text":"Диуретические препараты и функция почек:"}},{"type":"paragraph","data":{"text":"Тиазидные и тиазидоподобные диуретики эффективны в полной мере только у больных с нормальной или незначительно нарушенной функцией почек (содержание креатинина в плазме крови у взрослых лиц ниже 25 мг/л или 220 мкмоль/л). У пациентов пожилого возраста нормальный уровень креатинина в плазме крови рассчитывают с учетом возраста, массы тела и пола."}},{"type":"paragraph","data":{"text":"Спортсмены"}},{"type":"paragraph","data":{"text":"Влияние на способность управлять автомобилем и выполнение работ, требующих повышенной скорости физической и психической реакций"}},{"type":"paragraph","data":{"text":"Действие веществ, входящих в состав препарата Арифон  ретард, не приводит к нарушению психомоторных реакций. Однако у некоторых людей в ответ на снижение артериального давления могут развиться различные индивидуальные реакции, особенно в начале терапии или при добавлении к проводимой терапии других гипотензивных средств. В этом случае способность управлять автомобилем или другими механизмами может быть снижена."}}]},{"id":17,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"\n\nТаблетки с контролируемым высвобождением, покрытые пленочной оболочкой, 1,5 мг."}},{"type":"paragraph","data":{"text":"По 15 таблеток в блистер (ПВХ/Ал). По 2 блистера вместе с инструкцией по применению в картонную пачку."}},{"type":"paragraph","data":{"text":"По 30 таблеток в блистер (ПВХ/Ал). По 1 блистеру вместе с инструкцией по применению в картонную пачку."}},{"type":"paragraph","data":{"text":"При расфасовке (упаковке)/ производстве на ООО «Сердикс»:"}},{"type":"paragraph","data":{"text":"Таблетки с контролируемым высвобождением, покрытые пленочной оболочкой, 1,5 мг."}},{"type":"paragraph","data":{"text":"По 30 таблеток в блистер (ПВХ/Ал). По 1 блистеру вместе с инструкцией по применению в картонную пачку."}},{"type":"paragraph","data":{"text":"Упаковка для стационаров:"}},{"type":"paragraph","data":{"text":"По 30 таблеток в блистер (ПВХ/Ал). По 3 блистера с инструкцией по медицинскому применению в пачку картонную."}},{"type":"paragraph","data":{"text":"По 30 таблеток в блистер (ПВХ/Ал). По 10 блистеров в пачку картонную (пачку не маркируют). По 3 пачки картонные с инструкциями по медицинскому применению в коробку картонную.\n\n"}}]},{"id":18,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"\n\nХранить при температуре не выше 30 °С."}},{"type":"paragraph","data":{"text":"Хранить в недоступных для детей местах.\n\n"}}]},{"id":19,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"\n\n2 года."}},{"type":"paragraph","data":{"text":"ПРЕПАРАТ НЕЛЬЗЯ ПРИМЕНЯТЬ ПО ИСТЕЧЕНИИ СРОКА ГОДНОСТИ, УКАЗАННОГО НА УПАКОВКЕ.\n\n"}}]},{"id":20,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"По рецепту."}}]},{"id":21,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"\n\n«Лаборатории Сервье Индастри»:"}},{"type":"paragraph","data":{"text":"905, шоссе Саран, 45520 Жиди, Франция"}},{"type":"paragraph","data":{"text":"905, route de Saran, 45520 Gidy, France\n\n"}}]}],"source":{"title":"36.6","url":"https://366.ru"}},"description_toggle":false,"short_description":"Фармакодинамика Индапамид относится к производным сульфонамида с индольным кольцом и по фармакологическим свойствам близок к тиазидным диуретикам, которые ингибируют реабсорбцию ионов натрия в кортикальном сегменте петли нефрона. При этом увеличивается выделение почками ионов натрия, хлора и в меньшей степени ионов калия и магния, что сопровождается увеличением диуреза и гипотензивным эффектом. В клинических исследованиях II и III фаз при использовании индапамида в режиме монотерапии в дозах, не оказывающих выраженного диуретического эффекта, был продемонстрирован 24-часовой гипотензивный эффект. Антигипертензивная активность индапамида связана с улучшением эластических свойств крупных артерий, уменьшением артериолярного и общего периферического сосудистого сопротивления. Индапамид уменьшает гипертрофию левого желудочка. Тиазидные и тиазидоподобные диуретики при определенной дозе достигают плато терапевтического эффекта, в то время как частота побочных эффектов продолжает увеличиваться при дальнейшем повышении дозы препарата. Поэтому не следует увеличивать дозу препарата, если при приёме рекомендованной дозы не достигнут терапевтический эффект. В коротких, средней длительности и долгосрочных исследованиях с участием больных с артериальной гипертензией было показано, что индапамид: - не влияет на показатели липидного обмена, в том числе на уровень триглицеридов, холестерина, липопротеинов низкой плотности и липопротеинов высокой плотности; - не влияет на показатели обмена углеводов, в том числе у больных сахарным диабетом. Фармакокинетика Всасывание Высвободившийся индапамид быстро и полностью всасывается в желудочно-кишечном тракте. Прием пищи незначительно увеличивает время всасывания препарата, не влияя при этом на полноту абсорбции. Максимальная концентрация в плазме крови достигается через 12 часов после приема внутрь однократной дозы. При повторных приемах колебания концентрации препарата в плазме крови в промежуток между приемами препарата сглаживаются. Распределение Около 79 % препарата связывается с белками плазмы крови. Период полувыведения составляет 14-24 часа (в среднем, 18 часов). Равновесная концентрация достигается через 7 дней приема препарата. 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