круглые, слегка двояковыпуклые таблетки белого до слегка бежевого цвета, с риской для деления на одной стороне и тиснением «75» на другой.
Фармакотерапевтическая группа
Тиреоидное средство
Фармакологические свойства
Фармакологические свойства
Синтетический левовращающий изомер тироксина. После частичного превращения в трийодтиронин (в печени и почках) и перехода в клетки организма, оказывает влияние на развитие и рост тканей, на обмен веществ. В малых дозах обладает анаболическим действием на белковый и жировой обмен. В средних дозах стимулирует рост и развитие, повышает потребность тканей в кислороде, стимулирует метаболизм белков, жиров и углеводов, повышает функциональную активность сердечно-сосудистой системы и центральной нервной системы.
В больших дозах угнетает выработку тиротропин-рилизинг гормона гипоталамуса и тиреотропного гормона (ТТГ) гипофиза.
Терапевтический эффект наблюдается через 7-12 дней, в течение этого же времени сохраняется действие после отмены препарата. Клинический эффект при гипотиреозе проявляется через 3-5 сут. Диффузный зоб уменьшается или исчезает в течение 3-6 мес.
Фармакокинетика
При приеме внутрь левотироксин натрия всасывается почти исключительно в верхнем отделе тонкой кишки. Всасывается до 80% принятой дозы препарата.
Прием пищи снижает всасываемость левотироксина натрия. Максимальная концентрация в сыворотке крови достигается примерно через 5-6 часов после приема внутрь. После всасывания более 99% препарата связывается с белками сыворотки крови (тироксин-связывающим глобулином, тироксин-связывающим преальбумином и альбумином). В различных тканях происходит монодейодирование примерно 80% левотироксина натрия с образованием трийодтиронина (Т3) и неактивных продуктов. Тиреоидные гормоны метаболизируются главным образом в печени, почках, головном мозге и в мышцах.
Небольшое количество препарата подвергается дезаминированию и декарбоксилированию, а также конъюгированию с серной и глюкуроновыми кислотами (в печени). Метаболиты выводятся почками и через кишечник. Период полувыведения препарата составляет 6-7 дней. При тиреотоксикозе период полувыведения укорачивается до 3-4 дней, а при гипотиреозе удлиняется до 9-10 дней.
Показания к применению
- гипотиреоз;
- эутиреоидный зоб;
- в качестве заместительной терапии и для профилактики рецидива зоба после резекции щитовидной железы;
- рак щитовидной железы (после оперативного лечения);
- диффузный токсический зоб: после достижения эутиреоидного состояния антитиреоидными препаратами (в виде комбинированной или монотерапии);
- в качестве диагностического средства при проведении теста тиреоидной супрессии.
Противопоказания
- повышенная чувствительность к действующему веществу или к любому из вспомогательных веществ, входящих в состав препарата (см. раздел Состав);
- нелеченный тиреотоксикоз;
- острый инфаркт миокарда, острый миокардит;
- нелеченная недостаточность коры надпочечников.
С осторожностью
С осторожностью следует назначать препарат при заболеваниях сердечно- сосудистой системы: ИБС (атеросклероз, стенокардия, инфаркт миокарда в анамнезе), артериальной гипертензии, аритмии, при сахарном диабете, тяжелом длительно существующем гипотиреозе, синдроме мальабсорбции (может потребоваться коррекция дозы).
Применение при беременности и в период грудного вскармливания
В период беременности и грудного вскармливания терапия препаратом, назначенным по поводу гипотиреоза, должна продолжаться. В период беременности требуется увеличение дозы препарата из-за повышения содержания тироксин-связывающего глобулина. Количество тиреоидного гормона, секретируемого с грудным молоком при лактации (даже при проведении лечения высокими дозами препарата), не достаточно для того, чтобы вызвать какие-либо нарушения у ребенка.
Применение препарата в комбинации с антитиреоидными средствами при беременности противопоказано, так как прием левотироксина натрия может потребовать увеличение доз антитиреоидных препаратов. Поскольку антитиреоидные препараты, в отличие от левотироксина натрия, могут проникать через плаценту, то у плода может развиться гипотиреоз. В период грудного вскармливания препарат следует принимать с осторожностью, строго в рекомендуемых дозах под наблюдением врача.
Способ применения и дозы
Суточная доза определяется индивидуально в зависимости от показаний, клинического состояния пациента и данных лабораторного обследования.Суточную дозу левотироксина натрия принимают внутрь утром натощак, по крайней мере, за 30 минут до приема пищи, запивая таблетку небольшим количеством жидкости (полстакана воды) и не разжевывая.При проведении заместительной терапии гипотиреоза у пациентов моложе 55 лет при отсутствии сердечно-сосудистых заболеваний левотироксин натрия применяют в суточной дозе 1,6-1,8 мкг на 1 кг массы тела; у пациентов старше 55 лет или с сердечно-сосудистыми заболеваниями - 0,9 мкг на 1 кг массы тела.
Начальный этап заместительной терапии при гипотиреозе:
Пациенты без сердечно-сосудистых заболеваний моложе 55 лет:
Начальная доза:
- женщины - 75-100 мкг/сут;
- мужчины - 100-150 мкг/сут
Пациенты с сердечно-сосудистыми заболеваниями старше 55 лет:
Начальная доза - 25 мкг/сут
- Увеличивать на 25 мкг каждые 2 месяца до нормализации показателя ТТГ в крови
- При появлении или ухудшении симптомов со стороны сердечно-сосудистой системы провести коррекцию терапии сердечно-сосудистых заболеваний.
Рекомендуемые дозы левотироксина натрия для лечения врожденного гипотиреоза
Возраст / Суточная доза (мкг) / Доза в расчете на массу тела (мкг/кг).
Профилактика рецидива после хирургического лечения эутиреоидного зоба / 75-200;
В комплексной терапии тиреотоксикоза / 50-100;
Супрессивная терапия рака щитовидной железы / 150-300.
Грудным детям и детям до 3 лет суточную дозу левотироксина натрия дают в один прием за 30 минут до первого кормления. Таблетку растворяют в воде (10-15 мл) до тонкой взвеси, которую готовят непосредственно перед приемом препарата и дают запивать дополнительно небольшим количеством жидкости (5-10 мл).
У пациентов с тяжелым длительно существующим гипотиреозом лечение следует начинать с особой осторожностью, с малых доз - с 12,5 мкг/сут, дозу увеличивают до поддерживающей через более продолжительные интервалы времени - на 12,5 мкг/сут каждые 2 недели и чаще определяют концентрацию ТТГ в крови.
При гипотиреозе левотироксин натрия принимают, как правило, в течение всей жизни. При тиреотоксикозе левотироксин натрия применяют в комплексной терапии с антитиреоидными препаратами после достижения эутиреоидного состояния. Во всех случаях длительность лечения препаратом определяет врач.
Для точного дозирования необходимо использовать наиболее подходящую дозировку левотироксина натрия.
Побочное действие
При правильном применении под контролем врача побочные эффекты не наблюдаются.
При повышенной чувствительности к препарату могут наблюдаться аллергические реакции.
Передозировка
При передозировке препарата наблюдаются симптомы, характерные для тиреотоксикоза: тахикардия, нарушение ритма сердца, боли в сердце, беспокойство, тремор, бессонница, гипергидроз, снижение аппетита, снижение массы тела, диарея, рвота, головная боль, повышенная утомляемость, спазм мышц. В зависимости от выраженности симптомов врачом может быть рекомендовано уменьшение суточной дозы препарата, перерыв в лечении на несколько дней, назначение бета- адреноблокаторов. После исчезновения побочных эффектов лечение следует начинать с осторожностью с более низкой дозы.
Взаимодействие с другими лекарственными средствами
Левотироксин натрия усиливает действие непрямых антикоагулянтов, что может потребовать снижения их дозы.
Применение трициклических антидепрессантов с левотироксином натрия может привести к усилению действия антидепрессантов.
Тиреоидные гормоны могут увеличивать потребность в инсулине и пероральных гипогликемических препаратах. Более частый контроль концентрации глюкозы крови рекомендуется проводить в период начала лечения левотироксином натрия, а также при изменении дозы препарата.
Левотироксин натрия снижает действие сердечных гликозидов. При одновременном применении колестирамин, колестипол и алюминия гидроксид уменьшают плазменную концентрацию левотироксина натрия за счет торможения всасывания его в кишечнике.
При одновременном применении с анаболическими стероидами, аспарагиназой, тамоксифеном возможно фармакокинетическое взаимодействие на уровне связывания с белком.
При одновременном применении с фенитоином, салицилатами, клофибратом, фуросемидом в высоких дозах повышается содержание не связанного с белками плазмы крови левотироксина натрия и Т4.
Соматотропин при одновременном применении с левотироксином натрия может ускорить закрытие эпифизарных зон роста.
Прием фенобарбитала, карбамазепина и рифампицина может увеличивать клиренс левотироксина натрия и потребовать повышения дозы.
Эстрогены повышают концентрацию связанной с тиреоглобулином фракции, что может привести к снижению эффективности препарата.
Амиодарон, аминоглутетимид, пара-аминосалициловая кислота (ПАСК), этионамид, антитиреоидные лекарственные средства, бета-адреноблокаторы, хлоралгидрат, диазепам, леводопа, допамин, метоклопрамид, ловастатин, соматостатин оказывают влияние на синтез, секрецию, распределение и метаболизм препарата.
Особые указания
При гипотиреозе, обусловленном поражением гипофиза, необходимо выяснить, имеется ли одновременно недостаточность коры надпочечников. В данном случае заместительную терапию глюкокортикостероидами следует начинать до начала лечения гипотиреоза тиреоидными гормонами во избежание развития острой надпочечниковой недостаточности.
Влияние на способность управлять автомобилем и движущимися механизмами
Препарат не оказывает влияния на профессиональную деятельность, связанную с вождением транспортных средств и управлением механизмами.
Форма выпуска
Таблетки 75 мкг.
По 25 таблеток в контурную ячейковую упаковку (блистер) [ПВХ /ПВДХ/фольга алюминиевая].
По 1, 2 или 4 блистера вместе с инструкцией по применению помещают в картонную пачку.
Условия хранения
Список Б
При температуре не выше 25 °С.
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Срок годности
2 года.
Не применять по истечении срока годности.
Условия отпуска
По рецепту.
Производитель
Berlin-Chemie AG/Meranini Group
Glinicker Weg, 125
Берлин-Хеми АГ
Глиникер Вег 125
12489, Берлин
Германия
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другой."}}]},{"id":6,"name":"Фармакотерапевтическая группа","slug":"","body":[{"type":"paragraph","data":{"text":"Тиреоидное средство"}}]},{"id":7,"name":"Фармакологические свойства","slug":"pharmacologic_effects","body":[{"type":"paragraph","data":{"text":"\n\nФармакологические свойства"}},{"type":"paragraph","data":{"text":"Синтетический левовращающий изомер тироксина. После частичного превращения в трийодтиронин (в печени и почках) и перехода в клетки организма, оказывает влияние на развитие и рост тканей, на обмен веществ. В малых дозах обладает анаболическим действием на белковый и жировой обмен. В средних дозах стимулирует рост и развитие, повышает потребность тканей в кислороде, стимулирует метаболизм белков, жиров и углеводов, повышает функциональную активность сердечно-сосудистой системы и центральной нервной системы."}},{"type":"paragraph","data":{"text":"В больших дозах угнетает выработку тиротропин-рилизинг гормона гипоталамуса и тиреотропного гормона (ТТГ) гипофиза."}},{"type":"paragraph","data":{"text":"Терапевтический эффект наблюдается через 7-12 дней, в течение этого же времени сохраняется действие после отмены препарата. Клинический эффект при гипотиреозе проявляется через 3-5 сут. Диффузный зоб уменьшается или исчезает в течение 3-6 мес."}},{"type":"paragraph","data":{"text":"Фармакокинетика"}},{"type":"paragraph","data":{"text":"При приеме внутрь левотироксин натрия всасывается почти исключительно в верхнем отделе тонкой кишки. Всасывается до 80% принятой дозы препарата."}},{"type":"paragraph","data":{"text":"Прием пищи снижает всасываемость левотироксина натрия. Максимальная концентрация в сыворотке крови достигается примерно через 5-6 часов после приема внутрь. После всасывания более 99% препарата связывается с белками сыворотки крови (тироксин-связывающим глобулином, тироксин-связывающим преальбумином и альбумином). В различных тканях происходит монодейодирование примерно 80% левотироксина натрия с образованием трийодтиронина (Т\u003csub\u003e3\u003c/sub\u003e) и неактивных продуктов. Тиреоидные гормоны метаболизируются главным образом в печени, почках, головном мозге и в мышцах."}},{"type":"paragraph","data":{"text":"Небольшое количество препарата подвергается дезаминированию и декарбоксилированию, а также конъюгированию с серной и глюкуроновыми кислотами (в печени). Метаболиты выводятся почками и через кишечник. Период полувыведения препарата составляет 6-7 дней. При тиреотоксикозе период полувыведения укорачивается до 3-4 дней, а при гипотиреозе удлиняется до 9-10 дней.\n\n"}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"\n\n- гипотиреоз;"}},{"type":"paragraph","data":{"text":"- эутиреоидный зоб;"}},{"type":"paragraph","data":{"text":"- в качестве заместительной терапии и для профилактики рецидива зоба после резекции щитовидной железы;"}},{"type":"paragraph","data":{"text":"- рак щитовидной железы (после оперативного лечения);"}},{"type":"paragraph","data":{"text":"- диффузный токсический зоб: после достижения эутиреоидного состояния антитиреоидными препаратами (в виде комбинированной или монотерапии);"}},{"type":"paragraph","data":{"text":"- в качестве диагностического средства при проведении теста тиреоидной супрессии.\n\n"}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"\n\n- повышенная чувствительность к действующему веществу или к любому из вспомогательных веществ, входящих в состав препарата (см. раздел Состав);"}},{"type":"paragraph","data":{"text":"- нелеченный тиреотоксикоз;"}},{"type":"paragraph","data":{"text":"- острый инфаркт миокарда, острый миокардит;"}},{"type":"paragraph","data":{"text":"- нелеченная недостаточность коры надпочечников.\n\n"}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"С осторожностью следует назначать препарат при заболеваниях сердечно- сосудистой системы: ИБС (атеросклероз, стенокардия, инфаркт миокарда в анамнезе), артериальной гипертензии, аритмии, при сахарном диабете, тяжелом длительно существующем гипотиреозе, синдроме мальабсорбции (может потребоваться коррекция дозы)."}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"\n\nВ период беременности и грудного вскармливания терапия препаратом, назначенным по поводу гипотиреоза, должна продолжаться. В период беременности требуется увеличение дозы препарата из-за повышения содержания тироксин-связывающего глобулина. Количество тиреоидного гормона, секретируемого с грудным молоком при лактации (даже при проведении лечения высокими дозами препарата), не достаточно для того, чтобы вызвать какие-либо нарушения у ребенка."}},{"type":"paragraph","data":{"text":"Применение препарата в комбинации с антитиреоидными средствами при беременности противопоказано, так как прием левотироксина натрия может потребовать увеличение доз антитиреоидных препаратов. Поскольку антитиреоидные препараты, в отличие от левотироксина натрия, могут проникать через плаценту, то у плода может развиться гипотиреоз. В период грудного вскармливания препарат следует принимать с осторожностью, строго в рекомендуемых дозах под наблюдением врача.\n\n"}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Суточная доза определяется индивидуально в зависимости от показаний, клинического состояния пациента и данных лабораторного обследования.Суточную дозу левотироксина натрия принимают внутрь утром натощак, по крайней мере, за 30 минут до приема пищи, запивая таблетку небольшим количеством жидкости (полстакана воды) и не разжевывая.При проведении заместительной терапии гипотиреоза у пациентов моложе 55 лет при отсутствии сердечно-сосудистых заболеваний левотироксин натрия применяют в суточной дозе 1,6-1,8 мкг на 1 кг массы тела; у пациентов старше 55 лет или с сердечно-сосудистыми заболеваниями - 0,9 мкг на 1 кг массы тела."}},{"type":"paragraph","data":{"text":"Начальный этап заместительной терапии при гипотиреозе:"}},{"type":"paragraph","data":{"text":"Пациенты без сердечно-сосудистых заболеваний моложе 55 лет:"}},{"type":"paragraph","data":{"text":"Начальная доза:"}},{"type":"paragraph","data":{"text":"- женщины - 75-100 мкг/сут;"}},{"type":"paragraph","data":{"text":"- мужчины - 100-150 мкг/сут"}},{"type":"paragraph","data":{"text":"Пациенты с сердечно-сосудистыми заболеваниями старше 55 лет:"}},{"type":"paragraph","data":{"text":"Начальная доза - 25 мкг/сут"}},{"type":"paragraph","data":{"text":"- Увеличивать на 25 мкг каждые 2 месяца до нормализации показателя ТТГ в крови"}},{"type":"paragraph","data":{"text":"- При появлении или ухудшении симптомов со стороны сердечно-сосудистой системы провести коррекцию терапии сердечно-сосудистых заболеваний."}},{"type":"paragraph","data":{"text":"Рекомендуемые дозы левотироксина натрия для лечения врожденного гипотиреоза"}},{"type":"paragraph","data":{"text":"Возраст / Суточная доза (мкг) / Доза в расчете на массу тела (мкг/кг)."}},{"type":"paragraph","data":{"text":"0-6 месяцев / 25-50 / 10-15;"}},{"type":"paragraph","data":{"text":"6-12 месяцев / 50-75 / 6-8;"}},{"type":"paragraph","data":{"text":"1-5 лет / 75-100 / 5-6;"}},{"type":"paragraph","data":{"text":"6-12 лет / 100-150 / 4-5;"}},{"type":"paragraph","data":{"text":">12 лет / 100-200 / 2-3."}},{"type":"paragraph","data":{"text":"Показания / Рекомендуемые дозы левотироксина натрия (мкг/сут):"}},{"type":"paragraph","data":{"text":"Лечение эутиреоидного зоба / 75-200;"}},{"type":"paragraph","data":{"text":"Профилактика рецидива после хирургического лечения эутиреоидного зоба / 75-200;"}},{"type":"paragraph","data":{"text":"В комплексной терапии тиреотоксикоза / 50-100;"}},{"type":"paragraph","data":{"text":"Супрессивная терапия рака щитовидной железы / 150-300."}},{"type":"paragraph","data":{"text":"Грудным детям и детям до 3 лет суточную дозу левотироксина натрия дают в один прием за 30 минут до первого кормления. Таблетку растворяют в воде (10-15 мл) до тонкой взвеси, которую готовят непосредственно перед приемом препарата и дают запивать дополнительно небольшим количеством жидкости (5-10 мл)."}},{"type":"paragraph","data":{"text":"У пациентов с тяжелым длительно существующим гипотиреозом лечение следует начинать с особой осторожностью, с малых доз - с 12,5 мкг/сут, дозу увеличивают до поддерживающей через более продолжительные интервалы времени - на 12,5 мкг/сут каждые 2 недели и чаще определяют концентрацию ТТГ в крови."}},{"type":"paragraph","data":{"text":"При гипотиреозе левотироксин натрия принимают, как правило, в течение всей жизни. При тиреотоксикозе левотироксин натрия применяют в комплексной терапии с антитиреоидными препаратами после достижения эутиреоидного состояния. Во всех случаях длительность лечения препаратом определяет врач."}},{"type":"paragraph","data":{"text":"Для точного дозирования необходимо использовать наиболее подходящую дозировку левотироксина натрия."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"\n\nПри правильном применении под контролем врача побочные эффекты не наблюдаются."}},{"type":"paragraph","data":{"text":"При повышенной чувствительности к препарату могут наблюдаться аллергические реакции.\n\n"}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"При передозировке препарата наблюдаются симптомы, характерные для тиреотоксикоза: тахикардия, нарушение ритма сердца, боли в сердце, беспокойство, тремор, бессонница, гипергидроз, снижение аппетита, снижение массы тела, диарея, рвота, головная боль, повышенная утомляемость, спазм мышц. В зависимости от выраженности симптомов врачом может быть рекомендовано уменьшение суточной дозы препарата, перерыв в лечении на несколько дней, назначение бета- адреноблокаторов. После исчезновения побочных эффектов лечение следует начинать с осторожностью с более низкой дозы."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"\n\nЛевотироксин натрия усиливает действие непрямых антикоагулянтов, что может потребовать снижения их дозы."}},{"type":"paragraph","data":{"text":"Применение трициклических антидепрессантов с левотироксином натрия может привести к усилению действия антидепрессантов."}},{"type":"paragraph","data":{"text":"Тиреоидные гормоны могут увеличивать потребность в инсулине и пероральных гипогликемических препаратах. Более частый контроль концентрации глюкозы крови рекомендуется проводить в период начала лечения левотироксином натрия, а также при изменении дозы препарата."}},{"type":"paragraph","data":{"text":"Левотироксин натрия снижает действие сердечных гликозидов. При одновременном применении колестирамин, колестипол и алюминия гидроксид уменьшают плазменную концентрацию левотироксина натрия за счет торможения всасывания его в кишечнике."}},{"type":"paragraph","data":{"text":"При одновременном применении с анаболическими стероидами, аспарагиназой, тамоксифеном возможно фармакокинетическое взаимодействие на уровне связывания с белком."}},{"type":"paragraph","data":{"text":"При одновременном применении с фенитоином, салицилатами, клофибратом, фуросемидом в высоких дозах повышается содержание не связанного с белками плазмы крови левотироксина натрия и Т\u003csub\u003e4\u003c/sub\u003e."}},{"type":"paragraph","data":{"text":"Соматотропин при одновременном применении с левотироксином натрия может ускорить закрытие эпифизарных зон роста."}},{"type":"paragraph","data":{"text":"Прием фенобарбитала, карбамазепина и рифампицина может увеличивать клиренс левотироксина натрия и потребовать повышения дозы."}},{"type":"paragraph","data":{"text":"Эстрогены повышают концентрацию связанной с тиреоглобулином фракции, что может привести к снижению эффективности препарата."}},{"type":"paragraph","data":{"text":"Амиодарон, аминоглутетимид, пара-аминосалициловая кислота (ПАСК), этионамид, антитиреоидные лекарственные средства, бета-адреноблокаторы, хлоралгидрат, диазепам, леводопа, допамин, метоклопрамид, ловастатин, соматостатин оказывают влияние на синтез, секрецию, распределение и метаболизм препарата.\n\n"}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"\n\nПри гипотиреозе, обусловленном поражением гипофиза, необходимо выяснить, имеется ли одновременно недостаточность коры надпочечников. В данном случае заместительную терапию глюкокортикостероидами следует начинать до начала лечения гипотиреоза тиреоидными гормонами во избежание развития острой надпочечниковой недостаточности."}}]},{"id":17,"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","body":[{"type":"paragraph","data":{"text":"Препарат не оказывает влияния на профессиональную деятельность, связанную с вождением транспортных средств и управлением механизмами."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"\n\nТаблетки 75 мкг."}},{"type":"paragraph","data":{"text":"По 25 таблеток в контурную ячейковую упаковку (блистер) [ПВХ /ПВДХ/фольга алюминиевая]."}},{"type":"paragraph","data":{"text":"По 1, 2 или 4 блистера вместе с инструкцией по применению помещают в картонную пачку.\n\n"}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"\n\nСписок Б"}},{"type":"paragraph","data":{"text":"При температуре не выше 25 °С."}},{"type":"paragraph","data":{"text":"Хранить в недоступном для детей месте!\n\n"}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"\n\n2 года."}},{"type":"paragraph","data":{"text":"Не применять по истечении срока годности.\n\n"}}]},{"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":"Berlin-Chemie AG/Meranini Group"}},{"type":"paragraph","data":{"text":"Glinicker Weg, 125"}},{"type":"paragraph","data":{"text":"Берлин-Хеми АГ"}},{"type":"paragraph","data":{"text":"Глиникер Вег 125"}},{"type":"paragraph","data":{"text":"12489, Берлин"}},{"type":"paragraph","data":{"text":"Германия"}}]}],"source":null},"description_toggle":false,"short_description":"Фармакологические свойства Синтетический левовращающий изомер тироксина. После частичного превращения в трийодтиронин (в печени и почках) и перехода в клетки организма, оказывает влияние на развитие и рост тканей, на обмен веществ. В малых дозах обладает анаболическим действием на белковый и жировой обмен. В средних дозах стимулирует рост и развитие, повышает потребность тканей в кислороде, стимулирует метаболизм белков, жиров и углеводов, повышает функциональную активность сердечно-сосудистой системы и центральной нервной системы. В больших дозах угнетает выработку тиротропин-рилизинг гормона гипоталамуса и тиреотропного гормона (ТТГ) гипофиза. Терапевтический эффект наблюдается через 7-12 дней, в течение этого же времени сохраняется действие после отмены препарата. Клинический эффект при гипотиреозе проявляется через 3-5 сут. Диффузный зоб уменьшается или исчезает в течение 3-6 мес. Фармакокинетика При приеме внутрь левотироксин натрия всасывается почти исключительно в верхнем отделе тонкой кишки. Всасывается до 80% принятой дозы препарата. Прием пищи снижает всасываемость левотироксина натрия. Максимальная концентрация в сыворотке крови достигается примерно через 5-6 часов после приема внутрь. После всасывания более 99% препарата связывается с белками сыворотки крови (тироксин-связывающим глобулином, тироксин-связывающим преальбумином и альбумином). В различных тканях происходит монодейодирование примерно 80% левотироксина натрия с образованием трийодтиронина (Т3) и неактивных продуктов. Тиреоидные гормоны метаболизируются главным образом в печени, почках, головном мозге и в мышцах. Небольшое количество препарата подвергается дезаминированию и декарбоксилированию, а также конъюгированию с серной и глюкуроновыми кислотами (в печени). Метаболиты выводятся почками и через кишечник. Период полувыведения препарата составляет 6-7 дней. При тиреотоксикозе период полувыведения укорачивается до 3-4 дней, а при гипотиреозе удлиняется до 9-10 дней.","substance":[{"id":276,"title":"Левотироксин натрия","title_latin":"Levothyroxinum natrium","slug":"levotiroksin_natriya_276"}],"branding":null,"valid_for_quick_buy":true,"is_available_to_delivery":false,"comments":null,"image_alt":"L-Тироксин Берлин-Хеми - фото упаковки","image_share":{"isTouch":{"default":"https://vseapteki.ru/cropping/thumbnails/101/61388/share_default/"},"isFromTablet":{"default":"https://vseapteki.ru/cropping/thumbnails/101/61388/share_default/"}},"diseases":[{"id":"258","title":"Злокачественное новообразование щитовидной железы","slug":"258-zlokachestvennoe_novoobrazovanie_schitovidnoy_zhelezy"},{"id":"359","title":"Диффузный (эндемический) зоб, связанный с йодной недостаточностью","slug":"359-diffuznyy_endemicheskiy_zob_svyazannyy_s_yodnoy_nedostatochnostyu"},{"id":"360","title":"Многоузловой (эндемический) зоб, связанный с йодной 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