Трансплантация солидных органов (почка, печень, сердце, сердечно-легочный комплекс, легкие, поджелудочная железа) и костного мозга, эндогенные увеиты, нефротический синдром, выраженные формы ревматоидного артрита в активной фазе, тяжелые формы псориаза и атопического дерматита.
Противопоказания
Гиперчувствительность.
Инструкция
Состав
Циклоспорина 50 мг.
Описание
Концентрат Сандиммун для приготовления инфузионного раствора - иммунодепрессивный препарат, представляет собой циклический полипептид, состоящий из 11 аминокислот.
Фармакологические свойства
Иммунодепрессивное средство, циклический ундекапептид. Оказывает избирательное действие на T-лимфоциты. Ингибирует активацию кальцийневрина лимфоцитов в фазе G0 или G1 клеточного цикла. Таким образом, предотвращается активация Т-лимфоцитов и, на клеточном уровне, антиген-зависимое высвобождение лимфокинов, включая интерлейкин-2 (фактор роста Т-лимфоцитов). Циклоспорин действует на лимфоциты специфично и обратимо. В отличие от цитостатиков не подавляет гемопоэз и не влияет на функцию фагоцитов. При прогнозируемом угнетении продукции слезной жидкости у больных с сухим кератоконъюнктивитом считают, что циклоспорин при местном применении (в форме эмульсии) частично действует как иммуномодулятор. Точный механизм действия не установлен. Указано статистически значимое увеличение функциональных показателей слезной железы. Не отмечено увеличения тяжести течения воспалительных заболеваний глаз бактериальной или грибковой природы при местном применении циклоспорина.
Показания к применению
Трансплантация солидных органов (почка, печень, сердце, сердечно-легочный комплекс, легкие, поджелудочная железа) и костного мозга, эндогенные увеиты, нефротический синдром, выраженные формы ревматоидного артрита в активной фазе, тяжелые формы псориаза и атопического дерматита.
Противопоказания
Гиперчувствительность.
Применение при беременности и в период грудного вскармливания
Во время беременности Сандиммун применяют с осторожностью. Грудное вскармливание на время лечения должно быть прекращено.
Способ применения и дозы
Выбор начальной дозы, а также коррекцию режима дозирования в процессе лечения проводят с учетом клинических и лабораторных параметров, а также значений концентрации Сандиммуна в плазме крови, определяемых ежедневно. Взрослым при пересадке костного мозга в день, предшествующий пересадке, Сандиммун вводят внутривенно капельно в дозе 3-5 мг/кг/сутки. Введение этой дозы продолжают во время непосредственного посттрансплантационного периода в течение сроков до 2 недель, затем переходят на поддерживающую терапию пероральными формами циклоспорина. В случаях, когда нарушено всасывание препарата, может потребоваться применение внутривенного введения. При пересадке солидных органов назначают однократно в дозе 3-5 мг/кг массы тела за 4-12 часов перед операцией. В течение 1-2 недель после операции препарат назначают ежедневно в той же дозе, после чего дозу постепенно снижают, под контролем концентрации циклоспорина в крови, до достижения поддерживающей дозы 0.7-2 мг/кг/сутки. При назначении Сандиммуна в комбинации с глюкокортикоидами или другими иммунодепрессантами можно применять меньшие дозы Сандиммуна (например, 1 мг/кг/сутки внутривенно в начальной фазе лечения). Детям старше 1 года назначают Сандиммун в тех же дозах, что и взрослым (из расчета на 1 кг массы тела). Имеется опыт применения у детей более высоких доз Сандиммуна (на килограмм массы тела), по сравнению с дозами у взрослых. Правила приготовления и введения инфузионного раствора. Концентрат следует разбавлять в соотношении 1: 20-1: 100 физиологическим раствором или 5% раствором глюкозы и вводить в течение примерно 2-6 часов. Неиспользованный готовый раствор через 48 часов следует выбрасывать. Для приготовления инфузионного раствора желательно использовать стеклянные контейнеры. Контейнеры и их пробки не должны содержать силиконовое масло и другие жирные вещества.
Побочное действие
Боли в животе, анорексия, тошнота, рвота, диарея, головная боль, слабость, парестезии, судороги, мышечные спазмы, миопатия, тремор, гипертензия, нарушение функции почек и печени, отеки, панкреатит, обратимая дисменорея и аменорея, анемия; тромбоцитопения, в некоторых случаях сопровождающаяся микроангиопатической гемолитической анемией и почечной недостаточностью; гиперкалиемия, гиперурикемия, гипомагниемия, увеличение массы тела, гипертрофия десен, гипертрихоз, повышенная восприимчивость к инфекциям, развитие малигнизации и лимфопролиферативных расстройств.
Особые указания
Сандиммун должен использоваться только врачами, имеющими опыт проведения иммуносупрессивной терапии и обладающими возможностью обеспечить адекватное наблюдение за больным, включая регулярное полное физикальное обследование, измерение АД и контроль концентрации креатинина в сыворотке . Наблюдение за больными, перенесшими трансплантацию и получающими препарат, следует проводить только в тех учреждениях, которые обеспечены обученным медицинским персоналом, адекватными лабораторными и прочими ресурсами. Следует иметь в виду, что при применении циклоспорина, равно как и других иммунодепрессантов, повышается риск развития лимфом и других злокачественных новообразований, чаще кожных покровов. Повышенный риск развития этого осложнения связан больше со степенью и длительностью иммуносупрессии, чем с использованием конкретного препарата. Таким образом, следует соблюдать осторожность при применении комбинированных режимов иммуносупрессивной терапии, помня о вероятности развития лимфопролиферативных заболеваний и солидных органных опухолей, иногда приводящих к летальным исходам. Применение циклоспорина, как и других иммунодепрессантов, предрасполагает к развитию различных бактериальных, грибковых, паразитарных и вирусных инфекций, причем часто с участием условно-патогенных возбудителей. Учитывая потенциальную опасность этих инфекций для жизни больного, следует применять эффективную систему профилактических и лечебных мероприятий, особенно в случаях длительного применения комбинированного иммуносупрессивного лечения. В течение первых нескольких недель терапии Сандиммуном Неоралом может появиться частое и потенциально опасное осложнение - повышение уровня креатинина и мочевины в сыворотке . Эти функциональные изменения обратимы и дозозависимы, нормализуются при снижении дозы. При длительном лечении у некоторых больных возможно развитие в почках структурных изменений (например, интерстициального фиброза), которые у пациентов с почечными трансплантатами следует дифференцировать с изменениями при хроническом отторжении. Сандиммун Неорал может также вызывать дозозависимое обратимое повышение билирубина сыворотки и, редко, ферментов печени. В этих случаях требуется тщательное наблюдение за показателями функции почек и печени. В случае отклонений этих показателей от нормы может потребоваться снижение дозы. Для контроля концентраций циклоспорина в крови предпочтительно использование специфических моноклональных антител (измерение количества неизмененного препарата). Можно использовать метод ВЭЖХ, при помощи которого также измеряется концентрация неизмененного вещества. Если используется плазма или сыворотка, то следует придерживаться стандартной методики разделения (время и температура). Для начального определения концентрации циклоспорина у больных с трансплантатами печени следует использовать специфические моноклональные антитела. Возможно также проведение параллельных определений с использованием специфических и неспецифических моноклональных антител, чтобы добиться дозы, обеспечивающей адекватную иммуносупрессию. Следует помнить, что концентрация циклоспорина в крови, плазме или сыворотке - это только один из многих факторов, характеризующих клиническое состояние больного. Результаты определения концентрации циклоспорина являются только одним из факторов, определяющих режим дозирования, и рассматриваются во взаимосвязи с различными клиническими и лабораторными показателями. При лечении Сандиммуном Неоралом требуется регулярный контроль АД. При повышении АД должна быть назначена соответствующая антигипертензивная терапия. Влияние на способность к вождению автотранспорта и управлению механизмами В настоящее время нет данных о влиянии Сандиммуна Неорала на способность водить автомобиль и работать с механизмами.
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Оказывает избирательное действие на T-лимфоциты. Ингибирует активацию кальцийневрина лимфоцитов в фазе G0 или G1 клеточного цикла. Таким образом, предотвращается активация Т-лимфоцитов и, на клеточном уровне, антиген-зависимое высвобождение лимфокинов, включая интерлейкин-2 (фактор роста Т-лимфоцитов). Циклоспорин действует на лимфоциты специфично и обратимо. В отличие от цитостатиков не подавляет гемопоэз и не влияет на функцию фагоцитов. При прогнозируемом угнетении продукции слезной жидкости у больных с сухим кератоконъюнктивитом считают, что циклоспорин при местном применении (в форме эмульсии) частично действует как иммуномодулятор. Точный механизм действия не установлен. Указано статистически значимое увеличение функциональных показателей слезной железы. Не отмечено увеличения тяжести течения воспалительных заболеваний глаз бактериальной или грибковой природы при местном применении циклоспорина."}}]},{"id":4,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Трансплантация солидных органов (почка, печень, сердце, сердечно-легочный комплекс, легкие, поджелудочная железа) и костного мозга, эндогенные увеиты, нефротический синдром, выраженные формы ревматоидного артрита в активной фазе, тяжелые формы псориаза и атопического дерматита."}}]},{"id":5,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Гиперчувствительность."}}]},{"id":6,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Во время беременности Сандиммун применяют с осторожностью. Грудное вскармливание на время лечения должно быть прекращено."}}]},{"id":7,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Выбор начальной дозы, а также коррекцию режима дозирования в процессе лечения проводят с учетом клинических и лабораторных параметров, а также значений концентрации Сандиммуна в плазме крови, определяемых ежедневно. Взрослым при пересадке костного мозга в день, предшествующий пересадке, Сандиммун вводят внутривенно капельно в дозе 3-5 мг/кг/сутки. Введение этой дозы продолжают во время непосредственного посттрансплантационного периода в течение сроков до 2 недель, затем переходят на поддерживающую терапию пероральными формами циклоспорина. В случаях, когда нарушено всасывание препарата, может потребоваться применение внутривенного введения. При пересадке солидных органов назначают однократно в дозе 3-5 мг/кг массы тела за 4-12 часов перед операцией. В течение 1-2 недель после операции препарат назначают ежедневно в той же дозе, после чего дозу постепенно снижают, под контролем концентрации циклоспорина в крови, до достижения поддерживающей дозы 0.7-2 мг/кг/сутки. При назначении Сандиммуна в комбинации с глюкокортикоидами или другими иммунодепрессантами можно применять меньшие дозы Сандиммуна (например, 1 мг/кг/сутки внутривенно в начальной фазе лечения). Детям старше 1 года назначают Сандиммун в тех же дозах, что и взрослым (из расчета на 1 кг массы тела). Имеется опыт применения у детей более высоких доз Сандиммуна (на килограмм массы тела), по сравнению с дозами у взрослых. Правила приготовления и введения инфузионного раствора. Концентрат следует разбавлять в соотношении 1: 20-1: 100 физиологическим раствором или 5% раствором глюкозы и вводить в течение примерно 2-6 часов. Неиспользованный готовый раствор через 48 часов следует выбрасывать. Для приготовления инфузионного раствора желательно использовать стеклянные контейнеры. Контейнеры и их пробки не должны содержать силиконовое масло и другие жирные вещества."}}]},{"id":8,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Боли в животе, анорексия, тошнота, рвота, диарея, головная боль, слабость, парестезии, судороги, мышечные спазмы, миопатия, тремор, гипертензия, нарушение функции почек и печени, отеки, панкреатит, обратимая дисменорея и аменорея, анемия; тромбоцитопения, в некоторых случаях сопровождающаяся микроангиопатической гемолитической анемией и почечной недостаточностью; гиперкалиемия, гиперурикемия, гипомагниемия, увеличение массы тела, гипертрофия десен, гипертрихоз, повышенная восприимчивость к инфекциям, развитие малигнизации и лимфопролиферативных расстройств."}}]},{"id":9,"name":"Особые указания","slug":"cautions","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Сандиммун должен использоваться только врачами, имеющими опыт проведения иммуносупрессивной терапии и обладающими возможностью обеспечить адекватное наблюдение за больным, включая регулярное полное физикальное обследование, измерение АД и контроль концентрации креатинина в сыворотке . Наблюдение за больными, перенесшими трансплантацию и получающими препарат, следует проводить только в тех учреждениях, которые обеспечены обученным медицинским персоналом, адекватными лабораторными и прочими ресурсами. Следует иметь в виду, что при применении циклоспорина, равно как и других иммунодепрессантов, повышается риск развития лимфом и других злокачественных новообразований, чаще кожных покровов. Повышенный риск развития этого осложнения связан больше со степенью и длительностью иммуносупрессии, чем с использованием конкретного препарата. Таким образом, следует соблюдать осторожность при применении комбинированных режимов иммуносупрессивной терапии, помня о вероятности развития лимфопролиферативных заболеваний и солидных органных опухолей, иногда приводящих к летальным исходам. Применение циклоспорина, как и других иммунодепрессантов, предрасполагает к развитию различных бактериальных, грибковых, паразитарных и вирусных инфекций, причем часто с участием условно-патогенных возбудителей. Учитывая потенциальную опасность этих инфекций для жизни больного, следует применять эффективную систему профилактических и лечебных мероприятий, особенно в случаях длительного применения комбинированного иммуносупрессивного лечения. В течение первых нескольких недель терапии Сандиммуном Неоралом может появиться частое и потенциально опасное осложнение - повышение уровня креатинина и мочевины в сыворотке . Эти функциональные изменения обратимы и дозозависимы, нормализуются при снижении дозы. При длительном лечении у некоторых больных возможно развитие в почках структурных изменений (например, интерстициального фиброза), которые у пациентов с почечными трансплантатами следует дифференцировать с изменениями при хроническом отторжении. Сандиммун Неорал может также вызывать дозозависимое обратимое повышение билирубина сыворотки и, редко, ферментов печени. В этих случаях требуется тщательное наблюдение за показателями функции почек и печени. В случае отклонений этих показателей от нормы может потребоваться снижение дозы. Для контроля концентраций циклоспорина в крови предпочтительно использование специфических моноклональных антител (измерение количества неизмененного препарата). Можно использовать метод ВЭЖХ, при помощи которого также измеряется концентрация неизмененного вещества. Если используется плазма или сыворотка, то следует придерживаться стандартной методики разделения (время и температура). Для начального определения концентрации циклоспорина у больных с трансплантатами печени следует использовать специфические моноклональные антитела. Возможно также проведение параллельных определений с использованием специфических и неспецифических моноклональных антител, чтобы добиться дозы, обеспечивающей адекватную иммуносупрессию. Следует помнить, что концентрация циклоспорина в крови, плазме или сыворотке - это только один из многих факторов, характеризующих клиническое состояние больного. Результаты определения концентрации циклоспорина являются только одним из факторов, определяющих режим дозирования, и рассматриваются во взаимосвязи с различными клиническими и лабораторными показателями. При лечении Сандиммуном Неоралом требуется регулярный контроль АД. При повышении АД должна быть назначена соответствующая антигипертензивная терапия. 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