Никсар Таблетки, пачка, 10 шт, 20 мг, для приема внутрь, для ЛОР органов, для взрослых

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свойства","slug":"pharmacologic_effects","body":[{"type":"paragraph","data":{"text":"Фармакодинамика"}},{"type":"paragraph","data":{"text":"Биластин – неседативное антигистаминное средство длительного действия, избирательно блокирует периферические H1-рецепторы."}},{"type":"paragraph","data":{"text":"Значимый терапевтический эффект наблюдается через 1 ч после приема препарата."}},{"type":"paragraph","data":{"text":"Антигистаминное действие биластина сохраняется в течение 24 ч."}},{"type":"paragraph","data":{"text":"В клинических исследованиях, проведенных у взрослых и подростков с аллергическим риноконъюнктивитом (сезонным и круглогодичным) при применении биластина в дозе 20 мг 1 раз в сутки в течение 14-28 дней отмечалось облегчение таких симптомов как чихание, ринорея, зуд и заложеннсоть носа, ощущение зуда и жжения в глазах, слезотечение и покраснение глаз. Терапевтический эффект биластина сохранялся 24 ч."}},{"type":"paragraph","data":{"text":"В клинических исследованиях, проведенных у пациентов с хронической идиопатической крапивницей, при применении биластина в дозе 20 мг 1 раз в сутки в течение 28 дней отмечалось облегчение кожного зуда и уменьшение количества и размера волдырей, уменьшение дискомфорта, связанного с крапивницей, а также улучшение сна и качества жизни."}},{"type":"paragraph","data":{"text":"Возможно незначительное проникновение биластина через гематоэнцефалический барьер, но при этом изученный в клинических исследованиях профиль безопасности биластина в отношении центральной нервной системы был сходен с таковым у плацебо. Биластин не вызывал седативного эффекта (в клинических исследованиях частота возникновения сонливости и повышенной утомляемости при лечении биластином была сопоставима с таковой в группе плацебо) и не оказывал влияния на центральную нервную систему."}},{"type":"paragraph","data":{"text":"Биластин не оказывает антихолинергического действия. В клинических исследованиях применение биластина не сопровождалось удлинением интервала QTc на ЭКГ или какими-либо другими кардиоваскулярными эффектами ни при применении в супратерапевтических дозах (200 мг один раз в день в течение 7 дней), ни при одновременном применении с ингибиторами Р-гликопротеина (кетоконазол, эритромицин)."}},{"type":"paragraph","data":{"text":"Фармакокинетика"}},{"type":"paragraph","data":{"text":"Всасывание. После приема внутрь биластин быстро абсорбируется из желудочно-кишечного тракта. Время достижения максимальной концентрации в плазме крови (TСmах) составляет 1,3 ч. Биодоступность биластина при приеме внутрь составляет 61 %. Одновременный прием пищи снижает биодоступность биластина на 30 %. Кумуляции препарата не наблюдается."}},{"type":"paragraph","data":{"text":"Распределение. В исследованиях in vitro и in vivo показано, что биластин является субстратом Р-гликопротеина и белка-переносчика органических анионов ОАТР (см. раздел \"Взаимодействие с другими лекарственными препаратами\"). По всей видимости, биластин не является субстратом переносчика BCRP или почечных переносчиков OTC2, OAT1 и OAT3. Зарегистрировано слабое ингибирование биластином З-гликопротеина, OATP2B1 и OCT1. На основании результатов исследований in vitro, в системной циркуляции не ожидается ингибирования биластином таких переносчиков, как Р-гликопротеин, MRP2, BCRP, BSEP, OATP1B1, OATP1B3, OATP2B1, OAT1, OAT3, OCT1, OCT2, и NTCP. Согласно оценке, конценрация полумаксимального ингибирования (IC50>300 мкМ) биластином данных переносчиков значительно выше его расчетной клинической максимальной конценрации (Cmax) в плазме крови, вследствие чего взаимодействие биластина с ними не имеет клинического значения. Основываясь на этих результатах, нельзя, однако, исключить ингибирования биластином белков-переносчиков в слизистой оболочке кишечника (например, З-гликопротеина). При применении в терапевтических дозах связь биластина с белками плазы крови - 84-90%."}},{"type":"paragraph","data":{"text":"Метаболизм и выведение. Биластин метаболизируется незначительно. После однократного применения до 95 % биластина от принятой дозы выводится в неизмененном виде почками (28,3%) и с желчью (66,5%). В исследованиях in vitri показано, что биластин не является индуктором или ингибитором изоферментов системы цитохрома Р450. Период полувыведения (T1/2) биластина у здоровых добровольцев составляет в среднем 14,5 ч."}},{"type":"paragraph","data":{"text":"У пациентов с почечной недостаточностью легкой степени тяжести (скорость клубочковой фильтрации (СКФ) 50-80 мл/мин/1.73 м2) скорость элиминации биластина значимо не отличалась от таковой у пациентов без почечной недостаточности (скорость клубочковой фильтрации (СКФ) >80 мл/мин/1.73 м2). У пациентов с почечной недостаточностью средней степени тяжести (скорость клубочковой фильтрации (СКФ) 30-50 мл/мин/1.73 м2) и тяжелой степени тяжести (СКФ < 30 мл/мин/1,73 м2) скорость элиминации биластина замедляется, что может привести к увеличению концентрации биластина в плазме крови. Не ожидается, что изменение данных фармакокинетических параметров может оказывать влияние на профиль безопасности биластина, так как концентрация биластина в плазме крови у пациентов с почечной недостаточностью остается в пределах безопасных значений."}},{"type":"paragraph","data":{"text":"При печеночной недостаточности клинически значимых изменений фармакокинетических параметров биластина не происходит, так как биластин незначительно метаболизируется в печени. Фармакокинетические данные, полученные у пациентов с печеночной недостаточностью, отсутствуют."}},{"type":"paragraph","data":{"text":"Значимых различий фармакокинетических параметров биластина у пациентов старше 65 лет по сравнению с таковыми у пациентов в возрасте от 18 до 35 лет не наблюдалось. Фармакокинетические данные биластина у подростков (от 12 до 17 лет) отсутствуют, поскольку для данной популяции возможна экстраполяция фармакокинетических данных, полученных у взрослых."}},{"type":"paragraph","data":{"text":"В исследованном диапазоне доз (5-220 мг) фармакокинетика биластина имеет линейный характер."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Симптоматическое лечение аллергического (сезонного и круглогодичного) риноконъюнктивита: для облегчения чихания, ринореи, зуда и заложенности носа, ощущения зуда и жжения в глазах, покраснения глаз, слезотечение)."}},{"type":"paragraph","data":{"text":"Симптоматическое лечение крапивницы: для уменьшения кожного зуда и сыпи."}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"Повышенная чувствительность к биластину или вспомогательным компонентам препарата; возраст до 12 лет (эффективность и безопасность не установлены); беременность и период грудного вскармливания."}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"Беременность"}},{"type":"paragraph","data":{"text":"Применение препарата Никсар® во время беременности и в период грудного вскармливания противопоказано в связи с отсутствием клинических данных о безопасности применения у беременных и кормящих женщин."}},{"type":"paragraph","data":{"text":"В исследованиях репродуктивной токсичности влияние биластина на плод (пре- и постимплантационная гибель плода у крыс, неполная оссификация костей черепа, стернебров и конечностей кроликов) отмечалось только при применении биластина в дозах, токсичных для матери. Уровень системной экспозиции, возникающий при применении биластина в максимальной дозе, не вызывающей наблюдаемого побочного действия у животных, значительно (более чем в 30 раз) превышал уровень системной экспозиции, возникающий при применении биластина в рекомендованной терапевтической дозе у человека."}},{"type":"paragraph","data":{"text":"Грудное вскармливание"}},{"type":"paragraph","data":{"text":"Не изучалось, проникает ли биластин в грудное молоко у человека. По имеющимся фармакокинетическим данным биластин проникает в грудное молоко у животных. Биластин обнаруживался в молоке кормящих крыс после однократного перорального введения в дозе 20мг/кг. Концентрация биластина в молоке составляла около половины его концентрации в материнской плазме крови. Значимость этих результатов для человека неизвестна. На время лечения препаратом Никсар® грудное вскармливание необходимо прекратить. При невозможности прекратить грудное вскармливание препарат Никсар® следует отменить. Данное решение должно приниматься врачом на основании тщательной оценки соотношения потенциальной пользы терапии для матери и риска отказа от грудного вскармливания для ребенка."}},{"type":"paragraph","data":{"text":"Фертильность"}},{"type":"paragraph","data":{"text":"Клинические данные ограничены или отсутствуют. В исследовании на крысах отрицательного влияния биластина на фертильность выявлено не было. В исследовании фертильности у крыс биластин вводили животным перорально в дозах до 1000 мг/кг/сут; при этом влияния биластина на женские и мужские половые органы выявлено не было. Индексы спаривания, фертильности и беременности не менялись."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Внутрь."}},{"type":"paragraph","data":{"text":"Если врачом не предписано иначе, для лечения симптомов аллергического риноконъюнктивита и крапивницы рекомендуются следующие дозы препарата Никсар®:"}},{"type":"paragraph","data":{"text":"Взрослые и дети старше 12 лет: по 1 таблетке препарата Никсар®, что соответствует 20 мг биластина, один раз в сутки."}},{"type":"paragraph","data":{"text":"Максимальная суточная доза биластина составляет 20 мг."}},{"type":"paragraph","data":{"text":"Таблетку принимают за один час до еды или через 2 часа после еды (или фруктового сока), запивая достаточным количеством воды. Риска на таблетке предназначена только для деления таблетки с целью облегчения проглатывания, но не для деления таблетки на две равные дозы. Рекомендуется принимать суточную дозу целиком за один прием."}},{"type":"paragraph","data":{"text":"При аллергическом риноконъюнктивите препарат Никсар® применяется в течение всего периода контакта с аллергенами. При сезонном аллергическом риноконъюнктивите лечение может быть прекращено после исчезновения симптомов. При повторном появлении симптомов лечение можно возобновить. При круглогодичном аллергическом риноконъюнктивите лечение может продолжаться в течение периода контакта с аллергенами."}},{"type":"paragraph","data":{"text":"При крапивнице лечение препаратом Никсар® продолжают до исчезновения или облегчения симптомов."}},{"type":"paragraph","data":{"text":"Особые группы пациентов"}},{"type":"paragraph","data":{"text":"Пациенты с нарушением функции печени"}},{"type":"paragraph","data":{"text":"У пациентов с нарушением функции печени коррекция дозы не требуется. Поскольку биластин не подвергается метаболизму, не ожидается, что нарушение функции печени может увеличить системную экспозицию биластина выше безопасного уровня."}},{"type":"paragraph","data":{"text":"Пациенты с нарушением функции почек"}},{"type":"paragraph","data":{"text":"У пациентов с нарушением функции почек коррекция дозы не требуется."}},{"type":"paragraph","data":{"text":"Пожилые пациенты"}},{"type":"paragraph","data":{"text":"У пациентов пожилого возраста коррекция дозы не требуется. В клинических исследованиях не наблюдалось различий между профилем эффективности и безопасности биластина у пациентов пожилого возраста (65 лет и старше) и у более молодых пациентов."}},{"type":"paragraph","data":{"text":"Пациенты педиатрического профиля"}},{"type":"paragraph","data":{"text":"Безопасность и эффективность биластина у детей младше 12 лет не установлены. Препарат Никсар® противопоказан у детей младше 12 лет."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Возможные побочные эффекты приведены ниже по нисходящей частоте возникновения случая: очень часто (>1/10), часто (>1/100,<1/10), нечасто (>1/1000,<1/100), редко (>1/10000,<1/1000), очень редко, включая отдельные сообщения (<1/10000), частота не установлена (по имеющимся данным оценка невозможна)."}},{"type":"paragraph","data":{"text":"Нарушения со стороны желудочно-кишечного тракта"}},{"type":"paragraph","data":{"text":"Нечасто: сухость слизистой оболочки полости рта, диарея, диспепсия, гастрит, боль в животе, боль в верхних отделах живота, неприятные ощущения в желудке, тошнота."}},{"type":"paragraph","data":{"text":"Нарушения со стороны кожи и подкожных тканей"}},{"type":"paragraph","data":{"text":"Нечасто: кожный зуд."}},{"type":"paragraph","data":{"text":"Нарушения со стороны нервной системы"}},{"type":"paragraph","data":{"text":"Часто: сонливость, головная боль;"}},{"type":"paragraph","data":{"text":"Нечасто: головокружение"}},{"type":"paragraph","data":{"text":"Нарушения психики"}},{"type":"paragraph","data":{"text":"Нечасто: тревожность, бессонница."}},{"type":"paragraph","data":{"text":"Нарушения обмена веществ"}},{"type":"paragraph","data":{"text":"Нечасто: повышение аппетита, увеличение массы тела."}},{"type":"paragraph","data":{"text":"Нарушения со стороны органа слуха и лабиринтные нарушения"}},{"type":"paragraph","data":{"text":"Нечасто: шум в ушах, вертиго."}},{"type":"paragraph","data":{"text":"Нарушения со стороны дыхательной системы, органов грудной клетки и средостения"}},{"type":"paragraph","data":{"text":"Нечасто: одышка, сухость слизистой оболочки носа, неприятные ощущения в носу."}},{"type":"paragraph","data":{"text":"Нарушения со стороны сердечно-сосудистой системы"}},{"type":"paragraph","data":{"text":"Нечасто: блокада правой ножки пучка Гиса, синусовая аритмия, удлинение интервала QT на электрокардиограмме, другие изменения на электрокардиограмме."}},{"type":"paragraph","data":{"text":"Частота не установлена: \"ощущение сердцебиения\", тахикардия."}},{"type":"paragraph","data":{"text":"Инфекционные и паразитарные заболевания"}},{"type":"paragraph","data":{"text":"Нечасто: герпетическое поражение полости рта."}},{"type":"paragraph","data":{"text":"Прочие:"}},{"type":"paragraph","data":{"text":"Нечасто: жажда, повышенная утомляемость, улучшение течения уже имеющегося заболевания, астения, лихорадка, увеличение концентрации триглицеридов в плазме крови, увеличение концентрации триглицеридов в плазме крови, увеличение концентрации креатинина в плазме крови, повышение активности аспартатаминотрансферазы, повышение активности аланинаминотрансферазы, повышение активности гамма-глутамилтрансферазы."}},{"type":"paragraph","data":{"text":"Частота не установлена: реакции гиперчувствительности (анафилаксия, ангионевротический отек, диспноэ, сыпь, локализованный отек, эритема)."}},{"type":"paragraph","data":{"text":"В клинических исследованиях у пациентов с аллергическим ринитом или хронической идиопатической крапивницей, получавших биластин в дозе 20 мг, общая частота возникновения нежелательных явлений была сопоставима с таковой у пациентов, получавших плацебо (12,7% и 12,8%, соответственно). Наиболее часто встречающимися нежелательными реакциями у пациентов с аллергическим ринитом или хронической идиопатической крапивницей, получавших биластин в дозе 20 мг, были головная боль, сонливость, головокружение и повышенная утомляемость. Данные нежелательные явления возникали также в группе пациентов, получавших плацебо с сопоставимой частотой (сонливость – 3,06% и 2,86%; головная боль – 4,01% и 3,38%; головокружение – 0,83% и 0,59%; повышенная утомляемость – 0,83% и 1,32% в группе биластина и в группе плацебо, соответственно)."}},{"type":"paragraph","data":{"text":"Для наблюдения за соотношением пользы и риска при применении лекарственного препарата необходимо сообщать о возникновении побочных эффектов. Если наблюдаются побочные эффекты, описанные выше, либо они наблюдаются в более выраженной степени, или если вы отметили любые другие побочные эффекты, то, пожалуйста, немедленно сообщите об этом вашему лечащему врачу. Работники здравоохранения должны сообщать о случаях возникновения побочных эффектов через национальную систему фармаконадзора."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Симптомы: в клинических исследованиях у здоровых добровольцев при применении биластина в дозе, превышающей терапевтическую в 10-11 раз (220 мг однократно или по 200 мг в день в течение 7 дней), побочные эффекты возникали в 2 раза чаще, чем при применении плацебо. Чаще всего отмечались следующие симптомы: головокружение, головная боль, тошнота. Серьезных побочных эффектов, в т.ч. значимого удлинения интервала QTс, отмечено не было. Информация, полученная в пострегистрационных исследованиях, подтверждает профиль безопасности биластина, описанный в предрегистрационных клинических исследованиях."}},{"type":"paragraph","data":{"text":"Оценка влияния многократных супратерапевтических доз биластина (100 мг в день в течение 4 дней) на желудочковую реполяризацию (кроссоверное исследование интервала QT/QTc) у 30 здоровых добровольцев не выявила значимой пролонгации сегмента QTc на кардиограмме."}},{"type":"paragraph","data":{"text":"Лечение: симптоматическая и поддерживающая терапия. Специфического антидота нет."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"При одновременном применении биластина с кетоконазолом или эритромицином площадь под кривой «концентрация-время» (AUC) биластина увеличивалась в 2 раза, а максимальная концентрация (Cmах) – в 2-3 раза. Поскольку биластин является субстратом Р-гликопротеина и не метаболизируется, подобные изменения можно объяснить взаимодействием на уровне белков-переносчиков, отвечающих за выведение лекарственных препаратов из клеток кишечника. Эти изменения не оказывали влияния на профиль безопасности биластина, кетоконазола или эритромицина."}},{"type":"paragraph","data":{"text":"При одновременном применении биластина в дозе 20 мг и дилтиазема в дозе 60 мг Cmax биластина увеличивалась на 50%. Подобные эффекты можно объяснить взаимодействием на уровне белков-переносчиков (в т.ч. P-гликопротеина), отвечающих за выведение лекарственных препаратов из клеток кишечника, поскольку биластин является субстратом Р-гликопротеина. Эти изменения не оказывали влияния на профиль безопасности биластина."}},{"type":"paragraph","data":{"text":"При одновременном применении биластина и других лекарственных препаратов, являющихся субстратами или ингибиторами P-гликопротеина (например, циклоспорин), может увеличиваться концентрация биластина в плазме крови. "}},{"type":"paragraph","data":{"text":"Грейпфрутовый и другие фруктовые соки снижают биодоступность биластина на 30%. Данное взаимодействие обусловлено способностью фруктов подавлять активность белка-переносчика органических анионов OATP1A2, для которого биластин является субстратом. Лекарственные средства, являющиеся субстратами или ингибиторами OATP1A2 (например, ритонавир или рифампицин), могут снижать концентрацию биластина в плазме крови."}},{"type":"paragraph","data":{"text":"Биластин не усиливает действие этанола на центральную нервную систему. Параметры психомоторных реакций после одновременного приема этанола и биластина в дозе 20 мг были сходны с таковыми после одновременного приема этанола и плацебо."}},{"type":"paragraph","data":{"text":"При одновременном применении биластина в дозе 20 мг и лоразепама в дозе 3 мг в течение 8 дней усиления подавляющего влияния лоразепама на центральную нервную систему не выявлено."}},{"type":"paragraph","data":{"text":"Взаимодействие биластина с другими лекарственными препаратами изучалось только у взрослых. Ожидается, что у детей в возрасте 12-17 лет взаимодействие биластина с другими лекарственными препаратами будет иметь сходные характеристики."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"У пациентов с почечной недостаточностью средней степени тяжести (СКФ < 30-50 мл/мин/1,73 м2) и тяжелой степени тяжести (СКФ < 30 мл/мин/1,73 м2) одновременное применение биластина с ингибиторами P-гликопротеина может приводить к повышению концентрации биластина в плазме крови, что увеличивает риск возникновения побочных эффектов биластина. В связи с этим у пациентов с почечной недостаточностью средней и тяжелой степени тяжести необходимо соблюдать осторожность при одновременном применении биластина с ингибиторами Р-гликопротеина (кетоконазолом, эритромицином, циклоспорином, ритонавиром, дилтиаземом и др.)."}}]},{"id":17,"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","body":[{"type":"paragraph","data":{"text":"В исследовании, проведенном с целью оценки влияния биластина в дозе 20 мг на способность к управлению транспортными средствами, отрицательного действия препарата не было выявлено. Однако пациенты должны быть предупреждены, что в очень редких случаях возможно появление головокружения, сонливости, что в свою очередь может повлиять на способность к управлению транспортными средствами или к выполнению других видов деятельности, требующих повышенной концентрации внимания. При появлении описанных нежелательных явлений следует воздержаться от выполнения указанных видов деятельности."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Таблетки, 20 мг."}},{"type":"paragraph","data":{"text":"По 10 таблеток в контурной ячейковой упаковке (блистер) [фольга алюминиевая/фольга алюминиевая]."}},{"type":"paragraph","data":{"text":"По 1, 2, 3, 4 или 5 блистеров с инструкцией по применению препарата в картонной пачке."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"При температуре не выше 30°С."}},{"type":"paragraph","data":{"text":"Хранить в недоступном для детей месте."}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"5 лет."}},{"type":"paragraph","data":{"text":"Не применять по истечении срока годности, указанного на упаковке."}}]},{"id":21,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"Отпускаются по рецепту."}}]},{"id":22,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"А. Менарини Мэнюфекчеринг Лоджистик энд Сервисиз С.р.л."}},{"type":"paragraph","data":{"text":"Виа Кампо ди Пиле"}},{"type":"paragraph","data":{"text":"67100 Л’Аквила"}},{"type":"paragraph","data":{"text":"Италия."}}]},{"id":23,"name":"Организация, принимающая претензии потребителей","body":[{"type":"paragraph","data":{"text":"ООО «Берлин-Хеми/А. Менарини», Россия"}},{"type":"paragraph","data":{"text":"123112, г. Москва, Пресненская набережная, дом 10, БЦ «Башня на Набережной», Блок Б, тел. (495) 785-01-00, факс (495) 785-01-01."}}]}],"source":null},"description_toggle":false,"short_description":"Фармакодинамика Биластин – неседативное антигистаминное средство длительного действия, избирательно блокирует периферические H1-рецепторы. Значимый терапевтический эффект наблюдается через 1 ч после приема препарата. Антигистаминное действие биластина сохраняется в течение 24 ч. В клинических исследованиях, проведенных у взрослых и подростков с аллергическим риноконъюнктивитом (сезонным и круглогодичным) при применении биластина в дозе 20 мг 1 раз в сутки в течение 14-28 дней отмечалось облегчение таких симптомов как чихание, ринорея, зуд и заложеннсоть носа, ощущение зуда и жжения в глазах, слезотечение и покраснение глаз. Терапевтический эффект биластина сохранялся 24 ч. В клинических исследованиях, проведенных у пациентов с хронической идиопатической крапивницей, при применении биластина в дозе 20 мг 1 раз в сутки в течение 28 дней отмечалось облегчение кожного зуда и уменьшение количества и размера волдырей, уменьшение дискомфорта, связанного с крапивницей, а также улучшение сна и качества жизни. Возможно незначительное проникновение биластина через гематоэнцефалический барьер, но при этом изученный в клинических исследованиях профиль безопасности биластина в отношении центральной нервной системы был сходен с таковым у плацебо. Биластин не вызывал седативного эффекта (в клинических исследованиях частота возникновения сонливости и повышенной утомляемости при лечении биластином была сопоставима с таковой в группе плацебо) и не оказывал влияния на центральную нервную систему. Биластин не оказывает антихолинергического действия. В клинических исследованиях применение биластина не сопровождалось удлинением интервала QTc на ЭКГ или какими-либо другими кардиоваскулярными эффектами ни при применении в супратерапевтических дозах (200 мг один раз в день в течение 7 дней), ни при одновременном применении с ингибиторами Р-гликопротеина (кетоконазол, эритромицин). Фармакокинетика Всасывание. После приема внутрь биластин быстро абсорбируется из желудочно-кишечного тракта. Время достижения максимальной концентрации в плазме крови (TСmах) составляет 1,3 ч. Биодоступность биластина при приеме внутрь составляет 61 %. Одновременный прием пищи снижает биодоступность биластина на 30 %. Кумуляции препарата не наблюдается. Распределение. В исследованиях in vitro и in vivo показано, что биластин является субстратом Р-гликопротеина и белка-переносчика органических анионов ОАТР (см. раздел \"Взаимодействие с другими лекарственными препаратами\"). По всей видимости, биластин не является субстратом переносчика BCRP или почечных переносчиков OTC2, OAT1 и OAT3. Зарегистрировано слабое ингибирование биластином З-гликопротеина, OATP2B1 и OCT1. На основании результатов исследований in vitro, в системной циркуляции не ожидается ингибирования биластином таких переносчиков, как Р-гликопротеин, MRP2, BCRP, BSEP, OATP1B1, OATP1B3, OATP2B1, OAT1, OAT3, OCT1, OCT2, и NTCP. Согласно оценке, конценрация полумаксимального ингибирования (IC50\u003e300 мкМ) биластином данных переносчиков значительно выше его расчетной клинической максимальной конценрации (Cmax) в плазме крови, вследствие чего взаимодействие биластина с ними не имеет клинического значения. Основываясь на этих результатах, нельзя, однако, исключить ингибирования биластином белков-переносчиков в слизистой оболочке кишечника (например, З-гликопротеина). При применении в терапевтических дозах связь биластина с белками плазы крови - 84-90%. Метаболизм и выведение. Биластин метаболизируется незначительно. После однократного применения до 95 % биластина от принятой дозы выводится в неизмененном виде почками (28,3%) и с желчью (66,5%). В исследованиях in vitri показано, что биластин не является индуктором или ингибитором изоферментов системы цитохрома Р450. Период полувыведения (T1/2) биластина у здоровых добровольцев составляет в среднем 14,5 ч. У пациентов с почечной недостаточностью легкой степени тяжести (скорость клубочковой фильтрации (СКФ) 50-80 мл/мин/1.73 м2) скорость элиминации биластина значимо не отличалась от таковой у пациентов без почечной недостаточности (скорость клубочковой фильтрации (СКФ) \u003e80 мл/мин/1.73 м2). У пациентов с почечной недостаточностью средней степени тяжести (скорость клубочковой фильтрации (СКФ) 30-50 мл/мин/1.73 м2) и тяжелой степени тяжести (СКФ\u003c30 мл/мин/1,73 м2) скорость элиминации биластина замедляется, что может привести к увеличению концентрации биластина в плазме крови. Не ожидается, что изменение данных фармакокинетических параметров может оказывать влияние на профиль безопасности биластина, так как концентрация биластина в плазме крови у пациентов с почечной недостаточностью остается в пределах безопасных значений. При печеночной недостаточности клинически значимых изменений фармакокинетических параметров биластина не происходит, так как биластин незначительно метаболизируется в печени. Фармакокинетические данные, полученные у пациентов с печеночной недостаточностью, отсутствуют. Значимых различий фармакокинетических параметров биластина у пациентов старше 65 лет по сравнению с таковыми у пациентов в возрасте от 18 до 35 лет не наблюдалось. Фармакокинетические данные биластина у подростков (от 12 до 17 лет) отсутствуют, поскольку для данной популяции возможна экстраполяция фармакокинетических данных, полученных у взрослых. 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