Фамотидин является мощным конкурентным ингибитором Н2-гистаминовых рецепторов. Основным клинически значимым фармакологическим действием фамотидина является ингибирование желудочной секреции. Фамотидин снижает как концентрацию соляной кислоты, так и объем желудочной секреции, в то время как изменения секреции пепсина пропорциональны секретируемому объему. У здоровых добровольцев и пациентов с гиперсекрецией фамотидин ингибирует базальную и ночную секрецию соляной кислоты и пепсиногена, а также секрецию, стимулируемую введением пентагастрина, бетазола, кофеина, инсулина и физиологическим рефлексом блуждающего нерва. Продолжительность ингибирования секреции при использовании доз 20 мг и 40 мг составляет от 10 до 12 часов. Фамотидин практически не оказывает влияния на концентрацию гастрина в сыворотке натощак или после приема пищи. Фамотидин не оказывает влияния на опорожнение желудка, экзокринную функцию поджелудочной железы, кровоток в печени и портальной системе. Фамотидин не оказывает влияния на ферментную систему цитохрома Р450 в печени. Антиандрогенного влияния препарата не отмечено.
Показания к применению
язвенная болезнь двенадцатиперстной кишки и желудка в фазе обострения, профилактика рецидивов; лечение и профилактика симптоматических язв желудка и двенадцатиперстной кишки (связанных с приемом НПВП, стрессовых, послеоперационных); эрозивный гастродуоденит; функциональная диспепсия, ассоциированная с повышенной секреторной функцией желудка; рефлюкс-эзофагит; синдром Золлингера-Эллисона; профилактика рецидивов кровотечений из верхних отделов ЖКТ; предупреждение аспирации желудочного сока при проведении общей анестезии (синдром Мендельсона).
Противопоказания
Гиперчувствительность к действующему веществу или любому из вспомогательных веществ, беременность, период лактации, детский возраст.
Применение при беременности и в период грудного вскармливания
Фамотидин проникает через плаценту. Контролируемых исследований у человека не проводилось. Квамател не рекомендуется использовать во время беременности. Фамотидин секретируется с грудным молоком у человека; в связи с этим грудное вскармливание во время применения Кваматела следует прекратить.
Способ применения и дозы
Квамател предназначен только для внутривенного введения. Квамател рекомендован к использованию у госпитализированных пациентов, которые не имеют возможности принимать препарат внутрь. Квамател может использоваться до тех пор, пока проведение пероральной терапии не станет возможным. Рекомендованная доза составляет 20 мг внутривенно (в/в) два раза в день (каждые 12 часов). При язвенной болезни желудка и двенадцатиперстной кишки в стадии обострения, гиперсекреторных состояниях: в/в медленно, в течение 2 мин по 20 мг 2 раза/сут в разбавленном виде; в/в инфузия: медленно, в течение 15-30 мин по 20 мг 2 раза/сут. При рефлюкс-эзофагите начальная доза - 20 мг 2 раза/сут в/в медленно. При синдроме Золлингера-Эллисона: начальная доза составляет 20 мг в/в каждые 6 часов. Далее: доза препарата зависит от объема секреции и клинического состояния пациента. При обшей анестезии для предотвращения аспирации кислого желудочного содержимого: Квамател применяется в дозе 20 мг в/в утром в день операции или, по меньшей мере, за 2 часа до начала операции. Начальная доза для внутривенного введения не может превышать 20 мг. Для проведения внутривенной инъекции содержимое флакона следует растворить в 5 - 10 мл 0,9% раствора натрия хлорида (ампула растворителя), а затем медленно ввести (в течение не менее 2 минут). При инфузии препарата раствор следует вводить на протяжении 15-30 минут. Растворы следует готовить непосредственно перед введением. Можно использовать только прозрачные бесцветные растворы. Применение при почечной недостаточности. Поскольку фамотидин экскретируется преимущественно почками, у пациентов с тяжелой почечной недостаточностью необходимо соблюдать меры предосторожности. Если клиренс креатинина составляет менее 30 мл/мин, а сывороточная концентрация креатинина превышает 3 мг/100 мл, то суточную дозу необходимо снизить до 20 мг или увеличить интервалы между введениями до 36-48 часов. Применение у детей: Безопасность и эффективность препарата у детей не установлены. Применение у пожилых пациентов: Коррекция дозы в зависимости от возраста не требуется.
Побочное действие
Со стороны пищеварительной системы: сухость во рту, тошнота, рвота, боли в животе, метеоризм, запор, диарея, снижение аппетита; повышение активности трансаминаз печени, гепатоцеллюлярный, холестатический или смешанный гепатит, острый панкреатит. Со стороны системы кроветворения: очень редко - агранулоцитоз, панцитопения, лейкопения, тромбоцитопения, гипо- или аплазия костного мозга. Аллергические реакции: крапивница, кожная сыпь, зуд, бронхоспазм, ангионевротический отек, анафилактический шок. Со стороны сердечно-сосудистой системы: аритмия, брадикардия, AV-блокада, снижение АД. Со стороны ЦНС: головная боль, головокружение, сонливость, галлюцинации, спутанность сознания, повышенная утомляемость, депрессия, возбуждение, тревога. Со стороны органов чувств: снижение остроты зрения, шум в ушах. Со стороны половой системы: при длительном применении в высоких дозах - гиперпролактинемия, гинекомастия, аменорея, снижение либидо. Со стороны костно-мышечной системы: артралгия, мышечные спазмы. Дерматологические реакции: алопеция, обыкновенные угри, сухость кожи, токсический эпидермальный некролиз. Прочие: лихорадка.
Передозировка
У пациентов с синдромом патологической гиперсекреции использовались дозы до 800 мг в сутки на протяжении периода свыше одного года, что не сопровождалось возникновением серьезных нежелательных явлений. Лечение передозировки: симптоматическая и поддерживающая терапия; мониторинг состояния пациента.
Особые указания
Перед началом терапии фамотидином или, если такой возможности нет, перед переходом на пероральное лечение необходимо исключить наличие злокачественного новообразования желудка. При печеночной недостаточности Квамател следует использовать с осторожностью в сниженной дозе. Поскольку в случае использования блокаторов Н2-гистаминовых рецепторов была описана перекрестная реактивность, применение Кваматела у пациентов, имеющих в анамнезе гиперчувствительность к другим блокаторам Н2-гистаминовых рецепторов, требует осторожности.
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Основным клинически значимым фармакологическим действием фамотидина является ингибирование желудочной секреции. Фамотидин снижает как концентрацию соляной кислоты, так и объем желудочной секреции, в то время как изменения секреции пепсина пропорциональны секретируемому объему. У здоровых добровольцев и пациентов с гиперсекрецией фамотидин ингибирует базальную и ночную секрецию соляной кислоты и пепсиногена, а также секрецию, стимулируемую введением пентагастрина, бетазола, кофеина, инсулина и физиологическим рефлексом блуждающего нерва. Продолжительность ингибирования секреции при использовании доз 20 мг и 40 мг составляет от 10 до 12 часов. Фамотидин практически не оказывает влияния на концентрацию гастрина в сыворотке натощак или после приема пищи. Фамотидин не оказывает влияния на опорожнение желудка, экзокринную функцию поджелудочной железы, кровоток в печени и портальной системе. Фамотидин не оказывает влияния на ферментную систему цитохрома Р450 в печени. 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Контролируемых исследований у человека не проводилось. Квамател не рекомендуется использовать во время беременности. Фамотидин секретируется с грудным молоком у человека; в связи с этим грудное вскармливание во время применения Кваматела следует прекратить."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Квамател предназначен только для внутривенного введения. Квамател рекомендован к использованию у госпитализированных пациентов, которые не имеют возможности принимать препарат внутрь. Квамател может использоваться до тех пор, пока проведение пероральной терапии не станет возможным. Рекомендованная доза составляет 20 мг внутривенно (в/в) два раза в день (каждые 12 часов). 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При инфузии препарата раствор следует вводить на протяжении 15-30 минут. Растворы следует готовить непосредственно перед введением. Можно использовать только прозрачные бесцветные растворы. Применение при почечной недостаточности. Поскольку фамотидин экскретируется преимущественно почками, у пациентов с тяжелой почечной недостаточностью необходимо соблюдать меры предосторожности. Если клиренс креатинина составляет менее 30 мл/мин, а сывороточная концентрация креатинина превышает 3 мг/100 мл, то суточную дозу необходимо снизить до 20 мг или увеличить интервалы между введениями до 36-48 часов. Применение у детей: Безопасность и эффективность препарата у детей не установлены. 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