Взрослые: профилактика отсроченной тошноты и рвоты, вызванной химиотерапией. Профилактика тошноты и рвоты, вызванной лучевой терапией. Симптоматическое лечение тошноты и рвоты, в том числе при острой мигрени. Метоклопрамид может применяться в сочетании с пероральными анальгетиками с целью улучшения абсорбции анальгетиков при острой мигрени. Подростки ...
Таблетки Метоклопрамид - лекарственный препарат противорвотного действия, применяемый при рвоте различного происхождения. Препарат устраняет также тошноту и икоту, регулирует функцию желудочно-кишечного тракта: усиливает его моторику (двигательную активность). Опорожнение желудка ускоряется, при этом секреторная функция желудка (выделение желудочного сока) не изменяется. Продвижение пищи по тонкому кишечнику ускоряется, но понос при этом не возникает. Нормализуется выделение желчи, устраняется дискинезия желчного пузыря. Метоклопрамид способствует заживлению язв в двенадцатиперстной кишке и в желудке. Препарат оказывает стимулирующее влияние на выработку пролактина (гормона передней доли гипофиза с разносторонним действием на организм).
Фармакологические свойства
Противорвотное средство, способствует уменьшению тошноты, икоты; стимулирует перистальтику ЖКТ. Противорвотное действие обусловлено блокадой допаминовых D2-рецепторов и повышением порога хеморецепторов триггерной зоны, является блокатором серотониновых рецепторов. Полагают, что метоклопрамид ингибирует расслабление гладкой мускулатуры желудка, вызываемое допамином, усиливая таким образом холинергические реакции гладкой мускулатуры ЖКТ. Способствует ускорению опорожнения желудка путем предотвращения расслабления тела желудка и повышения активности антрального отдела желудка и верхних отделов тонкой кишки. Уменьшает рефлюкс содержимого в пищевод за счет увеличения давления сфинктера пищевода в состоянии покоя и повышает клиренс кислоты из пищевода благодаря увеличению амплитуды его перистальтических сокращений. Метоклопрамид стимулирует секрецию пролактина и вызывает транзиторное повышение уровня циркулирующего альдостерона, что может сопровождаться кратковременной задержкой жидкости.
Показания к применению
Взрослые: профилактика отсроченной тошноты и рвоты, вызванной химиотерапией. Профилактика тошноты и рвоты, вызванной лучевой терапией. Симптоматическое лечение тошноты и рвоты, в том числе при острой мигрени. Метоклопрамид может применяться в сочетании с пероральными анальгетиками с целью улучшения абсорбции анальгетиков при острой мигрени. Подростки 15-18 лет: профилактика отсроченной тошноты и рвоты, вызванных химиотерапией – в качестве терапии второй линии.
Противопоказания
Кровотечения из ЖКТ, механическая кишечная непроходимость, перфорация желудка или кишечника, феохромоцитома, экстрапирамидные нарушения, эпилепсия, пролактинозависимые опухоли, глаукома, беременность, лактация, одновременное применение антихолинергических препаратов, повышенная чувствительность к метоклопрамиду.
Применение при беременности и в период грудного вскармливания
Метоклопрамид противопоказан в III триместре беременности в связи с риском развития у новорожденных экстрапирамидных расстройств. При применении метоклопрамида у беременных следует проводить наблюдение за новорожденными. Метоклопрамид выделяется с грудным молоком. Не рекомендуется применение метоклопрамида в период кормления грудью, при необходимости применения препарата следует прекратить грудное вскармливание.
Способ применения и дозы
Внутрь за 30 минут до еды, запивая небольшим количеством воды. Взрослые: рекомендуемая разовая доза составляет 10 мг до 3 раз в сутки. Максимальная суточная доза – 30 мг. Подростки 15-18 лет: по 10 мг до 3 раз в сутки. Максимальная суточная доза составляет 30 мг. Таблетки не назначают подросткам с массой тела менее 61 кг. Максимальная продолжительность лечения составляет 5 дней. Следует соблюдать 6-часовой интервал между приемом препарата, даже в случае рвоты или если доза не была абсорбирована. Особые группы пациентовПожилые пациенты: следует рассмотреть вопрос о снижении дозы с учетом функции почек и печени, а также общего состояния пациента. Нарушение функции почек: у пациентов с терминальной стадией почечной недостаточности (клиренс креатинина ≤ 15 мл/мин) суточная доза должна быть снижена на 75%. У пациентов с умеренным или тяжелым нарушением функции почек (клиренс креатинина 15-60 мл/мин) доза должна быть снижена наполовину. Нарушение функции печени: у пациентов с тяжелым нарушением функции печени доза должна быть снижена наполовину.
Побочное действие
Частота нежелательных реакций приводится в соответствии с классификацией: очень часто (≥1/10), часто (≥1/100, <1/10), нечасто (≥1/1000, <1/100), редко (≥1/10000, <1/1000), очень редко (<1/10000), частота неизвестна (частоту невозможно оценить на основе имеющихся данных). Нарушения со стороны крови и лимфатической системы: частота неизвестна – метгемоглобинемия, вероятно связанная с дефицитом фермента НАДH-зависимой цитохром-b5 редуктазы (особенно у новорожденных), сульфгемоглобинемия (чаще всего при одновременном применении высоких доз серосодержащих препаратов). Нарушения со стороны сердца: нечасто – брадикардия, частота неизвестна – остановка сердца, которая может быть вызвана брадикардией, атриовентрикулярная блокада, блокада синусного узла, удлинение интервала QT на электрокардиограмме, аритмия типа «пируэт». Нарушения со стороны сосудов: часто – понижение артериального давления, частота неизвестна – кардиогенный шок, острое повышение артериального давления у пациентов с феохромоцитомой. Нарушения со стороны эндокринной системы: нечасто – аменорея, гиперпролактинемия, редко – галакторея, частота неизвестна – гинекомастия. *Эндокринные нарушения во время продолжительного лечения связаны с гиперпролактинемией (аменорея, галакторея, гинекомастия). Нарушения со стороны желудочно-кишечного тракта: часто – диарея, редко – сухость во рту. Нарушения со стороны иммунной системы: нечасто – реакции гиперчувствительности, частота неизвестна – анафилактические реакции (в том числе анафилактический шок). Нарушения со стороны нервной системы: очень часто – сонливость, часто – экстрапирамидные расстройства (особенно у детей и молодых пациентов и/или при превышении рекомендованных доз препарата, даже после однократного введения), паркинсонизм, акатизия, нечасто – дистония, дискинезия, нарушение сознания, редко – судороги, особенно у пациентов с эпилепсией, частота неизвестна – поздняя дискинезия иногда персистирующая, во время или после длительного лечения, особенно у пожилых пациентов, злокачественный нейролептический синдром. Нарушения психики: часто – депрессия, нечасто – галлюцинации, редко – спутанность сознания. Общие расстройства и нарушения в месте введения: часто – астения. Нежелательные реакции, наиболее часто встречающиеся при применении высоких доз препарата: экстрапирамидные симптомы (острая дистония и дискинезия, синдром паркинсонизма, акатизия развивались даже после применения однократной дозы препарата, особенно у детей и молодых пациентов), сонливость, снижение уровня сознания, спутанность сознания, галлюцинации.
Передозировка
Симптомы: экстрапирамидные расстройства, сонливость, снижение уровня сознания, спутанность сознания, галлюцинации, остановка сердца и дыхания. Лечение: В случае развития экстрапирамидных симптомов, вызванных передозировкой или по другой причине, лечение носит исключительно симптоматический характер (бензодиазепины у детей и/или антихолинергические противопаркинсонические препараты у взрослых). Требуется симптоматическое лечение и постоянный контроль сердечной и дыхательной функции в зависимости от клинического состояния пациента.
Особые указания
Противопоказания Повышенная чувствительность к метоклопрамиду или другим компонентам препарата, желудочно-кишечное кровотечение, механическая кишечная непроходимость, перфорация стенки желудка или кишечника, состояния, при которых стимуляция перистальтики желудочно-кишечного тракта представляет риск, подтвержденная или подозреваемая феохромоцитома в связи с риском развития тяжелой артериальной гипертензии, эпилепсия (увеличение частоты и тяжести припадков), болезнь Паркинсона, поздняя дискинезия, которая развилась после лечения нейролептиками или метоклопрамидом в анамнезе, одновременное назначение с леводопой или агонистами дофаминергических рецепторов, метгемоглобинемия вследствие приема метоклопрамида или дефицита никотинамидадениндинуклеотида (НАДН) цитохрома-b5 в анамнезе, пролактинзависимые опухоли, беременность (III триместр), период грудного вскармливания, глюкозо-галактозная мальабсорбция, недостаточность лактазы, детский возраст до 15 лет. С осторожностью – пожилой возраст, почечная/печеночная недостаточность, бронхиальная астма, нарушение сердечной проводимости (включая удлинение интервала QT), нарушение водно-электролитного баланса, брадикардия, одновременный прием других препаратов, удлиняющих интервал QT, артериальная гипертензия, сопутствующие неврологические заболевания, одновременный прием препаратов, воздействующих на центральную нервную систему, депрессия (в анамнезе), беременность (I, II триместр). Не эффективен при рвоте вестибулярного генеза. Не назначают после операций на желудочно-кишечном тракте (как пилоропластика или анастомоз кишечника), поскольку энергичные мышечные сокращения препятствуют заживлению. На фоне применения метоклопрамида возможны искажения данных лабораторных показателей функции печени и определения концентрации альдостерона и пролактина в плазме. При назначении метоклопрамида, чаще в высоких дозах, могут развиваться экстрапирамидные расстройства, особенно у детей и пациентов молодого возраста, даже после введения одной дозы. Необходимо соблюдать осторожность при применении у пациентов с сопутствующими неврологическими заболеваниями и у пациентов, принимающих препараты, воздействующие на центральную нервную систему. При применении препарата также могут отмечаться симптомы болезни Паркинсона. Сообщалось о случаях возникновения метгемоглобинемии, которая могла быть вызвана дефицитом фермента НАДH-зависимой цитохром-b5 редуктазы. В этом случае приемпрепарата необходимо незамедлительно прекратить и предпринять соответствующие меры. Сообщалось о случаях тяжелых сердечно-сосудистых побочных эффектах, включая сосудистую недостаточность, выраженную брадикардию, остановку сердца и удлинение интервала QT после введения метоклопрамида. Особую осторожность следует соблюдать при назначении внутривенно пациентам с синдромом «слабого синуса» или другими нарушениями проводимости сердечной мышцы (включая удлинение интервала QT), пожилым пациентам, пациентам с нарушениями электролитного баланса, брадикардией, а также при приеме препаратов, удлиняющих интервал QT. Большинство побочных эффектов возникают в течение 36 часов от начала лечения и исчезают в течение 24 часов после отмены. Курс лечения должен быть по возможности кратковременным. В период лечения препаратом не рекомендовано употребление алкоголя. Влияние на способность к концентрации внимания: при приеме препарата следует избегать потенциально опасных видов деятельности, требующих повышенного внимания, быстрой психической и двигательной реакции (управление транспортными средствами и др.) в связи с возможным развитием таких побочных эффектов, как головокружение, сонливость, дискинезия, дистония.
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Вспомогательные вещества: лактоза – 50,0 мг, картофельный крахмал – 37,9 мг, повидон – 1,9 мг, стеарат магния – 0,2 мг."}}]},{"id":2,"name":"Описание","slug":"common_description","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Таблетки Метоклопрамид - лекарственный препарат противорвотного действия, применяемый при рвоте различного происхождения. Препарат устраняет также тошноту и икоту, регулирует функцию желудочно-кишечного тракта: усиливает его моторику (двигательную активность). Опорожнение желудка ускоряется, при этом секреторная функция желудка (выделение желудочного сока) не изменяется. Продвижение пищи по тонкому кишечнику ускоряется, но понос при этом не возникает. Нормализуется выделение желчи, устраняется дискинезия желчного пузыря. Метоклопрамид способствует заживлению язв в двенадцатиперстной кишке и в желудке. Препарат оказывает стимулирующее влияние на выработку пролактина (гормона передней доли гипофиза с разносторонним действием на организм)."}}]},{"id":3,"name":"Фармакологические свойства","slug":"pharmacologic_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Противорвотное средство, способствует уменьшению тошноты, икоты; стимулирует перистальтику ЖКТ. Противорвотное действие обусловлено блокадой допаминовых D2-рецепторов и повышением порога хеморецепторов триггерной зоны, является блокатором серотониновых рецепторов. Полагают, что метоклопрамид ингибирует расслабление гладкой мускулатуры желудка, вызываемое допамином, усиливая таким образом холинергические реакции гладкой мускулатуры ЖКТ. Способствует ускорению опорожнения желудка путем предотвращения расслабления тела желудка и повышения активности антрального отдела желудка и верхних отделов тонкой кишки. Уменьшает рефлюкс содержимого в пищевод за счет увеличения давления сфинктера пищевода в состоянии покоя и повышает клиренс кислоты из пищевода благодаря увеличению амплитуды его перистальтических сокращений. Метоклопрамид стимулирует секрецию пролактина и вызывает транзиторное повышение уровня циркулирующего альдостерона, что может сопровождаться кратковременной задержкой жидкости."}}]},{"id":4,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Взрослые: профилактика отсроченной тошноты и рвоты, вызванной химиотерапией. Профилактика тошноты и рвоты, вызванной лучевой терапией. Симптоматическое лечение тошноты и рвоты, в том числе при острой мигрени. Метоклопрамид может применяться в сочетании с пероральными анальгетиками с целью улучшения абсорбции анальгетиков при острой мигрени. Подростки 15-18 лет: профилактика отсроченной тошноты и рвоты, вызванных химиотерапией – в качестве терапии второй линии."}}]},{"id":5,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Кровотечения из ЖКТ, механическая кишечная непроходимость, перфорация желудка или кишечника, феохромоцитома, экстрапирамидные нарушения, эпилепсия, пролактинозависимые опухоли, глаукома, беременность, лактация, одновременное применение антихолинергических препаратов, повышенная чувствительность к метоклопрамиду."}}]},{"id":6,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Метоклопрамид противопоказан в III триместре беременности в связи с риском развития у новорожденных экстрапирамидных расстройств. При применении метоклопрамида у беременных следует проводить наблюдение за новорожденными. Метоклопрамид выделяется с грудным молоком. Не рекомендуется применение метоклопрамида в период кормления грудью, при необходимости применения препарата следует прекратить грудное вскармливание."}}]},{"id":7,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Внутрь за 30 минут до еды, запивая небольшим количеством воды. Взрослые: рекомендуемая разовая доза составляет 10 мг до 3 раз в сутки. Максимальная суточная доза – 30 мг. Подростки 15-18 лет: по 10 мг до 3 раз в сутки. Максимальная суточная доза составляет 30 мг. Таблетки не назначают подросткам с массой тела менее 61 кг. Максимальная продолжительность лечения составляет 5 дней. Следует соблюдать 6-часовой интервал между приемом препарата, даже в случае рвоты или если доза не была абсорбирована. Особые группы пациентовПожилые пациенты: следует рассмотреть вопрос о снижении дозы с учетом функции почек и печени, а также общего состояния пациента. Нарушение функции почек: у пациентов с терминальной стадией почечной недостаточности (клиренс креатинина ≤ 15 мл/мин) суточная доза должна быть снижена на 75%. У пациентов с умеренным или тяжелым нарушением функции почек (клиренс креатинина 15-60 мл/мин) доза должна быть снижена наполовину. Нарушение функции печени: у пациентов с тяжелым нарушением функции печени доза должна быть снижена наполовину."}}]},{"id":8,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Частота нежелательных реакций приводится в соответствии с классификацией: очень часто (≥1/10), часто (≥1/100, \u003c1/10), нечасто (≥1/1000, \u003c1/100), редко (≥1/10000, \u003c1/1000), очень редко (\u003c1/10000), частота неизвестна (частоту невозможно оценить на основе имеющихся данных). Нарушения со стороны крови и лимфатической системы: частота неизвестна – метгемоглобинемия, вероятно связанная с дефицитом фермента НАДH-зависимой цитохром-b5 редуктазы (особенно у новорожденных), сульфгемоглобинемия (чаще всего при одновременном применении высоких доз серосодержащих препаратов). Нарушения со стороны сердца: нечасто – брадикардия, частота неизвестна – остановка сердца, которая может быть вызвана брадикардией, атриовентрикулярная блокада, блокада синусного узла, удлинение интервала QT на электрокардиограмме, аритмия типа «пируэт». Нарушения со стороны сосудов: часто – понижение артериального давления, частота неизвестна – кардиогенный шок, острое повышение артериального давления у пациентов с феохромоцитомой. Нарушения со стороны эндокринной системы: нечасто – аменорея, гиперпролактинемия, редко – галакторея, частота неизвестна – гинекомастия. *Эндокринные нарушения во время продолжительного лечения связаны с гиперпролактинемией (аменорея, галакторея, гинекомастия). Нарушения со стороны желудочно-кишечного тракта: часто – диарея, редко – сухость во рту. Нарушения со стороны иммунной системы: нечасто – реакции гиперчувствительности, частота неизвестна – анафилактические реакции (в том числе анафилактический шок). Нарушения со стороны нервной системы: очень часто – сонливость, часто – экстрапирамидные расстройства (особенно у детей и молодых пациентов и/или при превышении рекомендованных доз препарата, даже после однократного введения), паркинсонизм, акатизия, нечасто – дистония, дискинезия, нарушение сознания, редко – судороги, особенно у пациентов с эпилепсией, частота неизвестна – поздняя дискинезия иногда персистирующая, во время или после длительного лечения, особенно у пожилых пациентов, злокачественный нейролептический синдром. Нарушения психики: часто – депрессия, нечасто – галлюцинации, редко – спутанность сознания. Общие расстройства и нарушения в месте введения: часто – астения. Нежелательные реакции, наиболее часто встречающиеся при применении высоких доз препарата: экстрапирамидные симптомы (острая дистония и дискинезия, синдром паркинсонизма, акатизия развивались даже после применения однократной дозы препарата, особенно у детей и молодых пациентов), сонливость, снижение уровня сознания, спутанность сознания, галлюцинации."}}]},{"id":9,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Симптомы: экстрапирамидные расстройства, сонливость, снижение уровня сознания, спутанность сознания, галлюцинации, остановка сердца и дыхания. Лечение: В случае развития экстрапирамидных симптомов, вызванных передозировкой или по другой причине, лечение носит исключительно симптоматический характер (бензодиазепины у детей и/или антихолинергические противопаркинсонические препараты у взрослых). Требуется симптоматическое лечение и постоянный контроль сердечной и дыхательной функции в зависимости от клинического состояния пациента."}}]},{"id":10,"name":"Особые указания","slug":"cautions","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Противопоказания Повышенная чувствительность к метоклопрамиду или другим компонентам препарата, желудочно-кишечное кровотечение, механическая кишечная непроходимость, перфорация стенки желудка или кишечника, состояния, при которых стимуляция перистальтики желудочно-кишечного тракта представляет риск, подтвержденная или подозреваемая феохромоцитома в связи с риском развития тяжелой артериальной гипертензии, эпилепсия (увеличение частоты и тяжести припадков), болезнь Паркинсона, поздняя дискинезия, которая развилась после лечения нейролептиками или метоклопрамидом в анамнезе, одновременное назначение с леводопой или агонистами дофаминергических рецепторов, метгемоглобинемия вследствие приема метоклопрамида или дефицита никотинамидадениндинуклеотида (НАДН) цитохрома-b5 в анамнезе, пролактинзависимые опухоли, беременность (III триместр), период грудного вскармливания, глюкозо-галактозная мальабсорбция, недостаточность лактазы, детский возраст до 15 лет. С осторожностью – пожилой возраст, почечная/печеночная недостаточность, бронхиальная астма, нарушение сердечной проводимости (включая удлинение интервала QT), нарушение водно-электролитного баланса, брадикардия, одновременный прием других препаратов, удлиняющих интервал QT, артериальная гипертензия, сопутствующие неврологические заболевания, одновременный прием препаратов, воздействующих на центральную нервную систему, депрессия (в анамнезе), беременность (I, II триместр). Не эффективен при рвоте вестибулярного генеза. Не назначают после операций на желудочно-кишечном тракте (как пилоропластика или анастомоз кишечника), поскольку энергичные мышечные сокращения препятствуют заживлению. На фоне применения метоклопрамида возможны искажения данных лабораторных показателей функции печени и определения концентрации альдостерона и пролактина в плазме. При назначении метоклопрамида, чаще в высоких дозах, могут развиваться экстрапирамидные расстройства, особенно у детей и пациентов молодого возраста, даже после введения одной дозы. Необходимо соблюдать осторожность при применении у пациентов с сопутствующими неврологическими заболеваниями и у пациентов, принимающих препараты, воздействующие на центральную нервную систему. При применении препарата также могут отмечаться симптомы болезни Паркинсона. Сообщалось о случаях возникновения метгемоглобинемии, которая могла быть вызвана дефицитом фермента НАДH-зависимой цитохром-b5 редуктазы. В этом случае приемпрепарата необходимо незамедлительно прекратить и предпринять соответствующие меры. Сообщалось о случаях тяжелых сердечно-сосудистых побочных эффектах, включая сосудистую недостаточность, выраженную брадикардию, остановку сердца и удлинение интервала QT после введения метоклопрамида. Особую осторожность следует соблюдать при назначении внутривенно пациентам с синдромом «слабого синуса» или другими нарушениями проводимости сердечной мышцы (включая удлинение интервала QT), пожилым пациентам, пациентам с нарушениями электролитного баланса, брадикардией, а также при приеме препаратов, удлиняющих интервал QT. Большинство побочных эффектов возникают в течение 36 часов от начала лечения и исчезают в течение 24 часов после отмены. Курс лечения должен быть по возможности кратковременным. В период лечения препаратом не рекомендовано употребление алкоголя. Влияние на способность к концентрации внимания: при приеме препарата следует избегать потенциально опасных видов деятельности, требующих повышенного внимания, быстрой психической и двигательной реакции (управление транспортными средствами и др.) в связи с возможным развитием таких побочных эффектов, как головокружение, сонливость, дискинезия, дистония."}}]}],"source":{"title":"36.6","url":"https://366.ru"}},"description_toggle":false,"short_description":"Противорвотное средство, способствует уменьшению тошноты, икоты; стимулирует перистальтику ЖКТ. Противорвотное действие обусловлено блокадой допаминовых D2-рецепторов и повышением порога хеморецепторов триггерной зоны, является блокатором серотониновых рецепторов. Полагают, что метоклопрамид ингибирует расслабление гладкой мускулатуры желудка, вызываемое допамином, усиливая таким образом холинергические реакции гладкой мускулатуры ЖКТ. 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