Для системного применения: в качестве монотерапии и в составе комбинированной терапии - артериальная гипертензия, профилактика приступов стенокардии напряжения. Для местного применения в офтальмологии: хроническая открытоугольная глаукома, повышение внутриглазного давления, состояние после лазерной трабекулопластики.
Противопоказания
Кардиогенный шок; острая сердечная недостаточность, хроническая сердечная недостаточность в стадии декомпенсации, не компенсирующаяся в результате лечения диуретиками, инотропными средствами, ингибиторами АПФ, другими вазодилататорами; AV-блокада II и III степени (без установленного искусственного водителя ритма); стенокардия Принцметала (противопоказана ...
Бетаксолола гидрохлорид 20 мг Вспомогательные вещества: лактозы моногидрат - 128.1 мг, целлюлоза микрокристаллическая - 85.8 мг, магния стеарат - 2.5 мг, карбоксиметилкрахмал натрия - 7.4 мг, аэросил - 1.2 мг. Состав пленочной оболочки: опадрай II белый 85F18422, в т. ч. поливиниловый спирт - 2 мг, титана диоксид - 1.25 мг, макрогол - 1.01 мг, тальк - 0.74 мг.
Фармакологические свойства
Кардиоселективный бета1-адреноблокатор без внутренней симпатомиметической активности. Обладает слабой мембраностабилизирующей активностью. Оказывает гипотензивное действие, связанное со снижением минутного объема сердца и уменьшением симпатической стимуляции периферических сосудов. При применении в терапевтических дозах не оказывает кардиодепрессивного действия, не влияет на обмен глюкозы, не уменьшает бронхорасширяющего действия бета-адреномиметиков, не вызывает задержки в организме ионов натрия. Действует длительно. При местном применении в виде глазных капель понижает повышенное внутриглазное давление. Резорбтивное действие выражено незначительно.
Показания к применению
Для системного применения: в качестве монотерапии и в составе комбинированной терапии - артериальная гипертензия, профилактика приступов стенокардии напряжения. Для местного применения в офтальмологии: хроническая открытоугольная глаукома, повышение внутриглазного давления, состояние после лазерной трабекулопластики.
Противопоказания
Кардиогенный шок; острая сердечная недостаточность, хроническая сердечная недостаточность в стадии декомпенсации, не компенсирующаяся в результате лечения диуретиками, инотропными средствами, ингибиторами АПФ, другими вазодилататорами; AV-блокада II и III степени (без установленного искусственного водителя ритма); стенокардия Принцметала (противопоказана монотерапия); СССУ, синоатриальная блокада; выраженная брадикардия (ЧСС менее 45-50 уд./мин); выраженные нарушения периферического кровообращения, тяжелые формы бронхиальной астмы и ХОБЛ; тяжелые формы болезни Рейно и облитерирующих заболеваний периферических артерий; феохромоцитома без одновременного приема альфа-адреноблокаторов; артериальная гипотензия (систолическое АД меньше 100 мм рт. ст.); анафилактические реакции в анамнезе; метаболический ацидоз; кардиомегалия (без признаков сердечной недостаточности); одновременное применение с сультопридом и флоктафенином; одновременный прием ингибиторов МАО; детский и подростковый возраст до 18 лет; повышенная чувствительность к бетаксололу.
Применение при беременности и в период грудного вскармливания
При беременности и в период лактации (грудного вскармливания) применение бетаксолола возможно только в случаях, когда предполагаемая польза для матери превышает возможный риск для плода или ребенка.
Способ применения и дозы
Для системного применения при приеме внутрь - по 20 мг 1 раз/сут. Для больных, находящихся на постоянном гемодиализе или перитонеальном диализе, начальная доза составляет 10 мг/сут; время приема бетаксолола устанавливают независимо от режима проведения сеансов диализа. Для местного применения в офтальмологии - по 1 капле 2 раза/сут в пораженный глаз. В течение первого месяца терапия проводится под контролем уровня внутриглазного давления, в дальнейшем частота измерения внутриглазного давления определяется индивидуально. В случае применения бетаксолола после предшествующего лечения другим аналогичным препаратом режим дозирования устанавливают индивидуально.
Побочное действие
Со стороны сердечно-сосудистой системы: в начале лечения - AV-блокада, синусовая брадикардия, артериальная гипотензия, сердечная недостаточность, синдром Рейно. Со стороны пищеварительной системы: редко - боли в животе, тошнота, рвота. Со стороны ЦНС и периферической нервной системы: в начале лечения - астения, парестезии конечностей, нарушения сна, депрессия, сонливость, головокружение. Со стороны дыхательной системы: редко - бронхоспазм. Аллергические реакции: редко - псориазоподобные кожные проявления. Местные реакции: при применении в форме глазных капель сразу после закапывания возможны кратковременный дискомфорт в глазах, иногда слезотечение; редко - уменьшение чувствительности роговицы, эритема, зуд, пятнистая окрашенность роговицы, кератит, анизокория, светобоязнь.
Особые указания
С осторожностью следует применять при бронхиальной астме и ХОБЛ среднетяжелого течения (начинать лечение с малых доз и желательно под контролем показателей функции внешнего дыхания; благодаря бета1-селективности бетаксолола при возникновении приступа бронхиальной астмы на фоне его приема возможно купирование приступа бета2-адреномиметиками); при хронической сердечной недостаточности в стадии компенсации (лечение бетаксололом возможно только под строгим медицинским наблюдением; лечение следует начинать с очень малых доз с постепенным их повышением); при AV-блокаде I степени (требуется тщательное наблюдение, включая ЭКГ-контроль); при облитерирующих заболеваниях периферических артерий, синдроме Рейно (за исключением тяжелой формы) (возможно усиление нарушений периферического кровообращения); при стенокардии Принцметала (возможно учащение приступов стенокардии; применение селективного бета1-адреноблокатора возможно только при одновременном применении вазодилататоров); при леченной феохромоцитоме (требуется тщательное наблюдение за показателями АД); у пациентов пожилого возраста (следует начинать лечение с малых доз и под тщательным медицинским наблюдением); при почечной недостаточности (при КК более 20 мл/мин - тщательное наблюдение за пациентом в течение первых нескольких дней лечения; при КК менее 20 мл/мин и/или проведении гемодиализа требуется коррекция режима дозирования); при печеночной недостаточности (требуется более тщательное клиническое наблюдение в начале лечения); у пациентов с сахарным диабетом (необходим регулярный контроль концентрации глюкозы в крови, включая активный самоконтроль пациентом, в начале лечения; возможно уменьшение выраженности предвестников развития гипогликемии, таких как тахикардия, ощущение сердцебиения и повышенное потоотделение); при псориазе (бета-адреноблокаторы могут ухудшать течение псориаза); при проведении десенсибилизирующей терапии. Отмену бетаксолола следует проводить постепенно, особенно у пациентов, страдающих ИБС, стенокардией. Бетаксолол не влияет на величину зрачка, поэтому при закрытоугольной глаукоме препарат следует применять только в сочетании с миотиками. При переводе пациента на бетаксолол после лечения несколькими антиглаукомными препаратами последние отменяют постепенно, в срок не менее 1 недели на препарат. При одновременном применении бетаксолола в форме глазных капель и бета-адреноблокаторов внутрь возможно развитие аддитивных эффектов как со стороны внутриглазного давления, так и проявлений системного действия бета-адреноблокаторов. Перед проведением плановой операции бета-адреноблокаторы, в т.ч. бетаксолол, следует отменить. При местном применении бетаксолола не следует носить контактные линзы. Не рекомендуется применять бетаксолол у детей. Влияние на способность к вождению автотранспорта и управлению механизмами С осторожностью применяют у пациентов, деятельность которых требует повышенного внимания и быстрых психомоторных реакций.
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Со стороны ЦНС и периферической нервной системы: в начале лечения - астения, парестезии конечностей, нарушения сна, депрессия, сонливость, головокружение. Со стороны дыхательной системы: редко - бронхоспазм. Аллергические реакции: редко - псориазоподобные кожные проявления. 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