Тиреотоксикоз; - подготовка к хирургическому лечению тиреотоксикоза; - подготовка к лечению тиреотоксикоза радиоактивным йодом; - терапия в латентный период действия радиоактивного йода - проводится до начала действия радиоактивного йода (в течение 4-6 мес); - в исключительных случаях длительная поддерживающая терапия тиреотоксикоза, когда в связи с ...
Повышенная чувствительность к компонентам препарата и к производным тиомочевины; - агранулоцитоз во время ранее проводившейся терапии карбимазолом или тиамазолом; - гранулоцитопения (в т.ч. в анамнезе); - холестаз перед началом лечения; - терапия тиамазолом в комбинации с левотироксином при беременности; - детский возраст до 3 лет. Тирозол содержит ...
Действующее вещество: Тиамазол (Thiamazole)Концентрация действующего вещества (мг): 5
Фармакологические свойства
Антитиреоидный препарат. Нарушает синтез гормонов щитовидной железы, блокируя фермент пероксидазу, участвующую в йодировании тиронина в щитовидной железе с образованием трийод- и тетрайодтиронина. Поэтому препарат эффективен при симптоматической терапии тиреотоксикоза (за исключением случаев развития заболевания вследствие высвобождения гормонов после разрушения клеток щитовидной железы после лечения радиоактивным йодом или при тиреоидите). Тирозол не влияет на процесс высвобождения синтезированных тиронинов из фолликулов щитовидной железы. Этим объясняется латентный период различной продолжительности, который может предшествовать нормализации уровня T3 и Т4 в плазме крови, т.е. улучшению клинической картины. Препарат снижает основной обмен, ускоряет выведение из щитовидной железы йодидов, повышает реципрокную активацию синтеза и секреции гипофизом ТТГ, что может сопровождаться некоторой гиперплазией щитовидной железы. Продолжительность действия препарата после однократного приема составляет почти 24 ч.
Показания к применению
Тиреотоксикоз; - подготовка к хирургическому лечению тиреотоксикоза; - подготовка к лечению тиреотоксикоза радиоактивным йодом; - терапия в латентный период действия радиоактивного йода - проводится до начала действия радиоактивного йода (в течение 4-6 мес); - в исключительных случаях длительная поддерживающая терапия тиреотоксикоза, когда в связи с общим состоянием или по индивидуальным причинам невозможно выполнить радикальное лечение; - профилактика тиреотоксикоза при назначении препаратов йода (включая случаи применения йодсодержащих рентгеноконтрастных средств) при наличии латентного тиреотоксикоза, автономных аденом или тиреотоксикоза в анамнезе.
Противопоказания
Повышенная чувствительность к компонентам препарата и к производным тиомочевины; - агранулоцитоз во время ранее проводившейся терапии карбимазолом или тиамазолом; - гранулоцитопения (в т.ч. в анамнезе); - холестаз перед началом лечения; - терапия тиамазолом в комбинации с левотироксином при беременности; - детский возраст до 3 лет. Тирозол содержит лактозу, поэтому не рекомендуется его применение у пациентов с редкими наследственными заболеваниями, связанными с непереносимостью галактозы, дефицитом лактазы или синдромом глюкозо-галактозной мальабсорбции.
Применение при беременности и в период грудного вскармливания
Отсутствие лечения гиперфункции щитовидной железы при беременности может привести к серьезным осложнениям: преждевременные роды, пороки развития плода. Тем не менее, гипотиреоз, вызванный лечением неадекватными дозами, может привести к невынашиванию беременности. Тиамазол проникает через плацентарный барьер и в крови плода достигает такой же концентрации, как у матери. Поэтому при беременности препарат следует назначать только после полной оценки пользы и риска его применения, в минимальной эффективной дозе (до 10 мг/сут) и без дополнительного применения левотироксина натрия. Тиамазол в дозах, значительно превышающих рекомендованные, может вызвать образование зоба, гипотиреоз у плода, а у новорожденного возможна пониженная масса тела при рождении. В период лактации лечение тиреотоксикоза препаратом Тирозол при необходимости может быть продолжено. Поскольку тиамазол выделяется с грудным молоком и может достигать в нем концентрации, соответствующей уровню тиамазола в крови матери, у новорожденного возможно развитие гипотиреоза. Необходимо регулярно контролировать функцию щитовидной железы у новорожденных.
Способ применения и дозы
Препарат принимают внутрь после приема пищи. Таблетки следует принимать не разжевывая, запивая достаточным количеством жидкости. Суточную дозу назначают в 1 прием или разделяют на 2-3 разовые дозы. В начале лечения разовые дозы принимают в течение дня в строго определенное время. Поддерживающую дозу следует принимать в один прием после завтрака. При тиреотоксикозе в зависимости от тяжести заболевания препарат назначают в дозе 20-40 мг/сут в течение 3-6 нед. После нормализации функции щитовидной железы (обычно через 3-8 недель) переходят на прием поддерживающей дозы 5-20 мг/сут. С этого времени рекомендуется дополнительный прием левотироксина натрия. При подготовке к хирургическому лечению тиреотоксикоза назначают 20-40 мг/сут до достижения эутиреоидного состояния. С этого времени рекомендуется дополнительный прием левотироксина натрия. С целью сокращения времени, необходимого для подготовки к операции, дополнительно назначают бета-адреноблокаторы и препараты йода. При подготовке к лечению радиоактивным йодом назначают 20-40 мг/сут до достижения эутиреоидного состояния. При терапии в латентный период действия радиоактивного йода в зависимости от тяжести заболевания назначают 5-20 мг/сут до наступления действия радиоактивного йода (4-6 мес). При длительной тиреостатической поддерживающей терапии Тирозол назначают в дозах 1.25-2.5-10 мг/сут с дополнительным приемом левотироксина натрия в небольших дозах. При лечении тиреотоксикоза длительность терапии составляет от 1.5 до 2 лет. С целью профилактики тиреотоксикоза при назначении препаратов йода (включая случаи применения йодсодержащих рентгеноконтрастных средств) при наличии латентного тиреотоксикоза, автономных аденом или тиреотоксикоза в анамнезе Тирозол назначают в дозе 10-20 мг/сут и перхлорат калия 1 г/сут в течение 8-10 дней перед приемом йодосодержащих средств. Детям в возрасте от 3 до 17 лет Тирозол назначают в начальной дозе 0.3-0.5 мг/кг массы тела в 2-3 равных разделенных дозах ежедневно. Максимальная рекомендуемая доза для детей с массой тела более 80 кг - 40 мг/сут. Поддерживающая доза - 0.2-0.3 мг/кг/сут. При необходимости дополнительно назначают левотироксин натрия. Не рекомендуется применение у детей в возрасте от 0 до 3 лет. При беременности препарат назначают в минимальных дозах: разовая - 2.5 мг, суточная - 10 мг. При печеночной недостаточности препарат назначают в минимальной эффективной дозе под тщательным врачебным контролем. При подготовке к операции пациентов с тиреотоксикозом лечение препаратом проводится до достижения эутиреоидного состояния в течение 3-4 недель до запланированного дня операции (в отдельных случаях - более длительно) и заканчивается за день до нее.
Побочное действие
Со стороны системы кроветворения: нечасто - агранулоцитоз (симптомы могут появиться даже спустя недели и месяцы после начала лечения и привести к необходимости отмены препарата); очень редко - генерализованная лимфаденопатия, тромбоцитопения, панцитопения. Со стороны эндокринной системы: очень редко - инсулиновый аутоиммунный синдром с гипогликемией. Со стороны нервной системы: редко - обратимое изменение вкусовых ощущений, головокружение; очень редко - неврит, полиневропатия. Со стороны пищеварительной системы: очень редко - увеличение слюнных желез, рвота. Со стороны печени и желчевыводящих путей: очень редко - холестатическая желтуха и токсический гепатит. Со стороны кожи и подкожных тканей: очень редко - генерализованные высыпания на коже, алопеция, волчаночноподобный синдром. Аллергические реакции: кожные проявления (зуд, покраснение, высыпания). Со стороны костно-мышечной системы: часто - медленно прогрессирующая артралгия без клинических признаков артрита. Общие реакции: редко - повышение температуры, слабость, увеличение массы тела.
Передозировка
Симптомы: при длительном применении препарата в высоких дозах возможно развитие субклинического и клинического гипотиреоза, а также увеличение размеров щитовидной железы вследствие повышения уровня ТТГ в крови. Этого можно избежать путем снижения дозы препарата до достижения состояния эутиреоза или, если это необходимо, дополнительным назначением препаратов левотироксина натрия. Как правило, после отмены препарата Тирозол наблюдается спонтанное восстановление функции щитовидной железы. Прием тиамазола в очень высоких дозах (около 120 мг/сут) может приводить к развитию миелотоксических эффектов. Препарат в таких дозах следует применять только по специальным показаниям (тяжелые формы заболевания, тиреотоксический криз). Лечение: отмена препарата, промывание желудка, симптоматическая терапия, при необходимости, переключение на антитиреоидный препарат другой группы.
Особые указания
Пациентам со значительным увеличением щитовидной железы, сужающей просвет трахеи, Тирозол назначают кратковременно в комбинации с левотироксином натрия, т.к. при длительном применении возможно увеличение зоба и еще большее сдавление трахеи. Необходимо проводить тщательное наблюдение за больным (контроль уровня ТТГ и трахеального просвета). В период лечения препаратом необходим регулярный контроль картины периферической крови. Тиамазол и производные тиомочевины могут снижать чувствительность ткани щитовидной железы к лучевой терапии. Если во время лечения препаратом внезапно появляются боли в горле, затрудненное глотание, повышение температуры тела, признаки стоматита или фурункулез (возможные симптомы агранулоцитоза) следует прекратить прием препарата и немедленно обратиться к врачу. При появлении во время лечения подкожных кровоизлияний или кровотечений неясного генеза, генерализованной кожной сыпи и зуда, упорной тошноты или рвоты, желтухи, сильных болей в эпигастральной области и выраженной слабости требуется отмена препарата. В случае раннего прекращения лечения возможен рецидив заболевания. Появление или ухудшение течения эндокринной офтальмопатии не является побочным действием адекватного лечения препаратом Тирозол, проводимого должным образом. В редких случаях после окончания лечения может возникнуть поздний гипотиреоз, который не является побочным действием препарата, а связан с воспалительными и деструктивными процессами в ткани щитовидной железы, протекающими в рамках основного заболевания. Влияние на способность к вождению автотранспорта и управлению механизмамиТиамазол не оказывает влияния на способность управлять транспортными средствами и механизмами.
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Нарушает синтез гормонов щитовидной железы, блокируя фермент пероксидазу, участвующую в йодировании тиронина в щитовидной железе с образованием трийод- и тетрайодтиронина. Поэтому препарат эффективен при симптоматической терапии тиреотоксикоза (за исключением случаев развития заболевания вследствие высвобождения гормонов после разрушения клеток щитовидной железы после лечения радиоактивным йодом или при тиреоидите). Тирозол не влияет на процесс высвобождения синтезированных тиронинов из фолликулов щитовидной железы. Этим объясняется латентный период различной продолжительности, который может предшествовать нормализации уровня T3 и Т4 в плазме крови, т.е. улучшению клинической картины. Препарат снижает основной обмен, ускоряет выведение из щитовидной железы йодидов, повышает реципрокную активацию синтеза и секреции гипофизом ТТГ, что может сопровождаться некоторой гиперплазией щитовидной железы. Продолжительность действия препарата после однократного приема составляет почти 24 ч."}}]},{"id":3,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Тиреотоксикоз; - подготовка к хирургическому лечению тиреотоксикоза; - подготовка к лечению тиреотоксикоза радиоактивным йодом; - терапия в латентный период действия радиоактивного йода - проводится до начала действия радиоактивного йода (в течение 4-6 мес); - в исключительных случаях длительная поддерживающая терапия тиреотоксикоза, когда в связи с общим состоянием или по индивидуальным причинам невозможно выполнить радикальное лечение; - профилактика тиреотоксикоза при назначении препаратов йода (включая случаи применения йодсодержащих рентгеноконтрастных средств) при наличии латентного тиреотоксикоза, автономных аденом или тиреотоксикоза в анамнезе."}}]},{"id":4,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Повышенная чувствительность к компонентам препарата и к производным тиомочевины; - агранулоцитоз во время ранее проводившейся терапии карбимазолом или тиамазолом; - гранулоцитопения (в т.ч. в анамнезе); - холестаз перед началом лечения; - терапия тиамазолом в комбинации с левотироксином при беременности; - детский возраст до 3 лет. Тирозол содержит лактозу, поэтому не рекомендуется его применение у пациентов с редкими наследственными заболеваниями, связанными с непереносимостью галактозы, дефицитом лактазы или синдромом глюкозо-галактозной мальабсорбции."}}]},{"id":5,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Отсутствие лечения гиперфункции щитовидной железы при беременности может привести к серьезным осложнениям: преждевременные роды, пороки развития плода. Тем не менее, гипотиреоз, вызванный лечением неадекватными дозами, может привести к невынашиванию беременности. Тиамазол проникает через плацентарный барьер и в крови плода достигает такой же концентрации, как у матери. Поэтому при беременности препарат следует назначать только после полной оценки пользы и риска его применения, в минимальной эффективной дозе (до 10 мг/сут) и без дополнительного применения левотироксина натрия. Тиамазол в дозах, значительно превышающих рекомендованные, может вызвать образование зоба, гипотиреоз у плода, а у новорожденного возможна пониженная масса тела при рождении. В период лактации лечение тиреотоксикоза препаратом Тирозол при необходимости может быть продолжено. Поскольку тиамазол выделяется с грудным молоком и может достигать в нем концентрации, соответствующей уровню тиамазола в крови матери, у новорожденного возможно развитие гипотиреоза. Необходимо регулярно контролировать функцию щитовидной железы у новорожденных."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Препарат принимают внутрь после приема пищи. Таблетки следует принимать не разжевывая, запивая достаточным количеством жидкости. Суточную дозу назначают в 1 прием или разделяют на 2-3 разовые дозы. В начале лечения разовые дозы принимают в течение дня в строго определенное время. Поддерживающую дозу следует принимать в один прием после завтрака. При тиреотоксикозе в зависимости от тяжести заболевания препарат назначают в дозе 20-40 мг/сут в течение 3-6 нед. После нормализации функции щитовидной железы (обычно через 3-8 недель) переходят на прием поддерживающей дозы 5-20 мг/сут. С этого времени рекомендуется дополнительный прием левотироксина натрия. При подготовке к хирургическому лечению тиреотоксикоза назначают 20-40 мг/сут до достижения эутиреоидного состояния. С этого времени рекомендуется дополнительный прием левотироксина натрия. С целью сокращения времени, необходимого для подготовки к операции, дополнительно назначают бета-адреноблокаторы и препараты йода. При подготовке к лечению радиоактивным йодом назначают 20-40 мг/сут до достижения эутиреоидного состояния. При терапии в латентный период действия радиоактивного йода в зависимости от тяжести заболевания назначают 5-20 мг/сут до наступления действия радиоактивного йода (4-6 мес). При длительной тиреостатической поддерживающей терапии Тирозол назначают в дозах 1.25-2.5-10 мг/сут с дополнительным приемом левотироксина натрия в небольших дозах. При лечении тиреотоксикоза длительность терапии составляет от 1.5 до 2 лет. С целью профилактики тиреотоксикоза при назначении препаратов йода (включая случаи применения йодсодержащих рентгеноконтрастных средств) при наличии латентного тиреотоксикоза, автономных аденом или тиреотоксикоза в анамнезе Тирозол назначают в дозе 10-20 мг/сут и перхлорат калия 1 г/сут в течение 8-10 дней перед приемом йодосодержащих средств. Детям в возрасте от 3 до 17 лет Тирозол назначают в начальной дозе 0.3-0.5 мг/кг массы тела в 2-3 равных разделенных дозах ежедневно. Максимальная рекомендуемая доза для детей с массой тела более 80 кг - 40 мг/сут. Поддерживающая доза - 0.2-0.3 мг/кг/сут. При необходимости дополнительно назначают левотироксин натрия. Не рекомендуется применение у детей в возрасте от 0 до 3 лет. При беременности препарат назначают в минимальных дозах: разовая - 2.5 мг, суточная - 10 мг. При печеночной недостаточности препарат назначают в минимальной эффективной дозе под тщательным врачебным контролем. При подготовке к операции пациентов с тиреотоксикозом лечение препаратом проводится до достижения эутиреоидного состояния в течение 3-4 недель до запланированного дня операции (в отдельных случаях - более длительно) и заканчивается за день до нее."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Со стороны системы кроветворения: нечасто - агранулоцитоз (симптомы могут появиться даже спустя недели и месяцы после начала лечения и привести к необходимости отмены препарата); очень редко - генерализованная лимфаденопатия, тромбоцитопения, панцитопения. Со стороны эндокринной системы: очень редко - инсулиновый аутоиммунный синдром с гипогликемией. Со стороны нервной системы: редко - обратимое изменение вкусовых ощущений, головокружение; очень редко - неврит, полиневропатия. Со стороны пищеварительной системы: очень редко - увеличение слюнных желез, рвота. Со стороны печени и желчевыводящих путей: очень редко - холестатическая желтуха и токсический гепатит. Со стороны кожи и подкожных тканей: очень редко - генерализованные высыпания на коже, алопеция, волчаночноподобный синдром. Аллергические реакции: кожные проявления (зуд, покраснение, высыпания). Со стороны костно-мышечной системы: часто - медленно прогрессирующая артралгия без клинических признаков артрита. Общие реакции: редко - повышение температуры, слабость, увеличение массы тела."}}]},{"id":8,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Симптомы: при длительном применении препарата в высоких дозах возможно развитие субклинического и клинического гипотиреоза, а также увеличение размеров щитовидной железы вследствие повышения уровня ТТГ в крови. Этого можно избежать путем снижения дозы препарата до достижения состояния эутиреоза или, если это необходимо, дополнительным назначением препаратов левотироксина натрия. Как правило, после отмены препарата Тирозол наблюдается спонтанное восстановление функции щитовидной железы. Прием тиамазола в очень высоких дозах (около 120 мг/сут) может приводить к развитию миелотоксических эффектов. Препарат в таких дозах следует применять только по специальным показаниям (тяжелые формы заболевания, тиреотоксический криз). Лечение: отмена препарата, промывание желудка, симптоматическая терапия, при необходимости, переключение на антитиреоидный препарат другой группы."}}]},{"id":9,"name":"Особые указания","slug":"cautions","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Пациентам со значительным увеличением щитовидной железы, сужающей просвет трахеи, Тирозол назначают кратковременно в комбинации с левотироксином натрия, т.к. при длительном применении возможно увеличение зоба и еще большее сдавление трахеи. Необходимо проводить тщательное наблюдение за больным (контроль уровня ТТГ и трахеального просвета). В период лечения препаратом необходим регулярный контроль картины периферической крови. Тиамазол и производные тиомочевины могут снижать чувствительность ткани щитовидной железы к лучевой терапии. Если во время лечения препаратом внезапно появляются боли в горле, затрудненное глотание, повышение температуры тела, признаки стоматита или фурункулез (возможные симптомы агранулоцитоза) следует прекратить прием препарата и немедленно обратиться к врачу. При появлении во время лечения подкожных кровоизлияний или кровотечений неясного генеза, генерализованной кожной сыпи и зуда, упорной тошноты или рвоты, желтухи, сильных болей в эпигастральной области и выраженной слабости требуется отмена препарата. В случае раннего прекращения лечения возможен рецидив заболевания. Появление или ухудшение течения эндокринной офтальмопатии не является побочным действием адекватного лечения препаратом Тирозол, проводимого должным образом. В редких случаях после окончания лечения может возникнуть поздний гипотиреоз, который не является побочным действием препарата, а связан с воспалительными и деструктивными процессами в ткани щитовидной железы, протекающими в рамках основного заболевания. Влияние на способность к вождению автотранспорта и управлению механизмамиТиамазол не оказывает влияния на способность управлять транспортными средствами и механизмами."}}]}],"source":{"title":"36.6","url":"https://366.ru"}},"description_toggle":false,"short_description":"Антитиреоидный препарат. Нарушает синтез гормонов щитовидной железы, блокируя фермент пероксидазу, участвующую в йодировании тиронина в щитовидной железе с образованием трийод- и тетрайодтиронина. Поэтому препарат эффективен при симптоматической терапии тиреотоксикоза (за исключением случаев развития заболевания вследствие высвобождения гормонов после разрушения клеток щитовидной железы после лечения радиоактивным йодом или при тиреоидите). Тирозол не влияет на процесс высвобождения синтезированных тиронинов из фолликулов щитовидной железы. Этим объясняется латентный период различной продолжительности, который может предшествовать нормализации уровня T3 и Т4 в плазме крови, т.е. улучшению клинической картины. Препарат снижает основной обмен, ускоряет выведение из щитовидной железы йодидов, повышает реципрокную активацию синтеза и секреции гипофизом ТТГ, что может сопровождаться некоторой гиперплазией щитовидной железы. 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