гиперчувствительность к активному веществу или вспомогательным компонентам; период после проведения аортокоронарного шунтирования; некомпенсированная сердечная недостаточность; анамнестические данные о приступе бронхообструкции, ринита; полное или неполное сочетание бронхиальной астмы, рецидивирующего полипоза носа и околоносовых пазух и непереносимости ...
гиперчувствительность к активному веществу или вспомогательным компонентам; период после проведения аортокоронарного шунтирования; некомпенсированная сердечная недостаточность; анамнестические данные о приступе бронхообструкции, ринита; полное или неполное сочетание бронхиальной астмы, рецидивирующего полипоза носа и околоносовых пазух и непереносимости ацетилсалициловой кислоты и других НПВС (в т.ч. в анамнезе); эрозивно-язвенные изменения слизистой желудка или двенадцатиперстной кишки, активное желудочно-кишечное кровотечение; воспалительные заболевания кишечника (неспецифический язвенный колит, болезнь Крона); цереброваскулярное или иные кровотечения; выраженная печеночная недостаточность или заболевание печени в активной фазе; выраженная почечная недостаточность у больных, не подвергающихся диализу (Cl креатинина меньше30 мл/мин), прогрессирующие заболевания почек, в т.ч. подтвержденная гиперкалиемия; беременность; период грудного вскармливания; возраст до 15 лет.
C осторожностью: для снижения риска развития нежелательных явлений следует использовать минимальную эффективную дозу, по возможности более коротким курсом, при ИБС, цереброваскулярных заболеваниях, застойной сердечной недостаточности, дислипидемии/гиперлипидемии, сахарном диабете, заболеваниях периферических артерий, курении, Cl креатинина меньше60 мл/мин, анамнестических данных о язвенном поражении ЖКТ, наличии инфекции Helicobacter pylori, в пожилом возрасте, при длительном использовании НПВС, частом употреблении алкоголя, тяжелых соматических заболеваниях, сопутствующей терапии следующими препаратами: антикоагулянты (например варфарин), антиагреганты (например ацетилсалициловая кислота, клопидогрел), пероральные ГКС (например преднизолон), СИОЗС (например циталопрам, флуоксетин, пароксетин, сертралин).
Способ применения и дозы
В/м, глубоко — по 7,5–15 мг/сут. При незначительном или умеренном снижении функции почек (Cl креатинина больше25 мл/мин), а также при циррозе печени в стабильном клиническом состоянии коррекция дозы не требуется. Начальная доза у пациентов с повышенным риском побочных эффектов — 7,5 мг/сут.; Максимальная суточная доза — 15 мг, у пациентов с тяжелой почечной недостаточностью, находящихся на гемодиализе, — 7,5 мг.
Побочное действие
Со стороны пищеварительной системы: тошнота, рвота, отрыжка, боль в животе, запоры или диарея, метеоризм, повышение активности печеночных трансаминаз, гипербилирубинемия, стоматит, эрозивно-язвенные поражения ЖКТ, эзофагит, гастрит, колит, перфорация органов ЖКТ, желудочно-кишечное кровотечение (скрытое или явное), гепатит.; Со стороны нервной системы: головокружение, вертиго, головная боль, шум в ушах, спутанность сознания, сонливость, дезориентация, эмоциональная лабильность.; Со стороны дыхательной системы: бронхоспазм.; Со стороны органов кроветворения: анемия, лейкопения, тромбоцитопения.; Со стороны ССС: периферические отеки, повышение АД, приливы крови к коже лица и верхней части грудной клетки, сердцебиение.; Со стороны мочевыделительной системы: отеки, гиперкреатининемия, повышение концентрации мочевины в сыворотке крови; редко — острая почечная недостаточность, интерстициальный нефрит, альбуминурия, гематурия.; Со стороны органов чувств: конъюнктивит, нарушение (в т.ч. нечеткость) зрения.; Со стороны кожных покровов: зуд, кожная сыпь, крапивница, фотосенсибилизация, буллезные высыпания, мультиформная эритема, токсический эпидермальный некролиз.; Аллергические реакции: ангионевротический отек, анафилактоидные, анафилактические реакции.; Местные реакции: возможны жжение и боль в месте инъекции.
Передозировка
Симптомы: усиление побочных эффектов.; Лечение: симптоматическое. Специфического антидота и антагониста нет.
Особые указания
При возникновении пептических язв или желудочно-кишечного кровотечения, развитии побочных эффектов со стороны кожи и слизистых оболочек препарат следует отменить. У больных с уменьшением ОЦК и сниженной КФ (дегидратация, ХСН, хирургические операции) возможно появление клинически выраженной ХПН, которая полностью обратима после отмены препарата (у таких пациентов в начале лечения следует мониторировать суточный диурез и функцию почек). При стойком и существенном повышении трансаминаз и изменении других показателей функции печени препарат следует отменить и провести контрольные тесты. У больных с повышенным риском побочных эффектов лечение начинают с дозы 7,5 мг. В терминальной стадии ХСН у пациентов, находящихся на диализе, доза не должна превышать 7,5 мг/сут.; Влияние на способность управлять транспортными средствами и работать с механизмами. В период лечения необходимо соблюдать осторожность при вождении автотранспорта и занятии другими потенциально опасными видами деятельности, требующими повышенной концентрации внимания и быстроты психомоторных реакций (при появлении головокружений и сонливости).
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