Ганфорт - комбинированный лекарственный препарат, входящие в его состав биматопрост и тимолол снижают внутриглазное давление (ВГД) за счет сочетанного взаимодействия, приводя к значительно более выраженному гипотензивному эффекту по сравнению с эффектом каждого из компонентов в отдельности. Биматопрост относится к синтетическим простамидам, по химической структуре сходен с простагландином F2a (PGF2a). Биматопрост не оказывает влияния ни на один из известных типов рецепторов простагландина. Гипотензивное действие биматопроста осуществляется за счет усиления оттока внутриглазной жидкости через трабекулу и по увеосклеральному пути глаза. Тимолол - неселективный бета-адреноблокатор, не обладает внутренней симпатомиметической и мембраностабилизирующей активностью. Тимолол снижает ВГД за счет уменьшения образования внутриглазной жидкости. Точный механизм действия не установлен, возможно, он связан с угнетением синтеза циклического аденозинмонофосфата (ц-АМФ) и вызывается эндогенной стимуляцией бета-адренергических рецепторов.
Показания к применению
Внутриглазная гипертензия у пациентов с открытоугольной глаукомой
Недостаточная эффективность местного применения средств группы бета-адреноблокаторов или аналогов простагландина
Противопоказания
Гиперчувствительность
Повышенная реактивность дыхательных путей (бронхиальная астма, ХОБЛ включая запись в анамнезе)
Синусовая брадикардия, выраженная сердечная недостаточность, атриовентрикулярная блокада II или III степени, шок кардиогенный
Детский возраст
Беременность, лактация. Ганфорт может быть назначен с осторожностью при нарушениях функций печени либо почек. У лиц с риском развития отека макулы (афакия, псевдофакия, разрыв хрусталика). Страдающим сахарным диабетом либо нарушениями толерантности к глюкозе. Повышенная чувствительность
Применение при беременности и в период грудного вскармливания
Противопоказано при беременности и лактации.
Способ применения и дозы
Назначаемые дозы для взрослых (в т. ч. пациентов пожилого возраста): инстилляция одной капли ежесуточно с утра. При однократном пропуске очередного закапывания, препарат вводят на следующий день, не превышая рекомендуемой дозы - 1 инстилляция раз в сутки.
Побочное действие
• гиперемия конъюнктивы, повышенный рост ресниц; • эрозия роговицы, поверхностный кератит, ощущение жжения, зуд, ощущение инородного тела, жгучая боль, сухость слизистой оболочки, фотофобия, покраснение век, выделения из глаз, зуд кожи век, нарушение зрения; • иридоциклит, раздражение слизистой, отек конъюнктивы, блефарит, отечность век, эпифора, болезненность век, астенопия, снижение остроты зрения, трихиаз; • пигментация кожи век, кистоидный макулярный отек; • гирсутизм; • отеки, боли за грудиной, утомляемость, бронхоспазм, шум в ушах, головные боли, повышение артериального давления, ринит.
Передозировка
О случаях передозировки препарата Ганфорт не сообщалось; при введении в виде глазных капель передозировка маловероятна. БиматопростПри непреднамеренном приеме препарата Ганфорт внутрь может быть полезна следующая информация: не отмечено симптомов токсического воздействия биматопроста в дозах до 100 мг/кг/сут. в ходе 2-недельного перорального введения в эксперименте на крысах и мышах. Применяемая в исследовании доза, выраженная в мг/м, превышает в 70 раз возможную дозу биматопроста при случайном приеме внутрь содержимого флакона препарата Ганфорт ребенком с массой тела 10 кг. ТимололПри передозировке тимолола могут наблюдаться следующие симптомы: брадикардия, снижение артериального давления, бронхоспазм, головная боль, головокружение, одышка, остановка сердца. В исследованиях показано, что тимолол полностью не выводится при гемодиализе. Если передозировка происходит, необходимо проведение симптоматической терапии.
Особые указания
Так же, как и другие офтальмологические лекарственные препараты, Ганфорт может проникать в системный кровоток. Бста-адреноблокаторы могут маскировать симптомы гипогликемии, гипертиреоза и вызывать ухудшение течения стенокардии Принцметала, тяжелых периферических и центральных сосудистых нарушений, а также артериальной гипотензии. У больных с атопическими проявлениями в анамнезе и тяжелыми анафилактическими реакциями на различные аллергены дозы эпинефрина (адреналина), которые обычно используются для купирования анафилактических реакций, на фоне применения бета-адреноблокаторов могут быть неэффективны. У больных с заболеванием печени легкого течения или исходно повышенной активностью ферментов печени аланинаминотрансферазы (АЛТ), аспартатаминотрансферазы (ACT) и/или общего билирубина, биматопрост не оказывал влияния на функцию печени в течение периода изучения 4 ч продолжительностью более 24 месяцев. До начала лечения пациентов необходимо информировать о возможном росте ресниц, усилении пигментации кожи век и пигментации радужной оболочки глаз, поскольку эти побочные эффекты установлены в ходе исследований биматопроста и препарата Ганфорт. Некоторые изменения могут оказаться постоянными, и могут сопровождаться возникновением различий между глазами, если инстилляции препарата проводили только в один глаз. После отмены препарата Ганфорт пигментация радужной оболочки может остаться постоянной. Через 12 месяцев лечения препаратом Ганфорт частота пигментации радужной оболочки отмечена у 0.2% больных. А через 12 месяцев лечения только биматопростом в виде глазных капель 1.5%, дальнейшего увеличения частоты данного эффекта не наблюдалось в течение терапии продолжительностью 3 года. Усиление пигментации радужной оболочки глаза обусловлено усилением продукции меланоцитов, а не просто увеличением их количества. Вспомогательное вещество бензалкония хлорид, входящий в состав препарата Ганфорт, может вызвать раздражение слизистой оболочки глаз и изменение цвета мягких контактных линз. Контактные линзы необходимо снять до введения препарата, одеть их можно через 15 минут после инстилляции. Бензалкония хлорид может вызвать острый кератит и/или токсическую язву роговицы. В связи с этим необходимо наблюдение за состоянием пациента при частом или продолжительном лечении препаратом Ганфорт у лиц с синдромом «сухого» глаза и при изменениях роговицы. После вскрытия флакона нельзя исключить возможность микробной контаминации его содержимого, что может привести к воспалительным поражениям глаз. Срок годности препарата после первого вскрытия флакона составляет 28 суток. После истечения указанного времени флакон следует выбросить, даже если раствор полностью не использован. Рекомендуется записывать на картонной пачке лекарственного препарата дату вскрытия флакона. Влияние на способность управления транспортными средствами и механизмамиВозможно преходящее ухудшение зрения после введения препарата, поэтому больной должен подождать до полного восстановления зрения, прежде чем приступить к вождению автомобиля или управлению механизмами.
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Тимолол снижает ВГД за счет уменьшения образования внутриглазной жидкости. Точный механизм действия не установлен, возможно, он связан с угнетением синтеза циклического аденозинмонофосфата (ц-АМФ) и вызывается эндогенной стимуляцией бета-адренергических рецепторов."}}]},{"id":3,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"list","data":{"style":"unordered","items":["Внутриглазная гипертензия у пациентов с открытоугольной глаукомой","Недостаточная эффективность местного применения средств группы бета-адреноблокаторов или аналогов простагландина"]}}]},{"id":4,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"list","data":{"style":"unordered","items":["Гиперчувствительность","Повышенная реактивность дыхательных путей (бронхиальная астма, ХОБЛ включая запись в анамнезе)","Синусовая брадикардия, выраженная сердечная недостаточность, атриовентрикулярная блокада II или III степени, шок кардиогенный","Детский возраст","Беременность, лактация. 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