СССУ . - синоатриальная блокада . - AV-блокада II и III степени . - выраженная брадикардия (ЧСС менее 50 уд./мин) . - хроническая сердечная недостаточность III и IV функционального класса по классификации NYHA . - нестабильная стенокардия . - ангионевротический отек в анамнезе . - выраженная печеночная недостаточность (более 9 баллов по шкале Чайлд-Пью) . - хроническая почечная недостаточность (КК меньше30 мл/мин, содержание сывороточного креатинина больше160 мкмоль/л) . - возраст до 18 лет (эффективность и безопасность не установлены) . - период лактации . - непереносимость галактозы, дефицит лактазы или синдром мальабсорбции глюкозы-галактозы . - повышенная чувствительность к моксонидину и другим компонентам препарата. С осторожностью следует применять препарат при болезни Паркинсона (тяжелая форма), эпилепсии, глаукоме, депрессии, перемежающейся хромоте, болезни Рейно, AV-блокаде I степени, хронической почечной недостаточности (КК больше30 мл/мин, но меньше60 мл/мин), выраженных цереброваскулярных нарушениях, после перенесенного инфаркта миокарда, хронической сердечной недостаточности I и II функционального класса, нарушениях функции печени, гемодиализе, при беременности.
Селективный агонист имидазолиновых рецепторов, отвечающих за рефлекторную регуляцию симпатической нервной системы (локализованных в вентро-латеральном отделе продолговатого мозга). Обладает низким сродством к центральным α .2-адренорецепторам, за счет взаимодействия с которыми опосредованы седативный эффект и сухость слизистой оболочки полости рта. Моксонидин повышает индекс чувствительности к инсулину на 21% по сравнению с плацебо у пациентов с ожирением, инсулинрезистентностью с умеренной степенью артериальной гипертензии. Влияние на гемодинамику: снижение систолического и диастолического АД при однократном и продолжительном приеме моксонидина связано с уменьшением прессорного действия симпатической нервной системы на периферические сосуды, снижением ОПСС, в то время как сердечный выброс и ЧСС существенно не изменяются.
Показания к применению
артериальная гипертензия.
Противопоказания
СССУ . - синоатриальная блокада . - AV-блокада II и III степени . - выраженная брадикардия (ЧСС менее 50 уд./мин) . - хроническая сердечная недостаточность III и IV функционального класса по классификации NYHA . - нестабильная стенокардия . - ангионевротический отек в анамнезе . - выраженная печеночная недостаточность (более 9 баллов по шкале Чайлд-Пью) . - хроническая почечная недостаточность (КК меньше30 мл/мин, содержание сывороточного креатинина больше160 мкмоль/л) . - возраст до 18 лет (эффективность и безопасность не установлены) . - период лактации . - непереносимость галактозы, дефицит лактазы или синдром мальабсорбции глюкозы-галактозы . - повышенная чувствительность к моксонидину и другим компонентам препарата. С осторожностью следует применять препарат при болезни Паркинсона (тяжелая форма), эпилепсии, глаукоме, депрессии, перемежающейся хромоте, болезни Рейно, AV-блокаде I степени, хронической почечной недостаточности (КК больше30 мл/мин, но меньше60 мл/мин), выраженных цереброваскулярных нарушениях, после перенесенного инфаркта миокарда, хронической сердечной недостаточности I и II функционального класса, нарушениях функции печени, гемодиализе, при беременности.
Применение при беременности и в период грудного вскармливания
Клинических данных о негативном влиянии на течение беременности нет. Однако следует назначать Тензотран беременным только в том случае, если предполагаемая польза для матери превышает потенциальный риск для плода. Моксонидин выделяется с грудным молоком. В период лечения рекомендуется прекратить грудное вскармливание или отменить препарат.
Способ применения и дозы
Препарат назначают внутрь, независимо от приема пищи. Таблетки следует запивать достаточным количеством жидкости. В большинстве случаев начальная доза Тензотрана составляет 200 мкг/сут в 1 прием, предпочтительно в утренние часы. При недостаточности терапевтического эффекта дозу можно увеличить после 3 недель терапии до 400 мкг/сут в 2 приема (утром и вечером) или в 1 прием (утром). Максимальная суточная доза, которую следует разделить на 2 приема (утром и вечером), составляет 600 мкг. Максимальная однократная доза составляет 400 мкг. У пациентов пожилого возраста с нормальной функцией почек рекомендации по режиму дозирования такие же, как и для взрослых пациентов. У пациентов с почечной недостаточностью (КК от 30-60 мл/мин) и пациентов, находящихся на гемодиализе, разовая доза не должна превышать 200 мкг. Максимальная суточная доза - 400 мкг.
Побочное действие
Наиболее частыми побочными реакции, особенно в начале терапии, были сухость во рту, головная боль, астения и сонливость. Интенсивность их проявления и частота уменьшаются при повторном приеме. Частота развития побочных реакций определяется следующим образом: очень часто (больше1/10), часто (больше1/100, меньше1/10), иногда (больше1/1000 и меньше1/100), очень редко (меньше1/1000, включая отдельные сообщения). Со стороны ЦНС: часто - повышенная утомляемость, сонливость, головная боль, головокружение . иногда - бессонница, астения. Со стороны сердечно-сосудистой системы: часто - вазодилатация . иногда - чрезмерное снижение АД, ортостатическая гипотензия, парестезии, синдром Рейно, нарушения периферической микроциркуляции. Со стороны ЖКТ: очень часто - сухость слизитой оболочки полости рта . часто - тошнота, запор и другие нарушения функции ЖКТ . очень редко - гепатит, холестаз. Со стороны мочеполовой системы: иногда - задержка мочи или недержание, импотенция, снижение либидо. Аллергические реакции: иногда - кожные проявления, ангионевротический отек. Со стороны органа зрения: иногда - сухость глаз, вызывающая зуд или ощущение жжения. Прочие: иногда - отеки различной локализации, слабость в ногах, обморок, задержка жидкости, анорексия, боль в области околоушных желез, гинекомастия.
Особые указания
Наиболее частыми побочными реакции, особенно в начале терапии, были сухость во рту, головная боль, астения и сонливость. Интенсивность их проявления и частота уменьшаются при повторном приеме. Частота развития побочных реакций определяется следующим образом: очень часто (больше1/10), часто (больше1/100, меньше1/10), иногда (больше1/1000 и меньше1/100), очень редко (меньше1/1000, включая отдельные сообщения). Со стороны ЦНС: часто - повышенная утомляемость, сонливость, головная боль, головокружение . иногда - бессонница, астения. Со стороны сердечно-сосудистой системы: часто - вазодилатация . иногда - чрезмерное снижение АД, ортостатическая гипотензия, парестезии, синдром Рейно, нарушения периферической микроциркуляции. Со стороны ЖКТ: очень часто - сухость слизитой оболочки полости рта . часто - тошнота, запор и другие нарушения функции ЖКТ . очень редко - гепатит, холестаз. Со стороны мочеполовой системы: иногда - задержка мочи или недержание, импотенция, снижение либидо. Аллергические реакции: иногда - кожные проявления, ангионевротический отек. Со стороны органа зрения: иногда - сухость глаз, вызывающая зуд или ощущение жжения. Прочие: иногда - отеки различной локализации, слабость в ногах, обморок, задержка жидкости, анорексия, боль в области околоушных желез, гинекомастия.
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