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Этот метаболит обезвреживается путем конъюгации с глютатионом, однако он может кумулироваться и при передозировке парацетамола (150 мг парацетамола/кг или 10 г парацетамола перорально) вызывать некроз гепатоцитов."}},{"type":"paragraph","data":{"text":"Выводится почками в виде метаболитов, преимущественно в виде конъюгатов. В неизмененном виде выводится менее 5% принятой дозы."}},{"type":"paragraph","data":{"text":"Период полувыведения составляет от 1 до 3 часов."}},{"type":"paragraph","data":{"text":"\u003ci\u003eФенирамин:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Хорошо всасывается в пищеварительном тракте. Период полувыведения из плазмы крови составляет от одного до полутора часов. Выводится из организма преимущественно через почки."}},{"type":"paragraph","data":{"text":"\u003ci\u003eАскорбиновая кислота:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Хорошо всасывается в пищеварительном тракте. Время создания максимальной терапевтической концентрации (TCmax) после приема внутрь – 4 ч. Метаболизируется преимущественно в печени. Выводится почками, через кишечник, с потом, в неизмененном виде и в виде метаболитов."}}]},{"id":3,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Применяется при острых респираторных заболеваниях, острых респираторных вирусных инфекциях, ринофарингите для облегчения следующих симптомов:"}},{"type":"paragraph","data":{"text":"• ринорея, заложенность носа;"}},{"type":"paragraph","data":{"text":"• головная боль;"}},{"type":"paragraph","data":{"text":"• повышенная температура тела;"}},{"type":"paragraph","data":{"text":"• слезотечение;"}},{"type":"paragraph","data":{"text":"• чихание\n"}}]},{"id":4,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"• Повышенная чувствительность к парацетамолу, аскорбиновой кислоте, фенирамину или любому другому компоненту препарата."}},{"type":"paragraph","data":{"text":"• Эрозивно-язвенные поражения желудочно-кишечного тракта (в фазе обострения)."}},{"type":"paragraph","data":{"text":"• Печеночная недостаточность"}},{"type":"paragraph","data":{"text":"• Закрытоугольная глаукома"}},{"type":"paragraph","data":{"text":"• Задержка мочи, связанная с заболеваниями предстательной железы и нарушениями мочеиспускания"}},{"type":"paragraph","data":{"text":"• Портальная гипертензия."}},{"type":"paragraph","data":{"text":"• Алкоголизм."}},{"type":"paragraph","data":{"text":"• Фенилкетонурия."}},{"type":"paragraph","data":{"text":"• Дефицит глюкозо-6-фосфатдегидрогеназы."}},{"type":"paragraph","data":{"text":"• Детский возраст (до 15 лет)."}},{"type":"paragraph","data":{"text":"• Беременность и период лактации (безопасность не изучена)."}}]},{"id":14,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"Почечная недостаточность, врожденные гипербилирубинемии (синдромы Жильбера, Дубина-Джонсона и Ротора), вирусный гепатит, алкогольный гепатит, пожилой возраст.\n"}}]},{"id":5,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Адекватных и хорошо контролируемых исследований препарата Фервекс у беременных женщин не проводилось, поэтому применение препарата у данной группы пациентов не рекомендуется."}},{"type":"paragraph","data":{"text":"Неизвестно, проникают ли активные вещества препарата в грудное молоко. Препарат не следует применять в период лактации.\n"}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Внутрь, по 1 пакетику 2–3 раза в сутки. Перед применением содержимое пакетика необходимо растворить в стакане (200 мл) тёплой воды."}},{"type":"paragraph","data":{"text":"Максимальная продолжительность лечения – 5 дней."}},{"type":"paragraph","data":{"text":"Максимальная суточная доза парацетамола при массе тела более 50 кг не должна превышать 4 г/день (или 8 пакетиков препарата Фервекс); у детей или пациентов с массой тела 40–50 кг максимальная суточная доза парацетамола не должна превышать 3 г/день, при массе тела менее 40 кг – не более 2 г/день."}},{"type":"paragraph","data":{"text":"Интервал между приемами препарата должен быть не менее 4 часов. У пациентов с нарушениями функции почек (клиренс креатинина <10 мл/мин) интервал между приемами препарата должен составлять не менее 8 часов."}},{"type":"paragraph","data":{"text":"Не следует принимать препарат более 3-х дней в качестве жаропонижающего средства и более 5 дней в качестве обезболивающего средства."}},{"type":"paragraph","data":{"text":"У пациентов с хроническими или декомпенсированными заболеваниями печени, у пациентов с печеночной недостаточностью, хроническим алкоголизмом, у истощенных больных и при обезвоживании суточная доза парацетамола не должны превышать 3 г."}},{"type":"paragraph","data":{"text":"Если не наблюдается облегчения симптомов в течение 5 дней после начала приема препарата, сохраняется повышенная температура тела или после первоначального снижения она внезапно повышается снова, необходимо обратиться к врачу"}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Препарат хорошо переносится в рекомендованных дозах. При применении препарата отмечались следующие побочные эффекты (частота не установлена):"}},{"type":"paragraph","data":{"text":"Нарушения со стороны крови и лимфатической системы: анемия, лейкопения, агранулоцитоз, тромбоцитопения;"}},{"type":"paragraph","data":{"text":"Нарушения со стороны иммунной системы: аллергические реакции (эритема, кожная сыпь, зуд, отек Квинке, анафилактический шок);"}},{"type":"paragraph","data":{"text":"Нарушения со стороны нервной системы: сонливость, спутанность сознания, галлюцинации, нарушение концентрации внимания (чаще – у пожилых пациентов), возбуждение, нервозность, бессонница, координационная дисфункция, тремор;"}},{"type":"paragraph","data":{"text":"Нарушения со стороны органа зрения: нарушение аккомодации;"}},{"type":"paragraph","data":{"text":"Нарушения со стороны сердца: ощущение сердцебиения;"}},{"type":"paragraph","data":{"text":"Нарушения со стороны сосудов: ортостатическая гипотония, головокружение;"}},{"type":"paragraph","data":{"text":"Нарушения со стороны желудочно-кишечного тракта: сухость во рту, тошнота, рвота, боль в животе, запор;"}},{"type":"paragraph","data":{"text":"Нарушения со стороны почек и мочевыводящих путей: нарушение мочеиспускания."}},{"type":"paragraph","data":{"text":"При появлении побочных реакций прекратите приём препарата и обратитесь к врачу."}}]},{"id":8,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"header","data":{"text":"Симптомы, обусловленные парацетамолом.","level":4}},{"type":"paragraph","data":{"text":"При передозировке возможна интоксикация, особенно у пожилых пациентов, детей, пациентов с заболеваниями печени (вызванных хроническим алкоголизмом), у пациентов с нарушением питания, а также у пациентов, принимающих индукторы микросомальных ферментов печени, при которой может развиться молниеносный гепатит, печеночная недостаточность, холестатический гепатит, в указанных выше случаях – иногда с летальным исходом. Порог передозировки у этих категорий пациентов может быть ниже. Клиническая картина остройпередозировки развивается в течение 24 ч после приема парацетамола."}},{"type":"paragraph","data":{"text":"Симптомы: желудочно-кишечные расстройства (тошнота, рвота, снижение аппетита, ощущение дискомфорта в брюшной полости и (или) абдоминальная боль), бледность кожных покровов. При одномоментном введении взрослым 7,5 г и более или детям более 140 мг/кг происходит цитолиз гепатоцитов с полным необратимым некрозом печени, развитием печеночной недостаточности, метаболического ацидоза и энцефалопатии, которые могут привести к коме и летальному исходу. Через 12–48 ч после введения парацетамола отмечается повышение активности микросомальных ферментов печени, лактатдегидрогеназы, концентрации билирубина и снижение концентрации протромбина. Клинические симптомы повреждения печени проявляются через 12–48 часов после передозировки препарата и достигают максимума на 4–6 день."}},{"type":"paragraph","data":{"text":"Лечение:"}},{"type":"paragraph","data":{"text":"Немедленная госпитализация. Промывание желудка в течение первых часов отравления, прием энтеросорбентов (активированный уголь, лигнин гидролизный). Определение количественного содержания парацетамола в плазме крови перед началом лечения в как можно более ранние сроки после передозировки. Введение донаторов SH-групп и предшественников синтеза глутатиона – метионина и ацетилцистеина – наиболее эффективно в первые 8 часов. Необходимость в проведении дополнительных терапевтических мероприятий (дальнейшее введение метионина, в/в введение ацетилцистеина) определяется в зависимости от концентрации парацетамола в крови, а также времени, прошедшего после его введения."}},{"type":"paragraph","data":{"text":"Симптоматическое лечение. Лабораторные исследования активности микросомальных ферментов печени следует проводить в начале лечения и затем – каждые 24 ч. В большинстве случаев активность микросомальных ферментов печени нормализуется в течение 1–2 недель. В очень тяжелых случаях может потребоваться пересадка печени."}},{"type":"header","data":{"text":"Симптомы, обусловленные фенирамином.","level":4}},{"type":"paragraph","data":{"text":"Признаками отравления фенирамином являются судороги, нарушения сознания, кома."}},{"type":"paragraph","data":{"text":"При появлении симптомов отравления следует немедленно прекратить применение препарата и обратиться к врачу. Рекомендуется промывание желудка, приём энтеросорбентов (активированный уголь, лигнин гидролизный), внутривенное или пероральное введение антидота ацетилцистеина (при возможности, в первые 10 часов после передозировки), симптоматическое лечение."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Этанол усиливает седативное действие антигистаминных препаратов (фенирамин), поэтому следует избегать его приема в период лечения препаратом Фервекс. Кроме того, этанол при одновременном применении с фенирамином способствует развитию острого панкреатита."}},{"type":"paragraph","data":{"text":"Фенирамин в составе препарата Фервекс усиливает действие седативных препаратов: производных морфина, барбитуратов, бензодиазепиновых и других транквилизаторов, нейролептиков (мепробамат, производные фенотиазина), антидепрессантов (амитриптилин, миртазапин, миансерин), антигипертензивных препаратов центрального действия, седативных средств, относящихся к группе Н1-блокаторов, баклофена; при этом не только возрастает седативный эффект, но и повышается риск развития побочных эффектов препарата (задержка мочи, сухость во рту, запоры)."}},{"type":"paragraph","data":{"text":"Следует учитывать возможность усиления центральных атропиноподобных эффектов при применении в комбинации с другими веществами, обладающими антихолинергическими свойствами (другие антигистаминные препараты, антидепрессанты группы имипрамина, нейролептики фенотиазинового ряда, м-холиноблокирующие противопаркинсонические средства, атропиноподобные спазмолитические средства, дизопирамид)."}},{"type":"paragraph","data":{"text":"При использовании препарата, вместе с индукторами микросомального окисления: барбитуратами, трициклическими антидепрессантами, противосудорожными средствами (фенитоин), флумецинолом, фенилбутазоном, рифампицином и этанолом, значительно повышается риск гепатотоксического действия (за счёт входящего в состав парацетамола)."}},{"type":"paragraph","data":{"text":"Глюкокортикостероиды при одновременном применении увеличивают риск развития глаукомы. Приём одновременно с салицилатами повышает риск нефротоксического действия. При одновременном применении с левомицетином (хлорамфениколом) токсичность последнего возрастает."}},{"type":"paragraph","data":{"text":"Парацетамол, содержащийся в препарате, усиливает действие антикоагулянтов непрямого действия и снижает эффективность урикозурических препаратов."}},{"type":"paragraph","data":{"text":"Аскорбиновая кислота повышает концентрацию в крови бензилпенициллина и тетрациклинов; в дозе 1 г/сут повышает биодоступность этинилэстрадиола (в т.ч. входящего в состав пероральных контрацептивов). Улучшает всасывание в кишечнике препаратов железа (переводит трехвалентное железо в двухвалентное); может повышать выведение железа при одновременном применении с дефероксамином."}},{"type":"paragraph","data":{"text":"Снижает эффективность гепарина и непрямых антикоагулянтов. При одновременном применении с ацетилсалициловой кислотой (АСК) повышается выведение с мочой аскорбиновой кислоты и снижается выведение АСК. АСК снижает абсорбцию аскорбиновой кислоты примерно на 30%. Увеличивает риск развития кристаллурии при лечении салицилатами и сульфаниламидами короткого действия, замедляет выведение почками кислот, увеличивает выведение лекарственных средств, имеющих щелочную реакцию (в т.ч. алкалоидов), снижает концентрацию в крови пероральных контрацептивов. Повышает общий клиренс этанола, который в свою очередь снижает концентрацию аскорбиновой кислоты в организме. Лекарственные средства хинолинового ряда, кальция хлорид, салицилаты, глюкокортикостероидные средства при длительном применении истощают запасы аскорбиновой кислоты."}},{"type":"paragraph","data":{"text":"При одновременном применении аскорбиновая кислота уменьшает хронотропное действие изопреналина. При длительном применении или применении в высоких дозах может препятствовать взаимодействию дисульфирама и этанола. В высоких дозах повышает выведение мексилетина почками. Барбитураты и примидон повышают выведение аскорбиновой кислоты с мочой. Уменьшает терапевтическое действие нейролептиков – производных фенотиазина, канальцевую реабсорбцию амфетамина и трициклических антидепрессантов."}}]},{"id":9,"name":"Особые указания","slug":"","displayInMenu":true,"body":[{"type":"header","data":{"text":"Препарат не содержит сахара и может применяться пациентами с сахарным диабетом.","level":4}},{"type":"paragraph","data":{"text":"Фервекс не следует применять одновременно с другими лекарствами, содержащими парацетамол. Во избежание токсического поражения печени парацетамол не следует сочетать с приемом алкогольных напитков, а также принимать лицам, склонным к хроническому потреблению алкоголя."}},{"type":"paragraph","data":{"text":"Риск развития повреждений печени возрастает у больных с алкогольным гепатозом."}},{"type":"paragraph","data":{"text":"Не следует применять одновременно с препаратами, обладающими снотворным и анксиолитическим действием, а при нарушении функции почек без консультации с врачом. При длительном приеме необходим контроль картины периферической крови, уровня глюкозы в крови и моче, билирубина, мочевой кислоты в плазме, активности «печеночных» трансаминаз и лактатдегидрогеназы."}},{"type":"paragraph","data":{"text":"При превышении рекомендованных доз и при длительном применении может появиться психическая зависимость от препарата."}},{"type":"paragraph","data":{"text":"Во избежание передозировки парацетамола следует убедиться, что суммарная суточная доза парацетамола, содержащегося во всех лекарственных препаратах, принимаемых пациентом, не превышает 4 г."}},{"type":"paragraph","data":{"text":"В состав препарата входит маннитол и аспартам (источник фенилаланина); в составе ароматизатора содержится декстроза."}}]},{"id":16,"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","body":[{"type":"paragraph","data":{"text":"Учитывая возможность развития таких нежелательных эффектов, как сонливость и головокружение, в период лечения препаратом рекомендуется воздержаться от управления автомобилем и механизмами."}}]},{"id":18,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"Хранить при температуре от 15 до 25 °С."}},{"type":"paragraph","data":{"text":"Хранить в недоступном для детей месте."}}]},{"id":19,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"3 года."}},{"type":"paragraph","data":{"text":"Не использовать препарат после истечения срока годности, указанного на упаковке."}}]},{"id":20,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"Без рецепта."}}]},{"id":21,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"УПСА САС, Франция"}},{"type":"paragraph","data":{"text":"979 авеню де Пирене, 47520 г. Ле Пассаж, Франция"}},{"type":"paragraph","data":{"text":"UPSA SAS, France"}},{"type":"paragraph","data":{"text":"979 avenue des Pyrénées, 47520 Le Passage, France"}}]},{"id":22,"name":"Организация, принимающая претензии потребителей","body":[{"type":"paragraph","data":{"text":"ООО «Свикс Биофарма». 125047, г. Москва, 1-я Тверская-Ямская ул., д. 23, стр. 1, эт. 5, пом. V ком.4."}},{"type":"paragraph","data":{"text":"Тел.: 8 (495) 229-06-61; E-mail: medinfo.russia@swixxbiopharma.com"}}]}],"source":{"title":"36.6","url":"https://366.ru"}},"description_toggle":true,"short_description":"Фервекс – комбинированный препарат, который содержит парацетамол, фенирамин и аскорбиновую кислоту. Парацетамол – ненаркотический анальгетик, блокирует циклооксигеназу, преимущественно в центральной нервной системе, воздействуя на центры боли и терморегуляции; оказывает анальгезирующее и жаропонижающее действие. 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