Дексалгин 25 Таблетки, коробка, 10 шт, 25 мг, для приема внутрь, покрытые пленочной оболочкой

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Одновременный прием пищи замедляет всасывание декскетопрофена, поэтому в случае острой боли рекомендуется применение препарата не менее чем за 30 минут до приема пищи.\u003cbr /\u003e\nВ зависимости от интенсивности болевого синдрома, рекомендуемая доза для взрослых составляет 12,5 мг декскетопрофена (1/2 таблетки препарата Дексалгин® 25) каждые 4-6 ч или 25 мг декскетопрофена (1 таблетка препарата Дексалгин® 25) каждые 8 ч.\u003cbr /\u003e\nМаксимальная суточная доза – 75 мг.\u003cbr /\u003e\nПрепарат Дексалгин® 25 не предназначен для длительной терапии, курс лечения препаратом не должен превышать 3-5 дней.\u003cbr /\u003e\nПациенты 65 лет и старше\u003cbr /\u003e\nПациентам пожилого возраста следует принимать препарат Дексалгин® 25, начиная с минимальной рекомендованной дозы. Максимальная суточная доза составляет 50 мг. В случае хорошей переносимости могут применяться дозы, рекомендованные для общей популяции.\u003cbr /\u003e\nПациенты с печеночной недостаточностью\u003cbr /\u003e\nПациентам с печеночной недостаточностью легкой и средней степени тяжести следует принимать препарат Дексалгин® 25, начиная с минимальной рекомендованной дозы. Максимальная суточная доза составляет 50 мг.\u003cbr /\u003e\nПрименение препарата Дексалгин® 25 у пациентов с печеночной недостаточностью тяжелой степени тяжести противопоказано.\u003cbr /\u003e\nПациенты с почечной недостаточностью\u003cbr /\u003e\nПациентам с почечной недостаточностью легкой степени тяжести - хроническая болезнь почек, стадия 2 (СКФ 60-89 мл/мин/1,73 м2) следует принимать препарат Дексалгин® 25, начиная с минимальной рекомендованной дозы. Максимальная суточная доза составляет 50 мг. Применение препарата Дексалгин® 25 у пациентов с хронической болезнью почек стадий 3а (СКФ 45-59 мл/мин/1,73 м2), 3б (СКФ 30-44 мл/мин/1,73 м2) и 4 (СКФ \u003c 30 мл/мин/1,73 м2) противопоказано."}}]},{"id":8,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Возможные побочные эффекты приведены в соответствии с классификаций Всемирной организации здравоохранения ниже по убыванию частоты возникновения: очень часто (≥ 1 / 10), часто (≥ 1 / 100, \u003c 1 / 10), нечасто (≥ 1 / 1000, \u003c 1 / 100), редко (≥ 1 / 10000, \u003c 1 / 1000), очень редко (\u003c 1 / 10000), включая отдельные сообщения.\u003cbr /\u003e\nНарушения со стороны крови и лимфатической системы\u003cbr /\u003e\nОчень редко: нейтропения, тромбоцитопения.\u003cbr /\u003e\nНарушения со стороны иммунной системы\u003cbr /\u003e\nРедко: отек гортани;\u003cbr /\u003e\nОчень редко: анафилактические реакции, включая анафилактический шок.\u003cbr /\u003e\nНарушения со стороны нервной системы\u003cbr /\u003e\nНечасто: головная боль, головокружение, сонливость;\u003cbr /\u003e\nРедко: парестезии, синкопальные состояния (преходящие кратковременные обмороки).\u003cbr /\u003e\nНарушения со стороны психики\u003cbr /\u003e\nНечасто: бессонница, ощущение беспокойства.\u003cbr /\u003e\nНарушения со стороны органа слуха и лабиринтные нарушения\u003cbr /\u003e\nНечасто: вертиго;\u003cbr /\u003e\nОчень редко: шум в ушах.\u003cbr /\u003e\nНарушения со стороны органа зрения\u003cbr /\u003e\nОчень редко: нечеткость зрения.\u003cbr /\u003e\nНарушения со стороны сердечно-сосудистой системы\u003cbr /\u003e\nНечасто: ощущение сердцебиения, чувство жара, гиперемия кожных покровов;\u003cbr /\u003e\nРедко: повышение артериального давления;\u003cbr /\u003e\nОчень редко: тахикардия, снижение артериального давления.\u003cbr /\u003e\nНарушения со стороны дыхательной системы\u003cbr /\u003e\nРедко: брадипноэ;\u003cbr /\u003e\nОчень редко: бронхоспазм, одышка.\u003cbr /\u003e\nНарушения со стороны желудочно-кишечного тракта\u003cbr /\u003e\nЧасто: тошнота, рвота, боль в животе, диспепсия, диарея;\u003cbr /\u003e\nНечасто: гастрит, запор, сухость во рту, метеоризм;\u003cbr /\u003e\nРедко: эрозивно-язвенные поражения желудочно-кишечного тракта (ЖКТ), кровотечение из язвы или ее перфорация;\u003cbr /\u003e\nОчень редко: поражение поджелудочной железы.\u003cbr /\u003e\nНарушения со стороны печени и желчевыводящих путей\u003cbr /\u003e\nРедко: гепатит, повышение активности «печеночных» ферментов (АЛТ, АСТ);\u003cbr /\u003e\nОчень редко: поражение печени.\u003cbr /\u003e\nНарушения со стороны почек и мочевыводящих путей\u003cbr /\u003e\nРедко: полиурия, острая почечная недостаточность;\u003cbr /\u003e\nОчень редко: нефрит или нефротический синдром.\u003cbr /\u003e\nНарушения со стороны репродуктивной системы\u003cbr /\u003e\nРедко: у женщин – нарушение менструального цикла, у мужчин – преходящее нарушение функции предстательной железы при длительном применении.\u003cbr /\u003e\nНарушения со стороны опорно-двигательной системы\u003cbr /\u003e\nРедко: боль в спине.\u003cbr /\u003e\nНарушения со стороны кожи и подкожных тканей\u003cbr /\u003e\nНечасто: кожная сыпь;\u003cbr /\u003e\nРедко: крапивница, угревая сыпь, повышенное потоотделение;\u003cbr /\u003e\nОчень редко: тяжелые кожные реакции (синдром Стивенса-Джонсона, токсический эпидермальный некролиз (синдром Лайелла)), ангионевротический отек, отек лица, аллергический дерматит, фотосенсибилизация, кожный зуд.\u003cbr /\u003e\nНарушения со стороны обмена веществ\u003cbr /\u003e\nРедко: анорексия.\u003cbr /\u003e\nОбщие нарушения\u003cbr /\u003e\nНечасто: повышенная утомляемость, астения, озноб, общее недомогание;\u003cbr /\u003e\nОчень редко: периферические отеки.\u003cbr /\u003e\nКак и при применении других НПВП, возможно развитие следующих побочных эффектов: асептический менингит, развивающийся преимущественно у пациентов с системной красной волчанкой или другими системными заболеваниями соединительной ткани, гематологические нарушения (тромбоцитопеническая пурпура, апластическая и гемолитическая анемии, в редких случаях - агранулоцитоз и гипоплазия костного мозга)."}}]},{"id":9,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Симптомы: тошнота, анорексия, боль в животе, головная боль, головокружение, дезориентация, бессонница.\u003cbr /\u003e\nЛечение: симптоматическая терапия, при необходимости – промывание желудка, прием активированного угля; гемодиализ малоэффективен."}}]},{"id":10,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Нижеследующие взаимодействия характерны для всех НПВП.\u003cbr /\u003e\nНежелательные комбинации\u003cbr /\u003e\nС другими НПВП, включая салицилаты в высоких дозах (более 3 г/сут): одновременное применение нескольких НПВП вследствие синергического эффекта повышает риск развития желудочно-кишечного кровотечения и язвы.\u003cbr /\u003e\nС антикоагулянтами: декскетопрофен, как и другие НПВП, может усиливать эффект антикоагулянтов, таких как варфарин в связи с высокой степенью связывания с белками плазмы крови, ингибированием агрегации тромбоцитов и поражением слизистой оболочки желудочно-кишечного тракта. В случае необходимости одновременного применения необходим тщательный контроль за состоянием пациента и регулярный мониторинг лабораторных показателей.\nС гепарином: при одновременном применении повышается риск развития кровотечения (в связи с ингибированием агрегации тромбоцитов и повреждающим действием на слизистую оболочку желудочно-кишечного тракта). В случае необходимости одновременного применения необходим тщательный контроль за состоянием пациента и регулярный мониторинг лабораторных показателей.\u003cbr /\u003e\nС глюкокортикостероидами: при одновременном применении повышается риск язвенного поражения желудочно-кишечного тракта и кровотечений.\nС препаратами лития: НПВП повышают концентрацию лития в плазме крови вплоть до токсической в связи с чем, данный показатель необходимо контролировать при одновременном применении с декскетопрофеном, изменении дозировки, а также после отмены НПВП.\u003cbr /\u003e\nС метотрексатом в высоких дозах (15 мг/нед и более): возможно повышение гематологической токсичности метотрексата в связи со снижением его почечного клиренса при одновременном применении с НПВП.\u003cbr /\u003e\nС гидантоинами и сульфонамидами: возможно усиление их токсического действия.\u003cbr /\u003e\nКомбинации, требующие осторожности\u003cbr /\u003e\nС диуретиками, ингибиторами ангиотензинпревращающего фермента (АПФ), антибиотиками из группы аминогликозидов, антагонистами рецепторов ангиотензина-II: одновременное применение с НПВП связано с риском развития острой почечной недостаточности у обезвоженных пациентов (снижение клубочковой фильтрации, обусловленное сниженным синтезом простагландинов). При одновременном применении НПВП могут уменьшать антигипертензивный эффект некоторых препаратов. При одновременном применении декскетопрофена и диуретиков необходимо убедиться, что у пациента отсутствуют признаки обезвоживания, а также в начале одновременного применения контролировать функцию почек.\u003cbr /\u003e\nС метотрексатом в низких дозах (менее 15 мг/нед): возможно повышение гематологической токсичности метотрексата в связи со снижением его почечного клиренса на фоне одновременного применения с НПВП. Необходим подсчет клеток крови в начале одновременного применения. При наличии нарушения функции почек даже легкой степени, а также у лиц пожилого возраста, необходимо тщательное медицинское наблюдение.\u003cbr /\u003e\nС пентоксифиллином: возможно повышение риска развития кровотечения. Необходим тщательный клинический мониторинг и регулярная проверка времени кровотечения (времени свертываемости крови).\u003cbr /\u003e\nС зидовудином: существует риск усиления токсического действия на эритроциты, обусловленного воздействием на ретикулоциты, с развитием тяжелой анемии через неделю после начала применения НПВП. Необходимо проведение общего анализа крови с подсчетом количества ретикулоцитов через 1-2 нед после начала терапии НПВП.\u003cbr /\u003e\nС пероральными гипогликемическими средствами: НПВП могут усиливать гипогликемическое действие препаратов сульфонилмочевины вследствие вытеснения сульфонилмочевины из мест связывания с белками плазмы крови.\u003cbr /\u003e\nКомбинации, которые необходимо принимать во внимание\u003cbr /\u003e\nС адреноблокаторами: При одновременном применении с НПВП может уменьшаться антигипертензивный эффект -адреноблокаторов вследствие ингибирования синтеза простагландинов.\u003cbr /\u003e\nС циклоспорином и такролимусом: НПВП могут увеличивать нефротоксичность, что опосредовано действием ренальных простагландинов. При одновременном применении необходимо контролировать функцию почек.\u003cbr /\u003e\nС тромболитиками: повышается риск развития кровотечения.\u003cbr /\u003e\nУвеличивается риск развития кровотечения из ЖКТ при одновременном применении с ингибиторами обратного захвата серотонина (циталопрам, флуоксетин, сертралин) и антикоагулянтами.\u003cbr /\u003e\nС пробенецидом: возможно повышение концентрации НПВП в плазме крови, что может быть обусловлено ингибирующим эффектом пробенецида на почечную тубулярную секрецию и/или конъюгацию с глюкуроновой кислотой; может потребоваться коррекция дозы НПВП.\u003cbr /\u003e\nС сердечными гликозидами: одновременное применение с НПВП может приводить к повышению концентрации сердечных гликозидов в плазме крови.\u003cbr /\u003e\nС мифепристоном: в связи с теоретическим риском изменения эффективности мифепристона под влиянием ингибиторов синтеза простагландинов, НПВП не следует применять ранее, чем через 8 - 12 сут после отмены мифепристона.\u003cbr /\u003e\nС хинолонами: данные, полученные в экспериментальных исследованиях на животных, указывают на высокий риск развития судорог при одновременном применении НПВП с хинолонами в высоких дозах.\u003cbr /\u003e\nВ случае необходимости одновременного применения препарата Дексалгин® 25 с вышеперечисленными лекарственными средствами следует проконсультироваться с врачом."}}]},{"id":11,"name":"Особые указания","slug":"cautions","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Нежелательные побочные эффекты можно свести к минимуму при применении препарата в наименьшей эффективной дозе при минимальной длительности применения, необходимой для купирования болевого синдрома.\u003cbr /\u003e\nРиск возникновения осложнений со стороны ЖКТ повышается у пациентов с язвенным поражением ЖКТ в анамнезе, у пожилых пациентов, при увеличении дозы НПВП; поэтому применение препарата Дексалгин® 25 у этой категории пациентов следует начинать с наименьшей рекомендуемой дозы.\u003cbr /\u003e\nПациентам вышеперечисленных категорий, а также пациентам, которым требуется одновременное применение низких доз ацетилсалициловой кислоты или других средств, повышающих риск возникновения осложнений со стороны ЖКТ, рекомендуется дополнительно одновременное применение гастропротекторов (мизопростол или блокаторы протонной помпы).\u003cbr /\u003e\nУ пациентов, одновременно принимающих антиагреганты или антикоагулянты, глюкокортикостероиды, также повышается риск возникновения желудочно-кишечного кровотечения.\u003cbr /\u003e\nПациенты с нарушениями со стороны желудочно-кишечного тракта или желудочно-кишечными заболеваниями в анамнезе должны находиться под тщательным медицинским наблюдением. В случае возникновения желудочно-кишечного кровотечения или язвенного поражения, применение препарата Дексалгин® 25 следует прекратить.\u003cbr /\u003e\nПрепарат Дексалгин ®25 следует применять с осторожностью у пациентов с желудочно-кишечными заболеваниями в анамнезе (язвенный колит, болезнь Крона), поскольку возможно обострение этих заболеваний.\u003cbr /\u003e\nВсе НПВП могут ингибировать агрегацию тромбоцитов и увеличивать время кровотечения за счет ингибирования синтеза простагландинов. В связи с этим применение препарата Дексалгин® 25 у пациентов, одновременно принимающих препараты, влияющие на систему гемостаза, такие как варфарин, производные кумарина и гепарины, не рекомендовано.\u003cbr /\u003e\nКак и другие НПВП, препарат Дексалгин® 25 может приводить к повышению концентрации креатинина и азота в плазме крови. Как и другие ингибиторы синтеза простагландинов, препарат Дексалгин® 25 может оказывать побочное действие на мочевыделительную систему, что может привести к развитию гломерулонефрита, интерстициального нефрита, папиллярного некроза, нефротического синдрома и острой почечной недостаточности. Следует соблюдать осторожность при применении препарата у пациентов, одновременно применяющих диуретики и пациентов, у которых возможно развитие гиповолемии, в связи с повышенным риском нефротоксичности.\u003cbr /\u003e\nКак и при применении других НПВП, на фоне терапии препаратом Дексалгин® 25 может наблюдаться небольшое преходящее повышение активности «печеночных» ферментов. У пациентов пожилого возраста необходим контроль функции печени и почек. В случае значительного повышения соответствующих показателей применение препарата Дексалгин® 25 следует прекратить.\u003cbr /\u003e\nКак и другие НПВП, декскетопрофен может маскировать симптомы инфекционных заболеваний. В случае обнаружения признаков инфекции или ухудшения самочувствия на фоне применения препарата Дексалгин® 25, пациенту необходимо сразу же обратиться к врачу.\u003cbr /\u003e\nПрепарат может вызывать задержку жидкости в организме, поэтому у пациентов с артериальной гипертензией, с почечной и/или сердечной недостаточностью препарат Дексалгин® 25 следует применять с особой осторожностью. В случае ухудшения состояния применение препарата Дексалгин® 25 необходимо прекратить.\u003cbr /\u003e\nУ пациентов с неконтролируемой артериальной гипертензией, ишемической болезнью сердца, застойной сердечной недостаточностью, заболеваниями периферических артерий и/или цереброваскулярными заболеваниями препарат следует применять с осторожностью. Аналогичный подход применим к пациентам с факторами риска развития сердечно-сосудистых заболеваний (артериальная гипертензия, гиперлипидемия, сахарный диабет, курение).\nНеобходимо соблюдать осторожность при назначении препарата Дексалгин® 25 пациентам с наличием в анамнезе сердечно-сосудистых заболеваний, особенно пациентам с сердечной недостаточностью, в связи с возможным риском прогрессирования.\u003cbr /\u003e\nКлинические исследования и эпидемиологические данные позволяют сделать вывод о том, что НПВП, особенно в высоких дозах и при длительном применении, могут приводить к незначительному риску развития острого инфаркта миокарда или инсульта. Для исключения риска данных событий при применении декскетопрофена данных недостаточно.\u003cbr /\u003e\nПожилые пациенты особенно подвержены неблагоприятным реакциям при применении НПВП, в том числе, риску возникновения желудочно-кишечных кровотечений и перфораций, угрожающим жизни пациента, снижению функций почек, печени и сердца. При применении препарата Дексалгин® 25 у данной категории пациентов необходим надлежащий клинический контроль.\u003cbr /\u003e\nИмеются данные о возникновении редких случаев кожных реакций (таких как эксфолиативный дерматит, синдром Стивенса-Джонсона, токсический эпидермальный некролиз) при применении НПВП. При первых проявлениях кожной сыпи, поражении слизистых оболочек или других признаках аллергической реакции прием препарата Дексалгин® 25 следует немедленно прекратить и обратиться к врачу.\u003cbr /\u003e\n\u003cbr /\u003e\nВлияние на способность к управлению транспортными средствами и другими механизмами\u003cbr /\u003e\nВ связи с возможным появлением головокружения и сонливости в период применения препарата Дексалгин® 25, способность к концентрации внимания и быстрота психомоторных реакций у пациентов могут снижаться, особенно в первый час после приема. 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