Ксефокам Таблетки, коробка, 30 шт, 8 мг, для приема внутрь, для взрослых, покрытые оболочкой

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Максимальная концентрация в плазме достигается приблизительно через 1-2 ч."}},{"type":"paragraph","data":{"text":"Абсолютная биодоступность составляет примерно 90-100%. Эффектов первого прохождения препарата через печень не обнаружено. Средний период полувыведения препарата составляет 3-4 ч."}},{"type":"paragraph","data":{"text":"При одновременном приеме лорноксикама с пищей C\u003csub\u003emax\u003c/sub\u003e снижается примерно на 30% и T\u003csub\u003emax\u003c/sub\u003e увеличивается с 1,5 до 2,3 ч. Абсорбция лорноксикама (рассчитанная по AUC) может снижаться до 20%."}},{"type":"paragraph","data":{"text":"Распределение"}},{"type":"paragraph","data":{"text":"Лорноксикам обнаруживается в плазме в неизмененном виде и в виде гидроксилированного метаболита. Степень связывания лорноксикама с белками плазмы составляет около 99% и не зависит от концентрации."}},{"type":"paragraph","data":{"text":"Биотрансформация"}},{"type":"paragraph","data":{"text":"Лорноксикам в значительной степени метаболизируется в печени, в основном посредством гидроксилирования до неактивного 5-гидроксилорноксикама. Биотрансформация лорноксикама осуществляется посредством изофермента CYP2C9. Вследствие полиморфизма гена, кодирующего данный фермент, существуют люди с медленным и быстрым метаболизмом препарата, что может привести к значительному повышению уровня лорноксикама в плазме у лиц с медленным метаболизмом. Гидроксилированный метаболит не обладает фармакологической активностью. Лорноксикам полностью метаболизируется: примерно 2/3 препарата выводится печенью, а 1/3 — почками в виде неактивного метаболита."}},{"type":"paragraph","data":{"text":"Выведение"}},{"type":"paragraph","data":{"text":"Период полувыведения лорноксикама в среднем составляет от 3 до 4 ч."}},{"type":"paragraph","data":{"text":"После приема внутрь примерно 50% препарата выводится с калом и 42% — почками, главным образом в виде 5-гидроксилорноксикама. Период полувыведения 5-гидроксилорноксикама составляет примерно 9 ч после парентерального введения 1 или 2 раза в сутки."}},{"type":"paragraph","data":{"text":"У лиц старческого возраста (старше 65 лет) клиренс препарата снижен на 30-40%."}},{"type":"paragraph","data":{"text":"У пациентов с нарушениями функции печени или почек не наблюдается значимых изменений кинетики лорноксикама, за исключением кумуляции у пациентов с хроническими заболеваниями печени после 7 дней лечения в суточной дозе 12 мг или 16 мг."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Кратковременное лечение легкого или умеренного острого болевого синдрома."}},{"type":"paragraph","data":{"text":"Симптоматическая терапия боли и воспаления на фоне остеоартрита."}},{"type":"paragraph","data":{"text":"Симптоматическая терапия боли и воспаления на фоне ревматоидного артрита."}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"list","data":{"style":"ordered","items":["гиперчувствительность к лорноксикаму или любому из вспомогательных веществ;","полное или неполное сочетание бронхиальной астмы, рецидивирующего полипоза носа или околоносовых пазух, ринит, ангионевротический отек, крапивница и непереносимость ацетилсалициловой кислоты и других НПВП (в т.ч. в анамнезе);","тромбоцитопения;","геморрагический диатез или нарушения свертываемости крови, а также тем, кто перенес операции, сопряженные с риском кровотечения или неполного гемостаза;","период после проведения аортокоронарного шунтирования;","декомпенсированная сердечная недостаточность;","эрозивно-язвенные изменения слизистой желудка или 12-перстной кишки, активное желудочно-кишечное кровотечение; цереброваскулярное или иное кровотечение;","желудочно-кишечные кровотечения или перфорация язвы в анамнезе, связанные с приемом НПВП;","активная пептическая язва или рецидивирующая пептическая язва в анамнезе;","воспалительные заболевания кишечника (болезнь Крона, неспецифический язвенный колит) в фазе обострения;","тяжёлая печёночная недостаточность;","выраженная почечная недостаточность (уровень сывороточного креатинина более 700 мкмоль/л), прогрессирующие заболевания почек, подтвержденная гиперкалиемия; беременность и период грудного вскармливания;","непереносимость лактозы, дефицит лактазы и глюкозно-галактозная мальабсорбция; пациентам в возрасте до 18 лет (из-за недостаточного клинического опыта)."]}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"При следующих нарушениях препарат Ксефокам следует назначать только после тщательной оценки ожидаемой пользы терапии и возможного риска:"}},{"type":"list","data":{"style":"ordered","items":["Нарушение функции почек: легкой степени (креатинин сыворотки 150-300 мкмоль/л) и умеренной степени (креатинин сыворотки 300-700 мкмоль/л), так как поддержание почечного кровотока зависит от уровня почечных простагландинов. Прием Лорноксикама следует прекратить в случае ухудшения функции почек в процессе лечения.","Контроль функции почек должен осуществляться у пациентов, которым было выполнено обширное оперативное вмешательство, пациентов с сердечной недостаточностью, получающих диуретики, а также, в случае применения препаратов, обладающих доказанной или предполагаемой нефротоксичностью.","Нарушение системы свертывания крови: рекомендовано тщательное клиническое наблюдение и оценка лабораторных показателей, например активированного частичного тромбинового времени (АЧТВ).","Нарушение функции печени (цирроз печени): следует проводить регулярное клиническое наблюдение и оценку лабораторных показателей, так как при лечении лорноксикамом в суточной дозе 12-16 мг возможна кумуляция препарата.","Длительное лечение (более 3-х месяцев): рекомендуется регулярная оценка лабораторных показателей крови (гемоглобин), функции почек (креатинин) и ферментов печени.","Пациенты старше 65 лет: рекомендуется контроль функции печени и почек. Применять с осторожностью у пожилых лиц в послеоперационном периоде.","Необходимо избегать одновременного приема с другими НПВП, включая селективные ингибиторы циклооксигеназы-2.","Нежелательные эффекты можно минимизировать, используя наименьшую эффективную дозу препарата в течение наименьшего промежутка времени, достаточного для контроля симптомов.","Желудочно-кишечное кровотечение, язва, перфорация, которые отмечались ранее при применении всех НПВП на любом этапе лечения и могут привести к летальному исходу.","Наличие Helicobacter pylori.","Явления желудочно-кишечной токсичности в анамнезе, в частности, в пожилом возрасте.","При одновременном приеме таких лекарственных средств как пероральные глюкокортикостероиды (например, преднизолон), антикоагулянты (например, варфарин), селективные ингибиторы обратного захвата серотонина (например, циталопрам, флуоксетин, пароксетин, сертралин) и антитромбоцитарные препараты (например, ацетилсалициловая кислота, клопидогрел).","При одновременном применении НПВП и гепарина при проведении спинальной и эпидуральной анестезии, повышается риск развития гематомы.","Патология ЖКТ в анамнезе (язвенный колит, болезнь Крона), так как их состояние может ухудшиться.","Артериальная гипертензия и/или сердечная недостаточность в анамнезе, так как при применении НПВП отмечалась задержка жидкости и развитием отеков.","При наличии заболеваний периферических артерий или цереброваскулярных заболеваний, наличии факторов риска развития сердечно-сосудистых заболеваний таких как артериальная гипертензия, гиперлипидемия, сахарный диабет, курение, следует назначать лорноксикам только после тщательной оценки ожидаемой пользы терапии и возможного риска.","Лорноксикам, как и другие НПВП, может повысить риск артериальных тромбоэмболических осложнений (например, инфаркта миокарда или инсульта).","С осторожностью следует назначать препарат пациентам с бронхиальной астмой в активной фазе или в анамнезе, поскольку известно, что НПВП могут спровоцировать у таких пациентов бронхоспазм.","В очень редких случаях возможны тяжелые кожные реакции, приводящие к летальному исходу, в том числе эксфолиативному дерматиту, синдрому Стивенса-Джонсона и токсическому эпидермальному некролизу.","Применение Лорноксикама, как и любого препарата, ингибирующего циклогеназу и синтез простагландинов, может нарушать способность к оплодотворению, поэтому не рекомендуется применять женщинам, желающим забеременеть.","У пациентов с системной красной волчанкой (СКВ) и смешанными заболеваниями соединительной ткани может быть повышен риск асептического менингита.","Лорноксикам подавляет агрегацию тромбоцитов и удлиняет время кровотечения, поэтому следует с осторожностью назначать его при повышенной склонности к кровотечениям.","Одновременное применение НПВП и такролимуса может привести к повышению риска нефротоксичного действия вследствие угнетения синтеза простациклина в почках.","Рекомендуется избегать применения лорноксикама при инфекциях, вызванных вирусом ветряной оспы."]}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"Из-за отсутствия данных по применению препарата Ксефокам в период беременности и кормления грудью, применять препарат не следует."}},{"type":"paragraph","data":{"text":"Подавление синтеза простагландинов может оказать побочное действие на беременность и/или развитие плода."}},{"type":"paragraph","data":{"text":"Применение ингибиторов синтеза простагландинов на раннем сроке беременности повышает риск выкидыша или развитие порока сердца. Считается, что риск пропорционален дозе и длительности лечения."}},{"type":"paragraph","data":{"text":"Назначение ингибиторов синтеза простагландинов в третьем триместре беременности может привести к токсичному влиянию на сердце и легкие плода (преждевременное закрытие артериального протока и развитие легочной гипертензии), а также нарушению функции почек и, следовательно, снижению амниотической жидкости. Применение на поздних сроках может вызвать удлинение времени кровотечения у матери и плода, а также, подавление сократительной активности матки, что может отсрочить или удлинить период родов."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Препарат Ксефокам таблетки, покрытые пленочной оболочкой, предназначен для приема внутрь и его следует запивать достаточным количеством жидкости."}},{"type":"paragraph","data":{"text":"Дозы"}},{"type":"paragraph","data":{"text":"Дозы и режим приема для всех пациентов должны быть основаны на индивидуальной реакции на препарат."}},{"type":"paragraph","data":{"text":"Боль"}},{"type":"paragraph","data":{"text":"Доза 8-16 мг/сутки, поделенная на 2-3 приема. Максимальная рекомендованная дневная доза составляет 16 мг."}},{"type":"paragraph","data":{"text":"Остеоартрит и ревматоидный артрит"}},{"type":"paragraph","data":{"text":"Стартовая рекомендованная доза составляет 12 мг лорноксикама, поделенная на 2-3 приема. Поддерживающая доза не должна превышать 16 мг в день."}},{"type":"paragraph","data":{"text":"Дополнительная информация для особых групп пациентов"}},{"type":"paragraph","data":{"text":"\u003ci\u003eДети и подростки\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Лорноксикам не предназначен для применения у детей и подростков младше 18 лет, так как данных по его безопасности и эффективности недостаточно."}},{"type":"paragraph","data":{"text":"\u003ci\u003eПожилые люди\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Специально подбирать дозу пожилым пациентам (старше 65 лет) не требуется, однако препарат следует назначать с осторожностью, поскольку в этой возрастной группе нежелательные явления со стороны ЖКТ переносятся хуже."}},{"type":"paragraph","data":{"text":"\u003ci\u003eПациенты с нарушением функции почек\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Для пациентов с легким и умеренным нарушением функции почек максимальная рекомендованная доза составляет 12 мг и должна быть поделена на 2 или 3 приема."}},{"type":"paragraph","data":{"text":"\u003ci\u003eПациенты с нарушением функции печени\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Для пациентов с умеренным нарушением функции печени максимальная рекомендованная доза составляет 12 мг и должна быть поделена на 2 или 3 приема."}},{"type":"paragraph","data":{"text":"Нежелательные эффекты можно минимизировать, используя наименьшую эффективную дозу препарата в течение наименьшего промежутка времени, достаточного для контроля симптомов."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"В каждой частной категории побочные эффекты сгруппированы по системно-органному классу и представлены в порядке убывания частоты: очень часто — 1/10 назначений (> 10%); часто — 1/100 назначений (> 1% и < 10%); нечасто — 1/1000 назначений (> 0,1% и < 1%); редко — 1/10000 назначений (> 0,01% и < 0,1%); очень редко — 1/10000 назначений (< 0,01%); частота неизвестна — на основании имеющихся данных оценка невозможна."}},{"type":"paragraph","data":{"text":"\u003ci\u003eИнфекции и инвазии\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Редко: фарингит."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСистема кроветворения и лимфатическая система\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Редко: анемия, тромбоцитопения, лейкопения, увеличение времени кровотечения."}},{"type":"paragraph","data":{"text":"Очень редко: экхимозы."}},{"type":"paragraph","data":{"text":"\u003ci\u003eРасстройства иммунной системы\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Редко: гиперчувствительность, анафилактоидные и анафилактические реакции."}},{"type":"paragraph","data":{"text":"\u003ci\u003eМетаболические и пищевые расстройства\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Нечасто: анорексия, изменение веса."}},{"type":"paragraph","data":{"text":"\u003ci\u003eПсихиатрические расстройства\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Нечасто: нарушение сна, депрессия."}},{"type":"paragraph","data":{"text":"Редко: спутанность сознания, нервозность, тревожное возбуждение."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНеврологические расстройства\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Часто: кратковременные головные боли слабой интенсивности, головокружение."}},{"type":"paragraph","data":{"text":"Редко: сомноленция, парестезии, нарушение вкуса, тремор, мигрень."}},{"type":"paragraph","data":{"text":"Очень редко: асептический менингит у больных СКВ и смешанными заболеваниями соединительной ткани."}},{"type":"paragraph","data":{"text":"\u003ci\u003eРасстройства зрения\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Нечасто: конъюнктивит."}},{"type":"paragraph","data":{"text":"Редко: расстройства зрения."}},{"type":"paragraph","data":{"text":"\u003ci\u003eРасстройства вестибулярного аппарата\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Нечасто: головокружение, шум в ушах."}},{"type":"paragraph","data":{"text":"\u003ci\u003eКардиологические расстройства\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Нечасто: сердцебиение, тахикардия, отеки, сердечная недостаточность."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСосудистые расстройства\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Нечасто: прилив крови к лицу, отеки."}},{"type":"paragraph","data":{"text":"Редко: артериальная гипертензия, приливы крови, кровоизлияние, гематома."}},{"type":"paragraph","data":{"text":"\u003ci\u003eРасстройства в дыхательной системе, грудной клетке и средостении\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Нечасто: ринит."}},{"type":"paragraph","data":{"text":"Редко: диспноэ, кашель, бронхоспазм."}},{"type":"paragraph","data":{"text":"\u003ci\u003eЖелудочно-кишечные расстройства\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Часто: тошнота, боли в животе, диспепсические явления, диарея, рвота."}},{"type":"paragraph","data":{"text":"Нечасто: запор, метеоризм, отрыжка, сухость во рту, гастрит, язвенная болезнь желудка, боли в эпигастральной области, язвенная болезнь двенадцатиперстной кишки, изъязвления в полости рта."}},{"type":"paragraph","data":{"text":"Редко: мелена, кровавая рвота, стоматит, эзофагит, гастроэзофагиальный рефлюкс, дисфагия, афтозный стоматит, глоссит, перфоративная пептическая язва, желудочно-кишечное кровотечение."}},{"type":"paragraph","data":{"text":"\u003ci\u003eРасстройства гепатобилиарной системы\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Нечасто: повышение показателей тестов функции печени, глутамат-пируват-трансаминазы (ГПТ) или глутамат-оксалоацетат-трансаминазы (АСТ). Повышение активности печеночных ферментов — аланинаминотрансферазы (АлАТ) или аспартатаминотрансферазы (АсАТ)."}},{"type":"paragraph","data":{"text":"Редко: нарушение функции печени."}},{"type":"paragraph","data":{"text":"Очень редко: повреждение гепатоцитов. Гепатотоксичность, которая может привести к печеночной недостаточности, гепатиту, желтухе и холестазу."}},{"type":"paragraph","data":{"text":"\u003ci\u003eКожные проявления и расстройства в подкожных тканях\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Нечасто: сыпь, зуд, потливость, эритематозная сыпь, крапивница, отек Квинке, алопеция."}},{"type":"paragraph","data":{"text":"Редко: дерматит и экзема, пурпура."}},{"type":"paragraph","data":{"text":"Очень редко: отеки, буллезные реакции, синдром Стивенса-Джонсона, токсический эпидермальный некролиз."}},{"type":"paragraph","data":{"text":"\u003ci\u003eРасстройства опорно-двигательной системы и соединительной ткани\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Нечасто: артралгия."}},{"type":"paragraph","data":{"text":"Редко: боли в костях, спазмы мышц, миалгия."}},{"type":"paragraph","data":{"text":"\u003ci\u003eПочечные нарушения и мочевыделительные расстройства\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Редко: никтурия, нарушения мочеиспускания, повышение уровня мочевины и креатинина в крови."}},{"type":"paragraph","data":{"text":"Очень редко: у пациентов с уже имеющимся нарушением функции почек, которым для поддержания почечного кровотока необходимы почечные простагландины, лорноксикам может спровоцировать острую почечную недостаточность. Нефротоксичность в различных формах, включая нефрит и нефротический синдром, является класс-специфическим эффектом НПВП."}},{"type":"paragraph","data":{"text":"\u003ci\u003eОбщие проявления и состояние места введения препарата\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Нечасто: недомогание, отек лица."}},{"type":"paragraph","data":{"text":"Редко: астения."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"В настоящее время нет данных по передозировке, которые позволяли бы оценить ее последствия или предложить специфическое лечение."}},{"type":"paragraph","data":{"text":"В случае передозировки препарата Ксефокам, могут наблюдаться следующие симптомы: тошнота и рвота, церебральные симптомы (головокружение, расстройство зрения, атаксия, переходящая в кому и судороги). Возможны изменения функции печени и почек и нарушения свёртываемости крови."}},{"type":"paragraph","data":{"text":"При реальной или предполагаемой передозировке следует прекратить приём лекарства. Благодаря короткому периоду полувыведения, лорноксикам быстро выводится из организма. Диализ неэффективен."}},{"type":"paragraph","data":{"text":"До настоящего времени о существовании специфического антидота не известно."}},{"type":"paragraph","data":{"text":"Необходимо предусмотреть проведение обычных неотложных мероприятий, включая промывание желудка. Исходя из общих принципов, применение активированного угля только при условии его приёма сразу же после приёма препарата Ксефокам может привести к уменьшению всасываемости препарата. Для лечения желудочно-кишечных расстройств могут применяться аналоги простагландина или ранитидин."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Одновременное применение препарата Ксефокам и:"}},{"type":"list","data":{"style":"ordered","items":["циметидина — повышает концентрацию лорноксикама в плазме. Взаимодействия с ранитидином и антацидными препаратами не выявлено;","антикоагулянтов или ингибиторов агрегации тромбоцитов — возможно увеличение времени кровотечения (повышенный риск кровотечения, необходим контроль международного нормализованного отношения (МНО);","фенпрокоумона: снижение эффективности лечения фенпрокоумоном;","гепарина: НПВС повышают риск развития спинальной/эпидуральной гематомы при одновременном применении с гепарином при проведении спинальной или эпидуральной анестезии;","бета-адреноблокаторов и ингибиторов ангиотензинпревращающего фермента может уменьшать их гипотензивный эффект;","диуретиков — снижает мочегонный эффект и гипотензивное действие петлевых и тиазидных диуретиков;","дигоксина — снижает почечный клиренс дигоксина;","хинолоновых антибиотиков — повышает риск развития судорожного синдрома;","антиагрегантов: повышает риск желудочно-кишечного кровотечения;","других НПВП или глюкокортикоидов — увеличивает риск развития язвенной болезни или ЖКТ кровотечений;","метотрексата — повышает концентрацию метотрексата в сыворотке;","селективных ингибиторов обратного захвата серотонина (например, циталопрам, флуоксетин, пароксетин, сертралин) повышает риск ЖКТ кровотечений;","солей лития — может вызывать увеличение пиковых концентраций лития в плазме и, тем самым, усиливать известные побочные эффекты лития;","циклоспорина — увеличивает нефротоксичность циклоспорина;","производных сульфонилмочевины — может усиливать гипогликемический эффект последних;","цефамандол, цефоперазон, цефотетан, вальпроевая кислота увеличивают риск кровотечения;","веществ, являющихся индукторами и ингибиторами изофермента IIC9 цитохрома P450: лорноксикам (как и другие НПВП, метаболизируемые изоферментом IIC9 цитохрома P450), взаимодействует с его индукторами и ингибиторами;","такролимуса — повышение риска нефротоксичного эффекта вследствии угнетения синтеза простациклина в почках;","пеметрекседа: НПВП могут снижать почечный клиренс пеметрекседа, что приводит к возрастанию нефротоксичности и желудочно-кишечной токсичности препарата, а также к угнетению кроветворения."]}},{"type":"paragraph","data":{"text":"В случае приема препарата Ксефокам, таблетки, покрытые пленочной оболочкой, с пищей всасывание лорноксикама замедляется. Поэтому препарат Ксефокам, таблетки, покрытые пленочной оболочкой, не следует принимать вместе с пищей, если требуется быстрое наступление действия препарата (снятие болевого синдрома)."}},{"type":"paragraph","data":{"text":"Прием с пищей может снижать всасывание лорноксикама примерно на 20% и повышать T\u003csub\u003emax\u003c/sub\u003e."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Не следует применять препарат одновременно с другими НПВП."}},{"type":"paragraph","data":{"text":"При появлении признаков поражения печени (кожный зуд, пожелтение кожных покровов, тошнота, рвота, боли в животе, потемнение мочи, повышение уровня «печеночных трансаминаз») следует прекратить прием препарата и обратиться к лечащему врачу."}},{"type":"paragraph","data":{"text":"Препарат может изменять свойства тромбоцитов, однако не заменяет профилактического действия ацетилсалициловой кислоты при сердечно-сосудистых заболеваниях."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Таблетки покрытые пленочной оболочкой, 4 мг и 8 мг."}},{"type":"paragraph","data":{"text":"По 10 таблеток в блистер из алюминиевой фольги и ПВХ пленки. 1, 2, 3, 5 или 10 блистеров с инструкцией по применению помещают в картонную пачку."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"При температуре не выше 25\u003csup\u003eо\u003c/sup\u003e С."}},{"type":"paragraph","data":{"text":"Хранить в недоступном для детей месте."}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"3 года. Не использовать после истечения срока годности, указанного на упаковке."}}]},{"id":21,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"Отпускают по рецепту."}}]},{"id":22,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"\n\nТакеда ГмбХ, Германия"}},{"type":"paragraph","data":{"text":"Леницштрассе 70-98, 16515,"}},{"type":"paragraph","data":{"text":"Ораниенбург, Германия"}},{"type":"paragraph","data":{"text":"Takeda GmbH, Germany,"}},{"type":"paragraph","data":{"text":"Lehnitzstrasse 70-98, 16515,"}},{"type":"paragraph","data":{"text":"Oranienburg, Germany\n\n"}}]},{"id":23,"name":"Организация, принимающая претензии потребителей","body":[{"type":"paragraph","data":{"text":"\n\nООО «Такеда Фармасьютикалс»"}},{"type":"paragraph","data":{"text":"119048 Москва, ул. Усачева д.2, стр.1"}},{"type":"paragraph","data":{"text":"тел. (495) 933 55 11, факс (495) 502 16 25"}},{"type":"paragraph","data":{"text":"Электронная почта: \u003ca href=\"mailto:russia@takeda.com\"\u003erussia@takeda.com\u003c/a\u003e"}}]}],"source":null},"description_toggle":false,"short_description":"Лорноксикам является нестероидным противовоспалительным средством, обладает выраженным обезболивающим и противовоспалительным действием, относится к классу оксикамов. В основе механизма действия лежит подавление синтеза простагландинов (ингибирование фермента циклооксигеназы), приводящее к подавлению воспаления. Лорноксикам не оказывает влияния на основные показатели состояния организма: температуру тела, частоту сердечных сокращений (ЧСС), артериальное давление (АД), данные электрокардиограммы (ЭКГ), спирометрию. Анальгетический эффект лорноксикама не связан с наркотическим действием. Препарат Ксефокам не оказывает опиатоподобного действия на центральную нервную систему (ЦНС) и, в отличие от наркотических анальгетиков, не угнетает дыхания, не вызывает лекарственной зависимости. Вследствие наличия местно-раздражающего действия в отношении желудочно-кишечного тракта (ЖКТ) и системного ульцерогенного эффекта, связанных с подавлением синтеза простагландинов, осложнения со стороны ЖКТ являются частыми нежелательными эффектами при лечении нестероидными противовоспалительными препаратами. Всасывание Лорноксикам быстро и практически полностью всасывается из желудочно-кишечного тракта. Максимальная концентрация в плазме достигается приблизительно через 1-2 ч. Абсолютная биодоступность составляет примерно 90-100%. Эффектов первого прохождения препарата через печень не обнаружено. Средний период полувыведения препарата составляет 3-4 ч. При одновременном приеме лорноксикама с пищей Cmaxснижается примерно на 30% и Tmaxувеличивается с 1,5 до 2,3 ч. Абсорбция лорноксикама (рассчитанная по AUC) может снижаться до 20%. Распределение Лорноксикам обнаруживается в плазме в неизмененном виде и в виде гидроксилированного метаболита. Степень связывания лорноксикама с белками плазмы составляет около 99% и не зависит от концентрации. Биотрансформация Лорноксикам в значительной степени метаболизируется в печени, в основном посредством гидроксилирования до неактивного 5-гидроксилорноксикама. Биотрансформация лорноксикама осуществляется посредством изофермента CYP2C9. Вследствие полиморфизма гена, кодирующего данный фермент, существуют люди с медленным и быстрым метаболизмом препарата, что может привести к значительному повышению уровня лорноксикама в плазме у лиц с медленным метаболизмом. Гидроксилированный метаболит не обладает фармакологической активностью. Лорноксикам полностью метаболизируется: примерно 2/3 препарата выводится печенью, а 1/3 — почками в виде неактивного метаболита. Выведение Период полувыведения лорноксикама в среднем составляет от 3 до 4 ч. После приема внутрь примерно 50% препарата выводится с калом и 42% — почками, главным образом в виде 5-гидроксилорноксикама. Период полувыведения 5-гидроксилорноксикама составляет примерно 9 ч после парентерального введения 1 или 2 раза в сутки. У лиц старческого возраста (старше 65 лет) клиренс препарата снижен на 30-40%. 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