Шизофрения, в т.ч. параноидная, шизоаффективные расстройства. психоз, в т.ч. инволюционный. психосоматические расстройства. депрессивные состояния, сопровождающиеся чувством страха. абстинентный синдром при хроническом алкоголизме, зуд (сильный, мучительный) при кожных заболеваниях, нарушения поведения (повышенная психомоторная активность) у детей.
Противопоказания
Гиперчувствительность (в т.ч. к производным фенотиазина), депрессия (острое состояние), коматозные состояния, феохромоцитома, порфирия, недостаточность кроветворения, I триместр и последняя неделя беременности, детский возраст до 4 лет.
Тиоридазин является пиперидиновым производным фенотиазина, оказывающим влияние на центральную и периферическую нервную систему. Оказывает алтипсихотическое, транквилизирующее, антидепрессивное, противозудное и противорвотное действие. Механизм антипсихотического действия обусловлен блокадой постсинаптических допаминовых рецепторов в мезолимбических структурах головного мозга. Центральное противорвотное действие обусловлено угнетением или блокадой допаминовых D2-рецепторов в хеморецепторной триггерной зоне ствола головного мозга, периферическое - блокадой блуждающего нерва в ЖКТ. Также обладает α-адреноблокирующим и м-холиноблокирующим действием. Блокада гистаминовых H1-рецепторов и м-холинорецепторов наиболее выражена среди всех нейролептиков. В малых дозах оказывает анксиолитическое действие, снижает чувство напряженности и тревоги, в более высоких дозах проявляет антипсихотические (нейролептические) свойства. Увеличивает выделение гипофизом пролактина. Тиоридазин дозозависимо удлиняет интервал QTc, что может привести к тяжелым жизнеугрожающим желудочковым аритмиям, включая пируэтную тахикардию.
Показания к применению
Шизофрения, в т.ч. параноидная, шизоаффективные расстройства. психоз, в т.ч. инволюционный. психосоматические расстройства. депрессивные состояния, сопровождающиеся чувством страха. абстинентный синдром при хроническом алкоголизме, зуд (сильный, мучительный) при кожных заболеваниях, нарушения поведения (повышенная психомоторная активность) у детей.
Противопоказания
Гиперчувствительность (в т.ч. к производным фенотиазина), депрессия (острое состояние), коматозные состояния, феохромоцитома, порфирия, недостаточность кроветворения, I триместр и последняя неделя беременности, детский возраст до 4 лет.
Применение при беременности и в период грудного вскармливания
При беременности применение препарата возможно только в том случае, если ожидаемая польза для матери превышает потенциальный риск для плода. Адекватные и хорошо контролируемые исследования безопасности препарата при беременности не проводилось. При необходимости назначения препарата в период лактации грудное вскармливание следует прекратить.
Способ применения и дозы
Внутрь. Режим дозирования индивидуальный (в зависимости от показаний и терапевтического ответа). При психозах: взрослым обычно - 150–400 мг/сут в 3–4 приема в амбулаторных условиях, в стационаре - 250–800 мг/сут. Лечение обычно начинают с низких доз, 25–75 мг/сут, постепенно увеличивая их до оптимальной терапевтической дозы, которая достигается в течение 7 дней (антипсихотический эффект отмечается спустя 10–14 дней). Курс лечения составляет несколько недель. Поддерживающая суточная доза - 75–200 мг однократно перед сном. У пожилых людей обычно применяют низкие дозы - 30–100 мг/сут. Препарат следует отменять постепенно. При легких умственных и эмоциональных расстройствах: терапевтическая доза - 50–200 мг/сут. Начинать лечение следует с низких доз, постепенно увеличивая их до оптимальной терапевтической дозы. При психосоматических расстройствах - 10–75 мг/сут. Для подавления сильного зуда: дозу препарата устанавливают индивидуально, и она не должна превышать 200 мг. Детям от 4 до 7 лет - 10–20 мг/сут в 2–3 приема в сутки; от 8 до 14 лет - 20–30 мг/сут в 3 приема в сутки; от 15 до 18 лет - 30–50 мг/сут в 2–3 приема в сутки.
Побочное действие
Со стороны нервной системы и органов чувств синдром паркинсонизма, дискинезия, акатизия, сонливость, апатия, раздражительность, депрессия, бред, судорожные приступы, нарушение терморегуляции. Со стороны сердечно-сосудистой системы и крови (кроветворение, гемостаз) тахикардия, ортостатическая гипотензия, агранулоцитоз, лейкопения, эозинофилия, панцитопения, тромбоцитопеническая пурпура. Со стороны органов ЖКТ запор, холестатическая желтуха. Со стороны кожных покровов аллергические реакции, дискоидная волчанка, фотосенсибилизация. Прочие гипер- или гипогликемия, гинекомастия, нарушение менструального цикла, понижение либидо.
Передозировка
Симптомы: Со стороны сердечно-сосудистой системы: аритмии, снижение АД, шок, изменения на ЭКГ, удлинение интервалов QT и PR, неспецифические изменения сегмента ST и зубца Т, брадикардия, синусовая стенокардия, AV-блокада, желудочковая тахикардия, фибрилляция желудочков, пируэтная тахикардия, угнетение функции миокарда. Со стороны ЦНС: седативный эффект, экстрапирамидные расстройства, спутанность сознания, ажитация, гипотермия, гипертермия, судороги, арефлексия, кома. Со стороны вегетативной нервной системы: мидриаз, миоз, сухость кожи и слизистой оболочки полости рта, заложенность носа, задержка мочи, нечеткость зрения. Со стороны дыхательной системы: угнетение дыхания, апноэ, отек легких. Со стороны пищеварительной системы: снижение моторики, запор, кишечная непроходимость. Со стороны мочевыделительной системы: олигурия, уремия. Токсичность начинает проявляться при концентрации тиоридазина в плазме более 10 мг/л, при концентрации 20-80 мг/л наступает смерть. Лечение: Необходимо обеспечить проходимость дыхательных путей и наладить адекватную оксигенацию и легочную вентиляцию. Немедленно начать длительный мониторинг сердечно-сосудистой деятельности (ЭКГ). Лечение заключается в коррекции электролитных нарушений и кислотно-щелочного баланса, введении лидокаина (рекомендуется соблюдать осторожность вследствие повышенного риска возникновения судорог), фенитоина, изопротеренола, вплоть до установки искусственных водителей ритма и дефибрилляции. Ввиду возможного дополнительного удлинения интервала QT следует избегать применения дизопирамида, про каинам ида и хинидина. Коррекция сниженного АД может потребовать введения инфузионных растворов и вазопрессоров. При устойчиво низком АД показано введение фснилэфрина, норэпинефрина или метараминола. Альфа-адреноблокирующее свойства производных фенотиазина не позволяют применять неселективные альфа- и бета-адреномиметики (эпинефрин, допамин) - риск парадоксальной вазодилатации. Для удаления неабсорбированной дозы препарата рекомендуется проводить промывание желудка с применением активированного угля. Индукция рвоты менее предпочтительна ввиду риска дистопии и потенциальной аспирации рвотных масс. Острые экстрапирамидные расстройства купируют дифенгидрамином или тригексифенидилом. При купировании судорог следует избегать введения барбитуратов (риск усугубления угнетения дыхания). За счет высокого объема распределения и сильного связывания с белками плазмы форсированный диурез, гемоперфузия, гемодиализ и изменение рН мочи, скорее всего, не влияют на выведение производных фенотиазина из организма.
Особые указания
В период лечения необходимо осуществлять контроль морфологического состава крови; воздерживаться от употребления этанола. Влияние на способность к вождению автотранспорта и управлению механизмами Препарат ослабляет двигательную координацию и снижает скорость психомоторных реакций, особенно в начале лечения, поэтому в период лечения препаратом следует воздержаться от управления транспортных средств и обслуживания движущихся механизмов.
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Вспомогательные вещества: крахмал кукурузный - 8 мг, кремния диоксид коллоидный - 1.5 мг, лактозы моногидрат - 26.4 мг, желатин - 0.1 мг, стеариновая кислота - 1 мг, тальк - 3 мг. Состав оболочки: сахароза - 35.799 мг, камедь акации - 0.5 мг, тальк - 13.70 мг, краситель пунцовый (Понсо 4R) - 0.001 мг."}}]},{"id":2,"name":"Фармакологические свойства","slug":"pharmacologic_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Тиоридазин является пиперидиновым производным фенотиазина, оказывающим влияние на центральную и периферическую нервную систему. Оказывает алтипсихотическое, транквилизирующее, антидепрессивное, противозудное и противорвотное действие. Механизм антипсихотического действия обусловлен блокадой постсинаптических допаминовых рецепторов в мезолимбических структурах головного мозга. Центральное противорвотное действие обусловлено угнетением или блокадой допаминовых D2-рецепторов в хеморецепторной триггерной зоне ствола головного мозга, периферическое - блокадой блуждающего нерва в ЖКТ. Также обладает α-адреноблокирующим и м-холиноблокирующим действием. Блокада гистаминовых H1-рецепторов и м-холинорецепторов наиболее выражена среди всех нейролептиков. В малых дозах оказывает анксиолитическое действие, снижает чувство напряженности и тревоги, в более высоких дозах проявляет антипсихотические (нейролептические) свойства. Увеличивает выделение гипофизом пролактина. 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Адекватные и хорошо контролируемые исследования безопасности препарата при беременности не проводилось. При необходимости назначения препарата в период лактации грудное вскармливание следует прекратить."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Внутрь. Режим дозирования индивидуальный (в зависимости от показаний и терапевтического ответа). При психозах: взрослым обычно - 150–400 мг/сут в 3–4 приема в амбулаторных условиях, в стационаре - 250–800 мг/сут. Лечение обычно начинают с низких доз, 25–75 мг/сут, постепенно увеличивая их до оптимальной терапевтической дозы, которая достигается в течение 7 дней (антипсихотический эффект отмечается спустя 10–14 дней). Курс лечения составляет несколько недель. Поддерживающая суточная доза - 75–200 мг однократно перед сном. У пожилых людей обычно применяют низкие дозы - 30–100 мг/сут. Препарат следует отменять постепенно. 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Со стороны сердечно-сосудистой системы и крови (кроветворение, гемостаз) тахикардия, ортостатическая гипотензия, агранулоцитоз, лейкопения, эозинофилия, панцитопения, тромбоцитопеническая пурпура. Со стороны органов ЖКТ запор, холестатическая желтуха. Со стороны кожных покровов аллергические реакции, дискоидная волчанка, фотосенсибилизация. Прочие гипер- или гипогликемия, гинекомастия, нарушение менструального цикла, понижение либидо."}}]},{"id":8,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Симптомы: Со стороны сердечно-сосудистой системы: аритмии, снижение АД, шок, изменения на ЭКГ, удлинение интервалов QT и PR, неспецифические изменения сегмента ST и зубца Т, брадикардия, синусовая стенокардия, AV-блокада, желудочковая тахикардия, фибрилляция желудочков, пируэтная тахикардия, угнетение функции миокарда. Со стороны ЦНС: седативный эффект, экстрапирамидные расстройства, спутанность сознания, ажитация, гипотермия, гипертермия, судороги, арефлексия, кома. Со стороны вегетативной нервной системы: мидриаз, миоз, сухость кожи и слизистой оболочки полости рта, заложенность носа, задержка мочи, нечеткость зрения. Со стороны дыхательной системы: угнетение дыхания, апноэ, отек легких. Со стороны пищеварительной системы: снижение моторики, запор, кишечная непроходимость. Со стороны мочевыделительной системы: олигурия, уремия. Токсичность начинает проявляться при концентрации тиоридазина в плазме более 10 мг/л, при концентрации 20-80 мг/л наступает смерть. Лечение: Необходимо обеспечить проходимость дыхательных путей и наладить адекватную оксигенацию и легочную вентиляцию. Немедленно начать длительный мониторинг сердечно-сосудистой деятельности (ЭКГ). 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Острые экстрапирамидные расстройства купируют дифенгидрамином или тригексифенидилом. При купировании судорог следует избегать введения барбитуратов (риск усугубления угнетения дыхания). За счет высокого объема распределения и сильного связывания с белками плазмы форсированный диурез, гемоперфузия, гемодиализ и изменение рН мочи, скорее всего, не влияют на выведение производных фенотиазина из организма."}}]},{"id":9,"name":"Особые указания","slug":"cautions","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"В период лечения необходимо осуществлять контроль морфологического состава крови; воздерживаться от употребления этанола. 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