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Метаболизируется в печени путем деметилирования до активного метаболита норфлуоксетина и ряда неидентифи- цированных метаболитов. Выводится почками, величина клиренса флуоксетина составляет 94-704 мл/мин, норфлуоксетина 60-336 мл/мин. Недостаточность почек не оказывает заметного влияния на скорость выведения флуоксетина. Около 12 % препарата выделяется через желудочно-кишечный тракт. Период полувыведения флуоксетина составляет около 2-3 суток, норфлуоксетина - 7-9 суток. У больных с недостаточностью печени период полувыведения флуоксетина и норфлуоксетина удлиняется. 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Проводится симптоматическая терапия, промывание желудка с назначением активированного угля, при судорогах - диазепам, поддержание дыхания, сердечной деятельности, температуры тела."}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"\u003ci\u003eС осторожностью\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"\u003ci\u003eСуицидальный риск\u003c/i\u003e: при депрессиях существует вероятность суицидальных попыток, которые могут сохраняться до наступления стойкой ремиссии. Отдельные случаи суицидальных мыслей и суицидального поведения описаны на фоне терапии или вскоре после ее окончания, подобно действию других препаратов близкого фармакологического действия (антидепрессантов). Необходимо тщательное наблюдение за пациентами, относящимися к группе риска. Врачам следует убедить пациентов незамедлительно сообщать о любых мыслях и чувствах, причиняющих беспокойство."}},{"type":"paragraph","data":{"text":"\u003ci\u003eЭпилептическиеприпадки\u003c/i\u003e: флоуксетин следует с осторожностью назначать больным, у которых отмечались эпилептические припадки."}},{"type":"paragraph","data":{"text":"\u003ci\u003eГипонатриемия\u003c/i\u003e: отмечались случаи гипонатриемии. В основном подобные случаи отмечались у больных пожилого возраста и у больных, принимавших диуретики, вследствие уменьшения объема циркулирующей крови."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСахарный диабет\u003c/i\u003e: гликемический контроль у больных диабетом вовремя лечения флуоксетином показывал гипогликемию, после отмены препарата развивалась гипергликемия. В начале или после лечения флуоксетином может потребоваться корректировка доз инсулина и/или гипогликемических препаратов для приема внутрь."}},{"type":"paragraph","data":{"text":"\u003ci\u003eПочечная/печеночная недостаточность\u003c/i\u003e: флуоксетин подвергается метаболизму в печени и выводится почками и через желудочно-кишечный тракт. Пациентами с выраженными нарушениями функции печени рекомендуется назначать более низкие дозы флуоксетина, либо назначать препарат через день. При приеме флуоксетина в дозе 20 мг/сут на протяжении двух месяцев не было выявлено отличий концентрации флуоксетина и норфлуоксетина в плазме крови здоровых лиц, имеющих нормальную функцию почек, и пациентов с выраженными нарушениями функции почек (клиренс креатинина 10 мл/мин), нуждающимися в гемодиализе."}},{"type":"header","data":{"text":"Применение при нарушениях функции печени","level":4}},{"type":"paragraph","data":{"text":"Флуоксетин подвергается метаболизму в печени и выводится почками и через ЖКТ. Пациентами с выраженными нарушениями функции печени рекомендуется назначать более низкие дозы флуоксетина, либо назначать препарат через день."}},{"type":"header","data":{"text":"Применение при нарушениях функции почек","level":4}},{"type":"paragraph","data":{"text":"Флуоксетин подвергается метаболизму в печени и выводится почками и через ЖКТ. При приеме флуоксетина в дозе 20 мг/сут на протяжении двух месяцев не было выявлено отличий концентрации флуоксетина и норфлуоксетина в плазме крови здоровых лиц, имеющих нормальную функцию почек, и пациентов с выраженными нарушениями функции почек (клиренс креатинина 10 мл/мин), нуждающимися в гемодиализе."}},{"type":"header","data":{"text":"Применение у детей","level":4}},{"type":"paragraph","data":{"text":"У детей и подростков с депрессией, другими психическими нарушениями антидепрессанты, по сравнению с плацебо, повышают риск возникновения суицидальных мыслей и суицидального поведения. Поэтому при назначении флуоксетина или любых др. антидепрессантов данной категории пациентов следует соотнести риск суицида и пользу от их применения."}},{"type":"header","data":{"text":"Применение у пожилых пациентов","level":4}},{"type":"paragraph","data":{"text":"Не существует данных об изменении доз в зависимости от возраста. Начинать лечение\u003cb\u003eпациентов пожилого возраста\u003c/b\u003e следует с дозы 20 мг/сут.\n\n"}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"Противопоказан при беременности и в период лактации."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Препарат принимают внутрь."}},{"type":"paragraph","data":{"text":"Начальная доза составляет 20 мг 1 раз в сутки в первой половине дня, независимо от прима пищи. При необходимости доза может быть увеличена до 40-60 мг/сут, разделн- ных на 2-3 прима. Максимальная суточная доза - 80 мг."}},{"type":"paragraph","data":{"text":"Клинический эффект развивается через 1-4 недели после начала лечения, у некоторых пациентов он может достигаться позже."}},{"type":"paragraph","data":{"text":"Обсессивно-компульсивные расстройства: рекомендованная доза составляет 20-60 мг в сутки."}},{"type":"paragraph","data":{"text":"При булимическом неврозе препарат применяется в суточной дозе 60 мг, разделнных на 2-3 прима."}},{"type":"paragraph","data":{"text":"У больных пожилого возраста рекомендуемая суточная доза составляет 20 мг. У больных с нарушениями функции печени и почек, а также с низкой массой тела рекомендуется применение более низких доз и удлинение интервала между примами."}},{"type":"paragraph","data":{"text":"Длительность приема определяется лечащим врачом и может длиться на протяжении нескольких"}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Со стороны центральной нервной системы: гипомания или мания, усиление суицидальных тенденций, тревога, повышенная раздражительность, ажитация, головокружение, головная боль, тремор, бессонница или сонливость, астенические расстройства."}},{"type":"paragraph","data":{"text":"Со стороны желудочно-кишечного тракта: снижение аппетита, нарушения вкуса, тошнота, рвота, сухость во рту или гиперсаливация, диарея."}},{"type":"paragraph","data":{"text":"Со стороны мочеполовой системы: недержание или задержка мочи, дисменорея, вагинит, снижение либидо, половая дисфункция у мужчин (замедленная эякуляция)."}},{"type":"paragraph","data":{"text":"При развитии, на фоне прима флуоксетина, судорожных припадков препарат следует отменить."}},{"type":"paragraph","data":{"text":"Редко встречаются: аллергические реакции в виде кожной сыпи, крапивницы, зуда, озноба, повышения температуры тела, боли в мышцах и суставах (возможно применение антигистаминных и стероидных препаратов), повышенное потоотделение, гипонатриемия, тахикардия, нарушение остроты зрения, васкулиты."}},{"type":"paragraph","data":{"text":"Возможно развитие анорексии и уменьшение массы тела."}},{"type":"paragraph","data":{"text":"Указанные побочные эффекты чаще возникают в начале терапии флуоксетином или при повышении дозы препарата."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Симптомы: психомоторное возбуждение, судорожные припадки, нарушения сердечного ритма, тахикардия, тошнота, рвота."}},{"type":"paragraph","data":{"text":"Лечение: специфические антагонисты к флуоксетину не найдены. Проводится симптоматическая терапия, промывание желудка с назначением активированного угля, при судорогах - диазепам, поддержание дыхания, сердечной деятельности, температуры тела."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Нельзя применять препарат одновременно с ингибиторами МАО, в том числе антидепрессантами - ингибиторами МАО, фуразолидоном, прокарбазином, селегилином, а также триптофаном (предшественник серотонина), так как возможно развитие серотонинергического синдрома, проявляющегося в спутанности сознания, гипоманиакальном состоянии, психомоторном возбуждении, судорогах, дизартрии, гипертонических кризах, ознобе, треморе, тошноте, рвоте, диарее. Интервал между окончанием терапии ингибиторами МАО и началом лечения флуоксетином должен составлять как минимум 14 дней, между окончанием лечения флуоксетином и началом терапии ингибиторами МАО - не менее 5 недель."}},{"type":"paragraph","data":{"text":"Одновременный прим флуоксетина с алкоголем или с препаратами центрального действия, вызывающими угнетение функции центральной нервной системы, усиливает их эффект."}},{"type":"paragraph","data":{"text":"Флуоксетин блокирует метаболизм трициклических и тетрациклических антидепрессив- ных средств, тразодона, карбамазепина, диазепама, метопролола, терфенадина, фенитоина (дифенин), что приводит к увеличению их концентрации в сыворотке крови, усиливая их действие и увеличивая частоту осложнений."}},{"type":"paragraph","data":{"text":"Совместное применение флуоксетина и солей лития требует тщательного контроля за концентрацией лития в крови, так как возможно е повышение."}},{"type":"paragraph","data":{"text":"Флуоксетин усиливает действие гипогликемических препаратов. При одновременном применении с препаратами, обладающими высокой степенью связывания с белками, особенно с антикоагулянтами и дигитоксином, возможно повышение концентрации в плазме свободных (несвязанных) лекарственных средств и увеличение риска развития неблагоприятных эффектов."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Имеются сообщения о возникновении кожной сыпи, анафилактических реакциях и прогрессирующих системных нарушениях с вовлечением в патологический процесс кожи, легких, печени, почек у пациентов, принимающих флуоксетин. При появлении кожной сыпи или других возможных аллергических реакций, этиология которых не может быть определена, прием флуоксетина следует отменить."}},{"type":"paragraph","data":{"text":"В исследованиях in vitro и на животных не получено доказательств канцерогенности. - - Безопасность и эффективность применения флуоксетина у детей не установлены."}},{"type":"paragraph","data":{"text":"При использовании препарата флуокситен пожилыми пациентами доза препарата должна быть уменьшена в 2 раза. Также дозу следует уменьшить в 2 раза при нарушенной функ-, ции печени и почек."}},{"type":"paragraph","data":{"text":"У больных с сахарным диабетом возможно развитие гипогликемии во время терапии флуоксетином и гипергликемии после его отмены. В начале и после окончания лечения флуоксетином может потребоваться коррекция доз инсулина и/или гипогликемических препаратов для приема внутрь. ."}},{"type":"paragraph","data":{"text":"На фоне проведения электросудорожной терапии возможно развитие продолжительных эпилептических припадков."}},{"type":"paragraph","data":{"text":"При лечении больных с дефицитом массы тела следует учитывать анорексигенные эффекты (возможна прогрессирующая потеря массы тела)."}},{"type":"paragraph","data":{"text":"После отмены препарата его терапевтическая концентрация в сыворотке крови может сохраняться в течение нескольких недель."}},{"type":"paragraph","data":{"text":"Во время лечения флуоксетином не допускается прием алкогольных напитков."}},{"type":"paragraph","data":{"text":"Требуется тщательное наблюдение за больными с суицидальными наклонностями, особенно в начале лечения. В большей степени риску суицида подвержены лица младше 24 лет."}}]},{"id":17,"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","body":[{"type":"paragraph","data":{"text":"В период лечения Флуоксетином следует воздерживаться от вождения автотранспорта и занятий потенциально опасными видами деятельности, требующими повышенной концентрации внимания и быстроты психомоторных реакций."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Капсулы 10 мг и 20 мг."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"В сухом, защищенном от света месте, при температуре не выше 25 С. 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."}}]},{"id":21,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"По рецепту"}}]},{"id":22,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"ЗАО «Биоком», Россия"}}]},{"id":23,"name":"Организация, принимающая претензии потребителей","body":[{"type":"paragraph","data":{"text":"ЗАО «Биоком», Россия"}}]}],"source":null},"description_toggle":false,"short_description":"Антидепрессант группы селективных ингибиторов обратного захвата серотонина. Обладает тимоаналептическим и стимулирующим действием. Избирательно блокирует обратный нейрональный захват серотонина (5НТ) в синапсах нейронов центральной нервной системы. Ингибирование обратного захвата серотонина приводит к повышению концентрации этого нейромедиатора в синаптической щели, усиливает и пролонгирует его действие на постсинаптические рецепторные участки. В терапевтических дозах флуоксетин блокирует захват серотонина тромбоцитами человека. Является слабым антагонистом мускариновых, гистаминовых HI, адренергических альфа1 и альфа2 рецепторов, мало влияет на обратный захват дофамина. Вызывает редукцию обсессивно-компульсивных расстройств, а также снижение аппетита, что может привести к снижению массы тела. Не вызывает седативного эффекта! При приеме в средних терапевтических дозах практически не влияет на функции сердечно-сосудистой и других систем. При приемевнутрь препарат хорошо всасывается из желудочно- кишечного тракта (до 95 % принятой дозы), применение с пищей незначительно тормозит всасывание флуоксетина. Максимальные концентрации в плазме крови достигаются через 6-8 часов. Биодоступность флуоксетина после приема внутрь составляет более 60 %. Препарат хорошо накапливается в тканях, легко проникает через гематоэнцефалический барьер, связывание с белками плазмы крови составляет более 90 %. Метаболизируется в печени путем деметилирования до активного метаболита норфлуоксетина и ряда неидентифи- цированных метаболитов. Выводится почками, величина клиренса флуоксетина составляет 94-704 мл/мин, норфлуоксетина 60-336 мл/мин. Недостаточность почек не оказывает заметного влияния на скорость выведения флуоксетина. Около 12 % препарата выделяется через желудочно-кишечный тракт. Период полувыведения флуоксетина составляет около 2-3 суток, норфлуоксетина - 7-9 суток. У больных с недостаточностью печени период полувыведения флуоксетина и норфлуоксетина удлиняется. Препарат выделяется с грудным молоком (до 25 % от концентрации в сыворотке крови).","substance":[{"id":1359,"title":"Флуоксетин","title_latin":"Fluoxetinum","slug":"fluoksetin_1359"}],"branding":null,"valid_for_quick_buy":false,"is_available_to_delivery":false,"comments":null,"image_alt":"Флуоксетин - фото упаковки","image_share":{"isTouch":{"default":"https://vseapteki.ru/cropping/thumbnails/101/52422/share_default/"},"isFromTablet":{"default":"https://vseapteki.ru/cropping/thumbnails/101/52422/share_default/"}},"diseases":[{"id":"491","title":"Депрессивный эпизод","slug":"491-depressivnyy_epizod"},{"id":"492","title":"Рекуррентное депрессивное расстройство","slug":"492-rekurrentnoe_depressivnoe_rasstroystvo"},{"id":"499","title":"Обсессивно-компульсивное расстройство","slug":"499-obsessivnokompulsivnoe_rasstroystvo"},{"id":"507","title":"Нервная булимия","slug":"507-nervnaya_bulimiya"}],"other_packages":[{"id":98379,"title":"Флуоксетин","subtitle":{"full":"Капсулы, 20 шт, 20 мг, для внутреннего применения, для взрослых, антидепрессант","short":"Капсулы, 20 шт, 20 мг","package":"20 шт, 20 мг"},"prescription":true,"catalog_section_id":100271,"manufacturer":{"id":5283,"title":"G.L. 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