Периферический вазодилататор с преимущественным влиянием на... Инструкция
Показания к применению
Профилактика приступов стенокардии у больных с ишемической болезнью сердца;
Хроническая сердечная недостаточность (в составе комбинированной терапии).
Противопоказания
Повышенная чувствительность к нитратам или другим компонентам препарата.
Артериальная гипотензия и гиповолемия (систолическое артериальное давление ниже 100 мм рт.ст., диастолическое артериальное давление ниже 60 мм рт.ст., центральное венозное давление ниже 4-5 мм рт.ст.);
Периферический вазодилататор с преимущественным влиянием на венозные сосуды.
Пектрол стимулирует образование в эндотелии сосудов оксида азота (эндотелиального релаксирующего фактора), вызывающего активацию внутриклеточной гуанилатциклазы, следствием чего является увеличение цГМФ (медиатор вазодилатации). Вазодилатация снижает венозный возврат к сердцу (преднагрузка), уменьшая нагрузку на сердце, что снижает потребность миокарда в кислороде. Дилатирующий эффект нитратов на артерии и артериолы снижает ОПСС (постнагрузку).
Пектрол обладает коронарорасширяющим действием. Снижает приток крови к правому предсердию, способствует снижению давления в малом круге кровообращения и регрессии симптомов при отеке легких. Способствует перераспределению коронарного кровотока в области со сниженным кровоснабжением.
Пектрол повышает толерантность к физической нагрузке у больных ИБС, стенокардией. Расширяет сосуды головного мозга, твердой мозговой оболочки, что может сопровождаться головной болью. Ингибирует агрегацию тромбоцитов, снижает внутритромбоцитарный синтез тромбоксана.
Как и к другим нитратам, развивается перекрестная толерантность. После отмены (перерыва в лечении) чувствительность быстро восстанавливается.
Антиангинальный эффект наступает через 30-40 мин после приема внутрь и продолжается до 8-10 ч.
Показания к применению
Профилактика приступов стенокардии у больных с ишемической болезнью сердца;
Хроническая сердечная недостаточность (в составе комбинированной терапии).
Противопоказания
Повышенная чувствительность к нитратам или другим компонентам препарата.
Артериальная гипотензия и гиповолемия (систолическое артериальное давление ниже 100 мм рт.ст., диастолическое артериальное давление ниже 60 мм рт.ст., центральное венозное давление ниже 4-5 мм рт.ст.);
Острая сердечная недостаточность;
Шок;
Сосудистый коллапс;
Левожелудочковая недостаточность с низким конечным диастолическим давлением;
Острый инфаркт миокарда (с выраженной артериальной гипотензией);
Тампонада сердца;
Токсический отек легких;
Заболевания;
Сопровождающиеся повышением внутричерепного давления (в том числе геморрагический инсульт, черепно-мозговая травма);
Период лактации;
Возраст до 18 лет (эффективность и безопасность не установлены).
С осторожностью:
Пролапс митрального клапана;
Аортальный и/или митральный стеноз;
Тенденция к ортостатическим нарушениям сосудистой регуляции;
Печеночная недостаточность (риск развития метгемоглобинемии).
Способ применения и дозы
Таблетки следует принимать внутрь, после еды, проглатываться целиком и запивать стаканом воды.
Обычная начальная доза составляет - 1 таблетка 40 мг в день, утром.
При необходимости доза может быть повышена до 60 мг в сутки.
В случае ночных приступов стенокардии таблетку следует принимать вечером.
Дозу препарата можно увеличить до 60 м г 1 раз в сутки или до 2-х таблеток 40 мг 2 раза в сутки в 2 приема. Доза препарата и кратность приема устанавливается индивидуально в зависимости от тяжести заболевания. В зависимости от выраженности клинического эффекта с 3-5 дня терапии разовую дозу можно увеличивать до 40 - 60 мг (в особых случаях до 80 мг/сут) при той же кратности приема.
Лечение хронической сердечной недостаточности обычно начинают в стационаре, где доза подбирается до тех пор, пока не будет определена соответствующая поддерживающая доза. Соответствующую дозу препарата следует определять с учетом клинического эффекта и побочного действия.
По обоим показаниям пациентам следует принимать 1 таблетку 40 мг или 60 мг 1 раз в сутки или таблетку 40 мг 2 раза в сутки (1 таблетку утром и вторую приблизительно через 7 часов). Должно пройти по крайней мере 12 часов между приемом последней дозы препарата вечером и первой дозы препарата на следующее утро.
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