Небилонг - кардиоселективный бета-адреноблокатор III поколения с вазодилатирующими свойствами.
Активное вещество представляет собой рацемат, состоящий из двух энантиомеров: D-небиволола и L-небиволола.
Небиволол является конкурентным и избирательным блокатором β1-адренорецепторов (сродство к β1-адренорецепторам в 288 раз выше, чем к β2-адренорецепторам), кроме того, оказывает мягкое вазодилатирующее действие за счет модуляции высвобождения релаксирующего фактора (NO) из эндотелия сосудов.
Небиволол снижает ЧСС и АД в состоянии покоя и при нагрузке, уменьшает конечное диастолическое давление левого желудочка, снижает ОПСС, улучшает диастолическую функцию сердца (снижает давление наполнения), увеличивает фракцию выброса; вызывает антиангинальный эффект у больных ИБС.
Оптимальное гипотензивное действие проявляется через 1-2 недели лечения. В некоторых случаях максимальный эффект достигается спустя 4 недели.
Бронхиальная астма, хроническая сердечная недостаточность в стадии декомпенсации, нелеченная феохромоцитома, тяжелые нарушения функции печени, депрессии, ангиоспастическая стенокардия (стенокардия Принцметала), облитерирующие заболевания периферических сосудов (синдром перемежающей хромота), артериальная гипотензия, кардиогенный шок, брадикардия (ЧСС менее 50 уд./мин), СССУ, AV-блокада II и III степени, миастения, мышечная слабость, детский и подростковый возраст до 18 лет, повышенная чувствительность к небивололу.
Применение при беременности и в период грудного вскармливания
Применение при беременности возможно только по строгим показаниям (в связи с возможным развитием у новорожденных брадикардии, артериальной гипотензии, гипогликемии и паралича дыхания).
Прием небиволола необходимо прекратить за 48-72 ч до родов. В тех случаях, когда это невозможно, следует обеспечивать строгое наблюдение за новорожденными в течение 48-72 ч после родов.
Способ применения и дозы
Взрослым для приема внутрь - 2.5-5 мг/сут. утром.
Оптимальный эффект развивается через 1-2 недели лечения, а в ряде случаев - через 4 недели.
При необходимости суточную дозу увеличивают до 10 мг/сут.
Для пациентов в возрасте старше 65 лет начальная доза составляет 2.5 мг/сут. При необходимости суточную дозу можно увеличить до 5 мг.
Побочное действие
Со стороны ЦНС и периферической нервной системы: головная боль, головокружение, чувство усталости, парестезии, депрессия, снижение способности к концентрации внимания, сонливость, бессонница, кошмарные сновидения, галлюцинации.
Со стороны пищеварительной системы: тошнота, запор, диарея, сухость во рту.
Со стороны сердечно-сосудистой системы: брадикардия, ортостатическая гипотензия, одышка, отеки, сердечная недостаточность, AV-блокада, нарушения ритма сердца, синдром Рейно, кардиалгии.
Аллергические реакции: кожная сыпь.
Прочие: бронхоспазм (в т.ч. при отсутствии обструктивных заболеваний легких в анамнезе), фотодерматоз, гипергидроз, ринит.
Передозировка
Симптомы: брадикардия, артериальная гипотензия, бронхоспазм и острая сердечная недостаточность.
Лечение: в случае передозировки или реакции гиперчувствительности пациент должен находиться под наблюдением врача и получать лечение в отделении интенсивной терапии. Необходимо определить концентрацию глюкозы крови. Промывание желудка, назначение слабительного средства и энтеросорбентов позволит предотвратить всасывание остатков препарата в ЖКТ.
При лечении брадикардии назначают атропин или метилатропин. При гипотензии проводят заменное переливание плазмы и введение катехоламинов. Эффект блокады β-адренорецепторов может быть устранен путем медленного в/в введения изопреналина гидрохлорида, начиная с дозы 5 мкг/мин, или добутамина, начиная с дозы 2,5 мкг/мин, до получения необходимого эффекта.
В случае отсутствия эффекта следует рассмотреть возможность в/в введения глюкагона 50–100 мкг/кг. При необходимости инъекцию можно повторить через час с последующей инфузией глюкагона в дозе 70 мкг/кг/ч.
Взаимодействие с другими лекарственными средствами
При одновременном применении с антиаритмическими препаратами I класса, амиодароном возможно усиление отрицательного инотропного действия и угнетение AV-проводимости.
При одновременном применении с блокаторами кальциевых каналов (верапамилом и дилтиаземом) усиливается отрицательное инотропное действие и угнетение AV-проводимости.
При одновременном применении с симпатомиметиками подавляется фармакологическая активность небиволола.
При одновременном применении со средствами для наркоза возможно подавление рефлекторной тахикардии и повышение риска развития артериальной гипотензии.
При одновременном применении с трициклическими антидепрессантами, барбитуратами, производными фенотиазина возможно усиление антигипертензивного действия небиволола.
При одновременном применении с циметидином возможно повышение концентрации небиволола в плазме крови.
Особые указания
Небилонг с осторожностью применять у пациентов с почечной недостаточностью, гиперфункцией щитовидной железы, аллергическими заболеваниями, псориазом, лицам в возрасте старше 65 лет и больным сахарным диабетом. Отмену бета-адреноблокаторов следует проводить постепенно, в течение 10 дней (до 2 недель у пациентов с ИБС). В начале лечения следует ежедневно контролировать АД и ЧСС.
Эффективность бета-адреноблокаторов у курильщиков ниже, чем у некурящих. Небиволол не оказывает влияния на уровень глюкозы у пациентов с сахарным диабетом, однако под действием небиволола могут оказаться замаскированными определенные признаки гипогликемии (тахикардия, учащенное сердцебиение), вызванные применением гипогликемических препаратов. При необходимости применения небиволола у пациентов с псориазом следует тщательно оценить ожидаемую пользу терапии и возможный риск обострения псориаза.
Бета-адреноблокаторы следует с осторожностью применять при повышенной функции щитовидной железы в связи с тем, что под влиянием бета-адреноблокаторов тахикардия может нивелирована. Небиволол может усиливать симптомы нарушения периферического кровообращения.
Пациенты, носящие контактные линзы, должны учитывать, что на фоне применения бета-адреноблокаторов возможно снижение продукции слезной жидкости. При проведении хирургических вмешательств следует предупредить анестезиолога о том, что пациент принимает бета-адреноблокаторы.
Контроль содержания глюкозы в плазме крови следует проводить 1 раз в 4-5 мес (у больных сахарным диабетом). Контроль лабораторных показателей функции почек следует проводить 1 раз в 4-5 мес (у пациентов пожилого возраста). Применение у детей не рекомендуется.
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В тех случаях, когда это невозможно, следует обеспечивать строгое наблюдение за новорожденными в течение 48-72 ч после родов."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Взрослым для приема внутрь - 2.5-5 мг/сут. утром."}},{"type":"paragraph","data":{"text":"Оптимальный эффект развивается через 1-2 недели лечения, а в ряде случаев - через 4 недели."}},{"type":"paragraph","data":{"text":"При необходимости суточную дозу увеличивают до 10 мг/сут."}},{"type":"paragraph","data":{"text":"Для пациентов в возрасте старше 65 лет начальная доза составляет 2.5 мг/сут. 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Необходимо определить концентрацию глюкозы крови. Промывание желудка, назначение слабительного средства и энтеросорбентов позволит предотвратить всасывание остатков препарата в ЖКТ."}},{"type":"paragraph","data":{"text":"При лечении брадикардии назначают атропин или метилатропин. При гипотензии проводят заменное переливание плазмы и введение катехоламинов. Эффект блокады β-адренорецепторов может быть устранен путем медленного в/в введения изопреналина гидрохлорида, начиная с дозы 5 мкг/мин, или добутамина, начиная с дозы 2,5 мкг/мин, до получения необходимого эффекта."}},{"type":"paragraph","data":{"text":"В случае отсутствия эффекта следует рассмотреть возможность в/в введения глюкагона 50–100 мкг/кг. При необходимости инъекцию можно повторить через час с последующей инфузией глюкагона в дозе 70 мкг/кг/ч."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"При одновременном применении с антиаритмическими препаратами I класса, амиодароном возможно усиление отрицательного инотропного действия и угнетение AV-проводимости."}},{"type":"paragraph","data":{"text":"При одновременном применении с блокаторами кальциевых каналов (верапамилом и дилтиаземом) усиливается отрицательное инотропное действие и угнетение AV-проводимости."}},{"type":"paragraph","data":{"text":"При одновременном применении с симпатомиметиками подавляется фармакологическая активность небиволола."}},{"type":"paragraph","data":{"text":"При одновременном применении со средствами для наркоза возможно подавление рефлекторной тахикардии и повышение риска развития артериальной гипотензии."}},{"type":"paragraph","data":{"text":"При одновременном применении с трициклическими антидепрессантами, барбитуратами, производными фенотиазина возможно усиление антигипертензивного действия небиволола."}},{"type":"paragraph","data":{"text":"При одновременном применении с циметидином возможно повышение концентрации небиволола в плазме крови."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Небилонг с осторожностью применять у пациентов с почечной недостаточностью, гиперфункцией щитовидной железы, аллергическими заболеваниями, псориазом, лицам в возрасте старше 65 лет и больным сахарным диабетом. Отмену бета-адреноблокаторов следует проводить постепенно, в течение 10 дней (до 2 недель у пациентов с ИБС). В начале лечения следует ежедневно контролировать АД и ЧСС."}},{"type":"paragraph","data":{"text":"Эффективность бета-адреноблокаторов у курильщиков ниже, чем у некурящих. Небиволол не оказывает влияния на уровень глюкозы у пациентов с сахарным диабетом, однако под действием небиволола могут оказаться замаскированными определенные признаки гипогликемии (тахикардия, учащенное сердцебиение), вызванные применением гипогликемических препаратов. При необходимости применения небиволола у пациентов с псориазом следует тщательно оценить ожидаемую пользу терапии и возможный риск обострения псориаза."}},{"type":"paragraph","data":{"text":"Бета-адреноблокаторы следует с осторожностью применять при повышенной функции щитовидной железы в связи с тем, что под влиянием бета-адреноблокаторов тахикардия может нивелирована. Небиволол может усиливать симптомы нарушения периферического кровообращения."}},{"type":"paragraph","data":{"text":"Пациенты, носящие контактные линзы, должны учитывать, что на фоне применения бета-адреноблокаторов возможно снижение продукции слезной жидкости. При проведении хирургических вмешательств следует предупредить анестезиолога о том, что пациент принимает бета-адреноблокаторы."}},{"type":"paragraph","data":{"text":"Контроль содержания глюкозы в плазме крови следует проводить 1 раз в 4-5 мес (у больных сахарным диабетом). Контроль лабораторных показателей функции почек следует проводить 1 раз в 4-5 мес (у пациентов пожилого возраста). Применение у детей не рекомендуется."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"При температуре 15–30 °C"}}]}],"source":null},"description_toggle":false,"short_description":"","substance":[{"id":437,"title":"Небиволол","title_latin":"Nebivololum","slug":"nebivolol_437"}],"branding":null,"valid_for_quick_buy":true,"is_available_to_delivery":false,"comments":null,"image_alt":"Небилонг - фото упаковки","image_share":{"isTouch":{"default":"https://vseapteki.ru/cropping/thumbnails/101/72551/share_default/"},"isFromTablet":{"default":"https://vseapteki.ru/cropping/thumbnails/101/72551/share_default/"}},"diseases":[{"id":"717","title":"Эссенциальная [первичная] гипертензия","slug":"717-essentsialnaya_pervichnaya_gipertenziya"},{"id":"721","title":"Стенокардия","slug":"721-stenokardiya"}],"other_packages":[{"id":99114,"title":"Небилонг","subtitle":{"full":"Таблетки, 30 шт, 5 мг","short":"Таблетки, 30 шт, 5 мг","package":"30 шт, 5 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