Гиповитаминоз Е и повышенная потребность организма в витамине Е (в т. ч. у новорожденных, недоношенных или с низкой массой тела, у детей младшего возраста при недостаточном поступлении витамина Е с пищей, при периферической невропатии, некротизирующей миопатии, абеталипопротеинемии, гастрэктомии, хроническом холестазе, циррозе печени, атрезии желчных ...
прозрачная маслянистая жидкость от светло-желтого до темно-желтого цвета без прогорклого запаха. Допускается зеленоватый оттенок.
Фармакологические свойства
Фармакологическое действие. Жирорастворимый витамин, функция которого до конца остается невыясненной. Как антиоксидант, тормозит развитие свободнорадикальных реакций, предупреждает образование перекисей, повреждающих клеточные и субклеточные мембраны, что имеет важное значение для развития организма, нормальной функции нервной и мышечной систем. Совместно с селеном тормозит окисление ненасыщенных жирных кислот (компонент микросомальной системы переноса электронов), предупреждает гемолиз эритроцитов. Является кофактором некоторых ферментных систем.
Фармакокинетика. Абсорбция из 12-перстной кишки (требует присутствия солей желчных кислот, жиров, нормальной функции поджелудочной железы) –50-80 %. Связывается с бета-липопротеинами крови. При нарушении обмена белков транспорт затрудняется. Время, необходимое для достижения максимальной концентрации (ТСmax) – 4 ч. Депонируется во всех органах и тканях, особенно в жировой ткани. Проникает через плаценту в недостаточных количествах: в кровь плода проникает 20-30 % от концентрации в крови матери. Проникает в грудное молоко.
Метаболизируется в печени до производных, имеющих хиноновую структуру (некоторые из них обладают витаминной активностью). Выводится с желчью – более 90 % (некоторое количество вновь всасывается и подвергается энтерогепатической циркуляции), почками – 6 % (в виде глюкуронидов токоферониевой кислоты и ее гамма-лактона).
Выводится медленно, особенно у недоношенных и новорожденных, у которых возможна его кумуляция.
Показания к применению
Гиповитаминоз Е и повышенная потребность организма в витамине Е (в т. ч. у новорожденных, недоношенных или с низкой массой тела, у детей младшего возраста при недостаточном поступлении витамина Е с пищей, при периферической невропатии, некротизирующей миопатии, абеталипопротеинемии, гастрэктомии, хроническом холестазе, циррозе печени, атрезии желчных путей, обструктивной желтухе, целиакии, тропической спру, болезни Крона, мальабсорбции, при парентеральном питании, беременности (особенно при многоплодной беременности), никотиновой зависимости, наркомании, в период лактации, при приеме колестирамина, колестипола, минеральных масел и железосодержащих продуктов, при назначении диеты с повышенным содержанием полиненасыщенных жирных кислот).
Новорожденным с низкой массой тела: для профилактики развития гемолитической анемии, бронхопульмональной дисплазии, осложнений ретролентальной фиброплазии.
Дозы и длительность лечения гиповитаминоза Е индивидуальны и зависят от тяжести состояния.
Следует учитывать, что 1 капля раствора 50-100-300 мг/мл из глазной пипетки содержит около 1, 2 и 6,5 мг токоферола ацетата соответственно.
Передозировка
Симптомы: при приеме в течение длительного периода в дозах 400 - 800 ЕД/сут (1 мг=1,21 МЕ) – нечеткость зрительного восприятия, головокружение, головная боль, тошнота, необычайная усталость, диарея, гастралгия, астения; при приеме более 800 ЕД/сут в течение длительного периода – увеличение риска развития кровотечений у больных с гиповитаминозом К, нарушение метаболизма тиреоидных гормонов, расстройства сексуальной функции, тромбофлебит, тромбоэмболия.
Лечение - симптоматическое, отмена препарата, назначение глюкокортикостероидов.
Взаимодействие с другими лекарственными средствами
При совместном применении облегчает абсорбцию, депонирование в печени, усвоение и снижает токсичность витамина А.
Назначение витамина Е в высоких дозах может вызвать дефицит витамина А в организме.
Уменьшает токсичность витамина D.
Одновременное применение витамина Е в дозе более 400 ЕД/сут с антикоагулянтами (производными кумарина и индандиона) повышает риск развития гипопротромбинемии и кровотечений.
Колестирамин, колестипол, минеральные масла снижают всасывание витамина Е.
Высокие дозы железа усиливают окислительные процессы в организме, что повышает потребность в витамине Е.
Особые указания
Согласно утвержденным нормам физиологических потребностей в энергии и пищевых веществах для различных групп населения РФ от 2008 г. потребность в витамине Е для детей: до 6 мес – 3 мг, с 6 мес до 3 лет – 4 мг, с 3 до 7 лет – 7 мг, с 7 до 11 лет – 10 мг, с 11 до 14 лет – 12 мг, с 14 до 18 лет – 15 мг. Взрослым – 15 мг/кг, беременным – 17 мг/сут, кормящим матерям – 19 мг/сут. Максимальное суточное потребление – 300 мг/сут.
Токоферолы содержатся в зеленых частях растений, особенно в молодых ростках злаков; большие количества токоферолов обнаружены в растительных маслах (подсолнечном, хлопковом, кукурузном, арахисовом, соевом, облепиховом). Некоторое количество их содержится в мясе, жире, яйцах, молоке.
Следует иметь в виду, что у новорожденных с низкой массой тела возможно возникновение гиповитаминоза Е в связи с низкой проницаемостью плаценты (в крови плода содержится лишь 20-30 % витамина Е от его концентрации в крови матери).
Диета с повышенным содержанием селена и серосодержащих аминокислот снижает потребность в витамине Е.
При рутинном назначении витамина Е новорожденным следует сопоставить пользу с потенциальным риском возникновения некротического энтероколита.
В настоящее время эффективность применения витамина Е считается необоснованной при лечении и профилактике следующих заболеваний: бета-талассемии, онкологических заболеваний, фиброзо-кистозной дисплазии молочной железы, воспалительных заболеваний кожи, выпадения волос, привычного выкидыша, заболеваний сердца, «перемежающейся» хромоты, постменопаузного синдрома, бесплодия, пептической язвы, серповидно-клеточной анемии, ожогов, порфирии, нарушений нервномышечной проводимости, тромбофлебитов, импотенции, укусов пчел, старческого лентиго, бурсита, пеленочного дерматита, легочной интоксикации при загрязнении атмосферы, атеросклероза, старения. Недоказанной считается применение витамина Е для повышения сексуальной активности.
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Допускается зеленоватый оттенок."}}]},{"id":7,"name":"Фармакологические свойства","slug":"pharmacologic_effects","body":[{"type":"paragraph","data":{"text":"Фармакологическое действие. Жирорастворимый витамин, функция которого до конца остается невыясненной. Как антиоксидант, тормозит развитие свободнорадикальных реакций, предупреждает образование перекисей, повреждающих клеточные и субклеточные мембраны, что имеет важное значение для развития организма, нормальной функции нервной и мышечной систем. Совместно с селеном тормозит окисление ненасыщенных жирных кислот (компонент микросомальной системы переноса электронов), предупреждает гемолиз эритроцитов. Является кофактором некоторых ферментных систем."}},{"type":"paragraph","data":{"text":"Фармакокинетика. Абсорбция из 12-перстной кишки (требует присутствия солей желчных кислот, жиров, нормальной функции поджелудочной железы) –50-80 %. Связывается с бета-липопротеинами крови. При нарушении обмена белков транспорт затрудняется. Время, необходимое для достижения максимальной концентрации (ТСmax) – 4 ч. Депонируется во всех органах и тканях, особенно в жировой ткани. Проникает через плаценту в недостаточных количествах: в кровь плода проникает 20-30 % от концентрации в крови матери. Проникает в грудное молоко."}},{"type":"paragraph","data":{"text":"Метаболизируется в печени до производных, имеющих хиноновую структуру (некоторые из них обладают витаминной активностью). Выводится с желчью – более 90 % (некоторое количество вновь всасывается и подвергается энтерогепатической циркуляции), почками – 6 % (в виде глюкуронидов токоферониевой кислоты и ее гамма-лактона)."}},{"type":"paragraph","data":{"text":"Выводится медленно, особенно у недоношенных и новорожденных, у которых возможна его кумуляция."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Гиповитаминоз Е и повышенная потребность организма в витамине Е (в т. ч. у новорожденных, недоношенных или с низкой массой тела, у детей младшего возраста при недостаточном поступлении витамина Е с пищей, при периферической невропатии, некротизирующей миопатии, абеталипопротеинемии, гастрэктомии, хроническом холестазе, циррозе печени, атрезии желчных путей, обструктивной желтухе, целиакии, тропической спру, болезни Крона, мальабсорбции, при парентеральном питании, беременности (особенно при многоплодной беременности), никотиновой зависимости, наркомании, в период лактации, при приеме колестирамина, колестипола, минеральных масел и железосодержащих продуктов, при назначении диеты с повышенным содержанием полиненасыщенных жирных кислот)."}},{"type":"paragraph","data":{"text":"Новорожденным с низкой массой тела: для профилактики развития гемолитической анемии, бронхопульмональной дисплазии, осложнений ретролентальной фиброплазии."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Внутрь."}},{"type":"paragraph","data":{"text":"Профилактика гиповитаминоза Е."}},{"type":"paragraph","data":{"text":"Взрослым и детям от 10 лет: мужчинам – 10 мг/сут (10 капель раствора 50 мг/мл, 5 капель раствора 100 мг/мл или 2 капли раствора 300 мг/мл), женщинам – 8 мг/сут (8 капель раствора 50 мг/мл, 4 капли раствора 100 мг/мл или 1 капля раствора 300 мг/мл), беременным – 10 мг/сут (10 капель раствора 50 мг/мл, 5 капель раствора 100 мг/мл или 2 капли раствора 300 мг/мл), кормящим матерям – 11-12 мг/сут (11-12 капель раствора 50 мг/мл, 5-6 капель раствора 100 мг/мл или 2 капли раствора 300 мг/мл); детям до 3 лет - 3-6 мг/сут (3-6 капель раствора 50 мг/мл, 2-3 капли раствора 100 мг/мл или 1 капля раствора 300 мг/мл), 3-10 лет – 7 мг/сут (7 капель раствора 50 мг/мл, 3 капли раствора 100 мг/мл или 1 капля раствора 300 мг/мл)."}},{"type":"paragraph","data":{"text":"Дозы и длительность лечения гиповитаминоза Е индивидуальны и зависят от тяжести состояния."}},{"type":"paragraph","data":{"text":"Следует учитывать, что 1 капля раствора 50-100-300 мг/мл из глазной пипетки содержит около 1, 2 и 6,5 мг токоферола ацетата соответственно."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Симптомы: при приеме в течение длительного периода в дозах 400 - 800 ЕД/сут (1 мг=1,21 МЕ) – нечеткость зрительного восприятия, головокружение, головная боль, тошнота, необычайная усталость, диарея, гастралгия, астения; при приеме более 800 ЕД/сут в течение длительного периода – увеличение риска развития кровотечений у больных с гиповитаминозом К, нарушение метаболизма тиреоидных гормонов, расстройства сексуальной функции, тромбофлебит, тромбоэмболия."}},{"type":"paragraph","data":{"text":"Лечение - симптоматическое, отмена препарата, назначение глюкокортикостероидов."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"При совместном применении облегчает абсорбцию, депонирование в печени, усвоение и снижает токсичность витамина А."}},{"type":"paragraph","data":{"text":"Назначение витамина Е в высоких дозах может вызвать дефицит витамина А в организме."}},{"type":"paragraph","data":{"text":"Уменьшает токсичность витамина D."}},{"type":"paragraph","data":{"text":"Одновременное применение витамина Е в дозе более 400 ЕД/сут с антикоагулянтами (производными кумарина и индандиона) повышает риск развития гипопротромбинемии и кровотечений."}},{"type":"paragraph","data":{"text":"Колестирамин, колестипол, минеральные масла снижают всасывание витамина Е."}},{"type":"paragraph","data":{"text":"Высокие дозы железа усиливают окислительные процессы в организме, что повышает потребность в витамине Е."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Согласно утвержденным нормам физиологических потребностей в энергии и пищевых веществах для различных групп населения РФ от 2008 г. потребность в витамине Е для детей: до 6 мес – 3 мг, с 6 мес до 3 лет – 4 мг, с 3 до 7 лет – 7 мг, с 7 до 11 лет – 10 мг, с 11 до 14 лет – 12 мг, с 14 до 18 лет – 15 мг. Взрослым – 15 мг/кг, беременным – 17 мг/сут, кормящим матерям – 19 мг/сут. Максимальное суточное потребление – 300 мг/сут."}},{"type":"paragraph","data":{"text":"Токоферолы содержатся в зеленых частях растений, особенно в молодых ростках злаков; большие количества токоферолов обнаружены в растительных маслах (подсолнечном, хлопковом, кукурузном, арахисовом, соевом, облепиховом). Некоторое количество их содержится в мясе, жире, яйцах, молоке."}},{"type":"paragraph","data":{"text":"Следует иметь в виду, что у новорожденных с низкой массой тела возможно возникновение гиповитаминоза Е в связи с низкой проницаемостью плаценты (в крови плода содержится лишь 20-30 % витамина Е от его концентрации в крови матери)."}},{"type":"paragraph","data":{"text":"Диета с повышенным содержанием селена и серосодержащих аминокислот снижает потребность в витамине Е."}},{"type":"paragraph","data":{"text":"При рутинном назначении витамина Е новорожденным следует сопоставить пользу с потенциальным риском возникновения некротического энтероколита."}},{"type":"paragraph","data":{"text":"В настоящее время эффективность применения витамина Е считается необоснованной при лечении и профилактике следующих заболеваний: бета-талассемии, онкологических заболеваний, фиброзо-кистозной дисплазии молочной железы, воспалительных заболеваний кожи, выпадения волос, привычного выкидыша, заболеваний сердца, «перемежающейся» хромоты, постменопаузного синдрома, бесплодия, пептической язвы, серповидно-клеточной анемии, ожогов, порфирии, нарушений нервномышечной проводимости, тромбофлебитов, импотенции, укусов пчел, старческого лентиго, бурсита, пеленочного дерматита, легочной интоксикации при загрязнении атмосферы, атеросклероза, старения. 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