Метоклопрамид Таблетки, 50 шт, 10 мг, цвет белый

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Метоклопрамид может применяться в сочетании с пероральными анальгетиками с целью улучшения абсорбции анальгетиков при острой мигрени."}},{"type":"paragraph","data":{"text":"Подростки 15-18 лет: профилактика отсроченной тошноты и рвоты вызванных химиотерапией - в качестве терапии второй линии."}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"- Повышенная чувствительность к метоклопрамиду или другим компонентам препарата;"}},{"type":"paragraph","data":{"text":"- желудочно-кишечное кровотечение механическая кишечная непроходимость перфорация стенки желудка или кишечника состояния при которых стимуляция перистальтики желудочно-кишечного тракта представляет риск;"}},{"type":"paragraph","data":{"text":"- подтвержденная или подозреваемая феохромоцитома в связи с риском развития тяжелой артериальной гипертензии;"}},{"type":"paragraph","data":{"text":"- эпилепсия (увеличение частоты и тяжести припадков);"}},{"type":"paragraph","data":{"text":"- болезнь Паркинсона;"}},{"type":"paragraph","data":{"text":"- поздняя дискинезия которая развилась после лечения нейролептиками или метоклопрамидом в анамнезе;"}},{"type":"paragraph","data":{"text":"- одновременное назначение с леводопой или агонистами дофаминергических рецепторов;"}},{"type":"paragraph","data":{"text":"- метгемоглобинемия вследствие приема метоклопрамида или дефицита никотинамидадениндинуклеотида (НАДН) цитохрома-b5 в анамнезе;"}},{"type":"paragraph","data":{"text":"- пролактинзависимые опухоли;"}},{"type":"paragraph","data":{"text":"- беременность (III триместр);"}},{"type":"paragraph","data":{"text":"- период грудного вскармливания;"}},{"type":"paragraph","data":{"text":"- глюкозо-галактозная мальабсорбция недостаточность лактазы;"}},{"type":"paragraph","data":{"text":"- детский возраст до 15 лет."}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"Пожилой возраст; почечная/печеночная недостаточность; бронхиальная астма; нарушение сердечной проводимости (включая удлинение интервала QT); нарушение водно-электролитного баланса; брадикардия; одновременный прием других препаратов; удлиняющих интервал QT; артериальная гипертензия; сопутствующие неврологические заболевания; одновременный прием препаратов воздействующих на центральную нервную систему; депрессия (в анамнезе); беременность (I II триместр)."}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"Метоклопрамид противопоказан в III триместре беременности в связи с риском развития у новорожденных экстрапирамидных расстройств. При применении метоклопрамида у беременных следует проводить наблюдение за новорожденными. Метоклопрамид выделяется с грудным молоком. Не рекомендуется применение метоклопрамида в период кормления грудью при необходимости применения препарата следует прекратить грудное вскармливание."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Внутрь за 30 минут до еды запивая небольшим количеством воды."}},{"type":"paragraph","data":{"text":"Взрослые: рекомендуемая разовая доза составляет 10 мг до 3 раз в сутки. Максимальная суточная доза - 30 мг."}},{"type":"paragraph","data":{"text":"Подростки 15-18 лет: по 10 мг до 3 раз в сутки. Максимальная суточная доза составляет 30 мг."}},{"type":"paragraph","data":{"text":"Таблетки не назначают подросткам с массой тела менее 61 кг."}},{"type":"paragraph","data":{"text":"Максимальная продолжительность лечения составляет 5 дней."}},{"type":"paragraph","data":{"text":"Следует соблюдать 6-часовой интервал между приемом препарата даже в случае рвоты или если доза не была абсорбирована."}},{"type":"paragraph","data":{"text":"Особые группы пациентов"}},{"type":"paragraph","data":{"text":"Пожилые пациенты"}},{"type":"paragraph","data":{"text":"Следует рассмотреть вопрос о снижении дозы с учетом функции почек и печени а также общего состояния пациента."}},{"type":"paragraph","data":{"text":"Нарушение функции почек"}},{"type":"paragraph","data":{"text":"У пациентов с терминальной стадией почечной недостаточности (клиренс креатинина < 15 мл/мин) суточная доза должна быть снижена на 75%."}},{"type":"paragraph","data":{"text":"У пациентов с умеренным или тяжелым нарушением функции почек (клиренс креатинина 15-60 мл/мин) доза должна быть снижена наполовину."}},{"type":"paragraph","data":{"text":"Нарушение функции печени"}},{"type":"paragraph","data":{"text":"У пациентов с тяжелым нарушением функции печени доза должна быть снижена наполовину."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Частота нежелательных реакций приводится в соответствии с классификацией: очень часто (≥ 1/10); часто (≥1/100 <1/10); нечасто (≥1/1000 <1/100); редко (≥1/10000 <1/1000); очень редко (<1/10000); частота неизвестна (частоту невозможно оценить на основе имеющихся данных)."}},{"type":"paragraph","data":{"text":"Нарушения со стороны крови и лимфатической системы: частота неизвестна - метгемоглобинемия вероятно связанная с дефицитом фермента НАДН-зависимой цитохром-b5 редуктазы (особенно у новорожденных) сульфгемоглобинемия (чаще всего при одновременном применении высоких доз серосодержащих препаратов)."}},{"type":"paragraph","data":{"text":"Нарушения со стороны сердца: нечасто - брадикардия; частота неизвестна - остановка сердца которая может быть вызвана брадикардией атриовентрикулярная блокада блокада синусного узла удлинение интервала QT на электрокардиограмме аритмия типа \"пируэт\"."}},{"type":"paragraph","data":{"text":"Нарушения со стороны сосудов: часто - понижение артериального давления; частота неизвестна - кардиогенный шок острое повышение артериального давления у пациентов с феохромоцитомой."}},{"type":"paragraph","data":{"text":"Нарушения со стороны эндокринной системы*: нечасто - аменорея гиперпролактинемия; редко - галакторея; частота неизвестна - гинекомастия."}},{"type":"paragraph","data":{"text":"* Эндокринные нарушения во время продолжительного лечения связаны с гиперпролактинемией (аменорея галакторея гинекомастия)."}},{"type":"paragraph","data":{"text":"Нарушения со стороны желудочно-кишечного тракта: часто -диарея; редко - сухость во рту."}},{"type":"paragraph","data":{"text":"Нарушения со стороны иммунной системы: нечасто - реакции гиперчувствительности; частота неизвестна - анафилактические реакции (в том числе анафилактический шок). Нарушения со стороны нервной системы: очень часто - сонливость; часто -экстрапирамидные расстройства (особенно у детей и молодых пациентов и/или при превышении рекомендованных доз препарата даже после однократного введения) паркинсонизм акатизия; нечасто - дистония дискинезия нарушение сознания; редко -судороги особенно у пациентов с эпилепсией; частота неизвестна - поздняя дискинезия иногда персистирующая во время или после длительного лечения особенно у пожилых пациентов злокачественный нейролептический синдром."}},{"type":"paragraph","data":{"text":"Нарушения психики: часто - депрессия; нечасто - галлюцинации; редко - спутанность сознания."}},{"type":"paragraph","data":{"text":"Общие расстройства и нарушения в месте введения: часто - астения."}},{"type":"paragraph","data":{"text":"Нежелательные реакции наиболее часто встречающиеся при применении высоких доз препарата:"}},{"type":"paragraph","data":{"text":"- Экстрапирамидные симптомы: острая дистония и дискинезия синдром паркинсонизма акатизия развивались даже после применения однократной дозы препарата особенно у детей и молодых пациентов (см. раздел \"Особые указания\")."}},{"type":"paragraph","data":{"text":"- Сонливость снижение уровня сознания спутанность сознания галлюцинации."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Симптомы: экстрапирамидные расстройства сонливость снижение уровня сознания спутанность сознания галлюцинации остановка сердца и дыхания."}},{"type":"paragraph","data":{"text":"Лечение: В случае развития экстрапирамидных симптомов вызванных передозировкой или по другой причине лечение носит исключительно симптоматический характер (бензодиазепины у детей и/или антихолинергические противопаркинсонические препараты у взрослых)."}},{"type":"paragraph","data":{"text":"Требуется симптоматическое лечение и постоянный контроль сердечной и дыхательной функции в зависимости от клинического состояния пациента."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Противопоказанные комбинации"}},{"type":"paragraph","data":{"text":"Одновременное применение метоклопрамида с леводопой или антагонистами дофаминовых рецепторов противопоказано в связи с имеющимся взаимным антагонизмом."}},{"type":"paragraph","data":{"text":"Комбинации которые следует избегать"}},{"type":"paragraph","data":{"text":"Алкоголь усиливает седативный эффект метоклопрамида."}},{"type":"paragraph","data":{"text":"Комбинации которые следует принимать во внимание"}},{"type":"paragraph","data":{"text":"В связи с прокинетическим эффектом метоклопрамида всасывание некоторых препаратов может нарушаться."}},{"type":"paragraph","data":{"text":"М-холиноблокаторы и производные морфина обладают взаимным антагонизмом с метоклопрамидом в отношении влияния на перистальтику желудочно-кишечного тракта. Лекарственные препараты угнетающие ЦНС (производные морфина транквилизаторы блокаторы Н1-гистаминовых рецепторов антидепрессанты с седативным эффектом барбитураты клонидин и прочие препараты этих групп) могут усиливать седативный эффект под влиянием метоклопрамида."}},{"type":"paragraph","data":{"text":"Метоклопрамид усиливает действие нейролептиков в отношении экстрапирамидных симптомов."}},{"type":"paragraph","data":{"text":"Применение метоклопрамида с серотонинергическими препаратами например с селективными ингибиторами обратного захвата серотонина повышает риск развития серотонинового синдрома (серотониновая интоксикация)."}},{"type":"paragraph","data":{"text":"Метоклопрамид снижает биодоступность дигоксина. Следует контролировать концентрацию дигоксина в плазме крови."}},{"type":"paragraph","data":{"text":"Метоклопрамид повышает биодоступность циклоспорина (С\u003csub\u003emах\u003c/sub\u003e на 46% и экспозицию на 22%). Необходимо регулярно контролировать концентрацию циклоспорина в плазме крови. Клинические последствия такого взаимодействия не установлены."}},{"type":"paragraph","data":{"text":"При одновременном назначении метоклопрамида с суксаметонием может увеличиваться продолжительность нейро-мышечной блокады (за счет ингибирования холинэстеразы в плазме)."}},{"type":"paragraph","data":{"text":"Экспозиция метоклопрамида увеличивается при одновременном применении с мощными ингибиторами изофермента CYP2D6 например флуоксетином и пароксетином. Хотя клиническая значимость такого взаимодействия не установлена необходимо следить за появлением у пациентов побочных реакций."}},{"type":"paragraph","data":{"text":"Метоклопрамид повышает всасывание тетрациклина ампициллина парацетамола ацетилсалициловой кислоты; замедляет всасывание циметидина."}},{"type":"paragraph","data":{"text":"Одновременное применение с лекарственными препаратами обладающими центральным стимулирующим действием (например ингибиторами моноаминооксидазы и симпатомиметиками) может приводить к изменению их эффекта что может потребовать корректировки дозировок."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Не эффективен при рвоте вестибулярного генеза."}},{"type":"paragraph","data":{"text":"Не назначают после операций на желудочно-кишечном тракте (как пилоропластика или анастомоз кишечника) поскольку энергичные мышечные сокращения препятствуют заживлению."}},{"type":"paragraph","data":{"text":"На фоне применения метоклопрамида возможны искажения данных лабораторных показателей функции печени и определения концентрации альдостерона и пролактина в плазме."}},{"type":"paragraph","data":{"text":"При назначении метоклопрамида чаще в высоких дозах могут развиваться экстрапирамидные расстройства особенно у детей и пациентов молодого возраста даже после введения одной дозы."}},{"type":"paragraph","data":{"text":"Необходимо соблюдать осторожность при применении у пациентов с сопутствующими неврологическими заболеваниями и у пациентов принимающих препараты воздействующие на центральную нервную систему."}},{"type":"paragraph","data":{"text":"При применении препарата также могут отмечаться симптомы болезни Паркинсона. Сообщалось о случаях возникновения метгемоглобинемии которая могла быть вызвана дефицитом фермента НАДН-зависимой цитохром-b5 редуктазы. В этом случае прием препарата необходимо незамедлительно прекратить и предпринять соответствующие меры."}},{"type":"paragraph","data":{"text":"Сообщалось о случаях тяжелых сердечно-сосудистых побочных эффектах включая сосудистую недостаточность выраженную брадикардию остановку сердца и удлинение интервала QT после введения метоклопрамида."}},{"type":"paragraph","data":{"text":"Особую осторожность следует соблюдать при назначении внутривенно пациентам с синдромом \"слабого синуса\" или другими нарушениями проводимости сердечной мышцы (включая удлинение интервала QT) пожилым пациентам пациентам с нарушениями электролитного баланса брадикардией а также при приеме препаратов удлиняющих интервал QT."}},{"type":"paragraph","data":{"text":"Большинство побочных эффектов возникают в течение 36 часов от начала лечения и исчезают в течение 24 часов после отмены. Курс лечения должен быть по возможности кратковременным."}},{"type":"paragraph","data":{"text":"В период лечения препаратом не рекомендовано употребление алкоголя."}}]},{"id":17,"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","body":[{"type":"paragraph","data":{"text":"При приеме препарата следует избегать потенциально опасных видов деятельности требующих повышенного внимания быстрой психической и двигательной реакции (управление транспортными средствами и др.) в связи с возможным развитием таких побочных эффектов как головокружение сонливость дискинезия дистония."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Таблетки 10 мг."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"При температуре не выше 25 °С."}},{"type":"paragraph","data":{"text":"Хранить в недоступном для детей месте."}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"3 года."}},{"type":"paragraph","data":{"text":"Не применять препарат 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":"Фармацевтический завод \"Польфарма\" АО, , Польша"}}]},{"id":23,"name":"Организация, принимающая претензии потребителей","body":[{"type":"paragraph","data":{"text":"Фармацевтический завод \"Польфарма\" АО"}}]}],"source":null},"description_toggle":false,"short_description":"Метоклопрамид является специфическим блокатором дофаминовых (D2) и серотониновых (5-НТ3) рецепторов. Оказывает противорвотное действие вследствие воздействия на хеморецепторы триггерной зоны продолговатого мозга. Препарат оказывает регулирующее и нормализующее влияние на деятельность желудочно-кишечного тракта. Понижает двигательную активность пищевода повышает тонус нижнего сфинктера пищевода ускоряет опорожнение желудка а также ускоряет продвижение пищи по тонкой кишке не вызывая диарею. Стимулирует секрецию пролактина. При пероральном приеме действие начинается через 30-60 минут. Длительность действия составляет 1 -2 часа. Метоклопрамид быстро всасывается из желудочно-кишечного тракта. Биодоступность составляет 80 ± 15%. Связывается с белками плазмы (13%-22%) в частности с альбуминами. Максимальные концентрации в крови пропорциональны принимаемой дозе пик концентрации в крови наблюдается через 1-2 часа. Период полувыведения составляет от 25 до 6 часов при нарушении функции почек-до 14 часов. Метаболизируется в печени. Выведение в основном через почки в течение 72 часов в неизменном виде и в виде конъюгатов. Метоклопрамид проходит через плацентарный и гематоэнцефалический барьеры и проникает в грудное молоко. Фармакокинетика в особых клинических случаях Нарушение функции почек У пациентов с тяжелым нарушением функции почек клиренс метоклопрамида снижается на 70% в то время как период полувыведения из плазмы увеличивается (приблизительно 10 часов при клиренсе креатинина 10-50 мл/мин и 15 часов при клиренсе креатинина\u003c10 мл/мин). 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