Острая фаза геморрагического инсульта, тяжелая форма ишемической болезни сердца, тяжелые нарушения ритма сердца.
Гиперчувствительность к винпоцетину или другим компонентам препарата.
Беременность, период кормления грудью.
Детский возраст до 18 лет (вследствие отсутствия данных клинических исследований).
Инструкция
Состав
Одна ампула содержит:
действующее вещество:
винпоцетин - 5 мг;
вспомогательные вещества:
аскорбиновая кислота - 0,5 мг,
бензиловый спирт - 10 мг,
натрия дисульфит (натрия метабисульфит) - 1 мг,
сорбитол (сорбит) - 75 мг,
винная кислота - 3 мг,
вода для инъекций - до 1 мл.
Фармакологические свойства
Психостимулирующее и ноотропное средство
Фармакодинамика:
Механизм действия винпоцетина складывается из нескольких элементов: он улучшает мозговой кровоток и обмен веществ, оказывает благоприятное воздействие на реологические свойства крови.
Нейропротекторное действие реализуется за счет снижения неблагоприятного цитотоксического влияния возбуждающих аминокислот. Блокирует Na- и Са2+-каналы и NMDA- и АМРА-рецепторы. Селективно ингибирует Са2+-кальмодулинзависимую-цГМФ-фосфодиэстеразу. Повышает обмен серотонина и норадреналина в головном мозге, стимулирует норадренергическую нейромедиаторную систему и оказывает антиоксидантное действие.
Улучшает микроциркуляцию в головном мозге за счет ингибирования агрегации тромбоцитов, снижения патологически повышенной вязкости крови, увеличения деформируемости эритроцитов и ингибирования обратного захвата аденозина; способствует переходу кислорода в клетки за счет снижения сродства к нему эритроцитов.
Избирательно увеличивает мозговой кровоток за счет снижения церебрального сосудистого сопротивления без существенного влияния на системные показатели кровообращения (артериальное давление (АД), сердечный выброс, частоту сердечных сокращений, общее периферическое сосудистое сопротивление); не вызывает эффект "обкрадывания".
Фармакокинетика:
Распределение
Распределение радиоактивно меченого винпоцетина, при введении крысам, наибольшая радиоактивность обнаруживалась в печени и желудочно-кишечном тракте. Максимальная концентрация в тканях отмечалась через 2-4 ч после введения. Концентрация в головном мозге не превышала значений, обнаруженных в крови.
У человека связь с белками плазмы составляет 66%. Биодоступность около 7%. Объем распределения 246,7±88,5 л, что свидетельствует о высоком связывании с тканями. Общий клиренс (66,7 л/ч) превышает скорость печеночного кровотока (50 л/ч), что указывает на внепеченочный метаболизм.
Метаболизм
Основным метаболитом является аповинкаминовая кислота (АВК), составляющая 25-30% от исходного соединения. Площадь под кривой "концентрация-время" АВК после приема внутрь вдвое превышает таковую при внутривенном введении винпоцетина. Таким образом, винпоцетин подвержен выраженному эффекту "первого прохождения" через печень.
К прочим метаболитам относятся: гидроксивинпоцетин, гидрокси-АВК, АВК-диоксиглицинат и их конъюгаты (сульфаты и (или) глюкурониды). Выведение неизмененного винпоцетина низкое (несколько процентов).
При нарушении функции печени или почек коррекция дозы не требуется, поскольку винпоцетин не кумулирует.
Выведение
При многократном введении в дозе 5 и 10 мг винпоцетин проявляет линейную фармакокинетику, равновесная плазменная концентрация составляет 1,2±0,27 и 2,1±0,33 нг/мл соответственно. Период полувыведения у человека составляет 4,83±1,29 ч. В исследованиях с радиоактивно меченым винпоцетином установлено, что выведение почками и кишечником происходит в соотношении 60:40%.
У крыс и собак высокая концентрация обнаруживается в желчи, однако отмечена значительная энтерогепатическая рециркуляция.
Фармакокинетика у особых групп пациентов
Поскольку винпоцетин предназначен в первую очередь для лечения пожилых, необходимо учитывать замедление распределения и метаболизма, а также выведения у этой возрастной группы, особенно при длительном применении. По результатам клинических исследований установлено, что кинетика винпоцетина у пожилых существенно не отличается от молодых, кумуляции не происходит.
При нарушениях функции печени и почек кумуляция не отмечается, что позволяет проводить длительную терапию.
Офтальмология: хронические сосудистые заболевания сетчатки и сосудистой оболочки глаза.
Отология: снижение слуха перцептивного типа, болезнь Меньера, ощущение шума в ушах, ухудшение слуха сосудистого или токсического (в том числе медикаментозного) генеза.
Противопоказания
Острая фаза геморрагического инсульта, тяжелая форма ишемической болезни сердца, тяжелые нарушения ритма сердца.
Гиперчувствительность к винпоцетину или другим компонентам препарата.
Беременность, период кормления грудью.
Детский возраст до 18 лет (вследствие отсутствия данных клинических исследований).
Применение при беременности и в период грудного вскармливания
Применение во время беременности и в период кормления грудью противопоказано.
Беременность
Винпоцетин проникает через плаценту, но плазменная концентрация, в плаценте и у плода ниже, чем у матери. Тератогенное и эмбриотоксическое действие не выявлено. В исследованиях на животных при введении высоких доз возникали плацентарные кровотечения и аборты (предположительно вследствие увеличения плацентарного кровотока).
Кормление грудью
Винпоцетин проникает в грудное молоко. Согласно доклиническим исследованиям с радиоактивно меченым винпоцетином его концентрация в грудном молоке животных превышала таковую в крови матери в 10 раз. За 1 ч в молоко проникает 0,25% принятой дозы.
Поскольку винпоцетин проникает в грудное молоко и опыт его применения у детей отсутствует, применение в период грудного вскармливания противопоказано.
Способ применения и дозы
Препарат предназначен только для внутривенной капельной инфузии, вводить медленно (скорость инфузии не должна превышать 80 капель/мин).
Внутривенное введение неразведенного препарата не допускается. Инфузионный раствор следует ввести в течение 3 часов с момента приготовления!
Для приготовления инфузии можно использовать раствор натрия хлорида 0,9% или растворы, содержащие декстрозу.
Начальная суточная доза 20 мг в 500 мл инфузионного раствора. В зависимости от переносимости, в течение 2-3 дней дозу можно увеличить не более чем до 1 мг/кг/день. Средняя продолжительность лечения 10-14 дней.
Средняя суточная доза при массе тела 70 кг - 50 мг.
При заболеваниях печени или почек коррекция дозы не требуется.
После окончания курса парентерального введения переходят на пероральный прием препарата (по 10 мг 3 раза в сутки). Перед отменой препарата дозу следует постепенно уменьшать.
Побочное действие
Нежелательные реакции классифицируются в зависимости от частоты их возникновения: 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 (из-за недостаточности данных).
Нарушения со стороны крови и лимфатической системы: редко - тромбоцитопения, агглютинация эритроцитов; очень редко - анемия.
Нарушения со стороны иммунной системы: очень редко - гиперчувствительность.
Нарушения метаболизма и питания: редко - гиперхолестеринемия, сахарный диабет, снижение аппетита; очень редко - анорексия.
Психические расстройства: нечасто - эйфория; редко - беспокойство; очень редко - депрессия, нарушение сна.
Нарушения со стороны нервной системы: редко - головная боль, головокружение, гемипарез, сонливость; очень редко - тремор, потеря сознания, гипотензия, предобморочное состояние.
Нарушения со стороны органа зрения: редко - кровоизлияние в переднюю камеру глаза, гиперметропия, снижение остроты зрения, миопия; очень редко - гиперемия конъюнктивы, отек диска зрительного нерва, диплопия.
Нарушения со стороны органа слуха и лабиринта: редко - нарушение слуха, гиперакузия, гипоакузия, истинное головокружение; очень редко - шум в ушах.
Нарушения со стороны сердца: редко - ишемия/инфаркт миокарда, стенокардия, брадикардия, тахикардия, экстрасистолия, сердцебиение; очень редко - сердечная недостаточность, фибрилляция предсердий, аритмия.
Сосудистые нарушения: редко - гипотензия, гипертензия, приливы; очень редко - колебания артериального давления, тромбофлебит.
Нарушения со стороны желудочно-кишечного тракта: редко - дискомфорт в животе, боль в эпигастрии, сухость во рту, тошнота; очень редко - гиперсекреция слюны, рвота, дисфагия, стоматит.
Патология кожи и подкожной клетчатки: редко - эритема, гипергидроз, крапивница; очень редко - дерматит, зуд.
Общие нарушения и реакции в месте введения: редко - астения, недомогание, чувство жжения и воспаление в месте инъекции, тромбоз, дискомфорт в грудной клетке.
Лабораторные нарушения: нечасто - снижение артериального давления; редко - повышение артериального давления; гипертриглицеридемия, депрессия сегмента ST, эозинопения, нарушение функциональных проб печени, удлинение сегмента QT; очень редко - повышение ЛДГ, аномальная ЭЭГ, PR продление.
Взаимодействие с другими лекарственными средствами
По результатам клинических исследований лекарственного взаимодействия с β-адреноблокаторами (пиндолол), клопамидом, глибенкламидом, дигоксином, гидрохлортиазидом и аценокумаролом не обнаружено.
Метилдопа может усиливать гипотензивное действие винпоцетина, поэтому при их одновременном применении требуется систематический контроль АД.
Несмотря на отсутствие клинических данных, одновременное применение со средствами, влияющими на центральную нервную систему, антикоагулянтами и антиаритмиками следует проводить с осторожностью.
Раствор винпоцетина фармацевтически несовместим с гепарином и растворами, содержащими аминокислоты.
Особые указания
Препарат следует применять с осторожностью при внутричерепной гипертензии, при одновременном применении с противоаритмическими лекарственными средствами, а также при синдроме удлиненного интервала QT или одновременном применении с препаратами, удлиняющими интервал QT. При синдроме удлиненного интервала QT или одновременном применении средств, удлиняющих интервал QT, следует осуществлять ЭКГ-мониторинг.
Влияние на способность управлять трансп. ср. и мех.:
Исследования о влиянии на способность управлять транспортными средствами не проводились. При возникновении нежелательных реакций со стороны нервной системы следует соблюдать осторожность при управлении транспортными средствами и работе с движущимися механизмами.
Условия хранения
В защищенном от света месте, при температуре не выше 25 °С.
Хранить в недоступном для детей месте.
Срок годности
2 года.
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Блокирует Na- и Са2+-каналы и NMDA- и АМРА-рецепторы. Селективно ингибирует Са2+-кальмодулинзависимую-цГМФ-фосфодиэстеразу. Повышает обмен серотонина и норадреналина в головном мозге, стимулирует норадренергическую нейромедиаторную систему и оказывает антиоксидантное действие."}},{"type":"paragraph","data":{"text":"Улучшает микроциркуляцию в головном мозге за счет ингибирования агрегации тромбоцитов, снижения патологически повышенной вязкости крови, увеличения деформируемости эритроцитов и ингибирования обратного захвата аденозина; способствует переходу кислорода в клетки за счет снижения сродства к нему эритроцитов."}},{"type":"paragraph","data":{"text":"Избирательно увеличивает мозговой кровоток за счет снижения церебрального сосудистого сопротивления без существенного влияния на системные показатели кровообращения (артериальное давление (АД), сердечный выброс, частоту сердечных сокращений, общее периферическое сосудистое сопротивление); не вызывает эффект \"обкрадывания\"."}},{"type":"paragraph","data":{"text":"Фармакокинетика:"}},{"type":"paragraph","data":{"text":"Распределение"}},{"type":"paragraph","data":{"text":"Распределение радиоактивно меченого винпоцетина, при введении крысам, наибольшая радиоактивность обнаруживалась в печени и желудочно-кишечном тракте. Максимальная концентрация в тканях отмечалась через 2-4 ч после введения. Концентрация в головном мозге не превышала значений, обнаруженных в крови."}},{"type":"paragraph","data":{"text":"У человека связь с белками плазмы составляет 66%. Биодоступность около 7%. Объем распределения 246,7±88,5 л, что свидетельствует о высоком связывании с тканями. Общий клиренс (66,7 л/ч) превышает скорость печеночного кровотока (50 л/ч), что указывает на внепеченочный метаболизм."}},{"type":"paragraph","data":{"text":"Метаболизм"}},{"type":"paragraph","data":{"text":"Основным метаболитом является аповинкаминовая кислота (АВК), составляющая 25-30% от исходного соединения. Площадь под кривой \"концентрация-время\" АВК после приема внутрь вдвое превышает таковую при внутривенном введении винпоцетина. Таким образом, винпоцетин подвержен выраженному эффекту \"первого прохождения\" через печень."}},{"type":"paragraph","data":{"text":"К прочим метаболитам относятся: гидроксивинпоцетин, гидрокси-АВК, АВК-диоксиглицинат и их конъюгаты (сульфаты и (или) глюкурониды). Выведение неизмененного винпоцетина низкое (несколько процентов)."}},{"type":"paragraph","data":{"text":"При нарушении функции печени или почек коррекция дозы не требуется, поскольку винпоцетин не кумулирует."}},{"type":"paragraph","data":{"text":"Выведение"}},{"type":"paragraph","data":{"text":"При многократном введении в дозе 5 и 10 мг винпоцетин проявляет линейную фармакокинетику, равновесная плазменная концентрация составляет 1,2±0,27 и 2,1±0,33 нг/мл соответственно. Период полувыведения у человека составляет 4,83±1,29 ч. В исследованиях с радиоактивно меченым винпоцетином установлено, что выведение почками и кишечником происходит в соотношении 60:40%."}},{"type":"paragraph","data":{"text":"У крыс и собак высокая концентрация обнаруживается в желчи, однако отмечена значительная энтерогепатическая рециркуляция."}},{"type":"paragraph","data":{"text":"Фармакокинетика у особых групп пациентов"}},{"type":"paragraph","data":{"text":"Поскольку винпоцетин предназначен в первую очередь для лечения пожилых, необходимо учитывать замедление распределения и метаболизма, а также выведения у этой возрастной группы, особенно при длительном применении. По результатам клинических исследований установлено, что кинетика винпоцетина у пожилых существенно не отличается от молодых, кумуляции не происходит."}},{"type":"paragraph","data":{"text":"При нарушениях функции печени и почек кумуляция не отмечается, что позволяет проводить длительную терапию."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Неврология: транзиторная ишемическая атака, симптоматическая терапия последствий ишемического инсульта, сосудистой вертебробазилярной недостаточности, сосудистой деменции, атеросклероза сосудов головного мозга, посттравматической, гипертонической энцефалопатии."}},{"type":"paragraph","data":{"text":"Офтальмология: хронические сосудистые заболевания сетчатки и сосудистой оболочки глаза."}},{"type":"paragraph","data":{"text":"Отология: снижение слуха перцептивного типа, болезнь Меньера, ощущение шума в ушах, ухудшение слуха сосудистого или токсического (в том числе медикаментозного) генеза."}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"Острая фаза геморрагического инсульта, тяжелая форма ишемической болезни сердца, тяжелые нарушения ритма сердца."}},{"type":"paragraph","data":{"text":"Гиперчувствительность к винпоцетину или другим компонентам препарата."}},{"type":"paragraph","data":{"text":"Беременность, период кормления грудью."}},{"type":"paragraph","data":{"text":"Детский возраст до 18 лет (вследствие отсутствия данных клинических исследований)."}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"Применение во время беременности и в период кормления грудью противопоказано."}},{"type":"paragraph","data":{"text":"Беременность"}},{"type":"paragraph","data":{"text":"Винпоцетин проникает через плаценту, но плазменная концентрация, в плаценте и у плода ниже, чем у матери. Тератогенное и эмбриотоксическое действие не выявлено. В исследованиях на животных при введении высоких доз возникали плацентарные кровотечения и аборты (предположительно вследствие увеличения плацентарного кровотока)."}},{"type":"paragraph","data":{"text":"Кормление грудью"}},{"type":"paragraph","data":{"text":"Винпоцетин проникает в грудное молоко. Согласно доклиническим исследованиям с радиоактивно меченым винпоцетином его концентрация в грудном молоке животных превышала таковую в крови матери в 10 раз. За 1 ч в молоко проникает 0,25% принятой дозы."}},{"type":"paragraph","data":{"text":"Поскольку винпоцетин проникает в грудное молоко и опыт его применения у детей отсутствует, применение в период грудного вскармливания противопоказано."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Препарат предназначен только для внутривенной капельной инфузии, вводить медленно (скорость инфузии не должна превышать 80 капель/мин)."}},{"type":"paragraph","data":{"text":"Внутривенное введение неразведенного препарата не допускается. Инфузионный раствор следует ввести в течение 3 часов с момента приготовления!"}},{"type":"paragraph","data":{"text":"Для приготовления инфузии можно использовать раствор натрия хлорида 0,9% или растворы, содержащие декстрозу."}},{"type":"paragraph","data":{"text":"Начальная суточная доза 20 мг в 500 мл инфузионного раствора. В зависимости от переносимости, в течение 2-3 дней дозу можно увеличить не более чем до 1 мг/кг/день. Средняя продолжительность лечения 10-14 дней."}},{"type":"paragraph","data":{"text":"Средняя суточная доза при массе тела 70 кг - 50 мг."}},{"type":"paragraph","data":{"text":"При заболеваниях печени или почек коррекция дозы не требуется."}},{"type":"paragraph","data":{"text":"После окончания курса парентерального введения переходят на пероральный прием препарата (по 10 мг 3 раза в сутки). Перед отменой препарата дозу следует постепенно уменьшать."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Нежелательные реакции классифицируются в зависимости от частоты их возникновения: 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 (из-за недостаточности данных)."}},{"type":"paragraph","data":{"text":"Нарушения со стороны крови и лимфатической системы: редко - тромбоцитопения, агглютинация эритроцитов; очень редко - анемия."}},{"type":"paragraph","data":{"text":"Нарушения со стороны иммунной системы: очень редко - гиперчувствительность."}},{"type":"paragraph","data":{"text":"Нарушения метаболизма и питания: редко - гиперхолестеринемия, сахарный диабет, снижение аппетита; очень редко - анорексия."}},{"type":"paragraph","data":{"text":"Психические расстройства: нечасто - эйфория; редко - беспокойство; очень редко - депрессия, нарушение сна."}},{"type":"paragraph","data":{"text":"Нарушения со стороны нервной системы: редко - головная боль, головокружение, гемипарез, сонливость; очень редко - тремор, потеря сознания, гипотензия, предобморочное состояние."}},{"type":"paragraph","data":{"text":"Нарушения со стороны органа зрения: редко - кровоизлияние в переднюю камеру глаза, гиперметропия, снижение остроты зрения, миопия; очень редко - гиперемия конъюнктивы, отек диска зрительного нерва, диплопия."}},{"type":"paragraph","data":{"text":"Нарушения со стороны органа слуха и лабиринта: редко - нарушение слуха, гиперакузия, гипоакузия, истинное головокружение; очень редко - шум в ушах."}},{"type":"paragraph","data":{"text":"Нарушения со стороны сердца: редко - ишемия/инфаркт миокарда, стенокардия, брадикардия, тахикардия, экстрасистолия, сердцебиение; очень редко - сердечная недостаточность, фибрилляция предсердий, аритмия."}},{"type":"paragraph","data":{"text":"Сосудистые нарушения: редко - гипотензия, гипертензия, приливы; очень редко - колебания артериального давления, тромбофлебит."}},{"type":"paragraph","data":{"text":"Нарушения со стороны желудочно-кишечного тракта: редко - дискомфорт в животе, боль в эпигастрии, сухость во рту, тошнота; очень редко - гиперсекреция слюны, рвота, дисфагия, стоматит."}},{"type":"paragraph","data":{"text":"Патология кожи и подкожной клетчатки: редко - эритема, гипергидроз, крапивница; очень редко - дерматит, зуд."}},{"type":"paragraph","data":{"text":"Общие нарушения и реакции в месте введения: редко - астения, недомогание, чувство жжения и воспаление в месте инъекции, тромбоз, дискомфорт в грудной клетке."}},{"type":"paragraph","data":{"text":"Лабораторные нарушения: нечасто - снижение артериального давления; редко - повышение артериального давления; гипертриглицеридемия, депрессия сегмента ST, эозинопения, нарушение функциональных проб печени, удлинение сегмента QT; очень редко - повышение ЛДГ, аномальная ЭЭГ, PR продление."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"\n\nПо результатам клинических исследований лекарственного взаимодействия с β-адреноблокаторами (пиндолол), клопамидом, глибенкламидом, дигоксином, гидрохлортиазидом и аценокумаролом не обнаружено."}},{"type":"paragraph","data":{"text":"Метилдопа может усиливать гипотензивное действие винпоцетина, поэтому при их одновременном применении требуется систематический контроль АД."}},{"type":"paragraph","data":{"text":"Несмотря на отсутствие клинических данных, одновременное применение со средствами, влияющими на центральную нервную систему, антикоагулянтами и антиаритмиками следует проводить с осторожностью."}},{"type":"paragraph","data":{"text":"Раствор винпоцетина фармацевтически несовместим с гепарином и растворами, содержащими аминокислоты."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Препарат следует применять с осторожностью при внутричерепной гипертензии, при одновременном применении с противоаритмическими лекарственными средствами, а также при синдроме удлиненного интервала QT или одновременном применении с препаратами, удлиняющими интервал QT. При синдроме удлиненного интервала QT или одновременном применении средств, удлиняющих интервал QT, следует осуществлять ЭКГ-мониторинг."}},{"type":"paragraph","data":{"text":"Влияние на способность управлять трансп. ср. и мех.:"}},{"type":"paragraph","data":{"text":"Исследования о влиянии на способность управлять транспортными средствами не проводились. При возникновении нежелательных реакций со стороны нервной системы следует соблюдать осторожность при управлении транспортными средствами и работе с движущимися механизмами."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"В защищенном от света месте, 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":"2 года."}}]}],"source":null},"description_toggle":false,"short_description":"Психостимулирующее и ноотропное средство Фармакодинамика: Механизм действия винпоцетина складывается из нескольких элементов: он улучшает мозговой кровоток и обмен веществ, оказывает благоприятное воздействие на реологические свойства крови. Нейропротекторное действие реализуется за счет снижения неблагоприятного цитотоксического влияния возбуждающих аминокислот. Блокирует Na- и Са2+-каналы и NMDA- и АМРА-рецепторы. Селективно ингибирует Са2+-кальмодулинзависимую-цГМФ-фосфодиэстеразу. Повышает обмен серотонина и норадреналина в головном мозге, стимулирует норадренергическую нейромедиаторную систему и оказывает антиоксидантное действие. Улучшает микроциркуляцию в головном мозге за счет ингибирования агрегации тромбоцитов, снижения патологически повышенной вязкости крови, увеличения деформируемости эритроцитов и ингибирования обратного захвата аденозина; способствует переходу кислорода в клетки за счет снижения сродства к нему эритроцитов. Избирательно увеличивает мозговой кровоток за счет снижения церебрального сосудистого сопротивления без существенного влияния на системные показатели кровообращения (артериальное давление (АД), сердечный выброс, частоту сердечных сокращений, общее периферическое сосудистое сопротивление); не вызывает эффект \"обкрадывания\". Фармакокинетика: Распределение Распределение радиоактивно меченого винпоцетина, при введении крысам, наибольшая радиоактивность обнаруживалась в печени и желудочно-кишечном тракте. Максимальная концентрация в тканях отмечалась через 2-4 ч после введения. Концентрация в головном мозге не превышала значений, обнаруженных в крови. У человека связь с белками плазмы составляет 66%. Биодоступность около 7%. Объем распределения 246,7±88,5 л, что свидетельствует о высоком связывании с тканями. Общий клиренс (66,7 л/ч) превышает скорость печеночного кровотока (50 л/ч), что указывает на внепеченочный метаболизм. Метаболизм Основным метаболитом является аповинкаминовая кислота (АВК), составляющая 25-30% от исходного соединения. Площадь под кривой \"концентрация-время\" АВК после приема внутрь вдвое превышает таковую при внутривенном введении винпоцетина. Таким образом, винпоцетин подвержен выраженному эффекту \"первого прохождения\" через печень. К прочим метаболитам относятся: гидроксивинпоцетин, гидрокси-АВК, АВК-диоксиглицинат и их конъюгаты (сульфаты и (или) глюкурониды). Выведение неизмененного винпоцетина низкое (несколько процентов). При нарушении функции печени или почек коррекция дозы не требуется, поскольку винпоцетин не кумулирует. Выведение При многократном введении в дозе 5 и 10 мг винпоцетин проявляет линейную фармакокинетику, равновесная плазменная концентрация составляет 1,2±0,27 и 2,1±0,33 нг/мл соответственно. Период полувыведения у человека составляет 4,83±1,29 ч. В исследованиях с радиоактивно меченым винпоцетином установлено, что выведение почками и кишечником происходит в соотношении 60:40%. У крыс и собак высокая концентрация обнаруживается в желчи, однако отмечена значительная энтерогепатическая рециркуляция. Фармакокинетика у особых групп пациентов Поскольку винпоцетин предназначен в первую очередь для лечения пожилых, необходимо учитывать замедление распределения и метаболизма, а также выведения у этой возрастной группы, особенно при длительном применении. По результатам клинических исследований установлено, что кинетика винпоцетина у пожилых существенно не отличается от молодых, кумуляции не происходит. 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