Состояние после проведения аортокоронарного шунтирования
Декомпенсированная сердечная недостаточность
Полное или неполное сочетание бронхиальной астмы, рецидивирующего полипоза слизистой оболочки носа и околоносовых пазух и непереносимости ацетилсалициловой кислоты и других НПВП (в т.ч. в анамнезе)
Эрозивно-язвенные изменения слизистой оболочки желудка или двенадцатиперстной кишки, активное желудочно-кишечное кровотечение
НПВП. Оказывает анальгезирующее, противовоспалительное и жаропонижающее действие. Механизм действия связан с ингибированием синтеза простагландинов в результате избирательного подавления ферментативной активности циклооксигеназы-2 (ЦОГ-2), участвующей в биосинтезе простагландинов в области воспаления. При назначении в высоких дозах, длительном применении и индивидуальных особенностях организма селективность в отношении ЦОГ-2 снижается. Подавляет синтез простагландинов в области воспаления в большей степени, чем в слизистой оболочке желудка или почках, что связано с относительно избирательным ингибированием ЦОГ-2. Реже вызывает эрозивно-язвенные заболевания ЖКТ. В меньшей степени мелоксикам действует на циклооксигеназу-1 (ЦОГ-1), участвующую в синтезе простагландинов, защищающих слизистую оболочку ЖКТ и принимающих участие в регуляции кровотока в почках.
Показания к применению
Симптоматическая терапия:
Остеоартроза
Ревматоидного артрита
Анкилозирующего спондилита (болезнь Бехтерева)
Противопоказания
Состояние после проведения аортокоронарного шунтирования
Декомпенсированная сердечная недостаточность
Полное или неполное сочетание бронхиальной астмы, рецидивирующего полипоза слизистой оболочки носа и околоносовых пазух и непереносимости ацетилсалициловой кислоты и других НПВП (в т.ч. в анамнезе)
Эрозивно-язвенные изменения слизистой оболочки желудка или двенадцатиперстной кишки, активное желудочно-кишечное кровотечение
Цереброваскулярное кровотечение или иные кровотечения
Выраженная печеночная недостаточность или активное заболевание печени
Хроническая почечная недостаточность у больных, не подвергающихся диализу (КК менее 30 мл/мин), прогрессирующие заболевания почек (в т.ч. подтвержденная гиперкалиемия)
Детский возраст до 12 лет (для таблеток)
Детский возраст до 18 лет (для раствора для в/м введения)
Беременность
Лактация (грудное вскармливание)
Повышенная чувствительность к мелоксикаму и другим компонентам препарата
В состав препарата в форме таблеток входит лактоза, поэтому пациенты с редкими наследственными заболеваниями, такими как непереносимость галактозы, дефицит лактазы или глюкозо-галактозная мальабсорбция, не должны принимать препарат.
С осторожностью;
ИБС
Цереброваскулярные заболевания
Компенсированная сердечная недостаточность
Дислипидемия/гиперлипидемия
Сахарный диабет
Заболевания периферических артерий
Курение
КК 30-60 мл/мин
Анамнестические данные о развитии язвенного поражения ЖКТ
Наличие инфекции Нeliсobacter pуlori
Пожилой возраст
Длительное использование НПВП
Частое употребление алкоголя
Тяжелые соматические заболевания
Сопутствующая терапия следующими препаратами: антикоагулянты (например, варфарин); антиагреганты (например, ацетилсалициловая кислота, клопидогрел); пероральные ГКС (например, преднизолон); селективные ингибиторы обратного захвата серотонина (например, циталопрам, флуоксетин, пароксетин, сертралин)
Для снижения риска развития нежелательных явлений со стороны ЖКТ следует использовать минимальную эффективную дозу минимально возможным коротким курсом.
Применение при беременности и в период грудного вскармливания
Препарат противопоказан при беременности и в период лактации (грудного вскармливания).; Применение Мовасина, как и других препаратов, блокирующих синтез простагландинов, может влиять на фертильность, поэтому не рекомендуется назначать женщинам, желающим забеременеть.
Способ применения и дозы
Таблетки; Препарат принимают внутрь, во время приема пищи, в суточной дозе 7.5-15 мг, 1 раз/сут.; При ревматоидном артрите рекомендуемая доза составляет 15 мг/сут; в зависимости от терапевтического эффекта доза может быть снижена до 7.5 мг/сут.; При остеоартрозе препарат назначают в дозе 7.5 мг/сут, при отсутствии эффекта дозу можно повысить до 15 мг/сут.; При анкилозирующем спондилоартрите суточная доза составляет 15 мг.; Максимальная суточная доза препарата Мовасин не должна превышать 15 мг.; У пациентов с повышенным риском развития побочных эффектов, а также у пациентов с тяжелой почечной недостаточностью, находящихся на гемодиализе, доза не должна превышать 7.5 мг/сут.; Раствор для в/м введения; В/м введение препарата показано только в течение первых 2-3 дней. В дальнейшем лечение продолжают с применением пероральных форм (таблетки).; Рекомендуемая доза составляет 7.5 мг или 15 мг 1 раз/сут, в зависимости от интенсивности болей и тяжести воспалительного процесса.; Препарат вводят глубоко в/м. В/в введение препарата запрещено!; У пациентов с повышенным риском побочных реакций суточная доза не должна превышать 7.5 мг.; При в/м введении у пациентов с терминальной стадией почечной недостаточности, находящихся на гемодиализе, и у пациентов с небольшими или умеренными нарушениями функции почек (КК более 30 мл/мин) доза препарата не должна превышать 7.5 мг.; Режим дозирования препарата для в/м инъекций у детей и подростков не определен, данная лекарственная форма может применяться только у взрослых пациентов. Максимальная рекомендуемая суточная доза - 15 мг.; При комбинированном применении различных лекарственных форм препарата его максимальная суточная доза в таблетках, суппозиториях и в виде раствора для инъекций составляет 15 мг.
Побочное действие
Со стороны пищеварительной системы: >1% - диспепсия, в т.ч. тошнота, рвота, абдоминальные боли, запор, метеоризм, диарея; 0.1-1% - преходящее повышение активности печеночных трансаминаз, гипербилирубинемия, отрыжка, эзофагит, гастродуоденальная язва, кровотечение из ЖКТ (в т.ч. скрытое), стоматит; меньше 0.1% - перфорация ЖКТ, колит, гепатит, гастрит.; Со стороны органов кроветворения: >1% - анемия; 0.1-1% - изменение формулы крови, в т.ч. лейкопения, тромбоцитопения.; Со стороны кожных покровов: >1% - зуд, кожная сыпь; 0.1-1% - крапивница; меньше 0.1% - фотосенсибилизация, буллезные высыпания, многоформная эритема, в т.ч. синдром Стивенса-Джонсона, токсический эпидермальный некролиз.; Со стороны дыхательной системы: меньше 0.1% - бронхоспазм.; Со стороны нервной системы: >1% - головокружение, головная боль; 0.1-1% - вертиго, шум в ушах, сонливость; меньше 0.1% - спутанность сознания, дезориентация, эмоциональная лабильность.; Со стороны сердечно-сосудистой системы: >1% - периферические отеки; 0.1-1% - повышение АД, сердцебиение, приливы крови к коже лица.; Со стороны мочевыделительной системы: 0.1-1% - гиперкреатининемия и/или повышение мочевины в сыворотке крови; меньше 0.1% - острая почечная недостаточность; связь с приемом мелоксикама не установлена - интерстициальный нефрит, альбуминурия, гематурия.; Со стороны органов чувств: меньше 0.1% - конъюнктивит, нарушение зрения, в т.ч. нечеткость зрения.; Аллергические реакции: меньше 0.1% - ангионевротический отек, анафилактоидные/анафилактические реакции.; Местные реакции: >1% - отечность в месте введения; меньше 0.1% - болезненные ощущения в месте введения
Передозировка
Симптомы: нарушение сознания, тошнота, рвота, боли в эпигастрии, кровотечение из ЖКТ, острая почечная недостаточность, печеночная недостаточность, остановка дыхания, асистолия.; Лечение: при приеме препарата внутрь - промывание желудка, прием активированного угля (в течение ближайшего часа); при необходимости проводят симптоматическую терапию. Форсированный диурез, защелачивание мочи, гемодиализ малоэффективны из-за высокой степени связывания мелоксикама с белками крови. Специфического антидота нет.
Особые указания
Следует соблюдать осторожность при применении препарата у пациентов, имеющих в анамнезе язвенную болезнь желудка и двенадцатиперстной кишки, и у пациентов, получающих терапию антикоагулянтами, т.к. у данной категории больных повышен риск развития эрозивно-язвенных поражений ЖКТ.; Следует соблюдать осторожность и контролировать показатели функции почек при применении препарата у пациентов пожилого возраста, пациентов с хронической сердечной недостаточностью с явлениями недостаточности кровообращения, у пациентов с циррозом печени, а также у пациентов с гиповолемией в результате хирургических вмешательств.; У пациентов с незначительным или умеренным снижением функции почек (КК более 30 мл/мин) не требуется коррекция режима дозирования.; Пациенты, принимающие одновременно мочегонные средства и мелоксикам, должны принимать достаточное количество жидкости.; При появлении аллергических реакций (зуд, кожная сыпь, крапивница, фотосенсибилизация) следует прекратить прием препарата.; Мелоксикам, также как и другие НПВС, может маскировать симптомы инфекционных заболеваний.; Влияние на способность к вождению автотранспорта и управлению механизмами; Применение препарата может вызывать возникновение нежелательных эффектов в виде головной боли и головокружений, сонливости, поэтому в период приема препарата следует отказаться от управления транспортными средствами и обслуживания машин и механизмов, требующих концентрации внимания.
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7.5 мг; Вспомогательные вещества: повидон 12600 - 6 мг, лактозы моногидрат - 52.5 мг, кросповидон (коллидон CL-M) - 4.5 мг, крахмал картофельный - 1.25 мг, тальк - 4.5 мг, магния стеарат - 1.5 мг, целлюлоза микрокристаллическая - до 150 мг."}}]},{"id":2,"name":"Фармакологические свойства","slug":"pharmacologic_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"НПВП. Оказывает анальгезирующее, противовоспалительное и жаропонижающее действие. Механизм действия связан с ингибированием синтеза простагландинов в результате избирательного подавления ферментативной активности циклооксигеназы-2 (ЦОГ-2), участвующей в биосинтезе простагландинов в области воспаления. При назначении в высоких дозах, длительном применении и индивидуальных особенностях организма селективность в отношении ЦОГ-2 снижается. Подавляет синтез простагландинов в области воспаления в большей степени, чем в слизистой оболочке желудка или почках, что связано с относительно избирательным ингибированием ЦОГ-2. Реже вызывает эрозивно-язвенные заболевания ЖКТ. В меньшей степени мелоксикам действует на циклооксигеназу-1 (ЦОГ-1), участвующую в синтезе простагландинов, защищающих слизистую оболочку ЖКТ и принимающих участие в регуляции кровотока в почках."}}]},{"id":3,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Симптоматическая терапия:"}},{"type":"list","data":{"style":"unordered","items":["Остеоартроза","Ревматоидного артрита","Анкилозирующего спондилита (болезнь Бехтерева)"]}}]},{"id":4,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"list","data":{"style":"unordered","items":["Состояние после проведения аортокоронарного шунтирования","Декомпенсированная сердечная недостаточность","Полное или неполное сочетание бронхиальной астмы, рецидивирующего полипоза слизистой оболочки носа и околоносовых пазух и непереносимости ацетилсалициловой кислоты и других НПВП (в т.ч. в анамнезе)","Эрозивно-язвенные изменения слизистой оболочки желудка или двенадцатиперстной кишки, активное желудочно-кишечное кровотечение","Воспалительные заболевания кишечника (язвенный колит, болезнь Крона)","Цереброваскулярное кровотечение или иные кровотечения","Выраженная печеночная недостаточность или активное заболевание печени","Хроническая почечная недостаточность у больных, не подвергающихся диализу (КК менее 30 мл/мин), прогрессирующие заболевания почек (в т.ч. подтвержденная гиперкалиемия)","Детский возраст до 12 лет (для таблеток)","Детский возраст до 18 лет (для раствора для в/м введения)","Беременность","Лактация (грудное вскармливание)","Повышенная чувствительность к мелоксикаму и другим компонентам препарата"]}},{"type":"paragraph","data":{"text":"В состав препарата в форме таблеток входит лактоза, поэтому пациенты с редкими наследственными заболеваниями, такими как непереносимость галактозы, дефицит лактазы или глюкозо-галактозная мальабсорбция, не должны принимать препарат."}},{"type":"paragraph","data":{"text":"С осторожностью;"}},{"type":"list","data":{"style":"unordered","items":["ИБС","Цереброваскулярные заболевания","Компенсированная сердечная недостаточность","Дислипидемия/гиперлипидемия","Сахарный диабет","Заболевания периферических артерий","Курение","КК 30-60 мл/мин","Анамнестические данные о развитии язвенного поражения ЖКТ","Наличие инфекции Нeliсobacter pуlori","Пожилой возраст","Длительное использование НПВП","Частое употребление алкоголя","Тяжелые соматические заболевания","Сопутствующая терапия следующими препаратами: антикоагулянты (например, варфарин); антиагреганты (например, ацетилсалициловая кислота, клопидогрел); пероральные ГКС (например, преднизолон); селективные ингибиторы обратного захвата серотонина (например, циталопрам, флуоксетин, пароксетин, сертралин)"]}},{"type":"paragraph","data":{"text":"Для снижения риска развития нежелательных явлений со стороны ЖКТ следует использовать минимальную эффективную дозу минимально возможным коротким курсом."}}]},{"id":5,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Препарат противопоказан при беременности и в период лактации (грудного вскармливания).; Применение Мовасина, как и других препаратов, блокирующих синтез простагландинов, может влиять на фертильность, поэтому не рекомендуется назначать женщинам, желающим забеременеть."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Таблетки; Препарат принимают внутрь, во время приема пищи, в суточной дозе 7.5-15 мг, 1 раз/сут.; При ревматоидном артрите рекомендуемая доза составляет 15 мг/сут; в зависимости от терапевтического эффекта доза может быть снижена до 7.5 мг/сут.; При остеоартрозе препарат назначают в дозе 7.5 мг/сут, при отсутствии эффекта дозу можно повысить до 15 мг/сут.; При анкилозирующем спондилоартрите суточная доза составляет 15 мг.; Максимальная суточная доза препарата Мовасин не должна превышать 15 мг.; У пациентов с повышенным риском развития побочных эффектов, а также у пациентов с тяжелой почечной недостаточностью, находящихся на гемодиализе, доза не должна превышать 7.5 мг/сут.; Раствор для в/м введения; В/м введение препарата показано только в течение первых 2-3 дней. В дальнейшем лечение продолжают с применением пероральных форм (таблетки).; Рекомендуемая доза составляет 7.5 мг или 15 мг 1 раз/сут, в зависимости от интенсивности болей и тяжести воспалительного процесса.; Препарат вводят глубоко в/м. В/в введение препарата запрещено!; У пациентов с повышенным риском побочных реакций суточная доза не должна превышать 7.5 мг.; При в/м введении у пациентов с терминальной стадией почечной недостаточности, находящихся на гемодиализе, и у пациентов с небольшими или умеренными нарушениями функции почек (КК более 30 мл/мин) доза препарата не должна превышать 7.5 мг.; Режим дозирования препарата для в/м инъекций у детей и подростков не определен, данная лекарственная форма может применяться только у взрослых пациентов. Максимальная рекомендуемая суточная доза - 15 мг.; При комбинированном применении различных лекарственных форм препарата его максимальная суточная доза в таблетках, суппозиториях и в виде раствора для инъекций составляет 15 мг."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Со стороны пищеварительной системы: \u003e1% - диспепсия, в т.ч. тошнота, рвота, абдоминальные боли, запор, метеоризм, диарея; 0.1-1% - преходящее повышение активности печеночных трансаминаз, гипербилирубинемия, отрыжка, эзофагит, гастродуоденальная язва, кровотечение из ЖКТ (в т.ч. скрытое), стоматит; меньше 0.1% - перфорация ЖКТ, колит, гепатит, гастрит.; Со стороны органов кроветворения: \u003e1% - анемия; 0.1-1% - изменение формулы крови, в т.ч. лейкопения, тромбоцитопения.; Со стороны кожных покровов: \u003e1% - зуд, кожная сыпь; 0.1-1% - крапивница; меньше 0.1% - фотосенсибилизация, буллезные высыпания, многоформная эритема, в т.ч. синдром Стивенса-Джонсона, токсический эпидермальный некролиз.; Со стороны дыхательной системы: меньше 0.1% - бронхоспазм.; Со стороны нервной системы: \u003e1% - головокружение, головная боль; 0.1-1% - вертиго, шум в ушах, сонливость; меньше 0.1% - спутанность сознания, дезориентация, эмоциональная лабильность.; Со стороны сердечно-сосудистой системы: \u003e1% - периферические отеки; 0.1-1% - повышение АД, сердцебиение, приливы крови к коже лица.; Со стороны мочевыделительной системы: 0.1-1% - гиперкреатининемия и/или повышение мочевины в сыворотке крови; меньше 0.1% - острая почечная недостаточность; связь с приемом мелоксикама не установлена - интерстициальный нефрит, альбуминурия, гематурия.; Со стороны органов чувств: меньше 0.1% - конъюнктивит, нарушение зрения, в т.ч. нечеткость зрения.; Аллергические реакции: меньше 0.1% - ангионевротический отек, анафилактоидные/анафилактические реакции.; Местные реакции: \u003e1% - отечность в месте введения; меньше 0.1% - болезненные ощущения в месте введения"}}]},{"id":8,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Симптомы: нарушение сознания, тошнота, рвота, боли в эпигастрии, кровотечение из ЖКТ, острая почечная недостаточность, печеночная недостаточность, остановка дыхания, асистолия.; Лечение: при приеме препарата внутрь - промывание желудка, прием активированного угля (в течение ближайшего часа); при необходимости проводят симптоматическую терапию. Форсированный диурез, защелачивание мочи, гемодиализ малоэффективны из-за высокой степени связывания мелоксикама с белками крови. Специфического антидота нет."}}]},{"id":9,"name":"Особые указания","slug":"cautions","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Следует соблюдать осторожность при применении препарата у пациентов, имеющих в анамнезе язвенную болезнь желудка и двенадцатиперстной кишки, и у пациентов, получающих терапию антикоагулянтами, т.к. у данной категории больных повышен риск развития эрозивно-язвенных поражений ЖКТ.; Следует соблюдать осторожность и контролировать показатели функции почек при применении препарата у пациентов пожилого возраста, пациентов с хронической сердечной недостаточностью с явлениями недостаточности кровообращения, у пациентов с циррозом печени, а также у пациентов с гиповолемией в результате хирургических вмешательств.; У пациентов с незначительным или умеренным снижением функции почек (КК более 30 мл/мин) не требуется коррекция режима дозирования.; Пациенты, принимающие одновременно мочегонные средства и мелоксикам, должны принимать достаточное количество жидкости.; При появлении аллергических реакций (зуд, кожная сыпь, крапивница, фотосенсибилизация) следует прекратить прием препарата.; Мелоксикам, также как и другие НПВС, может маскировать симптомы инфекционных заболеваний.; Влияние на способность к вождению автотранспорта и управлению механизмами; Применение препарата может вызывать возникновение нежелательных эффектов в виде головной боли и головокружений, сонливости, поэтому в период приема препарата следует отказаться от управления транспортными средствами и обслуживания машин и механизмов, требующих концентрации внимания."}}]}],"source":{"title":"36.6","url":"https://366.ru"}},"description_toggle":false,"short_description":"НПВП. 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