Обратимый ингибитор ацетилхолинэстеразы. Облегчает проведение нервных импульсов в области нервно-мышечных синапсов, усиливает процессы возбуждения в рефлекторных зонах спинного и головного мозга, хорошо проникает через ГЭБ. Повышает тонус и стимулирует сокращение гладкой и скелетной мускулатуры, секрецию пищеварительных и потовых желез, восстанавливает нервно-мышечную проводимость, блокированную курареподобными миорелаксантами недеполяризующего типа. Вызывает миоз, спазм аккомодации, снижает внутриглазное давление при закрытоугольной глаукоме.
Показания к применению
В неврологии:
Травматические повреждения нервной системы
Детский церебральный паралич
Заболевания спинного мозга (миелит, полиомиелит, полиомиелитная форма клещевого энцефалита)
Ночное недержание мочи. В анестезиологии и хирургии:
В качестве антагониста недеполяризирующих миорелаксантов
Для лечения послеоперационной атонии кишечника и мочевого пузыря. В физиотерапии:
В виде ионофореза при заболеваниях периферической нервной системы. В токсикологии:
Интоксикация холиноблокирующими лекарственными средствами, морфином и его аналогами. В рентгенологии:
Для улучшения качества функциональной диагностики состояния пищеварительной системы и желчного пузыря
Противопоказания
Бронхиальная астма
Брадикардия
AV-блокада
Стенокардия
Хроническая сердечная недостаточность в стадии декомпенсации
Эпилепсия
Гиперкинезы
Механическая кишечная непроходимость
Механические нарушения проходимости мочевыводящих путей
Тяжелая печеночная недостаточность
Почечная недостаточность тяжелой степени
Детский возраст до 1 года
Беременность
Период лактации (грудного вскармливания)
Повышенная чувствительность к компонентам препарата. С осторожностью назначают препарат при почечной недостаточности, нарушениях мочеиспускания, недавно перенесенном оперативном вмешательстве на предстательной железе, при оперативных вмешательствах с применением общей анестезии. Для улучшения качества рентгенологических исследований препарат не применяется у детей
Применение при беременности и в период грудного вскармливания
Противопоказан при беременности и в период лактации.
Способ применения и дозы
Препарат вводят п/к, в/м, в/в. Доза и продолжительность курса терапии устанавливают индивидуально, в зависимости от степени выраженности симптомов заболевания и индивидуальной реакции пациента. В начале лечения препарат назначают в минимальной дозе, затем ее постепенно увеличивают. Для взрослых максимальная разовая доза для п/к введения составляет 10 мг, максимальная суточная доза - 20 мг. Для детей доза препарата для п/к введения зависит от возраста: Возраст Суточная доза 1-2 года 0.25-1 мг (0.1-0.2 мл 0.25% р-ра) 3-5 лет 0.5-5 мг (0.2-0.4 мл 0.25% р-ра) 6-8 лет 0.75-7.5 мг (0.3-0.42 мл 0.25% р-ра) 9-11 лет 1-10 мг (0.5 мл 0.25% р-ра - 0.6 мл 0.5% р-ра) 12-15 лет 1.25-12.5 мг (0.7 мл 0.25% р-ра - 1 мл 0.5% р-ра) старше 15 лет 12.5-20 мг (0.2-0.7 мл 1% р-ра) Продолжительность лечения зависит от особенностей и тяжести заболевания и составляет в среднем 40-60 дней. Курс терапии можно повторять 2-3 раза с интервалами 1-2 мес. Препарат вводят 1 раз/сут. При применении Нивалина в высоких дозах суточную дозу можно разделить на 2 введения. Взрослым в качестве антагониста недеполяризующих миорелаксантов Нивалин вводят в/в в суточной дозе 10-20 мг. При проведении рентгенологических исследований препарат вводят взрослым в/м в дозе 1-5 мг. При заболеваниях периферической нервной системы и для лечения ночного недержания мочи детям препарат вводят в виде ионофореза в дозе 1-2 мл 0.25% раствора.
Побочное действие
Со стороны пищеварительной системы: часто - тошнота, рвота, схваткообразные боли в животе, диарея, повышенное слюноотделение, анорексия; редко - кишечная колика. Со стороны ЦНС: часто - усталость, головокружение, головная боль, сонливость; редко - бессонница, нарушения зрения (спазм аккомодации). Прочие: повышенное потоотделение; редко - ринит, брадикардия, инфекция мочевых путей, бронхоспазм, почечная колика.
Передозировка
Симптомы: тошнота, рвота, спазмы, диарея, снижение АД, брадикардия, бронхоспазм; в тяжелых случаях - судороги, кома. Лечение: проводят симптоматическую терапию, контроль функции дыхательной и сердечно-сосудистой системы. В качестве антидота - в/в введение атропина в дозе 0.5-1 мг в/в; дозу можно ввести повторно в зависимости от клинической картины.
Особые указания
Влияние на способность к вождению автотранспорта и управлению механизмами В период лечения пациентам следует воздерживаться от вождения автотранспорта и другой деятельности, требующей высокой концентрации внимания и скорости психомоторных реакций, т.к. препарат может вызывать сонливость, головокружение, нарушения зрения.
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