Обладает выраженным тиреостатическим эффектом. Препятствует процессу йодирования тиреоглобулина, снижает образование активной формы йода в щитовидной железе, блокируя систему пероксидаз. Тормозит превращение T4 в T3 путем образования реверсивного T3.
Показания к применению
тиреотоксикоз (диффузный токсический зоб, токсическая аденома щитовидной железы); -подготовка к резекции щитовидной железы; -подготовка к лечению радиоактивным йодом.
Во избежание осложнений применять только после консультации с врачом.
Противопоказания
гиперчувствительность; -лейкопения, агранулоцитоз; -гипотиреоз; -активный гепатит, цирроз печени, нарушение функции печени.
Применение при беременности и в период грудного вскармливания
Как тиреотоксикоз, так и гипотиреоз у беременных женщин ассоциируется с увеличением частоты выкидышей, мертворождения и аномалий развития.; Частота аномалий развития в случаях лечения Пропицилом; не отличается от частоты спонтанных аномалий развития плода.; Доза Пропицила; должна быть как можно более низкой во избежание выкидыша, а также развития гипотиреоза и зоба у плода.; В последние три месяца беременности часто наблюдается спонтанное уменьшение выраженности тиреотоксикоза.; При беременности лечение проводится под строгим наблюдением (уровень гормонов щитовидной железы должен находиться у верхнего предела нормы, уровень тиреотропина должен быть ниже нормы).; B период грудного вскармливания Пропицил; считается препаратом выбора, т.к. его концентрация в грудном молоке составляет 1/10 от уровня в сыворотке крови матери. Однако необходимо наблюдение за новорожденным, т.к. имеются сообщения об отдельных случаях развития гипотиреоза.; При сочетании диффузного токсического зоба и беременности Пропицил; назначают только в виде монотерапии.
Способ применения и дозы
Внутрь, не разжевывая, проглатывая целиком, запивая достаточным количеством жидкости, через каждые 6–8 ч.; В начале лечения взрослым и детям старше 10 лет назначают по 75–100 мг (от 1,5 до 2 табл.) в день. В тяжелых случаях и после предшествующей нагрузки йодом начальную суточную дозу увеличивают до 300–600 мг (6–12 табл., распределенных на 4–6 разовых доз).; Поддерживающая доза составляет 25–150 мг (от 0,5 до 3 табл.) в день.; Дети в возрасте от 6 до 10 лет получают в начале лечения 50–150 мг (от 1 до 3 табл.) в день, а при поддерживающем лечении — около 25–50 мг (от 0,5 до 1 табл.) в день.; При тиреотоксикозе у новорожденных назначают по 5–10 мг/кг/сут (суточную дозу распределяют на 3 приема). При отсутствии ответа на лечение рекомендуется увеличение дозы в 1,5–2 раза (на 75–100%).; Поддерживающая доза составляет 3–4 мг/кг/сут.; Согласно существующим данным, у больных, страдающих почечной недостаточностью или находящихся на гемодиализе, не возникает необходимости в корректировке дозы. При заболеваниях печени препарат можно принимать в рекомендуемых дозах с учетом соответствующих противопоказаний.; Продолжительность лечения определяется индивидуальной потребностью больного.; Опыт терапевтического применения препарата Пропицил; показывает, что продолжительность лечения тиреотоксикоза при диффузном токсическом зобе и токсической аденоме щитовидной железы должна составлять 1,5–2 года.; При подготовке к хирургическому вмешательству или лечению радиоактивным йодом продолжительность применения препарата должна соответствовать индивидуальной потребности больного. Пропицил; может использоваться для лечения диффузного токсического зоба как в виде монотерапии, так и в схеме «блокируй и замещай».
Побочное действие
Агранулоцитоз представляет собой тяжелое, но редкое побочное явление, сопровождающееся септическими осложнениями.; Иногда отмечаются высыпания на коже, крапивница, боли в желудке, артралгии без признаков воспаления суставов, образование зоба у новорожденного; в очень редких случаях (особенно при применении препарата в высоких дозах) наблюдались следующие побочные явления: поражения печени (печеночноклеточный некроз, транзиторный холестаз), реакции гиперчувствительности, лекарственная лихорадка, лимфоаденопатия и тромбоцитопения.; Имеются сообщения об отдельных случаях нервно-мышечных расстройств, полиартрита, волчаночноподобного синдрома, узелкового периартериита, желудочно-кишечных расстройств (тошнота, рвота), головокружения, нарушений эритропоэза, гемолиза, положительной реакции Кумбса, интерстициальной пневмонии, периферических отеков и алопеции.; В процессе лечения Пропицилом; может возникнуть увеличение щитовидной железы.
Передозировка
Случаев острой интоксикации не наблюдалось. Хроническая передозировка приводит к развитию зоба и гипотиреоза с симптомами, зависимыми от тяжести гипотиреоза, обусловленного специфическим действием антитиреоидного средства.; Лечение: специальных мер/мероприятий не существует. Промывание желудка и эндоскопическое удаление остатков таблеток не эффективны из-за быстрого всасывания активного вещества. При развитии зоба и гипотиреоза, сопровождающегося симптомами, коррелирующими с тяжестью гипотиреоза, и обусловленного хронической передозировкой препарата, лечение Пропицилом; прекращают и ожидают спонтанного восстановления функции щитовидной железы. Заместительную терапию тироксином проводят в том случае, если это оправдывается степенью тяжести гипотиреоза.
Особые указания
Пропицил; противопоказан больным, у которых ранее отмечались тяжелые побочные действия препарата (агранулоцитоз, тяжелые поражения печени).; При патологическом изменении числа форменных элементов крови и повышении активности трансаминаз Пропицил; можно применять только под строгим наблюдением врача.; Влияние на способность к вождению автомобиля и к управлению машинами и механизмами. Не влияет.
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При заболеваниях печени препарат можно принимать в рекомендуемых дозах с учетом соответствующих противопоказаний.; Продолжительность лечения определяется индивидуальной потребностью больного.; Опыт терапевтического применения препарата Пропицил; показывает, что продолжительность лечения тиреотоксикоза при диффузном токсическом зобе и токсической аденоме щитовидной железы должна составлять 1,5–2 года.; При подготовке к хирургическому вмешательству или лечению радиоактивным йодом продолжительность применения препарата должна соответствовать индивидуальной потребности больного. 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