Основным механизмом действия индометацина является ингибирование синтеза простагландинов, которые играют важную роль в патогенезе воспаления и боли.
Фармакокинетика
Имеются подтвержденные данные о том, что препарат проникает в переднюю камеру глаза. При однократной инстилляции действующее вещество препарата индометацин определяется во влаге передней камеры глаза в течение нескольких часов.
Системная абсорбция индометацина при местном применении препарата незначительна.
Показания к применению
Ингибирование миоза во время хирургических вмешательств на глазном яблоке;
Профилактика воспалительных осложнений после операции по поводу катаракты и в области передней камеры глаза;
Уменьшение болевого синдрома «в области глаза» в послеоперационном периоде после фоторефракционной кератэктомии в первые сутки после операции.
Противопоказания
Гиперчувствительность к активному или вспомогательным веществам препарата;
повышенная чувствительность к ацетилсалициловой кислоте (или другим салицилатам) и/или другим НПВП;
приступы бронхиальной астмы в анамнезе в ответ на применение ацетилсалициловой кислоты или других НПВП;
язвенная болезнь желудка;
тяжелая печеночная недостаточность;
тяжелая почечная недостаточность;
беременность (начиная с 6-го месяца);
период грудного вскармливания;
детский возраст до 18 лет (данные по эффективности и безопасности отсутствуют);
одновременное применение с непрямыми антикоагулянтами, другими НПВП, в том числе производными салициловой кислоты (в дозах от 3 r B сут. и выше взрослым);
одновременное применение с дифлунизалом, гепарином, препаратами лития, метотрексатом B высоких дозах (от 15 мг/нед и более) и тиклопидином.
С осторожностью пациентам предрасположенным K аллергическим реакциям;
при одновременном применении с диуретиками, ингибиторами ангиотензинпревращающего фермента (АПФ), метотрексатом (в дозах менее 15 мг/нед), пентоксифиллином; препаратами, оказывающими влияние на слизистую желудочно-кишечного тракта (ЖКТ) (солями, оксидами и гидроксидами магния, алюминия и кальция), эидовудином, бета-адреноблокаторами, циклоспорином, десмопрессином, тромбопитиками.
при имплантации внутриматочных устройств.
Применение при беременности и в период грудного вскармливания
В настоящее время отсутствуют адекватные и строго контролируемые клинические исследования по безопасности применения Индоколлира при беременности и в период лактации (грудного вскармливания).
Однако препарат можно применять в первые 5 месяцев беременности в том случае, если предполагаемая польза терапии для матери превышает потенциальный риск для плода. Начиная с 6 месяца беременности, назначать препарат не следует, т.к. это может привести к нарушению функции сосудистой системы и почек у плода.
Индометацин выделяется с грудным молоком, поэтому при необходимости применения препарата в период лактации следует решить вопрос о прекращении грудного вскармливания или избегать его применения в период грудного вскармливания.
Способ применения и дозы
Для местного применения в офтальмологии.
Глядя вверх, осторожно оттягивают вниз нижнее веко и закапывают препарат B конъюнктивальный мешок пораженного глаза.
Для ингибирования миоза во время хирургических вмешательств на главном яблоке - по 1 капле 4 раза в день накануне операции и по 1 капле 4 раза в течение 3 ч непосредственно перед операцией.
Для профилактики и лечения воспалительных осложнений после операции по поводу катаракты и в области передней камеры глаза — по 1 капле 4-6 раз в день начиная за 24 ч до операции и до полного исчезновения симптомов воспаления после нее.
Для снятия болевого синдрома (в области глаз) в послеоперационном периоде после фоторефракционной кератэктомии - по 1 капле 4 раза в день B течение первых нескольких дней.
Побочное действие
Частота побочных эффектов оценивалась следующим образом в соответствии с классификацией ВОЗ: очень часто (>1/1О), часто (>1/100, <1/10); нечасто (>1/1000, <1/100), редко (>1/10000, <1/1000), очень редко (<1/10000).
Со стороны органа зрения:
Редко - местные реакции повышенной чувствительности в виде зуда и гиперемии, чувство умеренного жжение и/или временная потеря четкости зрения непосредственно после закапывания глазных капель; повышенная светочувствительность, поверхностный точечный кератит.
Очень редко - изъязвление роговицы, которая может осложняться перфорацией роговицы, особенно у пациентов с поврежденной роговицей или получавших кортикостероиды.
Передозировка
В настоящее время не сообщалось о случаях передозировки. В случае местной передозировки препарата следует промыть глаза теплой водой. В случае подозрения на пероральное использование препарата лечение симптоматическое.
Взаимодействие с другими лекарственными средствами
Несмотря на то, что системная абсорбция индометацина при местном применении в виде глазных капель незначительна, нельзя полностью исключить риск лекарственного взаимодействия c другими лекарственными препаратами.
Непрямые антикоагулянты, другие НПВП, дифлунизал, гепарин.
Известно, что применение индометацина в других лекарственных формах одновременно с непрямыми антикоагулянтами, другими нестероидными противовоспалительными препаратами в их суточной дозе 3 r и выше (включая производные салициловой кислоты, например, ацетилсалициловую кислоту и пр.), дифлунизапом и гепарином увеличивает риск возникновения в желудочно-кишечном тракте язв и кровотечения, а в сочетании с дифлунизалом вплоть до фатального.
В свою очередь, дифлунизал может повышать концентрацию индометацина в плазме крови.
Препараты лития. Индометацин может увеличивать концентрацию лития в крови до токсических величин, вследствие уменьшения выведения лития почками.
Метотрексат (в дозе 15 мг в неделю и более). Вследствие уменьшения выведения метотрексата почками при одновременно приеме c индоментацином и/или другими противовоспалительными препаратами, его гематотоксическое действие возрастает.
С осторожностью индометацин применяют с метотрексатом (в дозе менее 15 мг/нед) - необходим еженедельный контроль показателей крови в первые недели комбинированного приема, а также контроль нарушений функции почек, особенно у лиц пожилого возраста.
Тиклопидин. Индометацин усиливает антитромбоцитарное действие тиклопидина и повышает риск кровотечения.
Индометацин при совместном применении с бета-адреноблокаторами может ослаблять их эффект.
Индометацин может усиливать нефротоксическое действие циклоспорина, особенно у пожилых пациентов.
НПВП могут привести к усилению антидиуретического эффекта десмопрессина.
Соблюдать осторожность при одновременном применение индометацина с диуретиками и ингибиторами АПФ, поскольку у пациентов с обезвоживанием есть риск возникновения острой почечной недостаточности (вследствие снижения клубочковой фильтрации путем ингибирования сосудорасширяющих простагландинов после приема НПВП) и снижение антигипертензивного эффекта.
В таких ситуациях необходимо обеспечить больного водой и осуществлять контроль функции почек в начале лечения.
Комбинированное применение с пентоксифиллином - повышенный риск развития кровотечений из ЖКТ (применение под врачебным контролем и контроль продолжительности кровотечения).
Препараты, оказывающими влияние на слизистую ЖКТ (соли, оксиды и гидроксиды магния, алюминия и кальция) снижают всасывание индометацина из ЖКТ; рекомендуют раздельный прием c антацидами (при возможности интервал свыше 2 часов).
НПВП, в том числе индометацин, могут привести к усилению токсического эффекта зидовудина на ретикулоциты с переходом в острую анемию через 8 дней после начала терапии НПВП.
Комбинированное применение с тромболитиками — повышенный риск развития кровотечения.
Есть предположение, что при применении индометацина возможен риск разрыва имплантируемого внутриматочного устройства.
При одновременном применении препарата Индоколлир с другими главными каплями, в том числе, содержащими кортикостероиды, для исключения эффекта «вымывания» (снижения концентрации), препараты следует вводить с интервалом не менее 15 мин.
Особые указания
Препарат Индоколлир содержит тиомерсал, который может вызвать аллергические реакции. При появлении признаков индивидуальной непереносимости препарат следует отменить.
Как и другие НПВП, Индоколлир может замедлять заживление роговицы.
При наличии инфекции или угрозе ее развития одновременно назначают адекватную антибактериальную терапию.
При совместного применении НПВП с препаратами пития по назначению врача - необходимо корректировать дозу последних до, во время и после лечения НПВП в зависимости от концентрации лития в крови.
НПВП могут удлинять время кровотечения при оперативном вмешательстве на главном яблоке, особенно у пациентов с нарушениями свертывания крови или получающих антикоагулянты. Совместное применение по медицинским показаниям препарата Индоколлир с непрямыми антикоагулянтами, гепарином и тиклопидином следует проводить под пристальным наблюдением врача и контролем лабораторных показателей, в том числе, времени кровотечения.
При комбинации препарата Индоколлир с метотрексатом B дозе менее 15 мг/нед на протяжении первых недель совместного применения следует контролировать число клеток крови, а также вести пристальное наблюдение за пациентами с симптомами почечной недостаточности и пожилыми пациентами.
Время между приемом препарата Индоколлир и любого антацида должно составлять не менее 2 ч.
При совместном использовании с диуретиками и ингибиторами АПФ необходимо контролировать функцию почек и не допускать обезвоживания организма пациента.
Перед применением препарата контактные линзы следует снять и установить обратно не ранее, чем через 15 минут после применения препарата.
Следует соблюдать интервал в 15 минут при одновременном применении препарата Индоколлир c другими глазными каплями.
Не следует прикасаться кончиком флакона к какой-либо поверхности, чтобы избежать загрязнения флакона и его содержимого.
Флакон необходимо закрывать после каждого использования.
Влияние на способность управлять автомобилем и движущимися механизмами
У некоторых пациентов применение препарата Индоколлир может сопровождаться временной потерей четкости зрительного восприятия (сразу после закапывания глазных капель), поэтому надо соблюдать осторожность при выполнении потенциально опасных видов деятельности, требующих повышенной концентрации внимания и быстроты психомоторных реакций (управление транспортными средствами, работа с движущимися механизмами).
Условия хранения
В защищенном от света месте при температуре не выше 25 °С.
Хранить в местах, недоступных для детей.
Срок годности
1,5 года. Не использовать после срока годности, указанного на упаковке.
Срок годности после вскрытия флакона - 15 дней
Условия отпуска
По рецепту.
Производитель
DR. MANN PHARMA. Страна производства: Германия.
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В случае подозрения на пероральное использование препарата лечение симптоматическое."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Несмотря на то, что системная абсорбция индометацина при местном применении в виде глазных капель незначительна, нельзя полностью исключить риск лекарственного взаимодействия c другими лекарственными препаратами."}},{"type":"paragraph","data":{"text":"Непрямые антикоагулянты, другие НПВП, дифлунизал, гепарин."}},{"type":"paragraph","data":{"text":"Известно, что применение индометацина в других лекарственных формах одновременно с непрямыми антикоагулянтами, другими нестероидными противовоспалительными препаратами в их суточной дозе 3 r и выше (включая производные салициловой кислоты, например, ацетилсалициловую кислоту и пр.), дифлунизапом и гепарином увеличивает риск возникновения в желудочно-кишечном тракте язв и кровотечения, а в сочетании с дифлунизалом вплоть до фатального."}},{"type":"paragraph","data":{"text":"В свою очередь, дифлунизал может повышать концентрацию индометацина в плазме крови."}},{"type":"paragraph","data":{"text":"Препараты лития. Индометацин может увеличивать концентрацию лития в крови до токсических величин, вследствие уменьшения выведения лития почками."}},{"type":"paragraph","data":{"text":"Метотрексат (в дозе 15 мг в неделю и более). Вследствие уменьшения выведения метотрексата почками при одновременно приеме c индоментацином и/или другими противовоспалительными препаратами, его гематотоксическое действие возрастает."}},{"type":"paragraph","data":{"text":"С осторожностью индометацин применяют с метотрексатом (в дозе менее 15 мг/нед) - необходим еженедельный контроль показателей крови в первые недели комбинированного приема, а также контроль нарушений функции почек, особенно у лиц пожилого возраста."}},{"type":"paragraph","data":{"text":"Тиклопидин. Индометацин усиливает антитромбоцитарное действие тиклопидина и повышает риск кровотечения."}},{"type":"paragraph","data":{"text":"Индометацин при совместном применении с бета-адреноблокаторами может ослаблять их эффект."}},{"type":"paragraph","data":{"text":"Индометацин может усиливать нефротоксическое действие циклоспорина, особенно у пожилых пациентов."}},{"type":"paragraph","data":{"text":"НПВП могут привести к усилению антидиуретического эффекта десмопрессина."}},{"type":"paragraph","data":{"text":"Соблюдать осторожность при одновременном применение индометацина с диуретиками и ингибиторами АПФ, поскольку у пациентов с обезвоживанием есть риск возникновения острой почечной недостаточности (вследствие снижения клубочковой фильтрации путем ингибирования сосудорасширяющих простагландинов после приема НПВП) и снижение антигипертензивного эффекта."}},{"type":"paragraph","data":{"text":"В таких ситуациях необходимо обеспечить больного водой и осуществлять контроль функции почек в начале лечения."}},{"type":"paragraph","data":{"text":"Комбинированное применение с пентоксифиллином - повышенный риск развития кровотечений из ЖКТ (применение под врачебным контролем и контроль продолжительности кровотечения)."}},{"type":"paragraph","data":{"text":"Препараты, оказывающими влияние на слизистую ЖКТ (соли, оксиды и гидроксиды магния, алюминия и кальция) снижают всасывание индометацина из ЖКТ; рекомендуют раздельный прием c антацидами (при возможности интервал свыше 2 часов)."}},{"type":"paragraph","data":{"text":"НПВП, в том числе индометацин, могут привести к усилению токсического эффекта зидовудина на ретикулоциты с переходом в острую анемию через 8 дней после начала терапии НПВП."}},{"type":"paragraph","data":{"text":"Комбинированное применение с тромболитиками — повышенный риск развития кровотечения."}},{"type":"paragraph","data":{"text":"Есть предположение, что при применении индометацина возможен риск разрыва имплантируемого внутриматочного устройства."}},{"type":"paragraph","data":{"text":"При одновременном применении препарата Индоколлир с другими главными каплями, в том числе, содержащими кортикостероиды, для исключения эффекта «вымывания» (снижения концентрации), препараты следует вводить с интервалом не менее 15 мин."}}]},{"id":9,"name":"Особые указания","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Препарат Индоколлир содержит тиомерсал, который может вызвать аллергические реакции. При появлении признаков индивидуальной непереносимости препарат следует отменить."}},{"type":"paragraph","data":{"text":"Как и другие НПВП, Индоколлир может замедлять заживление роговицы."}},{"type":"paragraph","data":{"text":"При наличии инфекции или угрозе ее развития одновременно назначают адекватную антибактериальную терапию."}},{"type":"paragraph","data":{"text":"При совместного применении НПВП с препаратами пития по назначению врача - необходимо корректировать дозу последних до, во время и после лечения НПВП в зависимости от концентрации лития в крови."}},{"type":"paragraph","data":{"text":"НПВП могут удлинять время кровотечения при оперативном вмешательстве на главном яблоке, особенно у пациентов с нарушениями свертывания крови или получающих антикоагулянты. Совместное применение по медицинским показаниям препарата Индоколлир с непрямыми антикоагулянтами, гепарином и тиклопидином следует проводить под пристальным наблюдением врача и контролем лабораторных показателей, в том числе, времени кровотечения."}},{"type":"paragraph","data":{"text":"При комбинации препарата Индоколлир с метотрексатом B дозе менее 15 мг/нед на протяжении первых недель совместного применения следует контролировать число клеток крови, а также вести пристальное наблюдение за пациентами с симптомами почечной недостаточности и пожилыми пациентами."}},{"type":"paragraph","data":{"text":"Время между приемом препарата Индоколлир и любого антацида должно составлять не менее 2 ч."}},{"type":"paragraph","data":{"text":"При совместном использовании с диуретиками и ингибиторами АПФ необходимо контролировать функцию почек и не допускать обезвоживания организма пациента."}},{"type":"paragraph","data":{"text":"Перед применением препарата контактные линзы следует снять и установить обратно не ранее, чем через 15 минут после применения препарата."}},{"type":"paragraph","data":{"text":"Следует соблюдать интервал в 15 минут при одновременном применении препарата Индоколлир c другими глазными каплями."}},{"type":"paragraph","data":{"text":"Не следует прикасаться кончиком флакона к какой-либо поверхности, чтобы избежать загрязнения флакона и его содержимого."}},{"type":"paragraph","data":{"text":"Флакон необходимо закрывать после каждого использования."}}],"slug":""},{"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","id":16,"body":[{"type":"paragraph","data":{"text":"У некоторых пациентов применение препарата Индоколлир может сопровождаться временной потерей четкости зрительного восприятия (сразу после закапывания глазных капель), поэтому надо соблюдать осторожность при выполнении потенциально опасных видов деятельности, требующих повышенной концентрации внимания и быстроты психомоторных реакций (управление транспортными средствами, работа с движущимися механизмами)."}}]},{"name":"Условия хранения","slug":"storage","id":18,"body":[{"type":"paragraph","data":{"text":"В защищенном от света месте при температуре не выше 25 °С."}},{"type":"paragraph","data":{"text":"Хранить в местах, недоступных для детей."}}]},{"name":"Срок годности","slug":"expiry_date","id":19,"body":[{"type":"paragraph","data":{"text":"1,5 года. Не использовать после срока годности, указанного на упаковке."}},{"type":"paragraph","data":{"text":"Срок годности после вскрытия флакона - 15 дней"}}]},{"name":"Условия отпуска","slug":"release_condition","id":20,"body":[{"type":"paragraph","data":{"text":"По рецепту."}}]},{"name":"Производитель","slug":"","id":21,"body":[{"type":"paragraph","data":{"text":"DR. MANN PHARMA. Страна производства: Германия."}}]}],"source":{"title":"36.6","url":"https://366.ru"}},"description_toggle":false,"short_description":"Фармакодинамика Индометацин — нестероидный противовоспалительный препарат (НПВП), обладающий противовоспалительным и обезболивающим действием. Основным механизмом действия индометацина является ингибирование синтеза простагландинов, которые играют важную роль в патогенезе воспаления и боли. Фармакокинетика Имеются подтвержденные данные о том, что препарат проникает в переднюю камеру глаза. При однократной инстилляции действующее вещество препарата индометацин определяется во влаге передней камеры глаза в течение нескольких часов. Системная абсорбция индометацина при местном применении препарата незначительна.","substance":[{"id":85,"title":"Индометацин","title_latin":"Indomethacinum","slug":"indometatsin_85"}],"branding":null,"valid_for_quick_buy":true,"is_available_to_delivery":false,"comments":null,"image_alt":"Индоколлир - фото упаковки","image_share":{"isTouch":{"default":"https://vseapteki.ru/cropping/thumbnails/101/69413/share_default/"},"isFromTablet":{"default":"https://vseapteki.ru/cropping/thumbnails/101/69413/share_default/"}},"diseases":[{"id":"614","title":"Конъюнктивит","slug":"614-konyunktivit"},{"id":"615","title":"Острый атопический (аллергический) конъюнктивит","slug":"615-ostryy_atopicheskiy_allergicheskiy_konyunktivit"},{"id":"616","title":"Другие острые конъюнктивиты","slug":"616-drugie_ostrye_konyunktivity"},{"id":"617","title":"Хронический конъюнктивит","slug":"617-hronicheskiy_konyunktivit"},{"id":"625","title":"Кератит","slug":"625-keratit"},{"id":"626","title":"Язва 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