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Потенциальный риск применения препарата Дилакса при беременности не установлен, однако исключить его нельзя. При применении НПВС, включая целекоксиб, вследствие ингибирования синтеза ПГ, у некоторых женщин возможно развитие изменений в яичниках, что может стать причиной осложнений во время беременности. При планировании беременности или проведении обследования по поводу бесплодия следует рассмотреть вопрос об отмене приема НПВС, включая целекоксиб. Целекоксиб, относящийся к группе ингибиторов синтеза ПГ, при применении во время беременности, особенно в III триместре, может вызывать слабость родовой деятельности и преждевременное закрытие артериального протока. Применение ингибиторов синтеза ПГ на ранних сроках беременности может негативно отразиться на течении беременности. Имеются ограниченные данные о выведении целекоксиба с грудным молоком. Учитывая потенциальный риск развития побочных эффектов у ребенка и необходимость применения целекоксиба для матери, следует оценить целесообразность грудного вскармливания."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Внутрь, не разжевывая, запивая водой, независимо от приема пищи. Поскольку риск сердечно-сосудистых осложнений может возрастать с увеличением дозы и продолжительности приема препарата Дилакса, следует принимать минимальную эффективную дозу препарата минимально возможным коротким курсом. Максимальная рекомендуемая суточная доза при длительном приеме составляет 400 мг. Симптоматическое лечение остеоартроза. Рекомендуемая доза составляет 200 мг/сут в 1 или 2 приема. Симптоматическое лечение ревматоидного артрита. Рекомендуемая доза составляет 100 или 200 мг 2 раза в сутки. Симптоматическое лечение анкилозирующего спондилита. Рекомендуемая доза составляет 200 мг/сут в 1 или 2 приема. У некоторых пациентов отмечена эффективность применения 400 мг 2 раза в сутки. Лечение болевого синдрома и первичной дисменореи. Рекомендуемая начальная доза составляет 400 мг, с последующим, при необходимости, приемом дополнительной дозы в 200 мг в первый день. В последующие дни рекомендуемая доза составляет 200 мг 2 раза в сутки, по необходимости. Пациенты пожилого возраста. Обычно коррекция дозы не требуется. Однако у пациентов с массой тела менее 50 кг лечение лучше начинать с минимальной рекомендуемой дозы. Нарушение функции печени. У пациентов с легкой степенью тяжести печеночной недостаточности (класс А по классификации Чайлд-Пью) коррекция дозы не требуется. В случае наличия печеночной недостаточности средней степени тяжести (класс B по классификации Чайлд-Пью) лечение следует начинать с минимальной рекомендуемой дозы. Опыта применения препарата Дилакса у пациентов с тяжелой печеночной недостаточностью (класс С по классификации Чайлд-Пью) нет (см. «Противопоказания»). Нарушение функции почек. У пациентов с легкой и средней степенью тяжести почечной недостаточности коррекция дозы не требуется. Опыта применения препарата Дилакса у пациентов с тяжелой почечной недостаточностью нет (см. «Особые указания», «Противопоказания»). Одновременное применение с флуконазолом. Пациентам, принимающим флуконазол (ингибитор изофермента CYP2C9), препарат Дилакса следует принимать в минимальной рекомендуемой дозе. Следует соблюдать осторожность при одновременном применении с другими ингибиторами изофермента CYP2C9. Медленный метаболизм субстратов изофермента CYP2C9. У пациентов, являющихся медленными метаболизаторами или с подозрением на такое состояние, следует применять препарат Дилакса с осторожностью, т.к. это может привести к накоплению целекоксиба в высоких концентрациях в плазме крови. У таких пациентов следует снизить начальную рекомендуемую дозу в 2 раза."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Классификация частоты развития побочных эффектов ВОЗ: очень часто - ≥ .1/10 . часто - от ≥ .1/100 до \u003c1/10 . нечасто - от ≥ .1/1000 до \u003c1/100 . редко - от ≥ . 1/10000 до \u003c1/1000 . очень редко - от \u003c1/10000. Со стороны ССС: часто - периферические отеки, повышение АД, включая утяжеление течения артериальной гипертензии . нечасто - приливы, ощущение сердцебиения . редко - ХСН, аритмия, тахикардия, ишемический инсульт и инфаркт миокарда. Со стороны пищеварительной системы: часто - боль в животе, диарея, диспепсия, метеоризм, рвота . нечасто - заболевания зубов (постэкстракционный луночковый альвеолит) . редко - язва желудка и двенадцатиперстной кишки, изъязвление пищевода . очень редко - перфорация кишечника, панкреатит. Со стороны нервной системы: часто - головокружение, бессонница . нечасто - беспокойство, повышение мышечного тонуса, сонливость . редко - спутанность сознания (психоз). Со стороны мочевыделительной системы: часто - инфекция мочевых путей. Со стороны дыхательной системы: часто - бронхит, кашель, синусит, инфекции верхних дыхательных путей . нечасто - фарингит, ринит. Со стороны кожных покровов: часто - кожный зуд (в т.ч. генерализованный), кожная сыпь . нечасто - крапивница, экхимозы . редко - алопеция. Со стороны органов кроветворения: нечасто - анемия . редко - тромбоцитопения. Со стороны органов чувств: нечасто - шум в ушах, нечеткость зрительного восприятия. Лабораторные показатели: нечасто - повышение активности печеночных ферментов (в т.ч. АЛТ и АСТ). Аллергические реакции: редко - ангионевротический отек . очень редко - буллезные высыпания (буллезный дерматит). Прочие: нечасто - обострение аллергических заболеваний (гиперчувствительность), гриппоподобный синдром, случайные травмы, отек лица. По данным постмаркетингового наблюдения Аллергические реакции: очень редко - анафилаксия (анафилактические реакции). Со стороны нервной системы: редко - галлюцинации . очень редко - кровоизлияния в головной мозг, асептический менингит, потеря вкусовых ощущений, потеря обоняния. Со стороны органов чувств: нечасто - конъюнктивит. Со стороны ССС: редко - ТЭЛА . очень редко - васкулит. Со стороны пищеварительной системы: редко - желудочно-кишечные кровотечения, гепатит . очень редко - печеночная недостаточность, фульминантный гепатит, некроз печени (см. «Особые указания», «Влияние на функцию печени»), холестаз, холестатический гепатит, желтуха. Со стороны кожных покровов: редко - реакции фоточувствительности . очень редко - синдром Стивенса-Джонсона, мультиформная эритема, токсический эпидермальный некролиз, лекарственная сыпь в сочетании с эозинофилией и системными симптомами (DRESS или синдром гиперчувствительности), острый генерализованный экзантематозный пустулез, эксфолиативный дерматит. Со стороны мочевыделительной системы: редко - острая почечная недостаточность (см. «Особые указания», подраздел «Влияние на функцию почек»), гипонатриемия . очень редко - интерстициальный нефрит, нефротический синдром, минимальное нарушение функции почек. Со стороны репродуктивной системы: редко - нарушение менструального цикла . частота неизвестна - снижение фертильности у женщин* (см. «Применение при беременности и кормлении грудью»). Прочие: нечасто - боль в грудной клетке. *Женщины, планирующие беременность, исключались из исследования, поэтому их не учитывали при подсчете частоты встречаемости"}}]},{"id":8,"name":"Особые указания","slug":"cautions","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Классификация частоты развития побочных эффектов ВОЗ: очень часто - ≥ .1/10 . часто - от ≥ .1/100 до \u003c1/10 . нечасто - от ≥ .1/1000 до \u003c1/100 . редко - от ≥ . 1/10000 до \u003c1/1000 . очень редко - от \u003c1/10000. Со стороны ССС: часто - периферические отеки, повышение АД, включая утяжеление течения артериальной гипертензии . нечасто - приливы, ощущение сердцебиения . редко - ХСН, аритмия, тахикардия, ишемический инсульт и инфаркт миокарда. Со стороны пищеварительной системы: часто - боль в животе, диарея, диспепсия, метеоризм, рвота . нечасто - заболевания зубов (постэкстракционный луночковый альвеолит) . редко - язва желудка и двенадцатиперстной кишки, изъязвление пищевода . очень редко - перфорация кишечника, панкреатит. Со стороны нервной системы: часто - головокружение, бессонница . нечасто - беспокойство, повышение мышечного тонуса, сонливость . редко - спутанность сознания (психоз). Со стороны мочевыделительной системы: часто - инфекция мочевых путей. Со стороны дыхательной системы: часто - бронхит, кашель, синусит, инфекции верхних дыхательных путей . нечасто - фарингит, ринит. Со стороны кожных покровов: часто - кожный зуд (в т.ч. генерализованный), кожная сыпь . нечасто - крапивница, экхимозы . редко - алопеция. Со стороны органов кроветворения: нечасто - анемия . редко - тромбоцитопения. Со стороны органов чувств: нечасто - шум в ушах, нечеткость зрительного восприятия. Лабораторные показатели: нечасто - повышение активности печеночных ферментов (в т.ч. АЛТ и АСТ). Аллергические реакции: редко - ангионевротический отек . очень редко - буллезные высыпания (буллезный дерматит). Прочие: нечасто - обострение аллергических заболеваний (гиперчувствительность), гриппоподобный синдром, случайные травмы, отек лица. По данным постмаркетингового наблюдения Аллергические реакции: очень редко - анафилаксия (анафилактические реакции). Со стороны нервной системы: редко - галлюцинации . очень редко - кровоизлияния в головной мозг, асептический менингит, потеря вкусовых ощущений, потеря обоняния. Со стороны органов чувств: нечасто - конъюнктивит. Со стороны ССС: редко - ТЭЛА . очень редко - васкулит. Со стороны пищеварительной системы: редко - желудочно-кишечные кровотечения, гепатит . очень редко - печеночная недостаточность, фульминантный гепатит, некроз печени (см. «Особые указания», «Влияние на функцию печени»), холестаз, холестатический гепатит, желтуха. Со стороны кожных покровов: редко - реакции фоточувствительности . очень редко - синдром Стивенса-Джонсона, мультиформная эритема, токсический эпидермальный некролиз, лекарственная сыпь в сочетании с эозинофилией и системными симптомами (DRESS или синдром гиперчувствительности), острый генерализованный экзантематозный пустулез, эксфолиативный дерматит. Со стороны мочевыделительной системы: редко - острая почечная недостаточность (см. «Особые указания», подраздел «Влияние на функцию почек»), гипонатриемия . очень редко - интерстициальный нефрит, нефротический синдром, минимальное нарушение функции почек. Со стороны репродуктивной системы: редко - нарушение менструального цикла . частота неизвестна - снижение фертильности у женщин* (см. «Применение при беременности и кормлении грудью»). Прочие: нечасто - боль в грудной клетке. *Женщины, планирующие беременность, исключались из исследования, поэтому их не учитывали при подсчете частоты встречаемости"}}]}],"source":{"title":"36.6","url":"https://366.ru"}},"description_toggle":false,"short_description":"НПВС. Является селективным ингибитором ЦОГ-2, благодаря этому блокирует образование воспалительных простаноидов. В терапевтических концентрациях у человека целекоксиб не ингибирует ЦОГ-1, следовательно, не оказывает влияния на простаноиды, синтезируемые за счет активации ЦОГ-1. Критерии определения специфичности по отношению к ЦОГ-2 включают в себя отсутствие побочных явлений, обусловленных действием ЦОГ-1, особенно язвенных поражений желудка и двенадцатиперстной кишки, серьезных осложнений со стороны верхних отделов ЖКТ (кровотечений, перфораций, обструкции пилорического отверстия) и отсутствие ингибирования ЦОГ-2-зависимой агрегационной активности тромбоцитов.","substance":[{"id":464,"title":"Целекоксиб","title_latin":"Celecoxibum","slug":"tselekoksib_464"}],"branding":null,"valid_for_quick_buy":true,"is_available_to_delivery":false,"comments":null,"image_alt":"Дилакса кап. - фото упаковки","image_share":{"isTouch":{"default":"https://vseapteki.ru/cropping/thumbnails/101/5105/share_default/"},"isFromTablet":{"default":"https://vseapteki.ru/cropping/thumbnails/101/5105/share_default/"}},"diseases":[{"id":"1012","title":"Серопозитивный ревматоидный 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