С осторожностью следует назначать препарат при стенокардии, ИБС, печеночной или почечной недостаточности, нарушении мозгового кровообращения, сахарном диабете типа 1.
Блокатор периферических постсинаптических 1-адренорецепторов.; Блокируя 1-адренорецепторы гладких мышц предстательной железы и шейки мочевого пузыря, препарат способствует нормализации мочеиспускания у пациентов с доброкачественной гиперплазией предстательной железы.; Вызывает расширение артериол и венул, уменьшает ОПСС и венозный возврат к сердцу, в результате чего снижается АД. Начало гипотензивного действия через 15 мин после приема внутрь (однократная доза). Длительность гипотензивного действия - 24 ч. Максимальный эффект при приеме однократной дозы достигается в течение 2-3 ч. Максимальный гипотензивный эффект достигается через 6-8 недель терапии. При длительном применении снижение АД не сопровождается, как правило, развитием рефлекторной тахикардии.; Препарат способствует нормализации липидного обмена: снижает содержание холестерина, ТГ, ЛПНП и ЛПОНП в крови, увеличивая при этом количество ЛПВП.; При систематическом применении Корнама отмечается регрессия гипертрофии левого желудочка.
С осторожностью следует назначать препарат при стенокардии, ИБС, печеночной или почечной недостаточности, нарушении мозгового кровообращения, сахарном диабете типа 1.
Применение при беременности и в период грудного вскармливания
Корнам можно применять при беременности и в период грудного вскармливания в том случае, если потенциальная польза для матери превышает возможный риск для плода или младенца.
Способ применения и дозы
При доброкачественной гиперплазии предстательной железы начальная доза составляет 1 мг 1 раз/сут перед сном. Постепенно дозу увеличивают до 2-10 мг/сут до достижения оптимального эффекта. Терапевтический эффект обычно отмечается через 2 недели с момента начала лечения. Для достижения стойкого эффекта курс лечения должен составлять 4-6 недель.; При артериальной гипертензии назначают препарат в начальной дозе 1 мг/сут перед сном. Постепенно дозу увеличивают до достижения клинического эффекта. Поддерживающая доза составляет 1-10 мг 1 раз/сут. Максимальная суточная доза - 20 мг. В случае временного прекращения приема препарата лечение возобновляют по той же схеме.
Побочное действие
При лечении доброкачественной гиперплазии предстательной железы; Со стороны сердечно-сосудистой системы: редко - ортостатическая гипотензия.; Со стороны ЦНС: сонливость, головокружение, астения.; Прочие: заложенность носа.; При лечении артериальной гипертензии; Со стороны сердечно-сосудистой системы: ортостатическая гипотензия - "эффект первой дозы" (наблюдалась у 1% пациентов, преимущественно получающих одновременно диуретики или бета-адреноблокаторы), проявляющаяся головокружением, тахикардией, возможны обморочные состояния; редко - ощущение сердцебиения, периферические отеки, заложенность носа.; Со стороны ЦНС: редко - головокружение, астения, сонливость, нарушение четкости зрительного восприятия.; Со стороны системы кроветворения: снижение (связанное с гемодилюцией) гематокрита, гемоглобина, лейкопения, гипопротеинемия, гипоальбуминемия.; Прочие: редко - снижение потенции, тошнота.
Передозировка
Симптомы: выраженное снижение АД, нарушения координации движений, обморок.; Лечение: необходимо уложить пациента, опустив головной конец кровати. В случае необходимости назначают гипертензивные средства, в/в введение жидкости. Гемодиализ не эффективен.
Особые указания
Для предотвращения развития ортостатической артериальной гипотензии лечение следует начинать с назначения Корнама в дозе 1 мг/сут перед сном, после чего пациент должен находиться в постели 6-8 ч.; Риск возникновения ортостатической артериальной гипотензии ("эффект первой дозы") наиболее высок в течение 30-90 мин после приема препарата и повышен у пациентов, одновременно получающих бета-адреноблокаторы и диуретики, при уменьшении ОЦК, гипосолевой диете, а также при возобновлении лечения препаратом после перерыва (несколько дней).; В случае временного прекращения лечения возобновляют терапию с той же дозы.; В процессе лечения уровень специфического антигена предстательной железы не изменяется. До начала терапии доброкачественной гиперплазии предстательной железы необходимо исключить рак предстательной железы.; Пациента необходимо проинформировать об увеличении риска развития ортостатической гипотензии при употреблении алкоголя, длительном стоянии или выполнении физических упражнений, а также при жаркой погоде.; Влияние на способность к вождению автотранспорта и управлению механизмами; В течение 12 ч после приема первой дозы, после увеличения дозы или прерывания терапии не рекомендуется заниматься потенциально опасными видами деятельности, требующими повышенного внимания и быстроты психомоторных реакций.
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