Лечение взрослых пациентов с рецидивирующим ремитирующим рассеянным склерозом.
Противопоказания
Повышенная чувствительность к активному веществу или любому вспомогательному компоненту препарата; - детский возраст до 18 лет (в связи с отсутствием клинических данных). С осторожностьюУ пациентов:- с исходно низким общим количеством лимфоцитов крови ( меньше 0.5×109/л); - с тяжелыми нарушениями функции почек (КК меньше 30 мл/мин/1.73 м2) или печени ...
Лечение взрослых пациентов с рецидивирующим ремитирующим рассеянным склерозом.
Противопоказания
Повышенная чувствительность к активному веществу или любому вспомогательному компоненту препарата; - детский возраст до 18 лет (в связи с отсутствием клинических данных). С осторожностьюУ пациентов:- с исходно низким общим количеством лимфоцитов крови ( меньше 0.5×109/л); - с тяжелыми нарушениями функции почек (КК меньше 30 мл/мин/1.73 м2) или печени (класс С по шкале Чайлд-Пью) (отсутствие клинических данных); - с заболеваниями ЖКТ при беременности и в период грудного вскармливания (в связи с ограниченными данными-см. Применение при беременности и в период грудного вскармливания); - при одновременном применении противоопухолевых и иммуносупрессивных препаратов.
Применение при беременности и в период грудного вскармливания
До сих пор нет никаких доказательств тератогенных эффектов фумаровой кислоты в организмечеловека. Однако эксперименты на животных действительно показали аномалии у потомства. Для псориаза поэтому применяется запрет на использование активного вещества длябеременности и кормления грудью. Применение для борьбы с рассеянным склерозом во время беременности и у женщин детородного возраста не использующие контрацепцию надежно, не рекомендуется. Препарат следует использовать только тогда , когда он держит доктора необходимую точно , и это представляет пользу для матери потенциальный риск для плода. Переход активного вещества в грудном молоке не может быть исключена, поэтому использование в период лактации следует избегать, если это возможно.
Способ применения и дозы
Применение препарата необходимо начинать под наблюдением врача, имеющего опыт в лечении данного заболевания. Капсулы или их содержимое не следует измельчать, делить, растворять, сосать, жевать, т.к. кишечнорастворимая оболочка микротаблеток, находящихся внутри капсул, препятствует раздражающему воздействию на слизистую оболочку ЖКТ. Начальная доза составляет 120 мг 2 раза/сут. Через 7 дней дозу рекомендуется увеличить до 240 мг 2 раза/сут. При возникновении нежелательных реакций со стороны ЖКТ или эпизодов «приливов» крови дозу препарата можно кратковременно снизить до 120 мг 2 раза/сут. В течение 1 мес рекомендуется возобновить прием препарата Текфидера в дозе 240 мг 2 раза/сут. Препарат Текфидера следует принимать во время еды, что может способствовать уменьшению интенсивности приливов крови и реакций со стороны ЖКТ. Особенности применения у отдельных групп пациентов. Пожилые пациенты: В клинических исследованиях препарата Текфидера принимало участие ограниченное число пациентов в возрасте 55 лет и старше. Также в исследования не было включено достаточное количество пациентов в возрасте 65 лет и старше для того, чтобы судить о различиях в переносимости препарата пожилыми и молодыми пациентами. Учитывая механизм действия активного вещества, с теоретической точки зрения, нет достаточных оснований для изменения дозы препарата при лечении пожилых пациентов.
Побочное действие
У пациентов, получавших лечение препаратом Текфидера, наиболее часто (у ≥10% пациентов) отмечались такие нежелательные лекарственные реакции (НЛР). как приливы крови и НЛР со стороны ЖКТ (в т.ч., диарея, тошнота, боль в животе, боль в верхней части живота). Приливы крови и НЛР со стороны ЖКТ чаще развиваются в начале терапии (в основном, в течение первого месяца). У пациентов, у которых развиваются подобные симптомы, приливы крови и желудочно-кишечные явления могут периодически возникать и в течение всего периода лечения. Наиболее часто причиной отмены препарата Текфидера (у больше 1% пациентов) были приливы крови (3%) и НЛР со стороны ЖКТ (4%). НЛР представлены в соответствии с поражением органов и систем органов (MedDRA) и классификацией ВОЗ по частоте встречаемости: очень часто - ≥1/10 ( больше 10%); часто - от ≥ 1/100 до меньше 1/10 (от ≥ 1% до меньше 10%); нечасто - от ≥1/1000 до меньше 1/100 (от ≥ 0.1% до меньше 1%); редко - от ≥1/10 000 до меньше 1/1000 (от ≥ 0.01% до меньше 0.1%); очень редко - меньше 1/10 000 ( меньше 0.01%); частота неизвестна - не может быть оценена по имеющимся данным.
Особые указания
Принимать лекарства можно с едой. Специально для пациентов, которые страдают от ощущения тепла или желудочно-кишечных жалоб, принимая вместе с едой улучшить переносимость препарата.
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