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"}}]},{"id":13,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"Гиперчувствительность к компонентам препарата, а\nтакже к производным пиразолона, угнетение костномозгового кроветворения\n(например, вследствие лечения цитостатиками) или заболевания кроветворной\nсистемы (агранулоцитоз, лейкопения, апластическая анемия), выраженная\nпеченочная и/или почечная недостаточность, дефицит глюкозо-6-фосфатдегидрогеназы,\nтахиаритмии, тяжелая стенокардия, декомпенсированная хроническая сердечная\nнедостаточность, закрытоугольная глаукома, гиперплазия предстательной железы (с\nклиническими проявлениями), кишечная непроходимость, мегалокон, коллапс, беременность,\nпериод грудного вскармливания, детский возраст до 8 лет; атония желчного и мочевого пузыря; непереносимость лактозы, дефицит лактазы, глюкозо-галактозная\nмальабсорбция, аллергия на пшеницу. \u003cb\u003e\u003c/b\u003e"}}]},{"id":14,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"Почечная и/или печеночная недостаточность,\nбронхиальная астма, склонность к артериальной гипотензии; гиперчувствительность\nк другим нестероидным противовоспалительным препаратам (НПВП) или\nненаркотическим анальгетикам, крапивница и/или острый ринит, спровоцированные\nприемом ацетилсалициловой кислоты или другим НПВП."}}]},{"id":5,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Применение препарата во время беременности и в\nпериод грудного вскармливания противопоказано."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Внутрь: лучше после еды, не разжевывая, запивая\nводой. "}},{"type":"paragraph","data":{"text":"Рекомендуемые суточные дозы"}},{"type":"paragraph","data":{"text":"\u003ci\u003eВзрослые\nи дети от 15 лет\u003c/i\u003e: 1-2\nтаблетки 2-3 раза в сутки. Суточная доза не должна превышать 6 таблеток."}},{"type":"paragraph","data":{"text":"У детей препарат применяют только по назначению\nврача. Дети от 8 до 11 лет – по половине таблетки 2-3\nраза в сутки. "}},{"type":"paragraph","data":{"text":"Дети от 12 до 15 лет – по одной\nтаблетке 2-3 раза в сутки. "}},{"type":"paragraph","data":{"text":"\u003cb\u003e\u003ci\u003eПродолжительность приема не должна\nпревышать 5 дней.\u003c/i\u003e\u003c/b\u003e"}},{"type":"paragraph","data":{"text":"Увеличение суточной дозы препарата или продолжительности лечения возможно\nтолько по рекомендации и под наблюдением врача."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Нежелательные реакции (НР) сгруппированы по\nсистемам и органам в соответствии со словарем MedDRA и классификацией частоты развития НР ВОЗ: очень\nчасто (> 1/10); часто (> 1/100 до <  1/10); нечасто (> 1/1000 до\n< 1/100); редко (> 1/10000 до < 1/1000); очень редко (< 1/10000);\nчастота неизвестна (частота не может быть определена на основе имеющихся\nданных). Перечисленные ниже нежелательные реакции вызваны в основном\nметамизолом натрия, который входит в состав лекарственного препарата. "}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо\nстороны крови и лимфатической системы: \u003c/i\u003eредко - лейкопения; очень редко - агранулоцитоз,\nтромбоцитопения, анемия (гемолитическая анемия, апластическая анемия). \u003ci\u003e\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо\nстороны имунной системы: \u003c/i\u003eредко - анафилактический шок, анафилактические или анафилактоидные реакции,\nособенно после парентерального применения; очень редко - приступ бронхиальной\nастмы (у пациентов с «аспириновой»\nастмой), циркуляторный шок.\u003ci\u003e\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо\nстороны кожи и подкожной клетчатки: \u003c/i\u003eнечасто - фиксированная лекарственная экзантема; редко - макулопапулезные и\nдругие виды высыпаний, синдром Лайелла или синдром Стивенса-Джонсона,\nангионевротический отек, уменьшение потоотделения."}},{"type":"paragraph","data":{"text":"В случае возникновения каких-либо кожных реакций\nприменение лекарственного препарата должно быть немедленно прекращено. "}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо\nстороны нервной системы:\u003c/i\u003e\nголовокружение, головная боль. \u003ci\u003e\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо\nстороны органов чувств (зрение): \u003c/i\u003eзрительные нарушения, нарушения аккомодации.\u003ci\u003e \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо\nстороны сердца: \u003c/i\u003eнечасто -\nощущение сердцебиения, тахикардия, нарушение сердечного ритма, цианоз. \u003ci\u003e\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо\nстороны сосудов: \u003c/i\u003eнечасто -\nартериальная гипотензия, гиперемия.\u003ci\u003e \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо\nстороны желудочно-кишечного тракта (ЖКТ)\u003c/i\u003e: частота неизвестна - сухость во рту, тошнота,\nрвота, боль в животе и дискомфорт, запор, в редких случаях рвота с примесью\nкрови и кишечные кровотечения. "}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо\nстороны печени и желчевыводящих путей:\u003c/i\u003e гепатит."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо\nстороны мочевыделительной системы\u003c/i\u003e: редко - протеинурия, олигурия, анурия, полиурия, интерстициальный нефрит,\nокрашивание мочи в красный цвет, затрудненное мочеиспускание, нарушение функции\nпочек; частота неизвестна - задержка мочи."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо\nстороны дыхательной системы:\u003c/i\u003e бронхоспазм."}},{"type":"paragraph","data":{"text":"\u003cb\u003e\u003ci\u003eОписание отдельных НР\u003c/i\u003e\u003c/b\u003e"}},{"type":"paragraph","data":{"text":"\u003ci\u003eАгранулоцитоз\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Риск появления агранулоцитоза невозможно\nпредсказать. Агранулоцитоз может возникнуть и у пациентов, принимавших\nметамизол натрия в прошлом без появления подобных НР."}},{"type":"paragraph","data":{"text":"\u003ci\u003eАнафилактические\nили анафилактоидные реакции\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Такие реакции могут возникнуть во время введения\nпрепарата или непосредственно после прекращения введения, но могут проявиться и\nчерез несколько часов. Обычно они развиваются в течение первого часа после\nинъекции. Более легкие реакции проявляются в виде типичных реакций со стороны\nкожи и слизистых оболочек (например, зуд, жжение, покраснение, крапивница,\nотеки - местные или общие), одышка и редко жалобы со стороны ЖКТ. Легкие\nреакции могут перейти в более тяжелые формы с генерализованной крапивницей,\nтяжелым ангионевротическим отеком (в том числе с ларингоспазмом), в тяжелый\nбронхоспазм, нарушение сердечного ритма, снижение артериального давления\n(иногда с предшествующим повышением артериального давления). "}},{"type":"paragraph","data":{"text":"По этой причине, если возникает любая кожная\nреакция гиперчувствительности, симптомы нарушения функции почек или\nгематотоксические реакции, применение препарата следует немедленно прекратить. "}},{"type":"paragraph","data":{"text":"\u003ci\u003eЦиркуляторный\nшок\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Шок может сопровождаться холодным потом,\nголовокружением, сонливостью, угнетением сознания, бледностью кожи, ощущением\nсдавливания в области сердца, поверхностным дыханием или тахипноэ, тахикардией,\nпохолоданием конечностей, сильным падением артериального давления. При первых\nпризнаках шока применение препарата необходимо отменить и принять\nсоответствующие меры неотложной помощи. "}},{"type":"paragraph","data":{"text":"\u003ci\u003eАртериальная\nгипотензия\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Гипотензивные реакции редко могут проявляться во\nвремя или после применения. Они могут сопровождаться или не сопровождаться\nдругими симптомами анафилактоидных или анафилактических реакций. "}},{"type":"paragraph","data":{"text":"Редко такие реакции могут быть результатом резкого\nснижения артериального давления. "}},{"type":"paragraph","data":{"text":"Критическое снижение артериального давления без\nдругих признаков гиперчувствительности дозозависимо и может проявиться в виде\nгиперпирексии. "}}]},{"id":8,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"При передозировке\nпрепаратом могут наблюдаться следующие симптомы: рвота, ощущение сухости во\nрту, снижение потоотделения, нарушение\nаккомодации, снижение артериального давления, сонливость, спутанность сознания,\nнарушение функции печени и почек, судороги."}},{"type":"paragraph","data":{"text":"Лечение – промывание\nжелудка, назначение активированного угля, симптоматическая терапия."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"При одновременном примениии \u003ci\u003eс блокаторами \u003c/i\u003e\u003ci\u003eН\u003csub\u003e1\u003c/sub\u003e-гистаминовых\nрецепторов, производными бутирофенона и фенотиазина, амантадином и хинидином\u003c/i\u003e возможно усиление М-холиноблокирующего\nдействия препарата."}},{"type":"paragraph","data":{"text":"Усиливает эффекты \u003ci\u003eэтанола\u003c/i\u003e."}},{"type":"paragraph","data":{"text":"Одновременное применение \u003ci\u003eс другими ненаркотическими анальгезирующими препаратами\u003c/i\u003e может\nпривести к взаимному усилению токсических эффектов."}},{"type":"paragraph","data":{"text":"\u003ci\u003eТрициклические\nантидепрессанты, пероральные контрацептивы, аллопуринол\u003c/i\u003e нарушают метаболизм метамизола натрия в\nпечени и повышают его токсичность. "}},{"type":"paragraph","data":{"text":"При одновременном применении препарата \u003ci\u003eс трициклическими антидепрессантами\u003c/i\u003e\nвозможно усиление его м-холиноблокирующего действия. "}},{"type":"paragraph","data":{"text":"\u003ci\u003eБарбитураты,\nфенилбутазон и другие индукторы микросомальных ферментов печени\u003c/i\u003e ослабляют действие метамизола натрия. "}},{"type":"paragraph","data":{"text":"\u003ci\u003eСедативные\nсредства и анксиолитические средства (транквилизаторы)\u003c/i\u003e усиливают обезболивающее действие препарата. "}},{"type":"paragraph","data":{"text":"Одновременное применение \u003ci\u003eс хлорпромазином или другими производными фенотиазина\u003c/i\u003e может\nпривести к развитию выраженной гипертермии. "}},{"type":"paragraph","data":{"text":"\u003ci\u003eРентгеноконтрастные\nвещества, коллоидные кровезаменители и пенициллин\u003c/i\u003e не должны применяться во время лечения\nпрепаратами, содержащими метамизол натрия, так как повышается риск развития\nанафилактических/анафилактоидных реакций. "}},{"type":"paragraph","data":{"text":"Метамизол натрия может снижать концентрацию \u003ci\u003eциклоспорина\u003c/i\u003e в сыворотке крови, поэтому\nпри одновременном применении препарата с циклоспорином следует контролировать\nконцентрацию циклоспорина. "}},{"type":"paragraph","data":{"text":"Метамизол натрия, вытесняя из связи с белками\nплазмы \u003ci\u003eпероральные гипогликемические\nпрепараты, непрямые антикоагулянты, глюкокортикостероиды и индометацин\u003c/i\u003e\n(лекарстенные препараты, имеющие высокую связь с белками плазмы), увеличивает\nих активность."}},{"type":"paragraph","data":{"text":"\u003ci\u003eМиелотоксические\nлекарственные средства\u003c/i\u003e\nусиливают проявление гематотоксичности препарата. "}},{"type":"paragraph","data":{"text":"Добавление препарата к лечению \u003ci\u003eметотрексатом\u003c/i\u003e может усиливать\nгематотоксическое действие последнего, особенно у пациентов пожилого возраста.\nПоэтому данной комбинации препаратов следует избегать."}},{"type":"paragraph","data":{"text":"Одновременное применение \u003ci\u003eс тиамазолом и сарколизином\u003c/i\u003e повышает риск развития лейкопении. "}},{"type":"paragraph","data":{"text":"\u003ci\u003eКодеин,\nблокаторы Н\u003csub\u003e2\u003c/sub\u003e-гистаминовых рецепторов и пропранолол\u003c/i\u003e усиливают эффекты метамизола натрия. "}},{"type":"paragraph","data":{"text":"При необходимости одновременного применения\nуказанных выше и других лекарственных препаратов следует проконсультироваться с\nврачом."}}]},{"id":9,"name":"Особые указания","slug":"","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"При лечении детей и пациентов, получающих\nцитостатические средства, лечение препаратом должно проводиться только под\nнаблюдением врача."}},{"type":"paragraph","data":{"text":"Повышенный риск развития реакций\nгиперчувствительности на входящий в состав препарата метамизол натрия\nобуславливают следующие состояния: "}},{"type":"paragraph","data":{"text":"-     бронхиальная астма, особенно в сочетании с\nполипозными риносинуситом;"}},{"type":"paragraph","data":{"text":"-     хроническая крапивница;"}},{"type":"paragraph","data":{"text":"-     непереносимость алкоголя (повышенная\nчувствительности к алкоголю), на фоне которой даже при приеме назначительного\nколичества некоторых алкогольных напитков у пациентов возникает чихание,\nслезотечение и выраженное покраснение лица. Непереносимость алкоголя может\nсвидетельствовать о ранее неустановленнном синдроме аспириновой астмы;"}},{"type":"paragraph","data":{"text":"-     непереносимость или повышенная\nчувствительность к красителям (например, к тартразину) или консервантам\n(например, к бензоату). "}},{"type":"paragraph","data":{"text":"Перед применением препарата необходимо провести\nтщательный опрос пациента. В случае выявления риска развития анафилактоидной\nреакции, применение препарата возможно только после полной оценки соотношения\nриск/польза. "}},{"type":"paragraph","data":{"text":"В случае применения препарата у таких пациентов\nнеобходим строгий медицинский контроль за их состоянием и обязательно наличие\nсредств оказания им неотложной помощи в случае развития\nанафилактических/анафилактоидных реакций. "}},{"type":"paragraph","data":{"text":"У предрасположенных пациентов может возникнуть\nанафилактический шок, поэтому пациентам с астмой или атопией препарат следует\nназначать с осторожностью. "}},{"type":"paragraph","data":{"text":"На фоне применения метамизола натрия были описаны\nугрожающие жизни кожные реакции, такие как синдром Стивенса-Джонсона и\nтоксический эпидермальный некролиз. При появлении симптомов данных заболеваний\n(таких как прогрессирующая кожная сыпь, часто с пузырями или поражениями\nслизистой оболочки) лечение препаратом следует немедленно прекратить и не\nследует начинать его повторно. "}},{"type":"paragraph","data":{"text":"Во время терапии метамизолсодержащими препаратами\nвозможно развитие агранулоцитоза. Он длится не менее недели, не зависит от дозы,\nможет быть тяжелым, угрожать жизни и даже привести к гибели пациента. В связи с\nэтим при появлении симптомов, возможно связанных с нейтропенией (лихорадка,\nозноб, боль в горле, затрудненное глотание, стоматит, эрозивно-язвенные\nпоражения ротовой полости, вагинит или проктит, снижение количества нейтрофилов\nв периферической крови - менее 1500/мм\u003csup\u003e3\u003c/sup\u003e), необходимо прекратить\nлечение и обратиться к врачу. "}},{"type":"paragraph","data":{"text":"Если пациент получает антибиотикотерапию, то\nтипичные проявления агранулоцитоза могут быть минимально выраженными. Скорость\nоседания эритроцитов значительно увеличивается, в то время как увеличение\nлимфатических узлов является слабо выраженным или отсутствует. "}},{"type":"paragraph","data":{"text":"Типичными симптомами тромбоцитопении являются\nповышенная склонность к кровотечению и возникновению петехий на коже и\nслизистых оболочках. "}},{"type":"paragraph","data":{"text":"В случае панцитопении лечение следует немедленно\nпрекратить, необходимо контролировать показатели развернутого анализа крови\nвплоть до их нормализации. "}},{"type":"paragraph","data":{"text":"Все пациенты должны быть осведомлены о том, что\nпри появлении симптомов патологического изменения крови (например, общего\nнедомогания, инфекции, стойкой лихорадки, образования гематом, кровотечения,\nбледности кожных покровов) на фоне применения препарата следует немедленно\nобратиться к врачу. "}},{"type":"paragraph","data":{"text":"Введение метамизолсодержащего препарата может\nвызывать отдельные гипотензивные реакции. Данные реакции, возможно, зависят от\nдозы препарата и чаще возникают после парентерального введения. "}},{"type":"paragraph","data":{"text":"Во избежание развития тяжелых гипотензивных\nреакций нужно придерживаться следующих рекомендаций: "}},{"type":"paragraph","data":{"text":"-     следует контролировать артериальное\nдавление, частоту сердечных сокращений и дыхание; "}},{"type":"paragraph","data":{"text":"-     пациентам с имеющейся гипотензией,\nснижением объема циркулирующей крови, дегидратацией, нестабильностью\nгемодинамики или с начальной стадией недостаточностти кровообращения требуется\nнормализация гемодинамики; "}},{"type":"paragraph","data":{"text":"-     при лечении пациентов с высокой\nтемпературой тела следует соблюдать осторожность. Пациентам, которым следует\nизбегать снижения артериального давления (например, при тяжелой ишемической\nболезни сердца или стенозе сосудов головного мозга), терапию следует проводить\nтолько при тщателном контроле гемодинамики."}},{"type":"paragraph","data":{"text":"В период лечения препаратом следует воздержаться\nот приема алкоголя."}},{"type":"paragraph","data":{"text":"Недопустимо применение препарата для купирования\nострых болей в животе (до выяснения причины). "}},{"type":"paragraph","data":{"text":"У пациентов с нарушением функции печени или почек\nрекомендуется избегать применения препарата в высоких дозах из-за снижения\nскорости выведения препарата. "}}]},{"id":16,"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","body":[{"type":"paragraph","data":{"text":"Действующее вещество препарата - фенпивериния\nбромид - имеет холинолитическое действие и может вызвать головокружение и\nнарушение аккомодации. Пациентов, которые управляют транспортными средствами\nили работают с машинами, следует предупредить о возможных побочных действиях\nпрепарата. Деятельность, требующую повышенного внимания, следует прекратить до\nисчезновения побочных эффектов."}}]},{"id":18,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"При температуре не выше 25 °С."}},{"type":"paragraph","data":{"text":"Хранить в недоступном для детей месте."}}]},{"id":19,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"2 года. Не применять по истечении срока годности."}}]},{"id":20,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"Отпускают без рецепта."}}]},{"id":21,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"Балканфарма-Дупница АД, Болгария, ул. Самоковское\nшоссе 3, 2600 Дупница, Болгария"}},{"type":"paragraph","data":{"text":"или "}},{"type":"paragraph","data":{"text":"АО ХФЗ «Здравле»,\nВлайкова 199, 16000 Лесковац, Сербия"}},{"type":"paragraph","data":{"text":"* В данном разделе указывают название и адрес\nкомпании производителя. "}}]},{"id":22,"name":"Организация, принимающая претензии потребителей","body":[{"type":"paragraph","data":{"text":"ООО «Тева»,\n115054, Москва, ул. Валовая, 35, "}},{"type":"paragraph","data":{"text":"тел.: +7 (495)\n644 22 34, факс: +7 (495) 644 22 35"}},{"type":"paragraph","data":{"text":"Адрес в\nинтернете: www.teva.ru"}}]}],"source":{"title":"36.6","url":"https://366.ru"}},"description_toggle":false,"short_description":"Спазмалгон ‒ комбинированный препарат, в состав которого входят: ненаркотический анальгетик метамизол натрия, миотромное спазмолитическое средство питофенон и м-холиноблокирующее средство фенпивериния бромид. 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В стенке кишечника гидролизуется с образованием активного метаболита, неизменный метамизол натрия в крови отсутствует (только после внутривенного введения незначительная его концентрация обнаруживается в плазме). Связь активного метаболита с белками крови ‒ 50-60 %. Метаболизируется в печени, выводится почками. В терапевтических дозах проникает в грудное молоко.Питофенон и фенпивериния бромид. В доступных литературных данных недостаточно сведений о фармакокинетике данных действующих веществ. Оба действующих вещества характеризуются неполной резорбцией, при этом они полностью ионизируются. Имеют слабую липорастворимость. Не проходят через гематэнцефалический барьер. 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