Профилактика приступов стенокардии у больных ИБС, в т.ч. после перенесенного инфаркта миокарда
Хроническая сердечная недостаточность (в составе комбинированной терапии)
Противопоказания
Острые нарушения кровообращения (шок, сосудистый коллапс)
Кардиогенный шок, если невозможна коррекция конечного диастолического давления левого желудочка с помощью внутриаортальной контрпульсации или за счет введения средств, оказывающих положительное инотропное действие
Выраженная артериальная гипотензия (систолическое АД<90 мм рт.ст., а диастолическое АД<60 мм рт.ст)
Одновременный прием ингибиторов фосфодиэстеразы, в т.ч. сильденафила, варденафила, тадалафила, поскольку они потенцируют гипотензивное действие препарата
Антиангинальный препарат, органический нитрат. Периферический вазодилататор с преимущественным влиянием на венозные сосуды. Стимулирует образование оксида азота (эндотелиального релаксирующего фактора) в эндотелии сосудов, вызывающего активацию внутриклеточной гуанилатциклазы, следствием чего является увеличение цГМФ (медиатор вазодилатации). Уменьшает потребность миокарда в кислороде за счет снижения преднагрузки и постнагрузки (уменьшает конечный диастолический объем левого желудочка и снижает систолическое напряжение его стенок). Обладает коронарорасширяющим действием. Снижает приток крови к правому предсердию, способствует снижению давления в малом круге кровообращения и регрессии симптомов при отеке легких. Способствует перераспределению коронарного кровотока в области со сниженным кровообращением. Повышает толерантность к физической нагрузке у больных ИБС, стенокардией. Расширяет сосуды головного мозга, твердой мозговой оболочки, что может сопровождаться головной болью. Как и к другим нитратам, развивается перекрестная толерантность. После отмены (перерыва в лечении) чувствительность к нему быстро восстанавливается. Антиангинальный эффект наступает через 30-45 мин после приема внутрь и продолжается до 8-10 ч.
Показания к применению
Профилактика приступов стенокардии у больных ИБС, в т.ч. после перенесенного инфаркта миокарда
Хроническая сердечная недостаточность (в составе комбинированной терапии)
Противопоказания
Острые нарушения кровообращения (шок, сосудистый коллапс)
Кардиогенный шок, если невозможна коррекция конечного диастолического давления левого желудочка с помощью внутриаортальной контрпульсации или за счет введения средств, оказывающих положительное инотропное действие
Выраженная артериальная гипотензия (систолическое АД<90 мм рт.ст., а диастолическое АД<60 мм рт.ст)
Одновременный прием ингибиторов фосфодиэстеразы, в т.ч. сильденафила, варденафила, тадалафила, поскольку они потенцируют гипотензивное действие препарата
Острый инфаркт миокарда с выраженной артериальной гипотензией
Черепно-мозговая травма, кровоизлияние в мозг
Анемия (тяжелая форма)
Наследственная непереносимость галактозы, дефицит лактазы или синдром мальабсорбции глюкозы и галактозы
Токсический отек легких
Детский и подростковый возраст до 18 лет (эффективность и безопасность не установлены)
Повышенная чувствительность к препарату, органическим нитратам. С осторожностью следует применять препарат при:
Гипертрофической обструктивной кардиомиопатии
Констриктивном перикардите
Тампонаде перикарда
Сниженном давлении наполнения левого желудочка, например, при остром инфаркте миокарда (риск снижения АД и тахикардии, которые могут усилить ишемию), снижении функции левого желудочка (левожелудочковой недостаточности). Не следует допускать снижения систолического АД<90 ммрт.ст
Аортальном и/или митральном стенозе
Склонности к артериальной гипотензии (ортостатические нарушения регуляции кровообращения)
Сердечной недостаточности с низким давлением наполнения левого желудочка
Глаукоме (риск повышения внутриглазного давления)
Заболеваниях, сопровождающихся повышением внутричерепного давления (ранее повышение давления отмечалось только при в/в введении высоких доз нитроглицерина), в т.ч. при геморрагическом инсульте, недавно перенесенной травме головы
Выраженной почечной недостаточности
Печеночной недостаточности (риск развития метгемоглобинемии)
Способ применения и дозы
Дозу препарата и кратность приема устанавливают индивидуально в зависимости от тяжести заболевания. Начинать терапию целесообразно с небольших доз препарата: по 10 мг 2 раза/сут. Затем постепенно повышать дозу до терапевтической - 20-40 мг в 1-2 приема. В случае необходимости дозу увеличивают до 60 мг/сут. Максимальная суточная доза - 80 мг. Длительность лечения и повторные курсы - по рекомендации врача. Таблетки следует принимать внутрь, после еды, проглатывая целиком, не разжевывая и запивая небольшим количеством жидкости.
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Информация предоставляется в справочных целях. Не занимайтесь самолечением. При первых признаках заболевания обратитесь к врачу.
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