Противогрибковый препарат. Флуконазол – представитель класса... Инструкция
Показания к применению
Лечение острого вагинального кандидоза, когда местная терапия не применима.
Противопоказания
• Одновременный прием терфенадина (на фоне многократного приема флуконазола в дозе 400 мг/сут и более) (см. раздел «Взаимодействие с другими лекарственными средствами»);
• Повышенная чувствительность к флуконазолу и другим компонентам препарата или близким по структуре азольным соединениям;
(для дозировки 50 мг) корпус: титана диоксид (Е 171) – 3,0000 %, железа оксид красный (Е 172) – 0,0857 %, желатин – до 100 %; крышечка: титана диоксид (Е 171) – 2,0000 %, железа оксид красный (Е 172) – 0,7286 %, желатин – до 100 %;
(для дозировки 150 мг) корпус и крышечка: титана диоксид (Е 171) – 2,0000 %, желатин – до 100 %.
Описание
Флюкостат — системный противогрибковый препарат для лечения «молочницы».
Фармакотерапевтическая группа
Противогрибковое средство
Фармакологические свойства
Противогрибковый препарат. Флуконазол – представитель класса триазольных противогрибковых средств, является мощным селективным ингибитором синтеза стеролов в клетке грибов.
Активен в отношении возбудителей оппортунистических микозов, в т.ч. вызванных Candida spp., Cryptococcus neoformans, Microsporum spp., Trichophyton spp. Показана также активность флуконазола на моделях эндемичных микозов, включая инфекции, вызванные Blastomyces dermatitidis, Coccidioides immitis и Histoplasma capsulatum.
Показания к применению
Лечение острого вагинального кандидоза, когда местная терапия не применима.
Противопоказания
• Одновременный прием терфенадина (на фоне многократного приема флуконазола в дозе 400 мг/сут и более) (см. раздел «Взаимодействие с другими лекарственными средствами»);
• Повышенная чувствительность к флуконазолу и другим компонентам препарата или близким по структуре азольным соединениям;
• Детский возраст до 18 лет;
• Период лактации (см. раздел «Применение при беременности и в период грудного вскармливания»);
• Одновременное применение с препаратами, увеличивающими интервал QT и метаболизирующимися с помощью изофермента CYP3A4, такими как цизаприд, астемизол, эритромицин, пимозид, хинидин и амиодарон (см. раздел «Взаимодействие с другими лекарственными средствами»);
• Проаритмогенные состояния у пациентов с множественными факторами риска (органические заболевания сердца, нарушения электролитного баланса, одновременный прием лекарственных средств, вызывающих аритмии);
• Нарушение функции почек;
• Появление сыпи на фоне применения флуконазола у больных с поверхностной грибковой инфекцией и инвазивными/системными грибковыми инфекциями;
• Одновременное применение терфенадина и флуконазола в дозе менее 400 мг/сут.
Применение при беременности и в период грудного вскармливания
Адекватных и контролируемых исследований применения флуконазола у беременных женщин не проводилось.
В настоящее время нет доказательств влияния низких доз флуконазола (150 мг однократно для лечения вульвовагинального кандидоза) на повышение частоты неблагоприятных исходов беременности, а также взаимосвязи с возникновением каких-либо специфических пороков развития у ребенка.
При применении высоких доз (400-800 мг/сут) флуконазола описано несколько случаев множественных врожденных пороков у новорожденных, матери которых на протяжении большей части или всего первого триместра получали терапию флуконазолом.
Применение препарата у беременных нецелесообразно, за исключением тяжелых или угрожающих жизни форм грибковых инфекций, если предполагаемая польза для матери превышает возможный риск для плода.
Женщинам детородного возраста следует использовать средства контрацепции.
Флуконазол находится в грудном молоке в такой же концентрации, как и в плазме, поэтому его назначение в период лактации противопоказано.
Способ применения и дозы
Внутрь. Капсулы проглатывают целиком.
При остром вагинальном кандидозе препарат применяют однократно внутрь в дозе 150 мг.
Применение у пожилых людей
У больных пожилого возраста при отсутствии нарушений функции почек следует придерживаться обычного режима дозирования препарата.
Применение у больных с почечной недостаточностью
При однократном приеме изменение дозы не требуется.
Побочное действие
Классификация побочных реакций по органам и системам представлена с указанием частоты их возникновения:
Нарушения со стороны желудочно-кишечного тракта: часто – боль в животе, диарея, рвота*, тошнота; нечасто – метеоризм, диспепсия*, сухость слизистой оболочки полости рта, запор.
Нарушения со стороны печени и желчевыводящих путей: часто – повышение сывороточной активности аминотрансфераз (аланинаминотрансферазы (АЛТ) и аспартатаминотрансферазы (АСТ)), щелочной фосфатазы; нечасто – желтуха*, холестаз, повышение концентрации билирубина; редко - гепатотоксичность, в некоторых случаях с летальным исходом, нарушение функции печени*, гепатит*, гепатоцеллюлярный некроз*, гепатоцеллюлярное повреждение.
Нарушения со стороны кожи и
подкожно-жировой клетчатки: часто – сыпь;нечасто – кожный зуд, крапивница, повышенное потоотделение, лекарственная сыпь;редко – эксфолиативные поражения кожи*, включая синдром Стивенса-Джонсона и токсический эпидермальныйнекролиз, острый генерализованныйэкзантематозныйпустулез, отек лица, алопеция*.
Нарушения со стороны крови и лимфатической системы*: редко – лейкопения, включая нейтропению и агранулоцитоз, тромбоцитопения, анемия.
Нарушения со стороны иммунной системы*: редко – анафилаксия (включая ангионевротический отек, отек лица).
Нарушения со стороны сердечно-сосудистой системы*: редко - увеличение продолжительности интервала QT на ЭКГ, желудочковая тахикардия по типу «пируэт» (см. раздел «Особые указания»).
Нарушения со стороны обмена веществ*: редко - повышение концентрации холестерина и триглицеридов в плазме крови, гипокалиемия.
Нарушения со стороны опорно-двигательного аппарата: нечасто - миалгия.
У некоторых больных, особенно с серьезными заболеваниями, такими как ВИЧ-инфекция или рак, при лечении флуконазолом и сходными препаратами наблюдались изменения показателей крови, функции почек и печени, однако клиническое значение этих изменений и их связь с лечением не установлены.
Если любые из указанных в инструкции побочных эффектов усугубляются, или отмечаются любые другие побочные эффекты, не указанные в инструкции, следует немедленно сообщить об этом врачу.
Передозировка
Симптомы: галлюцинации, параноидальное поведение.
Лечение: симптоматическое, промывание желудка, форсированный диурез. Гемодиализ в течение 3 ч снижает концентрацию в плазме приблизительно на 50%.
Взаимодействие с другими лекарственными средствами
При применении флуконазола с варфарином отмечалось увеличение протромбинового времени на 12%. В связи с этим рекомендуется контролировать протромбиновое время у пациентов, получающих Флюкостат в сочетании с кумариновыми антикоагулянтами.
При одновременном применении флуконазол увеличивает T1/2 пероральных гипогликемических препаратов - производных сульфонилмочевины (хлорпропамида, глибенкламида, глипизида и толбутамида). Совместное назначение флуконазола и пероральных гипогликемических препаратов допускается, но при этом следует учитывать возможность развития гипогликемии.
Одновременное применение флуконазола и фенитоина может сопровождаться повышением концентрации фенитоина в клинически значимой степени. Поэтому при необходимости сочетанного применения этих препаратов необходимо мониторирование концентрации фенитоина с коррекцией его дозы с целью обеспечения терапевтической концентрации в плазме крови.
Одновременное применение флуконазола и рифампицина приводит к снижению AUC на 25% и укорочению T1/2 флуконазола из плазмы на 20%. Поэтому у пациентов, получающих одновременно рифампицин, дозу флуконазола рекомендуется увеличить.
Рекомендуется контролировать концентрацию циклоспорина в крови у пациентов, получающих флуконазол, т.к. при применении флуконазола и циклоспорина у пациентов с пересаженной почкой прием флуконазола в дозе 200 мг/сут приводит к медленному повышению концентрации циклоспорина в плазме крови.
Пациенты, получающие теофиллин в высоких дозах, или у которых имеется вероятность развития теофиллиновой интоксикации, должны находиться под наблюдением с целью раннего выявления симптомов передозировки теофиллина, т.к. одновременный прием флуконазола приводит к снижению средней скорости клиренса теофиллина из плазмы.
При одновременном применении флуконазола и терфенадина или цизаприда описаны случаи нежелательных реакций со стороны сердца, включая пароксизмы желудочковой тахикардии (аритмии типа "пируэт").
Имеются сообщения о взаимодействии флуконазола и рифабутина, сопровождающемся повышением сывороточных уровней последнего. При одновременном применении флуконазола и рифабутина описаны случаи развития увеита. Необходимо тщательно наблюдать больных, одновременно получающих рифабутин и флуконазол.
При одновременном применении флуконазола и зидовудина отмечается повышение концентрации зидовудина в плазме, которое вызвано снижением превращения последнего в его метаболит.
При одновременном применении флуконазола с мидазоламом повышается риск психомоторных эффектов, с такролимусом - повышается риск нефротоксичности.
Особые указания
При применении флуконазола 150 мг по поводу вагинального кандидоза пациенты должны быть предупреждены, что улучшение симптомов обычно наблюдается через 24 ч, но для их полного исчезновения иногда требуется несколько дней. При сохранении симптомов в течение нескольких дней, следует обратиться к врачу.
В редких случаях применение флуконазола сопровождалось токсическими изменениями печени, в т.ч. с летальным исходом, главным образом у больных с серьезными сопутствующими заболеваниями. В случае гепатотоксических эффектов, связанных с флуконазолом, не отмечено явной зависимости их от общей суточной дозы, длительности терапии, пола и возраста больного.
Гепатотоксическое действие флуконазола обычно было обратимым; признаки его исчезали после прекращения терапии. Больных, у которых во время лечения препаратом наблюдаются нарушения показателей функции печени, необходимо наблюдать с целью выявления признаков более серьезного поражения печени. При появлении клинических признаков или симптомов поражения печени, которые могут быть связаны с применением флуконазола, препарат следует отменить.
Как и при применении других азолов, флуконазол в редких случаях может вызвать анафилактические реакции.
Во время лечения флуконазолому больных в редких случаях развивались эксфолиативные поражения кожи, такие как синдром Стивенса-Джонсона и токсический эпидермальный некролиз. Больные СПИДом более склонны к развитию тяжелых кожных реакций при применении многих препаратов. В тех случаях, когда у больных с поверхностной грибковой инфекцией развивается сыпь и она расценивается как определенно связанная с флуконазолом, препарат следует отменить. При появлении сыпи у больных с инвазивными/системными грибковыми инфекциями, их следует тщательно наблюдать и отменить флуконазол при появлении буллезных изменений или многоформной экссудативной эритемы.
Одновременное применение флуконазола в дозах менее 400 мг/сут и терфенадина следует проводить под тщательным контролем (см. раздел «Взаимодействие с другими лекарственными средствами»).
Как и другие азолы, флуконазол может вызывать увеличение интервала QT на ЭКГ. При применении флуконазола увеличение интервала QT и мерцание или трепетание желудочков отмечалось очень редко у больных с тяжелыми заболеваниями с множественными факторами риска, такими как органические заболевания сердца, нарушения электролитного баланса, а также способствующая развитию подобных нарушений сопутствующая терапия. Поэтому у таких пациентов с потенциально проаритмическими состояниями применять флуконазол следует с осторожностью.
Пациентам с заболеваниями печени, сердца и почек перед применением препарата рекомендуется проконсультироваться с врачом.
Сообщалось о случаях суперинфекции, вызванной отличными от Candida albicans штаммами Candida, которые часто обладают природной резистентностью к флуконазолу (например, Candidakrusei). В подобных случаях может потребоваться альтернативная противогрибковая терапия.
Влияние на способность управлять автомобилем и движущимися механизмами
В связи с возможностью возникновения головокружения и других побочных эффектов, связанных с приемом препарата, в период лечения пациентам рекомендуется воздержаться от управления автотранспортом и занятиями другими потенциально опасными видами деятельности, требующими повышенной концентрации внимания, быстроты психомоторных и двигательных реакций.
Форма выпуска
Капсулы 50 мг.
Условия хранения
Хранить при температуре не выше 25 °С.
Хранить в недоступном для детей месте.
Срок годности
3 года. Не использовать по истечении срока годности, указанного на упаковке.
Условия отпуска
Без рецепта
Производитель
ОАО "Фармстандарт-Лексредства"
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Флуконазол – представитель класса триазольных противогрибковых средств, является мощным селективным ингибитором синтеза стеролов в клетке грибов."}},{"type":"paragraph","data":{"text":"\u003ci\u003eАктивен в отношении\u003c/i\u003e возбудителей оппортунистических микозов, в т.ч. вызванных Candida spp., Cryptococcus neoformans, Microsporum spp., Trichophyton spp. Показана также активность флуконазола на моделях эндемичных микозов, включая инфекции, вызванные Blastomyces dermatitidis, Coccidioides immitis и Histoplasma capsulatum."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Лечение острого вагинального кандидоза, когда местная терапия не применима."}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"\n\n• Одновременный прием терфенадина (на фоне многократного приема флуконазола в дозе 400 мг/сут и более) (см. раздел «Взаимодействие с другими лекарственными средствами»);"}},{"type":"paragraph","data":{"text":"• Повышенная чувствительность к флуконазолу и другим компонентам препарата или близким по структуре азольным соединениям;"}},{"type":"paragraph","data":{"text":"• Детский возраст до 18 лет;"}},{"type":"paragraph","data":{"text":"• Период лактации (см. раздел «Применение при беременности и в период грудного вскармливания»);"}},{"type":"paragraph","data":{"text":"• Одновременное применение с препаратами, увеличивающими интервал QT и метаболизирующимися с помощью изофермента CYP3A4, такими как цизаприд, астемизол, эритромицин, пимозид, хинидин и амиодарон (см. раздел «Взаимодействие с другими лекарственными средствами»); "}},{"type":"paragraph","data":{"text":"• Непереносимость галактозы, дефицит лактазы, глюкозо-галактозная мальабсорбция.\n\n"}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"\n\n• Нарушение показателей функции печени;"}},{"type":"paragraph","data":{"text":"• Одновременный прием потенциально гепатотоксичных лекарственных средств;"}},{"type":"paragraph","data":{"text":"• Алкоголизм;"}},{"type":"paragraph","data":{"text":"• Проаритмогенные состояния у пациентов с множественными факторами риска (органические заболевания сердца, нарушения электролитного баланса, одновременный прием лекарственных средств, вызывающих аритмии);"}},{"type":"paragraph","data":{"text":"• Нарушение функции почек;"}},{"type":"paragraph","data":{"text":"• Появление сыпи на фоне применения флуконазола у больных с поверхностной грибковой инфекцией и инвазивными/системными грибковыми инфекциями;"}},{"type":"paragraph","data":{"text":"• Одновременное применение терфенадина и флуконазола в дозе менее 400 мг/сут.\n\n"}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"\n\nАдекватных и контролируемых исследований применения флуконазола у беременных женщин не проводилось."}},{"type":"paragraph","data":{"text":"В настоящее время нет доказательств влияния низких доз флуконазола (150 мг однократно для лечения вульвовагинального кандидоза) на повышение частоты неблагоприятных исходов беременности, а также взаимосвязи с возникновением каких-либо специфических пороков развития у ребенка. "}},{"type":"paragraph","data":{"text":"При применении высоких доз (400-800 мг/сут) флуконазола описано несколько случаев множественных врожденных пороков у новорожденных, матери которых на протяжении большей части или всего первого триместра получали терапию флуконазолом. "}},{"type":"paragraph","data":{"text":"Применение препарата у беременных нецелесообразно, за исключением тяжелых или угрожающих жизни форм грибковых инфекций, если предполагаемая польза для матери превышает возможный риск для плода."}},{"type":"paragraph","data":{"text":"Женщинам детородного возраста следует использовать средства контрацепции."}},{"type":"paragraph","data":{"text":"Флуконазол находится в грудном молоке в такой же концентрации, как и в плазме, поэтому его назначение в период лактации противопоказано.\n\n"}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"\n\nВнутрь. Капсулы проглатывают целиком."}},{"type":"paragraph","data":{"text":"При остром вагинальном кандидозе препарат применяют однократно внутрь в дозе 150 мг."}},{"type":"paragraph","data":{"text":"Применение у пожилых людей"}},{"type":"paragraph","data":{"text":"У больных пожилого возраста при отсутствии нарушений функции почек следует придерживаться обычного режима дозирования препарата."}},{"type":"paragraph","data":{"text":"Применение у больных с почечной недостаточностью"}},{"type":"paragraph","data":{"text":"При однократном приеме изменение дозы не требуется.\n\n"}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"\n\nКлассификация побочных реакций по органам и системам представлена с указанием частоты их возникновения:"}},{"type":"paragraph","data":{"text":"Нарушения со стороны желудочно-кишечного тракта: часто – боль в животе, диарея, рвота*, тошнота; нечасто – метеоризм, диспепсия*, сухость слизистой оболочки полости рта, запор."}},{"type":"paragraph","data":{"text":"Нарушения со стороны печени и желчевыводящих путей: часто – повышение сывороточной активности аминотрансфераз (аланинаминотрансферазы (АЛТ) и аспартатаминотрансферазы (АСТ)), щелочной фосфатазы; нечасто – желтуха*, холестаз, повышение концентрации билирубина; редко - гепатотоксичность, в некоторых случаях с летальным исходом, нарушение функции печени*, гепатит*, гепатоцеллюлярный некроз*, гепатоцеллюлярное повреждение."}},{"type":"paragraph","data":{"text":"Нарушения со стороны кожи и"}},{"type":"paragraph","data":{"text":" подкожно-жировой клетчатки: часто – сыпь;нечасто – кожный зуд, крапивница, повышенное потоотделение, лекарственная сыпь;редко – эксфолиативные поражения кожи*, включая синдром Стивенса-Джонсона и токсический эпидермальныйнекролиз, острый генерализованныйэкзантематозныйпустулез, отек лица, алопеция*."}},{"type":"paragraph","data":{"text":"Нарушения со стороны крови и лимфатической системы*: редко – лейкопения, включая нейтропению и агранулоцитоз, тромбоцитопения, анемия."}},{"type":"paragraph","data":{"text":"Нарушения со стороны иммунной системы*: редко – анафилаксия (включая ангионевротический отек, отек лица)."}},{"type":"paragraph","data":{"text":"Нарушения со стороны сердечно-сосудистой системы*: редко - увеличение продолжительности интервала QT на ЭКГ, желудочковая тахикардия по типу «пируэт» (см. раздел «Особые указания»). "}},{"type":"paragraph","data":{"text":"Нарушения со стороны обмена веществ*: редко - повышение концентрации холестерина и триглицеридов в плазме крови, гипокалиемия."}},{"type":"paragraph","data":{"text":"Нарушения со стороны опорно-двигательного аппарата: нечасто - миалгия."}},{"type":"paragraph","data":{"text":"Прочие: нечасто - слабость, астения, повышенная утомляемость, лихорадка, вертиго."}},{"type":"paragraph","data":{"text":"У некоторых больных, особенно с серьезными заболеваниями, такими как ВИЧ-инфекция или рак, при лечении флуконазолом и сходными препаратами наблюдались изменения показателей крови, функции почек и печени, однако клиническое значение этих изменений и их связь с лечением не установлены."}},{"type":"paragraph","data":{"text":"Если любые из указанных в инструкции побочных эффектов усугубляются, или отмечаются любые другие побочные эффекты, не указанные в инструкции, следует немедленно сообщить об этом врачу.\n\n"}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"\n\nСимптомы: галлюцинации, параноидальное поведение."}},{"type":"paragraph","data":{"text":"Лечение: симптоматическое, промывание желудка, форсированный диурез. Гемодиализ в течение 3 ч снижает концентрацию в плазме приблизительно на 50%.\n\n"}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"При применении флуконазола с варфарином отмечалось увеличение протромбинового времени на 12%. В связи с этим рекомендуется контролировать протромбиновое время у пациентов, получающих Флюкостат в сочетании с кумариновыми антикоагулянтами."}},{"type":"paragraph","data":{"text":"При одновременном применении флуконазол увеличивает T\u003csub\u003e1/2\u003c/sub\u003e пероральных гипогликемических препаратов - производных сульфонилмочевины (хлорпропамида, глибенкламида, глипизида и толбутамида). Совместное назначение флуконазола и пероральных гипогликемических препаратов допускается, но при этом следует учитывать возможность развития гипогликемии."}},{"type":"paragraph","data":{"text":"Одновременное применение флуконазола и фенитоина может сопровождаться повышением концентрации фенитоина в клинически значимой степени. Поэтому при необходимости сочетанного применения этих препаратов необходимо мониторирование концентрации фенитоина с коррекцией его дозы с целью обеспечения терапевтической концентрации в плазме крови."}},{"type":"paragraph","data":{"text":"Одновременное применение флуконазола и рифампицина приводит к снижению AUC на 25% и укорочению T\u003csub\u003e1/2\u003c/sub\u003e флуконазола из плазмы на 20%. Поэтому у пациентов, получающих одновременно рифампицин, дозу флуконазола рекомендуется увеличить."}},{"type":"paragraph","data":{"text":"Рекомендуется контролировать концентрацию циклоспорина в крови у пациентов, получающих флуконазол, т.к. при применении флуконазола и циклоспорина у пациентов с пересаженной почкой прием флуконазола в дозе 200 мг/сут приводит к медленному повышению концентрации циклоспорина в плазме крови."}},{"type":"paragraph","data":{"text":"Пациенты, получающие теофиллин в высоких дозах, или у которых имеется вероятность развития теофиллиновой интоксикации, должны находиться под наблюдением с целью раннего выявления симптомов передозировки теофиллина, т.к. одновременный прием флуконазола приводит к снижению средней скорости клиренса теофиллина из плазмы."}},{"type":"paragraph","data":{"text":"При одновременном применении флуконазола и терфенадина или цизаприда описаны случаи нежелательных реакций со стороны сердца, включая пароксизмы желудочковой тахикардии (аритмии типа \"пируэт\")."}},{"type":"paragraph","data":{"text":"Имеются сообщения о взаимодействии флуконазола и рифабутина, сопровождающемся повышением сывороточных уровней последнего. При одновременном применении флуконазола и рифабутина описаны случаи развития увеита. Необходимо тщательно наблюдать больных, одновременно получающих рифабутин и флуконазол."}},{"type":"paragraph","data":{"text":"При одновременном применении флуконазола и зидовудина отмечается повышение концентрации зидовудина в плазме, которое вызвано снижением превращения последнего в его метаболит."}},{"type":"paragraph","data":{"text":"При одновременном применении флуконазола с мидазоламом повышается риск психомоторных эффектов, с такролимусом - повышается риск нефротоксичности."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"\n\nПри применении флуконазола 150 мг по поводу вагинального кандидоза пациенты должны быть предупреждены, что улучшение симптомов обычно наблюдается через 24 ч, но для их полного исчезновения иногда требуется несколько дней. При сохранении симптомов в течение нескольких дней, следует обратиться к врачу."}},{"type":"paragraph","data":{"text":"В редких случаях применение флуконазола сопровождалось токсическими изменениями печени, в т.ч. с летальным исходом, главным образом у больных с серьезными сопутствующими заболеваниями. В случае гепатотоксических эффектов, связанных с флуконазолом, не отмечено явной зависимости их от общей суточной дозы, длительности терапии, пола и возраста больного."}},{"type":"paragraph","data":{"text":"Гепатотоксическое действие флуконазола обычно было обратимым; признаки его исчезали после прекращения терапии. Больных, у которых во время лечения препаратом наблюдаются нарушения показателей функции печени, необходимо наблюдать с целью выявления признаков более серьезного поражения печени. При появлении клинических признаков или симптомов поражения печени, которые могут быть связаны с применением флуконазола, препарат следует отменить. "}},{"type":"paragraph","data":{"text":"Как и при применении других азолов, флуконазол в редких случаях может вызвать анафилактические реакции."}},{"type":"paragraph","data":{"text":"Во время лечения флуконазолому больных в редких случаях развивались эксфолиативные поражения кожи, такие как синдром Стивенса-Джонсона и токсический эпидермальный некролиз. Больные СПИДом более склонны к развитию тяжелых кожных реакций при применении многих препаратов. В тех случаях, когда у больных с поверхностной грибковой инфекцией развивается сыпь и она расценивается как определенно связанная с флуконазолом, препарат следует отменить. При появлении сыпи у больных с инвазивными/системными грибковыми инфекциями, их следует тщательно наблюдать и отменить флуконазол при появлении буллезных изменений или многоформной экссудативной эритемы. "}},{"type":"paragraph","data":{"text":"Одновременное применение флуконазола в дозах менее 400 мг/сут и терфенадина следует проводить под тщательным контролем (см. раздел «Взаимодействие с другими лекарственными средствами»)."}},{"type":"paragraph","data":{"text":"Как и другие азолы, флуконазол может вызывать увеличение интервала QT на ЭКГ. При применении флуконазола увеличение интервала QT и мерцание или трепетание желудочков отмечалось очень редко у больных с тяжелыми заболеваниями с множественными факторами риска, такими как органические заболевания сердца, нарушения электролитного баланса, а также способствующая развитию подобных нарушений сопутствующая терапия. Поэтому у таких пациентов с потенциально проаритмическими состояниями применять флуконазол следует с осторожностью."}},{"type":"paragraph","data":{"text":"Пациентам с заболеваниями печени, сердца и почек перед применением препарата рекомендуется проконсультироваться с врачом. "}},{"type":"paragraph","data":{"text":"Сообщалось о случаях суперинфекции, вызванной отличными от Candida albicans штаммами Candida, которые часто обладают природной резистентностью к флуконазолу (например, Candidakrusei). В подобных случаях может потребоваться альтернативная противогрибковая терапия.\n\n"}}]},{"id":17,"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","body":[{"type":"paragraph","data":{"text":"В связи с возможностью возникновения головокружения и других побочных эффектов, связанных с приемом препарата, в период лечения пациентам рекомендуется воздержаться от управления автотранспортом и занятиями другими потенциально опасными видами деятельности, требующими повышенной концентрации внимания, быстроты психомоторных и двигательных реакций."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Капсулы 50 мг."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"\n\nХранить при температуре не выше 25 °С."}},{"type":"paragraph","data":{"text":"Хранить в недоступном для детей месте.\n\n"}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"3 года. Не использовать по истечении срока годности, указанного на упаковке."}}]},{"id":21,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"Без рецепта"}}]},{"id":22,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"ОАО \"Фармстандарт-Лексредства\""}}]}],"source":null},"description_toggle":false,"short_description":"Противогрибковый препарат. 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