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TIPHJIOKEHHE 1 KPATKA XAPAKTEPHCTHKA HA IIPOAYKTA 40212588 1. HME HA JIEKAPCTBEHHSI IIPOYKT BC/A4] Hyp -v7¥°/ 176 Cuim6uxopr TypSyxanep, 160 muxporpana/4,5 muxporpaMa/HHXaTaLUA, NpaX 3a HHXALTALIL Symbicort Turbuhaler, 160 micrograms/4.5 micrograms/inhalation, inhalation powder 2 KAYECTBEH H KOAMYECTBEH ChCTAB Beaka nonyyena 03a (03ara, npewunanaia npes MyHuyka), charwpxa: Gyaesonnt (budesonide) 160 wuxporpama/xaaui « dbopMoreposos yMapar xuxnapar (formoterol fumarate dihydrate) 4,5 mukporpama/MHxanauna, Beaka wamepenta osa cestspxka: Gysresonit (budesonide) 200 muxporpama/aHxanayua H opMorepos108 bymapar anxnapar (formoterol fumarate dihydrate) 6 wuxporpanta/aHxanautns, Tlomouttio nemiecT#o c wanecTHo nelicraHe Jlaxtosa wonoxnapat 730 muxporpaMa Ha nomyseHa 2038, 3a TAHA cnucEK Ha NoMoMIHHTe BeUIecTBA, BHDKTE TOHKA 6.1, 3. JIEKAPCTBEHA ®OPMA Tipax 3a wuxanauya, Ban npax. 4. 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JlosHposkara Ha ckcTaBkuTe Ha CHMGHKOPT ce miqMenzyanHa n TpsGRa 2a Ce KOPHTMpa B 3ABMCHMOCT OT TeKECTTa Ha 3aGonsBAHETO. Towa TpAGBA 1a ce ‘Ma mpes1Bi0| He CaMO MpH 3anowBaHe Ha eveHHe C KOMGHHMPAHH Mperiaparh, HO H MPH KOpeKtMA Ha OJUIBpxallloTO TeHeHHE. AKO TPH NaeH MALIMEHT € HEOGXOMMMO CbYETAHHE OT 03H, PARNHAHO OT HaTHunitTe & KOMOMHMpaHMTe HHXaAaTOpH, TpAGBA Na Ce MperIMMULAT OTHeAHH HHXAMATOPH Ha Br-anpenopeuenropun MuMeTHUM W/¥IM KOPTHKOCTEPOMIN B CbOTBCTHHTTE 203K. osara rpa6sa aa ce Tirrpupa 20 Haii-HuckaTa, MPH KOTO ce NocTHra edyukaceH KOHTPOM Ha CHMITTOMHTe, Cocrosimero Ha naulMeHT#Te TpaGpa fla ce npcolieHsBa penOBHO OT neKaps, NpexnHeat HOM sleNenHeTO/eKyBallIHA TH Z1eKap, 3a 2a © CHTYpHO, He AOSHpoBKaTa Ha CHMGHKOpT OCTaBa OnTHMaNTH. Korato ce nocturne marocpoeHt KoITport Ha CHMITOMHTe B Hail-HHeKaTa nperlopbyana 02a, cneaBaMaTa erbmka e Ja ce onHTa MoHOTepaIlNs c HEXATATOPeH KOPTHKOCTEpOHA. (Coutecraysar ipa ntozixona 3a newenwe cae CHMGHKOpT: A. 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B o6naiinara npaktuka, Koraro ¢ 2 MHXASIALINK JHEBHO Ce NOCTHTHE KOHTpONT Ha CHMITTOMHTE, ‘THTpHpaveTo s10 Hali-HHcKaTa edpHKACHa Osa MOE a BKmONBA MpHeMaHieTo Ha CHNGHKOPT eAHOKpATHO AWeBHO, KoraTO, cnOpeN MPeATIMCRALHA TO JeKap, 34 NOLISPAKAHE Ha KOHTpONa Ha CHMATTOMIETE We € HeOGXORHM eArONelicTBaU GPOHXOAHAATATOP B KOMGHHAILHA C HHXasIATOPeH KOPTHKOCTepOH. Yoennuapaniero Ha ynorpeSara Ha oraenen Gepsoneticrsam 6porrxonHaaTatop roBOpH 3a BOUIABaHe Ha nogexKamtoTo 3aGoaRBaHe H Hazara Mpeouienka ta 7eNeHHETO Ha actMara, Fleya (ua esapacm na u nad 6 coun): 3a nexenne Ha nena Ha suspact oF 6 0 11 roAMHH e HamHEH ‘RekapcTaeH MpoayKT B Nl0-HHcka 03a (80 Mukporpana/4,5 Mukporpawa/Muxastauis).. Fleya na sespacm nod 6 zodunu Tlopann Hanw4nero Ha orpaHHienn nani, mpHzoxeHHeTo Ha CuMOMKOPT ‘pH eua Ha BEspacr nln 6 romHEN He ce NpenopEyBa. B. 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Te TpaGBa Aa GbAaT NpeoucHeHH oamBpoxamata HM Tepanita - MPeocMHczeHta, Aleya (ua evspacm nod 12 zodunu): Tip neva He ce npenopsysa 1a ce poperkiia nosLIEpaKAO H oGnexuasauto cHMmTOMHTe sleHeHHe che CHMOHKOPT. XOBB Tlpenopowumenuu dozuposxu: Bespacmuu: 2 werxazaunn 2 msTH AHEBKO, O6ma nupopmanus Creyuasmu epymu naryuenm: Hana cneumaiiin YOHCKRAHHS 3a LosHpoBkara pH NauMeHTH B cTapyecKa BBspact. HaMa AANA 3a ynorpeGara Ha CumGuxopr np nauneHTu c YepHompo6na WM GsOpeHHa HeOCTaTE4HOCT. IToHEKe Gynesomna n dpopmorepon ce emHMHHHpaT OcHOBHO pes MeTaGOmUSHpaHe B YepHHA p05, MPH NaLweHTTH c ‘Teskka “epHo”poOHa LWMpO3a MOxKe a Ce ONAKBA NIOBHIIABAHE Ha €KCTOSHLMATA. Hawn a npwoxene ‘Hucmpyxinat 3a npasuanama ynompeGa na CunGuxopm TypGyxavep: (CunGixopr TypOyxaciep npencTannapa HEXaTaTOp, HHeTO eiiCTBMe 3ABHCH OT BL3AYUIMHA NOTOK MPH Baititipane, KOeTO O3Ha4aBa, He KOFATO NalWeHTbT BAHLUBA Npes MYHALYKa, eKapeTBOTO Ce YRIIKYA AMXATEAHMTE ITSTHIA OT BXHULAHHA BBSAYX, Beneana: Baxkno © nausenrite 2a Goaat mictpyKTHpant: © BunMaremto 2a npoyerar unerpykunire 3a ynorpeGa 8 HamHaTa ¢ BCeKH HIIXaaTOp JHCTOBKA 3a nauwerTa. © Da panuar cro 1 xeaGoKo npes MynamyKa, 3a 2a € cHTYpHO, ¥e 0 GectrTe npoGope AocTHTa onTHMamia 2038. Hurkora a He HanMunBaT pes MyHALyKa. Caen ynorpe6a, 1a sppitar Kartavero Ha CHMGnkopr TypGyxastep Ha MaCTO. Caen wirxamnpane Ha nomTpxKamtara cM 03a, na HSNAAKBAT YCTaTa CH C BOA, 38 2a, OT passHTHe Ha opo*apHHreamHa KaHHO3a. AKO ce pasate opodbapmureaznta Kan auwetTHTe TpaOBa fa HONAAKBAT YoTaTa CH C BONA H CHIEN HiEXANANKETe ,.1PH Tlopann Mankoro KonH¥ecTa0 Ha nlonysapaHoro sleKapeTaO, MpM wsrionsBane Ha TypOyxaslep nauIneHTET Monte sla He yoettia BKyCA Ny. 43 Tpormponoxasanus CipexsyscranrenHoct KbM AKTHBHHTe BEMLECTHA MIM KBM TIOMOUIHOTO BeIlecTBO, H36PoeHO B ToAKA 6.1 (aaxto3a, KosTO ChIbpka M@IKH KOJH4ECTBA MIE4HH TIpoTeHHH). 44° Cnennasn npeaynpeacienus npeanasim MepkH mpm ynorpeta Tipenopsupa ce, npx cnupavie Ha Ne4eHHeTo, ToBa Aa He CTaBA PABKO, A NOIATA Ja Ce HAMANISBA MOCTeNeHHO. Tinanoro orweMaHie Ha MHXaaTOpHitTe KOpTUKOCTepOMmH He TpAGHa 1a Ce OGMHCITR, OCBEH AKO BPEMEHHO He ce HSHCKBa, 3a a Ce NOTBBPAM JMarHo3a acTMa. Avo naieH nauvienrt cMaTa, Ye JleveHHeTO My ¢ HeeduKaCHO, HIM HazBHINaBA MaKCHMATHATa penoposnrenia aneana 03a CHNGHKOpT, TpsGBa a NOTBPCH MemIMILAHeKa NOMOWL (sk. TOUKa 4.2). 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Tlaunesrrure rpaGna 2a Oxaar chueraHH BMHarH 1a HOCsT y ceGe CH MHXaATOpA CH a eHEHMe KATO _chacwTeaHo iexapcr#o” — win CHMGHKOpT (sa MauIMeHTH € acTMa, KOMTO WsTION3Bat CuMONKOPT KATO TMORUTbprxaullo H OGneKYAaBALIO CHMITTOMHTE TeNeHHe), HAH OTHIEIEH GypsozelicTBau 6pouxoaNaaTarop (38 HK nauveHTH, KOHTO HartoBaT CHMBHKOpT CAMO KATO NOAATEPxAILO TeNeHtHe).. ‘Ha nauwesrrure TpsGea na ce HanioMis 2a npaBsT MHXanaLMHTe cH cue CHMOWKOPT TAKA, KAKTO Ca [MpeanHcaH 3a NOABpHKAMIO sIeNeHHe, AOPH H 2a Ca ACHMITTOME, Coes karo cmunromire Ha actwaTa Gbaar OBTaNeHH, MOE Ja Ce HMA MPpeABHLA HOCTeNeHHOTO HaMaTABAHe 1a josara Ha CHMGUKOpT. IIpH MOHIKABAHeTO Ha JOSHpOBKATA € BAXKTIO NanHeNTHTe a MHHABAT Ha peOBHH npernestH, TpsGea na ce uanom38a Hall-HcKATa edvuKacHa 03a CHMGMKOPT (Bx. TONKA 4.2). Tesennero crc CunGuKopr ne TpaGsa na ce sariowsa s repos Ha OGocTpaHE, Ha sHaNIMO RAOUIABAHE CHMMTOMHTe HH Ha OCTPO BOUIABAHE Ha aCTMaTa, Tlo Bpeme Ha nevenneTo crc CHMGHKOpT Moxke Ja ce pasBHAT CepHOsHH HexXenaHM PeaKiU, CBLPSAHH C acTMara, H exsaulepGauun. TlanveHTHTe TpsGaa Ja GsnaT npeayNpeXtaBAHH Ja MPOBUKAT s1eNeHHETO CH, HO Ja MlOTRPEAT ME;HLIMHCKA TOMOUL, AKO Cries sano4BAHe Ha sleHeHe cbc CHMGHKOPT CHMITOMHTE HM He ce nosamasar 11H ce BsIoMaaT. Hana HanH4HH 2aKHH OF KnMHHHH MpoysBanna che CHMGHKopr Typ6yxantep npH nawieHTH ¢ XOBB c EO} > 50% or ovakeanise Hopmanen npemH GpoHxoawiararop Mc DEO}< 70% or ovaKsanna HopMatent eA Gpowxonwsararop (8x. TO¥KA 5.1). Kaxro u mpi apyri wixataTopii sieKapcTBeHit MpoAYKTH, Mo%Ke sla ce passite napaoKcasteH 6PoHxocasyM cue sacpante Ha xprinonete Ht 3ajlyxa HenlocpemcTBeHO ci1ex MpHeMa. Axo ce passe NapaioKcaten GpoxxocnazeM, npunoxeHueTo Ha CuMGUKOpT TpAGRa sa ce npeKparH HesaGaBHO; CBCTORHMETO Ha rmaunenra TpaGpa 1a ce MpeotieHH H, akO ToRa e HEOGXORHMO, 1A Ce 3ANOUHE aUITePHATHBHO st TlapaoxcastHirr GpoxxocriaseM ce nosiusna oT GxpsonelicTBallin MHXasIATOpHH GpoHXo; ‘Tpabpa 2a ce ekypa HesaGasto (mx. TONKA 4.8). Tips mpazoxenme, Ha Kofiro H Jia € miixanaTopeH KOPTHKOCTePOHA, Morar Ja Ce pasBi ocoGeHo MPH NpenNHcBaHETO MY BLB BHCOKH 03H 3a npomWDKHTeNIHO BpeMe. Bepos ‘TaKiBa e*bexTH e MHOrO TlO-MasIKa NPM HiKKANIATOPHO, OTKOSIKOTO MpH JIeMeHHE ¢ repo 5 KopruxocTeponan. BEsMOAHHTe CHCTeMHH ed)eKTH BKIIO'BAT cHIAPOM Ha Cushing, KEINHHTONIEH xaGinTyc, HaNGEOpewHa cynpecs, sa0aRsHe Ha pACTe:Ka NpH Aletta H }OHOUIM, oHoKaBAHe Ha MuHepatHara KocTHa ILTBTHOCT, KaTapAKTa H TayKOMA, 1 HO-PSFIKO PesIMIA ICHXOOFHYECKH WIM TOBEEHYECKH eXpEKTH, [BKIHOMHTesIHO MICHXOMOTODHA XHNepaKTHBHOCT, MapYIleHME Ha CbHA, GesnoKolicrBO, Jenpecis WIM arpecHa (ecoGeno mpi nena) (wx. TO¥KA 4.8). ‘Tpa6na na ce uMaT npensiLa noTeHUMATHItTe e*eKTH BHPXY KOCTHATA TUTETHOCT, OCOGeHO MPH NALWEHTH Ha JIeMeHHe BB BHCOKH J1O3H 38 MPOABIKHTETHO BPEME H ChE CBITETCTBALM PUCKOBH AKTOPH 3a PASBHTHE Ha ‘ocreonoposa. JfirocpouHlTe MpOY'BAHHA Ha seNeHHe c MEXaTaTOpeH Gy.Aes0HA NPH eua Ha cpesIHa aueatia 2038 400 meikporpawa (npiaaran ¢ AosMpauta NloMma) HIM NpH BL3PACTHH Ha AHEBHA 103A 800 muixporpama (npiarant ¢ 2osmpatia Hontna) He MOKasBaT SHAYMM edeKTH BUPXY MuHepasHaTa KocTHA muretiocr, Hana Hamunia HNCopManlAt OTHOCHO edieKTa Ha CHGHKOPT B NO-BHCOKH 1O3H. Axo HMa mpHina fa ce npestnonara, ¥e HanGLOpeuiara hyHKAHA Moxe 2a € HapyLieHa B peay.rrar Ha peauiecTBaiuo sleweHHe C KOPTHKOCTEPOHLIM, NPEMHHABAHETO KEM sleYeHMe che CHMOUKOPT-TpAGBA Za ce OcbiMECTBSBA C MOBHIEHO BHHMAKHE. 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Crexjosatento, no Bpeme Ha MepHoaH Ha CTpec KATO TEKKH MIKHEKLNH WIM TULaHOBH OrlepaUH, TpABBA 2a ce HMA NPeAHA AOMTB:IHHTeNHO CHCTEMHO OGesmIeNaBaHe ¢ KOPTHKOCTepOHAM. BupsoTO HaMaNABAHe Ha osaTa Hla KOPTHKOCTepOMILHTe Moxe sla OTIIOYH Ocrpa HaxOEGpewHa HeocrarbuHocT. BeesHre H ‘cHMITToMTe Ha OcTpaTa HanOOpesia HeOCTATRUHOCT MOFAT Jia Ca HEACHM, KATO MOTAT 2a BK:OMBAT anlopexcus, sary6a Ha Tero, Gosika B KopeMa, OTMAIHALTOCT, FHapOGoAHe, FaeHe, NOBpBINAHe, NOTHCHATO ‘ChoHAHHe, rspHone, XMIIOTOHNA H XHTIOTIHKEMH. Tlevenero c jommsnirerHiTe cHCHTeMHH KOpTHKOCTepONH HIM HiXaaTOpeH| Gyxes0HNY He TpxGBa ja ce ‘ermpa psako. Tlo speme na npewmsasane oT mepopasna Tepaniis KEM CHMONKOPT, ke ce MpeTHpHH 3HAHTEMHO T10-HHCKO CHCTEMHO KOPTHKOCTePONAHO JeHieTBHE, KOETO MOA fla NOBEE 0 NOABATA Ha ANeprH'H WAH apTpHTHH CHMITOMH, KATO PHIHT, €KIeMa H MYCKY:IHa H CTaBHa Go.TKa, 3a Tes CLCTORHHA TPAGBA Ha ce 3anOuHE cneundusno nevenme. Tpa6pa a ce noxosupa expexr tia OGULa FIOKOKOPTHKOWINA HEAOCTATEHHOCT, AKO, B PeaKH Cay'aH, ce NOABST CHMIFTOMH KATO yMOpa, raBoGorHe, raleHe M NospBuaHe. B TakHBa cay¥an NOWAKOTa € HEOGXOTHMO EPeMEHHO NOBHIKIABAHE Ha O3aTa Ha Nepopa.tHs FNOKOKOPTHKOMIL. 3a na ce HaMaTH pHeKBT OT passHTHe Ha opoapHreaia KanmW03a (Bx. TOUKa 4.8), naunerTHTe TpAbBa 2a Goaat checTeann 2a usILIaKsaT YoTaTa CH ¢ Boa Caen BCAKa MHXAANWA Ha nlomIbp:Kama 1038, AKO ce ‘paseve opoapmHreanHa KaHIHsI038, NaLIMEHTHTe TpxOBA Na HSMLIGKBAT YeTaTA CH C BOA H CHIE MuxanaMTe ,.npH Hy”. ‘TpaGpa na ce waGarsa eHoBpeMeHHOTO JleveHHe ¢ HTpakOHasoa, pHTOHABHD HAM ApyrH MOU HHXHOWTOpH Ha CYP3A4 (Bx. ToUKa 4.5), AKO TOBA He € BBSMOKKHO, HHTEpBATET MERAY 1 ‘BoauMonelicreaumire cH MemHKaMeHTH TpAGBa fla e MaKcHMaHO AbTbr. He ce npenopyus: oGneKuapaulo cunmTomuTe seMeHHe CBe CHNGHKOPT NH aLLMeHTH, HBMOSBAL MOT CYP3A4. CuimGuxopr tpaGea 7a ce nprizara ¢ NoBHLIEHO BHHNAHHE TIpH NayHeHTH ¢ THpEOTOKCHKOZa, eoxpomownToM, saxapeH AHaGer, HeTeKyBala XHMOKATHEMHL, XHNepTpOdHHa OScTPYKTHBHA KapavoMMOTIaTHa, WAMOnATHNHa NlOMKANKa aopTia cTeHO3A, TexkKa apTepHaLiHa XHTIepTOHHA, aHEEpH3Ma WIM APYTO TekKO CBPHEHHO-CbOBO ACONABAHE KATO HeXeMHHA GoxeCT Ha CBPLETO, TAXHAPHTMHS! HIM ‘TeKKa CBpAeUHA HeNOCTATEUHOCT. C nosnineno sHuManne TpxGxa 2a ce MosXoxa MPH eHeHNE Ha nauneHTH ¢ yabsDKeH QTe HTepBAN. Canusar hopmotepoa moxke sa npenmsanKa yatwoKasane Ha QTc METEpRATa. HeoGxomusocrra or neeHnero H OSMpoBKara Ha MHKasIaTOpHUTe KOPTHKOCTePOHAH TpAGBa Za GoaaT IMpeoueHeHH NpH NaUWeMTH ¢ axTHBHA HAM slaTeHTHa GesonpOGHa TyGepKyz03a, TEGUIHH H BHPYCHH muxexuni Ha aunsaTeaHATe MTHUA. Bos sHcoxs 03H B:-anpeHopenlenTopHHTe MUMETHIIH MoraT 1a NPeAHSBHKAT pasBHTHeTO Ha NoTeMMATHO cepiostia xHToKammeMia, ExnoBpementnnsT npHeM ta Bo-anpeHopeuentopHit MHMETHIH ¢ sleKapeTRa, KOHTO Morar a MpesIHIBHKAT XHTOKAMHEMHA HIM Ja NOTEHLMPAT XHTIOKATHEMHEH expeKT, HaNpHMEP KcaHTHHODH MPOHSBOAHH, CTepOHIM H JIKYPETHINH, MORKE Ja 3ACHTM BESMOXKHHA XHIOKATHEMHYCH e*eKT Ha Br-anpenopenerrropans MuMeTiK. [Tpenopbupa ce a ce NOAXO‘a c OCOGeHO BHEMAHHe MIpH sIeNeHHe Ha HecraSiana acrwa ¢ MpoMeHLTHBO HanosaRaHe Ha OPOHXOAMIATATOPH KATO ,crlAcHTe:IHO stekapcTBO" H MIpH cTpa Tekka acTMa, NoHe:ke pHCKET MOXKe sla Ce YBeNHYH B PesysTTaT Ha XHNOKCHSTA, M MPH. APYTH CHCTOSHNA, PH KOMTO RepOsTHOCTTA 3a PASBHTHE Ha XHNOKATHEMHS Ce MOBMUABA. B NOTOGHH YCTOBHR ce penopona a ce c:1es1H CepyMniT Kati. Kaxo np npanoxenne a ncwskn Br-anpeHopeuerropHi MUMETHUM, MH nlameHTHTE ¢ mHaGeT TpaBBA 2a ‘ce HMA npexBHLA AOMRaHTeLeH KOHTPOM Ha KPEEHATA 3axap. 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[Ipx sa6ansane Ha pactexa, neveHMeTo TpaGBA fa Gre MpeouerIeHo c te HaMaaBaHe Ha OSHpOBKaTA Ha HEXATATOPHMTE KOPTHKOCTEPOHLAM 10 Hall-HHCKATa 1038, pH KOATO Ce Tommepxa exhexTHBeH KOHTPON Ha AcTMATa, AKO TOBA ¢ BBSMOXHO, BHHMATeAHO TpaGBa a ce NpeUcHAT oa3aTa OF eHeHHeTO ¢ KOPTHKOCTePOHAH H BRSMOAHHTE PHCKOBE NO OTHOUICHHE Ha 3a6aBAKIeTO Ha pacreska, B jombsHeHHe, TpxGsa a ce HMa NPeNBH H BESMOAHOCTTA 3a MpeHacowBaHte KEM nenwarep-nysimonor. Orparnrvest xan or msarocpoxn mpoy'saHHs covar, ve» Kpalia cMeTKa nloseYero Zeta 1OHOUI, "eRyoaHn ¢ wixanaTopeH GyneS0H, ROcTHTaT TapreTHns eH put KaTO suspacrHm, HaGmonasa ce, oGaXe, TMupsoviavamio eKo H npexonio waocraave w pacTexa (npuBmuHTesHO ¢ I cw). Tosa ce HaGmionaBa OGuxHoBeHO npes mspsata romuHa OT eveHHeTO. VT) e fry: Tyepmonna 1B HaGimonapa ce nosuiena YecTOTa Ha NHEBMOHHA, BKMONHTEAHO NHEBMOHHA Hanaraila XOd px naunienru c XOBB, Kono npuiemar mixasaropa koprukocteponan, MMa iiaKow aH Hck oF nea MOWHIX TPH MOBHABAH Ha cTepOHAWATA 11028, HO TOBA He Ce jeMoHCTpMPA YOeAHTENHO AMKHTe Ha BeHKH Mpoy'BasA, Hama yGeaurento KIMHHYHO 2OKasaTETCTBO 3a PaSINKH B PAMKHTe Ha Kiiaca Mexy HHXariaTOpHUTe KOpTHKOCTepOMAHH MpOAYKTH, OTHOCHO FOsIeMHHTA Ha PHCKA OT MHeBMOHIS, Jlekapure rpa6a ja npocneaspar 2a BbaMo%xHHO pasBHTHe Ha NHeBMOHHA NpH MauiMeHTH c XOBB, Toit Kato oTMHHHaTa Kapraia Ha TeSH HiKpEKUUAH Ce MpenloKpHBA cbc cHMMTTONHTE Ha excanepGauHH Ha XOBB, Puckopite dakTopH 3a THeBMOHHA MpH nauHeHTH c XOBB sksousar HacTomulo TIOTIOHOYUIeHe, NO- Hanpeawana BBapacT, HHCEK HHgeKC Ha TeecHa Maca H TexxKa XOBB, 4.5 Bsanmonelicrone c pyri aekapcrsenu mpoaykTa m ApyrH hopyit Ha B3anmonclicrBHe Papmaxoxunemen ssawnodeiiemene Moutirre uinxy6urropu wa CYP3A (Hamp. KeToKOHaD0., HTpaKOHASO.1, BOPHKOHASON, NOsAKOHAsO.T, Sc1apHTPOMHUNH, TenHTTPOMMUUN, He*>as0q0H M HIV nporeasiH MEXHGHTOPH) MOrAT SHAMHTETHO 3a TOBHIIAT ruTasMeHHTe HBA Ha GYAeIOHNLL H EAHOBPEMEHHOTO HIM MpHLTOReHHe TPAGBA Aa ce H36ArBA. AKO ‘TOBA HE € BLIMOAHO, BPEMETO MEAKIY NPHOACHHETO Ha HEXHEHTOPA H MpHLIOAKeHHETO Ha Byes0HH ‘TpaGea na e BtaMoxHo Hali-mBaro (Bx. TOuKa 4.4). He ce npenopbuBa NosIEp»KaIO H OG.TeKABAYO ‘cHMmTowiTe edeHHe cbc CHMOMKOPT pH NaUHeHTH, HANOTSBANIE MOULHH HHXHGHTOpH Ha CYP3A4. Moutnsr uixnGurrop na CYP3A4 keroxonason, 200 mg sestix AKeBHO, HOBMINaBA NaasMeHHTe HiBa Ha ‘eaHoBpemerHo nepopanHo NpHoxeH GynesoHHN (CAHENHA 2o3a OT 3 mg) NpHOANSHTeRHO Weer NETH. Koraro keroxonasoa ¢ mprioxeH 12 4aca crea GynesouH, KONMeHTTpautaTa ce NoBHULABA CpeaHO camo ‘TPH METH, KOETO THOKASBA, He CAMOCTORTENHOTO NPHAOKeHHE MOE fla NOHIGKH NOBHULABAHETO Ha TraaMenre Hitpa. Orpannvestt 2aHHH 3a TOBA BIaMMOseHCTBHE MIpH BHCOKH 03H HiKXAATOpeH GysesoHA NOKa3BAT, ie 3HAYTENTHO NOBMIIABANE Ha TUASMeHMTe HABA (CpeNHO HETHDH TIETH) MOrKE Jia HACTNM, AKO MrpakoHason, 200 mg seaHBax HEBHO, ce NpHAra EMHOBPEMENHO c HIXATATOPeH ByAesoHHA (CRHOKpATHA 03a or | 000 maxporpana). apmaxodunamun s2awnodeticmeus Bera-anpeopeuientopunre GrokepH Morar ja oTenaGaT a a MAXHOnpar edexra Ha opmorepor. Tlopaan ropa, CuMGnkopr He TpsGea s1a ce slaBa eaHOBpeMeHHO c f- anperopenierrropit GxoKepH (kOMHTEsTHO H KaNKH 3a O4H), OCBEH AKO MPHIHEHTE 3a TOBA He ca OCOGeHO cepHOSHIH. EnvospemeHvoTo evenMe ¢ XHHHANH, AWBONMpANHA, NPOKAHHAMHA, GbeHOTHASHHH, ATHXHCTAMHHH (repenanH) 4 TPHMKCIENHK aTHAENpeCAHTH, Moke a npeaWsBHKA yrwTAABaNe Ha QTe MTepBaLTA H sa YYBesIHM PHCKa OT pasBHTTHE Ha KAMEpHH apHTMK. B aormanenne mpuemst Ha L-DOPA, L-tHpokent, OKCHTOUME H ATKOXOA Mo%xe Zia HapyUIH CEpACHHHA ‘Tonepae KbM f2-CHMMATHKOMHMETHUNTE, EnuoapeneHHoro 1eseHe ¢ HiXHOWTOpH Ha MOHOAMHHOOKCHIASATa, BKIMOMHTE:IHO H C MEZHKAMEHTH CBC cxoatt cpolicrea Karo dbypasoaHsion M MpOKApGasHH, MoxKe sla NpeAHSBHKa XHNepTOHHHHH peaKUMH. Tipu naunerrra, noaysanautn anectesHa c XasioreHHpaHid BEIIeBONOPOAH, CbilleCTBYBA MOBHIEH pHCK OT aspire Ha apaTNtH, More a MMa noTeHLMAAHO asuITHBCH SporxomAnaTHpauy e*pex. XvmoKanneMHrTa Moxke Ja TOBHIM CKTOHHOCTTa 3a pasBHTTHe Ha apHTMHH MPH MAUHeHTH, FTeMeHHE Che CBPIENHH FAHKOSHAH. XumoKaneMmsra Moxke sae peayaTar oT Tepama ¢ f2-aroHHCTH H Moxke a Gee HloTeHUMpaHa npH eTHOBpeMeHeH MIPHEM ¢ KCAHTHHOBH MPOHSBOAHH, KOPTHKOCTEPOW.AM H AAHYPeTHUH (Bx. TONKA 4.4), He e yeranioneno Gyzesonnn H dbopmoTepor aa BsanMozelicTBar ¢ APYTH JekapeTBa, HSTOsT3BAHH MPH ewenme Ha acta, Teawarpusni ans Tipoy4eanns sa ssanmonciicrsusra ca nposexaaHH caMo MPH BBSpACTHH, 4.6 @eprnanter, Gpemennocr m KEpmene Bpemenoct Tlanceat KAM 2aHHH 3a eKcroaMUns KbM CHMGHKOPT WK eNHOBPEMeHHO 7AeHeHHE c (popMoTepON H Gynesouna no speme Ha GpemesHocr. JJaHiHTe OT Npoy¥BaHHATA 3a eMOpHOdeTaNHo pasBHTHE MPH TUTBXOBe He OBOPAT 3a HAIHHE Ha AOMBAIHHTENTEH CEKT Ha KOMOHHALMATA. Tinepat zoctarsnio anti of ynorpeSara a (bopMorepo pH GpementHH xen. B npoy¥sannaTa sa PenPOAYKTHRHA TOKCH'HOCT NpH AKHBOTHH ¢popMOTePON MpEIBBHKBA PASBHTHE Ha HEXETAHH PeaKUIAH CaMO MpH MHOTO BHCOKH CHCTeMHK eKCHOSHINHH (BK. TOUKA 5.3). Taste or npuGauesurenio 2 000 excnosHumi no BpeMe Ha GpemenHocT He roROps 3a NOBHIIEH ‘TepaToreHeH PHCK, CBEPIAH € MPHTOAEHMETO Ha MHXaIaTOPeH GysIesoHNA. OT NpOyyBAKNATA pH AHBOTHHL Ma aH, “ie TIOKOKOPTAKOCTEPOHLINTe NpeHSBHKBAT pasBHTHe Ha MaTbopMattin (BX, TONKA 5.3). TIpexeia npenopsurteniire 03H, He ce O¥aKBA Towa Na € OT MpaKTHYECKO 3Ha4eHHe MPH XOpa, TIpoyssanniara mpi 2xunoTHH TlOKASBAT CbilO Taka YHACTHE Ha MOBHLIEHHTE FAOKOKOPTHKOCTEPOW.INH HABA pevtarasiHo 8 NOBHUABAHeTO Ha pHCKa OT HHTPayTepHHHa PeTApAALWA Ha pactexka, pasBHTHe Ha ‘epresHo-cbT0BH 3aGonaBAHHA M TPaiiItH NPOMeHIH B rECTOTATA Ha FJOKOKOPTHKOMAHMTE PewenropHt, HeBpOTpaHicMHATepHHa TEPHOBEP H MPOMEHH B NOBEeHHETO MPH EKCHOSHLMH MO TeparoreHHHs 10308 par. Tlo apeme na Gpementiocrra, CumGukopr tpaGna 1a ce wanlonsba camo Torapa, KOraTO NONsHTe HANBMUABAT oTenunamutre puckose. TpaGxa aa ce usriosisba Hal-HicKaTa edpuKacia slosa 6yes0HNA, HeOGXOANMA 3a NogtepaKante Ha aslexBaTen KOHTpou Wa acTMaTa. Kepwene Byaesonna ce exckperapa s kepMara. IIpx TepanesTituHi 03H Gave, He ce oNaKBaT exbeKTH BEPXY kepaasiero, He e w28ecTHo Jami mpi xopa (popMoTepas ce ekckpeTupa & KEpMara. ITpH ILTBXORE B MIIAKOTO ce orkpunar maki KosHuectsa bopMorepan. [Ipisioxexie Ha CHMOHKOPT MpH CHM, KOHTO KEPMAT, MOXKE 2a ce WMA NpesIBHA caMo ToraBa, KOTATO OMAKBAHATA Tosa 3a MaliKaTa HAABHLNABA BLIMOXKHHTE PHCKOBE 38 aereTo. epruaurer TIuncear Aan 3a noTesupaTHHs edbexT oT ynoTpeGara Ha GyaesoHNA BEPXy deprunutera. VsnuTBaNHsTA ‘a penpoaykTieHa TOKCHSHOCT Ha (pOpMOTEPON MPH KHBOTHM, NOKASBAT NeKO HaMaeH peprwsiTer npHt MOKKH ILTBXOBE, MPH BHCOKA CHCTEMHa EKCTIOSHUUA. (BX. TONKA 5.3), 4.7. Egexrn supxy enocoSocrra 3a modupane w paGora ¢ Maun 4.8 Hexesaum aexapersenm peaxnunt Tloneke CumGnkopr chuteprka 4 GynesonHn, H popMorepasr, px Hero Morar sa ce pasBHT HEKEIAHM peaKUAH KaTO CROCUIABAHHTE 3a TeSH BeUlecTBA. FipH EHOBpeMeHHO MpHIOweH CBCTABKH He € HAGMORABAHO PASBHTHE Ha HEXENAHH PeaKUHH ¢ HoBMUIENA YecTOTa. Hali-ue\ 9 Ce TeKapeTBenHa NPORYKT Hexke-TaNH PeaKUK, ca cbapMakouIOrHHHO NPEABHAANMH HeAKeNaHH PeaKUUMHE Ha evenmeTo ¢ B2-aslpeHopelentopiin MHMeTHUK KATO TpeMop H nainHTaKHH. Te O6uaiiHO ca NeKH OGHKHOpeHO HOYe3BAT 8 PAMKHTe Ha HAKOAKO AHH OT HaYAOTO Ha AeeHHETO. Hexenanure peakuwu, cBEp3aHl ¢ mpHema Ha Gye20HK WIM (popMoTepon, ca MIpeslcTaBeHH NO-TONY, pynmpas no cuteTemo-opraHii kaacose H NecToTa. YecTorire ce seduampar KaTO: Mioro HecTH (2 1/10), yectu (2 1/100 ao < 1/10), Hewecra (2 1/1 000 go < 1/100), peaxu (2 1/10 000 ao < 1/1 000) 4 mHoro penkH (1/10 000). TaGanna 1 cOoK Wectora Herxesiana exapersena peaxunn Hiexinn w wripecrauna ecrm Opo*papusreania xaxmnnosa Tiesmowna (npn naunerH ¢ XOBB) “Hapyurenna aa unyenara Peakn [Bepan 0 KBCHH peakrunH Ha concrea CBpexsTyBCTBHTeAHOCT, HANp. exsaHTeM, Yprukapua, npypHTyc, epMarHT, aHTHOeTEM H. aniadwsaxTHsiiH peak Hapyuiennia a enzoxpuniara | Muoro peak | Cunpom na Cushing, naxv6peuna cynpecua, cucrema saGapaHe Ha pacTexka, NoHWDkaBaHe Ha Mullepatiara KocTHa nunsTHOCT Hapyuienns Ha weraGonuama w | Pesky XunoKanuemux xpanienero Muoro peaxu_| Xuneprankewna Tlewxwunu wapymenna Heuect ‘Arpecus, ficHXoMOTOpHa XunepaxTHBHOCT, GesnoxojicrBo, napytienna Ha chit Muro penkn | Jlenpecns, noseneryeckn npomenx (npenmaio npH neua) Hapyuienna wa Hepprara Weer TrasoSoave, Tpenop cuerena Hesecra Buen Ha coat ‘Muoro peaxn | Hapyuienna Ha seyca Flapyuienua wa ownre Heveca Bambreno spenne (wx. cpio TowKa 44) ‘Muoro peaxu | Karapaxra u rayKoma Copies wapyiiennx Yeon Tlasmrauio Hever “TaxuKapana Peakn ‘ApHTMn, Hamp. mpeacepano mbaxxeHe, axkaMepiia TaXnkapans, ekeTpacHeToH ‘Muoro peaxn | Aurata nextopuc. Yanmxasane na QTe surreppata (Ceao5n napymenns ‘Muoro peaxu | KoneGanns nia aprepuanioro wanarane Pecnparoptmn, pba Weer Jleko apasiene ta repzoTo, KaNWiMUa, Apesra: MenMacTHHATHH HapyulesHs rae Peakn Bporxocnasem ‘Cromaumo-apesin wapyurenua | Hevecr Tagene Hapywenns Ha KoxaTa Hesecra Kpeeoacananns HogKOKHaTa THKAH Hapywienna wa Hevecrat ‘Myexyann xpawina MyCKysIHO-ckenerHara cHcTeMa HW ceeaMHWTesIHaTa ThKAH Opobapinreantara KanmNA03a ce AWORH Ha OTHaTaHe Ha sleKapcTBeHNA NpOAyKT B oporapHtiKca. HaManaT TOSH PHCK, MauWeHTHTe TpABA 2a OAT cBBETBANH c:1ed NpHEM Ha BAKA MOTE HoMaKBat YeraTa cH ¢ Bona. OpodapaHrea:tHara karuuAOsHA MiKpEKUHA OOKHOBEHO OrroBay JIOKANHOTO MPOTHBOTKOHHHO sTeNeHHe, Ges a € HEOGXORMMO fla Ce NIpeKpaTaBa HHXa-1aTOPH KopTuKocTepont. AKO ce rlosH opocpapHHreania KaHANAO3a, NAUKEHTHTE TPAGRA Ja HsrtT BORA H CHEN MHXATALIMATTE NH HY? 10 Kaxro 1 mpi pyri Hixa1aTopHHt MeqHKAMeHTH, Moro p&sIKO —MpHt T1O-MasIko OT 1 Ha BCeKH 10 000 soBexa, Moxke aa ce pasBHe mapaioxcateH GpouNocTIaseM, MIpOsBaBall Ce CEC SACHBAHE Ha xplnogere 4 2a1yxa HenocpecrHeKO cue mpvema Ha jo3ara. TapatoKcanHis Gporxocniasba ce ossnasa oT GnpsoneticrRalln HxamaTOpHH GpoHxosMTATATOpH M TpAGBA sa ce sleKyBa Hesa6aBHO. TIpnnoxenmeto na CumGuxopr TpsGsa 1a ce cmpe HesaGaBHo, CbcTORHVETO Ha NaLWeHTa la ce MpeoueHH H, AKO ToBa € HeOGXoAHMO, Ja ce 3anO‘He arTepHaTHBHO sAeveRHE (BK. TO4KA 4.4), Tipu npuzoxenue, wa Kofiro u sla e MHXaaTOpeH KOpTHKOCTepOMA, MOTar ja ce pasBHsT CHCTeMHH e*beKTH, ocoGeHo MPH MpesIMicRAHETO My Bb BHCOKH 103K 3a MpOBiDAHTesIHO BPeMe, BepomTHOCTTa 3a pasBHTHe Ha ‘TakitBa e*beKTH € MHOTO N1O-MaIKa, OTKONIKOTO MIpH s1e¥eHHe ¢ MepopalHM KOPTHKOCTepOH,AH. BREMOHHTE cucremHn efexTa akuouaar cHHapom Ha Keunir (Cushing), kbumurowen xaGuryc, HanGEOpeuHa cympecus, 2aGansHe Ha pactexk pH jlewa H IOHOUIM, loHInxaBAH Ha MAMEpasiara KOCTHA TUTBTHOCT, KaTapakra H raykowa. Moke sta ce paseHrT M NOBHUIeHa NOATAMBOCT KbM HIKDEKUAH H HapywieHa crocoGHocr 3a npuenocoGanane Kem crpec. Tesi ecbexTit BepoxTHO SaBHCsT OT jO3aTa, BpeMeTO Ha eKCOSHUMS, CBTBTETBAMLMA HIM MpeMUIeCTBAI NPHEM Ha KOPTHKOCTePORAH H MILANBHALYATHATA syactanremnocr. Tleveneto c Br-anpenopeuenropHH MEMETHIH Moxke Aa ROBE 10 NOBMUAEAHe Ha CTOFHOCTITE Ha NHcyaMHa, CBOOOAHHTE NACTHH KHCeIHEH, FMHepOma M KETOTENATA B KPDETA. Teawarpusna nony. TIpenopsuntenio e BHCOUMHaTA Ha JeWaTa, NOAYABALIK NpONTBIDKHTEAHO sIeHeHHe C HHXaIATOpHH KOPTHKOCTEPOMAIH 2a Ce cxIenM penOBHO (Bx. TOHKA 4.4). 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Crea npaes na 6yzes01na 4 bopmorepon Kato MoHonpenapaTH H dbuKeHpanara KoMONAUNA, ‘bapmakoxinerHunTe napaMerpHt Ha cboTBETHITe pemlecTBa ca CpaBHAMH. 3a GyzesoHHLa, AUC, exopoerta a aGcopOuns H MakcHMaHaTa riaaMeHa KOHUCHTPAUIHA Ca MAIKO M10-BUCOKH Cile MPHTOKEHHE Ha ‘buxcupanara KoOnHaLNs. 3a GhopMoTepor, MaKcHMaAHaTa TuasMeHa KOHUEHTPALHA, Ces NPHTOKeHME Ha “bwxcnpanara KoMGMnaLWNA, € cxO.tHa c TASH NpH NpHAOKeHMe Ha MoHONpenapatuTe, Hi¥xanaTopHHST GynesoHMn ce abcopSupa Gxpso, a MaKcHMamHaTa niasMena KoHLeHTTpauHA ce NocTHrA Xo 30 MHYTH ces, mrxaannsra. B npoyssannata cpeaHoro Genoapo6Ho oTaarave Ha 6yae30HHA Cres HHXAMpAHe C ‘Typ6yxanep napupa or 32 % 10 44 % or noayenara josa. CucTemHaTa SuoHaTMUHOcT ¢ npHOnNsHTEAHO 49% or nonysewara 03a. 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MarnexKa oGaNe, 4e TeSH pesy.TaTH He ca COTHOCHMTH 3a xopa. 6. @APMAUEBTH4HH JAHHH 6.1 Cnmepk na nomomunre semecTsa Jlaxtosa monoxHapar (KoxTo chitbprka Mae4HH MpoTeHHH). 62 Hecbamectumoern Henprnoxnmo. 63 Cpox na roxuoct 3 roxmun, 6.4 Cnenmasnn yeaonus Ha cexpanenne ‘Tosu slexapersen mponykT He HSHCKBa creLIMasIHH YeTOBHA 3a coXpaneHHe. 65 Janum sa onaxonKxara (CumGuxopt TypSyxaciep © mioroos08 HHXanaTop 3a MpaX 34 MIXaIALH, pH KoitTO 3a HHXaAHpaHe Ce vonos13Ba HHCTNpaATOpHHST BRaAyUeH NOTOK. Muxanaroper e Gas, c BBpTaM ce vepBeH AHcK, Muxaneroper e worpageH oT passin nonmMepxH MarepnasH (PP, PC, HDPE, LDPE, LLDPE, PBT). Bos scaxa Bropiunia onakosxa uma | HHXaaTop, chinepacant 30 jt03H aK HMA 1, 2,3, 10 wt 18 wiEXaraTOpla), comppxam(n) 60 1H 120 2030. He pcwsixit probe onakonkH Morar jla Guat nycHATH B nponaKSa. 6.6 Cneumaann npeanasin Mepkn mpi waxeppaane Hewsnonspamusr nexapersen npoaykr HAH oTnaNBMNITe MaTepHAH OT Hero TpAGEA Hp chorpeTeTaie ¢ MecTHTe HBHCKBAHHS. 7. 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