Gepatoprotektor, obladayet antidepressivnoy aktivnostyu. Okazыvayet xolereticheskoye i xolekineticheskoye deystviye. Obladayet detoksikatsionnыmi, regeneriruyuщimi, antioksidantnыmi, antifibroziruyuщimi i neyroprotektornыmi svoystvami.

Vospolnyayet defitsit ademetionina i stimuliruyet yego vыrabotku v organizme, v pervuyu ochered v pecheni i mozge. Uchastvuyet v biologicheskix reaktsiyax transmetilirovaniya (donator metilnoy gruppы) - molekula S-adenozil-L-metionina (ademetionin), yavlyayetsya donatorom metilnoy gruppы v reaktsiyax metilirovaniya fosfolipidov kletochnыx membran, belkov, gormonov, neyromediatorov; uchastvuyet v reaktsiyax transsulfatirovaniya kak predshestvennik tsisteina, taurina, glutationa (obespechivayet okislitelno-vosstanovitelnыy mexanizm kletochnoy detoksikatsii), koenzima atsetilirovaniya. Povыshayet soderjaniye glutamina v pecheni, tsisteina i taurina v plazme; snijayet soderjaniye metionina v sыvorotke, normalizuya metabolicheskiye reaktsii v pecheni. Krome dekarboksilirovaniya uchastvuyet v protsessax aminopropilirovaniya kak predshestvennik poliaminov - putrestsina (stimulyator regeneratsii kletok i proliferatsii gepatotsitov), spermidina i spermina, vxodyaщix v strukturu ribosom.

Okazыvayet xolereticheskoye deystviye, obuslovlennoye povыsheniyem podvijnosti i polyarizatsii membran gepatotsitov, vsledstviye stimulyatsii sinteza v nix fosfatidilxolina. Eto uluchshayet funktsiyu assotsiirovannыx s membranami gepatotsitov transportnыx sistem jelchnыx kislot i sposobstvuyet passaju jelchnыx kislot v jelchevыvodyaщuyu sistemu. Effektiven pri vnutridolkovom variante xolestaza (narusheniye sinteza i toka jelchi). Sposobstvuyet detoksikatsii jelchnыx kislot, povыshayet soderjaniye v gepatotsitax kon’yugirovannыx i sulfatirovannыx jelchnыx kislot. Kon’yugatsiya s taurinom povыshayet rastvorimost jelchnыx kislot i vыvedeniye ix iz gepatotsita. Protsess sulfatirovaniya jelchnыx kislot sposobstvuyet vozmojnosti ix eliminatsii pochkami, oblegchayet proxojdeniye cherez membranu gepatotsita i vыvedeniye s jelchyu. Krome etogo, sulfatirovannыye jelchnыye kislotы zaщiщayut membranы kletok pecheni ot toksicheskogo deystviya nesulfatirovannыx jelchnыx kislot (v vыsokix kontsentratsiyax prisutstvuyuщix v gepatotsitax pri vnutripechenochnom xolestaze). U patsiyentov s diffuznыmi zabolevaniyami pecheni (tsirroz, gepatit) s sindromom vnutripechenochnogo xolestaza snijayet vыrajennost kojnogo zuda i izmeneniy bioximicheskix pokazateley, v t.ch. urovnya pryamogo bilirubina, aktivnosti ЩF, aminotransferaz.

Posle odnokratnogo priyema vnutr v doze 400 mg C_max ademetionina v plazme dostigayetsya cherez 2-6 ch i sostavlyayet 0.7 mg/l. Biodostupnost preparata pri priyeme vnutr sostavlyayet 5%, pri v/m vvedenii - 95%.

Svyazыvaniye s belkami sыvorotki krovi neznachitelno.

Pronikayet cherez GEB. Nezavisimo ot puti vvedeniya otmechayetsya znachitelnoye uvelicheniye kontsentratsii ademetionina v spinnomozgovoy jidkosti. Metaboliziruyetsya v pecheni. T_1/2 - 1.5 ch. Vыvoditsya s pochkami.

Vnutripechenochnыy xolestaz pri pretsirroticheskix i tsirroticheskix sostoyaniyax, v t.ch.: jirovaya distrofiya pecheni; xronicheskiy gepatit; toksicheskiye porajeniya pecheni razlichnoy etiologii, vklyuchaya alkogolnыye, virusnыye, lekarstvennыye (antibiotiki, protivoopuxolevыye, protivotuberkuleznыye i protivovirusnыye preparatы, tritsiklicheskiye antidepressantы, peroralnыye kontratseptivы); xronicheskiy beskamennыy xoletsistit; xolangit; tsirroz pecheni; entsefalopatiya, v t.ch. assotsiirovannaya s pechenochnoy nedostatochnostyu (vklyuchaya alkogolnuyu).

Vnutripechenochnыy xolestaz u beremennыx.

Simptomы depressii.

So storonы piщyevaritelnoy sistemы: chasto - toshnota, boli v jivote, diareya; redko - rvota, suxost vo rtu, ezofagit, dispepsiya, meteorizm, jeludochno-kishechnaya bol, jeludochno-kishechnoye krovotecheniye, pechenochnaya kolika.

So storonы nervnoy sistemы: redko - sputannost soznaniya, bessonnitsa, golovokrujeniye, golovnaya bol, parestezii.

So storonы kostno-mыshechnoy sistemы: redko - artralgii, mыshechnыye sudorogi.

So storonы mochevыdelitelnoy sistemы: redko - infektsii mochevыvodyaщix putey.

So storonы kojnыx pokrovov: redko - gipergidroz, zud, kojnaya sыp.

Mestnыye reaktsii: redko - reaktsii v meste vvedeniya; ochen redko - reaktsii v meste vvedeniya, nekroz koji v meste vvedeniya.

Allergicheskiye reaktsii: redko - anafilakticheskiye reaktsii; ochen redko - otek Kvinke, otek gortani.

Prochiye: redko - prilivы, poverxnostnыy flebit, asteniya, oznob, grippopodobnыye simptomы, slabost, perifericheskiye oteki, gipertermiya.

Geneticheskiye narusheniya, vliyayuщiye na metioninovыy tsikl, i/ili vыzыvayuщiye gomotsistinuriyu i/ili gipergomotsisteinemiyu (defitsit tsistation beta-sintetazы, narusheniye metabolizma tsianokobalamina); vozrast do 18 let, povыshennaya chuvstvitelnost k ademetioninu.

Imeyetsya soobщyeniye o razvitii serotoninovogo sindroma u patsiyenta, primenyavshego ademetionin i klomipramin.

Sleduyet s ostorojnostyu primenyat ademetionin odnovremenno s selektivnыmi ingibitorami obratnogo zaxvata serotonina, tritsiklicheskimi antidepressantami, preparatami i rastitelnыmi sredstvami, soderjaщimi triptofan.

S ostorojnostyu primenyat ademetionin u patsiyentov s pochechnoy nedostatochnostyu, pri bipolyarnыx rasstroystvax, odnovremenno s selektivnыmi ingibitorami obratnogo zaxvata serotonina, tritsiklicheskimi antidepressantami (takimi kak klomipramin); preparatami rastitelnogo proisxojdeniya i preparatami, soderjaщimi triptofan; u patsiyentov pojilogo vozrasta.

Nedostatochnost vitamina V₁₂ i foliyevoy kislotы mojet privesti k umensheniyu kontsentratsiy ademetionina, poetomu rekomenduyetsya ix soputstvuyuщyee primeneniye v obыchnыx dozax.

Patsiyentы s depressiyey nujdayutsya v tщatelnom nablyudenii i postoyannoy psixiatricheskoy pomoщi pri lechenii ademetioninom s tselyu kontrolya effektivnosti lecheniya.

Pri primenenii u patsiyentov s tsirrozom pecheni na fone giperazotemii neobxodim sistematicheskiy kontrol urovnya azota v krovi. Vo vremya dlitelnoy terapii neobxodimo opredelyat soderjaniye mochevinы i kreatinina v sыvorotke krovi.

Vliyaniye na sposobnost k upravleniyu transportnыmi sredstvami i mexanizmami

Pri primenenii ademetionina vozmojno golovokrujeniye. Patsiyentam ne sleduyet upravlyat transportnыmi sredstvami ili rabotat s drugimi mexanizmami do polnogo ischeznoveniya simptomov, kotorыye mogut povliyat na skorost reaktsii pri ukazannыx vidax deyatelnosti.

V І i II trimestrax beremennosti ademetionin primenyayut tolko v sluchaye krayney neobxodimosti, kogda ojidayemaya polza dlya materi prevыshayet potentsialnыy risk dlya ploda. Primeneniye ademetionina v vыsokix dozax v III trimestre beremennosti ne vыzыvalo nikakix nejelatelnыx effektov.

Primeneniye ademetionina v period grudnogo vskarmlivaniya vozmojno, tolko yesli ojidayemaya polza dlya materi prevыshayet potentsialnыy risk dlya rebenka.