Сайт предоставляет справочную информацию исключительно для ознакомления. Диагностику и лечение заболеваний нужно проходить под наблюдением специалиста. У всех препаратов имеются противопоказания. Консультация специалиста обязательна!
Препарат Карсил
Карсил относится к препаратам из группы гепатопротекторов на растительной основе. Действующим веществом данного препарата является силимарин, выделяемый из плодов расторопши.
Механизм действия силимарина еще не до конца изучен, но клинические испытания показали, что он способен:
1. Оказывать стабилизирующее воздействие на клеточные мембраны клеток печени.
2. Нормализовать жировой обмен.
3. Стимулировать выработку фосфолипидов.
4. Предохранять гепатоциты (клетки печени) от негативных воздействий.
5. Способствовать восстановлению гепатоцитов.
6. Замедлять развитие фиброза или жирового перерождения печени.
7. Оказывать антитоксическое действие.
8. Нормализовать микроциркуляцию крови в печени.
Благодаря этим свойствам Карсил способствует улучшению общего состояния больного, нормализации лабораторных показателей функций печени и уменьшению количества жалоб, связанных с нарушением пищеварения. Пациенты с пониженным усвоением пищи отмечают, что прием препарата приводит к улучшению аппетита и прибавке в весе.
Компоненты Карсила выводятся преимущественно с желчью, а незначительная их часть – с мочой. Препарат применяется для лечения и взрослых, и детей (старше 12 лет).
Препарат выпускается компанией Софарма (Болгария) под двумя названиями: Карсил и Карсил Форте (содержит большую дозировку действующего вещества).
Формы выпуска
Карсил: покрытое оболочкой драже двояковыпуклой формы и коричневого цвета, содержащее 35 мг силимарина и вспомогательные вещества – в блистерах по 10 штук, по 8 блистеров в картонной упаковке (80 шт.).
Карсил Форте: желатиновая капсула цилиндрической формы и светло-коричневого цвета с порошкообразной массой желто-коричневого или бледно-желтого цвета со специфическим легким запахом, содержащая 90 мг силимарина и вспомогательные вещества – в блистерах по 6 штук, по 5 блистеров в картонной упаковке (30 шт.).
Инструкция по применению Карсила
Показания к применению
Противопоказания
- Повышенная чувствительность к одному из компонентов препарата;
- период острой интоксикации;
- возраст до 12 лет.
Особые указания
При назначении Карсила пациенту с нарушениями работы вестибулярного аппарата врач должен предупредить его о том, что следует соблюдать осторожность при управлении транспортом и работе со сложными механизмами (или отказаться от этих действий на время приема Карсила). В остальных случаях препарат не способен влиять на способность управления механизмами и транспортом.
Карсил с осторожностью назначается пациентам с гормональными нарушениями (миома матки, эндометриоз, карцинома яичника, предстательной железы, молочной железы или матки), т. к. силимарин обладает эстрогеноподобным эффектом.
Препарат не назначается пациентам с аллергией на пшеницу, т. к. в состав вспомогательных веществ Карсила входит пшеничный крахмал. Присутствие сахарозы и лактозы в таблетках делает невозможным их прием для людей с редкой наследственной непереносимостью галактозы, фруктозы, дефицитом сахарозы-изомальтозы или глюкозо-галактозной мальабсорбцией, а также с лактозной недостаточностью Лаппа.
В некоторых случаях прием препарата может оказывать раздражающее воздействие на слизистую оболочку желудка и вызывать головную боль. Это объясняется присутствием глицерола в составе вспомогательных компонентов. В таких случаях врач может принять решение об отмене Карсила и назначении другого гепатопротектора.
Побочные действия
Лечение Карсилом
Как принимать Карсил?
Карсил или Карсил Форте принимают внутрь, до приема еды, запивая достаточным количеством питьевой воды. Драже нельзя разжевывать, а капсулы – вскрывать.
В случае пропуска одного из приемов Карсила рекомендуется выпить лекарство дополнительно как можно быстрее, но не принимать двойную дозу при последующем приеме.
При случайном приеме высокой дозы Карсила рекомендуется вызвать рвоту и выполнить промывание желудка. После этого необходимо принять сорбент и, при необходимости, провести симптоматическую терапию.
Дозировка Карсила и Карсила Форте
Дозировка и длительность приема определяются врачом и зависят от возраста и диагноза пациента. Как правило, курс приема составляет не менее 3 месяцев.
Дозировка Карсила для взрослых
- При тяжелых патологиях печени – 4 драже по 3 раза в день;
- в случаях легкого течения заболевания и в качестве поддерживающего лечения – по 1-2 драже 3 раза в день;
- для профилактики – 2-3 драже в течение дня.
Дозировка Карсил Форте для взрослых
- При тяжелых патологиях печени – 1 капсула 3 раза в день;
- в случаях легкого течения заболевания и в качестве поддерживающего лечения – по 1 капсуле 1 или 2 раза в день;
- для профилактики – по 1 капсуле 1 раз в день.
Карсил детям
Карсил, согласно инструкции, может применяться для лечения детей старше 12 лет, но в педиатрической практике его применяют и для лечения детей старше 5 лет. При назначении этого гепатопротектора детям младше 12 лет прием препарата должен выполняться только под наблюдением врача и с четким соблюдением всех его индивидуальных рекомендаций по дозированию и длительности приема.
Показания и противопоказания к приему Карсила у детей те же, что и у взрослых.
Дозировка Карсила для детей от 12 до 18 лет:
Карсил при беременности и лактации
Лекарственное взаимодействие Карсила
Аналоги Карсила
Аналогами Карсила, в состав которых входит силимарин, являются:
- Силегон (Венгрия);
- Силимарол (Польша);
- Силимар (Россия);
- Гепалекс (Германия);
- Гепарсил (Украина);
- Гипоглисил (Украина);
- Силимарин Гексал (Германия);
- Силимарин Сандоз (Германия);
- Силимарина СЕДИКО (Египет);
- Силимар экстракт сухой (Россия);
- Силибинин (Россия).
- Легалон 70 и Легалон 140 (Германия);
Принять решение о замене Карсила на аналог может только врач, он же проводит корректировку дозировки, т. к. в препарате-аналоге может содержаться другое количество силимарина.
Карсил или Эссенциале?
Часто пациенты задают вопрос, какой препарат лучше – Карсил или Эссенциале? Оба препарата относятся к группе гепатопротекторов, но механизм их действия несколько различен.
Большинство врачей рекомендуют прием Карсила и считают его более эффективным в следующих случаях:
- перенесенный гепатит;
- стеатоз;
- цирроз;
- невирусный хронический гепатит;
- токсические поражения;
- профилактика токсического воздействия на печень при хронических интоксикациях, длительном приеме лекарственных средств, алкоголя.
Эссенциале специалисты рекомендуют принимать при:
- жировой дегенерации печени;
- токсикозах беременных;
- радиационном синдроме;
- хронических гепатитах;
- токсическом поражении;
- псориазе;
- циррозе.
Подробнее о препарате Эссенциале
Отзывы о препарате
Большинство отзывов о препаратах Карсил и Карсил Форте положительны. Пациенты, принимавшие эти гепатопротекторы, отмечают улучшение общего самочувствия, нормализацию пищеварения и лабораторных показателей функции печени.
При плохой усвояемости пищи Карсил способствует улучшению аппетита и больные отмечают прибавку в массе тела.
Некоторые авторы отзывов отмечают, что после приема этого гепатопротектора у них улучшилось состояние волос и кожи.
В отзывах можно встретить мнения о том, что Карсил Форте более удобен в приеме и дозировании.
В большинстве отзывов пациенты не отмечают появления побочных действий препарата. Не сообщается и о случаях его передозировки.
О цене на Карсил и Карсил Форте большинство пациентов отзываются, как о "доступной" или "приемлемой".
Сегодня в продаже
Форма выпуска, состав и упаковка
◊ Драже , покрытые оболочкой с внешним слоем коричневого цвета и внутренним слоем белого цвета, двояковыпуклой формы; на изломе — от коричневато-желтого до светло-коричневого цвета.
| 1 драже | |
| сухой экстракт плодов расторопши пятнистой (эквивалент силимарина) | 35 мг |
Вспомогательные вещества: лактозы моногидрат, крахмал пшеничный, повидон (колидон 25), целлюлоза микрокристаллическая, магния стеарат, тальк, декстрозы моногидрат, сорбитол, натрия гидрокарбонат.
Состав оболочки: целлацефат, диэтилфталат, сахароза, акации камедь, желатин, тальк, титана диоксид, макрогол (ПЭГ 6000), краситель Broun Opalux (сахароза, оксид железа красный, оксид железа черный, метил- и пропилпарагидроксибензоат, вода очищенная), глицерол.
10 шт. — блистеры (8) — пачки картонные.
10 шт. — упаковки ячейковые контурные (8) — пачки картонные.
Клинико-фармакологическая группа
Фармакологическое действие
Гепатопротектор. Содержит сухой экстракт плодов расторопши пятнистой (эквивалент силимарина), который является смесью 4 изомеров флавонолигнанов: силибинина, изо-силибинина, силидианина и силикристина. Механизм действия препарата недостаточно ясен. Известно, что гепатопротекторное действие связано с конкурентным взаимодействием силимарина с токсинами за соответствующие рецепторы на мембране гепатоцитов; этим обусловлено мембраностабилизирующее действие.
Воздействует на метаболизм и другие клеточные процессы за счет подавления 5-липооксигеназного пути (в особенности лейкотриена В 4 ), связывания со свободными реактивными кислородными радикалами. Ускоряет регенеративные процессы за счет стимуляции синтеза белков (структурных и функциональных) и фосфолипидов в пораженных гепатоцитах.
Флавоноиды, к которым принадлежит силимарин, оказывают также антиоксидантное действие, улучшают микроциркуляцию. Клинически эти эффекты выражаются в улучшении субъективной симптоматики и в нормализации показателей функционального состояния печени (активности трансаминаз, уровня γ-глобулина, билирубина). Улучшается общее состояние пациентов, уменьшается количество предъявляемых жалоб, связанных с ЖКТ. У пациентов со сниженным усвоением пищи, связанным с заболеванием печени, повышается аппетит и происходит увеличение массы тела.
Фармакокинетика
Всасывание и распределение
После приема внутрь силимарин медленно абсорбируется из ЖКТ. Подвергается кишечно-печеночной циркуляции. Не кумулирует в организме.
При исследовании силибинина, меченного изотопом 14 С, самые высокие концентрации обнаруживаются в печени и совсем незначительные количества — в почках, легких, сердце и других органах.
Метаболизм и выведение
Метаболизируется в печени путем конъюгации. T 1/2 — 6 ч. Выводится преимущественно (80%) с желчью в виде глюкуронидов и сульфатов и в незначительной степени (около 5%) с мочой.
Показания к применению препарата
— токсические поражения печени;
— состояние после перенесенного гепатита;
— хронический гепатит невирусной этиологии;
— цирроз печени (в составе комплексной терапии);
— стеатоз печени (неалкогольный и алкогольный);
— в целях профилактики при длительном приеме лекарств, алкоголя, при хронических интоксикациях (в т.ч. профессиональных).
Режим дозирования
Взрослым и детям старше 12 лет для лечения тяжелых поражений печени препарат назначают в суточной дозе 420 мг — по 4 драже 3 раза/сут.
Для лечения более легких случаев и в качестве поддерживающей терапии назначают по 1-2 драже 3 раза/сут.
Для профилактики назначают по 2-3 драже/сут.
Курс лечения составляет не менее 3 месяцев.
Драже следует принимать внутрь, до еды, запивая достаточным количеством воды.
Побочное действие
Со стороны пищеварительной системы: редко — тошнота, диспепсия, диарея.
Аллергические реакции: в отдельных случаях — кожный зуд, сыпь.
Прочие: редко — обострение существующих вестибулярных нарушений, в отдельных случаях — алопеция.
Карсил переносится хорошо. Побочные эффекты возникают редко, имеют преходящий характер и исчезают после отмены приема препарата.
Противопоказания к применению препарата
— детский возраст до 12 лет;
— повышенная чувствительность к компонентам препарата.
Применение препарата при беременности и кормлении грудью
При беременности и в период лактации (грудного вскармливания) применение препарата не рекомендуется.
Применение при нарушениях функции печени
Препарат показан к применению при нарушениях функции печени.
Особые указания
При применении препарата возможно проявление эстрогеноподобного действия силимарина. Поэтому пациентам с гормональными нарушениями (эндометриоз, миома матки, карцинома молочной железы, яичников, матки, предстательной железы) препарат назначают с осторожностью.
В препарате Карсил в качестве вспомогательного средства содержится пшеничный крахмал, что может представлять риск для пациентов с целиакией (глютеновой энтеропатией).
Также в качестве вспомогательного компонента в препарате содержится глицерол, который в высоких дозах может вызывать головную боль или оказывать раздражающее действие на слизистую оболочку желудка.
Передозировка
На настоящий момент о случаях передозировке не сообщалось.
Лечение: при случайном приеме в высокой дозе следует вызвать рвоту, провести промывание желудка с применением активированного угля, симптоматическое лечение.
Лекарственное взаимодействие
При совместном применении силимарина с пероральными контрацептивными препаратами и лекарствами, которые используются при гормональной заместительной терапии, возможно уменьшение эффектов последних.
Силимарин подавляет систему цитохрома Р450 и может усиливать эффекты таких лекарств как диазепам, алпразолам, кетоконазол, ловастатин, винбластин.
Условия отпуска из аптек
Препарат разрешен к применению в качестве средства безрецептурного отпуска.
Условия и сроки хранения
Препарат следует хранить в сухом, защищенном от света, недоступном для детей месте при температуре не выше 25°C. Срок годности — 2 года.
Инструкция по применению
Немного фактов
Мировой медицинской практикой за последнее время отмечается существенное увеличение количества клинических случаев, связанных с различными нарушениями функционирования печени. Полноценное функционирование печени имеет важное значение для здоровья всего организма человека. Главная функция печени — это детоксикация. Печеночные ферменты способны перерабатывать разнообразные токсины в более безопасную форму. Также в этой железе происходят жизненно важные обменные процессы, в частности, синтезируется желчь, которая отвечает за нормальное пищеварение, происходит формирование многих витаминов и гормонов.
Современная фармакология обладает значительным арсеналом средств, позволяющих как контролировать, так и полностью лечить данные заболевания. Такие средства составляют группу гепатопротекторных препаратов.
Одним из популярных гепатопротекторных лекарственных средств является Карсил, производства болгарской фармакологической компании АО «Софарма».
Карсил – это эффективно действующее гепатопротекторное лекарство на растительной основе. Его активным составляющим компонентом является силимарин (Silimari), который выделяется из плодов лекарственного растения — расторопши.
Расторопша пятнистая (чертополох молочный) — вид травянистого растения, относящегося к семейству сложноцветных Астрововых. Сырье для фармакологического средства получают из зрелых плодов расторопши (на латыне Fructus Silybi mariani). В них в большом количестве содержатся полезные флавоноидные соединения, представленные силибинином, силидианином и силикристином. Все они имеют фенилхроманоновую структуру и обладают мембраностабилизирующим, антиоксидантным и метаболическим эффектами.
Силимарин вступает во взаимосвязь со свободными радикалами, находящимися в печеночных тканях, и понижает их токсичное действие.
Лекарственная форма и состав
Выпускается в виде драже, которое имеет двояковыпуклую форму. Внутреннее белое содержимое сверху покрыто плотной коричневатой оболочкой. На стороне излома может иметь желто-коричневый окрас.
Драже фасуется в блистеры общим количеством 10 штук и по 8 блистерных пластинок в картонной упаковке, в которую вкладывается инструкция по применению.
Одно драже состоит из экстракта расторопши в перерасчете на сухой эквивалент силимарина — 35 mg.
В качестве вспомогательных и связующих компонентов использованы: лактоза, натуральный крахмал, поливинилпирролидон, микроцеллюлоза, соль магния и стеариновой кислоты, тальк, глюкоза, подсластитель, натрия гидрокарбонат.
Фармакологические свойства
Фармакодинамика
Карсил содержит силимарин, полученный из экстракта семени расторопши. До конца механизм действия не изучен. Однако, доказано, что гепатопротекторная эффективность силимарина обусловлена отрицательным взаимодействием с токсическими веществами на рецепторы в мембранах гепатоцитов, оказывая укрепляющее и стабилизирующее воздействие.
Силимарин обладает выраженным регулирующим воздействием и способен влиять на процессы метаболизма на клеточном уровне. Саморегулирует проницаемость мембран, ингибируя липоксигеназный путь окисления арахидоновой кислоты, подавляя синтезирование активных медиаторов воспалительного процесса, в особенности Leukotriene B4. Легко вступает во взаимодействие со свободными радикалами и содействует продуцированию протеинов. Восстанавливает фосфолипиды в поврежденных клетках паренхимы печени, активизируя тем самым регенерацию тканей печени.
Положительное действие силимарина детерминировано его антиоксидантными свойствами и способностью существенно улучшать микроциркулирование в тканях. В общем итоге это ведет к нивелированию симптоматики заболевания и к нормализации функционирования печени по основным лабораторным показателям: трансаминазы, гаммаглобулина, билирубина. Улучшается общее самочувствие, а также нормализируется пищеварение. У многих пациентов с ухудшенным усвоением пищи, возникающим из-за патологических болезней печени, повышается аппетит и идет набор веса.
Фармакокинетика
Силимарин, попадая в кишечник, всасывается достаточно медленно. Поддается энтерогепатической циркуляции. Не обладает кумулятивным эффектом.
При лабораторных исследованиях кинетики силибинина, меченого углеродом 14, наблюдалось наибольшее присутствие в печени, и в малых дозах в сегментах почек и иных органах.
Катаболизм вещества в печени происходит в результате конъюгации. В желчном ферменте как продукты метаболитов выявляются глюкурониды и сульфаты. Период полувыведения достигает шести часов. Выводится из организма преимущественно с желчным секретом (до 80 %) и в очень малой дозе мочевыводящими путями (до 5%).
Показания
Препарат Карсил используется при следующих состояниях:
- гепатотоксическое поражение;
- поддерживающая и восстановительная терапия после диагностированного и пролеченного гепатита;
- хронические воспаления, имеющие невирусную этиологию;
- жировой гепатоз;
- при циррозе в комплексном терапевтическом лечении;
- при различных печеночных поражениях, возникающих вследствие долгосрочного приема лекарственных средств, алкогольных напитков, интоксикации в качестве профилактики.
Инструкция по приему
Драже Карсила принимает перорально, желательно до еды, без разжевывая и цельными, запивая большим объемом воды.
При патологических состояниях легкой или средней степени для взрослых и детей достигших двенадцатилетнего возраста рекомендуется употреблять одно или два драже трижды в сутки.
При тяжелых патологиях дозировку следует удвоить до двух-четырех драже трижды в течении суток.
Для профилактических целей следует принимать два-три драже на протяжении суток.
Продолжительность курсового лечения определяется врачом в частном порядке отдельно каждому пациенту, зависимо от типа поражения и тяжести течения заболевания. В среднем длительность терапевтического курса составляет около трех месяцев.
Если по каких-либо причинах была пропущена доза, тогда необходимо ее принять сразу при возможности. Если же уже пришло время для приема следующей порции, тогда она принимается как обычно, но не в коем случае не принимается двойная дозировка для компенсации пропуска.
Противопоказания к применению
Не рекомендовано употреблять медикаментозное средство при наличии гиперчувствительности к активному веществу либо к другим составляющим компонентам.
Нельзя принимать таблетки при острых отравлениях разной этиологии.
Не используется препарат в назначениях детям не достигших пятилетнего возраста.
Согласно инструкции по применению, следует с особым вниманием и осторожностью следует подходить к назначению медикаментозного средства для пациентов, страдающих различными гормональными нарушениями, включая эндометриоз, миомы тела матки, злокачественные опухоли с локализацией в молочной железе, яичниках либо в предстательной железе. В таких случаях необходимо дополнительное консультирование с лечащим доктором.
Особенности употребления при беременности и грудном вскармливании
Вследствие отсутствия достоверной информации на организм беременной или кормящей женщины, не рекомендовано употреблять данный препарат.
Передозировка
На сегодня не существует достоверных данных, подтверждающих факты передозировки Карсилом. Если произошло случайное употребление многократно повышенной дозировки препарата, следует использовать промывание ЖКТ и принять энтеросорбенты. Далее используется симптоматическое лечение.
Побочные эффекты
Карсил изготовлен из натурального сырья, поэтому, как правило, очень хорошо переносится организмом пациентов. В крайних случаях могут развиваться побочные явления.
Со стороны пищеварения возникают такие реакции, как ухудшение пищеварения, болезненные ощущения в области эпигастрия, тошнота, расстройство стула. В отдельных случаях наблюдались дерматологические реакции аллергического характера: высыпания, зуд, раздражения на коже, алопеция. Зафиксированы редкие случаи усиления вестибулярных расстройств, которые уже существовали в анамнезе пациента.
Все побочные явления, возникающие в результате употребления драже Карсила, являются временными. Они не требуют назначения специальной терапии и исчезают сразу после остановки применения лекарства.
Взаимодействия с лекарствами и алкоголем
При комбинированном использовании препарата с употреблением пероральных контрацептивов возможно понижения эффективности воздействия последних.
Карсил усиливает эффективность успокоительных лекарств алпрозолама и диазепама, противогрибкового кетоконазола, цитостатика винбластина и гиполипидемического ловастатина. Усиление воздействия обусловлено ингибирующим воздействием препарата на ферменты семейства Р450.
Категорически запрещено принимать спиртосодержащие напитки во время терапии гепатопротектором.
Условия хранения
Карсил следует сберегать в специально отведенном для этого месте с оптимальными параметрами по влажности и с температурным режимом, не превышающим 25 градусов по Цельсию. Место для хранения лекарственного средства должно быть вне зоны доступа для детей.
Срок годности
Препарат сохраняет свои качества на протяжении 2 лет. По завершению срока годности, а также при нарушении условий хранения, не рекомендовано употреблять лекарство.
Отпуск из аптечной сети
Находится в свободной аптечной продаже и отпускается пациентам без рецептурного листа.
Лицензия аптеки ЛО-77-02-010329 от 18 июня 2019 г.
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