Active substanceDarifenacinDarifenacin
Similar drugsTo uncover
Dosage form: & nbsptablets of prolonged action, film-coated
Composition:

1 The prolonged-action tablet, coated with a film coating, contains:

active substance: darifenacin hydrobromide 8.929 mg or 17.858 mg, which corresponds to 7.5 mg or 15.0 mg of darifenacin base;

Excipients: calcium hydrophosphate monosubstituted 74.671 mg or 65.742 mg, hypromellose 114.4 mg, magnesium stearate 2 mg;

composition of the shell: hypromellose 2910, polyethylene glycol 4000, talc, titanium dioxide (E171).

Opadry® white (00F18296) (hypromellose 2910, polyethylene glycol 4000, talc, titanium dioxide E171) 8.5 mg or 8.1 mg;

Opadrai® Yellow (00F12951) (hypromellose 2910, polyethylene glycol 4000, talc, iron oxide yellow E172) 0 or 0.333 mg;

Fill Red® (00F15613) (hypromellose 2910, polyethylene glycol 4000, talc and iron oxide red E172) 0 or 0.066 mg.

Description:

Tablets of prolonged action, film-coated, 7.5 mg: round, slightly convex, film-coated white color tablets; on one side it is squeezed out "DF"and on the other -" 7.5 "(for tablets with a dosage of 7.5 mg).

Tablets of prolonged action, film-coated, 15 mg: round, slightly convex, film-coated, light-orange colored tablets; on one side it is squeezed out "DF"and on the other -" 15 "(for tablets with a dosage of 15 mg).

Pharmacotherapeutic group:antispasmodic
ATX: & nbsp

G.04.B   Other drugs for the treatment of urological diseases (including antispasmodics)

G.04.B.D.10   Darifenacin

Pharmacodynamics:

Darifenacin has a selective blocking effect on M3- muscarinic receptors (9-59 times more selective than other subtypes of muscarinic receptors). M3-muscarinic receptors - this is the main subtype of cholinergic receptors, which controls the reduction of detrusor of the bladder.

In cystometric studies in patients with involuntary contractions of the bladder against the background of therapy with darifenacin, there is an increase in bladder capacity due to an increase in the threshold for the occurrence of uneven contractions and a reduction in the frequency of uneven detrusor cuts.

With the use of the drug for 12 months in patients with involuntary contractions of the bladder, there is a decrease in the frequency of urination, mandatory urination, incontinence episodes and an increase in the average volume of urine when the bladder is emptied.

With the regular use of darifenacin at a dose of 7.5 and 15 mg, a significant decrease in the incidence of urinary incontinence(per week) 2 weeks after initiation of therapy, which is maintained during the course of therapy.

When darifenacin is administered in the same way as other M-holinoblokatorov, a dose-dependent increase in the time of movement of the contents along the large intestine and a decrease in salivation are observed.

Preclinical studies indicate that at concentrations equivalent to therapeutic, darifenacin has no effect on the ion channels in the heart cells. Nevertheless, in super therapeutic concentrations darifenacin has the property of blocking various ion channels.

Pharmacokinetics:

Suction

Medium bioavailability darifenacin in the equilibrium state is 15% for 7.5 mg and 19% for 15 mg.

After ingestion completely (> 98%) is absorbed, although its bioavailability is limited by metabolism during the "first passage" through the liver. After taking long-acting tablets, the maximum concentrations in the blood plasma (Cmax) are reached after about 7 hours; the equilibrium state of plasma concentrations is reached on day 6 of the application. In the equilibrium state, peak-peak fluctuations in the concentration of darifenacininsignificant (the maximum fluctuation values ​​are 0.87 for 7.5 mg and 0.76 for 15 mg); thus, maintaining the therapeutic concentration in the plasma is provided during the interval between doses of the drug. The intake of food had no effect on the pharmacokinetic parameters of darifenacin in the repeated use of long-acting tablets.

Distribution

Darifenacin is a lipophilic substance and binds to plasma proteins (predominantly with alpha-1 acidic glycoprotein) by 98%. The volume of distribution in the equilibrium state (Vss) is 163 liters.

Biotransformation / Metabolism

After oral administration darifenacin intensively metabolized in the liver. Metabolism is carried out with the participation of isoenzymes CYP2D6 and CYP3A4 systems of cytochrome P450. The three main metabolic pathways include monohydroxylation in the dihydrobenzofuran ring; disclosure of the dihydrobenzofuran ring; N-dealkylation of nitrogenous pyrrolidine. The initial products of hydroxylation and N-dealkylation - the main circulating metabolites, but none of them plays a significant role in the development of the clinical effect darifenacin.

Variability of metabolism:

a part of people (about 7% of the Caucasoid race) have insufficient isoenzyme activity CYP2D6 ("slow" metabolizers).

The metabolism of darifenacin in "slow" metabolizers will be carried out mainly with the participation of CYP3A4.

People with a full activity of isoenzyme CYP2D6 refer to "fast" metabolizers.

When applying darifenacin (15 mg once a day) in an equilibrium state, the ratio of CmOh and AUC "slow" metabolizers to those of "fast" were 1.9 and 1.7, respectively.

According to the population analysis of the results of pharmacokinetic studies, the average exposure in the equilibrium state of "slow" metabolizers was 66% higher than that of "fast" metabolizers.

However, given the clinical experience and significant coincidence between the exposure ranges in two populations, correction of the dosing regimen of the drug in "slow" metabolizers is not required.

Elimination

After ingestion in healthy volunteers, about 60% of the drug is excreted in the urine and 40% - with feces. In an unchanged form, only 3% of the drug is excreted.The calculated clearance of darifenacin is 40 l / h for "fast" metabolizers and 32 l / h for "slow" metabolizers. With regular use, the half-life of darifenacin is approximately 13-19 hours.

Floor

Exposure of darifenacin in men is 23% lower than that of women. Since in clinical trials the patient's sex did not affect the effectiveness and safety of the drug, dosage adjustment based on sex is not required.

Elderly patients

According to the population analysis, there is a tendency to decrease the clearance according to the age after 60 years of age (by 19% for every 10 years). Since in clinical trials the age of the patient did not influence the effectiveness and safety of the drug, correction of the dosing regimen according to age is not required.

Children

Pharmacokinetic studies of darifenacin in children have not been conducted.

Renal insufficiency

When darifenacin was administered at a dose of 15 mg 1 time / day until equilibrium was reached in patients with varying degrees of renal dysfunction (creatinine clearance from 10 to 136 ml / min), there was no correlation between renal function and clearance of darifenacin.

Liver failure

When darifenacin was administered at a dose of 15 mg 1 time / day until equilibrium was reached in patients with mild liver function disorders (5-6 points on the Child-Pugh scale), no changes in the pharmacokinetic parameters of the drug were detected.

In patients with impaired liver function of moderate degree (7-9 points on the Child-Pugh scale) there is a decrease in the binding of the drug to blood plasma proteins. After binding of darifenacin to plasma proteins, the calculated exposure value of unbound darifenacin in this category of patients was 4.7 times higher than in individuals with normal liver function.

Indications:

Hyperactivity of the bladder, manifested by persistent urination, urinary incontinence and frequent urination.

Contraindications:

- Hypersensitivity to darifenacin or any other component of the drug;

- retention of urine;

- slowing the emptying of the stomach;

- uncontrolled angle-closure glaucoma.

Carefully:

It is not recommended to prescribe Enablex to patients with severe liver dysfunction (more than 9 on the Child-Pugh scale).

Care should be taken when using Enablex in patients:

- with clinically significant impairment of outflow from the bladder;

- with the risk of developing a delay in urine;

- with severe constipation (2 or less bowel movements per week);

- with obstructive diseases of the digestive tract, for example pyloric stenosis;

- at the risk of reducing the motility of the gastrointestinal tract (GIT).

Caution should be given to Enabex patients receiving treatment for occlusive glaucoma.

Pregnancy and lactation:

Efficacy and safety of darifenacin in pregnant women not studied. Use the drug during pregnancy should be only in cases where the expected benefit for the mother exceeds the potential risk to the fetus.

In experimental studies, the isolation of darifenacin with breast milk. It is not known whether darifenacin with human breast milk. Care should be taken when using Enablex in women during lactation.

Dosing and Administration:

The drug should be taken 1 time per day, squeezed with liquid, regardless of food intake.

Tablets should be swallowed whole, not chewing, not dividing and not crushing.

For adult patients, the recommended initial dose is 7.5 mg per day.With insufficient therapeutic effect, the dose of the drug can be increased to 15 mg per day. The dose should be increased 2 weeks after the start of therapy, taking into account the patient's individual response to treatment.

Elderly patients

In elderly patients, dose adjustment is not required.

Use in children

Since the safety and efficacy of Enablex in children and adolescents (under 18 years of age) have not been established, the drug is not recommended for use in this category of patients.

Application for renal dysfunction

In patients with impaired renal function, dose adjustment is not required.

Application for violations of liver function

In patients with impaired liver function, there is a risk of increased exposure of the drug. In patients with mild violations of liver function (5-6 points on the Child-Pugh scale), dose adjustment is not required. In patients with moderate impairment of liver function (7-9 points on the Child-Pugh scale), the daily dose of Enablex 7.5 mg should not be exceeded. The use of the drug in patients with severe impairment of liver function (> 9 on the Child-Pugh scale) is not recommended.

Side effects:

The most frequent adverse events (AEs) with the use of the drug were dry mouth (20.2% for 7.5 mg and 35.0% for 15 mg) and constipation (14.8% for 7.5 mg and 21.0% for 15 mg). The withdrawal of drug therapy due to the development of AE data was low: for dry mouth 0% (for 7.5 mg) and 0.9% (for 15 mg), for constipation 0.6% and 1.2%, respectively .

In most cases, AEs were mild or moderate and did not require discontinuation of therapy. The incidence of serious adverse events with darifenacin at doses of 7.5 mg and 15 mg once daily was similar to that of placebo. When Enablex was used for 6 months, there was a decrease in the incidence of AE and the cases of withdrawal of drug therapy.

The frequency of AEs, possibly associated with the use of the drug, was estimated as follows: very often (≥1 / 10); often (≥1 / 100, <1/10); infrequently (≥1 / 1000, <1/100); rarely (≥1 / 10000, <1/1000), very rarely (<1/10000). Within each group, the frequency of AH is presented in order of decreasing frequency of development of AE, if the frequency of development is similar, then in order of decreasing importance.

Infections and infestations: infrequently - urinary tract infection.

Disorders of the psyche: infrequently - insomnia, pathological thinking.

From the nervous system: often - headache, infrequently - dizziness, dysgeusia, drowsiness.

From the side of the organ of vision: often - dry eye syndrome, infrequently - impaired vision.

From the cardiovascular system: infrequently - rise blood pressure.

From the respiratory system, chest and mediastinum: often - dryness in the nose, infrequently - shortness of breath, cough, rhinitis.

From the gastrointestinal tract: very often - constipation, dry mouth; often - abdominal pain, nausea, dyspepsia; infrequently - flatulence, diarrhea, ulcerative stomatitis.

From the skin and subcutaneous tissues: infrequently - rash, dry skin, itching, hyperhidrosis.

From the urinary system: infrequently - retention of urine, disorders of the urinary tract, pain in the bladder.

On the part of the reproductive system and mammary glands: infrequently - erectile dysfunction, vaginitis.

General disorders and disorders at the site of administration: infrequently - peripheral edema, asthenia, edema of the face, other swelling.

Laboratory data: infrequently - increasing the concentration of ASAT in the blood plasma, increasing the concentration of AlAT in blood plasma.

Injuries, poisoning and complications of the procedure of administration: infrequently - accidental injury.

Undesirable phenomena according to post-marketing reports

The following undesirable phenomena were identified according to individual post-marketing reports: generalized reactions hypersensitivity, angioedema with / without airway obstruction. Since the reports of these reactions were voluntary and the population size in which they occurred is not exactly known, the frequency of their occurrence is difficult to estimate (the frequency is unknown).

Overdose:

In case of an overdose of darifenacin, development of severe anticholinergic effects is possible. In case of an overdose, the drug should be given appropriate therapy (for example, physostigmine) in order to eliminate the anticholinergic symptoms under careful medical supervision.

Interaction:

The effect of other drugs on darifenacin

The metabolism of darifenacin is carried out mainly with the participation of isoenzymes CYP2D6 and CYP3A4 systems of cytochrome P450. Therefore, inhibitors of these enzymes may alter the pharmacokinetic parameters of darifenacin.

Inhibitor inhibitors CYP2D6

With the simultaneous use of darifenacin with isozyme inhibitors CYP2D6 correction of the dosing regimen is not required.When using Enablex in a dose of 30 mg once a day (2 times the recommended daily dose) in combination with a potent inhibitor of isoenzyme CYP2D6, paroxetine at a dose of 20 mg / day systemic exposure of darifenacin in the equilibrium state increased by 33%.

Inhibitor inhibitors CYP3A4

When used simultaneously with moderate isoenzyme inhibitors CYP3A4 (for example, with fluconazole, erythromycin) correction of the dosing regimen is not required.

When used simultaneously with potent inhibitors of isoenzyme CYP3A4 (eg, with ketoconazole, itraconazole, miconazole, troleandomycin, nefazadone and ritonavir) should not exceed the daily dose of Enablex 7.5 mg.

Mixed inhibitors of isoenzyme CYP450

Mean maximum concentration (CmOh) and the area under the curve "concentration-time" (AUC) darifenacin after taking it at a dose of 30 mg once a day in combination with cimetidine, a mixed isoenzyme inhibitor CYP450, were 42% and 34% higher.

P-glycoprotein inhibitors

Darifenacin is the substrate of the membrane carrier of molecules - P-glycoprotein. In vivo influence of P-glycoprotein inhibitors on darifenacin not studied.

Effect of darifenacin on other drugs

Substrates of the isoenzyme CYP2D6

Care should be taken when applying darifenacin concomitantly with drugs that are metabolized predominantly by isoenzyme CYP2D6 and have a narrow therapeutic range, for example, flecainide, thioridazine, tricyclic antidepressants (imipramine).

Substrates of the isoenzyme CYP3A4

Darifenacin does not have a clinically significant effect on the exposure of the substrate CYP3A4 midazolam and does not affect the pharmacokinetic parameters of oral contraceptives: levonorgestrel and ethinyl estradiol.

Other medicines

When darifenacin is used together with warfarin, standard therapeutic monitoring of prothrombin time should be continued. When used simultaneously with darifenacin, the effect of warfarin on prothrombin time does not change.

The use of darifenacin (30 mg once a day, which is twice the recommended daily dose) simultaneously with digoxin leads to a slight increase in the exposure of digoxin in the equilibrium state.In patients receiving therapy with digoxin, with the appointment of Enablex, standard therapeutic monitoring of digoxin should be carried out, especially at the beginning of treatment and with a change in the dose of darifenacin or discontinuation of therapy.

When darifenacin is administered together with other M-cholinoblockers, it is possible to increase the frequency and / or severity of such undesirable effects as dry mouth, constipation and blurred vision.

Special instructions:

Therapy with darifenacin at a dose of 7.5 mg and 15 mg, according to the questionnaire of King (The King's Health Questionnaire - KHQ), was associated with a statistically and clinically significant improvement in quality of life compared with placebo. Receiving darifenacin in a dose of 15 mg according to the questionnaire of King also leads to an improvement in the indicator of emotional state.

In a study evaluating the effect of a six-day treatment with darifenacin, it was found that taking these doses of the drug does not affect the duration of the interval QT in patients.

In this study, taking the drug at a dose of 15 mg and 75 mg led to a change in the heart rate on average by 3.1 and 1.3 beats per minute, respectively, compared with placebo. However, in II/III phases of clinical studies, there was no difference in heart rate for Enablex compared with placebo.

Patients receiving Enablex, like other anticholinergic drugs, should be warned about the need to stop taking the drug and immediately consult a doctor if they develop swelling of the tongue, nasopharynx, or difficulty breathing.

Effect on the ability to drive transp. cf. and fur:

Studies of Enablex's influence on the ability to drive vehicles and work with mechanisms have not been carried out. Because of Enablex's ability to cause dizziness and blurred vision, patients who experience these side effects should not drive the car, work with machinery, or perform other activities that require increased concentration.

Form release / dosage:

Tablets of prolonged action, film-coated, 7.5 mg and 15 mg.

Packaging:

For 7 or 14 pcs in a blister pack.

1 or 2 blisters for 7 tablets or 1, 2, 4 or 7 blisters for 14 tablets together with instructions for medical use in a cardboard bundle.

Storage conditions:

At a temperature of no higher than 30 ° C, in a place protected from light.

Keep out of the reach of children.

Shelf life:

3 years.

The drug should not be used after the expiration date.

Terms of leave from pharmacies:On prescription
Registration number:LSR-006979/08
Date of registration:01.09.2008
The owner of the registration certificate:Aspen Pharma Trading LimitedAspen Pharma Trading Limited
Manufacturer: & nbsp
Representation: & nbspNOVARTIS PHARMA LLCNOVARTIS PHARMA LLC
Information update date: & nbsp27.12.2015
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