Описание
Препарат Тизабри, с основным действующим веществом — Натализумаб, оказывает селективное влияние на иммунную систему. Препарат Тизабри — это моноклональное антитело — селективный ингибитор молекул адгезии, снижающий воспалительную активность в пораженных тканях и дальнейшее привлечение иммунных клеток к очагу воспаления, что уменьшает или замедляет повышение объема поражения головного мозга.
На данный момент в реальной клинической практике имеется более чем десятилетний опыт эксплуатации препарата Тизабри. В выборочном, двойном слепом, плацебо-контролируемом эксперименте было обнаружено, что терапия Тизабри позволяет снизить частоту обострений на 68 процентов, а риск прогрессирования инвалидизации на 42 процента. Использование препарата позволяет достигнуть долговременного управления над заболеванием и в некоторых случаях восстановить утраченные функции. На фоне терапии препаратом Тизабри существует риск развития ПМЛ, частота которой составляет 4,08 на 1000 случаев.
Показания препарата Тизабри
Препарат Тизабри воздействует на хронические, вялотекущие, острые формы рассеянного склероза. Используется для монотерапии высокоактивных форм заболеваний, с осложнениями в форме ремитирующего рассеянного склероза. Для монотерапии ремиттирующей формы рассеянного склероза следующим группам больных:
- пациентам с активным течением заболевания, не поддающемуся лечению полным и адекватным курсом (как минимум в течение одного года) интерферона бета, имеющим не менее одного рецидива в течение года терапии и не менее 9 Т2-гиперинтенсивных очагов на МРТ головного мозга или не менее одного очага, видимого при использовании МРТ с контрастным веществом. Под людьми «без ответа» на проводимое лечение подразумеваются пациенты с неизменной или повышенной частотой обострений в сравнении с предыдущим годом, либо с протекающими тяжелыми обострениями даже при терапии длительностью менее года;
- пациентам с резко прогрессирующим тяжелым ремиттирующим заболеванием. К данной категории относятся пациенты, перенесшие две или более количество обострений в течение года и/или имеющим один и/или более очагов поражения головного мозга на МРТ с контрастным веществом. Также к этой категории относятся пациенты, со значительным увеличением объема поражения головного мозга в режиме Т2 по сравнению с результатами предыдущей МРТ;
- препарат также хорошо применяется для облегчения прогрессирующего заболевания, при применении бета-интерферона и его производных.
Состав Тизабри
1 мл концентрата содержит:
Активное вещество: Натализумаб 20,00 мг/мл;
Вспомогательные компоненты: Натрия дигидрофосфата моногидрат, натрия гидрофосфата гептагидрат, натрия хлорид, полисорбат, вода для инъекций.
Фармакодинамика Тизабри
Препарат Тизабри содержит натализумаб — селективный ингибитор молекул адгезии. Тизабри взаимодействует с α4-субъединицей человеческого интегрина, на поверхности всех лейкоцитов в большом количестве экспрессирующегося (за исключением нейтрофилов). Натализумаб специфически связывается с α4β1-интегрином, блокируя при этом взаимосвязь с идентичным рецептором, адгезивной молекулой клеток сосудов (VCAM-1) и лигандом остеопонтина, доменом фибронектина. Также, натализумаб ингибирует взаимодействие α4β7-интегрина с адрессином-1 (MadCAM-1) — молекулой адгезии слизистой оболочки. Воздействия на эти молекулярные влияния тормозит миграцию мононуклеарных лейкоцитов через эндотелий в очаги воспаления органов. Механизм дальнейшего действия препарата может быть связан ингибированием воспалительных процессов путем торможения взаимодействия α4-экспрессирующих лейкоцитов с их лигандами. Следовательно натализумаб может ингибировать в пораженных тканях воспалительную активность и тем самым подавлять дальнейший иммунный ответ к очагу воспаления.
При переходе активированных Т-лимфоцитов через гематоэнцефалический барьер (ГЭБ) происходит повреждение тканей головного мозга при рассеянном склерозе. Взаимодействие между молекулами адгезии на поверхности активированных лейкоцитов и эндотелием кровеносных сосудов включает в себя миграция лейкоцитов через ГЭБ. Важным компонентом патогенеза формирования очагов воспаления в головном мозге является взаимодействие между α4β1 и его мишенями, поэтому активность воспаления снижает нарушение этих взаимодействий. VCAM-1 не экспрессируется при нормальных условиях в паренхиме головного мозга. Однако в присутствии противоспалительных цитокинов возможно выработка VCAM-1 в клетках эндотелия и в глиальных клетках, находящихся вблизи очага воспаления, регулируется по механизму положительной обратной связи. В условиях воспаления ЦНС при PC взаимодействие α4β1 с VCAM-1, CS-1 и остеопонтином опосредует прочную адгезию и миграцию лейкоцитов в головном мозге. Следовательно, в тканях ЦНС усиливается воспалительная активность. при PC в паренхиме головного мозга воспалительную активность снижает блокада молекулярных взаимодействий α4β1 с его мишенями и подавляет дальнейшее привлечение иммунных клеток, тем самым замедляя увеличение или снижая образование объема поражения.
Фармакокинетика
После повторного внутривенного введения в дозировке 300 мг больным с рассеянным склерозом средняя максимальная сывороточная концентрация натализумаба была 110 ± 52 мкг/мл. В период введения средняя стационарная концентрация натализумаба варьировала от 23 до 29 мкг/мл. Прогнозируемое время достижения равновесной концентрации составляло приблизительно 36 недель.
Для фармакокинетического анализа выборка включала более 1100 больных с рассеянным склерозом, получавших натализумаб в дозировке от 3 до 6 мг/кг. Из них в качестве монотерапии 581 человек получали фиксированную дозировку 300 мг. Среднее ± SD (стандартное отклонение) время клиренса при стационарном состоянии составляло 13,1±5,0 мл/ч со средним ± SD временем полувыведения 16±4 дня. влияние выборочных переменных было исследовано при анализе на фармакокинетику, включая массу возраст, пол, тела, функцию почек и печени, а также наличие антител к натализумабу.На распределение препарата было показано, что влияют только антитела к натализумабу и масса тела. Выявлено, что на клиренс натализумаба влияет масса тела, при этом это влияние меньше пропорционального; например 43 процента изменения массы тела приводит к изменению клиренса на 31-34 процента. Изменения клиренса не имеют клинического значения. Примерно втрое повышают клиренс к натализумабу циркулирующие антитела к нему, что соответствует наблюдаемому у больных с циркулирующими антителами снижению концентрации натализумаба.
Для снижения концентрации натализумаба в крови проводились исследования с участием 12 пациентов с PC эффективности и фармакодинамики плазмафореза. После трех процедур плазмафереза результаты выведения препарата (с более чем 5-8 дневным интервалом) составляли примерно 70-80 процентов. Это сопоставимо с 40 процентами выявленных в предыдущем исследовании после отмены препарата за аналогичный период времени. На восстановление миграции лимфоцитов влияние плазмафереза и, в конечном счете, на клиническое использование неизвестно.
Повторное введение
Эффективность и безопасность препарата при повторном введении не определяли.
Применение при беременности и кормлении грудью
Данных о введении натализумаба беременным женщинам недостаточно. Исследования на животных показали репродуктивную токсичность. Возможный риск для людей неизвестен. Не рекомендуется применять натализумаб во время беременности без особой необходимости. Терапию следует прекратить, если пациентка забеременеет во время приема Тизабри.
Тизабри выделяется с грудным молоком. Пациентки, получающие Тизабри, должны прекратить кормление грудью.
Применение при нарушениях функции печени
Не проводилось исследований по оценке результатов препарата Тизабри при нарушении функции печени.
Результаты изучения фармакокинетики и способа элиминации позволяют допустить, что препарат Тизабри можно назначать пациентам с нарушением функции печени без изменения дозы.
Применение при нарушениях функции почек
Не проводилось исследований по оценке результатов препарата Тизабри при нарушении функции почек.
Результаты изучения фармакокинетики и способа элиминации позволяют допустить, что препарат Тизабри можно назначать пациентам с нарушением функций почек без изменения дозы.
Применение у детей
Тизабри противопоказан детям и подросткам.
Применение у пожилых пациентов
Не рекомендуется использование препарата Тизабри у пациентов от 65 лет и старше, ввиду отсутствия данных о безопасности для этой категории пациентов.
Фармацевтические характеристики
Концентрат для приготовления раствора для инфузий. Бесцветный прозрачный или слегка опалесцирующий раствор
Упаковка, срок годности, условия хранения
Концентрат для приготовления раствора для инфузий 20 мг/мл. Тизабри поставляется в форме раствора. Продается во флаконах из медицинского стекла (первый тип). Пробка дополняется алюминиевой прокладкой-колпачком. Материал — бромбутил. Сверху устанавливается особая крышка, контролирующая процедуру первого вскрытия. По 15 мл в одном флаконе. Стеклянные флаконы вместе с инструкцией помещают в картонные упаковки. Внутри коробка разделена на несколько отсеков. Предусмотрена бумажная перфорация и защитные наклейки, для контроля первого вскрытия.
Хранить концентрат и готовый к применению раствор при температуре 2-8°С, в защищенном от света месте. Не замораживать. Хранить в недоступном для детей месте.
Срок годности: концентрат — 4 года, готовый к применению раствор — 8 часов. Не использовать по истечении срока годности.
Наша компания работает как на территории Казахстана, так и осуществляет доставку в страны ближнего зарубежья. Обращайтесь к нам за консультациями по контактным телефонам.
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A sensible bulk will not harm you, but gaining weight too quickly or eating massive amounts of unhealthy foods
may be detrimental to some well being markers. Newbie positive aspects are a truth, and newbies often see great outcomes from regular weight coaching and a nutritious diet.
If you’ve sure medical situations, like heart disease, diabetes, and hypertension, it’s a good
idea to talk to your doctor before bulking up.
Because you eat virtually no carbs on keto, your muscles
can’t rely upon glycogen to gas exercises. Fortunately, your body adapts to
a low-carb diet, and after a few weeks, it’ll have discovered to make
use of fats and ketones as an alternative. Your body doesn’t
absorb and use protein from plant-based sources fairly as well as from
animal-based. As A Result Of of that, you need to enhance your protein consumption by 25% should you only eat
plant-based meals to offer you as many muscle-building amino acids as
someone who eats meat and eggs. Weight gainer shakes
are designed to help people acquire weight and muscle mass.
They are principally a very calorie-dense meals in powdered type.
Creatine is a natural substance present in your muscles.
Your BMR is an estimate of the entire energy burned a day, while in a state of relaxation. I spent four years of faculty figuring out 5 days a week for
90 minutes a day making an attempt to get greater. Although I thought I
had known all of it (I had been coaching for 6 years in a gym!
I learn the muscle mags! I was in good shape already!), I nonetheless took the
free classes for the hell of it. After graduating
faculty, I moved to California, signed up for a gym membership, and received a couple of free personal trainer classes.
They should not be used to exchange a food regimen, however to help it.
Whereas it would be ideal to devour many dietary supplements a day,
except you might have a limiteless earnings then that isn’t potential.
The drawback is not the carbohydrates, but the amount of them that people eat at a
sitting. Out of the three forms of energy, carbs are essentially the most
eaten by far in average individuals’s diets. We have our total calorie intake, however it doesn’t
help us a lot if we do not know how to appropriately distribute these
calories. If we one way or the other conjure a meal that is 3500 calories and eat this entire meal in the morning, the outcomes would not be fairly.
600 or so could be used for normal features, whereas the opposite 2900 energy
would be excreted or stored as fat.
In only one month you’ll look greater and really feel better with this all-out energy assault.
It takes effort, dedication and a solid plan that covers all bases.
You need to commit to the journey and live the life totally.
For this reason I stick with the confirmed complement, creatine monohydrate.
Nitric Oxide will increase nutrient delivery to your muscles, which is
especially good for throughout and submit exercise. Like protein shakes, these serve as a meal addition or substitute.
They are great for individuals who wouldn’t have time
to repair meals each 2 or 3 hours.
If you’re new to exercise or haven’t skilled in properly over 3 months we’d suggest you opt
for a unique workout plan similar to our 12 week muscle building
program for novices. Welcome again, fitness enthusiasts, to Week 2 of MusclePharm’s 10-Week Bulking Blueprint Challenge!
If you conquered Week 1, get ready to elevate your recreation.
This week focuses on more sets, reps, and strategic relaxation for an intensified bulking journey.
Let’s delve into the primary points of this week’s routine designed to propel your features to the subsequent degree.
«Remember, we weren’t coaching to truly box three-minute rounds, however to drop physique fats and add most muscle bulk in a relatively quick area of time,»
says Thurston.
Slowly work up in weight, performing multiple mild warmup units.
Chris puts lots of emphasis on shoulder press energy within the offseason. Notice
that day 4 is a relaxation day, so we aren’t including
much data here.
They respond greatest to reasonable weights and high coaching volume.
To enhance the coaching depth, Ritchson combines arms training with abs workout.
Following Chris Bumstead’s coaching and food regimen plan will
not guarantee a Sandow trophy, but it’ll certainly get you positive aspects.
And should you’re not ready for an 8-day training schedule, there are many different great exercise
splits primarily based on how usually you prepare that will assist you see outcomes.
It’s a fantastic assistance train for the deadlift, and it’s nice for bulking up your hamstrings and
back.
Typically compound lifts end up neglecting certain muscle tissue.
All three are essential on your bulking journey.
Keep In Mind, as you achieve weight, your upkeep level will enhance, however this doesn’t mean your surplus will enhance.
To build muscle, you have to eat more energy than your body uses.
So, you should try to add slightly weight or maximize the reps in the recommended vary on a weekly basis.
Your strength days are the place the most important focus of development occurs,
however it will translate to heavier lifting for hypertrophy
days as nicely. For the bulking program beneath, the entire huge compound workout
routines shall be included, together with a variety of the assistance and accent lifts we
listed above.
The main purpose we’re utilizing an underhand grip is to construct
the power you have to do chin-ups, which are amazing once you can do them.
If this exercise feels too brief or too simple, that’s okay for this week.
Subsequent week, you possibly can add further sets to a number of the workouts.
If you want to add one other exercise to the top, that’s completely fine, too.
Biceps curls are in your biceps and/or brachialis muscles (which are right beneath your biceps).
Shoulder raises are for the edges of your shoulders, which will make
them broader. Here, we’re doing a giant set of all three arm workouts.
If you’re a beginner, it’ll eat you alive – you’d most likely be higher trying certainly one of our much less intense programs to
begin with. He holds a journalism diploma from the
College of North Texas, the place he competed in powerlifting.
His ultimate competitors was the Texas State Open in December of 1982, however has continued to check and apply muscle strength and hypertrophy.
He is a four-decade veteran of the medical system
business. Some of the best workouts for a particular physique
part are compound. Even though the anterior delts and triceps come to the get together, the way in which the Decline DB
Press works the pec main is extra biomechanically optimal than any other exercise and incurs less danger.
Aim for a nutrient stability of 40% protein, 20-25% fats, and 35-40% carbohydrates.
That way, you’re eating lots, but still eating right. Deadlifts are wonderful for constructing core power, which is essential for growing a thick, stable, well-defined trunk with musculature able
to defending in opposition to back injuries. It engages your «push muscles» via a full vary of movement,
with all of the focus concentrated squarely on the pectoral
muscles (with your triceps and shoulders as backup).
This always issues, but it issues even more while slicing as a end result of you’re in a
caloric deficit, and a caloric deficit is actually an vitality deficit.
Cardio is further exercise… and additional train requires extra recovery.
When slicing in the manner outlined above, you’ll certainly lose weight quick.
Mainly, the #1 objective when cutting the «wrong» means is to shed weight quick.
The typical old-school approach to slicing is basically
a reverse model of the old-school approach to bulking we talked about earlier.
If at any level you’ll find a way to hit 15 reps,
enhance the load. You’re aiming for 3-4 working units of every train with a great 3-5 minutes relaxation between sets.
Progressive overload refers again to the process of continually difficult your body.
The goal is to get out of your comfort zone and take every set to fatigue.
You don’t need to push to absolute failure, but grinding out that final rep makes all of the
distinction when it comes to stimulating muscle development.
We’re pulling no punches with this transformation plan.
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risk of any opposed effects.
There is high pressure on these people to constantly look in excellent condition, so
they make the most of Anavar as someone would with testosterone on TRT (testosterone replacement therapy).
We find that Anavar customers can drink small amounts of alcohol and never experience
any crucial hepatic issues. This is because of Anavar being metabolized by the kidneys, thus inflicting less stress to the liver.
Anavar’s testosterone-suppressing results, nevertheless,
can linger for a quantity of months.
These can embody zits, oily pores and skin, changes in libido, and potential liver toxicity.
It is essential to note that these side effects are generally
dose-dependent and might vary from individual to individual.
Moreover, combining oral anabolic steroids with prescribed hepatotoxic drugs
can cause liver complications. In this case, our
patient’s physique temperature will increase by roughly 1
diploma. We find that fats loss ceases roughly 4-6 weeks right into a cycle when the body inevitably
reaches homeostasis and cools down. This is why bodybuilders sometimes
cycle clenbuterol for brief durations, with transient protocols of 2 weeks on and a pair of weeks off.
Trenbolone considerably reduces fats mass while facilitating muscle progress.
Possession with no valid medical reason may result in penalties,
making accessibility and usage a matter of concern. Moreover,
side effects together with hormone imbalance, liver
toxicity, and cardiovascular issues are a half of the package with genuine Anavar utilization.
Next, educate your self on the significance of food regimen and vitamin when combined with an Anavar cycle.
Anavar is by far probably the most well-tolerated steroid for
females, not like Winstrol. Oral Winstrol remains to be thought-about a relatively mild steroid in comparability with most others.
Still, most ladies will find that Anavar is extra well-tolerated in phrases of controlling the unwanted side effects.
For ladies who want to use Winstrol, the oral kind only is
beneficial, and doses must be saved very low to
keep away from virilization. Anavar is not the
most suppressive steroid, however your natural testosterone production is likely to have taken successful.
This may cause symptoms of low testosterone when your cycle ends, including lack of muscle and fats gain. It’s strongly beneficial that Anavar not be used for longer than eight weeks because of its potential to cause stress to the liver as an oral steroid.
Users who administer common cycles of toxic anabolic steroids corresponding to Winstrol with
insufficient day off in between cycles are at larger threat of testosterone deficiency or infertility.
We have found incidents of zits vulgaris to be more prevalent on trenbolone as a result of excessive stimulation of
the sebaceous glands. Moreover, we observe a higher incidence of
hair follicle loss on trenbolone in comparability with other anabolic steroids.
This is the result of exponential will increase in dihydrotestosterone (DHT) ranges.
The Anavar cutting phase is an important a part
of this puzzle and ought to be approached with intent and information. An superior Anavar slicing cycle can also final between six to eight weeks, although some experienced users might prolong this era.
Nonetheless, longer cycles should be attempted with caution, as they may put the body underneath further strain. Listening to
your body’s feedback is crucial and will information any required modifications to your slicing
cycle. After finishing an Anavar cycle, it’s useful to permit the physique time to
recuperate and rebalance its hormone levels. Preserving the spectacular gains
achieved with the cycle also demands a disciplined food regimen and routine exercise.
On the opposite, legal Anavar options are substances created
to mirror the results of Anavar, without carrying the
same authorized and well being risks. They are
designed to be safer, selling muscle development and improved efficiency while making certain that customers don’t violate anti-doping rules or take
care of opposed health effects. In the following sections, we’ll dissect
the pros and cons of each to help make an informed determination about their
usage. Lastly, it’s value noting that stacking isn’t for everybody,
and it’s typically beneficial for people who have prior experience with
steroid use.
With this Deca Durabolin and Anadrol cycle, the person is using
higher doses. To combat this and preserve optimum sexual operate,
we prescribe Dostinex, otherwise often recognized as cabergoline.
This is a drug our doctors use to effectively treat hyperprolactinemia, a situation the place the physique produces too much prolactin.
Anavar doses in this range had been beneficial by
the medical institution for intervals of use no longer than 2
– four weeks, although some use has been seen to last for as
long as three months. Current prescription guidelines within the
Usa by the medical institution call for the exact same Anavar dosing
protocol as initially described over three a long time ago.
Past the initial weeks, continued use of Oxandrolone brings about more profound adjustments.
Correct PCT after Anavar ensures that you simply
keep your hard-earned features, normalize hormone levels, and protect long-term health.
Whether Or Not you’re a seasoned competitor or just exploring the world
of fitness, understanding Anavar’s distinctive advantages can help you
make knowledgeable decisions in your journey to peak performance.
Testosterone suppression will happen; nonetheless, post-cycle recovery is more probably to be quick, with this
drug failing to completely shut down this male hormone.
Mild opposed fluctuations in HDL and LDL levels of cholesterol
will happen on Primobolan. Oral Primobolan (Acetate) poses only mild
hepatic effects and is considered low-risk to the liver, primarily
based on our testing.
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