{"id":10316,"date":"2020-04-23T05:02:49","date_gmt":"2020-04-23T02:02:49","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/topiramat\/"},"modified":"2025-02-10T15:34:17","modified_gmt":"2025-02-10T13:34:17","slug":"topiramat","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/topiramat\/","title":{"rendered":"\u0422\u043e\u043f\u0438\u0440\u0430\u043c\u0430\u0442"},"content":{"rendered":"

Informa\u0163ii generale \u015fi recomand\u0103ri pentru testare<\/em><\/strong><\/span><\/p>\n

In practica medical\u0103 curent\u0103 este recunoscut\u0103 din ce \u00een ce mai mult importan\u0163a determin\u0103rii periodice a nivelului \u00een s\u00e2nge al multora din medicamentele administrate, fie datorit\u0103 poten\u0163ialului crescut de reac\u0163ii adverse, fie complian\u0163ei reduse a pacien\u0163ilor.<\/span><\/p>\n

Monitorizarea terapeutic\u0103 a unui medicament (Therapeutic Drug Monitoring, TDM) are drept scop men\u0163inerea concentra\u0163iei acestuia \u00een intervalul terapeutic<\/strong>, definit ca acel interval de valori ale nivelului \u00een ser, plasm\u0103 sau s\u00e2nge integral \u00een care medicamentul respectiv \u00ee\u015fi exercit\u0103 efectele clinice cu reac\u0163ii adverse minime pentru majoritatea pacien\u0163ilor.<\/span><\/p>\n

Conceptul de TDM se refer\u0103 astfel la m\u0103surarea concentra\u0163iei medicamentelor pentru a optimiza \u015fi adapta tratamentul la nivel individual (terapie personalizat\u0103). Pentru realizarea acestei \u0163inte terapeutice este important s\u0103 se cunoasc\u0103 pentru medicamentele administrate date legate de:<\/span><\/p>\n

-farmacocinetic\u0103<\/span>: studiaz\u0103 efectele medicamentului asupra organismului (rela\u0163ia doz\u0103-efect);<\/span><\/p>\n

-farmacodinamic\u0103<\/span>: studiaz\u0103 efectele organismului asupra medicamentelor (absorb\u0163ie, distribu\u0163ie etc);\u00a0<\/em><\/strong><\/span><\/p>\n

-farmacogenetic\u0103<\/span>: studiaz\u0103 modelul genetic al metaboliz\u0103rii medicamentelor lu\u00e2nd \u00een considerare varia\u0163iile individuale.\u00a0<\/em><\/strong><\/span><\/p>\n

Pentru a ob\u0163ine rezultate pentru concentra\u0163iile medicamentoase cu utilitate clinic\u0103 este important ca prob\u0103 s\u0103 fie recoltat\u0103 \u00een a\u015fa numita \u201esteady state\u201d<\/strong> (stare de echilibru) \u00een care rata de medicament ce p\u0103trunde \u00een organism este egal\u0103 cu cea eliminat\u0103. Atunci c\u00e2nd o doz\u0103 fix\u0103 de medicament este administrat\u0103 la intervale de timp regulate, acesta se va acumula \u00een organism \u00een cursul fazei de absorb\u0163ie p\u00e2n\u0103 este atins\u0103 starea de echilibru; perioada de timp necesar\u0103 pentru a se ajunge la steady state<\/em> depinde de\u00a0 timpul de \u00eenjum\u0103t\u0103\u0163ire al medicamentului (T1\/2<\/sub>)<\/strong>, adic\u0103 timpul \u00een care concentra\u0163ia medicamentului \u00een s\u00e2nge se reduce la jum\u0103tate. La r\u00e2ndul s\u0103u T1\/2 <\/sub>depinde de rata de metabolizare \u015fi excre\u0163ie. In condi\u0163iile unei distribu\u0163ii rapide \u015fi uniforme a medicamentului \u00een organism (cinetic\u0103 de ordinul I), precum \u015fi\u00a0\u00een absen\u0163a unei doze de \u00eenc\u0103rcare, este nevoie de un interval de timp echivalent cu cel pu\u0163in 5 T1\/2<\/sub>\u00a0 pentru a ob\u0163ine steady state<\/em> (vezi fig. 20.3.1<\/em>)1;2;3<\/sup>.<\/span><\/p>\n

\"-\"<\/span><\/p>\n

Fig 20.3.1 Ob\u0163inerea \u201e<\/strong>steady state\u201d<\/strong><\/span><\/p>\n

Acest proces poate fi rezumat astfel:<\/span><\/p>\n

k\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 k = constanta de dispari\u0163ie a lui D<\/span><\/span><\/p>\n

D\u2192E\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 D = concentra\u0163ia medicamentului\u00a0 E = forma excretat\u0103 a medicamentului<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>\u04231\/2<\/sub> = 0.693\/k<\/span><\/p>\n

A\u015fa cum reiese din ecua\u0163ie, T1\/2 <\/sub>este o constant\u0103\u00a0\u00a0<\/sub>\u015fi nu depinde de concentra\u0163ia medicamentului. Daca T1\/2 <\/sub>este cunoscut se poate calcula modul de \u00eemp\u0103r\u0163ire a dozelor \u015fi intervalul de timp la care trebuie administrate pentru a se atinge nivelul terapeutic.<\/span><\/p>\n

Totu\u015fi, unele medicamente sunt metabolizate printr-un alt tip de cinetic\u0103 dec\u00e2t cea de ordinul I, suferind mai \u00eent\u00e2i o metabolizare\u00a0\u00een ficat, urmat\u0103 de o distribu\u0163ie multicompartimental\u0103\u00a0\u00een organism (medicamentul are o anumit\u0103 rat\u0103 de distribu\u0163ie plasmatic\u0103\u00a0 \u015fi o rat\u0103 diferit\u0103 de distribu\u0163ie tisular\u0103). In aceste cazuri timpul necesar pentru a atinge steady state <\/em>poate s\u0103 fie diferit de echivalentul a 5 T1\/2<\/sub> .<\/span><\/p>\n

Cu excep\u0163ia urgentelor medicale, \u00een cazurile\u00a0\u00een care se modific\u0103 dozele administrate \u015fi se adaug\u0103 sau se scot medicamente asociate, se va a\u015ftepta ob\u0163inerea unei noi st\u0103ri de echilibru \u00eenainte de recoltarea probei pentru monitorizarea terapeutic\u0103. Intr-un mod similar, se va a\u015ftepta aceea\u015fi perioad\u0103 de timp p\u00e2n\u0103 cand un medicament aflat\u00a0\u00een steady state <\/em>se va elimina din organism la \u00eentreruperea administr\u0103rii2<\/sup>.<\/span><\/p>\n

Odat\u0103 atins\u0103 starea de echilibru probele de s\u00e2nge pot fi recoltate \u00een dou\u0103 momente diferite:<\/span><\/p>\n

\u2013 \u00een momentul nivelului maxim (peak samples<\/em>): la 2-3 ore dup\u0103 administrarea unei doze orale, la 30-60 minute dup\u0103 o doz\u0103 administrat\u0103 intravenos, la 2-4 ore dup\u0103 o doz\u0103 administrat\u0103 intramuscular sau la 1-1 si \u00bd ore dup\u0103 o doz\u0103 administrat\u0103 intranazal;<\/span><\/p>\n

\u2013 \u00een momentul nivelului minim (trough samples<\/em>): imediat \u00eenaintea administr\u0103rii urm\u0103toarei doze; acest moment este recomandat \u00een majoritatea cazurilor.<\/span><\/p>\n

Monitorizarea terapeutic\u0103 a medicamentelor este indicat\u0103 \u00een special \u00een urm\u0103toarele situa\u0163ii:<\/span><\/p>\n

\u2022 perturbarea rela\u0163iei doz\u0103-efect;<\/span><\/div>\n
\u2022 e\u015fec \u00een ob\u0163inerea efectului terapeutic sau suspectarea unei intoxica\u0163ii;<\/span><\/div>\n
\u2022 efect imposibil sau foarte greu de confirmat clinic (de exemplu \u00een cazul imunosupresoarelor);<\/span><\/div>\n
\u2022 interval terapeutic \u00eengust (de exemplu \u00een cazul glicozidelor);<\/span><\/div>\n
\u2022 complian\u0163a redus\u0103 a pacien\u0163ilor (persoane v\u00e2rstnice sau cu boli psihice);<\/span><\/div>\n
\u2022 prezen\u0163a unor afec\u0163iuni care afecteaz\u0103 absorb\u0163ia, distribu\u0163ia, metabolizarea \u015fi excre\u0163ia medicamentelor;<\/span><\/div>\n
\u2022 administrarea simultan\u0103 de medicamente care prezint\u0103 aceea\u015fi cale de eliminare;<\/span><\/div>\n
\u2022 copii \u015fi persoane v\u00e2rstnice la care este afectat volumul de distribu\u0163ie: redus \u00een cazul v\u00e2rstnicilor \u015fi crescut la copii.<\/span><\/div>\n

Clasele de medicamente pentru care se recomand\u0103 \u00een mod special TDM sunt urm\u0103toarele:<\/span><\/p>\n

    \n
  • glicozide cardiace: digoxin, digitoxin;<\/span><\/li>\n
  • antiaritmice:\u00a0 amiodarona, flecainida, procainamida, chinidina;<\/span><\/li>\n
  • antiastmatice: teofilina;<\/span><\/li>\n
  • antibiotice: aminoglicozide, vancomicina;<\/span><\/li>\n
  • antivirale: medicamentele pentru infec\u0163ia HIV, ganciclovir;<\/span><\/li>\n
  • anticonvulsivante: fenobarbital, carbamazepin, fenitoin, acid valproic, gabapentin, primidona, lamotrigin;<\/span><\/li>\n
  • medicamente psihotrope: litiu, antidepresive triciclice, neuroleptice;<\/span><\/li>\n
  • imunosupresoare: ciclosporina, tacrolimus, sirolimus, everolimus, acid micofenolic, azatioprina;<\/span><\/li>\n
  • citostatice: methotrexat1;2<\/sup>.<\/span><\/li>\n<\/ul>\n

    In tabelul de mai jos sunt precizate pentru anumite medicamente T1\/2<\/sub>, intervalul de timp necesar pentru a se ajunge la steady state<\/em>, tipul de prob\u0103 pentru TDM \u015fi stabilitatea acesteia, intervalul terapeutic1;3<\/sup>:<\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    \n

    MEDICAMENT<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    \u04231\/2<\/sub><\/strong>\u00a0<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    T p\u00e2n\u0103 la steady state<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    Tip prob\u0103<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    Stabilitate prob\u0103<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    Metoda de determinare<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    Interval terapeutic<\/strong><\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    \u0414\u0438\u0433\u043e\u043a\u0441\u0438\u043d<\/span><\/p>\n<\/td>\n

    		\n

    36-48 h<\/span><\/p>\n<\/td>\n

    		\n

    7-10 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    ECLIA<\/span><\/p>\n<\/td>\n

    		\n

    0.9-2 ng\/mL<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Amiodarona<\/span><\/p>\n<\/td>\n

    		\n

    26-107 zile<\/span><\/p>\n<\/td>\n

    		\n

    Nu se aplic\u0103<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n

    0.5-2 mg\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Flecainida<\/span><\/p>\n<\/td>\n

    		\n

    12-27 ore<\/span><\/p>\n<\/td>\n

    		\n

    3-6 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n

    0.2-0.8 mg\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Teofilina<\/span><\/p>\n<\/td>\n

    		\n

    7-11 ore (adult)<\/span><\/p>\n

    1-8 ore (copil)<\/span><\/p>\n

    \u00a0<\/span><\/td>\n

    		\n

    15-55 ore (adult)<\/span><\/p>\n

    5-40 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n
    < 1 an:<\/span><\/div>\n
    5-10 mg\/L<\/span><\/div>\n
    <\/div>\n
    \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2265 1 an:\u00a0\u00a0\u00a0<\/span><\/div>\n
    8-20 mg\/L<\/span><\/div>\n

    \u00a0<\/span><\/td>\n<\/tr>\n

    \n

    \u0412\u0430\u043d\u043a\u043e\u043c\u0438\u0446\u0438\u043d<\/span><\/p>\n<\/td>\n

    		\n

    3-8 ore<\/span><\/p>\n<\/td>\n

    		\n

    1-2 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    FPIA<\/span><\/p>\n<\/td>\n

    		\n

    5 \u2013 10 \u00b5g\/mL<\/span><\/p>\n

    \u00a0<\/span><\/td>\n<\/tr>\n

    \n

    Carbamazepin<\/span><\/p>\n<\/td>\n

    		\n

    14-47 ore (adult)<\/span><\/p>\n

    8-19 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    7-12 zile (adult)<\/span><\/p>\n

    2-4 zile (copil)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n

    4-10 mg\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    \u0412\u0430\u043b\u044c\u043f\u0440\u043e\u0435\u0432\u0430\u044f \u043a\u0438\u0441\u043b\u043e\u0442\u0430<\/span><\/p>\n<\/td>\n

    		\n

    9-16 ore (adult)<\/span><\/p>\n

    7-13 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    2-4 zile (adult)<\/span><\/p>\n

    2-4 zile (copil)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    CEDIA<\/span><\/p>\n<\/td>\n

    		\n

    50-100 mg\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    \u0422\u043e\u043f\u0438\u0440\u0430\u043c\u0430\u0442<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    19-23 ore<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    5 zile<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/strong><\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/strong><\/span><\/div>\n
    la 2-8\u00b0C<\/strong><\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/strong><\/span><\/p>\n<\/td>\n

    		\n

    1-10 mg\/L<\/strong><\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Etosuximid<\/span><\/p>\n<\/td>\n

    		\n

    50-60 ore (adult)<\/span><\/p>\n

    30 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    8-12 zile (adult)<\/span><\/p>\n

    6-10 zile (copil)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n

    40-100 mg\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    \u0424\u0435\u043d\u043e\u0431\u0430\u0440\u0431\u0438\u0442\u0430\u043b<\/span><\/p>\n<\/td>\n

    		\n

    81-117 ore (adult)<\/span><\/p>\n

    40-70 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    17-24 zile (adult)<\/span><\/p>\n

    8-15 zile (copil)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n

    10-40 mg\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    \u0424\u0435\u043d\u0438\u0442\u043e\u0438\u043d<\/span><\/p>\n<\/td>\n

    		\n

    18-22 ore (adult)<\/span><\/p>\n

    7-29 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    4-8 zile (adult)<\/span><\/p>\n

    2-5 zile (copil)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n
    <14 ani:<\/span><\/div>\n
    10-20 mg\/L<\/span><\/div>\n
    <\/div>\n
    >14 ani:<\/span><\/div>\n
    6-14 mg\/L<\/span><\/div>\n<\/td>\n<\/tr>\n
    \n

    \u0413\u0430\u0431\u0430\u043f\u0435\u043d\u0442\u0438\u043d<\/span><\/p>\n<\/td>\n

    		\n

    5-7 ore (adult)<\/span><\/p>\n

    4-6 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    1-2 zile (adult)<\/span><\/p>\n

    1-2 zile (copil)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n

    2 \u2013 10 \u00b5g\/mL<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    \u041b\u0430\u043c\u043e\u0442\u0440\u0438\u0434\u0436\u0438\u043d<\/span><\/p>\n<\/td>\n

    		\n

    15-30 ore (adult)<\/span><\/p>\n

    30 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    3-10 zile (adult)<\/span><\/p>\n

    3-10 zile (copil)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n
    <14 ani:<\/span><\/div>\n
    5-15 mg\/L<\/span><\/div>\n
    <\/div>\n
    >14 ani:<\/span><\/div>\n
    1-5 mg\/L<\/span><\/div>\n<\/td>\n<\/tr>\n
    \n

    \u041f\u0440\u0438\u043c\u0438\u0434\u043e\u043d<\/span><\/p>\n<\/td>\n

    		\n

    3-7 ore (adult)<\/span><\/p>\n

    4-6 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    16-60 ore (adult)<\/span><\/p>\n

    20-30 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n

    5-15 mg\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Amitriptilina<\/span><\/p>\n<\/td>\n

    		\n

    8-51 ore<\/span><\/p>\n<\/td>\n

    		\n

    2-6 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n

    7 zile la 2-8\u00b0C<\/span><\/p>\n<\/td>\n

    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    50-300 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    \u041b\u0438\u0442\u0438\u0439<\/span><\/p>\n<\/td>\n

    		\n

    14-30 ore<\/span><\/p>\n<\/td>\n

    		\n

    2-7 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n

    8 ore<\/em> la temperatura camerei; <\/span><\/p>\n

    24\u00a0ore<\/em> la 2-8\u00b0C; <\/span><\/p>\n

    6 luni<\/em> la -18\u00b0C.<\/span><\/p>\n<\/td>\n

    		\n

    ISE<\/span><\/p>\n<\/td>\n

    		\n

    Mania acut\u0103: 0.6-1.2 mmol\/L<\/span><\/p>\n

    \u2022 Protec\u0163ie impotriva viitoarelor episoade la pacien\u0163ii cu afec\u0163iune bipolar\u0103: 0.8-1.0 mmol\/L<\/span><\/p>\n

    \u2022 Depresie: 0.5- 1.5 mmol\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Clomipramin<\/span><\/p>\n<\/td>\n

    		\n

    12-36 ore<\/span><\/p>\n<\/td>\n

    		\n

    3 s\u0103pt\u0103mani<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    90-250 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Clozapina<\/span><\/p>\n<\/td>\n

    		\n

    4-66 ore<\/span><\/p>\n<\/td>\n

    		\n

    Nu se aplic\u0103<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    350-600 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Olanzapin<\/span><\/p>\n<\/td>\n

    		\n
    21-54 ore (adult<\/span><\/div>\n
    \u226465 ani)<\/span><\/div>\n
    <\/div>\n
    32-81 ore (adult >65 ani)<\/span><\/div>\n<\/td>\n
    		\n

    7 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    \u00a010-80 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Doxepin<\/span><\/p>\n<\/td>\n

    		\n

    8-25 ore<\/span><\/p>\n<\/td>\n

    		\n

    2.5-5 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    20-150 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n
    Imipramin<\/span><\/div>\n<\/td>\n
    		\n

    6-20 ore<\/span><\/p>\n<\/td>\n

    		\n

    2-5 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    45-150 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Maprotilin<\/span><\/p>\n<\/td>\n

    		\n

    36-105 ore<\/span><\/p>\n<\/td>\n

    		\n

    14 zile<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    125-200 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Trimipramin<\/span><\/p>\n<\/td>\n

    		\n

    16-39 ore<\/span><\/p>\n<\/td>\n

    		\n

    Nu se aplic\u0103<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    150-350 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Haloperidol<\/span><\/p>\n<\/td>\n

    		\n

    41-41 ore (lactat)<\/span><\/p>\n

    14-28 zile (decanoat)<\/span><\/p>\n<\/td>\n

    		\n

    3-9 zile (lactat)<\/span><\/p>\n

    nu se aplic\u0103<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    5-16 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Risperidon<\/span><\/p>\n<\/td>\n

    		\n

    3 ore (fast metabolizerrisperidon)<\/span><\/p>\n

    21 ore (fast metabolizer9-hidroxi-risperidon)<\/span><\/p>\n

    20 ore (slow metabolizerrisperidon)<\/span><\/p>\n

    30 ore (slow metabolizer9-hidroxi-risperidon)<\/span><\/p>\n<\/td>\n

    		\n

    1 zi (fast metabolizerrisperidon)<\/span><\/p>\n

    5-6 zile\u00a0 (fast metabolizer9-hidroxi-risperidon)<\/span><\/p>\n

    5 zile (slow metabolizerrisperidon)<\/span><\/p>\n

    nu se aplica (slow metabolizer9-hidroxi-risperidon)<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    10-120 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Ciclosporina A<\/span><\/p>\n<\/td>\n

    		\n

    6-27 ore<\/span><\/p>\n<\/td>\n

    		\n

    2-6 zile<\/span><\/p>\n<\/td>\n

    		\n

    S\u00e2nge EDTA<\/span><\/p>\n<\/td>\n

    		\n
    5 zile<\/span><\/div>\n
    la -20\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    Intervalul terapeutic variaz\u0103 \u00een func\u0163ie de tipul transplantului si perioada de timp de la transplant.<\/span><\/p>\n

    Pentru afec\u0163iuni dermatologice \u015fi reumatologice:<100 \u00b5g\/L<\/span><\/p>\n

    Pentru sindrom nefrotic: 60-160 \u00b5g\/L.<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Tacrolimus<\/span><\/p>\n<\/td>\n

    		\n

    4-35 ore (adult)<\/span><\/p>\n

    4-12 ore (copil)<\/span><\/p>\n<\/td>\n

    		\n

    2-6 zile (adult)<\/span><\/p>\n

    nu se aplic\u0103 la copil<\/span><\/p>\n<\/td>\n

    		\n

    S\u00e2nge EDTA<\/span><\/p>\n<\/td>\n

    		\n
    5 zile<\/span><\/div>\n
    la -20\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n
    \u2013 \u00een primele 2 luni de la transplant:<\/span><\/div>\n
    15-20 \u00b5g\/L<\/span><\/div>\n
    <\/div>\n
    \u00a0\u2013 dup\u0103<\/span>\u00a02 luni de la transplant:<\/span><\/div>\n
    8-15 \u00b5g\/L<\/span><\/div>\n<\/td>\n<\/tr>\n
    \n

    \u0421\u0438\u0440\u043e\u043b\u0438\u043c\u0443\u0441 \u0432 \u043a\u0440\u043e\u0432\u0438<\/span><\/p>\n<\/td>\n

    		\n

    46-78 ore<\/span><\/p>\n<\/td>\n

    		\n

    5-7 zile<\/span><\/p>\n<\/td>\n

    		\n

    S\u00e2nge EDTA<\/span><\/p>\n<\/td>\n

    		\n
    5 zile<\/span><\/div>\n
    la -20\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    LC-MS\/MS<\/span><\/p>\n<\/td>\n

    		\n

    4-20 \u00b5g\/L<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Acid micofenolic<\/span><\/p>\n<\/td>\n

    		\n

    8-18 ore (adult) variabil la copil<\/span><\/p>\n<\/td>\n

    		\n

    Nu se aplic\u0103<\/span><\/p>\n<\/td>\n

    		\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C<\/span><\/div>\n<\/td>\n
    		\n

    HPLC<\/span><\/p>\n<\/td>\n

    		\n

    1-3.5 \u00b5g\/mL<\/span><\/p>\n<\/td>\n<\/tr>\n

    \n

    Methotrexat<\/span><\/p>\n<\/td>\n

    		\n

    Cinetic\u0103 bifazic\u0103<\/span><\/p>\n<\/td>\n

    		-<\/span><\/td>\n\n

    \u0421\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0430<\/span><\/p>\n

    \u00a0<\/span><\/p>\n<\/td>\n

    		\n
    7 zile<\/span><\/div>\n
    la 2-8\u00b0C protejat de lumin\u0103<\/span><\/div>\n<\/td>\n
    		\n

    FPIA<\/span><\/p>\n<\/td>\n

    		\n

    Se asociaz\u0103 cu un risc crescut de toxicitate:<\/span><\/p>\n

    \u2013 valorile > 5-10\u00a0 \u00b5mol\/L la 24 h de la admistrare;<\/span><\/p>\n

    \u2013 valorile > 0.5-1\u00a0 \u00b5mol\/L la 48 h de la administrare;<\/span><\/p>\n

    \u2013 valorile > 0.2\u00a0 \u00b5mol\/L la 72 h de la administrare.<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    ECLIA = metoda imunochimic\u0103 cu detec\u0163ie prin chemiluminiscen\u0163\u0103<\/span><\/p>\n

    HPLC = cromatografie de lichide sub \u00eenalt\u0103 presiune<\/span><\/p>\n

    LC-MS\/MS = cromatografie de lichide cuplat\u0103 cu spectrometrie de mas\u0103<\/span><\/p>\n

    FPIA = fluorescent polarization immunoassay (metoda imunochimic\u0103 cu detec\u0163ie prin fluorescen\u0163\u0103 polarizat\u0103)<\/span><\/p>\n

    CEDIA = cloned enzyme donor immunoassay (metoda imunoenzimatic\u0103 care utilizeaz\u0103 tehnologia ADN-ului recombinant)<\/span><\/p>\n

    ISE = ion selective electrode (metoda poten\u0163iometric\u0103).<\/span><\/p>\n

    \u0422\u043e\u043f\u0438\u0440\u0430\u043c\u0430\u0442<\/strong><\/span><\/p>\n

    Este un antiepileptic cu spectru larg cu urm\u0103toarele mecanisme de ac\u0163iune:<\/span><\/p>\n

    -blocarea canalelor de sodiu;<\/span><\/div>\n
    -poten\u0163area activit\u0103\u0163ii GABA;<\/span><\/div>\n
    -inhibarea poten\u0163\u0103rii receptorului pentru glutamat.<\/span><\/div>\n
    <\/div>\n
    Datorit\u0103 acestor ac\u0163iuni topiramatul blocheaz\u0103 mai degrab\u0103 extinderea convulsiilor dec\u00e2t cre\u015fte pragul pentru convulsii.<\/span><\/div>\n
    Se administreaz\u0103 oral, se absoarbe rapid \u015fi sufer\u0103 o metabolizare minim\u0103. Nivelurile serice maxime sunt atinse dup\u0103 2-3 ore de la administrare. Se leag\u0103 \u00een propor\u0163ie mic\u0103 de proteinele plasmatice (<15%); se elimin\u0103 predominat pe cale renal\u0103 cu un T1\/2 <\/sub>de 19-23 ore.<\/span><\/div>\n
    Concentra\u0163iile serice ale altor anticonvulsivante nu sunt afectate semnificativ de administrarea concomitent\u0103 a topiramatului, cu excep\u0163ia unor pacien\u0163i afla\u0163i sub tratament cu fenitoin care prezint\u0103 cre\u015fterea concentra\u0163iei serice de fenitoin dup\u0103 ad\u0103ugarea de topiramat. Administrarea concomitent\u0103 de fenitoin sau carbamazepin\u0103 scade nivelul seric de topiramat.<\/span><\/div>\n
    Pacien\u0163ii cu insuficien\u0163\u0103 renal\u0103 prezint\u0103 un clearance sc\u0103zut al medicamentului2<\/sup>.<\/span><\/div>\n

    \u00a0<\/span><\/p>\n

    \u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/strong><\/p>\n

    1. Laborator Synevo. Referin\u0163e specifice tehnologiei de lucru utilizate. 2010. Ref Type: Catalog.<\/span><\/div>\n
    2. Matthew R. Pincus, Naif Z. Abraham. Toxicology and Therapeutic Drug Monitoring. In Henry\u2019s Clinical Diagnosis and Management by Laboratory Methods, Saunders-Elsevier, 21st Edition, 2007, 308-320.<\/span><\/div>\n
    3. Quest Diagnostics. Therapeutic Drug Monitoring. Drug Half-Life, Steady State, and Recommended Sample Collection Time. www.questdiagnostics.com. Ref Type: Internet Communication.<\/span><\/div>","protected":false},"excerpt":{"rendered":"

    \u0422\u043e\u043f\u0438\u0440\u0430\u043c\u0430\u0442 \u2013 \u043f\u0440\u043e\u0442\u0438\u0432\u043e\u044d\u043f\u0438\u043b\u0435\u043f\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u0439 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442 \u0438\u0437 \u0433\u0440\u0443\u043f\u043f\u044b \u0441\u0443\u043b\u044c\u0444\u0430\u0442\u0437\u0430\u043c\u0435\u0449\u0435\u043d\u043d\u044b\u0445 \u043c\u043e\u043d\u043e\u0441\u0430\u0445\u0430\u0440\u0438\u0434\u043e\u0432, \u043f\u0440\u0438\u043c\u0435\u043d\u044f\u0435\u043c\u044b\u0439 \u0432 \u043a\u0430\u0447\u0435\u0441\u0442\u0432\u0435 \u043c\u043e\u043d\u043e- \u0438\u043b\u0438 \u043a\u043e\u043c\u0431\u0438\u043d\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u043e\u0439 \u0442\u0435\u0440\u0430\u043f\u0438\u0438 \u043f\u0440\u0430\u043a\u0442\u0438\u0447\u0435\u0441\u043a\u0438 \u043f\u0440\u0438 \u0432\u0441\u0435\u0445 \u0432\u0438\u0434\u0430\u0445 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    \u041d\u0430 \u0444\u043e\u043d\u0435 \u043f\u0440\u0438\u0435\u043c\u0430 \u0442\u043e\u043f\u0438\u0440\u0430\u043c\u0430\u0442\u0430 \u043c\u043e\u0433\u0443\u0442 \u0432\u043e\u0437\u043d\u0438\u043a\u043d\u0443\u0442\u044c \u0433\u043e\u043b\u043e\u0432\u043d\u0430\u044f \u0431\u043e\u043b\u044c, \u0433\u043e\u043b\u043e\u0432\u043e\u043a\u0440\u0443\u0436\u0435\u043d\u0438\u0435, \u0441\u043e\u043d\u043b\u0438\u0432\u043e\u0441\u0442\u044c, \u0437\u0430\u0442\u043e\u0440\u043c\u043e\u0436\u0435\u043d\u043d\u043e\u0441\u0442\u044c, \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u0435 \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u0438 \u0432\u043d\u0438\u043c\u0430\u043d\u0438\u044f, \u043f\u0430\u0440\u0435\u0441\u0442\u0435\u0437\u0438\u0438, \u0447\u0443\u0432\u0441\u0442\u0432\u043e \u0443\u0441\u0442\u0430\u043b\u043e\u0441\u0442\u0438, \u0438\u0437\u0432\u0440\u0430\u0449\u0435\u043d\u0438\u0435 \u0432\u043a\u0443\u0441\u043e\u0432\u044b\u0445 \u043e\u0449\u0443\u0449\u0435\u043d\u0438\u0439, \u0432 \u0440\u0435\u0434\u043a\u0438\u0445 \u0441\u043b\u0443\u0447\u0430\u044f\u0445 \u2013 \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u044f \u0437\u0440\u0435\u043d\u0438\u044f, \u0430\u043c\u043d\u0435\u0437\u0438\u044f, \u0430\u0442\u0430\u043a\u0441\u0438\u044f, \u0434\u0435\u043f\u0440\u0435\u0441\u0441\u0438\u044f, \u044d\u043c\u043e\u0446\u0438\u043e\u043d\u0430\u043b\u044c\u043d\u0430\u044f \u043b\u0430\u0431\u0438\u043b\u044c\u043d\u043e\u0441\u0442\u044c. \u0421\u0447\u0438\u0442\u0430\u0435\u0442\u0441\u044f, \u0447\u0442\u043e \u043f\u043e\u0431\u043e\u0447\u043d\u044b\u0435 \u044f\u0432\u043b\u0435\u043d\u0438\u044f \u044f\u0432\u043b\u044f\u044e\u0442\u0441\u044f \u0434\u043e\u0437\u043e\u0437\u0430\u0432\u0438\u0441\u0438\u043c\u044b\u043c\u0438.<\/p>\n

    \u0423\u0440\u043e\u0432\u0435\u043d\u044c \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430 \u0432 \u043a\u0440\u043e\u0432\u0438 \u0440\u0435\u043a\u043e\u043c\u0435\u043d\u0434\u043e\u0432\u0430\u043d\u043e \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u044f\u0442\u044c \u043f\u0440\u0438 \u043f\u043e\u0434\u043e\u0437\u0440\u0435\u043d\u0438\u0438 \u043d\u0430 \u043f\u0435\u0440\u0435\u0434\u043e\u0437\u0438\u0440\u043e\u0432\u043a\u0443, \u0430 \u0442\u0430\u043a\u0436\u0435 \u0443 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u043e\u0432 \u0441 \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u044f\u043c\u0438 \u0444\u0443\u043d\u043a\u0446\u0438\u0438 \u043f\u0435\u0447\u0435\u043d\u0438 \u0438 \u043f\u043e\u0447\u0435\u043a.<\/p>\n

    \u0414\u043b\u044f \u0447\u0435\u0433\u043e \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u0435\u0442\u0441\u044f \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435?<\/strong><\/p>\n

      \n
    • \u041c\u043e\u043d\u0438\u0442\u043e\u0440\u0438\u043d\u0433 \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u0438 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430 \u0432 \u043a\u0440\u043e\u0432\u0438;<\/li>\n
    • \u043e\u0446\u0435\u043d\u043a\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u043d\u043e\u0433\u043e \u0432\u0437\u0430\u0438\u043c\u043e\u0434\u0435\u0439\u0441\u0442\u0432\u0438\u044f;<\/li>\n
    • \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0430 \u043f\u0435\u0440\u0435\u0434\u043e\u0437\u0438\u0440\u043e\u0432\u043a\u0438;<\/li>\n
    • \u0432\u044b\u044f\u0432\u043b\u0435\u043d\u0438\u0435 \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u0439 \u0440\u0435\u0436\u0438\u043c\u0430 \u043f\u0440\u0438\u0435\u043c\u0430 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430.<\/li>\n<\/ul>\n

      \u041a\u043e\u0433\u0434\u0430 \u043d\u0430\u0437\u043d\u0430\u0447\u0430\u0435\u0442\u0441\u044f \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435?<\/strong><\/p>\n

        \n
      • \u041f\u0440\u0438 \u0441\u043e\u0445\u0440\u0430\u043d\u0435\u043d\u0438\u0438 \u0441\u0438\u043c\u043f\u0442\u043e\u043c\u043e\u0432 \u0438\u043b\u0438 \u043e\u0431\u043e\u0441\u0442\u0440\u0435\u043d\u0438\u0438 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f \u043d\u0430 \u0444\u043e\u043d\u0435 \u043f\u0440\u0438\u0435\u043c\u0430 \u0442\u043e\u043f\u0438\u0440\u0430\u043c\u0430\u0442\u0430;<\/li>\n
      • \u043f\u0440\u0438 \u043d\u0430\u043b\u0438\u0447\u0438\u0438 \u0443 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u0439 \u0444\u0443\u043d\u043a\u0446\u0438\u0438 \u043f\u0435\u0447\u0435\u043d\u0438 \u0438 \u043f\u043e\u0447\u0435\u043a;<\/li>\n
      • \u043f\u0440\u0438 \u043e\u0434\u043d\u043e\u0432\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u043c \u043d\u0430\u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0438 \u0434\u0440\u0443\u0433\u0438\u0445 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u043e\u0432 (\u043d\u0430\u043f\u0440\u0438\u043c\u0435\u0440, \u0444\u0435\u043d\u0438\u0442\u043e\u0438\u043d\u0430, \u043a\u0430\u0440\u0431\u0430\u043c\u0430\u0437\u0435\u043f\u0438\u043d\u0430);<\/li>\n
      • \u043f\u0440\u0438 \u043f\u043e\u044f\u0432\u043b\u0435\u043d\u0438\u0438 \u043d\u0435\u0436\u0435\u043b\u0430\u0442\u0435\u043b\u044c\u043d\u044b\u0445 \u044f\u0432\u043b\u0435\u043d\u0438\u0439, \u0432\u0435\u0440\u043e\u044f\u0442\u043d\u043e, \u0441\u0432\u044f\u0437\u0430\u043d\u043d\u044b\u0445 \u0441 \u043f\u0440\u0438\u0435\u043c\u043e\u043c \u0442\u043e\u043f\u0438\u0440\u0430\u043c\u0430\u0442\u0430 \u0438 \u043f\u043e\u0434\u043e\u0437\u0440\u0435\u043d\u0438\u0438 \u043d\u0430 \u043f\u0435\u0440\u0435\u0434\u043e\u0437\u0438\u0440\u043e\u0432\u043a\u0443 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430.<\/li>\n<\/ul>\n

        \u0427\u0442\u043e \u043e\u0437\u043d\u0430\u0447\u0430\u044e\u0442 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u044b?<\/strong><\/p>\n

        \u0420\u0435\u0444\u0435\u0440\u0435\u043d\u0441\u043d\u044b\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u044f:\u00a05 \u2013 20 \u043c\u043a\u0433\/\u043c\u043b.<\/p>\n

        \u041e\u043f\u0442\u0438\u043c\u0430\u043b\u044c\u043d\u0430\u044f \u0442\u0435\u0440\u0430\u043f\u0435\u0432\u0442\u0438\u0447\u0435\u0441\u043a\u0430\u044f \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u044f \u0442\u043e\u043f\u0438\u0440\u0430\u043c\u0430\u0442\u0430 \u0432 \u043a\u0440\u043e\u0432\u0438 2 \u2013 20 \u043c\u043a\u0433\/\u043c\u043b, \u043e\u0434\u043d\u0430\u043a\u043e \u0434\u043b\u044f \u043d\u0435\u043a\u043e\u0442\u043e\u0440\u044b\u0445 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u043e\u0432 \u0438\u043d\u0434\u0438\u0432\u0438\u0434\u0443\u0430\u043b\u044c\u043d\u0430\u044f \u043f\u0435\u0440\u0435\u043d\u043e\u0441\u0438\u043c\u0430\u044f \u0434\u043e\u0437\u0430 \u043c\u043e\u0436\u0435\u0442 \u0437\u043d\u0430\u0447\u0438\u0442\u0435\u043b\u044c\u043d\u043e \u0432\u0430\u0440\u044c\u0438\u0440\u043e\u0432\u0430\u0442\u044c\u0441\u044f, \u0430 \u043f\u043e\u0431\u043e\u0447\u043d\u044b\u0435 \u044f\u0432\u043b\u0435\u043d\u0438\u044f\u00a0\u043c\u043e\u0433\u0443\u0442 \u0432\u043e\u0437\u043d\u0438\u043a\u0430\u0442\u044c \u0438 \u043f\u0440\u0438 \u043d\u0435\u0432\u044b\u0441\u043e\u043a\u0438\u0445 \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u044f\u0445.<\/p>\n

        \u0422\u043e\u043a\u0441\u0438\u0447\u0435\u0441\u043a\u0430\u044f \u043a\u043e\u043d\u0446\u0435\u043d\u0442\u0440\u0430\u0446\u0438\u044f \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430 \u0432 \u043a\u0440\u043e\u0432\u0438 \u043d\u0435 \u0443\u0441\u0442\u0430\u043d\u043e\u0432\u043b\u0435\u043d\u0430.<\/p>\n

        \u041a\u0430\u043a \u043f\u0440\u0430\u0432\u0438\u043b\u044c\u043d\u043e \u043f\u043e\u0434\u0433\u043e\u0442\u043e\u0432\u0438\u0442\u044c\u0441\u044f \u043a \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044e?<\/strong><\/p>\n

          \n
        • \u0414\u0435\u0442\u044f\u043c \u0432 \u0432\u043e\u0437\u0440\u0430\u0441\u0442\u0435 \u0434\u043e 1 \u0433\u043e\u0434\u0430 \u043d\u0435 \u043f\u0440\u0438\u043d\u0438\u043c\u0430\u0442\u044c \u043f\u0438\u0449\u0443 \u0432 \u0442\u0435\u0447\u0435\u043d\u0438\u0435 30-40 \u043c\u0438\u043d\u0443\u0442 \u0434\u043e \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044f.<\/li>\n
        • \u041d\u0435 \u043f\u0440\u0438\u043d\u0438\u043c\u0430\u0442\u044c \u043f\u0438\u0449\u0443 \u0432 \u0442\u0435\u0447\u0435\u043d\u0438\u0435 2-3 \u0447\u0430\u0441\u043e\u0432 \u0434\u043e \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044f, \u043c\u043e\u0436\u043d\u043e \u043f\u0438\u0442\u044c \u0447\u0438\u0441\u0442\u0443\u044e \u043d\u0435\u0433\u0430\u0437\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u0443\u044e \u0432\u043e\u0434\u0443.<\/li>\n
        • \u041d\u0435 \u043a\u0443\u0440\u0438\u0442\u044c \u0432 \u0442\u0435\u0447\u0435\u043d\u0438\u0435 30 \u043c\u0438\u043d\u0443\u0442 \u0434\u043e \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044f.<\/li>\n<\/ul>","protected":false},"featured_media":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[984],"product_tag":[],"class_list":{"0":"post-10316","1":"product","2":"type-product","3":"status-publish","5":"product_cat-monitorizare-terapeutica-medicamente-tdm","7":"first","8":"instock","9":"sold-individually","10":"shipping-taxable","11":"purchasable","12":"product-type-simple"},"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product\/10316","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/comments?post=10316"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=10316"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_brand?post=10316"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_cat?post=10316"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_tag?post=10316"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}