Contraceptive patch "Evra" - reviews, instructions for use and effect. Contraceptive patch Evra: instructions for use

Some medications, including hormonal contraceptives, require long-term, regular use. The effectiveness and ease of use in this case largely depends on the dosage form. One of the most modern and promising methods of delivering substances such as hormones is therapeutic transdermal systems or patches, which include the contraceptive for transdermal use Evra. Contraceptive patch as a means of protection, method of use, indications and contraindications, reviews, how much such a drug costs. You will find all the most important and interesting things in our article.

Patches or tablets: what to choose

Basically, hormonal contraceptives for women are oral medications that are a combination of progestin and estrogen. Depending on the dosage, there are high-dose, low-dose and micro-dose contraceptives. Today, preference is given to low-dose and micro-dose.

The effectiveness of contraception and the tolerability of such drugs directly depend on the regularity of use, that is, skipping a pill is extremely undesirable. That’s why the advent of a micro-dose contraceptive in the form of a patch seems like an excellent solution to the “oops, I forgot again!” problem. But this is not the only advantage of Evra:

1. Reliable fixation of the contraceptive patch. Its use does not exclude water treatments and physical activity.
2. Ease of use. The patch is applied once a week, unlike tablets, which need to be taken daily at the same time (this is also the reason for many good reviews about the drug).
3. Gradual and uniform release, no changes in the level of hormones in the blood serum during the day, which is typical for oral contraceptives.
4. Compact size, thin and smooth film (almost like a regular adhesive plaster) make it invisible under clothing.
5. There is no need to adjust the treatment regimen in connection with diseases of the gastrointestinal tract, when taking oral medications would be a problem.
6. Therapeutic effect. Like other contraceptives, in addition to protecting against unwanted pregnancy, the transdermal contraceptive patch eliminates such unpleasant symptoms as menstrual pain and intermenstrual discharge.

Despite all the advantages, like any contraceptive, the Evra patch can only be used as prescribed by a gynecologist, because it has a number of limitations and side effects.

Pharmacological action: how it works

The main indication for the use of Evra, according to the instructions, is the prevention of unwanted pregnancy in women. The effectiveness of the hormonal drug, provided that the method of application of the drug is followed, is more than 99%.

An important condition for achieving maximum effect from contraceptives is strict adherence to the instructions when using them.

One Evra patch contains a highly selective gestagen of the latest generation (norelgestromin - 6 mg) and an estrogenic component (ethinyl estradiol - 600 mcg). It is the presence of these substances that determines the contraceptive effect of the patch, which is based on the following mechanisms:

• Suppression of ovulation, as a result of which the egg does not leave the ovary and the fertilization process becomes impossible.
• Increased viscosity of the cervical fluid (cervical mucus), which makes it difficult for sperm to move.
• Impediment to implantation (the susceptibility of the endometrium to the blastocyte decreases).

Almost 100% protection against unwanted pregnancy with the help of the Evra dermal product is also achieved if drug interactions are taken into account and other instructions given in the instructions are followed.

Method of administration and dosage of the drug

The transdermal contraceptive patch is applied once a week, each time the old patch is replaced with a new one, so three patches are used per month. For convenience, you can navigate by day of the week (replacement is carried out on the same day of the week).

It is worth noting that this regimen is suitable if you have not previously taken oral contraceptives. Regarding this situation, separate instructions are given by the instructions, and they also describe in detail the method of using the contraceptive patch after an abortion, childbirth, and situations when the patch comes off.

Before using any contraceptive, you must consult a gynecologist.

The place of attachment of Evra can be the area of ​​the buttocks, abdomen, or shoulder. Here are some helpful tips on how to use the hormonal contraceptive patch:

1. The skin at the application site should be clean, dry and healthy.
2. You should not apply creams, powders, or cosmetics to the area where you plan to stick the patch.
3. For better adhesion, press and then smooth the patch with your hand.
4. Change the application location within the same area each time to avoid irritation.
5. Set yourself a reminder on your phone or set an alarm so you don’t miss “replacement day.”

The instructions indicate that approximately 150 mcg of gestogen and 20 mcg of estrogen enter the blood during the day. It is very important that the patch is tightly attached to the skin, otherwise the concentration of active substances in the blood will decrease, as will the contraceptive effect, and the likelihood of an unwanted pregnancy will increase. It is important not to miss “replacement days”.

What is important to know: contraindications and special instructions

The presence of contraindications, significant drug interactions, and special instructions once again indicates the need for prior consultation with a doctor. You should not take contraceptives on the recommendation of friends or after reading reviews on the Internet. Let's look at when it is not recommended to use hormonal contraceptives (including the hormonal contraceptive patch):

• Thrombosis, including history, risk factors for thrombosis, hereditary predisposition.
• Breast cancer, endometrial cancer, even if there is suspicion.
• Postmenopausal period and age up to 18 years.
• Postpartum period (4 weeks).
• Pregnancy and breastfeeding.

Transdermals are as effective as oral pills, but they have less negative effects on the body.

Women with endocrine disorders, high blood pressure, and impaired liver and kidney function should use the contraceptive patch with caution. If your body weight is more than 90 kg, the risk of pregnancy increases. As for drug interactions, metabolism can be affected by:

1. Antibiotics (ampicillin, tetracycline).
2. Antifungal agents (grisofulvin).
3. Antiepileptic drugs.
4. Herbal preparations (St. John's wort)

The instructions for use contain a more detailed list of drug interactions, as well as information on how test data may change while taking Evra.

Cost and opinions about the drug

Today, the Evra patch is the only contraceptive patch registered and approved for sale in Russia. The price per package may vary significantly depending on the city and region of the country.

On forums dedicated to women's health, we found mostly positive reviews about Evra hormonal patches. Negative reviews are caused by the price of the patch and the soiling of the surface; everyone notes the excellent contraceptive effect and significant superiority compared to others in the convenience of the drug. Of course, there are reviews that contain information about the appearance of discomfort and unusual sensations, but they are few.

Currently, there are various ways to prevent unwanted pregnancy in women. They resort to many methods: this technique, establishing a spiral, etc. One way to prevent this is the Evra contraceptive patch. This is a modern medicine that is aimed at avoiding fertilization. This adhesive plaster is a fairly popular and widespread product and has a good reputation.

What it is?

The hormonal contraceptive patch Evra is considered a good remedy, thanks to which fertilization does not occur in a woman’s body. The components contained in the patch prevent pregnancy. It has high results and efficiency of use, as well as being quite reliable and safe. This Chinese patch is easy to use, its substances affect the ovaries and promote changes in hormone production. Therefore, in females, ovulation does not occur; the mucus produced becomes thick and prevents sperm from penetrating into the uterine cavity. Because of this, the possibility of fertilization is reduced.

Evra is determined by significant reliability, good safety and results. According to the doctors who invented this transdermal patch, the effectiveness of protection against pregnancy is 99.4%. If you want to give birth, you just need to stop using contraceptives and after a while the woman will be able to get pregnant.

Important! This drug has a fairly extensive list of contraindications, so when using it, you should consult a medical specialist!

Composition and use of Evra patch

Evra is a contraceptive that includes certain components that prevent a woman from ovulating and fertilizing. These substances, upon contact with the skin, enter the body through the blood and affect the activity and formation of hormones by the ovaries.

One EUR patch contains 600 mcg of ethinyl estradiol, 6 mg of norelgestramine and this is quite a lot. Therefore, the use of this product is not intended for one day. Over the course of a day, a woman’s body receives about 20 mcg of the first and 150 mcg of the second substance. This dose is quite enough to prevent the female body from being ready for fertilization.

To achieve the desired effect, you need to use this product correctly. The Evra patch is externally a square-shaped plate with a smooth surface and rounded ends. On one side there is an adhesive area containing important medicinal components that prevent pregnancy.

The instructions for use will indicate the correct sequence of actions when using the patch. It includes the following rules:

1. You should prepare the area before applying the patch. It is recommended to thoroughly wash and dry the skin; the patch can be applied in several places: the stomach, buttocks, shoulder blades and shoulder area.
2. You need to carefully open the package and immediately stick it on any part of the body so that the properties of the drug do not decrease.
3. The duration of wearing the Evra adhesive plaster is 7 days, after which it should be replaced. And so repeat the course for 3 weeks, and then menstruation should begin, at this time the patch is not used.
4. You should start using it on the first day of your period; this date must be remembered, because it will be the day you change the patch.
5. Before use, you should consult your doctor, as Evra contraceptives contain certain contraindications and have side effects.
6. You need to peel off the patch carefully so as not to damage the skin; if necessary, you can moisten it with water.
7. This sticker is completely safe and provides high protection against unwanted pregnancy. Application is quite simple and easy and does not require specific knowledge.
8. It is possible to cancel the use of such a contraceptive drug if any side effects occur on your own. But basically, a gynecologist should prescribe and cancel it, based on the individual characteristics of the female body.

Contraindications for the contraceptive drug Evra

The contraceptive hormonal patch Evra evra is characterized by a certain effect on organs and has a mechanism of action on the female genital organs, preventing fertilization. But not all women can use such a patch, because it has a number of contraindications:

1. Diseases of the circulatory system (thrombosis, heart attack, angina pectoris, coronary disease, etc.).
2. Having severe migraine.
3. Oncological pathologies.
4. The age category is from 18 and often up to 35 years.
5. Lactation period – this product cannot be used while breastfeeding, because various substances in the patch can enter the baby’s body with milk. Therefore, when feeding, you should avoid using it.
6. Liver pathologies.
7. It is not recommended to use after childbirth; at least 4 weeks must pass.
8. The presence of allergic reactions to any components of the drug.
9. Diabetes.

The Evra adhesive plaster should be used very carefully; it should not be applied to areas of the mammary glands, and special care must be taken by women with varicose veins, certain syndromes, Crohn's disease and other serious pathologies.

Side effects of Evra patch

Nuvaring and the Evra patch have some side effects, so you should use this contraceptive drug with extreme caution. They are expressed:

1. Headache, dizziness, there may be cramps of the body and arms, disruption of nervous activity, which is expressed in stress, depression, excessive anxiety and fear.
2. It is possible to increase blood pressure, increase heart rate, and develop varicose veins.
3. The digestive system may suffer, nausea and vomiting, diarrhea, constipation, hemorrhoids, excessively increased appetite or anorexia may appear.
4. If respiratory activity is impaired, shortness of breath, bronchial asthma or infectious diseases of the respiratory tract may develop.
5. There may also be disruptions in the reproductive system, this is expressed in impaired functioning of the ovaries, a woman’s breasts grow, the menstrual cycle may be disrupted, and pain during sexual intercourse.
6. Various infectious formations of the genitourinary system.
7. There may be a rash, itching, redness, skin rash, acne, increased sweating or severe dry skin.
8. A woman may gain weight because birth control is a hormonal drug. There may also be frequent fatigue, malaise, and loss of strength.

Advantages of the drug Evra

This product has the following positive qualities:

1. Simple and easy to use, you can stick it on yourself.
2. Provides maximum protection against unwanted pregnancy, the reliability of the patch is 99.4%. Therefore, even if you are off schedule, the drug will work for 1-2 days, then you need to apply a new one.
3. The hormonal agent Evra can be applied to several areas, so any girl or woman can choose the right one for herself.
4. This product has a good layer for fixation, so it may come off in rare cases.
5. Using the Evra patch will help reduce pain during menstruation and improve hormonal levels.
6. It comes off easily without causing any inconvenience. If necessary, you can peel it off with water.
7. The mammary glands may become slightly enlarged.
8. Prevents the development of premenstrual syndrome.
9. Does not interfere with everyday life, physical activity, visiting bathhouses, swimming pools.
10. One patch contains the required amount of the drug, so there is no need to set the dosage.
11. The description and use of the product is written on the packaging.
12. It only needs to be used 3 times a month; during menstruation, the body does not need a patch.
13. It is not an obstacle to the use of additional medications, so antibiotics and other drugs can be used without fear.

Disadvantages of the hormonal drug Evra

In addition to the positive qualities of the patch, there are also negative ones. They are expressed as follows:

1. Since the product is hormonal, disturbances in the menstrual cycle, synthesis of female hormones, changes in the structure of mucus, etc. are possible.
2. The effect of the drug extends to the entire body, so if there are contraindications, all systems suffer.
3. If you weigh more than 90 kg, the effectiveness of the patch decreases and the likelihood of pregnancy increases.
4. The cost of the Euro patch is quite high, so this product is not available to every person.
5. Often peels off under the influence of external factors, one of which is water. And the peeled off product does not have the desired effect on the body, so the result becomes poor.
6. If you have an allergic disease, acute manifestations of symptoms are possible: rash, itching, etc.
7. For effectiveness, you should remember the first day of use and use the product no earlier and no later than this date.

Important! Before use, you should consult your doctor to know the possibility of use and side effects!

Contraceptive drug Qlaira

The hormonal drug Qlaira is an analogue of the Evra patch, only it is a tablet for internal use. Intended for contraception to avoid unwanted pregnancy.

This drug is used without interruption, so when menstruation begins, it does not play a special role. But if used for the first time, then it should be used at the beginning of the menstrual cycle. For greater effectiveness, you should constantly take the pills, because if you miss 1 medicine, fertilization may occur.

Just like Eura, it affects the function of the ovaries and causes mucus viscosity, which prevents the penetration of sperm. Their use helps normalize hormonal levels and reduce pain during menstruation. You can purchase contraceptives at any pharmaceutical establishment; compared to the patch, they are less expensive.

Cost and reviews of the hormonal drug euro

EVA patches can be purchased in pharmacies in any city and are freely available. Its price is quite high, and ranges around 500 rubles or more. For one month you need to use 3 patches, so this method of contraception is quite expensive, but reliable. You can also buy contraceptives online, but there is a high risk of fraud and counterfeiting. Therefore, a pharmacy product is still better.

The hormonal drug has many reviews, which are both positive and negative. Some women wonder: what is better, a patch or hormonal medications. There is no definite answer; the use of such a tool is everyone’s business. Therefore, for greater effectiveness and high protection, you should visit a doctor to recommend good contraceptive drugs according to the individual characteristics of the body.

Based on reviews from females, we can conclude that the Evra patch has good results, does not cause discomfort or other inconveniences, and is simple and easy to use.

One of the tasks of modern medicine is to prevent unwanted pregnancy, so that it is convenient and with minimal negative consequences for the woman’s body.

We can choose from a huge variety of barrier, intrauterine and hormonal contraceptives.

One of the most convenient is birth control pills. But women often complain that they forget to take them. An excellent alternative to pills is the contraceptive patch.

What is a contraceptive patch?

This is one of the most modern contraceptives. It looks like a rectangular piece of adhesive plaster measuring approximately 20 square meters. cm (5x4 cm). It is quite thin and smooth, so it is not very noticeable on the skin. Glue it on the shoulder blade, shoulder, stomach or buttocks. The patch must be changed every week.

The manufacturers of this contraceptive claim that its effectiveness is about 99.4%. The degree of reliability of the contraceptive patch is close to that of condoms, and it is much more convenient to use.

The patch contains the hormones ethinyl estradiol and norelgestromin. After gluing the plate, they begin to be absorbed through the skin into the bloodstream. Therefore, the effect of this drug is absolutely similar to tablets, only the method of delivering the active substance into the blood is different. Hormones penetrate transdermally gradually, so their level in the blood is always stable.

The substances released by the patch inhibit the gonadotropic function of the pituitary gland. This leads to suppression of follicular growth, eggs do not mature and ovulation does not occur. At the same time, the drug causes an increase in the viscosity of cervical mucus. Also, under its influence, the susceptibility of the uterine endometrium to blastocytes decreases. Thus, three levels of protection against untimely pregnancy are guaranteed.

Remember, the contraceptive patch does not protect against STDs, so in case of doubtful contacts, condoms should be used.

After fixing the plate, hormonal substances immediately begin to be released into the blood. But the required concentration of these substances is achieved only after two days. Then it does not change throughout the entire time the patch is worn. The amount of hormones in the blood does not depend on the place where the patch is attached.

Also, the rate of release of the active substance is not affected by temperature changes, physical activity of a woman and the influence of water. The incidence of pregnancy when using the product does not depend on the age and race of women using it. But it should be borne in mind that if you weigh more than 90 kg, the active substance may be small and in this case the likelihood of fertilization increases.

Three patches are sold in a package. The first one must be fixed at the very beginning of the menstrual cycle. Now the plates will have to be changed every time on this day after a week or two. If the plate was fixed at another time, condoms must be used for the first week.

You are allowed to wear one piece of contraceptive patch at a time.

When it's time for replacement, the old record must be removed and replaced with a new one. This can be done at any convenient time. After three weeks of use, take a break for 7 days. After this period, it is necessary to stick a new plate, even if the bleeding did not come at all during this cycle or it did not have time to end at that moment. You cannot take breaks between applications for more than 7 days - this increases the risk of pregnancy.

Use after abortion or miscarriage

If an abortion (spontaneous or performed in a medical facility) occurred before the 20th week of gestation, the patch can be applied immediately. There is no need to use any other methods of protection. After an abortion that occurs in the 20th week or later, the use of a contraceptive patch is allowed on the 21st-22nd day or on the first day of menstruation.

After childbirth

The use of a hormonal patch is prohibited during. Therefore, after childbirth it can be used if the patient is not breastfeeding.

In this case, the first plate must be glued 4 weeks after delivery. Doing this earlier is prohibited, and if you start using the patch later, you will have to use parallel barrier contraception for the entire first week. If there is a possibility of pregnancy, it is better to wait for the onset of menstruation.

What to do if the patch accidentally comes off?

Even a slight partial peeling of the plate leads to a decrease in the amount of hormones entering the blood. If this happened less than 24 hours ago, it must be glued back. If it doesn’t work, change it to a new one. In this case, auxiliary contraceptives will not be required, and replacement should be carried out on a regular day.

If the patch fell off more than a day ago or the woman is not sure when this happened, there is a possibility of fertilization. Therefore, it is necessary to start a new circle by sticking a new plate, and take this day as the first of the next cycle. For 7 days after this, it is advisable to use barrier protection.

You cannot try to attach a patch that has already lost its adhesive properties and is constantly falling off. It is strictly forbidden to use various adhesive tapes or compressive bandages for this purpose.

What to do if you missed the replacement day?

A new plate must be glued as soon as the woman realizes her forgetfulness. The next steps depend on how much time has passed since the missed “replacement day” and the period of the cycle:

• 24-48 hours. There is no need for additional contraception; the next plate is attached on the usual day.
• 2 days or more. You need to start a new cycle with mandatory non-hormonal contraception for 7 days.
• If you haven't removed the last plate in the cycle. Remove immediately upon detection and start a new cycle.

Can I use the patch without interruption?

Many women are concerned about the question: is it possible not to take 7-day breaks every month and live peacefully without menstruation? Theoretically, this is possible, but doctors still do not recommend such long-term use of hormonal drugs. Firstly, this increases the risk of developing side effects, and secondly, with continuous use of drugs, women begin to experience irregular intermenstrual discharge and spotting.

If you decide to change the “replacement day” or simply postpone your period for a cycle, you can simply attach a new plate on the 22nd day, and take a break after 6 weeks, not after 3. Then it is advisable to resume normal use of the patch again - 3 weeks later .

It is important to stick the hormonal plate on healthy, thoroughly cleansed and dry skin with a minimum of hairs. Manufacturers recommend the areas of the upper shoulder and torso, lower abdomen and upper buttocks. It is necessary to choose an area where the patch will not be torn off by tight clothing.

When gluing the next plate, you must choose a different place to avoid irritation. It is not prohibited to do this on the same part of the body.

Do not apply any cosmetics to the place where the plate is glued. This reduces its adhesiveness. The patch must be inspected daily and regularly to make sure everything is fine with it.

The main advantages of using the contraceptive patch

Women using this method of contraception noted many of its advantages. The main ones:

• Change the plate once a week. There is no need to take pills every day, which reduces the risk of forgetting to take a contraceptive.
• Ease of use. You can apply the patch yourself and do not need the help of a doctor. Therefore, consultation with a gynecologist is required only at the stage of selecting a product.
• The performance of the patch does not depend on the health of the gastrointestinal tract. For example, if a woman is vomiting, this will not affect the effectiveness of contraception, since the drug is absorbed through the skin and not through the gastric mucosa.
• Under the influence of the patch, a woman’s hormonal levels stabilize, and PMS symptoms, such as irritability and nervousness, disappear.
• Many women note that menstruation becomes more scanty and painless.
• According to some data, wearing a contraceptive patch reduces the risk of developing cancer of the reproductive organs and large intestine.

When used correctly, the contraceptive patch provides highly effective protection against unwanted pregnancy. However, it does not require any daily actions, such as taking pills or special preparation, as is the case with barrier and chemical methods.

The couple can focus on their feelings, and not on the instructions for the contraceptive. It is important that the patch does not dull the senses like a condom.

Disadvantages of this contraceptive patch

Although the hormonal patch is one of the most convenient and effective contraceptives, it also has disadvantages. Women who use it often complain about the following disadvantages:

• The patch may be noticeable on the body. This problem is especially important in the summer, when they wear light clothes made of thin transparent fabrics.
• Under the surface of the plate, the skin may itch and irritation is common.
• Like most hormonal medications, the patch has an impressive list of side effects. At the same time, the most common of them - headache, nervousness, soreness of the mammary glands are considered safe and usually go away after a couple of months. But there are also more serious side effects.
• Sometimes, with the use of such plates, non-cyclic bleeding often appears.

Side effects of the contraceptive patch

Even the most modern contraceptive patch is a serious hormonal medicine. It may cause side effects. The most dangerous of them is thrombosis. The likelihood of developing such a pathology is especially high in women who wear the plates for the first year, who are overweight, as well as in girls who smoke. An inactive lifestyle also increases the risk of blood clots.

There is an opinion that hormonal contraceptives increase the risk of developing breast cancer. These assumptions are not groundless, but have not been officially confirmed.

Like any medicine, hormones from a transdermal contraceptive are excreted by the liver, so they can negatively affect its condition. In addition, drugs from the plate can affect almost all organs of the body. Therefore, it is imperative to pay attention to any changes in well-being. But the widespread belief that hormonal drugs lead to excess weight gain has not been experimentally proven. Although using the patch may affect your appetite, if you eat right you should be fine.

Before you start using such a contraceptive, it is important to make sure that it is approved for you. Like any medicine, the patch has a number of contraindications. These include deep thrombosis, arterial hypertension, hereditary dyslipoproteinemia and many others. This product should not be used by people under the age of 18. And its effectiveness and safety have not been tested on patients over 45.

Dangerous symptoms when using the contraceptive patch

There are situations when contacting a doctor when using hormonal drugs should be immediate. Main dangerous symptoms:

• Sudden pain in the limbs;
• Chest pain that gets worse when you inhale;
• Numbness of the limbs, decreased sensitivity and deceptive sensations;
• Hemoptysis;
• Strong headache;
• Severe visual impairment;
• Causeless jaundice.

Such problems occur, fortunately, rarely, but vigilance does not hurt. If you take good care of your body and follow the instructions for the contraceptive patch, the likelihood of side effects will decrease, and birth control will be easy and safe.

Description:

A modern combined hormonal contraceptive (patch) for transdermal use.

Manufacturer:
Janssen-Cilag (Belgium).

Composition and release form

Transdermal therapeutic system (TTS) is square in shape, with a beige matte backing, rounded corners, a colorless adhesive layer and a transparent protective film; the inscription "EVRA" is embossed on the backing.

Active ingredient: 1 TTS contains norelgestromin 6 mg, ethinyl estradiol 600 mcg (releases norelgestromin 203 mcg, ethinyl estradiol 33.9 mcg within 24 hours).

Excipients:
Composition of the TTC base: an outer layer of pigmented low-density polyethylene and an inner layer of polyester. Composition of the TTC middle layer: adhesive mixture of polyisobutylene-polybutene, crospovidone, polyester non-woven material, lauryl lactate. Composition of the removable protective layer of TTS: polyethylene terephthalate film, polydimethylsiloxane coating.

pharmachologic effect

Contraceptive agent for transdermal use. Inhibits the gonadotropic function of the pituitary gland, suppresses the development of the follicle and interferes with the ovulation process. The contraceptive effect is enhanced by increasing the viscosity of cervical mucus and reducing the susceptibility of the endometrium to the blastocyte. Pearl index – 0.90.

The pregnancy rate does not depend on factors such as age, race and increases in women weighing more than 90 kg.

Pharmacokinetics

After application of the Evra patch, norelgestromin and ethinyl estradiol quickly appear in the serum, reaching a plateau after approximately 48 hours, and remain in equilibrium concentrations throughout the period of wearing the patch. This eliminates the daily rise and fall in serum hormone levels that occurs with oral contraceptives. The study examined the pharmacokinetics of norelgestromin and ethinyl estradiol in 37 women when the Evra patch was applied to the skin of the abdomen, buttocks, arms or back for 7 days. In all three studies, serum concentrations of norelgestromin and ethinyl estradiol remained within the target range throughout the entire period of wearing the Evra patch, regardless of application site. Absorption of norelgestromin when applied to all sites - buttocks, arm and torso - was therapeutically equivalent.

Evra allows for continuous delivery of norelgestromin and ethinyl estradiol into the systemic circulation and inhibits follicular development for an additional two full days after completion of the recommended 7-day period of wearing the patch. Even after a 2-day delay in patch replacement, serum concentrations of the two hormones remained within the target range. Because norelgestromin and ethinyl estradiol continue to provide contraceptive effect during this 2-day period, additional contraception is not necessary if up to 2 days are missed. During each of Evra's three 7-day attachment periods, 30 women wore the patch on their abdomen in one of six different conditions: normal activity, sauna, hydromassage, treadmill, cool water immersion, or a combination of these. During the study, under the influence of elevated temperature, humidity, cold and/or exercise in a fitness club, only one (1.1%) of 87 patches completely came off on its own. The values ​​of the maximum serum concentrations of norelgestromin and ethinyl estradiol indicate that in none of these conditions there was a sudden release of excess amounts of hormones.

Indications for use

Contraception (prevention of unwanted pregnancy) in women.

Mode of application

The patient should be informed that in order to achieve maximum contraceptive effect, it is necessary to strictly follow the instructions for use of TTC Evra. Only one TTS can be used at a time.

Each used TTC is removed and immediately replaced with a new one on the same day of the week (“replacement day”) on days 8 and 15 of the menstrual cycle (weeks 2 and 3). TTS can be changed at any time on the day of replacement. During the 4th week, from the 22nd to 28th day of the cycle, TTC is not used. A new contraceptive cycle begins the day after the end of the 4th week; the next TTS should be stuck on, even if there was no menstruation or it has not ended.

Under no circumstances should a break in the application of TTC Evra be longer than 7 days, otherwise the risk of pregnancy increases. In such situations, it is necessary to simultaneously use a barrier method of contraception for 7 days, because the risk of ovulation increases with each day the recommended duration of the period free from TTC use is exceeded. In case of sexual intercourse during such an extended period, the probability of conception is very high.

Start of application of TTS Evra

If the woman did not use hormonal contraception during the previous menstrual cycle
Contraception with TTC Evra begins on the first day of menstruation. One TTC Evra is glued to the skin and used for the whole week (7 days). The day of gluing the first TTS Evra (1st day/start day) determines the subsequent days of replacement. The replacement day will fall on the same day of each week (8th and 15th days of the cycle). On the 22nd day of the cycle, TTC is removed, and from the 22nd to 28th day of the cycle the woman does not use TTC Evra. The next day is considered the first day of the new contraceptive cycle. If a woman does not start using TTC Evra from the first day of the cycle, then she should simultaneously use barrier methods of contraception during the first 7 days of the first contraceptive cycle.
If a woman switches from using a combined oral contraceptive to using TTC Evra
TTC Evra should be applied to the skin on the 1st day of menstruation, which began after stopping the combined oral contraceptive. If menstruation does not begin within 5 days after taking the contraceptive pill, then pregnancy must be ruled out before starting to use TTC Evra.

If the use of Evra begins after the 1st day of menstruation, then for 7 days it is necessary to simultaneously use barrier methods of contraception. If more than 7 days have passed since the last contraceptive pill, a woman may be ovulating and should therefore consult a doctor before starting to use TTC Evra. Sexual intercourse during this extended period without taking contraceptive pills can lead to pregnancy.
If a woman switches from using progestogen-only medications to using TTC Evra
A woman can switch from using a drug containing only a progestogen at any day (on the day the implant is removed, on the day the next injection is due), but during the first 7 days of using TTC Evra, a barrier method should be used to enhance the contraceptive effect.

After an abortion or miscarriage

After an abortion or miscarriage before the 20th week of pregnancy, you can immediately begin using TTC Evra. If a woman begins to use TTC Evra immediately after an abortion or miscarriage, then no additional methods of contraception are required. A woman should know that ovulation can occur within 10 days after an abortion or miscarriage. After an abortion or miscarriage in the 20th week of pregnancy or later, the use of TTC Evra can be started on the 21st day after the abortion or miscarriage, or on the 1st day of the first menstrual period.
After childbirth
Women who are not breastfeeding should start using TTC Evra no earlier than 4 weeks after birth. If a woman starts using TTC Evra later, then during the first 7 days she must additionally use a barrier method of contraception. If sexual intercourse has taken place, pregnancy must be excluded before starting the use of TTC Evra, or the woman must wait until her first menstruation.

In case of complete or partial peeling off of TTS Evra

If TTS Evra has completely or partially peeled off, then an insufficient amount of its active ingredients enters the blood. Even if the TTS Evra is partially peeled off in less than a day (up to 24 hours): the TTS Evra should be re-glued in the same place or immediately replaced with a new TTS Evra. Additional contraception is not required. The next TTS Evra must be glued on the usual “replacement day”.

If partial peeling occurs for more than 24 hours (24 hours or longer), and if the woman does not know exactly when the TTC Evra partially or completely peeled off, pregnancy may occur. The woman should immediately start a new cycle by gluing a new Evra TTC and consider this day the first day of the contraceptive cycle. Barrier methods of contraception should be used simultaneously only in the first 7 days of a new cycle.

You should not try to re-glue TTS Evra if it has lost its adhesive properties; instead, you need to immediately glue the new TTS Evra. Do not use additional adhesive tapes or bandages to hold the Evra TTS in place.

If the next days of replacing TTS Evra are missed

At the beginning of any contraceptive cycle (1st week/1st day)

If there is an increased risk of pregnancy, a woman should glue the first TTC Evra of the new cycle as soon as she remembers it. This day is considered the new "1st day" and a new "replacement day" is counted. Non-hormonal contraception should be used simultaneously during the first 7 days of a new cycle. In case of sexual intercourse during such an extended period without the use of TTC Evra, conception may occur.

In the middle of the cycle (2nd week/8th day or 3rd week/15th day):
if 1 or 2 days have passed since the date of replacement (up to 48 hours): the woman should immediately glue a new TTS. The next TTS must be glued on the usual “replacement day”. If during the 7 days preceding the first missed day of TTC attachment, the use of TTC was correct, then additional contraception is not required;

if more than 2 days (48 hours or more) have passed since the date of replacement: there is an increased risk of pregnancy. The woman should stop the current contraceptive cycle and immediately begin a new 4-week cycle with a new Evra TTC. This day is considered the new "1st day" and a new "replacement day" is counted. Barrier contraception should be used simultaneously during the first 7 days of a new cycle;

at the end of the cycle (4th week/22nd day): if the TTC is not removed at the beginning of the 4th week (22nd day), then it should be removed as quickly as possible. The next contraceptive cycle should begin on the usual “replacement day,” which is the day after the 28th day. Additional contraception is not required.

Changing the replacement day

In order to postpone menstruation by one cycle, a woman must apply a new TTC Evra at the beginning of the 4th week (22nd day), thereby skipping the period free from the use of TTS Evra. Intermenstrual bleeding or spotting may occur. After 6 consecutive weeks of TTC use, there should be a 7-day TTC-free interval. After this interval ends, regular use of the drug is resumed.

If, on the designated day during the week free from use, a woman wants to change the day of replacement, she must complete the current cycle by removing the third TTC Evra; a woman can choose a new day of replacement by gluing the first TTC Evra of the next cycle on the selected day. The period free from the use of TTS Evra should in no case be more than 7 days. The shorter this period, the higher the likelihood that a woman will not have another menstruation, and during the next contraceptive cycle, intermenstrual bleeding or spotting may occur.

How to properly stick TTS Evra

TTC Evra should be applied to clean, dry, intact and healthy skin of the buttocks, abdomen, outer upper arm or upper torso with minimal hair growth, in areas where it will not come into contact with tight-fitting clothing.

To avoid possible irritation, each subsequent TTC Evra must be glued to a different area of ​​the skin; this can be done within the same anatomical area.

TTC Evra must be pressed tightly so that its edges are in good contact with the skin. To prevent a decrease in the adhesive properties of TTC Evra, you should not apply makeup, creams, lotions, powders and other local products to those areas of the skin where it is or will be glued.

A woman should inspect the Evra TTC daily to ensure that it is firmly attached.

Used TTS must be disposed of carefully according to instructions.

Side effect

When using TTC Evra, the following side effects may occur:

From the central nervous system and peripheral nervous system: dizziness, migraine, paresthesia, hypoesthesia, convulsions, tremor, emotional lability, depression, anxiety, insomnia, drowsiness.

From the cardiovascular system: increased blood pressure, palpitations, edema syndrome, varicose veins.

From the digestive system: gingivitis, anorexia or increased appetite, gastritis, gastroenteritis, dyspepsia, abdominal pain, vomiting, diarrhea, flatulence, constipation, hemorrhoids.

From the respiratory system: upper respiratory tract infections, shortness of breath, bronchial asthma.

From the reproductive system: pain during sexual intercourse (dyspareunia), vaginitis, dysmenorrhea, decreased libido, enlarged mammary glands, menstrual irregularities (including intermenstrual bleeding, hypermenorrhea), changes in vaginal secretion, changes in cervical mucus, lactation not occurring in connection with childbirth , ovarian dysfunction, mastitis, breast fibroadenomas, ovarian cysts.

From the urinary system: urinary tract infections.

From the musculoskeletal system: muscle cramps, myalgia, arthralgia, ostalgia (including back pain, pain in the lower extremities), tendinosis (tendon changes), muscle weakness.

Dermatological reactions: itching, urticaria, skin rash, contact dermatitis, bullous rash, acne, skin discoloration, eczema, increased sweating, alopecia, photosensitivity, dry skin.

From the organs of vision: conjunctivitis, visual impairment.

From the side of metabolism: weight gain, hypertriglyceridemia, hypercholesterolemia.
Other flu-like syndrome, feeling of fatigue, allergic reactions, chest pain, asthenic syndrome, fainting, anemia, abscesses, lymphadenopathy.

Rarely (with frequency from >0.01% to<0.1%) гипертонус или гипотонус мышц, нарушение координации движений, дисфония, гемиплегия, невралгия, ступор, повышение либидо, деперсонализация, апатия, паранойя, доброкачественные опухоли молочных желез, рак шейки матки in situ, боль в промежности, изъязвление гениталий, атрофия молочных желез, cнижение АД, энантема, сухость во рту или усиленное слюноотделение, колит, боль при мочеиспускании, гиперпролактинемия, меланоз, нарушения пигментации кожи, хлоазма, ксерофтальмия, снижение массы тела или ожирение, воспаление подкожной клетчатки, непереносимость алкоголя, холецистит, холелитиаз, нарушение функции печени, пурпура, "приливы" крови к лицу, тромбоз (в т.ч. тромбоз глубоких вен, тромбоз легочной артерии), тромбофлебит поверхностных вен, боль в венах, эмболия легочной артерии.

Contraindications for use

Venous thrombosis, incl. history (including deep vein thrombosis, pulmonary embolism);
- Arterial thrombosis, incl. history (including acute cerebrovascular accident, myocardial infarction, retinal artery thrombosis) or precursors of thrombosis (including angina pectoris or transient ischemic attack);
- The presence of serious or multiple risk factors for arterial thrombosis: severe arterial hypertension (more than 160/100 mmHg), diabetes mellitus with vascular damage;
- Hereditary dyslipoproteinemia;
- Hereditary predisposition to venous or arterial thrombosis (for example, activated protein C resistance, antithrombin III deficiency, protein C deficiency, protein S deficiency, hyperhomocysteinemia and antiphospholipid antibodies - antibodies against cardiolipin, lupus anticoagulant);
- Migraine with aura;
- Confirmed or suspected breast cancer;
- Endometrial cancer and confirmed or suspected estrogen-dependent tumors;
- Aadenoma and liver carcinoma;
- Genital bleeding;
- Postmenopausal period;
- Age up to 18 years;
- Postpartum period (4 weeks);
- Lactation period;
- Hypersensitivity to the components of the drug.

Do not use on the mammary glands, as well as on hyperemic, irritated or damaged areas of the skin.

Caution should be used when there is a family history of venous or arterial thromboembolism in brothers, sisters or parents at a relatively young age; with prolonged immobilization; obesity (body mass index more than 30 kg/m2, calculated as the ratio of body weight in kilograms to the square of height in meters); thrombophlebitis of superficial veins and varicose veins; dyslipoproteinemia; arterial hypertension; lesions of the heart valve apparatus; atrial fibrillation; diabetes mellitus; systemic lupus erythematosus; hemolytic-uremic syndrome; Crohn's disease; ulcerative colitis; liver dysfunction; hypertriglyceridemia (including family history); acute impairment of liver function during a previous pregnancy or previous use of sex hormones; for menstrual irregularities; renal dysfunction.

Use of the drug Evra during pregnancy and lactation

The drug Evra is contraindicated during pregnancy and lactation.

Use for liver and kidney dysfunctions

Evra should be used with caution in case of liver dysfunction; acute impairment of liver function during a previous pregnancy or previous use of sex hormones.
Use with caution in case of impaired renal function.

Use in children under 12 years of age

The drug Evra is contraindicated in children and adolescents under 18 years of age.

special instructions

There is no clinical evidence that the transdermal contraceptive system is in any way safer than oral contraceptives.

Before starting or resuming the use of TTC Evra, it is necessary to obtain a detailed medical history (including family history) and exclude pregnancy. Blood pressure should be measured and a physical examination should be performed, taking into account contraindications and warnings.

If a hereditary predisposition to venous thromboembolism is suspected (if venous thromboembolism occurred in a brother, sister or parent at a relatively young age), the woman should be referred for consultation with a specialist before deciding on the use of hormonal contraception.

The risk of vascular complications is increased in women with thrombophlebitis of the superficial veins and varicose veins, as well as in obesity (body mass index more than 30 kg/m2).

In case of prolonged immobilization, after major surgery on the lower extremities or severe trauma, it is recommended to stop using hormonal contraceptives (for planned surgery, this should be done 4 weeks before it) and resume hormonal contraception no earlier than 2 weeks later. after complete remobilization.

Some epidemiological studies have found an increased risk of cervical cancer in women who use combined oral contraceptives for a long time.

Women taking combined oral contraceptives may develop liver tumors, which can cause life-threatening intra-abdominal bleeding. If women using TTC Evra experience severe pain in the upper abdomen, liver enlargement or symptoms of intra-abdominal bleeding, differential diagnosis should be carried out to exclude a possible liver tumor.

Women with hypertriglyceridemia or a family history of this disease may have an increased risk of pancreatitis when using combined hormonal contraceptives.

If pharmacologically uncontrolled arterial hypertension occurs in women while using combined hormonal contraceptives, the drug should be discontinued. The use of TTC Evra can be resumed after normalization of blood pressure.

The following conditions have been reported to occur or be aggravated by oral use of combined hormonal contraceptives, but there is no convincing evidence that they are associated with the use of combined oral contraceptives. These include: jaundice and/or pruritus associated with cholestasis; cholelithiasis; porphyria; systemic erythematosis; hemolytic-uremic syndrome; Sydenham's chorea; gestational herpes, otosclerosis-related hearing loss. Hormonal contraceptives may affect some endocrine parameters, liver function markers, and blood components:
concentrations of prothrombin and coagulation factors VII, VIII, IX and X increase; the level of antithrombin III decreases; protein S levels decrease; norepinephrine-induced platelet aggregation increases;

the concentration of thyroxine-binding globulin increases, which causes an increase in the concentration of total thyroid hormone, which is measured by the content of protein-bound iodine, T4 content (determined using chromatography or radioimmunoassay); The binding of free T3 by the ion exchange resin decreases, as evidenced by an increase in the concentration of thyroxine-binding globulin, the concentration of free T4 does not change. Serum concentrations of other binding proteins may be increased;

The concentrations of sex hormone-binding globulins increase, which leads to an increase in the concentrations of total circulating endogenous sex hormones. At the same time, the concentrations of free or biologically active sex steroids decrease or remain unchanged.

In women using TTC Evra, the concentrations of HDL-C, total cholesterol, LDL-C and TG may slightly increase, while the LDL-C/HDL-C ratio may remain unchanged.

Hormonal contraceptives may cause a decrease in serum folate concentrations. This may have potentially clinically significant consequences if a woman becomes pregnant soon after stopping hormonal contraception. It is currently recommended that all women take folic acid during and after stopping hormonal contraception.

Combined hormonal contraceptives may affect peripheral insulin resistance and glucose tolerance, but there is no evidence that changes in diabetes mellitus therapy are necessary while using combined hormonal contraceptives. At the same time, the condition of patients suffering from diabetes mellitus should be carefully monitored, especially at the early stage of using TTC Evra.

Exacerbation of endogenous depression, epilepsy, Crohn's disease and ulcerative colitis has been reported in women taking combined oral contraceptives.

Women who have experienced facial hyperpigmentation during pregnancy should avoid exposure to sunlight or artificial ultraviolet light while wearing the Evra TTC. Often this hyperpigmentation is not completely reversible.

Women should be informed that hormonal contraceptives do not protect against HIV infection (AIDS) and other sexually transmitted diseases.

Women taking microsomal enzyme-inducing drugs (hydantoins, barbiturates, primidone, carbamazepine, rifampicin, oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin, modafinil and phenylbutazone) and antibiotics (except tetracyclines) should temporarily use a barrier method of contraception in addition to TTS Evra or choose another method of contraception. The barrier method must be used during the course of treatment with the above drugs, as well as within 28 days after discontinuation of microsomal enzyme inducers and within 7 days after stopping antibiotics. If the period of taking concomitant medications exceeds the 3-week cycle of using TTC Evra, then a new contraceptive cycle must be started immediately after the end of the previous one, i.e. without the usual period free from TTC use. Women receiving long-term therapy with drugs that induce liver enzymes should choose another method of contraception.

When prescribing drugs that are metabolized by isoenzymes CYP3A4, CYP2C19, especially those with a narrow therapeutic index (for example, cyclosporine), during the use of TTC Evra, the possibility of a clinically significant interaction should be excluded.

When using any combined hormonal contraceptives, the menstrual cycle may be disrupted (spotting or intermenstrual bleeding), especially in the first months of using these drugs. The duration of the adaptation period is about three cycles.

If, while using TTC Evra in accordance with the recommendations, persistence of intermenstrual bleeding is observed or such bleeding occurs after previous regular cycles, then reasons other than the use of TTC should be taken into account. One should keep in mind the possibility of non-hormonal causes of menstrual irregularities and, if necessary, conduct an adequate diagnostic examination to exclude organic disease or pregnancy.

In some women, menstruation may not occur during the period free from the use of TTC Evra. If a woman did not follow the instructions for use in the period preceding the first missed menstruation, or if she did not have two menstruation after breaks from using TTC, then pregnancy must be excluded before continuing to use TTC Evra.

In some women, discontinuation of hormonal contraceptives may provoke the occurrence of amenorrhea or oligomenorrhea, especially if they were present before starting hormonal contraception.

If the application of TTC Evra causes skin irritation, then you can glue a new TTC to another area of ​​the skin and wear it until the next day of replacement.

In women weighing 90 kg or more, contraceptive effectiveness may be reduced.

If symptoms of liver dysfunction occur, the use of combined hormonal contraceptives should be discontinued until liver function markers normalize.

In case of recurrence of cholestasis-related itching that occurred during a previous pregnancy or previous use of sex hormones, combined hormonal contraceptives should be discontinued.

The safety and effectiveness of TTC Evra are established only for women from 18 to 45 years of age.

Immediately after removing the TTS from the bag, it should be firmly glued to the skin. After TTS is removed, it still contains significant amounts of active ingredients. Residual hormones can be harmful to the environment if released into water, and therefore used TTCs should be disposed of carefully. To do this, separate a special sticky film from the outside of the bag. Place the used TTC in the bag so that its sticky side faces the colored area on the bag, and press lightly to seal. The sealed bag is thrown away. Used TTS should not be thrown into the toilet or sewer.

Overdose

Symptoms: nausea, vomiting, vaginal bleeding.
Treatment: there is no specific antidote. The TTS should be removed and symptomatic therapy performed.

Drug interactions

Hydantoins, barbiturates, primidone, carbamazepine and rifampicin, as well as oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin, modafinil and phenylbutazone, can cause an acceleration of the metabolism of sex hormones, which can cause intermenstrual bleeding or the ineffectiveness of hormonal contraception, i.e. the onset of unwanted pregnancy. The mechanism of interaction between these drugs and the active ingredients of TTS Evra is based on the ability of the above drugs to induce liver enzymes, with the participation of which sex hormones are metabolized. Maximum enzyme induction is usually achieved no earlier than 2-3 weeks, and may persist for at least 4 weeks after discontinuation of the corresponding drug.

Taking herbal preparations containing St. John's wort (Hypericum perforatum) simultaneously with the use of TTC Evra may lead to loss of contraceptive effect. Women who take such herbal remedies may experience intermenstrual bleeding and an unwanted pregnancy. This is due to the fact that St. John's wort induces enzymes that metabolize sex hormones. The inducing effect can last for 2 weeks. after discontinuation of a herbal preparation containing St. John's wort.

Antibiotics (including ampicillin and tetracyclines) can cause loss of contraceptive effect. A pharmacokinetic interaction study showed that oral administration of tetracycline hydrochloride 3 days before and for 7 days during use of TTC Evra does not have a significant effect on the pharmacokinetics of norelgestromin or ethinyl estradiol.

Storage conditions and periods

The drug should be stored out of the reach of children at a temperature of 15° to 25°C. Store in original packaging, do not store in refrigerator or freezer. Shelf life – 2 years.

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rTY YUBUFYUOPN PFLMEICHBOY ffu NEOEE YUEN CH FEYOOYE UHFPL (DP 24 YU): UMEDHEF ЪBOPChP RTYLMEYFSH ffu ABOUT FP TSE NEUFP YMY UTBH TSE ЪBNEOYFSH ITS OPChPK ffu. dPRPMOYFEMSHOSHE NETSCH LPOFTBGERGYY OE FTEVHAFUS. uMEDHAEHA ffu OEPVIPDYNP RTYLMEYFSH CH PVSHYUOSCHK "DEOSH EBNEOSCH".

rTY YUBUFYUOPN PFLMEICHBOY ffu VPMEE YUEN CH FEYOOYE UHFPL (24 YU Y DPMSHYE), B FBLCE EUMY OEYCHEUFOP, LPZDB ffu YUBUFYUOP YMY RPMOPUFSHA PFLMEYMBUSH, OEPVIPDYNP UTBH TSE OB YUBFSH OPCHSHCHK GYLM, RTYLMEYCH OPCHHA fffu Y UYUYFBFSH LFPF DEOSH RETCHSHN DOEN LPOFTBGERFYCHOPZP GYLMB. vBTSHETOSCH NEFPDSH LPOFTBGERGYY UMEDHEF PDOPCHTENEOOOP RTYNEOSFSH FPMSHLP CH RETCHSHE 7 MILKS OPChPZP GYLMB.

OE UMEDHEF ЪBOPChP RTYLMEYCHBFSH ffu, EUMY POB RPFETSMB UCHPY BDZEYCHOSCHE UCHPKUFCHB, OEPVIPDYNP UTBKH TSE RTYLMEYFSH OPCHHA ffu. oEMSHЪS RTYNEOSFSH DPRPMOYFEMSHOSH MYRLYE MEOFSH YMY RPCHSLY DMS KHDETTSBOYS ffu.

h UMHYUBE RTPRKHULB PYUETEDOPZP DOS ЪБNEOSCH ffu Ch OBYUBME MAVPZP LPOFTBGERFYCHOPZP GYLMB (1-S OEDEMS/1-K DEOSH): RTY RPCCHCHYEOOPN TYULE CHP'OILOPCHEOYS VETENEOOPUFY TSEOOYOB DPMTSOB RTYLMEYFSH RETCHHA ffu OPCHPZP GYLMB UTBH CE, LBL FPMSHLP CHURPNOIF PV LFPN. yFPF DEOSH UYUYFBEFUS OPCHSHCHN "1-N DOEN" Y PFUYUYFSHCHBEFUS OPCHSHCHK "DEOSH UBNEOSCH". oEZPTNPOBMSHOHA LPOFTBGERGYA UMEDHEF PDOPCHTENEOOOP RTYNEOSFSH CH FEYUEOYE RETCHSCHI 7 MILKS OPChPZP GYLMB, F.L. CH UMKHYUBE RPMPCHPZP UOPYEOYS PE CHTENS FBLPZP KHDMYOOOPZP RETYPDB VE YURPMSH'PCHBOYS ffu NPTsEF RTPYPKFY ЪББИБФЕ.

h UMHYUBE RTPRKHULB PYUETEDOPZP DOS ЪБNEOSCH ffu Ch UETEDYOE GYLMB (2-S OEDEMS/8-K DEOSH YMY 3-S OEDEMS/15-K DEOSH): EUMY UP DOS ЪBNEOSH RTPYMY 1-2 UHF (DP 48 YU): TsEOYOB DPMTSOB UTBKH TSE RTYLMEYFSH OPCHHA ffu. uMEDHAEHA ffu OEPVIPDYNP RTYLMEYFSH CH PVSHYUOSCHK "DEOSH EBNEOSCH". eUMY CH FEYUEOYE 7 MILKS, RTEDYUFCHPCHBCHYI RETCHPNH RTPRHEOOOPNH DOA RTYLTERMEOYS ffu, TsEOEYOB RTBCHYMSHOP YURPMSHJPCHBMB ffu, FP DPRPMOYFEMSHOBS LPOFTBGERGYS OE FTEVHEFU S. eUMY UP DOS ЪBNEOSH RTPYMP VPMEE 2 UHF (48 YU Y VPMEE) - UHEEUFCHHEF RPCCHCHYEOOOSCHK TYUL CHPOYLOPCHEOYS VETENEOOPUFY. TSEOYOB DPMTSOB RTELTBFYFSH FELHAKE LPOFTBGERFYCHOSCHK GYLM Y UTBH TSE OBYUBFSH OPCHSHCHK 4-OOEDEMSHOSCHK GYLM, RTYLMEYCH OPCHHA ffu. yFPF DEOSH UYUYFBEFUS OPCHSHCHN "1-N DOEN" Y PFUYUYFSHCHBEFUS OPCHSHCHK "DEOSH UBNEOSCH". vBTSHETOHA LPOFTBGERGYA UMEDHEF PDOPCHTENEOOOP RTYNEOSFSH CH FEYUEOYE 7 RETCHSCHI DOEK OPCHPZP GYLMB. h UMHYUBE RTPRKHULB PYUETEDOPZP DOS ЪБNEOSCH ffu Ch LPOGE GYLMB (4-C OED/22-K DEOSH): EUMY ffu OE HDBMEOB CH OBYUBME 4-K OEDEMY (22-K DEOSH), FP EE OHTSOP HDBMYFSH LBL NPTsOP VSHCHUFTEE . PYUETEDOPK GYLM LPOFTBGERGYY DPMTSEO OBYUBFSHUS CH PVSHYUOSCHK "DEOSH EBNEOSCH", LPFPTSCHK SCHMSEFUS UMEDHAEIN DOEN RPUME 28-ZP DOS. dPRPMOYFEMSHOBS LPOFTBGERGYS OE FTEVHEFUS.

yЪNEOOYE DOS ЪБNEOSCH: VHI FPZP YUFPVSH PFMPTSYFSH NEOUFTKHBGYA ABOUT PDYO GYLM, OEPVIPDYNP RTYLMEYFSH OPCHHA ffu CH OBYUBME 4-K OEDEMY (22-K DEOSH), RTPRKHUFYCH FEN UBNSHCHN RETYPD, UCH PVPDOSHCHK PF YURPMSHЪPCHBOYS ffu. NPZHF CHP'OILOHFSH NETSNEOUFTHBMSHOPE LTPCHPFEYOOYE YMY NBTSKHEYE CHSHCHDEMEOYS. rPUME 6 RPUMEDPCHBFEMSHOSHHI OEDEMSH RTYNEOOYS ffu DPMTSEO VSHFSH 7-DOECHOCHK YOFETCHBM, UCHPVPDOSCHK PF YURPMSHЪPCHBOYS ffu. rPUME PLPOYUBOYS LFPPZP YOFETCHBMB ChPЪPVOPCHMSAF TEZKHMSTOPE RTYNEOOYE RTERBTBFB. PE CHTENS OEDEMY, UCHPVPDOPK PF RTYNEOOYS, CH UMKHYUBE, EUMY TSEOEYOB IPUEF YJNEOYFSH DEOSH EBNEOSCH, POB DPMTSOB OBCHETYFSH FELHAKE GYLM, KHDBMYCH FTEFSHA ffu. nPTsOP ChShchVTBFSh OPChShchK DEOSH EBNEOSCH, RTYLMEYCH RETCHHA ffu UMEDHAEEZP GYLMB CH CHShVTBOOSHCHK DEOSH. RETYPD, UCHPVPDOSCHK PF YURPMSHЪPCHBOYS ffu, OE DPMTSEO VSHFSH VPMSHYE 7 MILKS. Yuen LPTPYUE LFPF RETYPD, FEN CHCHYE CHETPSFOPUFSH PFUHFUFCHYS PYUETEDOPK NEOUFTHBGYY, B PE CHTENS UMEDHAEEZP LPOFTBGERFYCHOPZP GYLMB NPZHF CHP'OILOHFSH NETSNEOUFTHBMSHOPE LTPP FEYOOYE YMY NBTSHEYE CHSHCHDEMEOYS.

dMS DPUFYTSEOYS NBLUYNBMSHOPZP LPOFTBGERFYCHOPZP LZHZHELFB TSEOOYOSCH DPMTSOSCH YURPMSHЪPCHBFSH ffu ch UFTPZPN UPPFCHEFUFCHYY Y KHLBBOYSNY. pDOPCHTEENOOOP NPTsOP YURPMSHЪPCHBFSH FPMSHLP PDOKH ffu.

LBTSDHA YURPMSHЪPCHBOOKHA ffu KhDBMSAF Y UTBH TSE ЪBNEOSAF OPChPK Ch PJO Y FPF TSE DEOSH OEDEMY ("DEOSH ЪBNEOSHCH") ABOUT 8-K Y 15-K DOY NEOUFTHBMSHOPZP GYLMB (2-S Y 3- S OEDEMS). ffu NPTsOP NEOSFSH H MAVPE CHTENS DOS UBNEOSCH. h FEYUEOYE 4-K OED, U 22-ZP RP 28-K DEOSH GYLMB, ffu OE YURPMSHJHAF. OPCCHK LPOFTBGERFYCHOSCHK GYLM OBUYOBEFUS ABOUT UMEDHAEIK DEOSH RPUME PLPOYUBOYS 4-K OED; UMEDHAEHA ffu UMEDHEF OBLMEIFSH, DBCE EUMY NEOUFTHBGYY OE VSHMP YMY POB OE ЪBLPOYUMBUSH.

RETETSHCHCH OPEYOYY FFU OE DPMTSEO RTECHSHCHYBFSH 7 DOEK, CH RTPFYCHOPN UMHYUBE RPCCHCHYBEFUS TYUL OBUFHRMEOYS VETENEOOPUFY. h FBLYI UYFHBGYSI ABOUT RTPFSTSEOYY 7 DOEK OEPVIPDYNP PDOPCHTENEOOOP YURPMSHЪPCHBFSH VBTSHETOSCHK NEFPD LPOFTBGERGYY, F.L. TYUL PCHHMSGYY CHPTBUFBEF U LBTSDSCHN DOEN RTECHSHCHYEOYS TELPNEODKHENPK RTDPDPMTSYFEMSHOPUFY RETYPDB, UCHPVPDOPZP PF RTYNEOOYS ffu. h UMHYUBE RPMPCHPZP UOPYEOYS PE CHTENS FBLPZP KHCHEMYUEOOPZP RETYPDB CHETPSFOPUFSH ЪBYUBFYS CHEUSHNB CHSHUPLB.

ZhBTNBLPMPZYUEULPE DEKUFCHYE

xZOEFBEF ZPOBDPFTPROH ZHOLGYA ZYRPZHYB, RPDBCHMSEF TBCHYFYE ZHPMMYLHMB Y RTERSFUFCHHEF RTPGEUUH PCHHMSGYY. lPOFTBGERFYCHOSCHK YZHZHELF HUYMYCHBEFUS ЪB UYUEF RPCHSHCHYEOYS CHSLPUFY GETCHYLBMSHOPK UMMYYY UOYTSEOYS CHPURTYYNYUYCHPUFY JODPNEFTYS L VMBUFPGYFH. YODELU rETMS - 0.90.

yuBUFPFB OBUFKHRMEOYS VETENEOOPUFY OE ЪBCHYUYF PF FBLYI ZBLFPTPCH LBL CHPTBUF, TBUPCHBS RTYOBDMETSOPUFSH Y KHCHEMYUYCHBEFUS H TsEOEYO U NBUUPK FEMB VPMEE 90 LZ.

rPVPYUOSHE DEKUFCHYS

UP UFPTPOSH GEOFTBMSHOPK Y RETYZHETYYUUEULPK OETCHOPK UYUFENSCH: ZPMPCHPLTHTSEOYE, NYZTEOSH, RBTEUFEYY, ZYREUFEYS, UHDPTPZY, FTENPT, LNPGYPOBMSHOBS MBVYMSHOPUFSH, DER TEUUYS, FTECHPTSOPUFSH, VEUUPOOYGB, UPOMYCHPUFSH.

UP UFPTPOSH RYEECHBTYFEMSHOPK UYUFENSCH: ZYOZYCHYF, BOPTELUYS YMY RPCCHCHYOEYE BRREFYFB, ZBUFTYF, ZBUFTPIOFETYF, DYURERUYS, VPMSH CH TSYCHPFE, TCHPFB, DYBTES, NEFEPTY ЪN, ЪBRPT, ZENPTTPK.

UP UFPTPOSH DSHHIBFEMSHOPS UYUFENSCH: YOZHELGYY CHETIOYI DSHHIBFEMSHOSCHI RHFEC, PDSHYLB, VTPOIBMSHOBS BUFNB.

UP UFPTPPOSH TERTPPDHLFYCHOPK UYUFENSCH: VPMSH RTY RPMPCHPN UOPYEOYY (DYURBTEHOYS), CHBZYOYF, UOTSEOYE MYVYDP , KHCHEMYUEOYE NPMPYUOSHI TSEME, OBTHYEOYS NEOUFTHBMSHOPZP GYLMB (CH F.YU. NETSNEOUFTHBMSHOSCH LTPCHPFEYUEOYS, ZYRETNEOPTES), YЪNEOOYS CHMBZBMYEOOPK UELTEGYY, YЪNEOOYS GETCHILBMSHOPK UMYYY, MBLFBGYS, ChPЪOILBAEBS OE H UCHSY U TPDBNY, OBTHYEOYS ZHKHOLGYY SYUOILPC, NBUFYF, ZHYVTPBDEOPNB NMPPUOSHI TSEMEM, LYUFSH SYUOILPC.

UP UFPTPOSH NPYUECHCHCHPDSEEK UYUFENSCH: YOZHELGYY NPYUECHPZP FTBLFB.

UP UFPTPOSH PRPTOP-DCHYZBFEMSHOPZP BRRBTBFB: NSHCHYEYUOSCHE UHDPTPZY, NYBMZYS, BTFTBMZYS, PUUBMZYS (CH F.Yu. VPMSH CH URYOE, OYTSOYI LPOYUOPUFSI), FEODYOP, NSHCHYYUOBS UMBV PUFFSH.

UP UFPTPOSH LPTSOSCHI RPLTPCHPCH: LPTSOSCHK ЪHD, LTBRYCHOYGB, LPTSOBS USCHRSH (CH F.YU. VKHMMEOBS), LPOFBLFOSHK DETNBFYF, KHZTY, OBTHYEOYE RYZNEOFBGYY LPTSY, LYENB, KHUI MEOOPE RPFPPFDEMEOYE, BMPREGYS, ZhPFPUEOOUYVIMYYBGYS, UHIPUFSH LPTSY.

UP UFPTPOSH PVNEOB CHEEUFCH: HCHEMYUEOYE NBUUSCH FEMB, ZYRETFTYZMYGETYDENYS, ZYRETIPMEUFETYOENYS.

rTPYUYE: ZTYRRPRPDPVOSCHK UYODTPN, YUKHCHUFChP KHUFBMPUFY, BMMETZYUUEULYE TEBLGYY, VPMSH CH ZTHDY, BUFEOYUEULYK UYODTPN, PVNPTPPL, BOENYS, BVUGEUUSCH, MYNZHBDEOPRBFY S.

TEDLP (U YUBUFPFPK 1/10000-1/1000): ZYRET- YMY ZYRPFPOKHU NSHCHYG, OBTHYEOYE LPPTDYOBGYY DCHYTSEOYK, DIUZHPOYS, ZENYRMEZYS, OECHTBMZYS, UFKHRPT, KHUIMEOYE MYYYDP, DERET UPOBMYBGYS, BRBFYS, RBTBOPS, DPVTPLBUEUFCHEOOSCH PRKHIPMY NPMPYUSHI TSEMEM, TBL YEKLY NBFLY in situ , VPMSH CH RTPNETSOPUFY, YYYASYUCHMEOYE UMYYUFPK PVPMPYULY OBTHTSOSHI RPMPCHSCHI PTZBOPC, BFTPZHYS NPMPYUOSHI TSEME, UOTSEOYE BD, LPTSOBS USCHRSH, UHIPUFSH PE TFH YMY KHUIMEOOPE U MAOPPFDEMEOYE, LPMYF, VPMSH RTY NPYUEYURKHULBOYY, ZYRETRTPMBLFYOENYS, NEMBOPYE, OBTHYEOYS RYZNEOFBGYY LPTSY, IMPBNB, LUETPZhFBMSHNYS, UOYTSEOYE NBUUSCH FEMB YMY PTSYTEOYE, CHPURBMEOYE RPDLPTSOPK LMEFYUBFLY, OERETEOPUINPUFSH LFBOPMB, IPMEGYUFYF, IPMEMYFIYB, OBTHYEOYE ZHOLGYY REYUEOY, RHTRKHTTB, LTPCHY L MYGH, FTPNVP (Ch F. Yu. BTFFETYY.reTEDPYTPCHLB. uYNRFPNSCH: FPYOPFB, TCHPFB, CHMBZBMYEOSHCH LTPCHPPFEYUEOOYS. MEYOOYE: UREGYJYUEULPZP BOFYDPFB OEF. uMEDHEF HDBMYFSH ffu Y RTPCHPDYFSH UYNRFPNBFYUEULHA FETBRYA.

PUPVSHCHE HLBBOYS

OE UHEEUFCHHEF LMYOYUUEULYI DPLBBBFEMSHUFCH FPZP, YuFP ffu VPMEE VEJPRBUOB, YUEN RETPTBMSHOSHE LPOFTBGERFYCHSHCH.

RETED OBYUBMPN YMY CHPVOPCHMEOYEN RTYNEOOYS ffu OEPVIPDYNP UPVTBFSH RPDTPVOSCHK NEDYGYOULYK BOBNOYE (CHLMAYUBS UENEKOSHCHK) Y YULMAYUYFSH VETENEOOPUFSH . uMEDHEF RTPCHEUFY PVEENEDYGYOULPE PVUMEDPCHBOYE (CH F.YU. YJNETEOYE bd) U KHUEFPN RTPFYCHPRPLBBBOYK Y RTEDHRTETSDEOOK.

rTY RPDPJTEOY ABOUT OBUMEDUFCHOOHA RTEDTBURMPTSEOOPUFSH L CHOPOPK FTPNVPPNVPMYY (EUMY CHOPOBS FTPNVPPNVPMYS YNEMB NEUFP X VTBFB, UEUFTSH YMY X TPDYFEMEC H PFOPUYFEM SHOP NPMPDPN CHPTBUFE), TSEOOEYOH UMEDHEF OBRTBCHYFSH ABOUT LPOUHMSHFBGYA L UREGYBMYUFKH, RTETSDE YUEN TEYBFSH CHPRTPU P RTYNEOOY ZPTNPOBMSHOPK LPOFTBGERGYY.

tyul UPUKhDYUFSHI PUMPTSOEOYK RPCHSHCHYEO X TSEOOYO U FTPNVPZHMEVYFPN RPCHETIOPUFOSHHI CHEO Y U CHBTILPOOSCHN TBUYYTEOYEN CHEO, B FBLCE RTY PCYTEOYY (YODELU NBUUSCH FEMB VPMEE 30 LZ/LCH. N).

rTY DMYFEMSHOPK YNNNPVYMYBGYY, RPUME PVIYTOPZP IYTHTZYUEULPZP CHNEYBFEMSHUFCHB ABOUT OITSOYI LPOYUOPUFSI YMY FSTSEMPK FTBCHNSCH TELPNEODHEFUS RTELTBFYFSH YURPMSH'PCHBOYE ZP TNPOBMSHOSHI LPOFTBGERFYCHPCH (RTY RMBOPCHPK PRETBGYY - ЪБ 4 OED DP OEE) Y CHPЪPVOPCHYFSH ZPTNPOBMSHOHA LPOFTBGERGYA OE TBOEE YUEN YUETEЪ 2 OED RPUME RPMOPK TENPVIYMYBGYY.

oELPFPTSCHE RYDENYPMZYUEULYE YUUMEDPCHBOYS CHSCCHYMY RPCHSHCHYEOOSCHK TYUL TBCHYFYS TBLB YEKLY NBFLY ABOUT ZHPOE DMYFEMSHOPZP RTYENB LPNVYOTPCHBOOSCHI RETPTBMSHOSHI LPOFTBGER FYCHHR.

lPNVYOTPCHBOOSCH RETPTBMSHOSCH LPOFTBGERFYCHSHCH NPZHF VSHFSH RTYUYOPK PRKHIPMEK REYUEOY, CH F.YU. U KHZTPTSBAEYNYY TSYYOYOFTBBVDPNYOBMSHOSHSHNYY LTPCHPPFEYOOYSNY. h UMKHYUBE CHP'OILOPCHEOYS UIMSHOSHI VPMEK h CHETIOEK RPMPCHYOE TsYCHPFB, KhCHEMYUEOYS REYUEOY YMY UINRFPNPCH YOFTBBVDPNYOBMSHOPZP LTPCHPFEYUEOYS, UMDHEF RTPCHEUFY DYZHZHETEOGYBM SHOKHA DYBZOPUFYLH DMS YULMAYUEOYS PRHIPMY REYUEOY.

rTY ZYRETFTYZMYGETYDENYY (CH F.YU. CH UENEKOPN BOBNOYE) RPCCHCHYEO TYUL TBCHYFYS RBOLTEBFYFB CH UMHYUBE RTYNEOOYS LPNVOYTPCHBOOSCHI ZPTNPOBMSHOSHI LPOFTBGERFYCHPCH.

rTY CHP'OILOPCHOOY ZHBTNBLPMPZYUUEULY OELPOFTPMYTHENPK BTFETYBMSHOPK ZYRETFEOYY PE CHTENS YURPMSH'PCHBOYS LPNVIYTPCHBOOSHI ZPTNPOBMSHOSHI LPOFTBGERFYCHPCH RTERBTBF UMEDHEF PFNEOIFSH. yURPMSHЪPCHBOYE ffu NPTsOP ChPЪPVOPCHYFSH RPUME OPTNBMYBGYY bd. UPPVEBMPUSH, YuFP RTY RETPTBMSHOPN RTYENE LPNVYOTPCHBOOSCHI ZPTNPOBMSHOSCHI LPOFTBGERFYCHPCH NPZHF CHPKOILBFSH YMY PVPUFTSFSHUS RETEYUYUMEOOSCH OYCE ЪBVPMECHBOYS, PDOBLP KHVEDY FEMSHOSHI DPLBBFEMSHUFCH YI UCHSY U YURPMSHЪPCHBOYEN LPNVIOTPCHBOOSCHI RETPTBMSHOSHI LPOFTBGERFYCHPCH OEF: TSEMFHIB Y/YMY LPTSOSCHK YKhD, UCHSBOOSCH U IPMEUFBBPN; IPMEMYFYB, RPTZHYTYS, UYUFENOSHCHK TYFENBFP, ZENPMYFYLP-HTENYUEULYK UYODTPN, IPTES UYDEOSBNB (NBMBS IPTES), ZEUFBGYPOOSCHK ZETREU, UCHSBOOBS U PFPULMETP PN RPFETS UMHIB.

zPTNPOBMSHOSH LPOFTBGERFYCHSH NPZHF CHMYSFSH ABOUT OELPFPTSHCHE RPLBBBFEMY JODPLTYOOOPZP UFBFKHUB, NBTLETSCH ZHOLGYY REYUEOY Y RPLBЪBFEMY ACCOUNTFSHCHCHBOYS LTPCHY: ZYRETRTPFTPNV YOENYS, RPCHSHCHYYE LPOGEOFTBGYY ZBLFPTPCH UCHETFSHCHBOYS VII, VIII, IX X, UOTSEOYE LPOGEOFTBGYY BOFYFTPNVIOB III, ZYRPRTPFEYO S, KHUIMEOYE CHCHBOOPC OPTBDTEOBMYOPN BZTEZBGY Y FTPNVPGYFPCH; RPCHSHCHYEOYE LPOGEOFTBGYY FYTPLUYOUCHSCHCHBAEEZP ZMPVKHMYOB, YuFP CHSHCHCHCHBEF RPCHSHCHYOEYE LPOGEOFTBGYY PVEEZP FYTEPYDOPZP ZPTNPOB, LPFPTSCHK YYNETSAF RP LPOGEOFTBGYY KPDB, UCHSЪBOOPZP U VEMLPN, UPDETSBOYA f4 (PRTEDEMSAF U RPNPESHA ITPNBFPZTBZHYY YMY TBDYPYNNHOOZP BOBMYYB), UOTSEOYE UCHSCHCHBOYS UCHPVPDOPZP f3 YPOPPVNEOOOPK UNPMPK (P YuEN U CHYDEFEMSHUFCHHEF RPCHSHCHYOEYE LPOGEOFTBGYY FYTPLUYOUCHSCHCHBAEEZP ZMPVHMYOB, LPOGEOFTBGYS UCHPVPDOPZP f4 OE JNEOSEFUS), RPCCHYEOYE LPOGEOFTBGYY CH USHCHPTPFLE LTPCHY DT. UCHSCHCHBAEYI VEMLPCH, CH F.YU. ZMPVHMYOPCH, UCHSCHCHBAEYI RPMPCHSHCHE ZPTNPOSCH, YuFP RTYCHPDYF L HCHEMYUEOYA LPOGEOFTBGYK PVEYI GYTLHMYTHAEYI LODPZEOOSCHI RPMPCHCHI ZPTNPOPCH. chNEUFE U FEN, LPOGEOFTBGYY UCHPVPDOSCHI YMY VYPMPZYUEULY BLFYCHOSHI RPMPCHSHCHI ZPTNPOPCH UOTZBAFUS YMY PUFBAFUS OEYNEOOOSCHNY.

x TsEOEYO, YURPMSHQHAEYI ffu, NPZHF OOBYUIFEMSHOP RPCHSHCHYBFSHUS LPOGEOFTBGYY IPMEUFETYOB mrchr, PVEEZP IPMEUFETYOB, IPMEUFETYOB mror Y FTYZMYGETYDPCH, FPZDB LBL UPPFOPEYOEYE IPMEUFETYOB mror/mrchr NPTsEF PUFBCHBFSHUS OEYJNEOOOSCHN. zPTNPOBMSHOSH LPOFTBGERFYCHSH NPZHF CHSHCHCHBFSH UOTSEOYE LPOGEOFTBGYK USCHCHPTPFPYUSHI ZHPMBFPCH, YUFP NPTsEF VSCHFSH LMYOYUEULY OBYUYNP CH UMHYUBE OBUFHRMEOYS VETENEOOPUFY CH ULPTE RPUME PFNEOSCH fffu. TELPNEODHEFUS RTYOINBFSH ZHPMYECHHA LYUMPFKH PE CHTENS Y RPUME PLPOYUBOYS ZPTNPOBMSHOPK LPOFTBGERGYY.

lPNVYOTPCHBOOSCH ZPTNPOBMSHOSCH LPOFTBGERFYCHSH NPZHF CHMYSFSH ABOUT TEYUFEOFOPUFSH RETYZHETYYUEULYI FLBOEK L YOUKHMYOH Y ABOUT FPMETBOFOPUFSH L ZMALPYE, PDOBLP OEF DPLBBEBFEMSH UFCH OEPVIPDYNPUFY YNEOSFSH TETSYN FETBRYY UBIBTOPZP DYBVEFB PE CHTENS YURPMSH'PCHBOYS LPNVIOTPCHBOOSHI ZPTNPOBMSHOSHI LPOFTBGERFYCHPCH. oEPVIPDYNP LPOFTPMYTPCHBFSH UPUFPSOYE RBGYEOFPCH, UFTBDBAEYI UBIBTOSCHN DYBVEFPN, PUPVEOOP ABOUT TBOOEK UFBDYY YURPMSH'PCHBOYS ffu.

UPPVEBMPUSH PV PVPUFTEOYY JODPZEOOPK DERTEUUYY, RYMERUYY, VPMEY LTPOB Y SJCHOOOPZP LPMYFB ABOUT ZHPOE RTYENB LPNVOYTPCHBOOSCHI RETPTBMSHOSHI LPOFTBGERFYCHPCH.

TsEOEYOSCH, X LPPTTSCHI OBVMADBMBUSH ZYRETRYZNEOFBGYS LPTSY MYGB PE CHTENS VETENEOOPUFY, DPMTSOSCH Y'VEZBFSH CHPDEKUFCHYS UPMOEYUOPZP YMY YULHUUFCHEOOPZP hzh-YЪMKHYUEOYS PE CHTENS OPEYEOYS ffu. h TEDLYI UMKHYUBSI ZYRETRYZNEOFBGYS VSCCHBEF OE RPMOPUFSHA PVTBFYNPK.

TsEOEYO UMEDHEF RTPYOZHPTNYTPCHBFSH P FPN, YuFP ZPTNPOBMSHOSHE LPOFTBGERFYCHSHCH OE ЪBEYEBAF PF chyu-YOZHELGYY (urydB) Y DT. JBVPMECHBOYK, RETEDDBCHBENSHI RPMPCHSHCHN RKHFEN.

h UMHYUBE RTYENB ABOUT ASS fffu mu, YODHGYTHAEYI NYLTPUPNBMSHOSHE ZHETNEOFSH REYUEOY (RTPYCHPDOSHE ZYDBOFPYOB, VBTVYFKHTBFSCH, RTYNDPO, LBTVBNBERYO, TYZHBNRYGYO, P LULBTVBYORYO, FPRYTBNBF, ZHEMVBNBF, TYFPOBCHYT, ZTYJEPZHHMSHCHYO, NPDBZHOYOM Y ZHEOMVKHFBPO) Y BOFYVYPFYLY (ЪB YULMAYUEOYEN FEFTBGYILMYOPCH), OEPVIPDYNP CH TENEOOP YURPMSHЪPCHBFSH VBTSHETOSCHK NEFPD CH DPRPMOEOYE L RTYNEOOYA ffu PE CHTENS CHUEZP LHTUB MEUEOYS CHCHYERETEYYUMEOOSCHNYY mu, B FBLCE CH FEYUEOYE 28 DOEK RPUME PFNEOSCH YODHLFPTPCH NYLTPUPNBMSHOSHI ZHETNEOFPCH Y CH FEYUEOY E 7 DOEK RPUME RTELTBEEOYS RTYENB BOFYVYPFYLPCH YMY CHSHCHVTBFSH YOPK NEFPD LPOFTBGERGYY. eUMY RETYPD RTYENB UPRHFUFCHHAEYI mu RTECHSHCHYBEF 3-OOEDEMSHOSCHK GYLM YURPMSHЪPCHBOYS ffu, FP OPCHSHCHK LPOFTBGERFYCHOSCHK GYLM OEPVIPDYNP OBUYOBFSH UTBH RPUME PLPOYUBOYS RTEDSH DHEESP, F.E. VEJ PVSHYUOPZP RETYPDB, UCHPVPDOPZP PF RTYNEOOYS ffu. rTY DMYFEMSHOPK FETBRYY mu, YODHGYTHAEYNY REYUEOPYUOSCHE ZHETNEOFSHCH, OEPVIPDYNP CHSHCHVTBFSH DT. NEFPD LPOFTBGERGYY.

rTY PDOPCHTEENEOOPN OBYUEOYY mu, NEFBVPMYYTHAEYIUS ZHETNEOFBNY UYUFENSH GIFPPITPNB t450 (CH F.YU. CYP 3A4, CYP 2C19), PUPVEOOOP YNEAEYI HLYK FETBRECHFYUEULYK YODELU ( OBRTYNET, GYLMPURPTYO), UMEDHEF CHONBFEMSHOP YHKHYUFSH TELPNEODBGYY RP RTYNEOOYA RTERBTBFPCH, DMS FPZP YUFPVSH YULMAYUYFSH CHETPSFOPUFSH CHP'OILOPCHEOYS LMYOYUEULY OBYUYNPZP CHBYNPDEKUFCHYS.

rTY YURPMSHЪPCHBOY MAVSHI LPNVOYTPCHBOOSCHI ZPTNPOBMSHOSCH LPOFTBGERFYCHPCH NPTsEF OBTHYBFSHUS NEOUFTHBMSHOSCHK GYLM (NBTSKHEYE CHSHCHDEMEOYS YMY NETSNEOUFTHBMSHOSHE LTPCHPPFEYUEOY C), PUPVEOOOP CH RETCHSHE NEUSGSH RTYNEOOYS LFYI UTEDUFCH. rTPDPMTSYFEMSHOPUFSH RETYPDB BDBRFBGYY - PLPMP FTEI GYLMPCH. eUMY PE CHTENS YURPMSHЪPCHBOYS ffu CH UPPFCHEFUFCHYY U TELPNEODBGYSNY OBVMADBEFUS RETUYUFEOGYS NETSNEOUFTHBMSHOSHI LTPCHPPFEYOOYK YMY FBLPE LTPCHPFEYOOYE CHP'OILBEF RPUME RTEDYUFCHHAEYI TEZKHMSTOSCHI GYLMPCH, FP UMEDHEF HYYFSHCHBFSH YOSCHE RTYYUOSCH, RPNYNP RTYNEOOYS ffu (CH F.YU. OEZPTNPOBMSHOSHCHE) Y, RTY OEPVIPDYNPUFY, RTPCHEUFY BDELCHBFOPE DYBZOPUF YUEULPE PWUMEDPCHBOIE DMS YULMAYUEOYS PTZBOYUEULPZP ЪBVPMECHBOYS YMY VETENEOOPUFY.