Kodi pali kusiyana kotani pakati pa Finlepsin ndi Finlepsin retard? Finlepsin retard: malangizo ogwiritsira ntchito

Federal Center ku Neurosurgery

PANGANI UTHENGA Watsopano.

Koma ndinu wogwiritsa ntchito osavomerezeka.

Ngati munalembetsa kale, ndiye kuti "lowani" (fomu yolowera kumtunda kumanja kwa tsambalo). Ngati ino ndi nthawi yanu yoyamba kuno, lowani.

Ngati mungalembetse, mudzatha kutsata mayankho amawu anu mtsogolo, pitilizani kukambirana mitu yosangalatsa ndi ogwiritsa ntchito ena ndi alangizi. Kuphatikiza apo, kulembetsa kudzakuthandizani kuchita makalata azinsinsi ndi alangizi ndi ogwiritsa ntchito tsambalo.

Mlingo ndi makonzedwe

100 mg madzulo 100 mg madzulo
Mankhwala okonza a 200-600 mg tsiku lililonse m'mawa 400-600 mg madzulo
200 mg m'mawa 200-400 mg madzulo 200-400 mg m'mawa 400-600 mg madzulo

Mulingo wa mankhalawo womwe utchulidwa patebulopo suyenera kupitilira.
Chithandizo cha kuchotsa kwa mowa kuchipatala.
Pafupifupi tsiku lililonse tsiku limafanana ndi 600 mg a carbamazepine (200 mg m'mawa ndi 400 mg madzulo).
O
Woopsa milandu, m'masiku oyamba, mlingo utha kuwonjezeka mpaka 1200 mg wa carbamazepine patsiku, womwe umagawidwa pawiri. Finlepsin retard sayenera kuphatikizidwa ndi mankhwala a sedative-hypnotic. Ngati ndi kotheka, Finlepsin retard ikhoza kuphatikizidwa ndi zinthu zina zomwe zimagwiritsidwa ntchito pochotsa mowa. Pa mankhwala, ndikofunikira kuwunika pafupipafupi zomwe zili m'magazi a carbamazepine. Pokhudzana ndi chitukuko cha zoyipa kuchokera pakatikati ndi autonomic mantha dongosolo, odwala amayang'aniridwa mosamala pachipatala.
Trigeminal neuralgia, idiopathic neuropathy ya glossopharyngeal nerve.
Mlingo woyambirira ndi 200-400 mg wa carbamazepine patsiku, womwe umagawidwa pawiri. Mlingo woyambirira umakulitsidwa kufikira ululu utazimiririka, pafupifupi 400-800 mg ya carbamazepine patsiku. Pambuyo pake, mu gawo lina la odwala, chithandizo chitha kupitilizidwa ndi mlingo wocheperako wa 400 mg wa carbamazepine.
Finlepsin retard ndi mankhwala okalamba odwala ndi odwala khunyuazepine koyamba mlingo wa 100 mg carbamazepine (1/2 piritsi 200 mg) 2 pa tsiku.
Ululu wa matenda ashuga a m'mimba.
Wapakati tsiku lililonse 200 mg m'mawa ndi 400 mg wa carbamazepine madzulo. Mwapadera, Finlepsin retard imatha kutumikiridwa muyezo wa 600 mg ya carbamazepine 2 pa tsiku. Epileptiform kugunda angapo sclerosis.
O
Wapakati tsiku ndi tsiku ndi 400 - 800 mg wa carbamazepine, amene agawidwa awiri Mlingo.
Chithandizo ndi kupewa psychosis
Mlingo woyambirira, womwe nthawi zambiri umafanana ndi mlingo wokonza, ndi 200-400 mg wa carbamazepine patsiku. Ngati ndi kotheka, mankhwalawa akhoza kuchuluka kwa 800 mg ya carbamazepine patsiku, omwe amagawidwa pawiri.
Kutalika kwa nthawi ya ntchito kumatengera zomwe wodwalayo angagwiritse ntchito. Khunyu imachiritsidwa kwa nthawi yayitali. Dokotala wodziwa bwino ayenera kusankha pa kusamutsidwa kwa wodwala ku Finlepsin retard, nthawi yogwiritsira ntchito komanso kuthetsedwa kwa aliyense payekha. Mlingo wa mankhwalawa utha kuchepetsedwa kapena kusiyiratu chithandizo osati kale kwambiri osadutsa zaka 2-3 osakomoka.
Chithandizo chimayimitsidwa ndi kuchepa kwapang'onopang'ono kwa mlingo wa mankhwalawa kwa zaka 1-2. Pankhaniyi, ana ayenera kuganizira kuwonjezeka kwa thupi. Zizindikiro za Electroencephalogram siziyenera kuwonongeka.
Mankhwala a neuralgia, ndikofunikira kuperekera mankhwala a Finlepsin mu mlingo wokwanira wopweteketsa ululu, kwa milungu ingapo. Potsitsa mlingo, ndikofunikira kudziwa momwe zingabwezeretsere zizindikiro. Ndi kuyambiranso kwa kupweteka, chithandizo chimapitilizidwa ndi mlingo wokonzanso.
Kutalika kwa mankhwalawa kupweteka kwa matenda ashuga a m'mimba ndipo khunyu imagwira mu angapo sclerosis ndi chimodzimodzi kwa neuralgia.
Finlepsin achire mankhwala a mowa achire matenda amayimitsidwa ndi pang'onopang'ono mlingo kuchepetsa kwa masiku 7-10.

Njira zopewera kupewa ngozi

Finlepsin Retard - mankhwala ochizira dibenzazepine angapo khunyu. Ili ndi antidepressant, antipsychotic, vasopressin-like action. Mwa anthu omwe ali ndi vuto la mitsempha yowonongeka, yodziwika ndi kupweteka kwamkati mwa malo amitsempha, imawonetsa analgesic. Kuchulukitsa kwa zamankhwala kumachitika chifukwa cha kuthekera kwa njira zamagetsi zamagetsi zamagetsi, zomwe zimapangitsa kuti ma membala amitsempha omwe amakhala osangalala kwambiri azikhala okhazikika, m'badwo wa kutulutsa kosiyanasiyana kwa mitsempha komanso kupatsirana kwa ma pulses pa synapses kumapanikizika. Amalepheretsa glutamate, amino acid yokhala ndi ntchito ya neurotransmitter, kulowa malo ophatikizana, ndipo imakankhira kulumikizana kwa ubongo, potero imapereka mphamvu ya antiepileptic. Chimalimbikitsa transmembrane yogwira kwambiri ya ion ya potaziyamu. Mu anthu omwe ali ndi matenda a khunyu (makamaka kwa ana ndi achinyamata), mankhwalawa amachepetsa nkhawa, kuuma kowonekera, kukhumudwa kumachepa, ndipo kupsa mtima kumatha. Zotsatira za chidziwitso cha ntchito ndi malingaliro a psychomotor zimatsimikiziridwa ndi mlingo wa mankhwala omwe amwe. Mphamvu ya anticonvulsant imayamba kuwonekera pamtunda kuyambira maola 3-4 mpaka masiku angapo (nthawi zina - mpaka masiku 30). Ndi hangover syndrome, imakankhira kukhazikika kwa ubongo m'munsi mothandizidwa ndi mowa, kuponderezera zizindikiro zakuchotsa (kumachotsa kusefukira, kunjenjemera kwadzidzidzi kwa zala, kukhazikika mwamtundu wa gait).

Mphamvu ya antipsychotic imawonekera patatha masiku 7-10. Kutalika kwa mankhwala kwa nthawi yayitali motero kungaphatikizidwe ndi kuponderezedwa kwa dopamine ndi norepinephrine metabolism. Finlepsin Retard ndi njira yayitali yogwiritsira ntchito mulingo womwe umapereka gawo lokhazikika la plasma ndi pafupipafupi makonzedwe a 1-2 patsiku. Ndi pakamwa mankhwala, mankhwala pang'onopang'ono koma odzipereka kwathunthu m'mimba thirakiti (kukhalapo kwa chakudya mkati m'mimba thirakiti alibe tanthauzo kutulutsa ndi kukwana kwa mayamwidwe). Peak ndende yogwira zigawo zikuluzikulu m'magazi zimawonedwa pambuyo pa maola 32 Hafu ya moyo imakonda pafupifupi maola 70. Kutulutsa kuchokera mthupi kumachitika makamaka ndi impso ndipo, pang'ono, ndi matumbo. Nthawi yokwanira kudya imakhala ndi kapena mukatha kudya. Amaloledwa kusungunula piritsi kapena gawo lake m'madzi musanayambe kupangika: Kutalika kwa mankhwalawa sikuvutikira ndi izi. Kuchulukitsa kuvomerezeka - katatu patsiku. Njira ya mankhwalawa imayamba ndi mlingo wochepa tsiku ndi tsiku ndikuwonjezereka mpaka kufikira atatchulidwanso kuti achire.

Pharmacology

Mankhwala othandizira antiepileptic ochokera ku tricyclic iminostilbene. Amakhulupirira kuti zotsatira za anticonvulsant zimagwirizanitsidwa ndi kuchepa kwa mphamvu ya ma neurons kuti asunge kwambiri zochitika zomwe zingachitike mobwerezabwereza poyambitsa masodium njira. Kuphatikiza apo, kuletsa kwa ma neurotransmitter kumasulidwa ndi kutsekereza njira za preynaptic sodium komanso kukula kwa zinthu zina zomwe zimachepetsa kufalitsa kwa synaptic, zikuwoneka kuti ndizofunikira.

Imakhala ndi antimaniacal, antipsychotic zotsatira, komanso analgesic zotsatira zopweteka za neurogenic. Ma GABA receptors, omwe amatha kuphatikizidwa ndi njira za calcium, akhoza kutengapo gawo machitidwe, komanso zotsatira za carbamazepine pama neurotransmitter modulator system nawonso zikuwoneka kuti ndizofunikira.

Mphamvu yotsutsa ya carbamazepine imatha kuphatikizidwa ndi hypothalamic zotsatira za osmoreceptors, zomwe zimayendetsedwa kudzera mchinsinsi cha ADH, komanso chifukwa cha kuthana ndi vuto la aimpso.

Pharmacokinetics

Pambuyo pakumwa pakamwa, carbamazepine imangokhala yodzaza kwathunthu kuchokera kumimba. Kumangiriza kwa mapuloteni a plasma ndi 75%. Imagwira ma enzymes a chiwindi ndipo imathandizira kagayidwe kake.

T 1/2 ndi maola 12 mpaka 29. 70% amachotsedwa mu mkodzo (mwa ma metabolites) ndipo 30% yokhala ndi ndowe.

Kutulutsa Fomu

Mapiritsi okhala ndi nthawi yayitali kuyambira oyera mpaka oyera okhala ndi chikasu chachikasu, chopyapyala, chosalala, chokhala ndi mizere yolumikizidwa, mizere yolakwika yozungulira mbali zonse ziwiri ndi nsonga zinayi pambali.

Omwe amathandizira: kopolymer wa ethyl acrylate, methyl methacrylate ndi trimethylammonioethyl methacrylate (1: 2: 0,1) (Eudragit RS30D), triacetin, talc, kopolymer wa methaconic acid ndi ethyl acrylate (1: 1) (Eudragit L30D-55) cellstryine magnesium wakuba.

Ma PC 10 - matuza (5) - mapaketi a makatoni.
Ma PC 10 - matumba otumphuka (5) - mapaketi a makatoni.
Ma PC 10 - matumba otumphukira (3) - mapaketi a makatoni.
Ma PC 10 - mapaketi a matuza (4) - mapaketi a makatoni.

Ikani payekha. Mukamamwa pakamwa kwa akulu ndi achinyamata azaka 15 ndi akulu, mlingo woyambayo ndi 100-400 mg. Ngati ndi kotheka, ndi kuganizira matenda, mlingo ukuwonjezeka osapitirira 200 mg / tsiku limodzi pakapita sabata 1. Pafupipafupi oyang'anira ndi nthawi 1-4 / tsiku. Mankhwala okonza nthawi zambiri amakhala ali ndi 600 mg00 mg / tsiku zingapo. Kutalika kwa chithandizo kumatengera zikuwonetsa, kuthandizira kwake, momwe wodwalayo amayankhira chithandizo.

Mwa ana osakwana zaka 6, 10-20 mg / kg / tsiku amagwiritsidwa ntchito mu Mlingo wogawika 2-3, ngati kuli koyenera komanso chifukwa chololera, mlingo umachulukitsa osapitilira 100 mg / tsiku limodzi pakapita sabata 1, makonzedwe okonza nthawi zambiri amakhala 250 -350 mg / tsiku ndipo sizidutsa 400 mg / tsiku. Ana a zaka zapakati pa 6 mpaka 12 - 100 mg 2 / tsiku tsiku loyamba, ndiye kuti mlingo umakulitsidwa ndi 100 mg / tsiku ndi nthawi 1 sabata. mpaka mulingo woyenera kwambiri, mlingo wokonzanso nthawi zambiri ndi 400-800 mg / tsiku.

Mlingo waukulu: mukamamwa pakamwa, akulu ndi achinyamata a zaka 15 ndi okalamba - 1,2 g / tsiku, ana - 1 g / tsiku.

Kuchita

Ndi munthawi yomweyo kugwiritsa ntchito zoletsa za isoenzyme CYP3A4, kuchuluka kwa carbamazepine m'madzi amwazi.

Ndi munthawi yomweyo kugwiritsa ntchito zopangira za CYP3A4 isoenzyme dongosolo, mathamangitsidwe kagayidwe ka carbamazepine, kuchepa kwake kugundika mumagazi am'magazi, ndi kuchepa kwa achire kungatheke.

Ndi munthawi yomweyo kugwiritsa ntchito carbamazepine kumapangitsa kagayidwe ka anticoagulants, folic acid.

Pogwiritsa ntchito munthawi yomweyo ndi valproic acid, kuchepa kwa kuchuluka kwa carbamazepine ndi kuchepa kwakukulu kwa ndende ya valproic acid m'madzi a m'magazi kumatha. Nthawi yomweyo, kugwiritsidwa ntchito kwa carbamazepine metabolite, carbamazepine epoxide, kumawonjezera (mwina chifukwa cha kuletsa kwake kusintha kwake kwa carbamazepine-10,11-trans-diol), yomwe imakhalanso ndi ntchito yotsutsana, kotero zotsatira za kuyanjanaku zimatha kuyendetsedwa, koma mawonekedwe osokoneza nthawi zambiri amapezeka - masomphenya osokoneza, chizungulire, kusanza, kufooka, nystagmus. Pogwiritsa ntchito munthawi yomweyo valproic acid ndi carbamazepine, kukula kwa hepatotoxic kungatheke (mwachiwonekere, chifukwa cha kupangika kwa metabolite yachiwiri ya valproic acid, yomwe imakhala ndi hepatotoxic athari).

Pogwiritsa ntchito munthawi yomweyo, valpromide imachepetsa kagayidwe kake ka chiwindi cha carbamazepine ndi metabolite carbamazepine-epoxide chifukwa chopewera kwa enzyme epoxide hydrolase. Metabolite yotchulidwa imakhala ndi zochita za anticonvulsant, koma pakuwonjezereka kwa ndende ya plasma imatha kukhala ndi poizoni.

Pogwiritsa ntchito munthawi yomweyo ndi verapamil, diltiazem, isoniazid, dextropropypyphene, viloxazine, fluoxetine, fluvoxamine, cimetidine, acetazolamide, danazole, desipramine, nicotinamide (mu akulu, mwa Mlingo wambiri), erythromycin, trolezcinzcin, trolezcin. kuphatikizanso ndi itraconazole, ketoconazole, fluconazole, terfenadine, loratadine, kuchuluka kwa carbamazepine mu plasma ya magazi ndikotheka ndi chiopsezo cha mavuto (chizungulire, kugona, ataxia, diplopia).

Pogwiritsa ntchito munthawi yomweyo ndi hexamidine, mphamvu ya anticonvulsant ya carbamazepine imafooka, ndi hydrochlorothiazide, furosemide - ndizotheka kuchepetsa zofunikira za m'magazi, ndi njira yolerera ya mahomoni - ndizotheka kufooketsa mphamvu ya njira zakulera komanso kukula kwa magazi a acyclic.

Pogwiritsa ntchito nthawi yomweyo ndi mahomoni a chithokomiro, ndizotheka kuwonjezera kuthetseratu kwa mahomoni a chithokomiro, omwe ali ndi clonazepam, ndizotheka kuwonjezera chidziwitso cha clonazepam ndikuchepetsa chilolezo cha carbamazepine, ndikukonzekera kwa lifiyamu, kupititsa patsogolo mphamvu ya neurotoxic.

Pogwiritsa ntchito munthawi yomweyo primidone, kuchepa kwa kuchuluka kwa carbamazepine m'madzi a m'magazi kungatheke. Pali malipoti kuti primidone imatha kuwonjezera kuchuluka kwa plasma yogwira metabolac - - carbamazepine-10,11-epoxide.

Pogwiritsa ntchito munthawi yomweyo ndi ritonavir, mavuto a carbamazepine akhoza kupitilizidwa, ndi sertraline, kuchepa kwa kuchuluka kwa sertraline ndikotheka, ndi theophylline, rifampicin, cisplatin, doxorubicin, kuchepa kwa kuchuluka kwa carbamazepine m'magazi a plasma, ndi tetracycline.

Pogwiritsa ntchito munthawi yomweyo ndi felbamate, kuchepa kwa kuchuluka kwa carbamazepine m'madzi a m'magazi kungatheke, koma kuwonjezeka kwa kuchuluka kwa metabolite ya carbamazepine-epoxide, pomwe kuchepa kwa ndende mu plasma ya felbamate ndikotheka.

Ndi munthawi yomweyo kugwiritsa ntchito phenytoin, phenobarbital, kuchuluka kwa carbamazepine m'madzi amwazi kumachepa. Kuchepetsa mphamvu za zochita za anticonvulsant ndikotheka, ndipo nthawi zina, kulimbitsa kwake.

Zotsatira zoyipa

Kuchokera kumbali ya chapakati mantha dongosolo ndi zotumphukira mantha dongosolo: Nthawi zambiri - chizungulire, ataxia, kugona, kuthekera kupweteka kwa mutu, diplopia, chisokonezo pogona, osowa - kusuntha mwadzidzidzi, nystagmus, zina - oculomotor zosokoneza, dysarthria, zotumphukira neuritis, paresthesia, kufooka kwa minofu, zizindikiro paresis, kuyerekezera zinthu m`maganizo, kukhumudwa, kutopa, kuchita ukali, kusokonezeka kwa chikumbumtima, kuchuluka kwa psychosis, kukoma kuwonongeka, conjunctivitis, tinnitus, hyperacusis.

Kuchokera pamimba: kukhumudwa, kuchuluka kwa GGT, kuchuluka kwa zamchere phosphatase, kusanza, pakamwa kowuma, kawirikawiri - kuchuluka kwa transaminases, jaundice, hepatitis ya cholestatic, kutsekula m'mimba kapena kudzimbidwa, nthawi zina - kuchepa kwa chakudya, kupweteka kwam'mimba, glossitis, stomatitis.

Kuchokera pamtima wamtima: kawirikawiri - kusokonezeka kwa mtima.

Kuchokera pa hemopoietic dongosolo: leukopenia, eosinophilia, thrombocytopenia, osowa - leukocytosis, nthawi zina - agranulocytosis, aplasic anemia, erythrocytic aplasia, megaloblastic anemia, reticulocytosis, hemolytic anemia, granulomatous hepatitis.

Kuchokera kumbali ya kagayidwe: hyponatremia, kusungika kwamadzimadzi, edema, kunenepa kwambiri, kuchepa kwa osmolality ya plasma, nthawi zina - kuperewera kwapakati pa porphyria, kuperewera kwa asidi wa folic acid, kusokonezeka kwa calcium calcium, kuchuluka kwa cholesterol ndi triglycerides.

Kuchokera ku endocrine system: gynecomastia kapena galactorrhea, kawirikawiri - kusowa kwa chithokomiro.

Kuchokera kwamikodzo dongosolo: kawirikawiri - kusokonezeka kwa impso, zamkati nephritis ndi aimpso kulephera.

Kuchokera pakapumidwe: munthawi zina - dyspnea, chibayo kapena chibayo.

Thupi lawo siligwirizana: zotupa pakhungu, kuyabwa, kawirikawiri - lymphadenopathy, malungo, hepatosplenomegaly, arthralgia.

Matenda a khunyu: akuluakulu, osakanikirana, osakanikirana (kuphatikiza zazikulu ndi zozama) khunyu. Kupweteka kwamatenda makamaka kwa chiyambi cha neurogenic, kuphatikiza kofunikira mu triuralmural neuralgia, trigeminal neuralgia mu sclerosis yofunikira, glossopharyngeal neuralgia. Kupewa kuukira ndi vuto lochotsa mowa. Magwiridwe othandizira komanso osokoneza bongo (monga njira yoletsera). Matenda a diabetes a neuropathy. Matenda a shuga a insipidus apakatikati, polyuria ndi polydipsia ya chikhalidwe cha neurohormonal.

Mimba komanso kuyamwa

Ngati ndi kotheka, gwiritsani ntchito panthawi yomwe muli ndi pakati (makamaka pa trimester yoyamba) komanso mkaka wa m`mawere ayenera kuganizira bwino za chithandizo chomwe mayi akuyembekezera komanso chiwopsezo kwa mwana wosabadwayo kapena mwana. Pankhaniyi, carbamazepine tikulimbikitsidwa kuti azigwiritsidwa ntchito ngati monotherapy mu Mlingo wothandiza kwambiri.

Amayi amisinkhu yobala mwana panthawi yochizira ndi carbamazepine akulimbikitsidwa kugwiritsa ntchito njira zolerera za mahomoni.

Malangizo apadera

Carbamazepine sagwiritsidwa ntchito kukomoka kapena kuwononga khunyu pang'ono, kugwidwa ndi myoclonic kapena atonic epileptic. Sipamayenera kugwiritsidwa ntchito pochepetsa ululu wamba, monga prophylactic panthawi yayitali yotulutsidwa kwa trigeminal neuralgia.

Amagwiritsidwa ntchito mosamala ngati matenda obwera chifukwa cha mtima wamitsempha, matenda a chiwindi ndi / kapena ntchito ya impso, matenda a shuga, kuchuluka kwa kukakamira, ndi mbiri ya kusintha kwa hematological kugwiritsa ntchito mankhwala ena, hyponatremia, kusungika kwamikodzo, komanso chidwi chachikulu cha antidepressants atatu. , ndi zomwe zikuwonetsa mbiri ya kusokonezeka kwa chithandizo cha carbamazepine, komanso ana ndi odwala okalamba.

Chithandizo chikuyenera kuchitika moyang'aniridwa ndi dokotala. Ndi chithandizo chotenga nthawi yayitali, ndikofunikira kuwongolera chithunzi cha magazi, momwe chiwindi chimagwirira ntchito komanso impso, kuchuluka kwa ma electrolyte m'magazi amwazi, komanso kuyezetsa maso. Pafupipafupi kutsimikiza kwa kuchuluka kwa carbamazepine m'madzi a m'magazi tikulimbikitsidwa kuwunika momwe ntchito ikugwirira ntchito komanso chitetezo.

Osachepera milungu iwiri musanayambe mankhwala a carbamazepine, ndikofunikira kusiya mankhwala ndi mao inhibitors.

Munthawi ya chithandizo musalole kumwa mowa.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu

Pa chithandizo, munthu ayenera kupewa kuchita zinthu zomwe zingakhale zovulaza zomwe zimafunikira chidwi chochulukirapo, komanso kuthamanga kwa zochitika zama psychomotor.

mankhwala . Finlepsin retard ndi anticonvulsant zotumphukira za tricyclic iminostilbene. Imawonetsa antiepileptic, neurotropic ndi psychotropic ntchito. The achire zotsatira makamaka chifukwa chopinga wa kupatsirana kwa transaptic wa zotulutsa ndipo, chifukwa, kutsika kufalikira kwa otsutsa motsimikiza. Pazowonjezera, carbamazepine imayambitsa kuchepa kwa mphamvu ya pambuyo-tetanic. Finlepsin achibwezera amachepetsa kukula kwa ululu mu trigeminal neuralgia. Izi zimachitika chifukwa chopinga chopatsirana cha synaptic cha kupsinjika mu msana wa minyewa ya trigeminal. Ndi insipidus ya matenda a shuga, Finlepsin retard imakhala ndi vuto linalake, mwina chifukwa cha vuto la hypothalamic pa osmoreceptors.

Pharmacokinetics Pambuyo pakukonzekera pakamwa, carbamazepine imatengeka pang'onopang'ono ndipo pafupifupi kwathunthu.

Nthawi ya theka la moyo ndi maola 8.5 ndipo ili ndi magulu osiyanasiyana (pafupifupi maola 1.72-12). Pakadutsa kamodzi pa C max, carbamazepine m'madzi am'madzi mwa anthu akuluakulu amapezeka pambuyo pa maola 4-16 (osowa kwambiri pambuyo pa maola 35), mwa ana pambuyo pa maola pafupifupi 6. Kuphatikizika kwa carbamazepine m'magazi a m'magazi sikuti kumadalira mlingo, ndipo akagwiritsidwa ntchito pamiyeso yapamwamba, momwe amapondera paplasma amakhala ndi mawonekedwe.

Mankhwala atatulutsidwa kwa nthawi yayitali, mapiritsi a carbamazepine m'madzi a m'magazi amatheka kuposa mapiritsi wamba.

Kuzunzanitsa koyenera kumachitika pambuyo pa masiku 2-8. Palibe kuyanjana kwapakati pakati pa mlingo wa carbamazepine ndi ndende yokhazikika yofanana mu plasma yamagazi.

Pazokhudza zochizira komanso poizoni zama carbamazepine m'madzi am'magazi, zikuwonetsedwa kuti kukomoka kumatha kutha ndi plasma ya 4-12 -12g / ml. Kuchuluka kwa mankhwalawa m'madzi am'magazi owonjezera 20 μg / ml, kumapangitsa chithunzi cha matenda.

Finlepsin achigonjetse pa ndende yogwira ya madzi a m'magazi a 5-18 μg / ml amachotsa kupweteka kwa trigeminal neuralgia.

70-80% ya carbamazepine imamangiriza mapuloteni a plasma. Gawo la carbamazepine losasinthika ndi mapuloteni pazomwe zimapanga 50 μg / ml zimakhalabe. 48-53% ya pharmacologically yogwira metabolite carbamazepine-10, 11-epoxide imamangiriza mapuloteni a plasma. Kuzunza kwa carbamazepine ku CSF ndi 33% ya plasma.

Carbamazepine amawoloka chotchinga ndipo amachotsedwa mkaka wa m'mawere.

Pakangotha ​​mlingo umodzi, carbamazepine amachotsedwa m'madzi a m'magazi a ma T ½ 36. Ndi chithandizo cha nthawi yayitali, T ½ imatsika ndi 50% chifukwa chogwiritsa ntchito michere ya chiwindi.

Mwa anthu athanzi, chilolezo chochokera ku madzi a m'magazi chimakhala pafupifupi 19.8 ml / h / kg, mwa odwala monotherapy - pafupifupi 54.6 ml / h / kg, odwala omwe ali ndi chithandizo cha mankhwala - pafupifupi.33 ml / h / kg

Pambuyo pakamwa kamodzi pa carbamazepine, 72% ya mankhwala mu mawonekedwe a metabolites amachotsedwa m'thupi ndi impso. 28% yotsalayi imachotsedwapo limodzi ndi ndowe, pang'ono pang'ono - osasinthika. 2-3% yokha ya chinthu china chilichonse chomwe chimatuluka mu mkodzo ndi carbamazepine sichinasinthidwe.

khunyu: kugwidwa kosavuta kapena kosavuta (pogwira kapena popanda kuzindikira), kugwidwa mwamtundu wa toni, mitundu yosakanikirana ya kukoka.

Finlepsin retard ingagwiritsidwe ntchito ngati monotherapy komanso ngati gawo la mankhwala ophatikiza.

Pachimake mikhalidwe, othandizira mankhwala a kupuma zovuta kukhudzana pofuna kupewa kukokomeza kapena kuchepetsa kukula kwa matenda mawonetsedwe.

Zizindikiro zakumwa mowa.

Idiopathic trigeminal neuralgia ndi trigeminal neuralgia mu sclerosis yambiri (yofanana komanso atypical).

Idiopathic neuralgia ya glossopharyngeal nerve.

Finlepsin retard imalembedwa pakamwa, nthawi zambiri mlingo wa tsiku ndi tsiku uyenera kugawidwa mu 2 Mlingo. Mutha kumwa mankhwalawa, mukatha kudya kapena pakati pa chakudya, ndi madzi pang'ono.

Asanayambe chithandizo, odwala omwe ali amtundu waku China Han kapena odwala ochokera ku Thai ayenera, ngati kuli kotheka, ayufuzenso HLA-B * 1502, popeza izi zimatha kudzetsa matenda oopsa a carbamazepine ogwirizana ndi Stevens-Johnson.

Khunyu Chithandizo chimayamba ndikugwiritsa ntchito mlingo wochepa tsiku lililonse, womwe umayamba kuwonjezereka pang'onopang'ono (kusinthidwa, poganizira zosowa za wodwala aliyense) kufikira momwe zitheke.

Ngati zingatheke, Finlepsin retard iyenera kutumizidwa ngati monotherapy, koma ikagwiritsidwa ntchito ndi mankhwala ena, mankhwalawa amakulanso pang'onopang'ono muyezo wa mankhwalawa. Ngati Finlepsin retard imawonjezeredwa ku mankhwala omwe alipo kale, mankhwalawa amayenera kuwonjezeka pang'onopang'ono, pomwe Mlingo wa mankhwala omwe amagwiritsidwa ntchito sasintha kapena kusintha ngati pakufunika.

Kusankha mulingo woyenera wa mankhwalawa, kungakhale kothandiza kudziwa mulingo wa yogwira magazi m'magazi a m'magazi. The achire ndende ya mankhwala plasma magazi ayenera 4-12 beg / ml.

Odwala ena, pogwiritsa ntchito mapiritsi a retard, pangafunikire kuwonjezera kuchuluka kwa mankhwalawa.

Akuluakulu Mlingo woyambitsidwa ndi 100-200 mg 1-2 kawiri patsiku, ndiye kuti mwambowu umakulitsidwa pang'onopang'ono mpaka mulingo woyenera, nthawi zambiri muyezo wa 800 ndi 800 mg, womwe umagawidwa pawiri. Odwala ena angafune kuchuluka kwa Finlepsin retard kufika 1600 mg kapena 2000 mg / tsiku.

Odwala okalamba. Popeza mankhwala amakhudzana ndi mankhwala osiyanasiyana a antiepileptic, okalamba ayenera kusankhidwa mosamala muyezo wa retlepsin.

Ana kuyambira zaka 5. Nthawi zambiri, chithandizo chikuyenera kuchitika pa 10-16 mg / kg pa thupi patsiku zingapo.

Ana azaka za 5-10 - 400-600 mg / tsiku.

Ana a zaka zapakati pa 10-15 - 600-1000 mg / tsiku.

Pachimake manic zinthu ndi thandizo mankhwala othandizira (kupuma) mavuto. Mulingo wosiyanasiyana ndi 400-1600 mg / tsiku mu 2 mgawidwe.

Childs, mankhwala ikuchitika pa mlingo wa 400-600 mg / tsiku 2 waukulu magawo. Mankhwalawa pachimake manic zinthu, mlingo wa Finlepsin achigonjetse ayenera kuchuluka kwambiri 800 mg / tsiku. Ndi chithandizo chowongolera cha kupuma kwamatenda, kuwonjezeka kwapang'onopang'ono kwa Mlingo wotsika kumalimbikitsidwa kuti mutsimikizire kulolerana bwino.

Mowa kusiya matenda. Wapakati mlingo ndi 600 mg / tsiku mu 2 waukulu magawo. Woopsa milandu, kumwa mankhwalawa mutha kuwonjezereka m'masiku ochepa (mwachitsanzo, mpaka 1200 mg / tsiku, logawidwa mu 2 waukulu). Kuwonetsedwa kwambiri kwa kusiya kumwa, mankhwalawa amayamba ndi kuphatikiza kwa Finlepsin retard ndi mankhwala osokoneza bongo (mwachitsanzo, clanzoazole, chlordiazepoxide), kutsatira malangizo omwe ali pamwambapa. Pambuyo pachimake gawo, mankhwala ndi Finlepsin chifuwa akhoza kupitiriza monga monotherapy.

Idiopathic trigeminal neuralgia ndi trigeminal neuralgia mu sclerosis yambiri (yofanana komanso atypical). Idiopathic neuralgia ya glossopharyngeal nerve. Mlingo woyambirira wa Finlepsin Retard ndi 200-400 mg / tsiku (100 mg 2 kawiri patsiku kwa odwala okalamba). Iyenera kuwonjezeka pang'onopang'ono mpaka ululu utazimiririka (nthawi zambiri mpaka mlingo wa 400-800 mg, wogawidwa mu Mlingo wa 1-2). Nthawi zina, mlingo wa tsiku ndi tsiku wa 1600 mg ungafunike. Pambuyo pakutha kwa ululu, mlingo uyenera kuchepetsedwa pang'onopang'ono mpaka osachepera kukonza.

Finlepsin Retard sayenera kukhazikitsidwa:

• ndi hypersensitivity yokhazikitsidwa kwa carbamazepine kapena mankhwala ofanana ndi mankhwala (tricyclic antidepressants), kapena zigawo zina za mankhwala,
• ndi AV block,
• mbiri yakulepheretsa kugwira ntchito kwa marow,
• odwala omwe ali ndi mbiri ya hepatic porphyria (mwachitsanzo, porphyria pachimake, porphyria wosakanikirana, porphyria wa khungu),
• kuphatikiza ndi mao inhibitors,
• kuphatikiza ndi voriconazole, chifukwa mankhwalawa angagwire ntchito.

Zotsatira zoyipa zomwe zimachitika nthawi zambiri zimachitika ndi mankhwala ophatikiza kuposa monotherapy. Kutengera mlingo komanso makamaka kumayambiriro kwa chithandizo, zovuta zina zimatha kuchitika. Mwambiri, amadzisungilira okha patatha masiku 8-14 kapena atasiya kuchepetsedwa kwakanthawi.

Mbali ya magazi ndi zamitsempha yamagazi: leukocytosis, eosinophilia, leukopenia, thrombocytopenia, kuperewera kwa folic acid, agranulocytosis, aplastic anemia, pancytopenia, erythrocytic aplasia, kuchepa kwa magazi, megaloblastic anemia, pachimake porphyria, hemgryria hemorrhage.

Kuchokera ku chitetezo chamthupi: mankhwala totupa ndi eosinophilia ndi zokhudza zonse zizindikiro (DRESS), anachedwetsa michere ambiri hypersensitivity ndi malungo, zotupa pakhungu, vasculitis, lymphadenopathy, zizindikiro zofanana ndi lymphoma, arthralgia, leukopenia. bile ducts (kuwononga ndi kuwonongeka kwa intrahepatic bile ducts), aseptic meningitis ndi myoclonus ndi zotumphukira eosinophilia, anaphylactic zimachitika, angioedema, hypogammaglobulinemia. Ziwalo zina (mwachitsanzo, chiwindi, mapapu, impso, kapamba, myocardium, matumbo akulu) zitha kukhudzidwa.

Kuchokera ku endocrine system: edema, kusungunuka kwa madzi, kuchuluka kwa thupi, kuchepa kwa magazi m'magazi m'magazi am'mimba kudzera mu zotsatira za carbamazepine, zofanana ndi zomwe zimachitika mu mahomoni a antidiuretic, omwe nthawi zina amabweretsa matenda oopsa, omwe amatsatiridwa ndi kufinya, kusanza, kupweteka mutu, kusokonezeka ndi mitsempha, kuchuluka kwa prolactin kapena popanda zizindikiro zamankhwala monga galactorrhea ndi gynecomastia, zotsatira zachilendo za mayeso a chithokomiro: kuchepa kwa L-thyroxine (FT 4, T 4, T 3) ndi kuchuluka kwa TSH, zomwe nthawi zambiri zimatha popanda chiwonetsero chazachipatala, kuchepa kwa mafupa a metabolism (kuchepa kwa calcium plasma ndi 25-hydroxycolecalciferol m'madzi am'magazi, zomwe zimapangitsa kuti osteomalacia / osteoporosis, kuchuluka kwa cholesterol, kuphatikiza cholesterol ya HDL ndi triglycerides. Kutsika kwa plasma a vitamini B 12 motsogozedwa ndi carbamazepine komanso kuwonjezeka kwa milingo ya Homocysteine ​​akunenedwanso.

Kuchokera kumbali ya kagayidwe kazakudya ndi mavuto akudya: kuperewera kwa folate, kuchepa kwamtima, porphyria pachimake, porphyria.

Kuchokera kumbali ya psyche: kuyerekezera zinthu (zowoneka kapena zamawu), kukhumudwa, kusowa kwa chakudya, kuda nkhawa, kuchita zinthu mwamtopola, kusokonezeka, kusokonezeka kwa manjenje, kusokonezeka, kusinthika kwa malingaliro, kusintha kwa malingaliro, kusinthasintha kwa nkhawa kapena kusinthasintha kwa malingaliro, phokoso, kusowa chilimbikitso, kusuntha kosafunikira, monga asterixis.

Kuchokera ku dongosolo lamanjenje: kufooka wamba, chizungulire, ataxia, kugona, kusinza, kutopa, kupweteka kwa mutu, kusokonezeka kwa Reflex, (mwachitsanzo, kunjenjemera, dystonia, nth), nystagmus, orofacial dyskinesia, kuganiza mochedwa, vuto la kuyankhula (mwachitsanzo dysarthria kapena mawu osakhazikika), choreoathetosis, zotumphukira neuropathy, paresthesia, kufooka kwa minofu ndi paresis, kulumala kukomoka, zilonda za antipsychotic syndrome, kuwonongeka kwa kukumbukira, vuto la atax ndi cerepatar, lomwe nthawi zina limayendetsedwa ndi mutu. oh zowawa.

Kuchokera kumbali ya gawo la masomphenyawo: conjunctivitis, malo operewera (diplopia, kusawona bwino), kuchuluka kwazomwezo, kuyendetsa ma lens, retinotoxicity, kusokonekera kwa oculomotor.

Kumbali ya chiwalo chothandizira kumva ndi zida zapamwamba: kumva kuwonongeka, tinnitus, tinnitus, hyperacusis, hypoacusia, kusokonezeka kwa kuzindikira kwa phula.

Kuchokera pamtima: intracardiac conduction chisokonezo, bradycardia, arrhythmia, kukulira kwa mtima wamatenda, mtima wosakhazikika, kugunda kwa magazi, AV blockade yokhala ndi syncope, matenda oopsa kapena hypotension, vasculitis, thrombophlebitis, thromboembolism (mwachitsanzo pulmonary embolism).

hypersensitivity kuchokera m'mapapu, yomwe imadziwika ndi kuwonjezeka kwa kutentha kwa thupi, kufupika, pulmonitis kapena chibayo. Zikatero hypersensitivity zimachitika, mankhwala ayenera anasiya.

kudya kwakachepa, kamwa yowuma, nseru, kusanza, kutsegula m'mimba, kudzimbidwa, kupweteka pamimba, stomatitis, gingivitis, glossitis, kapamba, khansa.

Matenda a hepatobiliary: kusintha kwa zisonyezero zoyeserera kwa chiwindi chogwira ntchito (kuchuluka kwa kusintha kwa gamma-glutamyl, kuchuluka kwa alkaline phosphatase, transaminases), jaundice, mitundu ingapo ya hepatitis (cholestatic, hepatocellular, granulomatous, osakanikirana), chiopsezo cha chiwopsezo cha hepatitis, chiwopsezo cha chiwindi.

Pa khungu ndi mafuta onunkhira: Matenda a chifuwa, urticaria, pruritus, kukoka kwa khungu, erythroderma, necrosis yapamwamba khungu ndi blistering (matenda a Lyell), photosensitivity, redensing ya khungu ndi polymorphic totupa mu mawonekedwe mawanga ndi mapangidwe maselo, zotupa zam'mimba. Stevens-Johnson), petechial hemorrhages in the khungu and lupus erythematosus (wogawa lupus erythematosus, alopecia), diaphoresis, kusintha kwa khungu pakhungu, ziphuphu, hirsutism, vasculitis, pu pura, kuchuluka thukuta, pachimake zowombetsa mkota exanthematous pustulosis (AGEP), lichenoid keratosis, onihomadez.

Kuchokera ku minculoskeletal system: arthralgia, myalgia, kukokana kwa minofu, kupweteka kwa minofu, kukomoka, kuchepa kwa mafupa a mineralens.

Kuchokera ku impso ndi kwamkodzo thirakiti: proteinuria, hematuria, oliguria, dysuria, polakiuria, kwamikodzo posungira, tubulointerstitial nephritis, kulephera kwaimpso, kuchuluka kwa magazi urea / azotemia, pafupipafupi kukodza.

Kuchokera pakubala kuphwanya kwa spermatogenesis (ndi kuchepa kwa chiwerengero ndi / kapena mphamvu ya spermatozoa), kukanika kwa erectile, kusabala, kuchepa chilakolako chogonana.

Matenda ndi zofalikira: kukonzanso kwa matenda a herpes virus VI.

Kupatuka kwa zotsatira zoyeserera zasayansi: hypogammaglobulinemia.

carbamazepine iyenera kuyang'aniridwa pokhapokha kuyang'aniridwa ndi achipatala, pokhapokha pofufuza phindu / zoopsa komanso kuyang'aniridwa mosamala kwa odwala omwe ali ndi mbiri ya mtima, chiwopsezo cha hepatic kapena aimpso, kusintha kwa hematological kwa mankhwala ena, kapena odwala omwe ali ndi vuto la carbamazepine.

Carbamazepine ikuwonetsa ntchito zochepa za anticholinergic, chifukwa chake, odwala omwe ali ndi vuto la intraocular ayenera kuchenjezedwa ndikufunsidwa za zomwe zingachitike pachiwopsezo.

Tiyenera kukumbukira za kutseguka kwa ma psychent ovomerezeka, komanso okhudzana ndi okalamba - zokhudzana ndi kuyambitsa chisokonezo ndi kukulitsa nkhawa.

Mankhwalawa nthawi zambiri amakhala osagwira chifukwa chotsalira (kukomoka pang'ono) komanso kugwidwa myoclonic. Amilandu ena amawonetsa kuti kudwala kowonjezereka kumatha kuchitika kwa odwala omwe akusowa kwa atypical.

Hematologic zotsatira. Kugwiritsa ntchito mankhwalawa kumalumikizidwa ndi kukula kwa agranulocytosis ndi aplastic anemia, koma chifukwa chochepa kwambiri pazomwe zimachitika, nkovuta kuyesa chiopsezo chachikulu mukamamwa carbamazepine.

Odwala ayenera kudziwa zoyambirira za kawopsedwe ndi chizindikiro cha kuthekera kwa hematologic, komanso zizindikiro za kukhudzana kwa khungu ndi chiwindi. Wodwalayo ayenera kuchenjezedwa kuti pakachitika zinthu monga kutentha thupi, zilonda zapakhosi, zotupa pakamwa, zilonda zamlomo, zotupa zomwe zimachitika mosavuta, kuloza hemorrhages kapena hemorrhagic purpura, muyenera kufunsa dokotala nthawi yomweyo.

Ngati kuchuluka kwa leukocytes kapena mapulateleti kuchepa kwambiri pakumwa, wodwalayo ayenera kuyang'aniridwa mosamala, komanso kuyezetsa magazi pafupipafupi kwa wodwalayo kuyeneranso kuchitidwa. Kuchiza ndi carbamazepine kuyenera kutha ngati wodwalayo atayamba kukhala ndi leukopenia, yomwe imakhala yolimba, yopita patsogolo, kapena yodziwika ndi matenda, monga malungo kapena zilonda zapakhosi. Kugwiritsa ntchito carbamazepine kuyenera kutha pomwe zizindikiro za kulepheretsa kwa ntchito m'mafupa zikuwonekera.

Nthawi ndi nthawi kapena nthawi zambiri pamakhala kuchepa kwakanthawi kapena kosasunthika kaamba ka mapulateleti kapena leukocytes pokhudzana ndi kutenga carbamazepine. Komabe, kwa ambiri mwa milandu iyi, kupusa kwawo kunatsimikiziridwa ndipo sikuwonetsa kukula kwa aplastic anemia kapena agranulocytosis. Asanayambe chithandizo komanso nthawi yamakhalidwe, kuyezetsa magazi kuyenera kuchitidwa, kuphatikizapo kutsimikiza kwa kupatsidwa zinthu za m'magazi (komanso, mwina, kuchuluka kwa reticulocytes komanso kuchuluka kwa hemoglobin).

Zoopsa zazakhungu. Zovuta zazikulu za dermatological, kuphatikiza poizoni wa epidermal necrolysis (TEN) kapena matenda a Lyell, a Stevens-Johnson syndrome (SJS), ndizosowa kwambiri ndi carbamazepine. Odwala omwe ali ndi vuto lalikulu la dermatological angafunike kuchipatala, chifukwa izi zitha kukhala zowopsa m'moyo ndipo zimatha kufa. Milandu yambiri ya SJS / TEN imayamba mu miyezi ingapo yoyambirira ya mankhwala a carbamazepine. Ndi chitukuko cha zizindikiro ndi zizindikiritso zoopsa za dermatological reaction (SJS, matenda a Lyell / TEN), carbamazepine iyenera kusiyidwa pomwepo ndipo njira zina zochiritsira ziyenera kutumizidwa.

Mankhwala. Pali umboni wowonjezereka wa zotsatira za ma HLA osiyanasiyana pamawonekedwe a wodwalayo pazovuta zomwe zimakhudzana ndi chitetezo chathupi.

Kuyankhulana ndi (HLA) -B * 1502. Kafukufuku wofufuzira odwala aku China amtundu wa Khan adawonetsa kulumikizana pakati pakusintha khungu kwa SJS / TEN yokhudzana ndi carbamazepine ndi kukhalapo kwa leukocyte antigen (HLA), allele (HLA) -B * 1502 mwa odwalawa. Malipoti ochuluka okhudza kukhazikitsidwa kwa SJS (m'malo osowa kwambiri) ali ndi mbiri ya maiko ena ku Asia (mwachitsanzo, zilumba za Taiwan, Malaysia ndi Philippines), komwe allele (HLA) -B * 1502 ilipo pakati pa anthu. Chiwerengero chaonyamula awa pamtundu wa Asia ndi> 15% ku Philippines, Thailand, Hong Kong ndi Malaysia, ≈10% - pa Fr. Taiwan, pafupifupi 4% - ku Northern China, ≈2-4% - ku South Asia (kuphatikiza India) ndi mawonekedwe a Mlingo: & nbsp mapiritsi

Piritsi limodzi lili:

ntchito yogwira : carbamazepine 200 mg kapena 400 mg,

obwera : ethyl acrylate, methyl methacrylate ndi trimethylammonioethyl methacrylate kopolymer (Eudragit ® RS 30 D), triacetin, talc, methaconic acid ndi ethyl acrylate Copolymer (Eudragit ® L 30 D-55), microcrystalline cellulose, rospovidon, colospose.

Kutulutsa mapiritsi a 200 mg:

Mapiritsi a 400 mg osasinthika: kuyambira oyera kufikira oyera okhala ndi tint wachikasu, mapiritsi okhala ozungulira okhala ndi mbali zokutidwa, okhala ndi mizere yolakwika mbali zonse ziwiri ndi zinkhanira zinayi kumbali yakumaso.

Gulu la Pharmacotherapeutic: antiepileptic wothandizira ATX: & nbsp

Pharmacodynamics: Mankhwala othandizira antiepileptic (dibenzazepine derivative), amenenso ali ndi antidepressant, antipsychotic ndi antidiuretic zotsatira, ali ndi mphamvu ya analgesic kwa odwala a neuralgia. Limagwirira ntchito limalumikizidwa ndi blockade yamagetsi yamagetsi-gated sodium, komwe kumayambitsa kukhazikika kwa membrane wa overexcited neurons, kuletsa mawonekedwe a serial kutulutsa kwa neurons ndi kuchepa kwa synaptic impulse impuction. Imalepheretsa kupangidwanso kwa Na + -kudalira kothandizirana mu ma neurons a depolarized. Kuchepetsa kumasulidwa kwa kukondoweza kwa neurotransmitter amino acid glutamate, kumakulitsa kuchepa kwapang'onopang'ono kwa chapakati mantha dongosolo, motero, kumachepetsa chiopsezo chodwala khunyu. Imawonjezera kuyendetsa kwa K +, modulates vol-gated Ca 2+ njira, zomwe zimathandizanso pakuyambitsa kwa anticonvulsant ya mankhwala.

Ndiwothandiza kugwidwa koyang'ana (pang'ono komanso kovuta), kutsagana kapena kutsagana ndi kutsika kwachiwiri, kugwidwa konsekonse kwamtundu wamtundu umodzi, komanso kuphatikiza mitundu iyi ya kukomoka (nthawi zambiri sikothandiza kwa kugwidwa kwakanthawi - zilonda zapakhosi, kusowa ndi kugwirira myoclonic. )

Odwala omwe ali ndi khunyu (makamaka ana ndi achinyamata) amakhala ndi zotsatira zabwino pazizindikiro za nkhawa komanso kukhumudwa, komanso kuchepa kwa kusakwiya komanso kukwiya.

Zokhudzana ndi kuzindikira kwa ntchito ndi psychomotor magwiridwe ake amadalira mlingo. Kukhazikika kwa anticonvulsant zotsatira kumasiyana kwa maola angapo mpaka masiku angapo (nthawi zina mpaka mwezi umodzi chifukwa chogwiritsa ntchito kagayidwe kachakudya).

Pogwiritsa ntchito neuralgia yofunikira komanso yachiwiri ya trigeminal nthawi zambiri imalepheretsa kuwoneka kwa ululu.

Kupumula kwamphamvu mu trigeminal neuralgia kumadziwika pambuyo pa maola 8-72.

Ndikumwa mowa mwauchidakwa, kumawonjezera mpata wokonzekera zolimba, zomwe nthawi zambiri zimachepetsedwa pamenepa, ndikuchepetsa zovuta zomwe matendawa amawonetsa pakuwonekera kwa matenda (kuwonjezereka kwa mkwiyo, kunjenjemera, matenda a gait).

Machitidwe a antipsychotic (antimaniacal) amakula pambuyo pa masiku 7-10, mwina chifukwa cha kuletsa kwa kagayidwe ka dopamine ndi norepinephrine.

Kutalika kwa nthawi yayitali kumathandizira kuti magazi azisungika kwambiri m'magazi mukamamwa 1-2 pa tsiku.

Mafuta amayamba pang'onopang'ono koma amphumphu (kudya sikumakhudza kwambiri kuchuluka ndi mayamwidwe). Pambuyo pa gawo limodzi la piritsi, kuchuluka kwakukulu kumafikira pambuyo pa maola 32. Mtengo wapakati wazinthu zosasinthika pambuyo pa gawo limodzi la 400 mg ya carbamazepine ndi pafupifupi 2.5 μg / ml. Kufanana kwa mankhwalawa kwa plasma kumachitika pambuyo pa masabata 1-2 (kuchuluka kwa zomwe zimachitika zimadalira umunthu wa kagayidwe kake: kuyambitsa kwamphamvu kwa ziwonetsero za chiwindi, kupatsidwa kwa hetero ndi mankhwala ena omwe amagwiritsidwa ntchito munthawi yomweyo), komanso pamankhwala omwe wodwala ali nawo, kuchuluka kwa mankhwalawa komanso nthawi yayitali ya chithandizo. Kusiyanitsa kwakukulu pamalingaliro azitsulo zomwe anthu amawerengera amawerengedwa: mwa odwala ambiri, izi zimayambira ku 4 mpaka 12 μg / ml (17-50 μmol / l). Kuzungulira kwa carbamazepine-10,11-epoxide (pharmacologically yogwira metabolite) pafupifupi 30% ya kuchuluka kwa carbamazepine. Kuyankhulana ndi mapuloteni a plasma mwa ana - 55-59%, mwa akulu - 70-80%. Kuchulukitsa komwe kumawoneka ndi 0.8-1.9 l / kg. Kuzindikira kumapangidwa mu madzi am'magazi ndi malovu, omwe ali olingana ndi kuchuluka kwa zinthu zomwe sizimagwira ndi mapuloteni (20-30%). Imalowa mkati mwa chotchinga chachikulu. Kulowerera mkaka wa m'mawere ndi 25-60% ya plasma.

Zimapukusidwa mu chiwindi, makamaka panjira ya epoxy ndikupanga ma metabolites akuluakulu: yogwira carbamazepine-10,11-epoxide komanso yolumikizana ndi glucuronic acid. Isoenzyme yayikulu yomwe imapatsa biotransformation ya carbamazepine kwa carbamazepine-10,11-epoxide ndi cytochrome P450 (CYP3A4). Zotsatira zamtunduwu wa metabolic, metabolite ya 9-hydroxymethyl-10-carbamoylacridane imapangidwanso, yomwe imakhala ndi kufooka kwa pharmacological. imatha kupangitsa kagayidwe kake.

Hafu ya moyo pambuyo pakupeza mlingo umodzi ndi maola 60-100 (pafupifupi maola 70), mutagwiritsidwa ntchito kwa nthawi yayitali, theka la moyo limachepetsedwa chifukwa chodzipangira okha ma enzymme a chiwindi. Pambuyo pakamwa kamodzi pa carbamazepine, 72% ya mankhwalawo amachotsedwamo mkodzo ndi 28% ndi ndowe, pomwe 2% ya mlingo womwe umamwa umayatsidwa mu mkodzo ngati carbamazepine wosasinthika, ndipo pafupifupi 1% mu mawonekedwe a metabolite ya 10,11-epoxy.

Palibe umboni kuti pharmacokinetics of carbamazepine kusintha kwa okalamba.

Matenda a khunyu: kugwidwa koyambira kwakukulu (kupatula komwe kulibe), mitundu yina ya khunyu (yosavuta komanso yolimba), kukomoka kwachiwiri.

Trigeminal neuralgia,

Idiopathic glossopharyngeal neuralgia,

Ululu ndi kuwonongeka kwa mitsempha ya m'mitsempha yam'mimba, kupweteka kwa matenda a shuga

Epileptiform kupweteka kwa angapo sclerosis, mawonekedwe a nkhope ndi trigeminal neuralgia, kupweteka kwa tonic, mawu a paroxysmal ndi zovuta kusuntha (paroxysmal dysarthria and ataxia), paroxysmal paresthesias ndi kupweteka kwapadera.

Hyperal kusiya matenda (nkhawa, kukhumudwa, Hyper kusangalala, kugona tulo),

Matenda a Psychotic (kusokonezeka ndi zovuta za schizoaffective, psychoses, kusokonezeka kwa machitidwe a limbic).

Hypersensitivity kwa carbamazepine ndi zina za mankhwala, komanso tricyclic antidepressants,

Mavuto a mafupa a hematopoiesis (magazi m'thupi, leukopenia),

Pachimake porphyria (kuphatikizapo mbiri)

Imodzi munthawi ya kukonzekera kwa lithiamu ndikukonzekera ma MAO zoletsa.

Kuwonongeka kwa mtima kwakakomoka,

Kubereka hyponatremia (ADH hypersecretion syndrome, hypopituitarism, hypothyroidism, adrenal cortex insuffence),

Matenda a chiwindi ndi impso,

Kuledzera komwe kumagwira ntchito (kupsinjika kwa CNS kumakulirakulira, carbamazepine metabolism imakulitsa),

Kuletsa kwa mafupa hematopoiesis ndi mankhwala (mbiri),

Prostatic hyperplasia

Kuchulukitsa kwapanikizika,

Kuphatikizira ndi sedative-hypnotics.

Mimba ndi kuyamwa:

Pomwe zingatheke, Finlepsin ® retard imalembedwa kwa akazi amisinkhu yobala, muyezo wotsika kwambiri, popeza kuchuluka kwa kubereka kwa akhanda kuchokera kwa amayi omwe amamwa mankhwala oletsa antiepileptic kumakhala kwakukulu kuposa ndi monotherapy.

Mimba ikachitika, ndikofunikira kuyerekeza phindu lomwe mungayembekezere la chithandizo chamankhwala ndi zovuta zomwe zingatheke, makamaka munthawi yoyamba kubereka.Amadziwika kuti ana a amayi omwe ali ndi vuto la khunyu amakhala okonzekera kutukuka kwa intrauterine, kuphatikizapo kusokonekera. Fardlepsin ® retard ikhoza kuwonjezera ngozi za zovuta izi. Pali malipoti apadera a matenda obadwa nawo komanso kusokonezeka, kuphatikizapo kusatsekedwa kwa ziphuphu zakumaso (spina bifida).

Mankhwala othandizira antiepileptic amalimbikitsa kuchepa kwa folic acid, omwe nthawi zambiri amawonedwa panthawi yomwe ali ndi pakati, omwe amatha kukulitsa vuto la kubadwa kwa ana, chifukwa chake kutenga folic acid kumalimbikitsidwa asanakonzekere pakati komanso panthawi yomwe ali ndi pakati. Pofuna kupewa zovuta za hemorrhagic mwa akhanda, amayi omwe ali m'milungu yotsiriza ya mimba, komanso akhanda, amalimbikitsidwa kuti apereke vitamini K1.

Carbamazepine imadutsa mkaka wa m'mawere, motero maubwino komanso zosafunikira zoyamwitsa ziyenera kufananizidwa ndi chithandizo chanthawi zonse. Ndi kuyamwitsa mopitilira kumwa mankhwalawa, kuyang'anira mwana kuyenera kukhazikitsidwa pokhapokha ngati mukukumana ndi zovuta (mwachitsanzo, kugona kwambiri, khungu lanu siligwirizana).

Mlingo ndi makonzedwe:

Mkati, panthawi yakudya kapena itatha, mumamwa madzi ambiri.

Kuti mugwiritse ntchito mosavuta, piritsi (komanso theka kapena kotala) limatha kusungunuka kale m'madzi kapena madzi, popeza malo omwe amatulutsira ntchito kwa nthawi yayitali atatha kuyimitsa piritsi ndi madzi. Mlingo wambiri womwe umagwiritsidwa ntchito ndi 400-1200 mg tsiku lililonse, womwe umagawidwa mu Mlingo wa 1-2 patsiku.

Pazipita mlingo tsiku lililonse sayenera kupitirira 1600 mg.

Pomwe zingatheke, Finlepsin® retard iyenera kutumizidwa ngati monotherapy. Chithandizo chimayamba ndikugwiritsa ntchito mlingo wocheperako tsiku lililonse, womwe umayamba kuwonjezeka pang'onopang'ono mpaka utakwaniritsidwa. Kuphatikizidwa kwa Finlepsin ® retard to antiepileptic therapy kuyenera kuchitika pang'onopang'ono, pomwe Mlingo wa mankhwala omwe amagwiritsidwa ntchito sasinthidwa kapena, ngati kuli koyenera, akukonzedwa. Ngati wodwalayo wayiwala kumwa mlingo wotsatira wa mankhwalawa munthawi yake, mlingo womwe watayika uyenera kumwedwa nthawi yomweyo mukazindikira izi, ndipo simungathe kumwa mankhwalawo pawiri.

Mlingo woyambirira ndi 200-400 mg patsiku, ndiye kuti mwambowu umakulitsidwa pang'onopang'ono mpaka zotsatira zabwino zithe. Mlingo wokonza ndi 800-1200 mg tsiku lililonse, womwe umagawidwa mu Mlingo wa 1-2 patsiku.

Mlingo woyambirira wa ana kuyambira zaka 6 mpaka 15 ndi 200 mg patsiku, ndiye kuti mlingo umakulitsidwa pang'onopang'ono ndi 100 mg patsiku mpaka zotsatira zabwino.

Zizindikiro zogwiritsidwa ntchito

Finlepsin yolimbikitsidwa matenda angapo kuphatikiza:

• neuralgia
• khunyu
• nyengo zingapo zopweteketsa
• zokhudzana ndi malingaliro
• kusiya mowa

Dokotalayo amapanga nthawi yochita payekha motsatira malangizo ndi zofunikira za matenda. Kudzilamulira nokha pa mankhwala sikulimbikitsidwa.

Contraindication

Finlepsin osavomerezeka:

• kusalolera kwa chimodzi mwazigawo kapena kwa ma atidepressants (tricyclic)
• Kugwiritsa ntchito kwa MAO zoletsa kapena kukonzekera kwa lithiamu
• mavuto a mafupa hematopoiesis
• AV blockade
• pachimake porphyria

Mosamala kwambiri, mapiritsi amayikidwa kuti:

• ndi kuphwanya impso, chiwindi, mtima dongosolo
• odwala okalamba
• ntchito zofananira zamisala kapena mapiritsi ogona
• kuchuluka kwa mavuto (intracranial, intraocular)
• matenda a prostate
• uchidakwa wosatha

Zotsatira zoyipa za ntchito Finlepsin ikhoza kupereka kuphwanya lamulo lililonse kuti mugwiritse ntchito, mwachitsanzo, bongo. Mu mitundu iyi, kusokonezeka kwa magwiridwe antchito amanjenje ndi endocrine, komanso mu hematopoietic system, titha kuzindikira. Kulephera kutsatira malangizo omwe ali pamatchulidwe amtunduwu kumatha kuyambitsa mavuto osakhalitsa am'mutu kapena mseru, komanso zovuta zazikulu: leukocytosis, leukopenia, ndi zina zambiri.

Finlepsin imakhala ndi carbamazepine (chinthu chofunikira) komanso magawo othandizira: magnesium stearate, gelatin, croscarmellose sodium, MCC, ndi zina. mawonekedwe a mankhwalawo ndi mapiritsi. Mankhwalawa amalimbikitsidwa kuti amwe pokhapokha ngati adokotala adauzidwa komanso mogwirizana ndi malangizo.

Mapiritsi a Finlepsin: malangizo ogwiritsira ntchito

Finlepsin Mapiritsi malinga ndi malangizo ogwiritsira ntchito amapangidwira pakamwa, osaneneka pakudya. Kutengera ndi kuopsa kwa mikhalidwe kapena matenda ndi chithunzi chachikulu chachipatala, achikulire atha kupatsidwa mankhwala osachepera 200 mg (piritsi 1, chithandizo choyambirira), mankhwalawa akukonzekera kumwa mankhwalawa akuphatikiza kumwa 800 mg00 mg tsiku lililonse (logawidwa patupata tambiri). Mlingo woyenera wovomerezeka ndi 1.2-2 g Asanathe maphunzirowo, mlingo wa mankhwalawo umachepetsedwa pang'ono ndi pang'ono. Malinga ndi malangizowo, kusiya kwambiri kuvomereza kumatha kubweretsa mavuto. Ana, pamaziko a zisonyezo, akulimbikitsidwa kuti ayambe kumwa ndi mankhwalawa "Finlepsin Bweretsani "mgulu la 200 mg (analogue).

Ndi neuralgia ndingatenge?

Finlepsin amathandizira ndi neuralgia ya trigeminal, koma odwala ena anena kuti izi zinayambitsa chidwi, zomwe zinayambitsa kuchepa kwa kulumikizana ndi anthu. Mulimonse momwe zingakhalire, kuikidwiraku kumachitika ndi katswiri, chifukwa chake, ngati zosafunikira (mbali) zikuwoneka, muyenera kusiya kumwa mankhwalawo ndikuyang'ana dokotala wanu kachiwiri.

Pa mimba komanso ana angathe?

Pa nthawi yomwe mayi ali ndi pakati, azimayi amapatsidwa mankhwala, ngati n`kotheka, kuthandizira muyezo umodzi wa mankhwalawa. Izi zimachepetsa chiopsezo cha kubereka kwa mwana wosabadwayo. Kukhazikitsidwa kwa maphunziro ovomerezeka kumatsimikiziridwa ndi adokotala okha, malinga ndi zomwe wodwala akuonetsa. Malangizo omwewo, malinga ndi malangizo ogwiritsira ntchito, akuwonekeranso munthawi ya mkaka wa mkaka.

Kupangira analimbikitsa ana Finlepsin Retard (analogue) pamapiritsi a 200 mg:

• Zaka 1-5 - mulingo woyenera kwambiri ndi 400 mg patsiku (yambani kutenga, pang'onopang'ono kuchuluka kwa 200 kuchokera ku 400 mg kwawonetsedwa)
• 6-10 - pazipita tsiku lililonse 600mg
• Zaka 11 mpaka 15 - zovomerezeka tsiku lililonse zosachepera 1000 mg

Finlepsin achigonjetse

Malinga ndi malangizo ogwiritsira ntchito Finlepsin Amayamba kutenga chisamaliro mosamala, pang'onopang'ono kukulitsa mlingo. Mlingo umatengera zisonyezo: kuopsa kwa matendawa, mawonekedwe ake, zaka zake ndi machitidwe a thupi. Nthawi zina, ndizololeka kubweza Finlepsin Pobwerera ku analogue, adokotala yekha ndi omwe angapange chisankho.

Finlepsin ndi mowa zimagwirizana?

Zimatsimikiziridwa kuti chophatikizira chachikulu cha mankhwalawa chimachepetsa mphamvu ya Mowa. Komabe, malingana ndi malangizo ogwiritsira ntchito, sikulimbikitsidwa kuphatikiza mapiritsi ndi kumwa zakumwa zoledzeretsa - kuwopseza kwa zovuta zoyipa ngakhale zovuta zazikulu zimachulukirachulukira.

Zofananira zazikulu za mankhwala a Finlepsin (mapiritsi):

• Carbalepsin Retard (INN)
• Zeptol
• Zovomerezeka
• Tegretol
• Zagretol
• Stazepine

Dokotala wokha ndi amene angapereke malangizo ndi kupereka analog kuti mugwiritse ntchito. Malinga ndi malangizo ogwiritsira ntchito, kudziyendetsa pawokha sikulimbikitsidwa.

Kodi ndindalama zingati?

Mankhwala ndi mankhwala ndipo amawagwiritsa ntchito pokhapokha ngati akuwapatsa mankhwala. Mtengo wa mankhwalawa umasiyanasiyana monga ma ruble 200-280 (kutengera mlingo ndi mankhwala a pharmacy).

Zizindikiro zogwiritsidwa ntchito Finlepsin chachikulu. Akatswiri amawona kugwira kwake ntchito kwambiri pochiza mikhalidwe yambiri ndi matenda mosamalitsa kwambiri pamalangizo, monga zikuwonetsedwa ndi ndemanga zawo zabwino.

Malingaliro a odwala ndi ofanana makamaka ndi malingaliro a asing'anga, koma kuwonjezera pa kuwoneka bwino, zotsatira monga kuchepa kwa luntha, kudziwa kosakhazikika, ndi zina zotchulidwa. Nthawi zina, malingaliro adanenedwa kuti alowetse mapiritsi ndi analogues.

Khalidwe la Finlepsin

Wopangayo amapereka mankhwalawa monga mapiritsi okhala ndi 200 mg ya carbamazepine monga chophatikizira. Izi zimakhudza maselo aubongo, poletsa kupezeka kwa kukhudzidwa kwa mitsempha. Chifukwa cha izi, Finlepsin amapereka zotsatirazi zochizira:

• anticonvulsant, kuphatikizapo khunyu,
• anti-manic, kuchepetsa nkhawa, kusachedwa, kuwonetsa kukhumudwa,
• mankhwala ochita kupukusa osiyanasiyana a mitsempha, mwachitsanzo, mitsempha.

Mankhwalawa amathandizidwanso kuti azikhala wololera komanso wodwala yemwe amayamba chifukwa cha uchidakwa.

Finlepsin akuwonetsedwa mwa matenda otsatirawa:

• khunyu, kuphatikiza mitundu yake yosiyanasiyana,
• kupweteka kwa khunyu komwe kumachitika ndi ma sclerosis ambiri, paresthesia, diazartria ndi ma pathologies ena,
• kupweteka kwa mitsempha ndi kuwonongeka kwa mitsempha yotumphukira, kuphatikizapo kuyambitsa matenda a shuga,
• neuralgia wachidziwikire,
• Matenda amisala, kuphatikizapo omwe adapangidwa ndi kuledzera kwa thupi,
• monga mbali ya chithandizo chokwanira chazoyambira kulekeka.

Mankhwalawa ali ndi zotsutsana zambiri, kotero simungathe kuzigwiritsa ntchito popanda mankhwala a dokotala. Mwa zina mwa thupi zomwe sizikulimbikitsidwa kugwiritsa ntchito Finlepsin ndi hematopoiesis, atrioventricular block, porphyria, ndi tsankho la munthu pazigawo za mankhwala.

Poyerekeza ndi chithandizo cha mankhwala a Finlepsin, kukula kwa zovuta zoyambira m'mimba, mantha, mtima, endocrine, genitourinary system, musculoskeletal system, ziwalo zam'maganizo ndikupanga magazi. Mndandanda wazotsatira ndizitali. Ngati pali zizindikiro zilizonse zoipa, siyani kumwa mapiritsi ndi kukaonana ndi dokotala.

Finlepsin ali osavomerezeka ngati pali kuphwanya mapangidwe magazi, atrioventricular block, porphyria, tsankho la munthu pazigawo za mankhwala.

Kuyerekezera Mankhwala

Mankhwala ndi ofanana m'njira zambiri, koma amasiyana.

Zokonzekera zimakhala ndi zosakaniza zomwe zimagwiritsidwa ntchito, zimakhala ndi zofananira zomwe zingagwiritsidwe ntchito. Simalimbikitsidwa kuti azigwiritsidwa ntchito pogwiritsa ntchito thupi komanso zikhalidwe za thupi. Zotsatira zoyipa zomwe zimayambitsidwa ndimankhwala ndizofanana.

Mankhwala amapangidwa ndi mmodzi wopanga - kampani yopanga ya transatlantic Teva. Mankhwala onse awiri amapezeka pamankhwala.

Kodi pali kusiyana kotani?

Finlepsin retard imasiyana ndi yomwe idalipo kale. Kamodzi m'thupi, ziwalo zake zimamasulidwa pang'onopang'ono, chifukwa cha kuchuluka kwa mankhwalawa kumakhalapo kwa nthawi yayitali. Izi zimakhudza zoyipa - chiwopsezo cha kupezeka kwawo chimachepa.

Kuchepetsa Finlepsin kumayambitsa mavuto ambiri, kuphatikizapo nseru, kusanza, kugona, kusokonezeka, ndi mavuto amaso.

Ndemanga za Odwala

Marina, wazaka 27, Ryazan: “Ndinkakumana ndi Finlepsin pamene apongozi anga agwidwa. Sanali wodwala, koma amafanana ndi amenewo. Dotolo adayikira mankhwalawa, akunena kuti samagwiritsidwa ntchito kokha ndi odwala omwe ali ndi khunyu, komanso anthu omwe ali ndi vuto lalikulu. Apongozi ake adayamba kumwa mapiritsi, koma adayamba kudandaula chifukwa chizungulire komanso mseru. Ndidayenera kubwerera kwa dotolo yemwe adalamula Finlepsin retard. Abambo amalekerera bwino mapiritsi awa. ”

Irina, wazaka 41, Voronezh: “Finlepsin anapatsidwa mwayi wokhala ndi mwamuna wake atadwala matenda a hemorrhagic. Mnzake amamwa mapiritsi mwezi wachiwiri. Samadandaula za mavuto. Mkwatiyo akumva bwino, dokotalayo akutsimikizira kuti zotsatirapo zake ndi zabwino. ”

Madokotala amawunika Finlepsin ndi Finlepsin retard

Igor, wothandizira, wazaka 45, Nizhny Novgorod: "Mankhwalawa onse ndi othandiza kwambiri, opatsa chidwi ndi odwala. Mtengo wotsika mtengo. ”

Vladimir, wamisala, wazaka 51, Bryansk: "Kutengera ndi matendawo komanso thanzi la wodwalayo, ndimapereka mankhwala a Finlepsin kapena analogue of yaitali. Ndikhulupirira kuti mankhwalawa onse ndi othandiza. Zotsatira zoyipa zimakhala, koma kawirikawiri, ngati wodwalayo atsatira malangizo a chipatala. Kuphatikizanso ndi mtengo wa mankhwala: umapezeka kwa aliyense. ”