Saroten retard: malangizo ogwiritsira ntchito

Mukamatenga makapisozi a Saroten Retard, bwino bwino kumamwa ndi madzi. Makapisozi, komabe, amatha kutsegulidwa ndipo zomwe zili mkati mwake (ma pellets) zimatha kumwedwa ndi pakamwa. Mapelesi sayenera kutafunidwa.

Chigawo chokhumudwitsa. Mavuto azovuta mu schizophrenia. Imafotokozedwa kamodzi pa tsiku kwa maola 3-4 asanagone.

Kuchiza ndi Saroten Retard kuyenera kuyambitsidwa ndi kapisozi 50 mg imodzi yamadzulo. Ngati ndi kotheka, pakatha sabata, tsiku ndi tsiku mlingo ungathe kuwonjezeka pang'onopang'ono mpaka 2 - 3 makapisozi madzulo (100-150 mg). Mukakwaniritsa kusintha kwakukulu, mlingo wa tsiku ndi tsiku umatha kuchepetsedwa pang'ono, mwinanso mpaka makapisozi a 1-2 (50-100 mg / tsiku).

Vuto lothandizira antiepepressant limayamba pambuyo pa masabata awiri ndi awiri. Chithandizo cha kupsinjika maganizo ndichizindikiro, chifukwa chake, tikulimbikitsidwa kupitiliza kugwiritsa ntchito mankhwala ochepetsa nkhawa, kuphatikizapo Saroten Retard, mutakwaniritsa zomwe munanena kwa nthawi yayitali mpaka - miyezi 6 kupewa kubwereranso m'mbuyo. Odwala omwe ali ndi vuto la kubwerezabwereza (unipolar), makonzedwe a nthawi yayitali a Saroten Retard angafunike, mpaka zaka zingapo, pakukonzekera Mlingo womwe umakhala ndi anti-relocer.

Okalamba okalamba (woposa zaka 65)

Mmodzi 50 mg kapisozi madzulo.

Ntchito ya impso

Amitriptyline akhoza kutumikiridwa mwachizolowezi Mlingo wa odwala ndi aimpso kulephera.

Kuchepa kwa chiwindi

Muyenera kusamala mukamagwiritsa ntchito mankhwalawa odwala omwe ali ndi vuto la chiwindi, ma seramu amitriptyline ayenera kuyang'aniridwa ngati kuli kotheka.

Pambuyo pakuchotsa chithandizo, kusiya mankhwala kumalimbikitsidwa kuti zizichitika pang'onopang'ono kwa milungu ingapo kuti tipewe kuyambika kwa "kusiya" (onani gawo "Zotsatira zoyipa").

Zotsatira za pharmacological

Amitriptyline ndi mankhwala antidepressant atatu. Amine a tertiary amine, amitriptyline, mu vivo pafupifupi amalepheretsa kubwezeretsanso kwa norepinephrine ndi serotonin kumapeto kwa mitsempha ya Presynaptic. Metabolite yake yayikulu, nortriptyline, imalepheretsa kubwezeretsanso kwa norepinephrine motsimikiza kwambiri kuposa serotonin. Amitriptyline ali ndi m-anticholinergic, antihistamine ndi mphamvu yosinthi, imathandizira zochita za catecholamines.

Saroten Retard imathandizira kukhumudwa kwachilengedwe, kugwiritsa ntchito kwake kumakhala kothandiza kwambiri pakuchotsa matenda amkati ndi ma pulypical depressions, koma amathanso kuchepetsa zizindikiro za zovuta zina.

Chifukwa chakuwongolera, Sarotin Retard ndiwofunikira kwambiri mankhwalawa a nkhawa ndi kukhumudwa, kukhumudwa, nkhawa komanso kugona. Monga lamulo, antidepressant zotsatira zimachitika mkati mwa masabata 2-4

Pharmacokinetics

Chifukwa chakumasulidwa pang'onopang'ono kwa amitriptyline kuchokera ku makapisozi amachitidwe, kutsata kwa plasma kumawonjezera kusala,

kuchuluka kwakukulu kumeneku kuli pafupifupi 50% poyerekeza ndi mapiritsi omwe amasulidwa nthawi yomweyo. The ambiri ndende ya madzi am`magazi (T_mosamala) imafikiridwa pasanathe maola 4.

Oral bioavailability: pafupifupi 48%. Nortriptyline yopangidwa nthawi ya Presystemic metabolism imakhalanso ndi antidepressant.

Kuchulukitsa komwe kumawoneka ndi pafupifupi 14 l / kg. Mlingo womangidwa kumapuloteni a plasma pafupifupi 95%.

Amitriptyline ndi nortriptyline kudutsa placental zotchinga.

Metabolism ya amitriptyline imachitika makamaka chifukwa cha demethylation (isoenzymes CYP2D19, CYP3A) ndi hydroxylation (isoenzyme CYP2D6), motsatiridwa ndi kuphatikizika ndi glucuronic acid. Metabolism imadziwika ndi ma genetic polymorphism. Metabolite yayikulu yogwira ndi amine yachiwiri - nortriptyline. Ma metabolites cis- ndi trans-10-hydroxyamitriptyline ndi cis- ndi trans-10-hydroxynortriptyline amadziwika ndi zochitika zofananira ndi nortriptyline, ngakhale mphamvu zawo sizitchulidwa pang'ono. Demethylnortriptyline ndi amitriptyline-I-oxide amapezeka mu plasma mozindikira mosaganizira, metabolite yotsirizayi imakhala yopanda zochitika zamankhwala. Poyerekeza ndi amitriptyline, ma metabolites onse samatchulidwa m-anticholinergic kwenikweni.

Hafu ya moyo wa amitriptyline ndi maola pafupifupi 16 (± 6). Hafu ya moyo wa nortriptyline ndi maola pafupifupi 31 (± 13). Kutulutsa kwathunthu kwa amitriptyline ndi 0,9 l / min.

Imapukutidwa makamaka ndi impso. Zosasinthika, pafupifupi 2% ya mlingo wovomerezeka wa amitriptyline amachotsedwa.

Amitriptyline ndi nortriptyline amathandizidwa mu mkaka wa m'mawere. Kuwerengera kwa mkaka wa m'mawere ndi madzi am'magazi ndi pafupifupi 1: 1.

Equilibrium plasma wozungulira amitriptyline ndi nortriptyline mwa odwala ambiri amafikiridwa mkati mwa masiku 7-10. Mukamagwiritsa ntchito makapisozi omasulira nthawi yayitali kumadzulo, kuchuluka kwa ma amitriptyline kumafika mpaka pakanthawi kochepa usiku ndikuchepera masana, pomwe nortriptyline imakhazikika masana.

The achire plasma ndende ya amitriptyline ndi nortriptyline pa matenda a kukhumudwa ndi 370-925 nmol / L (100-250 ng / ml). Kuzindikira pamwambapa kwa 300-400 ng / ml kumalumikizidwa ndi chiwopsezo chowonjezeka cha kusokonezeka kwa mtima komanso kupezeka kwa AV block ndi QRS kukulitsa

Odwala ndi mkhutu aimpso ntchito

Kuwonongeka kwa impso sikukhudza pharmacokinestic, shedgiptilina kapena nortriptyline, Komabe, zotupa za metabolites zimachepetsedwa.

Odwala omwe ali ndi vuto la chiwindi

Kuchepa kwa chiwindi kungachepetse kagayidwe ka antidepressants atatu. .

Deta Yotetezera

Ma Tricyclic antidepressants ali ndi poizoni wamphamvu.

Kafukufuku wa kawopsedwe awonetsa kuti kuwopsa kwa amitriptyline mu mawonekedwe osungirako akumasamba ndikotsika kwambiri poyerekeza ndi mlingo womwewo wa amitriptyline ndikamasulidwa nthawi yomweyo.

Kwa zaka zopitilira 40 mukamagwiritsa ntchito pa nthawi yoyembekezera, zolakwika zazikulu zakubadwa kapena zamakhalidwe sizinanenedwe.

Zizindikiro zogwiritsidwa ntchito

Matenda okhumudwa (makamaka ndi nkhawa, kukhumudwa ndi kusokonezeka kwa kugona, kuphatikiza paubwana, amkati, zochotseka, zotakasika, zamitsempha, mankhwala osokoneza bongo, zotupa zochotsa bongo), zovuta zama psychizophrenic, kusokonezeka kwamalingaliro, zochita (zovuta) ndi chidwi), nocturnal enuresis (kupatula kwa odwala omwe ali ndi vuto la chikhodzodzo), bulimia amanosa, ululu wammbuyo (ululu waukulu kwa odwala khansa, migraine, matenda amitsempha, kupweteka kwayparis m'derali ndi anthu, postherpetic neuralgia, post-traumatic neuropathy, matenda ashuga kapena zina zotumphukira zamitsempha), mutu, mutu woletsa (kupewa), zilonda zam'mimba ndi zilonda 12 za duodenal.

Contraindication

Hypersensitivity, gwiritsani ntchito limodzi ndi ma MA inhibitors komanso masabata awiri isanayambike chithandizo, myocardial infarction (nthawi yayikulu komanso ya subacute), kumwa mowa kwambiri, kumwa mankhwala osokoneza bongo, mapiritsi a analgesic ndi psychoactive, glaucoma wotseka kwambiri, kuphwanya kwakukulu kwa AV ndi intraventricular conduction (blockade) Gisa, AV block II siteji), kuyamwa, zaka za ana (mpaka zaka 6 - mawonekedwe apakamwa, mpaka zaka 12 ndi i / m ndi iv) .C Chenjezo. Matenda osokoneza bongo, mphumu ya bronchial, psychic yododometsa, kupsinjika kwa mafupa hematopoiesis, matenda a CVD (angina pectoris, arrhythmia, mtima block, CHF, myocardial infarction, arterial hypertension), stroke, yafupika m'matumbo oyenda m'mimba (chiwopsezo cha kufinya kwamatumbo mkati), , chiwindi ndi / kapena kulephera kwa aimpso, thyrotoxicosis, hyperplasia ya prostatic, kusungika kwamikodzo, chikhodzodzo, chikhodzodzo (psychosis ikhoza kukhazikitsidwa), khunyu, mimba (makamaka ine trimester), ukalamba.

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

Mkati, osafuna kutafuna, mutangodya (kuchepetsa mkwiyo wa m'mimba). Mlingo woyamba wa akulu ndi 25-50 mg usiku, ndiye kuti mankhwalawa amawonjezereka masiku 5-6 kufika pa 150-200 mg / tsiku mu 3 Mlingo (gawo lalikulu la mankhwalawo limatengedwa usiku). Ngati palibe kusintha mkati mwa milungu iwiri, mlingo wa tsiku ndi tsiku umachulukitsidwa mpaka 300 mg. Ngati zizindikiro za kukhumudwa zitha, mankhwalawa amachepetsedwa kukhala 50-100 mg / tsiku ndipo chithandizo chimapitilizidwa kwa miyezi itatu. Mukakalamba, ndimavuto osaneneka, mlingo wa 30-100 mg / tsiku (usiku) umalembedwa, atatha kupeza chithandizo chamankhwala, amasinthana ndi mlingo wochepa - 25-50 mg / tsiku.

Intramuscularly kapena iv (jekeseni pang'onopang'ono) pa mlingo wa 20-40 mg 4 pa tsiku, pang'onopang'ono m'malo mwa kumeza. Kutalika kwa chithandizo sikupitilira miyezi 6-8.

Ndi usiku ma enursis mu ana a zaka 6 - 10 - 20 mg / tsiku usiku, zaka 11-16 - 25-50 mg / tsiku.

Ana ngati antidepressant: kuyambira zaka 6 mpaka 12 - 10-30 mg kapena 1-5 mg / kg / tsiku pang'ono, muubwana - 10 mg 3 katatu patsiku (ngati kuli kotheka, mpaka 100 mg / tsiku).

Pofuna kupewa migraine, kupweteka kwakanthawi kwamatenda a neurogenic (kuphatikizapo mutu wotalika) - kuyambira 12,5-25 mpaka 100 mg / tsiku (mlingo waukulu umatengedwa usiku).

Zotsatira zoyipa

Zotsatira za anticholinergic: kusawona bwino, ziwopsezo za malo okhala, mydriasis, kuchuluka kwa kukakamira (kokha mwa anthu omwe ali ndi chiyembekezo cham'tsogolo - mbali yaying'ono ya chipinda cham'kati), tachycardia, pakamwa pouma, chisokonezo, kuchepa kwamkamwa, kuyerekezera m'mimba, kuvulala kwamatumbo thukuta latsika.

Kuchokera ku dongosolo lamanjenje: kugona, asthenia, kukomoka, kuda nkhawa, kusokonezeka, kuyerekezera zinthu zina (makamaka odwala ndi odwala omwe ali ndi matenda a Parkinson), nkhawa, kukwiya, nkhawa zamagalimoto, manic state, hypomanic state, ukali, kusokonezeka kwa kukumbukira, kutsitsa , kuchuluka kwa nkhawa, kuchepa kwa chidwi, kusowa tulo, "maloto" osokoneza bongo, kugona, asthenia, kutsegula kwa zizindikiro za psychosis, mutu, myoclonus, dysarthria, kugwedezeka Oil minofu, makamaka mikono, manja, mutu ndi lilime, neuropathy zotumphukira (paresthesia), myasthenia gravis, myoclonus, ataxia, syndrome extrapyramidal, mathamangitsidwe ndi intensification a khunyu, akugwirira chimasintha.

Kuchokera kumbali ya CCC: tachycardia, palpitations, chizungulire, orthostatic hypotension, kusintha kwa chisangalalo cha ECG (kusungunuka kwa ST kapena T wave) mwa odwala opanda matenda a mtima, arrhasmia, kuthamanga kwa magazi (kuchepa kapena kuwonjezeka kwa magazi), intraventricular conduction kusokoneza (kukulira kwa zovuta) QRS, kusintha kosinthika kwa PQ, blockade ya miyendo yake.

Kuchokera pamimba yodyetsera: nseru, kusowa hepatitis (kuphatikizapo kuwonongeka kwa chiwindi ndi cholendatic jaundice), kutentha kwa mtima, kusanza, gastralgia, kuchuluka kwa chilimbikitso ndi thupi kapena kuchepa kwa chilimbikitso cha thupi ndi thupi, stomatitis, kusintha kwa kakomedwe, kutsegula m'mimba, kuyambitsa lilime.

Kuchokera ku dongosolo la endocrine: kuwonjezeka kwa kukula (edema) kwa ma testicles, gynecomastia, kuchuluka kwa tiziwalo ta mammary, galactorrhea, kuchepa kapena kuwonjezeka kwa libido, kuchepa kwa potency, hypo- kapena hyperglycemia, kuchepa kwa kapangidwe ka vasopressin), ndi kuchepa kwa kuperewera kwa vasopressin).

Kuchokera ku ziwalo za hemopoietic: agranulocytosis, leukopenia, thrombocytopenia, purpura, eosinophilia.

Thupi lawo siligwirizana: zotupa pakhungu, kuyabwa kwa khungu, urticaria, photosensitivity, kutupa kwa nkhope ndi lilime.

Zina: kusowa kwa tsitsi, tinnitus, edema, hyperpyrexia, zotupa zamitsempha, kusungika kwamkodzo, polakiuria, hypoproteinemia.

Zizindikiro zochotsa pamimba: kusiya mwadzidzidzi pambuyo povulaza kwa nthawi yayitali - kusanza, kusanza, kupweteka m'mimba, kupweteka m'mimba, kusokonezeka kwa tulo, maloto osazolowereka, kukomoka kopanda tanthauzo, kupweteka kwapang'onopang'ono pambuyo povomerezeka kwa nthawi yayitali - kusokonekera, nkhawa zamagalimoto, kusokonezeka kwa tulo, maloto osazolowereka.

Kulumikizana ndi kayendetsedwe ka mankhwala sikunakhazikitsidwe: lupus-like syndrome (nyamakazi yosamukasamu, maonekedwe a antinuclear antibodies and a rheumatoid factor), chiwopsezo cha ntchito ya chiwindi, Ageusia.

Momwe zimachitikira kukhudzana ndi iv: thrombophlebitis, lymphangitis, kutentha kwa moto, thupi lawo siligwirizana. Zizindikiro Kuchokera kumbali ya chapakati mantha dongosolo: kugona, stupor, chikomokere, kuyerekezera zinthu m`maganizo, nkhawa, psychomotor mukubwadamuka, kutsika luso lozama, kusokonezeka, chisokonezo, dysarthria, hyperreflexia, minofu kuuma, choreoathetosis, khunyu.

Kuchokera ku CCC: kuchepa kwa magazi, tachycardia, arrhythmia, kusokonezeka kwa intracardiac conduction, kusintha kwa ECG (makamaka QRS), kugwedezeka, kulephera kwa mtima, mawonekedwe a tricyclic antidepressant kuledzera, mantha, kulephera kwa mtima nthawi zina.

Zina: kupuma, kupuma movutikira, cyanosis, kusanza, hyperthermia, mydriasis, kuchuluka thukuta, oliguria kapena anuria.

Zizindikiro zimakhazikika patatha maola 4 pambuyo pa bongo, kufikira patatha maola 24 komanso masiku anayi otsiriza. Ngati mankhwala osokoneza bongo amakayikiridwa, makamaka mwa ana, wodwala ayenera kuchipatala.

Chithandizo: ndi pakamwa: kutsuka kwamatumbo, kugwiritsa ntchito makala othandizira, operewera komanso othandizira, pogwiritsa ntchito mphamvu ya anticholinergic (kuchepa kwa kuthamanga kwa magazi, arrhythmias, chikomokere, kukomoka kwa myoclonic) - makonzedwe a cholinesterase inhibitors (physostigmine osavomerezeka chifukwa chakuwonjezeka kwa chiwopsezo cha kukomoka). ), kukhalabe ndi kuthamanga kwa magazi komanso kuthana ndi ma electrolyte. Kuwongolera kwa ntchito za CCC (kuphatikiza ECG) kwa masiku 5 akuwonetsedwa (kuyambiranso kumatha kuchitika patatha maola 48 kapena mtsogolo), mankhwala othandizira, kupuma kwamphamvu, komanso njira zina zothandizira kuyambiranso. Hemodialysis ndi kukakamiza diuresis sikuthandiza.

Malangizo apadera

Musanayambe chithandizo, kayendetsedwe ka magazi kofunikira ndikofunikira (kwa odwala omwe ali ndi vuto lochepa kapena lolemetsa amatha kuchepa kwambiri), munthawi ya chithandizo ndikofunikira kuwongolera magazi aziphuphu (nthawi zina, agranulocytosis imatha kupezeka, chifukwa chake imalimbikitsidwa kuyang'anira chithunzi cha magazi, makamaka ndi kuchuluka kwa kutentha kwa thupi, kukulira kwa zizindikiro zofanana ndi chimfine ndi zilonda zapakhosi), ndi chithandizo cha nthawi yayitali - kuyang'anira ntchito za CVS ndi chiwindi. Okalamba ndi odwala omwe ali ndi matenda a CCC, kuwongolera kuthamanga kwa mtima, kuthamanga kwa magazi, ECG ikuwonetsedwa. Kusintha kwakanthawi kochepa kumawoneka pa ECG (kusintha kwa T wave, kukhumudwa kwa gawo la S-T, kukulira kwa QRS tata).

Kugwiritsa ntchito kwa makolo kumatheka kokha kuchipatala, moyang'aniridwa ndi dokotala, ndikupumula pabedi masiku oyamba a zamankhwala.

Kusamala kumafunikira pamene mwadzidzidzi akusunamira pamalo ofukula kuchokera pakama kapena pampando.

Pa mankhwala, Mowa uyenera kupatula.

Musaperekane kale kuposa masiku 14 atachotsedwa ma MA inhibitors, kuyambira pa Mlingo wochepa.

Ndi kutha kwadzidzidzi kwa makonzedwe atatenga nthawi yayitali, kukula kwa matenda a "achire" ndikotheka.

Amitriptyline mu Mlingo pamwamba pa 150 mg / tsiku amachepetsa kugunda kwa ntchito yogwira mtima (chiwopsezo cha kugwidwa ndi khunyu kwa odwala oyembekezeredwa, komanso pamaso pa ena, ayenera kuganiziridwazinthu zomwe zimadziwikiratu kuchitika kwa matenda opatsirana, mwachitsanzo, kuvulala kwamtundu uliwonse wa etiology, kugwiritsa ntchito nthawi yomweyo mankhwala a antipsychotic (antipsychotic), panthawi yomwe akukana ethanol kapena kusiya mankhwala omwe ali ndi anticonvulsant katundu, monga benzodiazepines.

Kupsinjika kwakukulu kumadziwika ndi chiopsezo chodzipha, chomwe chitha kupitilira mpaka kukhululukidwa kwakukulu. Pankhaniyi, kumayambiriro kwa chithandizo, kuphatikiza ndi mankhwala ochokera ku gulu la benzodiazepine kapena mankhwala a antipsychotic ndikuwunikira pafupipafupi (kuwalangiza odalirika kuti asunge ndikutulutsa mankhwala).

Odwala omwe ali ndi vuto la cyclic, panthawi yovutitsa, mikhalidwe ya manic kapena hypomanic imatha kuchitika pakubwera kwa mankhwala (kuchepetsa mankhwala kapena kusiya mankhwala ndi mankhwala a antipsychotic ndikofunikira). Pambuyo pakuleka izi, ngati zikuwonetsa, chithandizo chochepa kwambiri chitha kuyambiranso.

Chifukwa cha zotsatira za mtima ndi vuto, kusamala kumafunikira pochiza odwala a thyrotoxicosis kapena odwala omwe amalandila kukonzekera kwa mahomoni a chithokomiro.

Kuphatikiza ndi mankhwala a electroconvulsive, amangoikidwa ndi kuyang'aniridwa mosamala kuchipatala.

Mwa odwala omwe ali ndi chiyembekezo komanso odwala okalamba, zimatha kuyambitsa kupangika kwa psychoses ya mankhwala, makamaka usiku (atasiya kumwa mankhwalawa, amawonekera patangotha ​​masiku ochepa).

Zingayambitse kufooka kwamatumbo, makamaka mwa odwala omwe ali ndi kudzimbidwa, okalamba kapena odwala omwe amakakamizidwa kuti agone.

Asanayambe opaleshoni wamba, opaleshoni yachipatala ayenera kuchenjezedwa kuti wodwala akutenga amitriptyline.

Chifukwa cha anticholinergic zochita, kuchepa kwa lacilation komanso kuchuluka kwa ntchofu mu kapangidwe ka madzi osungunuka ndikotheka, zomwe zingayambitse kuwonongeka kwa corneal epithelium mwa odwala omwe amagwiritsa ntchito magalasi.

Pogwiritsa ntchito nthawi yayitali, kuwonjezeka kwa zochitika za mano kumawonedwa. Kufunika kwa riboflavin kungakulitsidwe.

Kafukufuku wokhudzana ndi kubereka nyama adawonetsa kuyipa kwa mwana wosabadwayo, ndipo maphunziro oyenerera komanso okhwima mwa amayi apakati sanatengepo. Mwa amayi apakati, mankhwalawa amayenera kugwiritsidwa ntchito pokhapokha ngati phindu lomwe lingapereke kwa mayi likupereka chiwopsezo kwa mwana wosabadwayo.

Imalowa mkaka wa m'mawere ndipo imapangitsa kugona mwa makanda.

Pofuna kupewa kufalikira kwa matenda obwera chifukwa chongobadwa kumene (kuwonetsedwa ndi kupuma, kugona, matumbo, kuchuluka kwakuchuluka, Hypotension kapena matenda oopsa, kunjenjemera kapena kusunthika kwa zinthu), amitriptyline imathetsedwa pang'onopang'ono masabata 7 mwana asanabadwe.

Ana amamvera kwambiri bongo wambiri, womwe ungawonedwe wowopsa komanso wowopsa.

Munthawi ya chithandizo, chisamaliro chikuyenera kuchitika poyendetsa magalimoto ndi kuchita zina zomwe zingakhale zoopsa zomwe zimafunikira chidwi chochulukirapo komanso kuthamanga kwa zochitika zama psychomotor.

Kuchita

Ndi kuphatikiza kwa ethanol ndi mankhwala osokoneza bongo omwe amachepetsa dongosolo lamkati lamitsempha (kuphatikizapo ma antidepressants, barbiturates, benzadiazepines ndi anesthetics), kuwonjezeka kwakukulu pazomwe zimalepheretsa dongosolo lamkati lamanjenje, kupuma kwamatenda ndi hypotensive.

Amawonjezera chidwi ndi zakumwa zomwe zimakhala ndi ethanol.

Kuchulukitsa mphamvu ya anticholinergic ya mankhwala omwe ali ndi anticholinergic ntchito (mwachitsanzo, phenothiazines, antiparkinsonia mankhwala, amantadine, atropine, biperidene, antihistamines), zomwe zimawonjezera chiopsezo cha zotsatira zoyipa (kuchokera pakatikati wamanjenje, masomphenya, matumbo ndi chikhodzodzo).

Akaphatikizidwa ndi antihistamines, clonidine, kuwonjezereka kwa mphamvu ya chapakati pamitsempha yam'mimba, ndi atropine, kumawonjezera chiopsezo cha kutsekeka kwamatumbo, komanso mankhwalawa omwe amachititsa kusintha kwa extrapyramidal kumawonjezera zovuta komanso pafupipafupi zotsatira za extrapyramidal.

Ndi munthawi yomweyo kugwiritsa ntchito mankhwala amitriptyline komanso anticoagulants (coumarin kapena indadione), kuwonjezeka kwa ntchito ya anticoagulant yamapeto ndikutha.

Amitriptyline imatha kuwonjezera kukhumudwa chifukwa cha corticosteroids.

Mukaphatikizidwa ndi mankhwala a anticonvulsant, ndizotheka kuwonjezera kufooka kwa chapakati pamitsempha yamagazi, kuchepetsa malo omwe agwirira ntchito (mutagwiritsidwa ntchito mu Mlingo wambiri) ndikuchepetsa mphamvu yotsiriza.

Mankhwala osokoneza bongo a chithokomiro amatenga chiopsezo cha agranulocytosis.

Kuchepetsa mphamvu ya phenytoin ndi alpha-blockers.

Zoletsa za microsomal oxidation (cimetidine) kutalika kwa T1 / 2, kuonjezera chiopsezo cha zotsatira za poizoni wa amitriptyline (kutsitsa kwa 20-30% kungafunike), olimbitsa microsomal chiwindi michere (barbiturates, carbamazepine, phenytoin, nikotini ndi kuletsa kwa pakamwa) kuchepetsa plasma kuchepetsa mphamvu ya amitriptyline.

Fluoxetine ndi fluvoxamine amachulukitsa kuchuluka kwa amitriptyline mu plasma (kuchepetsa kuchepetsa kwa amitriptyline ndi 50% kungafunike).

Akaphatikizidwa ndi anticholinergics, phenothiazines ndi benzodiazepines - kulimbikitsika kogwirizana ndi zotsatira zoyipa za anticholinergic komanso chiopsezo chowonjezereka cha kugwidwa khunyu (kuchepetsa kutsekeka kwa chindoko), phenothiazines, kuwonjezera, kungakulitse chiwopsezo cha matenda a neuroleptic malignant.

Ndi munthawi yomweyo kugwiritsa ntchito amitriptyline ndi clonidine, guanethidine, betanidine, reserpine ndi methyldopa - kuchepa kwa mphamvu ya chomaliza, ndi cocaine - chiopsezo cha mtima wambiri.

Mankhwala okhala ndi pakamwa a estrogen okhala ndi estrogens amatha kuwonjezera kukhudzana kwa amitriptyline, mankhwala osokoneza bongo (monga quinidine) amawonjezera chiopsezo cha kusokonezeka kwa miyendo (mwina kuchedwetsa kagayidwe ka amitriptyline).

Kugwiritsa ntchito limodzi ndi disulfiram ndi ma acetaldehydrogenase inhibitors kumakwiyitsa delirium.

Zosagwirizana ndi Mao inhibitors (kuwonjezereka kwa pafupipafupi kwa hyperpyrexia, kupweteka kwambiri, kusokonekera kwa magazi ndi kufa kwa wodwala).

Pimozide ndi probucol zimatha kukulitsa mtima wa arrhythmias, womwe umawonetsedwa pakukweza nthawi ya Q-T pa ECG.

Zimawonjezera zotsatira za epilephrine, norepinephrine, isoprenaline, ephedrine ndi phenylephrine pa CVS (kuphatikiza pamene mankhwalawa ali gawo la mankhwala opatsirana am'deralo) ndikukulitsa chiopsezo cha kusokonezeka kwa mtima, tachycardia, komanso matenda oopsa kwambiri.

Mukamagwiritsidwa ntchito molumikizana ndi alpha-adrenostimulants pakukonzekera kwa intranasal kapena kugwiritsa ntchito ophthalmology (yodziwika bwino ndi mayamwidwe), vasoconstrictor mphamvu yotsiriza imatha kukula.

Mukaphatikizidwa ndi mahomoni a chithokomiro - kuphatikiza kwamphamvu kwa zochizira ndi zotsatira zoyipa (zimaphatikizira mtima wa arrhythmias ndi chidwi chokhudza dongosolo lamanjenje lamkati).

Mankhwala otchedwa M-anticholinergics ndi antipsychotic (antipsychotic) amawonjezera chiopsezo cha hyperpyrexia (makamaka nyengo yotentha).

Ndi mgwirizano ndi mankhwala ena a hematotoxic, kuwonjezereka kwa hematotoxicity ndikotheka.

Saroten Retard (Saroten Retard) - mawonekedwe omasulidwa, mawonekedwe ndi ma CD

Makapisozi opanga nthawi yayitali amakhala olimba gelatin, kukula No. 2, opaque, wokhala ndi thupi komanso chivindikiro cha mtundu wofiirira, zomwe zili m'mapilogalamuwa ndi ma pellets kuyambira pafupifupi oyera mpaka chikasu.

1 zisoti. amitriptyline hydrochloride 56.55 mg, omwe amafanana ndi zomwe amitriptyline 50 mg.

Omwe amathandizira: mbewu za shuga (magawo a shuga), stearic acid, chipolopolo (chipolopolo chosakhala ndi sera), talc, povidone.

Mapangidwe a chipolopolo cha kapisozi: gelatin, utoto wazitsulo wofiira (E172), titanium dioxide (E171).

Saroten Retard (Saroten Retard) - pharmacokinetics

The bioavailability mkamwa amitriptyline pafupifupi 60%. Kuphatikiza kwa mapuloteni a Plasma kuli pafupi 95%. Kukumana kwa amitriptyline mu seramu yamagazi kumafika pazofunikira zake pang'onopang'ono kuposa momwe mukutenga mapiritsi a Saroten, pambuyo pa maola 4-10, pambuyo pake, komabe, amakhalabe okhazikika kwanthawi yayitali.

Mlingo wofanana, kuchuluka kwa kuchuluka kwa mankhwala omwe amapezeka m'madzi a m'magazi kumatsika mutatenga makapisozi, omwe amalumikizidwa ndi kuchepa kwa mtima ndi vuto la Saroten Retard.

Amitriptyline metabolism imachitika kudzera mu demethylation ndi hydroxylation. Nortriptyline imatengedwa ngati metabolite yayikulu ya amitriptyline. T1 / 2 ya kuchuluka kwa amitriptyline maola 25 (maola 16 mpaka 40), T1 / 2 ya nortriptyline - pafupifupi maola 27. Css imakhazikitsidwa pambuyo pa masabata 1-2. Amitriptyline imapukusidwa makamaka ndi mkodzo,, pang'ono, ndi ndowe. Amitriptyline ndi nortriptyline kudutsa chotchinga chachikulu ndipo ochepa amachotsedwa mkaka wa m'mawere.

Zisonyezero zamankhwala

Matenda okhumudwa, makamaka ndi nkhawa, kukhumudwa, ndi kusowa kwa tulo:

• Chithandizo cha amkati depressions a mtundu wa mono- ndi kupuma, anachulukitsa, otsekeka ndi okhumudwa
• dysphoria ndi kukhumudwa kwa uchidakwa,
• kuvutika maganizo
• kukhumudwa kwa neurosis
• mankhwalawa a schizophrenic nkhawa (kuphatikiza ma antipsychotic),
• zovuta zopweteka.

Saroten Retard (Saroten Retard) - Malamulo

Mukamatenga makapisozi a Saroten Retard, amauzidwa kuti amwe ndi madzi. Makapisozi, komabe, amatha kutsegulidwa ndipo zomwe zili mkati mwake (ma granules) zimatha kumwedwa ndi pakamwa. Ma granules saloledwa kutafuna.

Zochizira kukhumudwa, adayikidwa 1 nthawi / maola 3-4 asanagone mu Mlingo wofanana ndi 2/3 wa kuchuluka kwa Saroten pamapiritsi.

Akuluakulu ayenera kuyamba kulandira chithandizo ndi Saroten Retard ndi kapisozi 50 mg imodzi yamadzulo. Ngati ndi kotheka, pakatha milungu iwiri, mlingo wa tsiku ndi tsiku umatha kuwonjezeredwa ku 2-3 makapisozi madzulo (100-150 mg). Mukakwaniritsa kusintha kwakukulu, mlingo wa tsiku ndi tsiku umatha kuchepetsedwa pang'ono, nthawi zambiri mpaka makapisozi 1-2 (50-100 mg /). Pochiza kukhumudwa, akukonzekera kupitiliza kugwiritsa ntchito mankhwala ochepetsa mphamvu ya mankhwala, kuphatikiza Saroten Retard, mutakwaniritsa zomwe ananena kwa miyezi ina inayi. Mankhwala akukonzanso omwe ali ndi zotsutsana ndi kufikanso, Saroten retard imatha kutengedwa kwa nthawi yayitali, mpaka zaka zingapo.

Okalamba ayenera kuyamba kulandira chithandizo ndi Saroten ndi mapiritsi - 30 mg / (3 mpaka 10 mg). M'masiku ochepa, ndizotheka kusintha kuti mutenge makapu a Saroten Retard. Mlingo wa tsiku ndi tsiku ndi makapisozi 1-2 (50-100 mg), otengedwa madzulo.

Pazovuta zakumwa zopweteka kwa akuluakulu, mlingo wa tsiku lililonse ndi makapisozi awiri (50-100 mg), wotengedwa madzulo. Ndizotheka kuyamba kulandira mankhwalawa pomutenga Saroten m'mapiritsi a 25 mg kamodzi madzulo.

Zotsatira zoyipa zomwe zimakhudzana ndi anticholinergic zotsatira: kuuma ndi / kapena kukoma kowawa mkamwa, nseru, kusanza, stomatitis, kawirikawiri - cholestatic jaundice, kusawona bwino, kuchuluka kwazovuta zamitsempha, tachycardia, kudzimbidwa, kusakonda kwambiri. Amakonda kuwoneka koyambirira kwa chithandizo, ndiye, makamaka, kuchepa.

• Kuchokera kumbali ya dongosolo la mtima: tachycardia, arrhythmias, orthostatic hypotension, intracardiac conduction matenda, olembedwa kokha pa ECG, koma osawoneka m'chipatala.
• Kuchokera kumbali ya chapakati mantha dongosolo: kugona, kufooka, kusokonezeka ndende, mutu, chizungulire. Matendawa, omwe amapezeka kumayambiriro kwa amitriptyline chithandizo, amachepetsedwa panthawi yamankhwala. Pafupipafupi, makamaka ngati mankhwalawa oyamba agwiritsidwa ntchito, kuchepa kwina, kusokoneza, kusokoneza, kukoka, kuyerekezera zinthu, matenda amkati, kunjenjemera ndi kukokana kumatha kuchitika, kawirikawiri nkhawa.

Thupi lawo siligwirizana: zotupa pakhungu, kuyabwa ndizotheka.

Ena: nseru, thukuta, kuchuluka kwa thupi, kuchepa kwa libido kumatha kuchitika.

Contraindication

• kuphwanya kwaposachedwa kwaposachedwa,
• mtima conduction matenda
• poyizoni wazakumwa ndi mowa, barbiturates kapena opiates,
• kutseka-kotsekera glaucoma,
• gwiritsani ntchito limodzi ndi ma MA inhibitors komanso mpaka milungu iwiri atachotsedwa,
• Hypersensitivity kuti amitriptyline.

Saroten retard - Malangizo Apadera

Saroten Retard iyenera kulembedwa mosamala kwa odwala omwe ali ndi vuto losakhazikika, chosunga mkodzo, matenda oopsa a prostate, chiwindi chachikulu kapena matenda amtima.

Kukhala ndi mphamvu yotsogola, kumatha kuwononga kuyendetsa galimoto ndi zina. Odwala omwe akutenga Saroten Retard ayenera kuchenjezedwa ndi adokotala pasadakhale za mbali iyi ya mankhwalawa.

Saroten retard - bongo

Zizindikiro Kuponderezedwa kapena kusokonezeka kwa mitsempha yapakati. Kuwonetsa kwakukulu kwa anticholinergic (tachycardia, kupuma kwa mucous nembanemba, kwamikodzo posungira) ndi mtima wama mtima (arrhythmias, ochepa hypotension, kulephera kwa mtima). Matenda opatsirana. Hyperthermia.

Chithandizo. Amawonetsedwa ngati chizindikiro. Iyenera kuchitika kuchipatala. Mothandizidwa ndi pakamwa pa amitriptyline, chapamimba pake chiyenera kuchitidwa posachedwa ndipo makala oyenerera ayenera kuikidwa. Njira zoyenera kutsatiridwa kuti zipitirize kupuma ndi mtima. Kuwunikira ntchito zamtima mkati mwa masiku 3-5 ndikofunikira. Epinephrine (adrenaline) sayenera kukhazikitsidwa pazinthu zotere. Pazovuta zopweteka, diazepam angagwiritsidwe ntchito.

Saroten Retard (Saroten Retard) - mogwirizana ndi mankhwala

Amitriptyline imatha kupititsa patsogolo zotsatira za ethanol, barbiturates ndi zinthu zina zomwe zimakhumudwitsa dongosolo lamkati lamanjenje.

Kugwiritsa ntchito limodzi ndi MaO inhibitors kungayambitse vuto lalikulu kwambiri.

Popeza amitriptyline imathandizira zotsatira za anticholinergics, kuyang'anira pamodzi ndi iwo kuyenera kupewedwa.

Zimawonjezera zotsatira za sympathomimetics of epinephrine (adrenaline), norepinephrine (norepinephrine), chifukwa cha izi, mankhwala opezeka pano omwe ali ndi zinthuzi sayenera kugwiritsidwa ntchito nthawi yomweyo ndi amitriptyline.

Machepetsa mphamvu ya antihypertensive ya clonidine, betanidine, ndi guanethidine.

Mukaphatikizana ndi ma antipsychotic, muyenera kukumbukira kuti ma tridclic antidepressants ndi ma antipsychotic onse amalepheretsa kagayidwe kalikonse, kutsitsa njira yolimbirana.

Pogwiritsa ntchito munthawi yomweyo ndi cimetidine, kuchepa kwa kagayidwe ka amitriptyline, kuwonjezeka kwa kuchuluka kwake m'magazi am'magazi komanso kupanga poyizoni.