Amitriptyline Nycomed - malangizo a boma ogwiritsira ntchito

Amitriptyline Nycomed: malangizo ogwiritsira ntchito ndi kuwunika

Dzina lachi Latin: Amitriptyline-Nycomed

Code ya ATX: N06AA09

Zothandizira: amitriptyline (Amitriptylinum)

Wopanga: Takeda Pharma A / S (Denmark), Nycomed Danmark ApS (Denmark)

Kusintha malongosoledwe ndi chithunzi: 10/22/2018

Mitengo muma pharmacies: kuchokera ku ma ruble 54.

Amitriptyline Nycomed - mankhwala okhala ndi antidepressant kanthu.

Kutulutsa mawonekedwe ndi kapangidwe kake

Mlingo wa kutulutsidwa kwa Amitriptyline Nycomed:

• mapiritsi okutidwa (zidutswa 50 chilichonse m'mabotolo amdima amdima, botolo limodzi m'bokosi)
• mapiritsi okhala ndi filimu: oyera, biconvex, ozungulira (50 aliyense mumabotolo amdima amdima, botolo 1 mumtundu wa makatoni).

The yogwira pophika piritsi 1, wokutidwa / filimu wokutira: amitriptyline - 10 kapena 25 mg.

Zothandiza pazomwe zimapangidwira piritsi 1 yokutidwa: microcrystalline cellulose, polypropylene glycol, starch ya mbatata, magnesium stearate, lactose monohydrate, titanium dioxide, talc, methyl hydroxypropyl cellulose, mchere wowuma, gelatin, croscarmellose sodium.

Zothandiza pazolemba za piritsi 1, film-coated (10/25 mg):

• pakati: magnesium stearate - 0,25 / 0,5 mg, povidone - 0,83 / 0,6 mg, talc - 2.25 / 4.5 mg, cellcrystalline cellulose - 9,5 / 18 mg, mbatata wowuma - 28 , 2/38 mg, lactose monohydrate - 27 / 40.2 mg,
• chipolopolo: propylene glycol - 0,2 / 0,3 mg, titanium dioxide - 0,8 / 0,9 mg, hypromellose - 1.2 / 1.4 mg, talc - 0,8 / 0,9 mg.

Mankhwala

Amitriptyline Nycomed ndi amodzi mwa antidepressants opatsa chidwi kuchokera pagulu la osagwiritsa ntchito monoamine reuptake inhibitors. Ili ndi timoanaleptic komanso mphamvu yosintha.

Limagwirira ntchito limalumikizidwa ndi kuwonjezeka kwa zomwe zili serotonin ndi norepinephrine mu synaptic cleft mkati mwa mantha dongosolo. Kudzikundikira kwa ma neurotransmitters awa kumachitika chifukwa cha kulepheretsa kwawo kugwidwa ndi ma membrane am'mimba a presynaptic neurons.

Amitriptyline ndi blocker ya alpha-1-adrenergic receptors, H1-histamine receptors, M1- ndi M2-muscarinic cholinergic receptors. Kutengera zomwe zimatchedwa monoamine hypothesis, pali mgwirizano pakati pa ntchito ya ma neurotransmitters mu ma synapses a ubongo ndi kamvekedwe ka mawu.

Kuphatikizana koonekeratu pakati pa plasma ndende ya amitriptyline m'magazi ndi zotsatira zamankhwala sikuwonetsedwa, koma zikuwoneka kuti kuthekera koyenera kwamankhwala kumatheka chifukwa cha 100 mpaka 260 μg / L.

Kuchepetsa kwamankhwala kupsinjika kumatheka pambuyo pa milungu 2-6 yamankhwala (pambuyo pake poyerekeza ndi kuchuluka kwa plasma m'magazi kufikira).

Amitriptyline Nycomed alinso ndi zotsatira ngati quinidine pakukhalanso kwamtima.

Pharmacokinetics

Amitriptyline pambuyo pakamwa makonzedwe kwathunthu ndipo amatengedwa mwachangu kuchokera kumimba. Kukwaniritsa ndende yayikulu ya plasma (C_maxAmawonedwa kwa maola 2-6 atatha kukhazikitsa.

Masautso a placma amitriptyline m'magazi a odwala osiyanasiyana amatha kusiyanasiyana. The bioavailability wa amitriptyline pafupifupi 50%. Pafupifupi 95% ya chinthucho chimamangiriza mapuloteni a plasma. Nthawi yofika ndende yayikulu (Tc_max) pambuyo pakulimbitsa ndi maola 4, ndende yolingana ndi masiku pafupifupi 7 kuyambira chiyambi cha mankhwala. Kugawa voliyumu - pafupifupi 1085 l / kg. Thupi limadutsa pamtengowo ndipo limachotsedwa mkaka wa m'mawere.

Metabolism imachitika m'chiwindi, pafupifupi 50% imapukusidwa pakadutsa chiwindi choyamba. Kuphatikiza apo, amitriptyline imadutsa N-demethylation ndi cytochrome P450 ndi kupangidwa kwotsatira kwa metabolite yogwira - nortriptyline. Thupi ndi metabolite yake yogwira imakhala hydroxylated m'chiwindi. N-hydroxy-, 10-hydroxymetabolite ya amitriptyline, 10-hydroxynortriptyline imakhalanso ndi zochitika. Amitriptyline ndi nortriptyline zimalumikizana ndi glucuronic acid (ma conjugates ndi osagwira). Choyimira chachikulu chomwe chikuwonetsa kupezeka kwa impso ndi plasma ndende yamagazi ndi kuchuluka kwa hydroxylation. Mwa odwala ochepa, kuchepa kwa hydroxylation kumawonedwa (ali ndi chibadwa). Pamaso pa matenda opha ziwalo za hepatic, hafu ya moyo wa amitriptyline / nortriptyline mu plasma yamagazi imachulukitsidwa.

Hafu ya moyo (T1 / 2) wa amitriptyline kuchokera m'madzi a m'magazi amachokera ku maola 9 mpaka 46, nortriptyline imachokera ku 18 mpaka 95 maola.

Kuchulukitsa kumachitika makamaka mu mawonekedwe a metabolites ndi impso komanso matumbo. Mwanjira yosasinthika, gawo lochepa chabe la mlingo wotengedwa limatuluka kudzera impso. Ndi vuto laimpso, zovuta za amitriptyline ndi nortriptyline sizisintha, ngakhale kuti kutha kwawo kumachepa. Amitriptyline kuchokera m'madzi a m'magazi ndi dialysis samachotsedwa (chifukwa cha kulumikizana ndi mapuloteni am magazi).

Contraindication

• myocardial infaration (kuphatikizapo mbiri yaposachedwa)
• pachimake delirium
• kuledzera kwa pachimake,
• kuledzera pachimake ndi mankhwala okhala ndi mapiritsi ogona, analgesic ndi psychotropic,
• kutseka-kotsekera glaucoma,
• arrhythmias
• mavuto a intraventricular / atrioventricular conduction,
• lactose tsankho, kufupika kwa lactase ndi malisorption wa glucose-galactose,
• Prostate hyperplasia posunga kwamikodzo,
• bradycardia
• hypokalemia
• matumbo okhumudwa, pyloric stenosis,
• congenital elongated QT syndrome, komanso kuphatikiza mankhwala omwe amapangitsa kuti pakhale nthawi yayitali ya QT,
• kuphatikiza mankhwala ndi monoamine oxidase zoletsa, kuphatikiza masiku 14 musanagwiritse ntchito,
• wazaka 18
• kuyamwa
• tsankho limodzi ndi zigawo zikuluzikulu za mankhwala.

Wachibale (poikidwiratu Amitriptyline Nycomed, kusamala ndi kuyang'aniridwa kwa chipatala ndikofunikira):

• matenda a magazi ndi mtima dongosolo, kuphatikizapo angina pectoris ndi ochepa matenda oopsa,
• kamera yamaso kwambiri ndi kamera yakutsogolo ya diso,
• kutseka-kotsekera glaucoma,
• kuchuluka kwazovuta zamitsempha,
• kusungika kwamikodzo
• Prostatic hyperplasia,
• khunyu (kugwiritsidwa ntchito kwa Amitriptyline Nycomed kungayambitse kuchepa kwa chopunthwitsa),
• maphokoso
• hyperthyroidism
• chikhodzodzo hypotension,
• schizophrenia
• kupuma kwapafupipafupi
• chiwindi kapena impso ntchito.
• uchidakwa wambiri,
• kuphatikiza mankhwala osokoneza bongo ndi mapiritsi ogona ndi antipsychotic zotsatira,
• mimba
• ukalamba.

Malangizo ogwiritsira ntchito Amitriptyline Nycomed: njira ndi mlingo

Amitriptyline Nycomed mapiritsi 25 mg kapena 10 mg amatengedwa pakamwa, makamaka mukangomaliza kudya. Mapiritsi a kutafuna sayenera kukhala.

Mlingo wokhazikika wa odwala wamkulu ndi: kumayambiriro kwa mankhwalawa - 25-50 mg mu 2 Mlingo wogawanika, ngati kuli kotheka, mlingo wa tsiku ndi tsiku umakulitsidwa pang'onopang'ono mpaka 200 mg, nthawi yogwiritsira ntchito ndi miyezi 6 kapena kupitirira (pofuna kupewa kubwereranso).

Mlingo woyamba wa Amitriptyline Nycomed kwa odwala okalamba ndi 25-30 mg mu 1 mlingo (usiku). Ngati ndi kotheka, mpaka achire atakwaniritsidwa, mlingo tsiku lililonse limakulitsidwa mpaka 50-10 mg patsiku. Kukhazikitsidwa kwa maphunziro achiwiri kumafunikanso kuwunika.

Ndi kulephera kwa chiwindi, Amitriptyline Nycomed ndi mankhwala ochepetsedwa.

Pofuna kupewa kuoneka ngati achire (mwa mutu, kusokonezeka kwa tulo, kusokonekera komanso kudwala), mankhwalawa amayenera kuperekedwa pang'onopang'ono. Zizindikiro zotchulidwa sizisonyezo zodalira mankhwala.

Zotsatira zoyipa

Zina mwazotsatira zotsatirazi zosafunikira (makamaka, kunjenjemera, kupweteka mutu, kuchepa kwa kugona ndi chidwi, kudzimbidwa) zitha kukhala zizindikiro zakukhumudwa, ndipo nthawi zambiri zimakhala zopanda nkhawa.

Oposa 50% odwala panthawi yogwiritsa ntchito Amitriptyline Nycomed amatha kukhala ndi vuto limodzi kapena zingapo zotsatirazi. Mankhwalawa atha kubweretsa kusintha kwakutheka, zofanana ndi zomwe zimapangitsa antidepressants ena atatu.

Kutheka kovuta komwe kumachitika (> 10% - nthawi zambiri,> 1% ndi 0,1% ndi 0,01% ndi

Bongo

Zizindikiro za mankhwala osokoneza bongo amatha kuonekera mwadzidzidzi kapena kuyamba pang'onopang'ono. Mu maola 2 oyamba, wodwalayo ali ndi psychomotor mukubwadamuka kapena kugona, kuyerekezera zinthu m'maganizo, komanso zizindikiro chifukwa cha anticholinergic ntchito ya amitriptyline (tachycardia, kupuma kwa mucous membrane, kutentha thupi, mydriasis, kwamikodzo posungira, kupweteka komanso kufooka kwamatumbo. Pambuyo pake, kulephera kupuma, kuletsa kwakuthwa kwa ntchito za chapakati mantha amthupi ndi chikumbumtima chovuta (mpaka chikomokere) kumatha kuchitika.

Odwala osiyanasiyana amasiyana mosiyanasiyana ndi mankhwala osokoneza bongo, odwala omwe ndi ana amakhala ndi vuto la mtima ndi kugwidwa.

Kuchokera kumbali ya mtima, kuphatikiza kwa Amitriptyline Nycomed kumawonetsedwa ndi flutter ndi ventricular fibrillation, ventricular tachyarrhythmia. Kusintha kotsatiraku kukuwonekera pa ECG: kukulira kwa QRS zovuta, kulowererapo kapena kutengeka kwa funde ya T, kutalika kwa gawo la PR, kukhumudwa kwa gawo la ST, kutalika kwa nthawi ya QT, komanso magawo osiyanasiyana a blockade of intracardiac conduction (mpaka kumangidwa kwa mtima). Wodwala angayambitse ochepa hypotension, mtima kulephera, hypokalemia, Cardiogenic mantha, kagayidwe kachakudya acidosis, nkhawa wokwanira, ataxia, chisokonezo ndi kuyerekezera zinthu zina. Kugona kwamphamvu kumathanso.

Pankhani ya kumwa Amitriptyline Nycom pa mlingo waukulu kwambiri kuposa otetezeka, kapena mawonekedwe a mankhwala osokoneza bongo, owonetsa chizindikiro ndi othandizira amathandizidwa. Mankhwala ayenera kusiya. Wodwalayo amasambitsidwa ndi m'mimba ndikupatsidwa makala oyambitsa (ngakhale patadutsa nthawi atatha kumwa amitriptyline). Wodwala ayenera kuyang'aniridwa mosamala, ngakhale akuwoneka kuti ndiabwino. Ndikofunikira kuwongolera kupuma kwamphamvu ndi kugunda kwa mtima, kuchuluka kwa chikumbumtima ndi kuchuluka kwa kuthamanga kwa magazi. Pamafunika kupenda nthawi zonse kuchuluka kwa mpweya ndi ma electrolyte m'magazi. Onetsetsani kuti mpweya wabwino wabwinobwino ndi, ndipo ngati ndi kotheka, khalani ndi mpweya wabwino. ECG imayang'aniridwa kwa masiku 3-5 pambuyo pa bongo. Ventricular arrhythmias, kulephera kwa mtima ndi kukulitsa kwa zovuta za QRS zitha kuyimitsidwa ndikusunthira pH kupita kumbali ya zamchere (mwa hyperventilation kapena kutumiza sodium bicarbonate solution) ndikuyambitsa mwachangu sodium chloride solution (100-200 mmol Na +). Odwala omwe ali ndi ventricular arrhythmias, mankhwala othandizira antiarrhythmic angagwiritsidwe ntchito, mwachitsanzo, makonzedwe amkati a 50-100 mg lidocaine (1-1,5 mg / kg), akutsatiridwa ndi kulowetsedwa mwachangu kwa 1-3 mg / mphindi.

Ngati ndi kotheka, ikani ma defibrillation ndi cardioversion. Kuwongolera kwa kufalikira kwakazungulira kumachitika ndi njira zothetsera ma plasma, ndipo m'malo ovuta kwambiri, ndi kulowetsedwa kwa dobutamine (mlingo woyambira ndi 2-3 μg / kg / min, ndikutsatira kuwonjezeka kwake, kutengera mphamvu yomwe wapeza). Kutembenuka ndi kukwiya zitha kuyimitsidwa ndi diazepam.

Chithandizo cha metabolic acidosis ndi muyezo. Kutsegula m'mimba kuti muchotse amitriptyline m'magazi sikuthandiza, chifukwa kuchuluka kwa zinthu zopanda madzi mu plasma ndizochepa.

Odwala achikulire, kuledzera moyenera kapena koopsa kumayamba kumwa 500 mg kapena kupitilira kwa amitriptyline. Ngati mutenga 1000 mg kapena kupitilira, zotsatira zakupha ndizotheka.

Malangizo apadera

Musanayambe chithandizo ndi Amitriptyline Nycomed, ndikofunikira kuwongolera kuthamanga kwa magazi, monga mwa anthu omwe ali ndi zilema kapena magazi ochepa, mwina amathanso kuchepera.

Odwala sayenera kuyimirira mokhazikika (kutenga malo owongoka) kuchokera pamalo abodza kapena malo okhala. Kafukufuku (kuchuluka kwa kafukufukuyu ndi odwala wazaka 50 ndi kupitirira) adawonetsa kuti kugwiritsa ntchito mankhwala ochepetsa chidwi chazomwe zimayambitsa chiwopsezo cha kufooka kwa mafupa, koma njira yochitira njirayi komanso kuchuluka kwa ngozi sizidziwika.

Pa mankhwala, tikulimbikitsidwa kuwongolera kapangidwe ka magazi a zotumphukira (makamaka ndi kupangika kwa tillillitis, malungo kapena mawonekedwe a chimfine), komanso ndi chithandizo chachitali - ntchito ya chiwindi ndi mtima dongosolo. Odwala omwe ali ndi matenda amtima ndi odwala okalamba, ndikofunikira kuwongolera ECG, kuthamanga kwa magazi ndi kugunda kwa mtima.

Amitriptyline imagwiritsidwa ntchito mosamala nthawi yomweyo ndi ma inducers kapena zoletsa za cytochrome P₄₅₀ CYPZA4.

Munthawi yamankhwala, ndikofunikira kupatula zakumwa zoledzeretsa.

Kuchotsa mankhwala osokoneza bongo kuyenera kuchitika pang'onopang'ono, popeza kusiya mwadzidzidzi kuvomereza, makamaka pambuyo panjira yayitali, kungayambitse kukula kwa matenda obwera nawo.

M-anticholinergic ntchito ya amitriptyline imatha kuyambitsa kuwonjezeka kwa kukakamira kwaziphuphu. Ndikothekanso kuchepetsa kuchepa kwa magazi ndikuwonjezera kuchuluka kwa ntchofu mu madzi osalala, zomwe zimatha kuwononga gawo lakunja la ziphuphu mwa anthu omwe amagwiritsa ntchito magalasi.

Muzochita zamankhwala, kumwalira chifukwa cha arrhythmia yomwe imachitika patatha maola makumi asanu ndi limodzi atatha kumwa mankhwala ambiri.

Odwala omwe ali ndi chizolowezi chofuna kudzipha, chiopsezo chofuna kudzipha chimapitilira chithandizo chonse mpaka kusintha kwakukuru pazizindikiro zakukhumudwa kumatheka. Popeza achire zotsatira za amitriptyline zimayamba kuwonekera pokhapokha pakadutsa milungu iwiri - 2, kuyang'anitsitsa odwala omwe amafuna kudzipha nkofunikira mpaka mkhalidwe wawo utasintha. Anthu omwe m'mbuyomu adawafotokozera za kufuna kudzipha kapena zochitika zodzipha, komanso kuyesera kudzipha asanayambe chithandizo kapena panthawi ya chithandizo, ayenera kuyang'aniridwa ndi achipatala nthawi zonse. Kugawa mankhwala kwa odwala otere kumachitika kokha ndi anthu ovomerezeka. Amitriptyline Nycomed (monga antidepressants ena) pawokha amatha kuwonjezera kuchuluka kwa odzipha mwa odwala omwe ali ndi zaka 24, motero, asanapereke mankhwala kwa odwala omwe ali ndi zaka 24, ndikofunikira kudziwa kuchuluka kwake kwa kugwiritsidwa ntchito kwake komanso chiopsezo chodzipha.

Kwa anthu omwe ali ndi manic-depression syndrome, amitriptyline angayambitse gawo lamanuna. Pazifukwa za manic, mankhwalawa ayenera kusiyidwa.

Odwala omwe amalandila mankhwala ochepetsa mphamvu ya mankhwalawa nthawi imodzi kapena mankhwala wamba opatsa chidwi amatha kukulitsa kuchepa kwa kuthamanga kwa magazi komanso kukhazikika kwa arrhythmias. Ichi ndichifukwa chake ndikofunika kuletsa mankhwalawa musanachite opareshoni yomwe mwakonzekera. Pakachitika chithandizo chamankhwala chodzidzimutsa, wopeza mankhwala ayenera kudziwitsidwa za kutenga amitriptyline.

Mankhwala amatha kusokoneza insulin ndikusintha kuchuluka kwa shuga m'magazi mutatha kudya. Odwala omwe ali ndi matenda a shuga, kusintha kwa mankhwalawa kungafunike. Mkhalidwe wokhumudwa pawokha ungasinthe kagayidwe kachakudya.

Anthu omwe amamwa Amitriptyline Nycomed ayenera kudziwitsa dotolo wamano wawo za kumwa mankhwalawa.Pakamwa pakamwa kumayambitsa kutupa, kusintha kwa kamwa kam'kamwa, makutu amano, ndikumverera koyaka mkamwa. Odwala amalangizidwa kuti azicheza ndi dotolo wamano pafupipafupi.

Mimba komanso kuyamwa

Zomwe adakumana nazo Amitriptyline Nycomed mwa amayi apakati ndizochepa. Chitetezo cha amitriptyline kwa mwana wosabadwa sichinakhazikitsidwe.

Mankhwala samalimbikitsidwa kulembedwera pa nthawi yobereka, makamaka ma trimesters a I ndi III, kupatula pokhapokha ngati phindu lomwe mayi akuyembekezera limaposa chiwopsezo cha mwana wosabadwayo. Ndikofunikira kuchenjeza mayi woyembekezera za chiwopsezo chachikulu cha zotsatira zoyipa za mankhwalawa mwana wosabadwa, makamaka mu trimester ya III. Mlingo wambiri wa ma tridclic antidepressants omwe amagwiritsidwa ntchito mu trimester yachitatu angayambitse zovuta zamitsempha mwa makanda. Nkhani za kugona kwayokhako zinalembedwera mwa makanda omwe amayi awo adatenga nortriptyline pa nthawi yapakati, komanso milandu yokhudzana ndi kusokonekera kwamakanda idakambidwanso.

Mu maphunziro a nyama, zotsatira zoyipa za mankhwalawa zimadziwika mutatenga Mlingo wowirikiza kangapo poyerekeza ndi njira yothandizira anthu.

Amitriptyline amachotseredwa mkaka wa m`mawere, kotero kuyamwitsa kuyenera kutha panthawi ya mankhwalawa.

Kuyanjana kwa mankhwala osokoneza bongo

Amitriptyline Nycomed imapangitsa kuti ziletso zamkati zizigwira ntchito motere: mankhwalawa ndi ma analgesics apakati, ma antipsychotic, anticonvulsants, hypnotics ndi sedative, mowa, komanso mankhwala oletsa kupweteka.

Mankhwala omwe amalepheretsa CYP2D6 isoenzyme (isoenzyme yayikulu yomwe ma tridclic antidepressants amaphatikizidwa) amatha kuletsa metabolite ya amitriptyline ndikuwonjezera ndende yake ya plasma. Mankhwalawa ndi monga: antipsychotic, anti-anti-hymic mankhwala a mbadwo wotsiriza (propafenone, procainamide, esmolol, amiodarone, phenytoin), serotonin reuptake inhibitors (kupatula citalopram, chomwe chimalepheretsa kwambiri), P-blockers.

Amitriptyline Nycomed adatsutsana kuti agwiritsidwe ntchito munthawi yomweyo ndi Mao inhibitors, popeza kuphatikiza kotereku kumabweretsa chitukuko cha serotonin syndrome, chomwe chimaphatikizapo ma spasms pamene akusangalala, myoclonus, matenda amisala omwe ali ndi chikumbumtima chosazindikira komanso chikomokere. Mankhwalawa atha kuyamba kugwiritsidwa ntchito pakatha masabata awiri atachotsa pakubweza mankhwala osasinthika, osasankha ma inhibitors a MAO ndi tsiku limodzi atachotsa moclobemide (inhibitor ya MAO inhibitor). Nawonso, chithandizo ndi zoletsa za MAO sichitha kuyamba kale kuposa masabata awiri atachotsedwa Amitriptyline Nycomed. M'milandu yoyamba komanso yachiwiri, chithandizo chamankhwala ndi Mao inhibitors ndi amitriptyline chimayamba ndi Mlingo wocheperako, womwe pambuyo pake umachulukitsidwa.

Mankhwala osavomerezeka kuti agwiritsidwe ntchito munthawi yomweyo ndi awa:

• sympathomimetics (adrenaline, isoprenaline, phenylephhedrine, norepinephrine, ephedrine, dopamine): zotsatira za mankhwalawa pa mtima zimakhazikika.
• adrenergic blocking agents (methyldopa, clonidine): kufooka kwa antihypertensive mphamvu ya adrenergic yotseka othandizira ndikotheka,
• m-anticholinergics (phenothiazine zotumphukira, atropine, antiparkinsonian mankhwala, biperiden, H blockers₁-histamine receptors): amitriptyline imatha kukulitsa mphamvu ya mankhwalawa pamatumbo, chikhodzodzo, gawo lamawonedwe ndi dongosolo lamanjenje lamkati, kugwiritsidwa ntchito palimodzi kuyenera kupewedwa chifukwa chakuwonjezeka kwa kutentha ndi kutsekeka kwamatumbo.
• mankhwala omwe amakulitsa nthawi yayitali ya QT (antiarrhythmic mankhwala, antipsychotic ena, H blockers₁histamine receptors, anesthetics, sotalol, chloral hydrate): chiopsezo chotukula kwamitsempha yamagazi cham'mimba chimawonjezeka,
• Mchere wa lithiamu: ndikotheka kuwonjezera kuwopsa kwa lifiyamu, yowonetsedwa ndi kukoka kwa tonic-clonic, kunjenjemera, kuganiza molakwika, kuyerekezera zinthu m'maganizo, kuvutika kukumbukira komanso kupweteka kwa antipsychotic syndrome,
• antifungal agents (terbinafine, fluconazole): seramu ndende ya amitriptyline imawonjezeka ndipo kawopsedwe kazinthu zomwe zimagwirizanitsidwa ndi izo zimachulukanso.

Amitriptyline Nycomed amagwiritsidwa ntchito mosamala nthawi yomweyo ndi mankhwala otsatirawa:

• Mankhwala omwe amaletsa chapakati mantha dongosolo (wamphamvu analgesics, sedative ndi hypnotics, Mowa ndi ethanol-mankhwala): n`zotheka kuwonjezera zoletsa ntchito za chapakati mantha dongosolo,
• inducers of microsomal chiwindi michere (carbamazepine, rifampicin): metabolite amitriptyline ingachuluke ndipo ndende yake ya plasma itha kuchepa, zomwe pamapeto pake zimapangitsa kufooka kwa mphamvu ya antidepressant,
• antipsychotic: kuphatikiza kwa kagayidwe kazachilengedwe ndikotheka, komwe kumapangitsa kutsika kwa khumbo ndikupangitsa kukulitsa khumbo (nthawi zina mlingo wa antipsychotic ndi amitriptyline umafunika),
• wodekha calcium njira blockers, methylphenidate, cimetidine: plasma ndende ya amitriptyline imachulukirapo ndipo kawopsedwe wake umachulukana,
• mapiritsi ogona ndi antipsychotic: kugwiritsa ntchito nthawi imodzi amitriptyline, mapiritsi ogona ndi ma antipsychotic ali osavomerezeka (ngati kuli koyenera, kugwiritsa ntchito kuphatikiza uku kuyenera kukhala kosamala makamaka).
• valproic acid: kuchuluka kwa amitriptyline ndi nortriptyline (kungafune kutsika kwa mlingo wa mankhwalawa),
• sucralfate: mayamwa a amitriptyline amachepa ndipo mphamvu yake yotsutsana imachepa,
• phenytoin: metabolism ya phenytoin imalephereka ndipo kuwonjezereka kwa kawopsedwe (ataxia, kunjenjemera, nystagmus ndi hyperreflexia ndikotheka),
• Kukonzekera kwa hypericum perforatum: kagayidwe ka amitriptyline m'chiwindi kumayendetsedwa ndipo kuchuluka kwake kwa plasma kumachepa (kusintha kwa amitriptyline kungafunike).

Analogues a Amitriptyline Nycomed ndi Amitriptyline, Amitriptyline Zentiva, Amitriptyline Grindeks, Vero-Amitriptyline, Amitriptyline-Ferein, Saroten retard, etc.

Fomu ya Mlingo:

mapiritsi okhala ndi filimu

Piritsi limodzi lokhathamira 10 mg lili ndi:
ntchito: amitriptyline hydrochloride 11.3 mg molingana ndi amitriptyline 10 mg,
zokopa: magnesium stearate 0,25 mg, povidone 0.83 mg, talc 2.25 mg, microcrystalline cellulose 9,5 mg, mbatata wowuma 28.2 mg, lactose monohydrate 27.0 mg,
chipolopolo: propylene glycol 0,2 mg, titanium dioxide 0,8 mg, hypromellose 1.2 mg, talc 0,8 mg.
Piritsi limodzi lokhathamiritsa 25 mg lomwe lili ndi:
ntchito: amitriptyline hydrochloride 28.3 mg malinga ndi amitriptyline 25 mg,
zokopa: magnesium stearate 0,5 mg, povidone 0,6 mg, talc 4.5 mg, microcrystalline cellulose 18.0 mg, mbatata wowonda 38.0 mg, lactose monohydrate 40.2 mg,
chipolopolo: propylene glycol 0,3 mg, titanium dioxide 0,9 mg, hypromellose 1.4 mg, talc 0,9 mg.

Kufotokozera

Mapiritsi, okhala ndi utoto woyera, wozungulira, wa biconvex.

Ndemanga za Amitriptyline Nycomed

Mankhwala ali ndi ndemanga zabwino komanso zoipa. Ndikulimbikitsidwa kugwiritsa ntchito pafupifupi 75% ya ogwiritsa ntchito. Ubwino waukulu wa mankhwala oletsa kupanikizika: Kuchita bwino, kulolera bwino, mtengo wotsika. Mankhwalawa amathetsa nkhawa, amathandizanso kupweteka kwambiri, kugona tulo komanso kukhumudwa, kumeta, kupumula kwamanjenje, kumachepetsa nkhawa komanso neurosis.

Zoyipa za Amitriptyline Nycomed, malinga ndi odwala, ndizotsatira zoyipa (kuchuluka kwa chidwi ndi kuchuluka kwa thupi, pakamwa kowuma, dzanzi la lilime, kutsika magazi, kugona.). Ogwiritsa ntchito ena amadandaula za kusowa kwa chida. Mankhwalawa ali ndi zambiri zokhudzana ndi zovuta, zimagawidwa pokhapokha ngati mumalandira mankhwala osokoneza bongo, kuledzera ndikotheka, kotero, kuchotsedwa pang'onopang'ono kumafunikira - izi ndiye zovuta zazikulu zomwe zanenedwa mu ndemanga.

Mankhwala

Amitriptyline ndi mankhwala onunkhira kwambiri kuchokera pagulu la omwe sanasankhe monoamine reuptake inhibitors. Ili ndi mphamvu yamphamvu yokhala ndi chidziwitso.
Mankhwala
Kupanga kwa antidepressant zochita za amitriptyline kumalumikizidwa ndi kuwonjezeka kwa zomwe zili mu norepinephrine ndi serotonin mu synaptic cleft mkati mwa mantha dongosolo (CNS).
Kudzikundikira kwa ma neurotransmitters amenewa kumachitika chifukwa choletsa kutembenuka kwawo kosakanikirana ndi ma membala am'mimba a presynaptic neurons.
Amitriptyline ndi blocker of Ml ndi M2 muscarinic cholinergic receptors, H1 histamine receptors ndi cy1 adrenergic receptors. Malinga ndi zomwe amati monoamine hypothesis, pali kulumikizana pakati pa kamvekedwe ka mawu ndi ntchito ya ma neurotransmitters mu ma synapses a ubongo.
Kuphatikizana koonekeratu pakati pa kuchuluka kwa amitriptyline m'magazi am'magazi ndi zotsatira zamankhwala sikuwonetsedwa, koma kuthekera koyenera kwamankhwala, mwachiwonekere, kumakwaniritsidwa pazokhazikika pamndandanda wa 100-260 μg / L.
Kuchepa kwamankhwala kwa matenda amtundu kumatheka pambuyo poti ndende yofanana ya plasma ifike, pambuyo pa milungu 2-6 yamankhwala.
Kuphatikiza apo, amitriptyline imakhala ndi zotsatira ngati quinidine pakukhazikitsidwa kwa mtima.
Pharmacokinetics
Zogulitsa
Pambuyo pakukonzekera pakamwa, amitriptyline imathamanga mwachangu komanso kwathunthu kuchokera kumimba. Kuzindikira kwakukulu mu plasma ya magazi (Cmax) kumatheka mkati mwa maola 2-6 pambuyo pa kuperekedwa.
Kugawa
Kuchuluka kwa amitriptyline m'madzi am'magazi a odwala osiyanasiyana kumasiyana kwambiri.
The bioavailability wa amitriptyline pafupifupi 50%. Amitriptyline pamlingo waukulu (95%) womanga mapuloteni a plasma. Nthawi yofika kwambiri pamankhwala osokoneza bongo (TCmax) pambuyo pakumwa kwa pakamwa ndi maola 4, ndipo ndende yolingana ndi sabata pafupifupi sabata itatha Kuchulukitsa kwa magawidwe kumakhala pafupifupi 1085 l / kg. Onse amitriptyline ndi nortriptyline amadutsa placenta ndipo amamuchotsa mkaka wa m'mawere.
Kupenda
Amitriptyline imapangidwa mu chiwindi ndipo imapukusidwa kwambiri (pafupifupi 50%) nthawi yoyamba yomwe imadutsa m'chiwindi. Nthawi yomweyo, amitriptyline amadutsa N-demethylation ndi cytochrome P450 ndikupanga kwa metabolite yogwira - nortriptyline. Onse amitriptyline ndi nortriptyline amathanso hydroxylated m'chiwindi. Nitroxy ndi 10-hydroxymetabolite amitriptyline ndi 10-hydroxynortriptyline nawonso amagwira ntchito. Onse amitriptyline ndi nortriptyline amalumikizidwa ku glucuronic acid, ndipo ma conjugates awa ndi osagwira ntchito.
Choyimira chachikulu chomwe chikuwonetsa kuvomerezeka kwa impso, ndipo, motero, kuchuluka kwa madzi am'magazi, ndi kuchuluka kwa hydroxylation. Mwa anthu ochepa, ma hydroxylation osachedwa kusintha amawonedwa. Odwala omwe ali ndi vuto la chiwindi, theka la moyo wa amitriptyline ndi nortriptyline mu plasma yamagazi limachulukitsidwa.
Kuswana
Hafu ya moyo (T1 / 2) kuchokera ku madzi a m'magazi ndi ma 9-46 maola amitriptyline ndi maola 18-95 a nortriptyline.
Amitriptyline imapukusidwa makamaka ndi impso komanso m'matumbo mwa mawonekedwe a metabolites. Gawo laling'ono chabe la mlingo wovomerezeka wa amitriptyline ndi omwe amamuchotsa impso osasinthika. Odwala omwe ali ndi vuto la impso, mawonekedwe a amitriptyline ndi nortriptyline metabolites amayamba kuchepa, ngakhale kagayidwe kameneka sikusintha. Chifukwa cha mgwirizano wake ndi mapuloteni amwazi, amitriptyline samachotsedwa m'madzi a m'magazi ndi dialysis.

Zizindikiro zogwiritsidwa ntchito

• Autism
• hypochondria
• kukhumudwa
• schizophrenic psychosis,
• bulimia amanosa
• kuyamwa,
• aakulu ululu syndromes
• zilonda zam'mimbazi
• migraine prophylaxis.

Pakati pa mndandanda wonse wamavuto akuluakulu amanjenje, ziyenera kudziwika kuti mankhwalawa amalembedwa ndi akatswiri ngakhale kwa odwala khansa kuti muchepetse kupweteka. Pankhani yakuphwanya mkhalidwe wamavuto ndi machitidwe, nkhawa yowonjezereka, kusokonezeka kwa kugona ndi kukhumudwa kosasiyidwa, mankhwalawa amathandiza 100%, ndikofunikira kukumbukira kokha kuti siyamba kuchita nthawi yomweyo.

Mitengo ya amitriptyline nycomed ku malo ogulitsa mankhwala ku Moscow

Madokotala amawunika za amitriptyline nycomed

Zomwe zimachitika pakugwiritsa ntchito Amitriptyline monga othandizira ena pothandizira ululu wa vertebrogenic zapangitsa kuti mawu omaliza azigwira bwino ntchito kwa odwala omwe ali ndi ululu wambiri. Kusintha komwe kulipo kunathandizira kuti magonedwe azisinthanso kumwa mankhwalawa.

Amitriptyline. Ili ndiye loyamba. Ndipo, chachiwiri, mwina chimapangidwa kuchokera ku zinthu "zoyera" kwambiri kuchokera ku amitriptyline onse omwe akupezeka mdera la Kemerovo. Ili ndi mulingo wa 10 mg, womwe umakhala wophweka kwambiri ngati utaperekedwa kwa odwala omwe ali ndi vuto lodziletsa ndipo (kapena) mosasamala mogwirizana ndi "antidepressants".

Mavuto wamba a amitriptyline: mtima, kuchuluka kwa prolactin m'magazi, kuchuluka kwa thupi, mapangidwe a cystitis amatha.

Amitriptyline abwino kwambiri pamsika wa Kemerovo.

Nthawi zambiri zimayambitsa kugona ndi cholinergic mavuto: kulemera kwa mutu, kusungika kwamikodzo, kudzimbidwa.

Chimodzi mwazinthu zowononga kwambiri, zomwe zimatchulidwa kuti zithane ndi nkhawa. Kugwiritsa ntchito muzochitika zazikuluzikulu za kukhumudwitsa, kupsinjika, kupsinjika ndi kupsinjika kwa ziwonetsero. Itha kugwiritsidwa ntchito ngati malo osakanikirana ndi nkhawa, okhala ndi vuto la kugona.

Ndemanga za wodwala za Nycomed amitriptyline

Sindikufuna kuti wina aliyense amve zomwe ndidamva chifukwa cha mankhwala oyipawa! Dotolo adati ndikadakhala wodekha, koma sanachenjeze kuti ndikadzakhala masamba. Izi ndizowopsa! Ngakhale nditakhala ndimaganizo ofuna kudzipha, Amitriptyline ndi amene anali ndi vuto. Zowopsa!

Dokotala wamankhwala anandiwuza Amitriptyline kuti ndichepetse migraine. Mankhwalawa amaperekedwa kokha ndi mankhwala, omwe sindimakonda, chifukwa mapiritsi atatha, muyenera kupita ku chipatala, mukayime mzere kwa kanthawi kochepa, kenako mutha kupita ku pharmacy kuti mumtsatire. Koma izi ndi theka lokhalokha zovuta, ndikuzitenga kwa miyezi isanu ndi umodzi, monga adokotala adanenera, kunalibe zotsatira, palibenso zovuta zina, iwonso sanayambenso kutuluka. Itha kukhala othandiza mu matenda ena, koma ayi.

Mu 2017, ndinakumana ndi vuto lachilendo kwambiri, lofanana ndi vuto la mtima, koma m'mene zidasinthira pambuyo pake - kuwopsa kwamantha. Ananditengera kuchipatala, mu mitsempha, pamenepo adotolo adandiuza mapiritsi, mankhwalawo anali theka la mapiritsi usiku ndipo kenaka adakula pang'ono ndi pang'ono, kotero kuti ndidawatenga molingana ndi chiwembu 0.5 0.5 1 (m'mawa, masana ndi madzulo ), poyamba panali kugona tulo tofa nato, kugona tulo kwambiri komanso mopanda phokoso, kugona ndi bang! Zotsatira zake zinali zowonekera bwino mkati mwa milungu iwiri, nditadzipeza ndimalingalira kuti kusangalala kwanga kunali kwakukulu kotero kuti sizinachitike! Ndinkakondwera ndi zinthu zosangalatsa kwambiri monga kuwonekera kwa dzuwa, kusefukira kwa masamba, nyimbo zomwe sizinayambitse chisangalalo cham'mbuyo, nthawi iyi idabweretsa chisangalalo chachikulu. Ndipo, inde, ndinalinso ndi maloto owoneka bwino! Pambuyo pake, mlingo unachepetsedwa, mankhwalawo amandithandiza bwino, adandiyenera bwino.Koma muyenera kumvera zomwe mukukumana nazo, chifukwa ndi payekha.

M'moyo wanga ndinakumana ndi matenda monga kukhumudwa. Ndidapeza katswiri wazamisala wanzeru, ndipo adandilembera Amitriptyline. Mankhwala ndi abwino, kuthana ndi nkhawa, kumachotsa tulo. Anandiika pa mlingo wa 20 mg usiku ndi 10 mg masana, ndipo posakhalitsa ndinangokhala pa mlingo wa usiku. Mankhwalawa, ngakhale ndi akale, koma amagwirizana ndi ntchito yake. Ambiri akuwopa zotsatira zoyipa, sindinali nawo, kugona chabe, koma kunali m'manja mwanga, chifukwa Kwa nthawi yayitali akudwala matenda osowa tulo.

"Amitriptyline" adalembedwa ndi akatswiri azachipatala, omwe anali ndi nkhawa za nkhawa. Mankhwalawa ndiabwino, ngati adayikidwa moyenera amathandizadi. Ndikofunika kumwa piritsi lomaliza mpaka maola 20,00, mwinanso kumapangitsa kusangalala kwamanjenje. Ngati kugona kuwoneka, tachycardia - mlingo uyenera kuchepetsedwa. 1/4 ya 10 mg 2 kawiri pa tsiku ndipo 1/2 ya 10 mg usiku amapatsa zotsatira zabwino. Panalibe zovuta zilizonse kupatula tachycardia.

Pharmacology

Antidepressant ku gulu la ma triceclic mankhwala, omwe amatengera dibenzocycloheptadine.

Kupanga kwa antidepressant kanthu kumalumikizidwa ndi kuwonjezeka kwa kuchuluka kwa norepinephrine mu ma synapses ndi / kapena serotonin mkati wamanjenje chifukwa cha kuletsa kutembenuka kwa mitsempha ya okhazikika awa. Kugwiritsa ntchito nthawi yayitali, kumachepetsa magwiridwe antchito a β-adrenergic receptors ndi serotonin receptors mu ubongo, imagwiranso ntchito kufalikira kwa adrenergic ndi serotonergic, ndikubwezeretsanso malire a machitidwe awa, omwe amasokonezeka m'malo ovuta. M'mayiko omwe muli ndi nkhawa, amachepetsa nkhawa, kukwiya ndi zofooka.

Ilinso ndi zotsatira za analgesic, zomwe zimakhulupirira kuti zimachitika chifukwa cha kusintha kwazomwe zimachitika mu monoamines m'chigawo chapakati chamanjenje, makamaka serotonin, komanso momwe machitidwe amkati mwa opioid amathandizira.

Ili ndi tanthauzo lotumphukira komanso pakati pa anticholinergic, chifukwa chogwirizana kwambiri ndi ma m-cholinergic receptors, mphamvu yolimba yokhudzana ndi mgwirizano wa histamine H₁-receptors, and alpha-adrenergic blocking action.

Ili ndi mphamvu yotsutsana ndi antiulcer, limagwirira ake omwe ali chifukwa chokhoza kuletsa histamine H₂- ma cell a parietal cell of m'mimba, komanso ndimomwe ndimayendedwe osokoneza bongo komanso m-anticholinergic (ngati zilonda zam'mimba ndi duodenum, amachepetsa ululu, ndikuthandizira kuchiritsa zilonda zam'mimba.

Kuchita bwino pa bedwetting kumachitika makamaka chifukwa cha ntchito ya anticholinergic, zomwe zimapangitsa kuti chikhodzodzo chizitambasulire, kukondweretsa mwachindunji kwa β-adrenergic, zochitika za α-adrenergic agonists, limodzi ndi kuwonjezeka kwa kamvekedwe ka sphincter komanso kachulidwe kakang'ono ka phokoso la serotonin.

Njira zochizira matenda mu bulimia amanosa sizinakhazikitsidwe (mwina zofanana ndi zomwe zikuchitika pakukhumudwa). Kuchita bwino kwa amitriptyline mu bulimia kumawonetsedwa kwa odwala onse popanda kupsinjika ndi kupezeka kwake, pomwe kuchepa kwa bulimia kumatha kuonedwa popanda kufooka kwamtundu womwewo.

Pochita opaleshoni ya m'magazi, amachepetsa kuthamanga kwa magazi ndi kutentha kwa thupi. Sikuletsa MAO.

Mphamvu yotsitsa ikukula mkati mwa masabata awiri atatha kugwiritsa ntchito.

Kuchita

Pogwiritsa ntchito munthawi yomweyo mankhwala osokoneza bongo omwe amakhumudwitsa kwambiri dongosolo lamanjenje, kuwonjezeka kwakukulu kwa zotsatira zoyipa zamagetsi zamkati, antihypertensive kwenikweni, ndi kupuma kwamatenda ndizotheka.

Pogwiritsa ntchito munthawi yomweyo mankhwala okhala ndi anticholinergic ntchito, kuwonjezeka kwa zotsatira za anticholinergic ndizotheka.

Pogwiritsa ntchito munthawi yomweyo, ndizotheka kuwonjezera mphamvu za othandizira pamtima pazida zamtima ndikuwonjezera chiopsezo chokhala ndi mtima wa arrhythmias, tachycardia, komanso matenda oopsa kwambiri.

Pogwiritsa ntchito munthawi yomweyo mankhwala a antipsychotic (antipsychotic), kagayidwe kake kamalepheretsa, pomwe chitseko chofuna kutsimikizika chikuchepa.

Pogwiritsa ntchito munthawi yomweyo ndi antihypertensive agents (kupatula clonidine, guanethidine ndi zotumphukira zawo), ndizotheka kuwonjezera antihypertensive zotsatira ndi chiwopsezo cha kukhala ndi orthostatic hypotension.

Pogwiritsa ntchito munthawi yomweyo ndi Mao inhibitors, kukula kwa vuto la matenda oopsa kungatheke, ndi clonidine, guanethidine - kuchepa kwa hypotensive zotsatira za clonidine kapena guanethidine ndikotheka, ndi barbiturates, carbamazepine - kuchepa kwa mphamvu ya amitriptyline chifukwa chowonjezeka kagayidwe kake.

Nkhani ya kukula kwa matenda a serotonin pogwiritsa ntchito munthawi yomweyo ndi sertraline akufotokozedwa.

Ndi munthawi yomweyo kugwiritsa ntchito sucralfate, kuyamwa kwa amitriptyline kumachepa, ndi fluvoxamine, kuchuluka kwa amitriptyline m'magazi am'magazi komanso chiwopsezo cha zotsatira zoyipa, ndi fluoxetine, kuchuluka kwa amitriptyline m'magazi a plasma kumawonjezeka komanso kusintha kwa poyizoni chifukwa cha kufooketsa kwa potidineinthininein theostidine of theididine of theididine of theididine of the formid metabolite wa amitriptyline, wokhala ndi cimetidine - ndizotheka kuchepetsa kuchepa kwa amitriptyline, kuonjezera kuchuluka kwake mu plasma ya magazi ndikupanga t ksicheskih zotsatira.

Pogwiritsa ntchito munthawi yomweyo ndi Mowa, mphamvu ya Mowa imalimbikitsidwa, makamaka m'masiku ochepa akuchira.

Mimba komanso kuyamwa

Amitriptyline sayenera kugwiritsidwa ntchito panthawi yomwe ali ndi pakati, makamaka ma trimesters a I ndi III, kupatula pangozi. Maphunziro okwanira komanso osamalidwa mosamalitsa a chitetezo cha amitriptyline pa nthawi yomwe ali ndi pakati sanachitike.

Kulandila kwa amitriptyline kuthetsedwera pang'onopang'ono masabata osachepera 7 mwana asanabadwe kuti akuyembekezere kuti asadwalidwe.

M'maphunziro oyesera, amitriptyline anali ndi mphamvu ya teratogenic.

Contraindified pa mkaka wa m`mawere. Imayamwa mkaka wa m'mawere ndipo imapangitsa kugona kwa makanda.

Analogi ndi mtengo

"Amitriptyline Nycomed" (25 mg) pamapiritsi am'magalimoto okhala ndi ndalama pafupifupi ma ruble 50-70 pa paketi iliyonse. Komanso, mankhwalawa amapezeka mu mawonekedwe a mayankho a jakisoni ndi kulowetsedwa.

Amitriptyline (25 mg) amapangidwa mwa mawonekedwe apiritsi ndi makampani ambiri omwe ali ndi dzina lomwelo.

Chifukwa chake, fanizo la mankhwala kuchokera ku kampani yopanga mankhwala "Nycomed" ndi mankhwala ochokera kwa opanga:

Komanso pali mtundu wotsika mtengo wa ntchito zapakhomo ndi mapiritsi omwe amatchedwa "VERO-AMITRIPTILINE", opangidwa ndi makampani ambiri akunja opanga mankhwala.

Zoletsa kugwiritsa ntchito

Kuphatikiza pa tsankho lomwe lilipo pazinthu zilizonse za mankhwalawa, ndizoletsedwa kugwiritsa ntchito:

• pakhungu ndi msambo,
• ana ochepera zaka zisanu ndi chimodzi
• nthawi yochira pambuyo vuto la mtima,
• ndi kutsekeka kwatseka khungu,
• ndi matenda akulu amtima,

Amaletsedwanso mwamphamvu kumwa "Amitriptyline", mowa, psychotropic, analgesic ndi mapiritsi ogona pamodzi.

Zotsatira zoyipa

Popeza "Amitriptyline Nycomed" (25 mg), malangizo ogwiritsira ntchito akufotokozedwa ngati othandizira amphamvu kwambiri, mndandanda wazotsatira zake zosafunikira ndizofunika kwambiri. Ngakhale izi, malinga ndi ndemanga, odwala ambiri samapezeka konse kapena chizungulire chimawonekera masiku oyambira atangoyamba kumene chithandizo.

Chifukwa chake, mankhwalawa amatha kuyambitsa zovuta kuchokera:

• dongosolo lamanjenje
• m'mimba
• zamtima
• endocrine
• hematopoietic.

Komanso, "Amitriptyline", malangizowa ali ndi mndandanda wathunthu wazotsatira zoyipa, amatha kuyambitsa zovuta zosiyanasiyana pakhungu lanu ngati totupa, kutupa kapena kuyabwa. Kuphatikiza apo, mwa odwala ena, kuchepa kwa tsitsi, zotupa zam'mimba, ndi tinnitus zimawonedwa panthawi ya maphunziro.

Mwa zina zoyipa zomwe zimachitika, odwala amasiyanitsa mawonekedwe a anticholinergic zochita. Izi zikuphatikiza chizungulire, pakamwa pouma, tachycardia, chisokonezo, muzochitika zina zapadera.

Matenda a dongosolo la kugaya chakudya monga nseru, kusintha kwa malingaliro, kusokonezeka kwa chilimbikitso, kutentha kwa mtima, stomatitis, kutsegula m'mimba ndizochepa. Osowa kwambiri, chiwopsezo cha chiwindi ndi hepatitis zimawonekera.

Kumbali ya chithokomiro cha chithokomiro, kukulitsidwa kwa m'mawere mwa akazi komanso kuphwanya kwa potency mwa amuna kumatha kuonedwa. Zotsatira zodziwika bwino pakati pa amuna ndi akazi ndi kuchepa kwa libido. Mu ntchito ya mtima, arrhythmias, tachycardia, chizungulire, zizindikiro zopanda pake panthawi ya electrocardiogram ndi zina zambiri zimatha kuwonekera.

Makamaka chisamaliro chikuyenera kuperekedwa ku mndandanda wazowonetsera zoyipa zamanjenje. Ngakhale kuti mankhwalawa amayikidwa pakukhazikika kwake, chiwopsezo cha mavuto obwera nacho chimaphatikizidwanso.

Chifukwa chake, odwala angadziwe:

• nkhawa
• kugona
• kuchuluka kwa nkhawa
• kukomoka
• manic limati
• chisokonezo
• psychosis
• mutu
• kusowa tulo
• zozizwitsa m'maloto
• kuchuluka kwa khunyu.

Malangizo owonjezera

Odwala omwe akupatsidwa chithandizo cha Amitriptyline ayenera kukumbukira kuti chinthu chogwira ntchito chimatha kuyambitsa chisokonezo pakasinthasintha lakuthwa kupita pamalo owongoka, motero muyenera kumadzuka bwino. Komanso, atakhala nthawi yayitali atachira komanso atasiya chithandizo chamankhwala, ambiri amakhala ndi vuto loti abwerere.

Popeza mankhwalawa sagwirizana ndi mankhwala omwe amaletsa ma MAO, ayenera kuyamba kulandira chithandizo pasanathe milungu iwiri atasiya kumwa mankhwalawa.

Madokotala amayenera kuchenjezedwa nthawi zonse pakumwa mankhwalawa, makamaka chifukwa amatha kuthana ndi zotsatira za mankhwala ena. M'pofunikanso kuphatikiza munthawi yomweyo kasamalidwe ka ephedrine, phenylephrine ndi zinthu zina.

Odwala okalamba, makamaka iwo amene amapuma kugona ndipo osayenda pang'ono, mankhwalawa amatha kubweretsa m'matumbo. Zovuta zilizonse zolimbitsa thupi m'njira yamagetsi zimaloledwa kokha moyang'aniridwa ndi madokotala.

Kugwiritsa ntchito mankhwalawa kwa nthawi yayitali kumatha kubweretsa mawonekedwe a caries ndi kufunika kowonjezereka kwa riboflavin.

Ngati mankhwalawa adalangizidwa kwa wodwala tsiku lililonse woposa 150 mg, ndiye kuti kuphatikizika kwa zinthu m'thupi kungayambitsenso kuwonjezeka kwa khunyu komanso kuwonekeratu kwa matenda opatsirana mwa zina. Ndi kugwiritsa ntchito nthawi yayitali, ndikofunikira kulingaliranso kuti odwala amatha kukhala ndi malingaliro ofuna kudzipha, makamaka ndi kuleka kwa mankhwalawa.

Kugwiritsa ntchito zina

Muubwana, mankhwalawa amagwiritsidwa ntchito pokhapokha ngati ali ndi zaka 6 pazipiritsi. Madzi a jakisoni amalumikizidwa kwambiri. Zitha kugwiritsidwa ntchito kwa ana okha kuyambira azaka 12.

Pa nthawi yoyembekezera, mankhwalawa amaletsedwa kutenga, chifukwa, malinga ndi kafukufuku, amatha kukhala ndi vuto lililonse pakukula kwa mwana wosabadwayo. Kugwiritsira ntchito mankhwalawa kumaloledwa nthawi zambiri komanso pokhapokha yachiwiri, ngati phindu lingakwaniritse zovuta zonsezo. M'pofunikanso kuleka kuchira kwa nthawi kuti mwana asayambitse kulera pambuyo pobadwa. Mankhwala amayenera kusiya milungu isanu ndi iwiri isanakwane tsiku lobadwa.

Mukamadyetsa, "Amitriptyline Nycomed" sagwiritsidwa ntchito konse, chifukwa amatha kubweretsa kugona ndi kusuta kwa ana.

Mwa odwala okalamba, mankhwalawa nthawi zambiri amachititsa kuti matumbo asokonezedwe, omwe amayenera kuchotsedwa popanda chizindikiro kapena kusintha mankhwalawo ndi ena. Komanso mu ukalamba, pakhoza kukhala mankhwala a psychoses, omwe nthawi zambiri amachitika atasiya kumwa mankhwala usiku.

"Amitriptyline Nycomed" (25 mg) ndemanga za odwala odziwa ntchito amatenga osakaniza. Ambiri mwa omwe amathandizidwa ndi mankhwalawa adakhutira kwathunthu ndi zotsatira zake ndipo adazindikira chizungulire pang'ono pakumchira. Mtengo wotsika, womwe umapezeka kwa munthu aliyense, umasiyanitsidwa pakati pa zabwino zamankhwala, makamaka mukaganizira kuti maphunzirowa amatenga miyezi ingapo. Mwambiri, ngakhale mutaganizira zinthu zina zoyipa, aliyense amawona momwe zimagwirira ntchito. Mankhwalawa amathandiza odwala kwakanthawi kuti athetse mavuto azovuta zam'maganizo ndikubwezeretsanso chisangalalo cha moyo.

Mwa mphindi za mapiritsi, ndemanga zina zoyipa. Inde, ambiri amawonetsa kuti amadutsa nthawi, koma nthawi zina sizikhala choncho. Ngati wodwala saletsa kuwonetsa mawonedwe owonjezera chifukwa cha kumwa mankhwalawo, ndiye kuti ndikofunikira kukaonana ndi dokotala kuti amuchotsere mankhwala ena.

Zowona, ndemanga zoyipa zimapezeka kawirikawiri kuchokera kwa anthu omwe amasankha kumwa mankhwalawo payekha, chifukwa amagulitsidwa popanda kutsatira kwa dokotala. Kutengera mlingo woyesedwa molakwika kuti ali ndi mavuto. Malinga ndi ndemanga zochokera kwa madotolo, mawonekedwe aliwonse oyipa amatha kupewedwa potengera molondola mawonekedwe amunthu ndi kuwazindikira kwa wodwalayo.

Pomaliza

Ngakhale kuti masiku ano pali mankhwala ambiri osokoneza bongo, komabe, muyenera kudziteteza nthawi zonse. Musadzinyamule ndi ntchito yowonjezereka, ngati kuli kotheka, yeserani kuyenda pafupipafupi, kupita kumisonkhano yachikhalidwe, komanso kucheza ndi okondedwa anu. Musaiwale za kugona wathanzi. Ndipo pokhapokha simungachite mantha ndi nkhawa zilizonse.

Gwiritsani ntchito pa nthawi yoyembekezera komanso nthawi yoyamwitsa

Mimba
Kafukufuku wazinyama wawonetsa zotsatira zoyipa mosiyanasiyana kangapo pamtundu wa anthu wamba.
Zochitika zamankhwala ndi amitriptyline panthawi yokhala ndi pakati ndizochepa.
Chitetezo cha amitriptyline panthawi yoyembekezera sichinakhazikitsidwe.
Amitriptyline sichilimbikitsidwa pa nthawi yoyembekezera, makamaka koyambirira ndi kwachitatu, pokhapokha ngati phindu lomwe mayi akuyembekezera limaposa chiwopsezo cha mwana wosabadwayo.
Ngati mankhwalawa amagwiritsidwa ntchito ndi amayi apakati, ndikofunikira kuchenjeza za chiopsezo chachikulu chotengera mwana wosabadwayo, makamaka mu trimester ya III. Kugwiritsa ntchito milingo yapamwamba ya ma tridclic antidepressants mu nthawi yachitatu ya mimba kumatha kubweretsa zovuta m'mitsempha yatsopano.
Panali zochitika za kugona kwa akhanda omwe amayi awo amagwiritsa ntchito nortriptyline (a metabolite of amitriptyline) pa nthawi yapakati, ndipo milandu yodandaula kwamkodzo idadziwika.
Kuyamwitsa
Mukamagwiritsa ntchito amitriptyline, kuyamwitsa kuyenera kusiyidwa. Amitriptyline amadutsa mkaka wa m'mawere. Kuwerengera kwa mkaka wa m'mawere / madzi a m'mimba ndi 0.4-1,5 mwa khanda loyamwa. Zosakhumudwitsa zimachitika.

Mlingo ndi makonzedwe

Gawani mkati mopanda kutafuna (mukatha kudya).
Akuluakulu
Mlingo woyamba wa tsiku ndi tsiku ndi 25-50 mg, womwe umagawidwa pakawiri, kapena ngati kamodzi osagona. Ngati ndi kotheka, tsiku lililonse mlingo ungakulitse pang'onopang'ono mpaka 200 mg.
Njira yodziwika bwino yamankhwala nthawi zambiri imakhalapo miyezi 6 kapena kupitilirapo kuti musayambirenso.
Okalamba
Okalamba amamvera kwambiri zovuta za m-anticholinergic zotsatira zoyipa za amitriptyline. Chifukwa cha iwo, mlingo woyambirira ndi 25-30 mg / tsiku. Nthawi zambiri patsiku (usiku). Kuwonjezeranso kwa mlingo kuyenera kuchitika pang'onopang'ono, tsiku lina lililonse, kufikira, ngati kuli kofunikira, Mlingo wa 50-100 mg / tsiku, kufikira pakayankhidwa. Kufunsanso kowonjezereka ndikofunikira musanaperekenso chithandizo chachiwiri chamankhwala.
Matenda aimpso
Pamaso vuto laimpso, mankhwalawa angagwiritsidwe ntchito ngati muyezo.
Kuwonongeka kwa chiwindi
Odwala omwe ali ndi vuto la kuchepa kwa hepatic, mlingo wa amitriptyline uyenera kuchepetsedwa.
Kutalika kwa mankhwala
An antepepressant effect nthawi zambiri amawonekera patatha masabata 2-4.
Chithandizo cha antidepressant ndichizindikiro, chifukwa chake chikuyenera kukhala chokwanira, makamaka kwa miyezi 6 kapena kupitirira, kupewa kutenganso kukhumudwa.
Patulani
Mankhwala ayenera kusiyidwa pang'onopang'ono kuti muchepetse kukula kwa matenda a "kusiya", monga mutu, kusokonezeka kwa tulo, kusakwiya komanso kudwala. Zizindikirozi sichizindikiro cha kudalira mankhwala.

Zotsatira zoyipa

Oposa 50% ya odwala omwe amalandira mankhwalawa Amitriptyline Nycomed akhoza kukhala ndi chimodzi kapena zingapo zotsatirazi zotsatirazi. Amitriptyline imatha kuyambitsa mavuto ofanana ndi omwe amayamba chifukwa cha antidepressant ena.
Zina mwatsatanetsatane zomwe zimachitika pansipa, monga kupweteka mutu, kugwedezeka, kuchepa kwa chidwi, kudzimbidwa, komanso kutsika pakugonana, zitha kukhalanso zizindikiro za kukhumudwa, ndipo nthawi zambiri zimatha ndi nkhawa zochepa.
Pafupipafupi zotsatira zoyipa zimawonetsedwa ngati: pafupipafupi (> 1/10), nthawi zambiri (> 1/100, 1/1000, 1/10 000, kuchokera ku mtima:
Nthawi zambiri: palpitations ndi tachycardia, orthostatic hypotension.
Nthawi zambiri: arrhythmia (kuphatikizapo kusokonezeka kwa conduction, kutalika kwa gawo la QT), hypotension, AV block, conduction block pamiyendo ya mtolo wa Wake.
Nthawi zambiri: kuchuluka kwa kuthamanga kwa magazi.
Zosowa: myocardial infaration.
Kuchokera ku dongosolo lamanjenje:
Nthawi zambiri: sedative kwenikweni (oopsa, kugona tulo), kugwedeza, chizungulire, kupweteka kwa mutu.
Nthawi zambiri: Anachepetsa chidwi, kusokonezeka kwa kukomoka, maresthesia, ma extrapyramidal zizindikiro: ataxia, akathisia, parkinsonism, dystonic reaction, dyskinesia wamantha, kuyambiranso kulankhula.
Nthawi zambiri: kukokana.
Kuchokera pamikodzo:
Nthawi zambiri: kusungika kwamikodzo.
Pa khungu:
Nthawi zambiri: hyperhidrosis.
Nthawi zambiri: zotupa, vasculitis pakhungu, urticaria.
Zosowa: photosensitivity, alopecia.
Kuchokera pamalingaliro:
Nthawi zambiri: kuchepa kowoneka bwino, malo operewera (magalasi owerengera angafunike pakumwa).
Nthawi zambiri: mydriasis.
Nthawi zambiri: tinnitus, kuchuluka kwamitsempha yama cell.
Zosowa: kutayika kwa kuthekera kwogona, kuchuluka kwa glaucoma yopapatiza.
Vuto la Maganizo:
Nthawi zambiri: chisokonezo (chisokonezo mu okalamba odwala amadziwika ndi nkhawa, kusokonezeka kwa tulo, zovuta kukumbukira, psychomotor mukubwadamuka, malingaliro osokonekera, delirium), kusokoneza.
Nthawi zambiri: idachepetsa chidwi.
Nthawi zambiri: chidziwitso kuwonongeka, manic syndrome, hypomania, mania, mantha, nkhawa, kusowa tulo, zolakwika.
Zosowa: nkhanza, delirium (mu akulu), kuyerekezera zinthu zina (odwala ndi schizophrenia).
Si kawirikawiri: malingaliro ofuna kudzipha, kudzipha.
Kuchokera ku ziwalo za hemopoietic:
Zosowa: kuletsa mafupa ntchito, agranulocytosis, leukopenia, eosinophilia, thrombocytopenia.
Kuchokera m'mimba
Nthawi zambiri: kukamwa kowuma, kudzimbidwa, nseru.
Nthawi zambiri: Chuma, kutupa kwamkamwa, kuwola kwameno, kutentha kwamkamwa.
Nthawi zambiri: kutsegula m'mimba, kusanza, kutupa kwa lilime.
Zosowa: kufooka kwamatumbo, kutupa kwa parotid gland, cholestatic jaundice, kuphwanya chiwindi, chiwindi.
Mavuto wamba:
Nthawi zambiri: kufooka.
Nthawi zambiri: kutupa kwa nkhope.
Zosowa: malungo.
Kuchokera kumbali ya kagayidwe:
Nthawi zambiri: kunenepa kwambiri.
Zosowa: kuchepa kwamtima.
Si kawirikawiri: matenda osakwanira katulutsidwe wa antidiuretic timadzi.
Kuchokera pakubala:
Nthawi zambiri: kufooketsa kapena kukulitsa chilakolako chogonana.
Nthawi zambiri: mwa amuna - kusabala, kusokonekera kwa erection.
Zosowa: mwa amuna - kuchepa kwa msambo, gynecomastia, mwa akazi - galactorrhea, kuchedwa kwa minyewa, kulephera kuchita bwino.
Zizindikiro zasayansi:
Nthawi zambiri: Kusintha kwa ECG, kukuza nthawi ya QT, kukulitsa kwa QRS.
Zosowa: kupatuka ku chizolowezi cha mayesero a chiwindi, kuchuluka kwa zamchere phosphatase, transaminases.
Zoyipa
Kusiyidwa mwadzidzidzi kwa chithandizo pambuyo poti mugwiritse ntchito kwa nthawi yayitali kungayambitse nseru, kupweteka mutu, komanso kupweteka.
Kuchepetsa pang'onopang'ono kwa mankhwalawa kunakhudzana ndi mawonekedwe osakhalitsa monga kukwiya, kukwiya, kugona komanso kusokonezeka kwa masabata awiri oyambilira ochepetsa.
Nthawi zambiri, milandu yokhazikika ya manic state kapena hypomania imachitika mkati mwa masiku 2-7 kuchokera atachotsedwa kwa nthawi yayitali ndi antidepressants atatu.