Serotonin ndi norepinephrine reuptake inhibitor. Zimalepheretsa pang'ono kufufuzidwa kwa dopamine, ilibe ubale wofunikira wa histamine ndi dopamine, cholinergic ndi adrenergic receptors. Kupanga kwa achire zotsatira za duloxetine mu kukhumudwa ndi chifukwa choletsa kubwezeretsanso kwa serotonin ndi norepinephrine ndipo, chifukwa chake, kuchuluka kwa serotonergic ndi noradrenergic neurotransication mu chapakati mantha dongosolo. Duloxetine imathandizanso kupweteka kwapadera mu mitundu yoyeserera ya ululu wa neuropathic komanso yotupa ndipo imachepetsa kuuma kwa kupweteka m'zitsanzo zopweteka zopweteka. The analgesic zotsatira za duloxetine mwina chifukwa chakuchepetsa kufalitsa kwa nocicept zikhumbo zamkati zamanjenje dongosolo.
Duloxetine amadziwikiridwa bwino pambuyo pakamwa. Kwambiri ndende ya madzi am`magazi amafikira pambuyo 6 mawola. Zakudya zomwezi munthawi yomweyo zimachepetsa kuyamwa, nthawi yomwe kuchuluka kwa magazi m'magazi kumafikira kumawonjezeka kuchoka pa maola 6 mpaka 10, ndipo mayamwidwe amachepa (pafupifupi 11%).
Duloxetine amamangidwa kwambiri ndi mapuloteni a plasma (oposa 90%).
Duloxetine imapangidwa kwambiri mthupi, ma metabolites amathandizidwa makamaka mkodzo. Ma isoenzymes CYP 2D6 ndi CYP 1A2 amathandizira kukhazikitsa ma metabolites awiri akuluakulu a duloxetine (glucuronide wophatikizidwa ndi 4-hydroxyduloxetine, sulfate yophatikizidwa ndi 5-hydroxy, methoxy-duloxetine). Zotsatira zake za metabolites zilibe zochitika za pharmacological.
Hafu ya moyo wa duloxetine ndi maola 12. Kuyera pang'ono kwa duloxetine kuchokera m'madzi a m'magazi ndi 101 l / h.
Odwala omwe ali ndi vuto loti aimpso amalephera kudikirira, nthawi zambiri amawonjezera kuchuluka kwa duloxetine m'madzi am'magazi komanso kuwonjezeka kwa AUC poyerekeza ndi anthu athanzi. Chifukwa chake, odwala odwala aimpso kulephera, duloxetine zotchulidwa wochepa koyamba mlingo.

Kugwiritsa ntchito mankhwala Duloxetine

Pa kupsinjika ndi matenda a shuga, amamulemba pakamwa 60 mg kamodzi patsiku, mosasamala kanthu za kudya. Mwa odwala ena, mlingo woyenera ungalimbikitsidwe (mpaka okwanira -120 mg / tsiku mu Mlingo 2 wogawanika). Kutheka kwa makonzedwe Mlingo woposa 120 mg / tsiku sikunaphunzire.
Mlingo woyambirira wa odwala omwe ali mu gawo lomaliza la kulephera kwa aimpso (creatinine chilolezo cha ≤30 ml / min) ndi 30 mg 1 nthawi tsiku lililonse.
Odwala matenda a cirrhosis ndi mankhwala ochepa kapena ochepa pakatikati pa Mlingo.
Palibe kusintha kwa duloxetine mwa okalamba kapena odwala okalamba omwe amafunikira. Odwala ochepera zaka 18, zotsatira za duloxetine sizinaphunzire.

Zotsatira zoyipa za Duloxetine

M'mayesero azachipatala, zochitika zovuta monga kudzimbidwa, nseru, kamwa yowuma, chizungulire, kutopa kwambiri, kugona tulo ndi mutu (≥10%) zidadziwika. Pafupipafupi (ndi pafupipafupi ≤10%, koma ≥1%) - tachycardia, dyspepsia, kusanza, kufooka chilala, kugona, kunjenjemera, kuperewera, thukuta, kumva kutentha, kumva kuwawa. Pa gawo la njira yolerera, panali kusokonezeka kwamphamvu ndi kukokoloka (ndi pafupipafupi kwa ≤10%, koma ≥1%), kuchepa kwa libido ndi anorgasmia. Pafupipafupi (≤1%, koma ≥0.1%) - gastroenteritis, stomatitis, kuthamanga kwa magazi, kunenepa kwambiri, kusokonezeka kwa minofu, kulawa ndi kuwonongeka kwamaso, kukhumudwa, kusungika kwamikodzo.
Kuchiza ndi duloxetine pamavuto oyesedwa ndi placebo amayanjanitsidwa ndi kuwonjezeka pang'ono poyerekeza ndi placebo m'magulu a AlAT, AsAT ndi KFK.
M'mayesero azachipatala a duloxetine wochizira matenda a shuga M'maphunzirowa, panali kuwonjezeka pang'ono kwa magazi osokoneza bongo oyamba pambuyo pa masabata 12 mwa odwala omwe amatenga duloxetine poyerekeza ndi placebo, mwa njira yanthawi zonse kwa masabata 52. Panalibe kusintha kwa glycosylated hemoglobin, kulemera kwamthupi la wodwala, lipid concentration (cholesterol, LDL, HDL, TG) kapena zovuta zina zilizonse zokhudzana ndi matenda a shuga.
Malinga ndi kafukufuku wotsatsa malonda, zotsatira zotsatirazi zidadziwika:
mbali ya gawo la masomphenyawo: kawirikawiri (≤0.01%) - glaucoma,
kuchokera ku hepatobiliary system: kawirikawiri (≤0.01%) - chiwindi, jaundice,
Kuchokera ku chitetezo chathupi: kawirikawiri (≤0.01%) - anaphylactic reaction,
kuchokera ku zolemba zasayansi: kawirikawiri (≤0.01%) - kuchuluka kwa ntchito kwa AlAT, AcAT, alkaline phosphatase, mulingo wa bilirubin,
mbali ya kagayidwe: kawirikawiri (≤0.01%) - hyponatremia,
pakhungu: kawirikawiri (0.01-0.1%) - zidzolo, osowa kwambiri (≤0.01%) - angioedema, matenda a Stevens-Johnson, urticaria,
Kuchokera pamtima: kawirikawiri (≤0.01%) - orthostatic hypotension ndi syncope (makamaka kumayambiriro kwa chithandizo).

Malangizo apadera ogwiritsira ntchito mankhwala Duloxetine

Odwala omwe ali ndi chiopsezo chodzipha nthawi ya chithandizo amayenera kuyang'aniridwa mosamala, popeza isanayambike chikhululukiro chachikulu, mwayi wakuyesa kudzipha sunaperekedwe.
Kugwiritsa ntchito duloxetine kwa odwala osakwana zaka 18 sikunaphunzire, chifukwa chake, sikuyenera kutumizidwa kwa anthu azaka zam'badwo uno.
Monga momwe zingagwiritsire ntchito mankhwala ena omwe amakhala pakhungu lamitsempha yayikulu, odwala omwe ali ndi vuto la manic, mbiri ya kukomoka, duloxetine iyenera kugwiritsidwa ntchito mosamala.
Pakhala lipoti lonena za maonekedwe a mydriasis okhudzana ndi makonzedwe a duloxetine, chifukwa chake, kugwiritsa ntchito duloxetine kwa odwala omwe ali ndi vuto la intraocular kapena kuti atha kukhala ndi vuto la khungu lowopsa la glaucoma ayenera kugwiritsidwa ntchito mosamala.
Akuti kuwonjezeka kwa kuchuluka kwa duloxetine m'madzi am'magazi mwa odwala omwe amalephera kwambiri aimpso (creatinine clearance ≤30 ml / min) kapena kulephera kwambiri kwa chiwindi. Odwala amalangizidwa kuti apatsidwe duloxetine pamunsi koyamba.
Mwa odwala ena, kutenga duloxetine kumabweretsa kuwonjezeka kwa magazi. Odwala omwe ali ndi matenda oopsa (ochepa matenda oopsa) komanso / kapena matenda ena a mtima, timalimbikitsa kuti magazi azithamanga.
M'maphunziro azachipatala, kuwonjezereka kwa ntchito ya michere ya chiwindi m'magazi kunadziwika. Odwala ambiri omwe amalandila duloxetine, kuwonjezeka kumeneku kunali kwakanthawi ndipo kunazimiririka atasiya kugwiritsa ntchito duloxetine. Kuwonjezeka kwakukulu kwa ntchito ya ma enzymes a chiwindi (ochulukirapo kuposa nthawi 10) kapena kuwonongeka kwa chiwindi ndi cholestasis, kapena kuwonjezeka kwakukulu kwa ntchito ya enzyme kuphatikizana ndi kuwonongeka kwa chiwindi sikunali kochepa, nthawi zina zimagwirizana ndi kumwa mowa.
Duloxetine analibe mutagenic zotsatira zoyeserera mu vitro ndi mu vivo.
Maphunziro okwanira komanso olamulidwa bwino okhudzana ndi duloxetine mwa amayi apakati sanachitike, kotero kugwiritsa ntchito panthawi yomwe ali ndi pakati sikulimbikitsidwa.
Duloxetine amachotseredwa mkaka wa m'mawere. Mlingo wofananira watsiku lililonse wakhanda ndi 0,14% ya mlingo kwa mayi woyamwitsa (mg / kg). Chitetezo cha duloxetine mu makanda sichinakhazikitsidwe, kotero kuyamwitsa pakumwa duloxetine sikulimbikitsidwa.
Pa chithandizo ndi duloxetine, odwala ayenera kupewa zinthu zomwe zingakhale zoopsa zomwe zimafuna kuwonjezeredwa chidwi komanso kuthamanga kwa zochitika zama psychomotor.

Zochita Drugxetine

Duloxetine sayenera kutumikiridwa nthawi imodzi ndi Mao zoletsa kapena osachepera masiku 14 atasiya kulandira chithandizo ndi Mao zoletsa. Popeza theka la moyo wa duloxetine, zoletsa za MaO siziyeneranso kutumikiridwa kwa masiku osachepera 5 mutachotsedwa kwa duloxetine.
M'maphunziro azachipatala omwe amaphatikizidwa ndi theophylline, mawonekedwe a CYP 1A2 omwe amakhala ndi duloxetine pa mlingo wa 60 mg 2 kawiri pa tsiku, palibe kusintha kwakukulu mu pharmacokinetics awo. Zotsatira izi zikuwonetsa kuti duloxetine ndiyokayikitsa kuti ingakhale ndi zotsatira zamankhwala zazovuta zamatenda a CYP 1A2.
Popeza CYP 1A2 imagwira nawo kagayidwe ka duloxetine, kugwiritsa ntchito munthawi yomweyo duloxetine yokhala ndi ma inhibitors a CYP 1A2 kungayambitse kuchuluka kwa duloxetine m'madzi a m'magazi. Fluvoxamine (pa mlingo wa 100 mg kamodzi patsiku), wokhala choletsa CYP 1A2, amachepetsa chilolezo cha duloxetine kuchokera m'madzi am'magazi pafupifupi 77%. Pankhaniyi, popereka duloxetine wokhala ndi CYP 1A2 inhibitors (ena mwa ma quinolone antibacterial agents), ndikofunikira kupangira duloxetine muyezo wotsika.
Duloxetine ndi choletsa choletsa cha CYP 2D6. Popanga duloxetine pa mlingo wa 60 mg 2 pa tsiku ndi limodzi mlingo wa desipramine, womwe ndi gawo limodzi la CYP 2D6, AUC ya desipramine imachulukitsa katatu. The munthawi yomweyo duloxetine (pa 40 mg 2 kawiri pa tsiku) kuchuluka kwa AOL wa tolterodine (2 mg 2 kawiri pa tsiku) ndi 71%, koma sizikuwakhudza pharmacokinetics a 5-hydroxyl metabolite. Pankhaniyi, kusamala ndikofunikira popereka duloxetine ndi CYP 2D6 inhibitors, omwe ali ndi index yocheperako yamankhwala.
Popeza CYP 2D6 imakhudzana ndi metabolism ya duloxetine, kugwiritsa ntchito nthawi yomweyo duloxetine yokhala ndi ma inhibitors a CYP 2D6 kungayambitse kuchuluka kwa duloxetine m'magazi. Paroxetine (pa 20 mg kamodzi patsiku) amachepetsa chilolezo cha duloxetine kuchokera m'madzi a m'magazi ndi pafupifupi 37%. Pankhaniyi, kusamala ndikofunikira popereka duloxetine ndi CYP 2D6 inhibitors.
Popereka mankhwala a duloxetine osakanikirana ndi mankhwala ena omwe amakhudza ubongo wamkati, makamaka pogwiritsa ntchito njira yofananira, muyenera kusamala.
Duloxetine imamangidwa ndi mapuloteni a plasma (90%), motero, kuyendetsa duloxetine kwa wodwala yemwe amatenga mankhwala ena omwe amangidwa kwambiri ndi mapuloteni am'magazi amatha kubweretsa kuchuluka kwa ndende iliyonse ya mankhwalawa.

Mankhwala osokoneza bongo a Duloxetine, zizindikiro ndi chithandizo

Umboni wamankhwala wambiri wa duloxetine ndi woperewera. Panali milandu ya mankhwala osokoneza bongo (mpaka 1400 mg), kuphatikiza osakanikirana ndi mankhwala ena, koma sanayambitse imfa.
Poyeserera nyama, chiwonetsero chachikulu cha kuwopsa kwa mankhwala osokoneza bongo chinadziwika ndi chapakati chamanjenje ndi m'mimba thirakiti. Izi zinaphatikizapo zizindikiritso monga kugwedezeka, kukhudzika kwa chidwi, kutha, kusanza, ndi matenda a anorexia.
Mankhwala enieniwo sakudziwika. Mukangowonjezera bongo, kupweteka kwam'mimba ndi kupezeka kwa makala okhazikitsidwa kumawonetsedwa. Onetsetsani kuti muli panjira. Ndikulimbikitsidwa kuwunikira zizindikiro zazikulu zofunikira, makamaka zamtima, ndipo ngati kuli kotheka, chithandizo chothandizira komanso chothandizira. Duloxetine ali ndi buku lalikulu logawa, motero okakamizidwa diuresis, hemoperfusion ndi metabolic acid ngati mankhwala osokoneza bongo sagwira ntchito.

Mphamvu zamankhwala

Duloxetine amadziwika kuti antidepressants kuchokera pagululi la kusankha reuptake inhibitors norepinephrine ndi serotonin.

Kulemera kwa maselo omwe amaphatikizidwa ndi mankhwala = 297.4 magalamu pa Mole.

Amapezeka m'mapiritsi ndi mapiritsi, mu gawo la 30 ndi 60 mg.

Nthawi zambiri amapezeka mumapangidwe hydrochloride.

Pharmacodynamics ndi pharmacokinetics

Chida chimalepheretsa kugwiranso serotonin ndi norepinephrine, pang'ono - dopamine. Chifukwa cha izi, ma neurotransmitters amadziunjikira, ndipo kufalikira kwawo pakatikati kwamanjenje kumawonjezeka. Thupi limachepetsa ululu, limawonjezera malire a ululu wammbuyo yopweteka chifukwa cha mitsempha.

Mankhwala amatengeka msanga pambuyo pakamwa. Kuchuluka kwazinthu zambiri m'magazi kumatheka mwa maola awiri. Chakudya chofanana chimakulitsa nthawi kuti chitha kufikira kuchuluka kwa maola khumi. Kuposa 90% ya mankhwalawa amamangidwa kumapuloteni a plasma, albin ndi glycoprotein. Odwala omwe ali ndi matenda a impso ndi chiwindi, kuchuluka kwa kumanga kwa mapuloteni a plasma sikusintha.

Duloxetine imapangidwa, ma metabolites sagwira ntchito. 4-Hydroxyduloxetine Glucuronic Conjugate ndi 5-hydroxy-6-methoxyduloxetine sulfate conjugate chotsegulidwa ndi impso. Metabolism imachitika ndi kutenga nawo gawo CYP1A2 ndi CYP2D6. Hafu ya moyo wa mankhwalawa ndi pafupifupi maola 11-12.

Mwa akazi, kuchuluka kwa metabolites ndi kagayidwe kake ka mankhwalawa kumacheperachepera kuposa amuna. Komanso, pakati pa okalamba ndi odwala, malo omwe ali ndi "nthawi-yotsalira" yokhotakhota komanso nthawi yochotsa zinthu kuchokera pakuwonjezeka kwa thupi. Komabe, kusintha kwa mankhwalawa sikuchitika. Hepatic kusowa kumapangitsa kuti pang'onopang'ono chilolezo cha mankhwala. Pa siteji yothandizira kulephera kwa aimpso, kuphatikiza kwakukulu kumachulukitsidwa.

Contraindication

Duloxetine sanalembedwe:

• wopanda mbali glaucoma,
• molumikizana ndi Mao zoletsa, CYP1A2 zoletsa,
• at chifuwa pachinthu ichi
• odwala omwe ali ndi vuto lalikulu la chiwindi,
• kwambiri kulephera kwa aimpsoodwala pa hemodialysis,
• odwala osalamulirika ochepa matenda oopsa,
• mukamayamwa,
• ana ochepera zaka 18.

Zotsatira zoyipa

Pa mankhwala ndi antidepressant nthawi zambiri amakhala:

• mutu, kunjenjemera, kugona, chizungulire, paresthesia, kusowa tulo, maloto owoneka bwino, kukwiya,
• kuda nkhawa, ulesi, nseru,
• kutsegula m'mimbakusanza, kukamwa kowuma, kudzimbidwa, kudzimbidwa,
• kuchuluka kwa kupangika kwa mpweya, kupweteka m'dera la epigastric,
• kuchepa chilakolako chogonana, kusowa kwa malingaliro, anorgasmia,
• mafunde, palpitations, tinnitus, utachepa kowoneka bwino,
• minofu kukokana, kuwuma, kupweteka minofu ndi mafupa, thukutamakamaka usiku
• kusowa kwa chakudya, kuchepa thupi, kutopa.

Pocheperako, zotsatirazi zoyipa zimachitika:

• mantha, kulephera kulolera, dyskinesiamphwayi bulxism,
• stomatitiskubwatula chiwindikuchuluka kwa michere ya chiwindi,
• anuria, dysuria, nocturia, polyuriamavuto ndi kukodza, kuchepa kwa kugonana ndi kukhumba,
• gastroenteritis, gastritis, kulawa zosokoneza, ma hypersensitivity reaction,
• kukomoka tachycardiakuchepa kapena kuchuluka kuthamanga kwa magazimanja ozizira ndi zala,
• mydriasiskupweteka m'makutu vertigomagazi ochokera kumphuno, kumva kukakamiza pammero,
• Hypersensitivity kuti kuwala, subcutaneous hemorrhage, urticaria, dermatitisthukuta lozizira, loterera,
• hyperglycemia (at matenda ashuga), laryngitis, kunenepa kwambiri, kusakhazikika kwa ludzu, ludzu, kuzizira, kuchuluka creatine phosphokinase.

• Khalidwe lankhanza mania, mkwiyo, kukokana, kusokonekera kwa malingaliro,
• serotonin syndrome, kuyesa kudzipha, malingaliro odzipha, kuyerekezera,
• kupuma koyipa, magazi mu chopondapo, jaundice, kufooka kwa chiwindi, kusintha kwa kununkhira kwa mkodzo ndi zizindikiro za kusamba, matenda oopsa,
• fibrillation ya atria, supraventricular arrhythmia,
• mydriasis, glaucoma, chikhazikitso, kusowa kwamadzi,
• hyponatremia, hypercholesterolemiakupweteka kwa sternum anaphylactoid zimachitika.

Ndi lakuthwa kukhathamiritsa kwa kudya zimachitika achire syndrome: chizungulireparesthesia kusowa tulo, maloto owoneka bwino, nkhawa, kusanza, kunjenjemerakuchuluka kukwiya vertigo ndi thukuta.

Duloxetine, malangizo ogwiritsira ntchito (Njira ndi Mlingo)

Chithandizo chimayamba ndi kuchuluka kwa 60 mg, imwani kamodzi patsiku. Kenako mutha kuwonjezera pang'onopang'ono kuchuluka kwa 0,12 ga patsiku (kumwedwa kawiri pa tsiku).

Zowopsa kulephera kwa aimpso Osamwa zoposa 30 mg za mankhwala patsiku. Ndi kulephera kwa chiwindi, mlingo woyambirira umachepetsedwa ndipo pafupipafupi makonzedwe amachepetsa.

Kuchita

Akaphatikizidwa ndi Duloxetine theofylline pharmacokinetics ya mankhwala omaliza sasintha kwenikweni.

Kugwiritsa ntchito chinthu chokhala ndi zoletsa CYP1A2 kungayambitse kuchuluka kwa plasma ndende ya mankhwalawa. Mwachitsanzo fluvoxamine amachepetsa kukula kwa plasma chilolezo pafupifupi 75%. Ndikulimbikitsidwa kuphatikiza mankhwalawa mosamala desipramine, tolterodine ndi njira zina mu kagayidwe kazomwe zimakhudzidwa CYP2D6.

Zotheka Kuletsa CYP2D6 zingayambitse kuchuluka kwa duloxetine.

Mosamala kwambiri, phatikizani mankhwalawa ndi antidepressants ena, makamaka Paroxetine. Kuyera kwake kumachepetsedwa.

Kulandila kophatikizana kwa njira ndi benzodiazepines, Phenobarbitalmankhwala a antipsychotic ndi antihistamines, omwe ali ndi Mowa osavomerezeka.

Mosamala, phatikizani mankhwalawa ndi mankhwala omwe ali ndi mphamvu zambiri zomanga mapuloteni a plasma.

Ndikulimbikitsidwa kwambiri kuti musamwe mankhwalawa molumikizana ndi kusankha zoletsaMAO, ngakhale ndi zoletsa za MAO zosintha, moclobemide. Izi zitha kubweretsa chitukuko. hyperthermia, myoclonuskukhazikika kwa minofu, kusinthasintha kwakuthwa kuzizindikiro zofunika, chikomokerempaka kufa.

Mankhwala osakanikirana ndi anticoagulants ndi antiplatelet mankhwala amachititsa kuti magazi ayambe kutuluka. Akaphatikizidwa ndi Warfarin INR ikhoza kuwuka.

Kawirikawiri sizimakula serotonin syndrome mukamagwiritsa ntchito ma SSRI ena kuphatikiza ndi mankhwala. Chisamaliro chiyenera kuthandizidwa pothana ndi mankhwala oletsa kuponderezana, Amitriptyline, clomipramine, Venlafaxine, hypericum, patatu, pethidine, Tramadol ndi Khalid.

Ndemanga za Duloxetine

Ngakhale malingaliro abwinobwino a madokotala okhudzana ndi mankhwalawa, mwa odwala malingaliro awo nthawi zambiri amakhala osiyana. Anthu ambiri amalemba kuti mankhwalawa samalekeredwa bwino, zotsatira zoyipa zimayamba, matenda achire amakhala olimba pomwe chithandizo chimasokonekera, zotsatira zimabwera pang'onopang'ono, nthawi zina pambuyo pa miyezi ingapo yoyendetsedwa.

Ndemanga zina za kukonzekera kwa Duloxetine:

• “... Uwu ndi m'badwo waposachedwa kwambiri wa antidepressants, mankhwalawa ali ndi zotsatira zowirikiza, amathandiza odwala omwe ali ndi matenda amitsempha, kukhumudwa, kupweteka, komanso ali ndi mawonekedwe ambiri othandizira odwala. Odwala omwe ndidamupanga akhuta”,
• “... Ndakhala ndikumwa mankhwala pafupifupi chaka tsopano, ndinali ndi mwayi ndi zotsatira zoyipa - kulibe. Zowona, posachedwapa ndinayesera kuti ndisiye kumwa mwadzidzidzi; panali matenda ena achire. Tsopano zikuyambanso, zakwanira”,
• “... Anataya kulemera kwambiri kuchokera ku mankhwalawa, languid, mutu wake umapweteka pafupipafupi. Chilichonse chikuthandizidwa, kuthandizidwa, koma sizinaphule kanthu, sindikudziwa momwe ndingakhalirebe ndi izi”.

Mlingo

Mlingo 30 mg

Makupisozi amodzi amakhala ndi:

duloxetine, pellets 176.5 mg, kuphatikiza: duloxetine hydrochloride 33.68 mg, yowerengedwa ngati duloxetine 30 mg, hypromellose E5 (hydroxypropyl methyl cellulose) 10,54 mg, hypromellose HP55 (hydroxypropyl methyl cellulose) 15,51 mg, starch 44.09 mg, mannitol 47.3 mg, sodium lauryl sulfate 5.22 mg, sucrose 17.46 mg, titanium dioxide 1,15 mg, cetyl mowa 1.55 mg,

Bokosi la gelatin yolimba No. 3:

mlandu - utoto wa utoto wa buluu V, titanium dioxide, gelatin,

kapu - utoto wabuluu V, titanium dioxide, gelatin.

Mlingo 60 mg

Makupisozi amodzi amakhala ndi:

duloxetine, 353 mg pellets, kuphatikizapo: duloxetine hydrochloride 67.36 mg, potengera duloxetine 60 mg, hypromellose E5 (hydroxypropyl methyl cellulose) 21.08 mg, hypromellose HP55 (hydroxypropyl methyl cellulose) 31.02 mg, starch 88.18 mg, mannitol 94,6 mg, sodium lauryl sulfate 10,44 mg, sucrose 34.92 mg, titanium dioxide 2.3 mg, cetyl mowa 3.1 mg,

Ma capatin a gelatin olimba 1:

mlandu - utoto wa utoto wa buluu V, titanium dioxide, gelatin,

kapu - utoto wabuluu V, titanium dioxide, gelatin.

Pharmacokinetics

Duloxetine amadziwikiridwa bwino mukamamwa pakamwa. Mafuta amayamba 2 mawola atamwa mankhwalawa. Kuzindikira kwakukulu (C_max) imakwaniritsidwa maola 6 mutatha kumwa mankhwalawo.

Kudya sizimakhudzanso kuchuluka kwa mankhwalawa, koma kumawonjezera nthawi yofika ndende yayikulu (TS_max) kuyambira maola 6 mpaka 10, omwe amachepetsa mosavomerezeka mayamwidwe (pafupifupi 11%).

Duloxetine imamangiriza bwino mapuloteni a plasma (> 90%), makamaka ndi albumin ndi ₁--acid glycoprotein, koma zovuta za chiwindi kapena impso sizikhudza kuchuluka kwa mapuloteni.

Duloxetine imapangidwa mwamphamvu ndipo ma metabolites ake amathandizidwa makamaka mu mkodzo. Zonse ziwiri za CYP2D6 isoenzyme ndi CYP1A2 isoenzyme zimayambitsa kupangika kwa metabolites awiri akuluakulu (4-hydroxyduloxetine glucuronic conjugate, 5-hydroxy sulfate conjugate, 6-methoxyduloxetine).

Ma metabolites ozungulira sakhala ndi zochitika za pharmacological.

Hafu ya moyo (T _1/2 ) Duloxetine ndi maola 12. Chilolezo chapakati cha duloxetine ndi 101 l / h.

Magulu amodzi payekha odwala

ngakhale kuti kusiyana kwa ma pharmacokinetics pakati pa amuna ndi akazi kwadziwika (kuvomerezeka kwa duloxetine kumakhala kotsika mwa azimayi), kusiyana kumeneku sikuli kwakukulu kotero kuti pakufunika kusintha kwamankhwala malinga ndi jenda.

ngakhale kuti kusiyana kwa ma pharmacokinetics pakati pa odwala azaka zapakati ndi zachikale kwadziwika (dera lomwe lili pansi pa ndende / nthawi yokhotakhota (AUC) ndi yayitali ndipo nthawi T _1/2 mankhwalawa ndi okulirapo mu okalamba), kusiyanaku sikokwanira kusintha mlingo kutengera zaka za odwala.

Odwala kwambiri aimpso kuwonongeka (otsiriza siteji aimpso kulephera - aakulu aimpso Kulephera) akudwala hemodialysis, C mfundo_max ndi AUC ya duloxetine inachuluka 2 times. Pankhani imeneyi, kuthekera kwa kuchepetsa kuchuluka kwa mankhwalawa odwala omwe ali ndi vuto laimpso kuyenera kuganiziridwanso.

• Kuwonongeka kwa chiwindi:

odwala matenda a chiwindi kulephera, kuchepa kwa kagayidwe kachakudya ndi duloxetine zingaoneke. Mlingo umodzi wa 20 mg wa duloxetine mwa 6 odwala omwe ali ndi vuto la chiwindi ndi zolimbitsa chiwindi ntchito (Class B pa mwana-Pugh), nthawi T _1/2 Duloxetine anali wapamwamba pafupifupi 15% kuposa anthu athanzi la amuna kapena akazi okhaokha komanso msinkhu wowonjezereka kuwonekera kawiri. Ngakhale kuti C_max Odwala matenda a cirrhosis anali ofanana ndi anthu athanzi, T _1/2 inali pafupifupi nthawi zitatu.

• Kukhumudwa
• Mawonekedwe opweteka a zotumphukira za matenda a shuga,
• Matenda okhalanso ndi nkhawa,
• Kupweteka kwapakati pa minofu ndi mafupa (kuphatikizapo omwe amayamba chifukwa cha fibromyalgia, matenda a buolevoy) m'munsi mmbuyo komanso ndi nyamakazi ya bondo.

Mimba komanso kuyamwa

Chifukwa chosakwanira ndi duloxetine pa nthawi yomwe ali ndi pakati, mankhwalawa ayenera kuyikidwa pokhapokha ngati phindu lomwe lingakhalepo kwa mayi limaposa kuchuluka kwa chiopsezo kwa mwana wosabadwayo. Odwala ayenera kuchenjezedwa kuti pakakhala kutenga pakati kapena kukonzekera kutenga pakati pa chithandizo ndi Duloxetine, ayenera kudziwitsa dokotala.

Umboni wa epidemiological ukusonyeza kuti kugwiritsa ntchito kusankha kwa mankhwala a serotonin reuptake inhibitors (SSRIs) panthawi yapakati, makamaka pamapazi apambuyo pake, kungakulitse chiwopsezo cha kulimbikira kwamphamvu kwa pulmonary mu akhanda. Ngakhale kusowa kwa kafukufuku pakati pa kulumikizana kwamphamvu kwa pulmonary kwa akhanda ndi kugwiritsa ntchito ma SSRIs, chiwopsezo chomwe chilipo sichingasiyidwe kwina, chifukwa cha njira ya duloxetine (kuletsa kwa serotonin kubwezeretsanso).

Monga momwe amakhazikitsire mankhwala ena a serotonergic, matenda a "kuchoka" amatha kuonedwa mwa ana obadwa kumene pakugwiritsidwa ntchito kwa duloxetine ndi amayi atangobadwa kumene. Matenda a “kusiya” akuphatikiza ndi zotsatirazi: kuthamanga kwa magazi, kunjenjemera, kuwonjezeka kwa matenda a neuro-Reflex, kuvuta kudya, kupuma, komanso kupweteka. Zizindikiro zambiri zimawonedwa pakubadwa kwa mwana kapena masiku ochepa atabadwa.

Chifukwa chakuti duloxetine imadutsa mkaka wa m'mawere (kuchuluka kwa mwana wosabadwayo ndi pafupifupi 0,14% ya kuchuluka kwa amayi kutengera mg / kg pa kulemera kwa thupi), kuyamwitsa pakumwa mankhwala ndi duloxetine sikulimbikitsidwa.

Mlingo ndi makonzedwe

Mkati. Makapisozi amayenera kumezedwa lonse popanda kutafuna kapena kuphwanya. Osamawonjezera mankhwalawo pachakudya kapena kusakaniza ndi zakumwa, chifukwa izi zitha kuwononga kuphatikizira kwa pellets.

Mlingo woyambirira wa mankhwalawa ndi 60 mg 1 nthawi patsiku, mosasamala za chakudya.

Odwala ena, kuti akwaniritse bwino, ndikofunikira kuwonjezera mlingo kuchokera pa 60 mg kamodzi patsiku mpaka muyeso waukulu wa 120 mg tsiku lililonse mumagawo awiri ogawikana. Kuyesa mwadongosolo kumwa mankhwalawa muyezo woposa 120 mg sikunachitike.

Odwala aimpso kulephera:

Mlingo woyambirira uyenera kukhala 30 mg kamodzi patsiku kwa odwala omwe amadzidwala aimpso (mathero a CRF, chilengedwe cha 10%)

nthawi zambiri - 1/100 poika (> 1% ndi 0,1% ndi 0,01% ndi 15.

Nthawi zambiri: hyperglycemia (makamaka imawonedwa mwa odwala matenda a shuga).

Pafupipafupi: kuchepa madzi m'thupi, hyponatremia, matenda osakwanira katulutsidwe ka timadzi tating'onoting'ono 6.

Chofala kwambiri: kusowa tulo 11.

Nthawi zambiri: kukwiya 10, nkhawa, maloto osazungulira 20, kuchepa kwa libido (kuphatikizapo kuchepa kwa libido), kusokonekera kwa orgasm (kuphatikizapo anorgasmia).

Nthawi zambiri: malingaliro ofuna kudzipha 5.22, kusokonezeka kwa kugona, kugona, kusokoneza 19, kupanda chidwi.

Pafupipafupi: kudzipha 5.22, mania, kuyerekezera zinthu zina, kuchita ukali komanso kuzunza 4.

Kusokonezeka kwamanjenje

Nthawi zambiri: chizungulire, kupweteka mutu, kugona.

Nthawi zambiri: kunjenjemera, paresthesia 18.

Nthawi zambiri: myoclonus, akathisia 22, kuchuluka kukwiya, kusokonezeka, kugona, kugona, kugona, kugona mokwanira, kugona.

Pafupipafupi: serotonin syndrome 6, kupweteka kwa 1, psychomotor mukukweza 6, matenda amtundu wa extrapyramidal.

Kuphwanya gawo la masomphenyawo

Nthawi zambiri: Kusawona bwino.

Nthawi zambiri: mydriasis, kuwonongeka kwa mawonekedwe.

Si kawirikawiri: glaucoma, maso owuma.

Kumva kuwonongeka ndi labyrinthine

Nthawi zambiri: tinnitus 1.

Nthawi zambiri: vertigo, khutu.

Mavuto a mtima

Nthawi zambiri: palpitations.

Nthawi zambiri: tachycardia, supraventricular arrhythmia, makamaka atria fibrillation.

Vuto la mtima

Nthawi zambiri: hyperemia (kuphatikiza kunyezimira kwamoto).

Nthawi zambiri: matenda oopsa 3.22, kuthamanga kwa magazi 3.14, malekezero ozizira, orthostatic hypotension, kukomoka.

Si kawirikawiri: vuto la matenda oopsa 3.6.

Zovuta zamkati mwa kupuma, chifuwa ndi ziwalo zapakati

Nthawi zambiri: kuyungunuka, kupweteka kwa oropharynx.

Nthawi zambiri: kumverera kwamphamvu pakhosi, nosebleeds.

Matenda Am'mimba

Nthawi zambiri: mkamwa youma (12.8%), nseru (24.3%), kudzimbidwa.

Nthawi zambiri: kutsegula m'mimba, kusanza, dyspepsia (kuphatikiza m'mimba), kubala, kupweteka kwam'mimba 9.

Nthawi zambiri: m'mimba kutaya magazi 7, gastroenteritis, gastritis, belching, dysphagia.

Si kawirikawiri: stomatitis, halitosis, hematochesia.

Kuphwanya chiwindi ndi njira ziwiri

Nthawi zambiri: chiwindi 3, kuwonongeka kwa chiwindi.

Pafupipafupi: kulephera kwa chiwindi 6, jaundice 6.

Kusokonezeka kwa khungu ndi minofu yolowerera

Nthawi zambiri: kutuluka thukuta, zotupa, kuyabwa.

Kanthawi kochepa: thukuta la usiku, urticaria, dermatitis, kuzizira thukuta, photosensitivity, chizolowezi chowonjezeka.

Si kawirikawiri: Stevens-Johnson syndrome 6, angioedema 6.

Zosowa kwambiri: kusokonezeka kwa minofu.

Kusokonezeka kwa minofu ndi mafupa

Nthawi zambiri: kupweteka kwa minofu ndi mafupa 17, kuuma kwa minofu 16, minyewa yam'mimba.

Nthawi zambiri: minofu kukokana.

Kuphwanya impso ndi kwamikodzo thirakiti

Nthawi zambiri: kukodza pokodza.

Pafupipafupi: kusungika kwamikodzo, dysuria, kuvuta kwamikodzo, nocturia, polyuria, kutsika kwamikodzo kwamkodzo.

Pafupipafupi: fungo lachilendo la mkodzo.

Kuphwanya maliseche ndi nyamakazi

Nthawi zambiri: kukanika kwa erectile.

Kukhazikika: kuphwanya ejaculation 21, kuchedwa kuchepa, kusokonezeka pogonana, magazi am'mimba, kusamba kwa msambo, kupweteka kwa ma testicles.

Pafupipafupi: Zizindikiro za kusamba, galactorrhea, hyperprolactinemia.

Zovuta ndi zovuta zina pamalo a jakisoni

Nthawi zambiri: kutopa 13.

Nthawi zambiri: mathithi a 8, kusintha kukoma.

Nthawi zambiri: kupweteka pachifuwa 22, zomverera zam'mimba, njala, ludzu, kuzizira, malaise, kumva kutentha, kusokonezeka gait.

Zambiri zasayansi ndi zothandizira

Nthawi zambiri: kuwonda.

Pafupipafupi: kuchuluka kwa kulemera, kuchuluka kwa alanine aminotransferase (ALT), aspartate aminotransferase (ACT), alkaline phosphatase, gamma-glutamyl transpeptidase, bilirubin, creatine phosphokinase, pathological kupatuka kwa chiwindi michere.

Pafupipafupi: kuchuluka kwa mafuta m'thupi m'mwazi.

1 Milandu ya kukomoka ndi tinnitus adadziwikanso pambuyo pomaliza mankhwala ndi duloxetine.

2 Orthostatic hypotension ndi syncope adadziwika makamaka kumayambiriro kwa chithandizo.

3 Onani “Malangizo apadera”.

4 Milandu yaukali ndi udani idadziwika makamaka koyambirira kwa chithandizo ndi duloxetine kapena itatha.

Milandu 5 yamaganizidwe ofuna kudzipha kapena kudzipha idadziwika nthawi ya chithandizo ndi duloxetine kapena koyambirira atamaliza kulandira chithandizo.

6 Kulingaliridwa pafupipafupi kwakachitika zinthu zoyipa. Zinaonedwa panthawi ya mayeso azachipatala.

7 Amaphatikizanso kutsegula m'mimba, kukha magazi kuchokera kum'munsi thirakiti, kusanza magazi, kukha magazi m'mimba, melena, magazi amitsempha, kutulutsa magazi m'matumbo.

Mitsinje ya 8 inali yofala kwambiri ukalamba (≥ zaka 65).

9 Kuphatikizira kupweteka pamimba yakumbuyo ndi m'munsi, kusokonezeka kwa khoma lamkati lakumbuyo, kusakhazikika kwam'mimba, kupweteka kwam'mimba.

Kuphatikizapo kunjenjemera kwamkati, nkhawa zamagalimoto, kusokonezeka, phokoso la psychomotor.

Kuphatikiza kudzuka pakati pausiku, kudzuka m'mawa, zovuta kugona.

Kuphatikizapo hypersomnia, sedation.

Kuphatikizapo asthenia.

14 Kuphatikizira kuwonjezeka kwa kuthamanga kwa magazi a systolic, kuthamanga kwa diastolic, systolic hypertension, diastolic hypertension, hypertension, hypertension.

Kuphatikizapo anorexia.

Kuphatikiza kukhazikika kwa minofu.

17 Kuphatikiza myalgia ndi kupweteka m'khosi.

Kuphatikiza ma hypesthesia, hypesthesia yamtundu wamunthu, matupi a ziwalo zam'mimba, pamimba paresthesia, kawirikawiri (19 Kuphatikiza chisokonezo.

20 Kuphatikiza zoyipa.

Kuphatikiza kusowa kwa kumira.

22 Palibe kusiyana kwakukulu pamasamba ndi placebo.

Kuchotsedwa kwa duloxetine (makamaka nthawi yomweyo) kumayambitsa matenda a "kuchoka", omwe akuphatikizapo zizindikiro izi: chizungulire, kusokonezeka kwa malingaliro (kuphatikizapo paresthesia), kusokonezeka kwa tulo (kuphatikizapo kusowa tulo komanso maloto owoneka bwino), kufooka, kugona, kusokonezeka kapena kuda nkhawa, mseru komanso / kapena kusanza, kunjenjemera, kupweteka mutu, kusokonekera, kutsegula m'mimba, hyperhidrosis, ndi vertigo.

Mwambiri, mukamatenga SSRIs ndi serotonin ndi norepinephrine reuptake inhibitors (SSRIs), zochitika izi zimakhala ndi kufooka kapena kusamala pang'ono komanso kukhala ndi malire. Komabe, mwa odwala ena, izi zimatha kukhala zowawa kwambiri komanso / kapena zimapitilira.

Ndi makonzedwe aposachedwa a duloxetine (mpaka masabata 12), odwala omwe ali ndi vuto lopweteka la matenda osokoneza bongo a chiwindi amawonetsa kuwonjezeka pang'ono kwa kuthamanga kwa shuga m'magazi kwinaku akusunga nthawi yayitali ya glycosylated hemoglobin, onse omwe amamwa duloxetine komanso gulu la placebo. Ndi chithandizo chotenga nthawi yayitali ndi duloxetine (mpaka masabata 52), panali kuwonjezeka pang'ono kwa kuchuluka kwa hemoglobin ya glycosylated, yomwe inali 0,3% kuposa kuwonjezeka kwa chidziwitso chogwirizana ndi odwala omwe amalandila chithandizo china. Ponena za kuthamanga kwa shuga ndi cholesterol yathunthu m'magazi, odwala omwe akutenga duloxetine adawonetsa kuwonjezeka pang'ono kwa zizindikirozi poyerekeza ndi kuchepa kwapang'onopang'ono komwe kumagulu olamulira.

Nthawi yolungamitsidwa (yokhudzana ndi kugunda kwa mtima) QT pakati pa odwala omwe amatenga duloxetine sizinasiyane ndi zomwe zili mu gulu la placebo. Panalibe kusiyana kwakukulu pakatikati pa magawo a QT, PR, QRS, kapena QTcB pagulu la odwala omwe amatenga duloxetine ndi gulu la placebo.

Duloxetine - malangizo, ntchito, ndemanga

Duloxetine, mankhwala a psychotropic a m'badwo wachitatu, ndi osokoneza inhibitor ya serotonin ndi norepinephrine reuptake. Mosiyana ndi psychotropic mankhwala a m'badwo woyamba ndi wachiwiri, Duloxetine sichikhudza onse oyimira pakati pa ubongo. Mankhwala amasankha mothandizidwa ndi 5-hydroxytryptamine, dopamine ndi norepinephrine, chifukwa zosokoneza ntchito zawo zimayambitsa kukhumudwa.

Mankhwalawa ndiwothandizanso kwatsopano pamankhwala ena omwe samakhala ndi vuto la hypnotic. Malinga ndi malangizowo, Duloxetine ali ndi gawo lalikulu ndipo amawonedwa ngati mankhwala otetezedwa kwambiri a heterocyclic psychotropic. Choyamba, Duloxetine amagwiritsidwa ntchito pochita zamisala pochiza matenda okhumudwitsa.

Malangizo ogwiritsira ntchito Duloxetine: Mlingo ndi malamulo ovomerezeka

Malinga ndi malangizo, mankhwalawa amayenera kuyamba ndi 60 mg ya Duloxetine patsiku. Ndi mlingo, mankhwalawa amatengedwa 1 nthawi patsiku. Ngati ndi kotheka, mlingo umakulitsidwa kwa 120 mg, koma kuchuluka kwa mankhwalawa kuyenera kugawidwa pawiri. Sitikulimbikitsidwa kumwa mankhwala oposa 120 mg patsiku.

Odwala wochepetsedwa glomerular kusefera mlingo mankhwala 30 mg tsiku. Ndi vuto la chiwindi, mlingo woyambirira wa mankhwala oletsa kuponderezedwa uyeneranso kuchepetsedwa kapena kuti pakhale nthawi yoti munthu amwe mankhwala ayenera kuchuluka.

Mlingo wa odwala okalamba si wosiyana.

Chochita chake chimapangidwira kuti azigwiritsa ntchito mkati. Mapiritsi amatengedwa mosasamala chakudya, ayenera kumeza ndi madzi pang'ono. Kuwonongeka kwa makapisozi kuyenera kupewedwa.

Lekani kumwa pang'onopang'ono, kwa masiku 14. Kutha kwamankhwala kwakanthawi kungayambitse kuwonongeka kwa wodwala.

Mankhwala, kumwa mowa kumaletsedwa. Pa chithandizo ndi Duloxetine, kusamala kuyenera kuchitidwa poyendetsa galimoto ndi ntchito zina zomwe zingakhale zoopsa.

Zotsatira zoyipa

Kuchuluka kwa mankhwala ofunikira kuti pakhale zovuta zimayambira payekhapayekha, ndipo zimatengera kulimba kwamthupi.

Duloxetine, monga ma heterocyclic antidepressants, alibe poizoni kuposa tricyclic, koma mavuto ake ndi ofanana:

• mtima ndi kotheka kugwiritsa ntchito mankhwalawa kwa nthawi yayitali, koma ngozi yake ndiyochepa,
• sedative athari (kugona, kuwonda, ulesi, kusokonezeka kwa malingaliro ndi kukumbukira) sizingalephereke,
• Kukondoweza kwa CNS (kusowa tulo, kusakwiya, kuda nkhawa) kumayamba chifukwa cha kugwiritsidwa ntchito kwakanthawi kapenanso kusiya mankhwala mwachangu, ngozi ndiyochepa,
• orthostatic hypotension ikhoza kuchitika (chifukwa cha kutseka kwa alpha), chiwopsezo ndichochepa kwambiri,
• M-anticholinergic zochita zimafotokozedwanso mochepera (pakamwa pouma, kusokonezeka kwa peristalsis, kusungika kwamikodzo, kusokonezeka kwa nyumba, kuchuluka kwa mapangidwe a intraocular, tachycardia).

Kwa pakati komanso kuyamwa

Mankhwala ochepetsa kupanikizika amatha kulembedwa panthawi yomwe ali ndi pakati pokhapokha phindu pazinthu zimakulitsa chiwopsezo kwa mwana, izi zimachitika chifukwa cha kusowa kwa kachipatala ndi odwala omwe ali pamalopo. Ngati mayi akufuna kubereka kapena zafika, ndiye kuti muyenera kudziwitsa dokotala wanu nthawi yomweyo.

Yogwira ntchito imalowera yosadziwika mkaka wa m'mawere, motero tikulimbikitsidwa kuti muzisinthana ndi chakudya chongopanga munthawi yoyamwa.

Zolemba zogwiritsira ntchito

Sikulimbikitsidwa kupitilira muyeso wa tsiku ndi tsiku wa 0,12 gramu.

Kusintha kwa mankhwalawa ndikofunikira pochiza odwala omwe ali ndi vuto laimpso komanso kulephera kwa chiwindi.

Kuchotsa mankhwala kumachitika pang'onopang'ono, pamakhala chiopsezo chachikulu chodziyimira pakhungu.

Pambuyo kumwa mankhwalawa, palibe kuphwanya mtundu wa zochitika zama psychomotor, kukumbukira komanso ntchito zina zanzeru, koma kugona nthawi zambiri kumachitika. Chifukwa chake, kuyendetsa galimoto ndikuchita zinthu zoopsa sikulimbikitsidwa.

Momwemonso

Analogue yathunthu ya Duloxetine - Symbalta.

Ma antidepressants akuphatikiza:

1. Paxil
2. Amitriptyline,
3. Fluxonil
4. Sinekwan,
5. Voxemel
6. Zoloft
7. Venlafaxine
8. Phloxet
9. Aleval
10. Citalopram,
11. Rexetin
12. Gelarium
13. Flunisan
14. Kwambiri
15. Fevarin,
16. Citalift,
17. Lenuxin,
18. Siozam
19. Maprotibene
20. Efevelon
21. Asafen
22. Mirzaten
23. Stimuloton
24. Brintellix
25. Miracitol
26. Elicea
27. Wophunzitsidwa
28. Tsipralex,
29. Zosintha,
30. Coaxil
31. Selectra,
32. Amizole
33. Newwell,
34. Elivel
35. Anthu
36. Prodep
37. Chimango
38. Thorin
39. Valdoxan
40. Duloxetine
41. Tsipramil,
42. Azona
43. Asentra
44. Kuponderezana
45. Clomipramine,
46. Miansan
47. Imipramine
48. Noxibel
49. Chakumbuyo
50. Neuroplant
51. Fluoxetine,
52. Escitalopram
53. Oprah
54. Alventa
55. Heparetta
56. Cytol,
57. Xel
58. Esprital
59. Serlift,
60. Chinyengo
61. Umorap,
62. Paroxetine
63. Calixta
64. Chinsinsi
65. Velaxin,
66. Aurorix
67. Heptor.

Kutulutsa mawonekedwe ndi kapangidwe kake

Mlingo wa mawonekedwe a Duloxetine canon - makapisozi enteric: kukula No. 3 (30 mg) kapena Na. 1 (60 mg), gelatin yolimba, yokhala ndi thupi komanso chivindikiro cha mtundu wamtambo, nkhani - zowoneka ndi microspheres kuyambira pafupi kuyera mpaka kutuwa loyera (7, 10 , Ma pcs 14 kapena 15. M'matumba, pamakatoni 1, 2 kapena 4 mapaketi 7, kapena 2, 3 kapena 6 mumapaketi 10, kapena 1, 2 kapena 6 mumapaketi 14, kapena 2 kapena 4 mapaketi a 15 makapisozi).

Kaphatikizidwe 1 kapisozi:

• yogwira mankhwala: duloxetine - 30 kapena 60 mg,
• zosagwiritsidwa ntchito: titanium dioxide, mannitol, wowuma, mowa wa cetyl, sodium lauryl sulfate, sucrose, hypromellose HP55 (hydroxypropyl methyl cellulose), hypromellose E5 (hydroxypropyl methyl cellulose),
• kapisozi kapangidwe kake: gelatin, titanium dioxide, utoto wabuluu wamtundu V.

Zambiri pazamankhwala Duloxetine

Duloxetine imagwiritsidwa ntchito pochotsa kupsinjika ndi kupweteka panthawi ya neurosis. Mankhwala amaletsa kutenga kwa norepinephrine ndi serotonin ndi adrenergic neurons (amachepetsa kubwezeretsanso kwa mahomoni awa). Mankhwala amakhudza kugwidwa kwa dopamine mofooka. Chithandizo chogwira chimaletsa kupweteka kwambiri mu zovuta za neurotic.

Gulu lazachipatala, INN, kuchuluka

Gulu lazachipatala komanso zamankhwala omwe amapezeka pamankhwala othandizira amakhala othandizira. Dzinalo losavomerezeka padziko lonse lapansi ndi Duloxetin (Duloxetinum). Mankhwalawa amagwiritsidwa ntchito mwachindunji zotupa za zotumphukira zamitsempha yamagetsi komanso kusokonezeka maganizo kosiyanasiyana. Chifukwa chogwira ntchito kwambiri komanso kusavulaza, mankhwalawa apeza mitundu yambiri yazachipatala.

Tulutsani mafomu ndi mitengo ya Duloxetine Canon

Duloxetine amapangidwa mwanjira yamapiritsi amtambo-oyera kapena amtambo wobiriwira wamtambo wobiriwira. Pa kapisozi iliyonse, mulingo (30 kapena 60 mg) ndi nambala yodziwitsa (9543 kapena 9542) umayamwa ndi utoto wamadzimadzi. Makapisozi amadzazidwa ndi granules yoyera kapena imvi.

Mtengo wa mankhwalawa Duloxetine Canon, wopangidwa ndi kampani yaku Russia ya Canonfarm Production:

The yogwira pophika mankhwala ndi duloxetine hydrochloride, amene amachepetsa chapakati limagwirira ululu. Kuphatikiza pazomwe zimagwirira ntchito, mawonekedwe a makapisozi amaphatikizapo zinthu zina:

• chakudya utoto E171,
• mannitol
• amylose ndi amylopectin polysaccharides,
• muyezo
• sodium dodecyl sulfate,
• shuga nzimbe
• hypopellose HP55,
• hydrolyzed collagen protein,
• chakudya chowonjezera E131.

Zizindikiro ndi contraindication Duloxetine

Zisonyezo zogwiritsa ntchito mankhwalawa ndi:

• zovuta za matenda ashuga zomwe dongosolo lamanjenje limakhudzidwa,
• Kukhumudwa

Mndandanda wa contraindication ulinso wocheperako. Mankhwalawa sagwiritsidwa ntchito:

• mankhwala hypersensitivity
• munthawi yomweyo ndi antidepressants omwe amachepetsa enzyme monoamine oxidase.

Chenjezo liyenera kumwedwa kwa odwala omwe ali ndi zizindikiro zotsatirazi:

• mtima wofuna kudzipha
• psychic-depression psychosis,
• mbiri yakulanda
• pachimake pangala
• kukanika kwa impso ndi chiwindi,
• ochepa matenda oopsa.

Kuphatikiza apo, sikulimbikitsidwa kumwa mankhwalawa kwa odwala omwe zaka zawo sizinafike zaka 18, popeza palibe chidziwitso pakuchita bwino komanso chitetezo cha kugwiritsa ntchito Duloxetine ndi odwala a gululi. Pazifukwa zomwezi, mankhwalawa saikidwa panthawi yovomerezeka ndi kuyamwitsa.

Zotsatira zoyipa za duloxetine ndi bongo

Mwa odwala omwe adamwa Duloxetine, kulekerera mankhwala kunali kwabwino. Zotsatira zoyipa zimawoneka kawirikawiri kwambiri kapena zimachitika kumayambiriro kwa chithandizo, ndipo pamapeto pake zimangokhala zokha. Komabe, mawonekedwe a zotsatirazi akuyenera kuonana ndi dokotala kuti musinthe:

• kudzimbidwa
• nseru
• xerostomia,
• chizungulire
• kufooka wamba
• kusowa tulo
• Hypersomnia,
• cephalgia
• kuchuluka kwa mtima,
• chimbudzi chovuta komanso chopweteka,
• kusanza
• kuchepa kwamtima
• miyendo yanjenjemera
• kutsika kwamachitidwe,
• thukuta
• kumva kutentha
• kuyungunuka
• kusowa pogonana
• Katundu wam'mimba ndi matumbo,
• kuwonongeka kwa mucosa wamlomo,
• kuthamanga kwa magazi
• kunenepa
• kupsinjika kwa minofu
• kulawa zosokoneza,
• kuwonongeka kwamawonekedwe
• nkhawa yamagalimoto
• kusungika kwamikodzo
• kuchuluka kwa alanine aminotransferase, aspartate aminotransferase ndi creatine phosphokinase.
• kuchuluka kwazovuta zamitsempha,
• matenda a chiwindi otupa, matenda a Gospel,
• anaphylactic reaction,
• kuphwanya mulingo wamagetsi wamadzi,
• matenda a pakhungu ndi mucous nembanemba,
• Edema ya Quincke, totupa pakhungu ndi mucous nembanemba, urticaria,
• dontho lakuthwa mu kuthamanga kwa magazi ndi kukomoka.

Zotsatira zoyipa chifukwa chopitilira muyeso womwe umalimbikitsa unawonedwa kokha ndi mankhwala ogwirizana ndi mankhwala ena.

Mankhwala osokoneza bongo akufotokozedwa ndi zizindikiro zotsatirazi:

• Hypersomnia,
• kupweteka m'dzenje la m'mimba, kusanza,
• minyewa yodzipereka,
• kuchuluka kwa mtima,
• chikomokere.

Pankhani ya mankhwala osokoneza bongo, tikulimbikitsidwa kuti tichite zochotsa m'mimba ndikuyika makala ochititsidwa kuti muchepetse kuyamwa kwa chinthucho. Woopsa milandu, hospitalization tikulimbikitsidwa.

Malingaliro a madotolo

Madotolo amawona kuti mankhwalawa ndiwothandiza komanso wotsika mtengo wogwiritsa ntchito mankhwala othandizira odwala achilendo. Kwenikweni amasiya ndemanga zabwino za mankhwalawa:

1. Savenko L. M., dokotala wamisala: “Odwala omwe amamwa mankhwalawa amakhala ndi moyo tokha. Amayamba kugwiritsa ntchito foni komanso kudzidalira. Poyerekeza ndi anzawo akunja, Duloxetine ndiokwera mtengo, motero ndimapereka mankhwala kwa odwala anga, makamaka okalamba. ”
2. Rogachevsky R. Yu., A Psychiatrist: "Mankhwalawa ndiwotsika poyerekeza ndi othandizira ena opindulitsa, koma amakhalanso ndi zovuta zochepa. Mankhwalawa amathandizanso kupsinjika, koma kukhudzika ndi kusintha kwa chikhalidwe cha anthu omwe ali ndi Duloxetine sikukwaniritsidwa. ”

Chifukwa chake, madokotala amawona kugwira ntchito bwino kwa mankhwalawo polimbana ndi kukhumudwa. Koma ndimavuto akulu m'maganizo, zingakhale zofunikira kugwiritsa ntchito mankhwala ena.

Ndemanga za Odwala

Ndemanga za odwala omwe amamwa mankhwalawo sizikhala zabwino nthawi zonse. Ambiri amadziwa zoyipa zomwe zimapezeka chifukwa chothandizidwa ndi mankhwalawo komanso kusakwanira kwake. Ena, mmalo mwake, amawona zabwino za mankhwalawo komanso kulekerera kosavuta:

1. Diana, wazaka 22: “Ndinakumana ndi zovuta zoyambirira zamankhwala nditangomaliza mankhwala. Pambuyo pake, palibe zowonetsa zoyipa zomwe zidatulukira. Mphamvu yoletsa kupanikizika idawonekera mwachangu: minyewa ya tsiku ndi tsiku inali itapita, panali chiyembekezo chabwino kwambiri. Komabe, nditha kulandira chithandizo chamankhwala, ndinakumana ndi vuto lodziletsa, “ngakhale kuti mlingo unachepetsedwa pang'onopang'ono.”
2. Peter, wazaka 32: "Mankhwalawa adathandizira kuchepetsa zizindikiro za fibromyalgia: kupweteka kunachepa kwambiri, kukhumudwa kunatha, kunakhala kosavuta kuganizira. Komabe, mankhwalawo adandipangitsa kuti ndiziwononga kwambiri ndipo posakhalitsa mlingo wabwinobwino unasiya kuthandiza. ”

Duloxetine ndimankhwala othana ndi matenda othana ndi banja omwe amathana bwino ndi kupsinjika kwa magwero osiyanasiyana. Ndikofunikira kumwa mankhwalawa mosamala, chifukwa zimayambitsa chizolowezi chamankhwala komanso "kusiya". Musanagwiritse ntchito, ndikofunikira kufunsa dokotala.

Zizindikiro zogwiritsidwa ntchito

• mavuto okhumudwitsa
• nkhawa nkhawa,
• kupweteka mawonekedwe a zotumphukira matenda ashuga,
• aakulu ululu matenda a minofu ndi mafupa dongosolo, kuphatikizapo m'munsi kumbuyo, ndi nyamakazi ya bondo olowa ndi chifukwa cha fibromyalgia.

Malangizo ogwiritsira ntchito Duloxetine Canon: njira ndi mlingo

Duloxetine Canon akuwonetsedwa pakamwa. Makapisozi ayenera kumezedwa kwathunthu, osaphwanya, osafuna kutafuna.Kudya sikukhudza kugwiritsidwa ntchito kwa mankhwalawa, koma makapisozi sayenera kusakanikirana ndi zakumwa kapena kuwonjezera chakudya, chifukwa kuwonongeka kwa membrane wa enteric ndikotheka.

Kumayambiriro kwa mankhwalawa, 60 mg nthawi zambiri amapatsidwa kamodzi patsiku. Ngati ndi kotheka, onjezani mlingo mpaka 60 mg 2 pa tsiku.

Odwala matenda a cirrhosis ayenera kuchepetsa koyamba mlingo kapena kuchepetsa pafupipafupi makonzedwe.

Mlingo woyambirira wa Duloxetine Canon kwa odwala omwe ali ndi vuto la impso (creatinine chilolezo 10%, nthawi zambiri kuchokera> 1% mpaka 0,1% mpaka 0,01% mpaka

Duloxetine canon: mitengo muma pharmacin opezeka pa intaneti

Duloxetine Canon 30 mg enteric-sungunuka makapisozi 14 ma PC.

DULOKSETIN CanON 30mg 14 ma PC. makapisozi enteric

Duloxetine Canon 60 mg kapisozi, enteric, 28 ma PC.

DULOKSETIN CanON 60mg 28 ma PC. makapisozi enteric

Duloxetine Canon Caps. Ksh / sol 60mg n28

Maphunziro: Rostov State Medical University, apadera "General Medicine".

Zambiri zokhudzana ndi mankhwalawa ndizofanana, zimaperekedwa pazidziwitso ndipo sizilowa m'malo mwa malangizo ovomerezeka. Kudzipatsa nokha mankhwala kuopsa!

Mwazi wa munthu "umayenda" m'matumbo omwe akukakamizidwa kwambiri, ndipo ngati umphumphu wake waphwanyidwa, amatha kuwombera mpaka 10 metres.

Kulemera kwaubongo wamunthu kuli pafupifupi 2% ya kulemera konse kwathupi, koma kumadya pafupifupi 20% ya mpweya womwe umalowa m'magazi. Izi zimapangitsa kuti ubongo wamunthu ukhale wovuta kwambiri kuwonongeka chifukwa cha kusowa kwa mpweya.

Malinga ndi kafukufuku, azimayi omwe amamwa magalasi angapo a mowa kapena vinyo pamlungu amakhala pachiwopsezo chotenga khansa ya m'mawere.

Munthu aliyense samangokhala ndi zala zapadera, komanso chilankhulo.

James Harrison wazaka 74 yemwe amakhala ku Australia amakhala wopereka magazi pafupifupi nthawi 1,000. Ali ndi mtundu wamagazi osafunikira, ma antibodies omwe amathandizira akhanda omwe ali ndi vuto lalikulu la magazi kukhala ndi moyo. Chifukwa chake, waku Australia adapulumutsa ana pafupifupi mamiliyoni awiri.

Mimba ya munthu imagwira ntchito yabwino ndi zinthu zakunja komanso popanda chithandizo chamankhwala. Madzi am'mimba amadziwika kuti amasungunula ngakhale ndalama.

Madokotala a mano adapezeka posachedwa. Kalelo m'zaka za zana la 19, inali ntchito ya tsitsi wamba kuti akatulutse mano odwala.

Amayi ambiri amatha kusangalala mwakuganizira za thupi lawo lokongola pakalilore kuposa kugonana. Chifukwa chake, akazi, yesetsani kuyanjana.

Ngati mungagwere kuchokera pabulu, mukuluka khosi lanu kusiyana ndi kugwa kuchokera pa kavalo. Ingoyesani kutsutsa mawu awa.

Mankhwala odziwika bwino "Viagra" adapangidwa kuti azichitira matenda oopsa.

Impso zathu zimatha kuyeretsa malita atatu a magazi mphindi imodzi.

Chiwindi ndi chiwalo cholemera kwambiri m'thupi lathu. Kulemera kwake pafupifupi 1.5 kg.

Pochezera pafupipafupi pakama pofufuta, mwayi wokhala ndi khansa yapakhungu umawonjezeka ndi 60%.

Caries ndimatenda ofala kwambiri padziko lonse lapansi omwe ngakhale chimfine sangathe kupikisana nawo.

Zoposa $ 500 miliyoni pachaka zimagwiritsidwa ntchito pa mankhwala azisamba okha ku United States. Kodi mukukhulupilirabe kuti njira yoti mugonjetse ziwengo ikapezeka?

Mafuta a nsomba akhala akudziwika kwazaka zambiri, ndipo munthawi imeneyi zatsimikiziridwa kuti zimathandizira kupewetsa kutupa, kuchepetsa ululu wolumikizana, kukonza sos.