Carbamazepine Retard-Akrikhin > Chithandizo ndi kupewa

Matenda a khunyu (kupatula zilonda zam'mimba, kugwidwa kwa myoclonic kapena kuchepa kwa khungu) - kugwidwa pang'ono ndi zovuta komanso zosavuta, kukomoka kwakukulu komanso kwachiwiri kusokonekera ndi kukomoka kwa tonic-clonic, kugwidwa kosiyanasiyana (monotherapy kapena kuphatikiza ndi anticonvulsants ena).

Zoopsa manic (monotherapy komanso kuphatikiza ndi Li + ndi mankhwala ena a antipsychotic). Mavuto oyenda mosiyanasiyana a gawo (kuphatikizapo kupumula) kupewa kufalikira, kufooka kwa mawonetseredwe azachipatala pakuchulukana.

Hyperal kusiya matenda (nkhawa, kukhudzika, Hyper kusangalala, kugona tulo).

Matenda a diabetes a neuropathy.

Shuga insipidus wa chapakati. Polyuria ndi polydipsia ya chikhalidwe cha neurohormonal.

Kugwiritsanso ntchito ndikothekanso (zikuwonetsa potengera luso lazachipatala, palibe maphunziro omwe amawongolera omwe adachitika):

- ndi matenda amisala (okhala ndi vuto lothandizika ndimatenda amisempha, malingaliro, zovuta zamkati, zosagwirizana ndi matenda a matenda a schizophrenia, matenda opuwala a limbic system),

- ndi mtima wankhanza wa odwala omwe akuwonongeka mu ubongo, kukhumudwa, chorea,

- Pankhani ya nkhawa, dysphoria, somatization, tinnitus, senile dementia, Kluver-Bucy syndrome (mayiko awiri kuwonongera kwa amygdala tata), mavuto okakamiza, kusiya kwa benzodiazepine, cocaine,

- Ndi ululu matenda a neurogenic chiyambi: ndi msana, angapo chifuwa, pachimake idiopathic neuritis (Guillain-Barré syndrome), matenda ashuga polyneuropathy, kupweteka kwa miyendo, kupsinjika kwa miyendo matenda (Ekboma syndrome), hemifacial spasm, post-traumatic neuropathy ndi neuralgia ,

- chifukwa cha migraine prophylaxis.

Mlingo

Mapiritsi otetezedwa osasunthika, 200 mg kapena 400 mg

ntchito yogwira - carbamazepine 200 mg kapena 400 mg,

obwera: eudragit RS 30D-ammonium methacrylate Copolymer (mtundu B) kupezeka, triacetin (glycerol triacetate), talc, eudragit L 30D-55 methaconic acid-ethyl acrylate Copolymer (1: 1) kupezeka kwa 30%, crospovidone, anhydrous silicon collo microcrystalline mapadi.

Mapiritsi ndi oyera kapena achikasu amtundu, wozungulira, wowoneka ngati tsamba la clover wokhala ndi mbali zokutidwa, ndi malo osalala, okhala ndi mizere yolakwika mbali zonse ziwiri ndi notches 4 kumbali yakumaso.

Contraindication

Hypersensitivity kwa carbamazepine kapena mankhwala ofanana ndi mankhwala (mwachitsanzo, tricyclic antidepressants) kapena china chilichonse chamankhwala, mavuto am'matumbo hematopoiesis (anemia, leukopenia), pachimake porphyria (kuphatikizapo mbiri), AV block, munthawi yomweyo kutenga ma MAO.C zoletsa mosamala. Kuwonongeka kwa mtima kwa mtima, dilution hyponatremia (ADH hypersecretion syndrome, hypopituitarism, hypothyroidism, adrenal insuffence), uchidakwa wopitilira muyeso (kupsinjika kwa CNS kumakulitsidwa, kagayidwe ka carbamazepine kakulidwe), kufooka kwa mafupa kumalumikizidwa, ndipo kulephera kwa chiwindi kumalumikizidwa ndi kuchepa kwa magazi, ndipo , Prostatic hyperplasia, kuchuluka kwa ma intraocular.

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

Mkati, osasamala chakudyacho ndi madzi pang'ono.

Mapiritsi a retard (piritsi lonse kapena theka) ayenera kumezedwa lonse, osafuna kutafuna, ndimadzi ochepa, kawiri pa tsiku.Mwa odwala ena, mukamagwiritsa ntchito mapiritsi obwezeretsa, zingafunikire kuwonjezera kuchuluka kwa mankhwalawa.

Khunyu Ngati zingatheke, carbamazepine iyenera kutumizidwa ngati monotherapy. Chithandizo chimayamba ndikugwiritsa ntchito mlingo wocheperako tsiku lililonse, womwe umayamba kuwonjezeka pang'onopang'ono mpaka utakwaniritsidwa.

Kuphatikiza kwa carbamazepine pothandizira antiepileptic mankhwala kuyenera kuchitika pang'onopang'ono, pomwe Mlingo wa mankhwala ogwiritsidwa ntchito sasintha kapena, ngati pakufunika, musinthe.

Kwa akuluakulu, mlingo woyambirira ndi 100-200 mg 1-2 kawiri pa tsiku. Kenako mlingo umakulitsidwa pang'onopang'ono mpaka mulingo woyenera wowonjezera (nthawi zambiri umagwiritsidwa ntchito kwa 400 mg katatu patsiku, kuchuluka kwa 1.6-2 g / tsiku).

Ana kuyambira zaka 4 - muyezo woyambirira wa 20-60 mg / tsiku, pang'onopang'ono akuwonjezeka ndi 20-60 mg tsiku lililonse. Mwa ana okulirapo zaka 4 - mu koyamba mlingo wa 100 mg / tsiku, mlingo umakulitsidwa pang'onopang'ono, sabata iliyonse ndi 100 mg. Kuthandiza Mlingo: 10-20 mg / kg patsiku (Mlingo wambiri): kwa zaka 4-5 - 200-400 mg (mu Mlingo wa 1-2), zaka 6-10 - 400-600 mg (mu 2-3 ), kwa zaka 11-15 - 600-1000 mg (mu 2-3 waukulu).

Ndi trigeminal neuralgia, 200-400 mg / tsiku limayikidwa tsiku loyamba, pang'onopang'ono limawonjezeka osapitilira 200 mg / tsiku mpaka ululu utatha (pafupifupi 400-800 mg / tsiku), kenako ndikuchepetsa. Ngati mukumva kupweteka kwa chiyambi cha neurogenic, mlingo woyambayo ndi 100 mg 2 kawiri patsiku patsiku loyamba, ndiye kuti mlingo umakulitsidwa osaposa 200 mg / tsiku, ngati kuli kofunikira, kuwonjezera ndi 100 mg maola 12 aliwonse mpaka ululu utachira. Njira yokonza ndi 200-1200 mg / tsiku angapo Mlingo.

Mankhwalawa okalamba ndi odwala omwe ali ndi hypersensitivity, mlingo woyambirira ndi 100 mg 2 kawiri pa tsiku.

Alcohol achire syndrome: avareji ya 200 mg katatu patsiku, nthawi yayikulu, m'masiku ochepa, mankhwalawa amatha kuchuluka mpaka 400 mg katatu pa tsiku. Kumayambiriro kwa chithandizo chazovuta zochizira, tikulimbikitsidwa kupereka mankhwala osakanikirana ndi mankhwala a sedative-hypnotic (clidweazole, chlordiazepoxide).

Shuga insipidus: avareji ya mankhwala akuluakulu ndi 200 mg katatu patsiku. Mwa ana, mlingo uyenera kuchepetsedwa malinga ndi zaka komanso kulemera kwa thupi kwa mwana.

Matenda a shuga odwala matenda ashuga, limodzi ndi mavuto: pafupifupi 200 mg 2 mg kawiri pa tsiku.

Popewa kubwereranso pamankhwala oyanjana ndi osokoneza bongo - 600 mg / tsiku mu 3-4 Mlingo.

M'mavuto owopsa okhudzana ndi zovuta komanso zosokoneza (bipolar), Mlingo wa tsiku ndi tsiku ndi 400-1600 mg. Wapakati tsiku ndi tsiku ndi 400-600 mg (mu 2-3 waukulu). Mu woopsa manic boma, mlingo ukuwonjezeka mwachangu, ndi kukonza mankhwala a matenda akhungu - pang'onopang'ono (kusintha kulolerana).

Zotsatira za pharmacological

Mankhwala a antiepileptic (dibenzazepine derivative), omwe amakhalanso ndi standardotymic, antimaniacal, antidiuretic (odwala matenda a shuga insipidus) ndi analgesic (odwala a neuralgia).

Limagwirira ntchito limalumikizidwa ndi blockade yamagetsi yamagetsi-gated Na +, yomwe imatsogolera kukhazikika kwa membrane wa neuron, kulepheretsa kuwoneka kwa serial kutulutsa kwa ma neurons ndi kuchepa kwa synaptic conduction ya impulses. Imalepheretsa kupangidwanso kwa Na + -kudalira kothandizirana mu ma neurons a depolarized. Kuchepetsa kumasulidwa kwa glotamate yosangalatsa ya neurotransmitter amino acid, kumawonjezera kufupika kwapang'onopang'ono, ndi zina zotero. amachepetsa chiopsezo chodwala. Imawonjezera kuyendetsa kwa K +, modulates voltage-gated Ca2 + njira, zomwe zingayambenso anticonvulsant zotsatira za mankhwala.

Amawongolera umunthu wa khunyu ndipo pamapeto pake umawonjezera kulumikizana kwa odwala, amathandizira kukhazikika kwawo. Itha kutumikiridwa ngati mankhwala othandizira komanso kuphatikiza ndi mankhwala ena a anticonvulsant.

Kugwirira mwamphamvu (kosavuta komanso kovuta), kumayendetsedwa kapena kutsagana ndi kutsata kwachiwiri, kugwidwa mwamtundu wa tonic-clonic, komanso kuphatikiza mitundu iyi (nthawi zambiri imagwira ntchito pang'ono pogwidwa - petit mal, kukhalapo ndi kugwidwa myoclonic) .

Odwala omwe ali ndi khunyu (makamaka ana ndi achinyamata) amakhala ndi zotsatira zabwino pazizindikiro za nkhawa komanso kukhumudwa, komanso kuchepa kwa kusakwiya komanso kukwiya. Zotsatira zakugwirira ntchito mwamphamvu ndi ntchito yama psychomotor zimadalira mlingo ndipo zimasiyana kwambiri.

Kukhazikika kwa anticonvulsant zotsatira kumasiyana kwa maola angapo mpaka masiku angapo (nthawi zina mpaka mwezi umodzi chifukwa chogwiritsa ntchito kagayidwe kachakudya).

Pogwiritsa ntchito neuralgia yofunikira komanso yachiwiri ya trigeminal nthawi zambiri imalepheretsa kuwoneka ngati ululu. Kuthandiza kuthetsa ululu wa neurogenic pakuuma kwa msana, pambuyo pa zoopsa za paresthesias ndi postherpetic neuralgia. Kupumula kwamphamvu mu trigeminal neuralgia kumadziwika pambuyo pa maola 8-72.

Pankhani ya kusiya kudzipereka kwa matenda, kumawonjezera poyambira kutsimikiza (komwe nthawi zambiri kumachepetsedwa pamenepa) komanso kumachepetsa zovuta zakuchipatala kuwonekera kwa matenda (kuchuluka kosangalatsa, kugwedezeka, matenda a gait).

Odwala odwala matenda ashuga insipidus kumabweretsa kulipira mwachangu madzi bwino, amachepetsa diuresis ndi ludzu.

Ntchito ya antipsychotic (antimaniacal) imayamba pambuyo pa masiku 7-10, mwina chifukwa cha kuletsa kwa kagayidwe ka dopamine ndi norepinephrine.

Fomu yotalikira ya magazi imathandizira kukonzanso kwa carbamazepine m'magazi popanda "nsonga" ndi "ziphuphu", zomwe zimathandizira kuchepetsa pafupipafupi komanso kuopsa kwa zovuta zovuta zamankhwala, kuonjezera mphamvu ya chithandizo chamankhwala ngakhale mutagwiritsa ntchito Mlingo wocheperako. Dr. mwayi wofunikira wa fomu yotalikilapo ndikuti mungatenge ma 1-2 tsiku limodzi.

Zotsatira zoyipa

Mukamayesa kuchuluka kwa zomwe zimachitika mosiyanasiyana, makondedwe otsatirawa amagwiritsidwa ntchito: nthawi zambiri - 10% ndipo nthawi zambiri, nthawi zambiri 1-10%, nthawi zina 0,1-1%, kawirikawiri 0.01-0.1%, kawirikawiri 0.01%.

Mlingo wothandizidwa ndi Mlingo umasowa patangopita masiku ochepa, zonse munthawi yomweyo ndipo pambuyo pochepetsedwa kwakanthawi mlingo wa mankhwala. Kukula kwa zoyipa zimachitika ku chapakati mantha dongosolo mwina chifukwa cha kuchuluka kwa mankhwala kapena kusinthasintha kwa ndende ya yogwira plasma. Zikatero, tikulimbikitsidwa kuwunikira kuchuluka kwa mankhwala omwe amapezeka m'madzi a m'magazi.

Kuchokera kumbali ya chapakati mantha dongosolo: nthawi zambiri - chizungulire, ataxia, kugona, asthenia, nthawi zambiri - kupweteka mutu, paresis malo okhalamo, nthawi zina - zachilendo mwadzidzidzi kayendedwe (mwachitsanzo, kugwedezeka "kugwedezeka" kugwedezeka - asterixis, dystonia, tics), nystagmus, kawirikawiri - orofacial dyskinesia , kusokonezeka kwa oculomotor, kusokonezeka kwa mawu (mwachitsanzo, dysarthria), kusokonezeka kwa choreoathetoid, zotumphukira za neuritis, paresthesias, myasthenia gravis ndi zizindikiro za paresis. Udindo wa carbamazepine ngati mankhwala omwe amachititsa kapena amalimbikitsa kukula kwa zilonda zam'mimba za antipsychotic, makamaka ngati zimaperekedwa limodzi ndi antipsychotic, sizikudziwika bwinobwino.

Kuchokera pagawo lamalingaliro: kawirikawiri - kuyerekezera zinthu m'maganizo (zowoneka kapena zowerengera), kukhumudwa, kuchepa kwamphwayi, kuda nkhawa, kuchita zamtopola, kukwiya, kusokonezeka, kawirikawiri - kuyambitsa psychosis.

Zotsatira zoyipa: pafupipafupi - urticaria, nthawi zina - erythroderma, kawirikawiri - lupus-ngati khungu, kuyabwa pakhungu, kawirikawiri - ultiforme exudative erythema (kuphatikizapo Stevens-Johnson syndrome), poyizoni epermermal necrolysis (matenda a Lyell), photosensitivity.

Pafupipafupi, matupi ambiri amachedwa-mtundu wa hypersensitivity zimachitika ndi kutentha, zotupa za pakhungu, vasculitis (kuphatikizapo erythema nodosum monga mawonekedwe a khungu vasculitis), lymphadenopathy, zizindikiro zofanana ndi zamitsempha, arthralgia, leukopenia, eosinophilia, chiwindi chimagwira ndi chiwindi ndi hepatosplenomegaly. wopezeka mumitundu yosiyanasiyana). Mukhoza kutenga nawo mbali, etc.ziwalo (mwachitsanzo, mapapu, impso, kapamba, myocardium, colon). Osowa kwambiri - aseptic meningitis ndi myoclonus ndi zotumphukira eosinophilia, anaphylactoid anachita, angioedema, chifuwa chachikulu cha pneumonitis kapena eosinophilic chibayo. Ngati zotupa zakumwambazi zikuchitika, kugwiritsa ntchito mankhwalawa kuyenera kusiyiratu.

Hematopoietic ziwalo: pafupipafupi - leukopenia, nthawi zambiri - thrombocytopenia, eosinophilia, kawirikawiri - leukocytosis, lymphadenopathy, kuperewera kwa asidi folic, osowa kwambiri - agranulocytosis, aplasic anemia, zoona erythrocytic aplasia, megaloblastic anemia, puteorrume kuchepa magazi

Kumbali ya chiwindi: pafupipafupi - kuwonjezeka kwa ntchito ya GGT (chifukwa cha kukhazikitsidwa kwa puloteni iyi m'chiwindi), yomwe nthawi zambiri ilibe kanthu, nthawi zambiri - kuwonjezeka kwa ntchito ya mankhwala a phosphatase ya alkaline, nthawi zina - kuwonjezeka kwa zochitika za "chiwindi" transaminases, kawirikawiri - hepatitis ya hematocellular kapena hepatocellular mtundu wosakanikirana, jaundice, osowa kwambiri - granulomatous hepatitis, kulephera kwa chiwindi.

Kuchokera ku CCC: kawirikawiri - kusokonezeka kwa mtima wa mtima, kuchepa kapena kuwonjezeka kwa magazi, kawirikawiri - bradycardia, arrhythmias, AV block ndi kukomoka, kugwa, kuchuluka kapena kukulira kwa kulephera kwa mtima, kufalikira kwa matenda a mtima (kuphatikiza kapena kuwonjezeka kwa matenda a angina), thrombophlebitis, thromboembolic syndrome.

Kuchokera ku endocrine dongosolo ndi kagayidwe: nthawi zambiri - edema, kuchepa kwamadzi, kulemera, hyponatremia (kuchepa kwa osmolarity chifukwa cha zotsatira zofanana ndi za ADH, zomwe nthawi zina zimayambitsa kuchepa kwa magazi, kutsagana ndi kufinya, kusanza, kupweteka mutu, kusokoneza ndi zovuta zamitsempha), kawirikawiri - hyperprolactinemia (ikhoza kutsagana ndi galactorrhea ndi gynecomastia), kuchepa kwa ndende ya L-thyroxine (T4 yaulere, T4, T3) komanso kuchuluka kwa TSH (nthawi zambiri sikuyenda limodzi) mawonetseredwe azachipatala), metabolism ya calcium-phosphorous yomwe imachepa mu minofu yam'mafupa (yafupika plasma Ca2 + ndi 25-OH-colecalciferol): osteomalacia, hypercholesterolemia (kuphatikizapo HDL cholesterol) ndi hypertriglyceridemia.

Kuchokera ku minculoskeletal system: kawirikawiri - arthralgia, myalgia kapena kukokana.

Kuchokera kumalingaliro am'maganizo: kawirikawiri - kusokonezeka kwa kulawa, kuyendetsa ma mandala, conjunctivitis, kuvulala kwamakutu, kuphatikiza tinnitus, hyperacusia, hypoacusia, amasintha kuzindikira kwa phula.

Zina: zovuta za pakhungu la khungu, purpura, ziphuphu, kuchuluka thukuta, alopecia. Nthawi zambiri vuto la hirsutism lidanenedwa, koma kuphatikizana kwa vuto la carbamazepine pano sikumadziwika. Zizindikiro: Nthawi zambiri zimawonetsa kusokonekera kwa dongosolo lamkati lamanjenje, CVS, ndi kupuma.

Kuchokera kumbali ya dongosolo lamkati lamanjenje ndi ziwalo zamatsenga - kuponderezedwa kwamitsempha yamagazi, kukhumudwitsa, kugona, kukhumudwa, kuyerekezera zinthu, kukomoka, chikomokere, kuwoneka kosokonekera ("chifunga" pamaso pa maso), dysarthria, nystagmus, ataxia, dyskinesia, hyperreflexia (poyamba), hyporeflexia (poyamba), hyporeflexia ), zopweteka, zovuta zama psychomotor, myoclonus, hypothermia, mydriasis).

Kuchokera ku CCC: tachycardia, kutsitsa magazi, nthawi zina kumawonjezera kuthamanga kwa magazi, kusokonezeka kwa kulowetsedwa kwa intraventricular ndi kukulira kwa QRS zovuta, kumangidwa kwa mtima.

Pa mbali ya kupuma dongosolo: kupuma kupsinjika, pulmonary edema.

Kuchokera pamimba: kukomoka ndi kusanza, kuchedwa kutulutsa chakudya m'mimba, kuchepa mphamvu ya matumbo.

Kuchokera kwamikodzo dongosolo: kwamikodzo posungira, oliguria kapena anuria, madzi osungira, hyponatremia dilution.

Zizindikiro zasayansi: leukocytosis kapena leukopenia, hyponatremia, metabolic acidosis, hyperglycemia ndi glucosuria, kuwonjezeka kwa gawo la minofu ya KFK.

Chithandizo: palibe mankhwala enaake. Chithandizo chimatengera wodwala, kuchipatala, kutsimikiza kwa kuchuluka kwa carbamazepine mu madzi a m'magazi (kutsimikizira poizoni ndi mankhwalawa komanso kuyesa kuchuluka kwa kuchuluka), kutsekeka kwa m'mimba, kuyika kwa makala oyamwa (kutulutsidwa mochedwa kwa chapamimba kungayambitse kuchepetsedwa kwa masiku awiri ndi atatu ndikuyambiranso) kuwoneka kwa zizindikiro za kuledzera panthawi yakachira.

Kukakamizidwa diuresis, hemodialysis, ndi peritoneal dialysis sikuthandiza (dialysis imasonyezedwa ndikuphatikiza kwa poizoni wamphamvu ndi kulephera kwa aimpso). Ana aang'ono angafunike kuthiridwa magazi. Zizindikiro zothandizira mu chipinda chosamalira bwino, kuyang'anira ntchito za mtima, kutentha kwa thupi, mawonekedwe a impso, impso ndi chikhodzodzo, kukonza masoka a electrolyte. Ndi kuchepa kwa kuthamanga kwa magazi: malo okhala ndi mutu wachepetsedwa, m'malo mwa plasma, osakwanira - iv dopamine kapena dobutamine, ndikusokonekera kwa mtima - chithandizo chimasankhidwa payekha, ndi kupweteka - kuyambitsa kwa benzodiazepines (mwachitsanzo diazepam), mosamala (chifukwa cha kuchuluka kwa kukhumudwa kupuma) kukhazikitsidwa kwa ma anticonvulsants ena (mwachitsanzo, phenobarbital). Ndi chitukuko cha dilution hyponatremia (madzi kuledzera) - kutsekeka kwa magazi ndi kuyamwa pang'onopang'ono kulowetsedwa kwa 0.9% NaCl yankho (kungathandize kupewa kukula kwa matenda a edema). Hemosorption pa kaboni sorbents tikulimbikitsidwa.

Malangizo apadera

Monotherapy ya khunyu imayamba ndi kukhazikitsidwa kwa Mlingo wocheperako, womwewo umawonjezera iwo kuti akwaniritse zofunikira zochizira.

M'pofunika kudziwa kuchuluka kwa plasma kuti musankhe mlingo woyenera, makamaka ndi kuphatikiza mankhwala.

Mukasamutsa wodwala ku carbamazepine, mlingo wa mankhwala omwe adagwiritsidwa ntchito kale antiepileptic uyenera kuchepetsedwa pang'onopang'ono mpaka kuthe.

Kutha kwadzidzidzi kwa carbamazepine kungayambitse kugwidwa. Ngati kuli koyenera kusokoneza mwadzidzidzi chithandizo, wodwalayo ayenera kusinthidwa kupita ku mankhwala ena antiepileptic pachiwonetsero cha kukonzekera chomwe chawonetsedwa mwa milandu (mwachitsanzo, diazepam kutumikiridwa pamitsempha kapena rectally, kapena phenytoin yoyendetsedwa iv).

Pali milandu ingapo yosanza, kutsekula m'mimba ndi / kapena kuchepa kwa chakudya, kukhudzika ndi / kapena kupsinjika kwa ana akhanda omwe amayi awo amakhala ndi carbamazepine mogwirizana ndi anticonvulsants ena (izi zimatha kukhala mawonetseredwe a "kuchoka" kwa akhanda).

Musanalembe carbamazepine komanso munthawi ya chithandizo, kafukufuku wokhudzana ndi ntchito ya chiwindi ndikofunikira, makamaka kwa odwala omwe ali ndi mbiri ya matenda a chiwindi, komanso odwala okalamba. Pankhani yakuwonjezeka kwa vuto la chiwindi lomwe likupezeka kale kapena ngati matenda a chiwindi akugwira, mankhwalawo ayenera kusiyidwa. Musanayambe chithandizo, ndikofunikira kuti mupange kafukufuku wamagazi (kuphatikiza kupatsidwa zinthu za m'magazi, kuchuluka kwa maselo), seramu Fe ndende, urinalysis, magazi urea, EEG, kutsimikiza kwa serum electrolyte ndende (komanso nthawi yamankhwala, chifukwa chitukuko cha hyponatremia). Pambuyo pake, zizindikirozi ziyenera kuyang'aniridwa m'mwezi woyamba wamankhwala sabata iliyonse, kenako mwezi uliwonse.

Carbamazepine iyenera kuchotsedwa nthawi yomweyo ngati thupi lawo siligwirizana kapena ngati zikuwoneka kuti akuganiza kuti akupanga matenda a Stevens-Johnson kapena a Lyell. Kutulutsa kofatsa (kosiyanitsa macular kapena maculopapular exanthema) nthawi zambiri kumatha patatha masiku angapo kapena milungu ingapo ndikupitilira chithandizo kapena pakumachepetsa mlingo (wodwalayo ayenera kuyang'aniridwa ndi adokotala panthawiyi).

Carbamazepine ali ndi anticholinergic ofooka, akalembetsedwa odwala omwe ali ndi vuto la intraocular, kuwunika kwake nthawi zonse ndikofunikira.

Kuthekera kwa kutseguka kwa ma psychoses komwe kumachitika posachedwapa kuyenera kukumbukiridwa, ndipo odwala okalamba, mwayi wokhala ndi chisokonezo kapena kukondwerera.

Mpaka pano, pakhala pali malipoti osiyana abwinobwino a chonde cha abambo ndi / kapena vuto la spermatogenesis (ubale wa mavuto awa ndi carbamazepine sunakhazikitsidwe).

Pali malipoti okhetsa magazi kwa azimayi pakati pa nthawi ya kusamba kwa amuna pamene milandu ya pakamwa imagwiritsidwa ntchito nthawi yomweyo. Carbamazepine ikhoza kusokoneza kudalirika kwa mankhwala opatsirana kudzera pakamwa, chifukwa chake amayi omwe ali ndi zaka zobereka ayenera kugwiritsa ntchito njira zina zodzitetezera pakati pamankhwala.

Carbamazepine iyenera kugwiritsidwa ntchito moyang'aniridwa ndi achipatala.

Ndikofunikira kudziwitsa odwala za zizindikiro zoyambirira za poizoni mu zovuta za hematologic, komanso zizindikiro kuchokera pakhungu ndi chiwindi. Wodwalayo amadziwitsidwa zakufunika kofunsira dokotala nthawi yomweyo pakagwiritsidwa ntchito kosafunikira monga malungo, zilonda zapakhosi, zotupa, zotupa zamkamwa, chifukwa chovulaza, zotupa m'mimba mwa mawonekedwe a petechiae kapena purpura.

Nthawi zambiri, kuchepa kwapang'onopang'ono kapena kupitirirabe kwa kuchuluka kwa maselo am'magazi sikutanthauza kuyambika kwa aplasic anemia kapena agranulocytosis. Komabe, asanayambe chithandizo, komanso nthawi ndi nthawi yamankhwala, kuyezetsa magazi kwa kachipatala kuyenera kuchitidwa, kuphatikizapo kuwerengera kwamapulogalamu am'magazi komanso ma reticulocytes, komanso kudziwa kuchuluka kwa Fe mu seramu yamagazi.

Asymptomatic leukopenia yopanda patsogolo sikufunikira kuchoka, komabe, chithandizo chikuyenera kutha ngati leukopenia kapena leukopenia wapita patsogolo, limodzi ndi zizindikiro zamatenda a matenda opatsirana.

Musanayambe chithandizo, ndikofunikira kuti mupange mayeso a ophthalmological, kuphatikiza kuyang'ana kwa fundus ndi nyali yoyenda ndi muyeso wa kukakamiza kwa intraocular ngati kuli kotheka. Potumiza mankhwala kwa odwala omwe ali ndi kukhudzika kwa intraocular, kuyang'anira chiwonetserochi kumafunikira.

Ndikulimbikitsidwa kukana kugwiritsa ntchito Mowa.

Mankhwalawa atakhala nthawi yayitali amatha kumwa kamodzi, usiku. Kufunika kochulukitsa mlingo mukamasintha mapiritsi ndikosowa kwambiri.

Ngakhale ubale pakati pa mlingo wa carbamazepine, kugwiritsidwa ntchito kwake mwamphamvu ndi matenda kapena kulolerana kuli kochepa kwambiri, komabe, kutsimikiza kwa nthawi yayitali kwa carbamazepine kungakhale kothandiza pazinthu zotsatirazi: kuwonjezeka kwambiri kwa pafupipafupi pakuwukira, kuti muwone ngati wodwala akumwa mankhwalawo moyenera pa mimba, mankhwala a ana kapena achinyamata, ndi akuganiza malabsorption a mankhwala, ndi akuwoneka kukula kwa poizoni zimachitika ngati wodwala maet mankhwala angapo.

Mwa amayi omwe ali ndi zaka zakubala, carbamazepine iyenera kugwiritsidwa ntchito ngati mankhwala othandizira ngati zingatheke (pogwiritsa ntchito mlingo wocheperako) - pafupipafupi malingaliro obadwa nawo mwa makanda obadwa kwa amayi omwe adalandira chithandizo cha antiepileptic ndi apamwamba kuposa omwe adalandira iliyonse ya mankhwalawa ngati monotherapy.

Mimba ikachitika (posankha kukhazikitsidwa kwa carbamazepine panthawi yapakati), ndikofunikira kuyerekeza bwino phindu lomwe lingachitike pakubwera kwa mankhwala ndi zovuta zake, makamaka m'miyezi itatu yoyambirira ya pakati. Amadziwika kuti ana obadwa kwa amayi omwe ali ndi matenda a khunyu amakhala okonzekera kutukuka kwa intrauterine, kuphatikizapo kupunduka. Carbamazepine, monga mankhwala ena onse antiepileptic, amatha kukulitsa chiwopsezo cha zovuta izi. Pali malipoti apadera a matenda obadwa nawo komanso kusokonezeka, kuphatikizapo kusatsekedwa kwa ziphuphu zakumaso (spina bifida). Odwala ayenera kupatsidwa chidziwitso chakuchulukitsa chiopsezo cha kusokonezeka komanso kuthekera kozindikira matenda oyembekezera.

Mankhwala othandizira antiepileptic amalimbikitsa kuchepa kwa folic acid, omwe nthawi zambiri amawonedwa pakakhala pakati, omwe amatha kukulitsa vuto la kubadwa kwa ana (asanachitike komanso nthawi yomwe ali ndi pakati, kupatsidwa folic acid kumalimbikitsidwa). Pofuna kupewa kuchulukitsa kwa magazi akhanda, ndikulimbikitsidwa kuti amayi omwe ali m'milungu yotsiriza ya mimba, komanso akhanda, akhazikitsidwe vitamini K1.

Carbamazepine akudutsa mkaka wa m'mawere; maubwino ndi zosafunikira zoyamwitsa ziyenera kuyerekezedwa ndi chithandizo chanthawi zonse. Amayi omwe amamwa carbamazepine amatha kuyamwitsa ana awo, malinga ngati mwana amawunikidwa kuti apange zovuta zoyipa (mwachitsanzo, kugona kwambiri, thupi lawo siligwirizana.

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

The munthawi yomweyo makonzedwe a carbamazepine ndi CYP 3A4 zoletsa angapangitse kuwonjezeka ake ndende ya madzi am`magazi komanso kukulitsa zovuta. Kugwiritsa ntchito kwa CYP 3A4 inducers kungayambitse kuchuluka kwa kagayidwe ka carbamazepine, kuchepa kwa kuchuluka kwake m'magazi am'magazi komanso kuchepa kwa njira yothandizira; m'malo mwake, kuthetsedwa kwawo kungachepetse kuchuluka kwa biotransfform ya carbamazepine ndikuwonjezera chiwonetsero chake.

Kuchuluka kwa carbamazepine mu plasma kumawonjezereka ndi verapamil, diltiazem, felodipine, dextropropoxyphene, viloxazine, fluoxetine, fluvoxamine, cimetidine, acetazolamide, danazole, desipramine, nicotinamide (mu akulu, kokha eosesy, ecinycinth, yacycinthoscincin, diaminthoscin. (itraconazole, ketoconazole, fluconazole), terfenadine, loratadine, isoniazid, propoxyphene, madzi a mphesa, ma virus a proteinase inhibitors ogwiritsidwa ntchito pochiza matenda a HIV (mwachitsanzo, ritonavir) - Mlingo kuyan'anila za woipa carbamazepine plasma.

Felmabat amachepetsa kuchuluka kwa carbamazepine mu plasma ndikuwonjezera kuchuluka kwa carbamazepine - 10,11 - epoxide, pamene kuchepa pamodzi kwa ndende mu seramu ya felbamate ndikotheka.

Mafuta a carbamazepine amachepetsedwa ndi phenobarbital, phenytoin, primidone, metsuximide, fensuximide, theophylline, rifampicin, cisplatin, doxorubicin, mwina: clonazepam, valpromide, valproic acid, oxcarbazepine ndi mankhwala azitsamba okhala ndi zonunkhira.Pali kuthekera kosamutsidwa kwa carbamazepine ndi valproic acid ndi primidone chifukwa cha mapuloteni a plasma ndikuwonjezereka kwa kuchuluka kwa pharmacologically yogwira metabolite (carbamazepine-10,11-epoxide). Pogwiritsa ntchito finlepsin ndi valproic acid kuphatikiza, pokha pokha, chikomokere ndi chisokonezo zimatha kuchitika.

Isotretinoin amasintha bioavailability ndi / kapena chilolezo cha carbamazepine ndi carbamazepine-10,11-epoxide (kuwunika plasma carbamazepine ndende ndikofunikira). Carbamazepine kungachepetse madzi a ndende (kuchepa kapena kwathunthu n'chongoletsa zotsatira) ndi kungafune Mlingo kudzudzulidwa mankhwala zotsatirazi: klobazama, clonazepam, digoxin, ethosuximide, primidone, asidi valproic, alprazolam, corticosteroids (prednisone, dexamethasone), cyclosporine, tetracyclines (doxycycline) , haloperidol, methadone, kukonzekera kwa pakamwa komwe kumakhala ndi estrogen ndi / kapena progesterone (kusankha njira zina zakulera ndikofunikira), theophylline, anticoagulants pamlomo (warf Mafuta, fenprocoumone, dicumarol); njira (gulu la dihydropyridones, mwachitsanzo felodipine), itraconazole, levothyroxine, midazolam, olanzapine, praziquantel, risperidone, tramadol, ciprasidone. Pali mwayi wowonjezera kapena kuchepetsa mulingo wa phenytoin mu plasma yamagazi motsutsana ndi maziko a carbamazepine ndikukulitsa mulingo wa mefenitoin. Pogwiritsa ntchito munthawi yomweyo carbamazepine ndi lithiamu kukonzekera, zotsatira za neurotoxic pazinthu zonse zomwe zimagwira zimatha kupitilizidwa.

Tetracyclines ikhoza kukhala yodziwika bwino yochizira carbamazepine. Akaphatikizidwa ndi paracetamol, chiwopsezo cha chiwopsezo chake pachiwindi chimawonjezeka komanso kuthandizira kwamankhwala amachepetsa (imathandizira kagayidwe ka paracetamol).

The munthawi yomweyo makonzedwe a carbamazepine ndi phenothiazine, pimozide, thioxanthenes, mindindone, haloperidol, maprotiline, clozapine ndi tricyclic antidepressants kumabweretsa kukulira kwa choletsa zotsatira zapakati zamanjenje komanso kufooketsa mphamvu ya anticonvulsant of carbamazepine. Monoamine oxidase inhibitors amachulukitsa chiopsezo cha vuto la hyperpyretic, kusokonekera kwa magazi, kugwidwa, ndi kufa (monoamine oxidase inhibitors ziyenera kuthetsedwa pamaso pa sabata la 2bbazazepine osavomerezeka, ngakhale ngati mkhalidwe wa chipatala umalola, ngakhale kwa nthawi yayitali).

Kugwirizana munthawi yomweyo ndi diuretics (hydrochlorothiazide, furosemide) kungayambitse hyponatremia, limodzi ndi mawonetsedwe azachipatala. Imapatsirana zotsatira za kusapondaponda kwa minofu yopumula (pancuronium). Pankhani yogwiritsa ntchito kuphatikiza uku, mwina pangafunikire kuwonjezera kuchuluka kwa opuma minofu, pomwe kuwunika wodwalayo kuli kofunikira chifukwa chitha kupumula msanga kwa opuma. Carbamazepine amachepetsa kulolera kwa ethanol. Mankhwala a Myelotoxic amakulitsa kuchuluka kwa mankhwalawo.

Imathandizira kagayidwe ka anticoagulants osadziwika, njira zakulera za mahomoni, folic acid, praziquantel, ndipo zimathandizira kuthetseratu mahomoni a chithokomiro.

Imathandizira kagayidwe ka mankhwala a anesthesia (enflurane, halotane, fluorotan) ndikuwonjezera chiopsezo cha hepatotoxic zotsatira, kumawonjezera mapangidwe a nephrotoxic metabolites a methoxyflurane. Imawonjezera hepatotoxic mphamvu ya isoniazid.

Bongo

Zizindikiro Nthawi zambiri zimawonetsa kusokonezeka kwa chapakati mantha dongosolo, mtima ndi kupuma dongosolo.

Pakati lamanjenje dongosolo kuponderezana kwa ntchito ya chapakati mantha dongosolo, kusokonezeka, kugona, kusokonezeka, kuyerekezera zinthu, chikomokere, kuona, kusakhazikika, dysarthria, nystagmus, ataxia, dyskinesia, hyperreflexia (koyambirira), hyporeflexia (pambuyo pake), kupsinjika, psychomotor mydriasis)

Matenda a mtima: tachycardia, kutsitsa magazi, nthawi zina kumawonjezera kuthamanga kwa magazi, kusokonezeka kwa kulowetsedwa kwa intraventricular ndi QRS zovuta zotulutsidwa, kukomoka, kumangidwa kwamtima,

Machitidwe opatsirana: kupsinjika, mapapu, edema,

Matumbo: mseru, kusanza, kuchedwa kutulutsa chakudya m'mimba, kuchepa mphamvu ya matumbo.

Njira zamankhwala: kusungika kwamikodzo, oliguria kapena anuria, madzi osungira, hyponatremia.

Palibe mankhwala enieni. Zizindikiro zothandizira zimafunikira m'chipinda chothandizira kwambiri, kuwunika ntchito zamtima, kutentha kwa thupi, mawonekedwe a corneal, ntchito ya impso, komanso kukonza ma electrolyte. Ndikofunikira kudziwa kuchuluka kwa carbamazepine mu madzi a m'magazi kuti atsimikizire poizoni ndi wothandizirayu ndikuwunika kuchuluka kwa mankhwala osokoneza bongo, kupweteka kwa m'mimba, komanso kuyika kwa makala omwe adamulowetsa. Kutuluka mochulukirapo kwa m'matumbo kumatha kubweretsa kuchepetsedwa kwa masiku 2 ndi 3 komanso kuyambiranso kwa zizindikiro za kuledzera panthawi yakachira.

Kukakamizidwa diuresis, hemodialysis, ndi peritoneal dialysis sikuthandiza, komabe, dialysis imasonyezedwa kuphatikiza poizoni wamphamvu ndi kulephera kwa aimpso. Mwa ana, pakhoza kufunikira hematotransfusion.

Tulutsani mafomu ndi ma CD

Pa mapiritsi 10 mumtambo wokuluka kuchokera ku filimu ya polyvinyl chloride ndi zojambulazo za aluminium.

Matumba a chithuza 5 komanso malangizo ogwiritsira ntchito zachipatala m'boma komanso zilankhulo zaku Russia zimayikidwa pabokosi.

Mankhwala Okhala Pamalo a Pharmacy

Zina ndi dziko la mabungwewopanga

"Ntchito za Teva Poland Sp.z.o.o"

80 st. Mogilska, 31-546 Krakow, Poland

Tchulani dziko ndiolembetsera makadi olembetsera

"Teva Pharmaceutical Polska Sp.z.o.o", Poland

Dzinalo ndi dziko la bungwe lonyamula

"Ntchito za Teva Poland Sp.z.o.o", Poland

Adilesi ya bungwe lolandila madandaulo kuchokera kwa ogula pa mtundu wa zinthu (katundu) mdera la Republic of Kazakhstan:

LLP "ratiopharm Kazakhstan"

050000, Republic of Kazakhstan Almaty, Al-Farabi Avenue 19,

Kuchita

Cytochrome CYP3A4 ndiye puloteni yayikulu yomwe imapatsa kagayidwe ka carbamazepine. The munthawi yomweyo makonzedwe a carbamazepine ndi CYP3A4 zoletsa angapangitse kuwonjezeka ake ambiri plasma ndi chifukwa zovuta. Kugwiritsa ntchito kwa CYP3A4 inducers kungayambitse kuchuluka kwa kagayidwe ka carbamazepine, kuchepa kwa kuchuluka kwa carbamazepine mu plasma ndi kuchepa kwa njira yothandizira, m'malo mwake, kuthetseratu kwawo kungachepetse kuchuluka kwa carbamazepine ndikuwonjezera kuchuluka kwake.

Kuchuluka kwa plasma carbamazepine ndende: verapamil, diltiazem, felodipine, dextropropoxyphene, viloxazine, fluoxetine, fluvoxamine, cimetidine, acetazolamide, danazole, desipramine, nicotinamide (mu akulu, kokha muyezo waukulu, erenciny, eryromythryy, phylcinth, eryromy. azoles (itraconazole, ketoconazole, fluconazole), terfenadine, loratadine, isoniazid, propoxyphene, msuzi wa mphesa, ma virus a protease inhibitors ogwiritsidwa ntchito pochiza matenda a HIV (mwachitsanzo ritonavir) - kusintha kwa mankhwalawa kumafunikira kuyan'anila za woipa carbamazepine plasma.

Felbamate amachepetsa kuchuluka kwa carbamazepine mu plasma ndikuwonjezera kuchuluka kwa carbamazepine-10,11-epoxide, pamene kuchepa kwamtundu umodzi mu ndende ya magazi ya felbamate kumatha.

Mafuta a carbamazepine amachepetsedwa ndi phenobarbital, phenytoin, primidone, metsuximide, fensuximide, theophylline, rifampicin, cisplatin, doxorubicin, mwina: clonazepam, valpromide, valproic acid, oxcarbazepine ndi masamba omwe ali ndi Hypercum. Pali malipoti a kuthekera kosamutsidwa kwa carbamazepine ndi valproic acid ndi primidone chifukwa cha mapuloteni a plasma ndikuwonjezereka kwa kuchuluka kwa pharmacologically yogwira metabolite (carbamazepine-10,11-epoxide).

Isotretinoin amasintha bioavailability ndi / kapena chilolezo cha carbamazepine ndi carbamazepine-10,11-epoxide (plasma concentration ya carbamazepine ndikofunikira).

Carbamazepine imatha kuchepetsa plasma ndende (kuchepetsa kapena ngakhale kupangitsa kuti izi zisinthe) ndikufunika kusintha kwa mankhwalawa: Mankhwala okhala ndi estrogens ndi / kapena progesterone (kusankha njira zina zakulera ndikofunikira), theophylline, anticoagulants mkamwa (warfarin, fenprocoumone, dicumarol), lamotrigine, topiramate, tricyclic antidepressants (imipramine, amitriptyline, nortriptyline, clomipramine), clozapine, felbamate, tiagabin, oxcarbazepine, proteinase inhibitors ogwiritsidwa ntchito pochiza matenda a HIV (indinavir, ritonavir, saquinovir), BMK (gulu la diydropididone, diydropididone, diydropididone midazolam, olazapine, praziquantel, risperidone, tramadol, cyprasidone.

Pali malipoti akuti ngakhale mutatenga carbamazepine, kuchuluka kwa phenytoin mu plasma kungakulitse kapena kuchepa, ndipo mulingo wa mefenitoin ukhoza kuwonjezeka (nthawi zina).

Carbamazepine ikaphatikizidwa ndi paracetamol imawonjezera chiopsezo cha chiwopsezo chake pachiwindi ndikuchepetsa mphamvu yothandizira (imathandizira kagayidwe ka paracetamol).

Mao inhibitors amalimbikitsa chiopsezo cha vuto la hyperpyretic, kusokonekera kwa magazi, kugwidwa, kufa (asanaikidwe kwa carbamazepine, maohibilosi a MAO ayenera kuchotsedwa osachepera milungu iwiri kapena, ngati zochitika zamankhwala zimalola, ngakhale kwa nthawi yayitali).

Kugwirizana munthawi yomweyo ndi diuretics (hydrochlorothiazide, furosemide) kungayambitse hyponatremia, limodzi ndi mawonetsedwe azachipatala.

Imapatsirana zotsatira za kusapondaponda kwa minofu yopumula (pancuronium). Pankhani yogwiritsira ntchito kuphatikiza koteroko, pangafunikire kuwonjezera kuchuluka kwa omangika minofu, pomwe kuli kofunikira kuyang'anira odwala mosamala, popeza kutha kwawo kungachitike mwachangu).

Imathandizira kagayidwe ka anticoagulants osadziwika, mankhwala oletsa kubereka a mahomoni, folic acid, praziquantel, ndipo mwina amathandizira kuthetseratu mahomoni a chithokomiro.

Imathandizira kagayidwe kachakudya ka mankhwala a opaleshoni yayikulu (enflurane, halotane, fluorotan) ndi chiwopsezo chowonjezera cha hepatotoxic, kumathandizira mapangidwe a nephrotoxic metabolites a methoxyflurane.

Imawonjezera hepatotoxic mphamvu ya isoniazid.

Mankhwala a Myelotoxic amathandizira kuwonetsa kwa hematotoxicity ya mankhwalawa.

Pharmacodynamics ndi pharmacokinetics

Gawo logwira ntchito limatengedwa dibenzazepine. Mankhwala ali antimaniacal, Normotymic, antidiuretic (odwala ndi matenda ashuga), mankhwala opweteka (ndi neuralgia) zotsatira.

Mfundo pazotsatira za mankhwalawa zimakhazikitsidwa ndi njira zopangira mphamvu zamagetsi zamagetsi zomwe zimapangitsa kuti ma neuron azichotsa, kukhazikika kwa membrane wa neurons, komwe kumatsogolera kuchepa kwa synaptic conduction.

Mankhwala amaletsa kukonzanso kwa sodium amadalira zochita mu kapangidwe ka zotupa za depolarized.

Carbamazepine imabweretsa kuchepa kwa glutamate yotulutsa (neurotransmitter amino acid), yomwe imachepetsa chiopsezo cha kukula khunyu. Mu ana ndi achinyamata ndi khunyu mukumwa mankhwalawa, pali chikhalidwe chabwino chokhudzana ndi kuopsa kwa kupsinjika ndi nkhawa, komanso kupsa mtima, mkwiyo.

Zovuta zamayendedwe a psychomotor, ntchito zazidziwitso zimadalira mtundu mwanjira, zimasintha pamitundu iliyonse.

At trigeminal neuralgia (zofunikira, sekondale) pali kuchepa kwa pafupipafupi kwamankhwala opweteka.

At postherpetic neuralgiachifukwa cha zoopsa paresthesias, chingwe chowuma cha msana - Carbamazepine amathandiza kuthetsa ululu wa neurogenic.

At kusiya mowa Mankhwala amatha kuchepetsa kuopsa kwa main Symbomatology (kugwedezeka kwa malekezero, kuchuluka kukwiya, matenda a gait), kumawonjezera chidaliro chotsimikiza.

Odwala matenda ashuga mankhwalawa amachepetsa kumva kutentha, diuresis, kumabweretsa kubwezeretsa mwachangu madzi olondola.

Mphamvu ya antimaniacal (antipsychotic) yajambulidwa patatha masiku 7-10 kuchokera ku mankhwala, amakula chifukwa choletsa kagayidwe norepinephrine, dopamine.

Kugwiritsa ntchito mitundu yayitali ya carbamazepine kumakupatsani mwayi wokhazikika wokhazikika wamagazi, popanda kulembetsa "ziphuphu" ndi "nsonga".

Mapiritsi a Carbamazepine, malangizo ogwiritsira ntchito (njira ndi Mlingo)

Mankhwala amatengedwa pakamwa ndi madzi okwanira. Mapiritsi okhala ndi nthawi yayitali (Carbamazepine Retard) samatafuna, kumeza lonse, kawiri patsiku.

Ndi khunyu Mankhwala ndi zotheka monga monotherapy. Chithandizo tikulimbikitsidwa kuti muyambe ndi yaying'ono Mlingo wowonjezera pang'onopang'ono, womwe umalola kuti zitheke. Mlingo woyambirira wa akuluakulu ndi 100-200 mg 1-2 kawiri pa tsiku, pang'onopang'ono kuchuluka kwa mankhwalawa kumawonjezeka.

Trigeminal neuralgia: tsiku loyamba la mankhwala ndi 200-400 mg, ndikuwonjezeka pang'onopang'ono mpaka 400-800 mg patsiku, kenako mankhwala a carbamazepine amathetsedwa.

Mlingo woyambirira Ndi ululu matenda a neurogenic chiyambi ndi 100 mg kawiri tsiku lililonse, ndikuwonjezeka kwa mlingo uliwonse maola 12 mpaka kupumula kwawawa. Mlingo wokonza ndi 200-1200 mg patsiku, wopangidwira milingo ingapo.

Mlingo wapakati Ndi mowa woletsa matenda 200 mg katatu patsiku, mukudwala kwambiri, mlingo umakulitsidwa mpaka 400 mg katatu patsiku.

M'masiku oyambirawa, ndikofunikira kuti mupatsidwe mankhwala chlordiazepoxide, clketazole ndi zina zotsitsa.

At matenda ashuga Akuluakulu amayikidwa 200 mg katatu patsiku.

At matenda ashuga a m'mimba ndi ululu 200 mg ndi mankhwala 2-4 kawiri pa tsiku.

Kupewa machitidwe a psychizo ndi opindulitsa: 600 mg ya mankhwala Mlingo wa 3-4 patsiku.

Tsiku lililonse ndi kupuma, mavuto okhudzana, zovuta za manic imasiya 400-1600 mg.

Malangizo ogwiritsira ntchito Carbamazepine Acry ndi ofanana.

Carbamazepine ndi mowa

Mankhwalawa amagwiritsidwa ntchito pochiza matenda obwera kuchokera kumwa mowa. Zimasintha mkhalidwe wamunthu wamunthu.Komabe, chithandizo ichi chikuyenera kugwiritsidwa ntchito kuchipatala, ndipo sikulimbikitsidwa kugwiritsa ntchito mankhwalawa limodzi kuti mupewe kukondoweza kwambiri.

Ndemanga pa carbamazepine

Pali ndemanga zochepa pamabwalo azokhudza mankhwala omwe amagwiritsidwa ntchito ngati mankhwala. Kwenikweni, malingaliro amasiya za mphamvu ya mankhwalawa ngati mankhwala.

Mankhwala akamagwiritsidwa ntchito pothana ndi mavuto osiyanasiyana amisala komanso matenda amisala, malingaliro amafotokozedwa pazakuyenda bwino kwake poyerekeza ndi ma fanizo amakono, omwe nthawi yomweyo amakhala ndi zotsatirapo zochepa. Mankhwala a trigeminal neuralgia, akukhulupirira kuti mankhwalawa ndi osathandiza.

Komanso, chifukwa chogwiritsa ntchito mankhwalawa atha kukhala osowa tulo.

Ndemanga za acbamazepine acre ndi zofanana.

The zikuchokera mankhwala

Mapiritsi a Carbamazepine retard amapezeka ndi zinthu zosiyanasiyana zomwe zimagwira ntchito:

Zogwira pophika: 200 kapena 400 mg ya carbamazepine
Zowonjezera zina: carbomer, CMC, Aerosil, E 572, sodium CMC.

Mankhwala omwe amakhala ndi nthawi yayitali, amakwaniritsidwa ndi njira yapadera ya mankhwalawa: atatha kuyamwa, chinthu chogwira ntchito chimapezekanso nthawi yayitali kuposa masiku onse.

Mankhwala a 200 mg - mapiritsi oyera, oyera, oyera kapena amtengo wa beige mu mawonekedwe a cylinder. White inclusions ndizotheka, ndikupanga modabwitsa. Kapangidwe kameneka ndi kololedwa ndipo sikawoneka ngati chilema. Mankhwalawa amayikidwa m'mbale ya masentimita 10. Phukusi: 1/2/5 mbale, zophatikizira.

Mankhwala a 400 mg - ozungulira, okhala ndi mawonekedwe owoneka bwino a phale. Atadzaza mitsuko ya PET kwa 50 zidutswa. Mu bokosi - 1 chidebe, malangizo.

Kuchiritsa katundu

Mphamvu ya anticonvulsant ya mankhwalawa imatheka chifukwa cha carbamazepine, zotumphukira zamitundu itatu ya eminostilbene. Amakhulupirira kuti mphamvu ya anticonvulsant ya chinthu imadziwonetsera kudzera mwa makina amachepetsa zochitika za Na + njira. Zotsatira zowonekera, ma membala amitsempha ya neural amakhala okhazikika ndipo zikhumbo za synaptic zimachepetsedwa. Nthawi yomweyo, kutulutsidwa kwa glutamate amino acid kumachepa, mulingo wamtunda wosakhazikika umasinthika, womwe umachepetsa mwayi wokhala ndi khunyu. Pa anticonvulsant kwenikweni, njira yothandizira kupititsa patsogolo kwa K + ndikuwongolera njira zama calcium zimagwiranso ntchito.

Pakapita kanthawi wodwalayo atayamba kumwa carbamazepine, zimayamba kuchitika, zomwe zimathandizira kulumikizana ndi ena.

Mwa ana, mankhwalawa amachepetsa nkhawa, kuda nkhawa, kuchita nkhanza. Mphamvu ya kuthekera kwazindikiritso imawonekera kutengera mlingo womwe umagwiritsidwa ntchito.

Kukhazikika kwa anticonvulsant zotsatira kumasintha - kuchokera maora angapo kapena masiku atatha kutsatiridwa (mwa odwala ena, amatha kupanga patatha mwezi umodzi)

Pambuyo pakukonzekera pakamwa, thupilo limatha kutengeka kwathunthu kuchokera kumimba, ¾ ya mlingo womwe umagwirizana ndi mapuloteni a plasma.

Zimapukusidwa mu chiwindi ndikupanga michere yake. Kutha kwa theka-moyo kumatenga maola 12 mpaka 30. Amapakidwa makamaka ndi mkodzo (pafupifupi 70-75 peresenti), ena onse ndi ndowe.

Njira yogwiritsira ntchito

Ndikulimbikitsidwa kuti mutengere fodya wa carbamazepine, mogwirizana ndi malangizo ogwiritsira ntchito, pakudya kapena mutangomaliza kudya. Ngati wodwalayo ali ndi vuto la kumeza, ndiye kuti mapiritsiwo amaloledwa kuti amwe mu mawonekedwe osungunuka, popeza mphamvu ya nthawi yayitali imasungidwa.

Mlingo watsiku ndi tsiku umachokera ku 400 mpaka 1200 mg (mu milingo ingapo), kuchuluka kwake, koletsedwa kupitirira, ndi 1600 mg.

Khunyu

Mankhwala othandizira antiepileptic a nthawi yayitali amalimbikitsidwa kuti atenge msanga msanga ndi monocourse.Mlingo woyambira uyenera kukhala wocheperako, ndiye pambuyo pophunzira momwe thupi limapangidwira, utha kuwonjezereka mpaka pakufunika. Nthawi yonse yomwe muyenera kuwunika momwe ntchito ya plasma ilili.

Ngati mankhwala omwe akhala akuchita kwa nthawi yayitali atawonjezeredwa ku antiepileptic chithandizo chomwe chikuchitika kale, ndiye kuti izi zikuyenera kuchitika pang'onopang'ono, ndikuyambitsa pang'ono. Ngati pazifukwa zilizonse wodwala sakanatha kumwa mankhwalawa, ndiye kuti mapiritsi amatengedwa nthawi yoyamba pamlingo woyenera, ndizoletsedwa kumwa kawiri kapena katatu.

Akuluakulu: kumwa kwa mapiritsi a carbamazepine a 200 mg kuyambira pa 1 mpaka 2 pt, ndiye kuchuluka kwa mankhwalawa tsiku lililonse, ngati kuli kofunikira, kumitengo yapamwamba. Mankhwala okonza, amaloledwa kugwiritsa ntchito 800 mpaka 1200 mg mu Mlingo wa 1-2. Malangizo Othandizidwa: kuchuluka koyamba - tengani madzulo 200-300 mg, ndi maphunziro okonza - m'mawa - 200-600 mg, madzulo - kuchokera 400 mpaka 600 mg.
Ana ndi achinyamata (zaka 4 mpaka 15): poyamba - 200 mg / tsiku. Kenako onjezerani ndi 100 mg / tsiku. mpaka muyeso wofunidwa. Zochizira odwala a zaka 4-10 - tsiku lililonse 400 mpaka 600 mg, kwa ana okulirapo (zaka 11-15) - kuchokera 600 mpaka 1000 mg / tsiku.

Kutalika kwa kayendetsedwe ka thupi kumatengera zomwe zimachitika chifukwa cha thupi. Chisankho chofuna kusamutsa wodwala kuti akhale mankhwala ndi nthawi yayitali, nthawi ya maphunzirowo, ndi zina zina. Kufunika kochepetsa mlingo wa carbamazepine ndi dokotala. Lingaliro la kuthekera kuchotsedwa kwathunthu kwa mankhwala litha kuperekedwa ngati matendawa sadziwonetsa pakubadwa kwazaka zitatu zothandizira. Kuchiza kuyenera kusiyidwa pang'onopang'ono, zaka 1-2 zimaperekedwa kuti zithetse mlingo.

Trigeminal neuralgia, idiopathic glossopharyngeal nerve neuralgia

Kumayambiriro kwa mankhwalawa, 200 mpaka 400 mg ya mankhwalawa amatchulidwa muyezo waukulu. Mlingo wa carbamazepine ukhoza kuwonjezereka mpaka ululu ukadzazimiririka, mpaka 400-800 mg / tsiku. Mukakwaniritsa zochizira, zimatha kugwiritsa ntchito mlingo wochepetsetsa kuti mukhalebe ndi zotsatira zabwino - 400 mg tsiku lililonse. Kuchuluka kwa tsiku ndi tsiku ndi 1.2 g.

Odwala okalamba komanso odwala omwe ali ndi chidwi chogwira ntchito amapatsidwa 100 mg kawiri patsiku, kuwonjezera kwina kumatheka pokhapokha mosamala kwambiri mpaka ululu utasiya. Pafupifupi, muyenera kutenga 3-4 p. / Tsiku. 200 mg aliyense. Pambuyo pakutha kwa zizindikiro za matenda, kuchuluka kwa mankhwalawo kumachepetsedwa pang'ono kufika pamlingo wokonza mankhwalawo.

Momwe mungalembetse Carbamazepine Retard

Kuchotsera kwa utsogoleri kuyenera kuganizira za kuwonongeka kwa mankhwala omwe akhala akuchita kwa nthawi yayitali. Kuchoka mwadzidzidzi kumatha kuyambitsa matenda a khunyu, motero mlingo uyenera kuchepetsedwa pang'onopang'ono. Pankhani yosamutsa wodwala kuchokera ku mankhwalawa kupita ku mankhwala ena antiepileptic, pangafunike kutenga mankhwala ena kuti aletse zosafunikira.

Pa nthawi yoyembekezera komanso yoyamwitsa

Kugwiritsa ntchito carbamazepine pa nthawi yoyembekezera komanso mkaka wa m`mawere kumafuna chisamaliro chachikulu.

Kwa azimayi omwe ali ndi ntchito zoletsedwa, ndibwino kuti mugwiritse ntchito mankhwalawa monotherapy, chifukwa pamenepa chiopsezo cha anomalies ndi pathologies mwa mwana ndizotsika kwambiri pochita mankhwala ena ophatikizana ndi antiepileptic.

Ngati mayi ali ndi pakati pa nthawi ya carbamazepine, kapena ngati pakufunika kuigwiritsa ntchito nthawi yakhazikitsidwa, ndikofunikira kupenda maubwino omwe mungayembekezeredwe ndi chithandizo chamankhwala komanso zovuta zomwe zingayambitse kukulira kwa mluza / fetus. Izi ndizofunikira kwambiri ngati antiepileptic imagwiritsidwa ntchito m'miyezi itatu yoyambirira.

Mukamapereka mankhwala, muyenera kumwa mlingo wotsika kwambiri womwe umapereka chithandizo, ndikuwunikira nthawi zonse zomwe zimapangitsa kuti pakhale magazi.

Kulowerera kwa mankhwalawa panthawi ya gestation sikuyenera kukhala, chifukwa amadziwika kuti kukokomeza kwa matenda a zam'kati ndi owopsa kwa mayi ndi mwana wake wosabadwa. Kuli kwodziwika kale kuti mwa ana omwe amayi awo ali ndi khunyu, zovuta za chitukuko cha intrauterine zimachitika kawirikawiri. Nthawi yomweyo, pamakhala zokayikitsa kuti carbamazepine imatha kupangitsa kukhazikika kwa ma pathologies, popeza milandu ya kubadwa kwa ana omwe ali ndi kobadwa nako spina bifida ndi mafupa am'mitsempha yamitsempha, zovuta za craniofacial, zonyansa za penis, zovuta zamtima ndi zovuta zina zinajambulidwa. Ngakhale ubale pakati pa momwe mankhwalawa amachitikira komanso izi sizinatsimikiziridwebe, mwayi wakukula kwawo sungathetsedwe.

Amayi akuyenera kudziwitsidwa za zovuta za kubereka, ndikuzindikira pafupipafupi.

Monga mankhwala aliwonse a antiepileptic, carbamazepine imatha kuonjezera kudya kwa folic acid mthupi, yomwe imatha kukulitsa vuto la kubadwa kwa ana. Chifukwa chake, pakubala, pakufunika zina zowonjezera za vitamini.

Ngati mayi woyembekezera atenga mankhwalawo m'magawo omaliza (makamaka masabata apitawa), ndiye kuti mwana wakhanda angafunike njira ya vitamini K1 kuti achepetse kulimba kwa matenda omwe angakhalepo. Pathology imawonetsedwa ndi kupweteka, kupuma movutikira, matenda ammimba, kusowa kudya.

Kuchepetsa

Carbamazepine amatha kumuwotcha mkaka, chifukwa chake popereka mankhwala ndikofunikira kuti mupende bwino za chithandizo chamankhwala ndi chiwopsezo chotheka kwa mwana. Pa mankhwala, mkaka wa mkaka uyenera kutayidwa. Ngati adotolo adaganiza kuti palibe chifukwa chokanira HB, ndiye kuti khanda liyenera kuyang'aniridwa nthawi zonse kuti athe kuzindikira ndikuchotsa zoyipa za Carbamazepine pakapita nthawi.

Kuchita mankhwala osokoneza bongo

Kugwiritsa ntchito carbamazepine Retard kuyenera kuchitika poganizira zovuta zomwe zimachitika chifukwa cha ntchito ya mankhwala ndi mankhwala ena.

Kusintha kwa metabolism kwa carbamazepine kumachitika ndi kutenga nawo gawo la cytochrome CYP3A4. Pankhani yophatikiza ndi mankhwala omwe amalepheretsa dongosolo la ma enzymes awa, kuchuluka kwa antiepileptic mu plasma kumawonjezera, komwe kumathandizira osati kungowonjezera zithandizo zamankhwala, komanso mavuto. Munthawi yomweyo makonzedwe ndi inducers amathandizira imathandizira kagayidwe kachakudya ndi kuchepetsa zake plasma ndi kuchepetsa achire zotsatira.
Kuchuluka kwa carbazepine mthupi kumawonjezeka mchikakamizo cha verapamil, felodipine, fluoxetine, trazodone, cimetidine, acetazolamide, macrolides, cirofloxacin, amales, stiripentol, terfenadine, isoniazid, oxybutynin, ticlopidine, ritonavir ndi ena. Chifukwa chake, ndi munthawi yomweyo, kuwongolera kwa muyezo wa mankhwalawa kumafunika malinga ndi kuwerenga kwa zinthu zomwe zili mthupi.
Mlingo wa ndende ya carbazepine amachepetsa akaphatikizidwa ndi felbamate, ndipo zomwe mankhwala omaliza aponso amatha kusintha.
Loxapine, primidone, valproic acid ndi zotumphukira zake, pamene zimatengedwa pamodzi ndi carbamazene, zimatha kuwonjezera zomwe zili.
Carbamazepine imatha kuchoka ku plasma ndi valproic acid ndi primidone, motero imawonjezera zomwe zili metabolite. Ikaphatikizidwa ndi valproic acid, ziyenera kukumbukiridwa kuti kuphatikiza koteroko kumatha kuyambitsa kukhumudwa komanso kusokonezeka kwa chikumbumtima.
Carbamazepine imatha kuchepetsa kuchuluka kwa plasma ya clobazam, digoxin, primidone, glucocorticosteroids, cyclosporine, tetracyclines, mankhwala a mahomoni okhala ndi estrogen kapena progesterone, theophylline, anticoagulants pakamwa, TCAs, bupropion, sertraline, felbamate, occlazepinepineepineazine ndi mankhwala ena ambiri.Chithandizo chilichonse cha mankhwalawa chiyenera kuyang'aniridwa kuti chikugwirizana ndi carbamazepine, ndipo mulingo wa aliyense waiwo uyenera kusinthidwa potengera zotsatira zake.
Kuphatikiza kwa carbamazepine ndi phenytoin, munthu ayenera kuganizira mphamvu zomwe zingagwiritsidwe ntchito pochiritsa, komanso kukwera kwa mulingo wa mefenitoin.
Kuphatikizika kwa mankhwalawa ndi mankhwala okhala ndi lithiamu kapena metoclopramide kungapangitse kuti awononge thupi.
Mphamvu ya carbamazepine imafooketsedwa ndi maphunziro olumikizana ndi mankhwala a tetracycline.
Pa chithandizo, kusamala kuyenera kugwiritsidwa ntchito ngati paracetamol ikugwiritsidwa ntchito, popeza mphamvu yake pochita chiwindi imakonzedwa ndipo zotsatira zochizira zimachepa (chifukwa cha kuthamanga kwa njira za metabolic).
Carbamazepine imathandizira kuponderezedwa kwapakati pa NS ya phenothiazine, thioxanthene, haloperidol, clozapine, TCA, koma imafooka ndi kuphatikiza uku.
IMAO imatha kuwonjezera chiwopsezo cha zovuta za hyperpyretic ndi matenda oopsa, syndromes zopatsa mphamvu, imfa. Kupewa njira zakupha, pakati pa carbamazepine ndi Mao, nthawi yochepera milungu iwiri iyenera kusungidwa.
Kuphatikizika kwa antiepileptic mankhwala okhala ndi okodzetsa kumatha kupangitsa hyponatremia.
Carbamazepine imafooketsa mphamvu yothandizira odwala yopumitsa minofu, motero, kungakhale kofunikira kuti muwonjezere kuchuluka kwake pakuwonetsetsa kupezeka kwawo mu plasma.
Nthawi zina, mukaphatikiza antiepileptic ndi levetircetam, poizoni wa mankhwala otsiriza akhoza kuchuluka.
Carbamazepine amatha kuchepetsa kulolera kwa mowa wa ethyl.
Mankhwala a Myelotoxic amachititsa kuti mankhwalawo akhale amtundu wa mankhwalawo.
Antiepileptic imathandizira kusintha kwa metabolic kwa anticoagulants osadziwika, kulera kwa mahomoni, folic acid, komanso praziquantel, mankhwala oletsa kupweteka komanso kuthetsa mahomoni a chithokomiro. Imalimbikitsa chiwopsezo cha isoniazid pachiwindi.

Zotsatira zoyipa ndi bongo

Zochitika zina zoyipa za thupi (makamaka kuchokera ku dongosolo lamkati lamkati, khungu ndi m'mimba) zimawonetsedwa nthawi zambiri kumayambiriro kwa maphunziro, atagwiritsidwa ntchito Mlingo waukulu kapena odwala okalamba.

Zotsatira zokhudzana ndi Mlingo zimawonongeka pazokha kapena pambuyo pake. Zizindikiro za kusokonezeka kwapakati kwa NS zimatha kuchitika chifukwa cha kuledzera pang'ono kapena chifukwa cha kusiyana m'magulu a kuchuluka kwa mankhwala m'magazi. Pankhaniyi, muyenera kuyang'anitsitsa zomwe zikuwonetsedwa ndizomwe zimapangitsa kuti mankhwalawa asayambike.

Pa mankhwala, zotsatira zoyipa za carbamazepine ndi:

Kumbali yamitsempha yamagazi: leukopenia, leukocytosis, mapangidwe amitsempha ochepa, kusintha kwa eosinophilia, kuperewera kwa folic acid, kuchuluka kwapadera kwama cell am'magazi, erythrocyte aplasia, mitundu yosiyanasiyana ya magazi (aplastic / megoblastic / hemolytic, etc.), porphyria, dysphyssa, patphyria. msana.
Chitetezo chokwanira: totupa, vasculitis, arthralgia, aseptic meningitis, anaphylaxis, edema ya Quincke.
Endocrine dongosolo ndi kagayidwe: edema, kuchuluka kwa madzimadzi, kuchuluka kwa thupi, kuchepa mphamvu kwa thupi (kuchepa mphamvu, kupweteka kwa mutu, chizungulire, mitsempha), hyperprolactinemia kapena kapena galactorrhea, vuto la chithokomiro, mafupa, cholesterol yayikulu.
Malingaliro: kuyerekezera zinthu (masomphenya, "mawu"), kukhumudwa, kuchepa kapena kusowa kwa chakudya, nkhawa zochulukirapo, kupsa mtima, kukwiya, chisokonezo, kuchulukitsa kwa ma psychoses omwe alipo.
NS: sedation, kunjenjemera, dystonia, ma tics, kusokonezeka kwa masinthidwe a mucular, zida zamagetsi, zotumphukira za m'mimba, kuwonongeka kwa chidwi, kufooka kwa minofu, zomverera zolakwika, CNS, kusokonezeka kukumbukira.
Masomphenya, kumva: kusokonezeka kwa malo okhala, kuchuluka kwa hepatitis B, kuthina kwa mandala, tinnitus / tinnitus, hypo- kapena hyperacusia.
Matenda a mtima ndi mitsempha ya mtima: matenda amtundu wa mtima, matenda oopsa a m'magazi, bradycardia, vuto la mtima, kuchepa kwa matenda a mtima, thrombophlebitis, pulmonary embolism.
Kuyankha: Thupi lawo limatulutsa m'mapapu (kutentha thupi, chibayo, chibayo, ndi zina zambiri).
Ziwalo zogaya: mkamwa youma, kudzimbidwa / kutsekula m'mimba, kupweteka, kapamba, kutupa kwa lilime.
Chiwindi: kusintha kwa ntchito ndi kuchuluka kwa michere, kulephera kwa chiwindi.
Dermis ndi s / c fiber: dermatitis, urticaria (kwambiri mawonekedwe), SLE, kuyabwa, Stevens-Johnson syndromes, Lyell, photosensitivity, erythema (polyform, knobby), vuto la pigmentation, ziphuphu, tidura, thukuta lalikulu, tsitsi lamtundu wamwamuna kutaya tsitsi.
Musculoskeletal system: kupweteka kwa kuphatikizika, kupweteka kwa minofu, kupsinjika, kuthana ndi magwiridwe.
Genitourinary dongosolo: aimpso kukanika, nephritis, kuchuluka kukodza, kukodza pokodza, kusabala, spermatogeneis.
Zizindikiro zina: kutopa, kukonzanso kwa mtundu wa 6 herperovirus.

Carbamazepine imatha kusokoneza luso lanu lozama komanso kusankha zinthu mwachangu. Chifukwa chake, panthawi yogwiritsira ntchito, kusamala kowonjezereka kumafunikira poyendetsa magalimoto kapena kuchita zochitika zamtundu uliwonse zomwe zimawopseza thanzi kapena moyo wa wodwalayo.

Intoxication imawonetsedwa ndi kupuma, hyperreflexia, ndikutsatira kusintha kwa hyporeflexia, kutsika kwa kutentha, kusokonezeka kwa m'mimba thirakiti, komanso zovuta zoyipa.

Popeza palibe mankhwala enieni a carbamazepine, mankhwala osokoneza bongo amachotsedwa ndikutsuka m'mimba, kumwa ma sorbets, ndi chithandizo chamankhwala.

Wodwala amayenera kuyang'aniridwa nthawi zonse mpaka zizindikilo za kuledzera zithe. Ngati ndi kotheka, ana amapatsidwa magazi.

Carbamazepine analogues ndi masanjidwe ayenera kusankhidwa kokha ndi katswiri.

Dzuwa Pharma (India)

Mtengo: pitilizani. tabu. 200 mg (30 ma PC.) - ma ruble 81., 400 mg (30 ma PC.) - ma ruble 105.

Mankhwala osokoneza bongo mwachizolowezi kapena nthawi yayitali. Achire zotsatira za mankhwalawa zimatheka chifukwa cha carbamazepine. Zizindikiro zakugwiritsa ntchito ndi mawonekedwe ake ogwiritsira ntchito - malinga ndi zomwe zikuwonetsedwa.

Pharmacokinetics

Mafuta amayamba pang'onopang'ono koma amphumphu (kudya sikumakhudza kwambiri kuchuluka ndi mayamwidwe). Pakadutsa kamodzi piritsi limodzi, Stax imafikiridwa pambuyo pa maola 12. Palibe kusiyana kwakukulu pakumwedwa kwa chinthu pambuyo poti mugwiritsidwa ntchito mitundu yosiyanasiyana ya mankhwalawa pakumwa pakamwa (bioavailability mukamamwa mapiritsi okhala ndi 15% kutsika poyerekeza ndi kumwa mitundu yina ya mankhwalawa). Pambuyo pakamwa limodzi lokha 400 mg ya carbamazepine, 72% ya mankhwalawo amatengedwa mu mkodzo ndi 28% ndi ndowe. Pafupifupi 2% ya mankhwalawa amatengedwa mumkodzo ngati carbamazepine osasinthika, pafupifupi 1% - monga metabolite ya 10,11-epoxy. Mu ana, chifukwa cha kuchotsedwa msanga kwa carbamazepine, kugwiritsa ntchito mankhwalawa okwanira pa kilogalamu iliyonse ya kulemera kwa thupi kungafunike, poyerekeza ndi akulu. Palibe umboni kuti pharmacokinetics of carbamazepine kusintha kwa odwala okalamba (poyerekeza ndi achikulire achinyamata). Zambiri pa pharmacokinetics za carbamazepine mwa odwala omwe ali ndi vuto la impso kapena kwa chiwindi sizikupezeka.

Mimba komanso kuyamwa

Amayi oyembekezera omwe ali ndi khunyu amayenera kuthandizidwa mosamala kwambiri.

Ngati mayi yemwe akutenga carbamazepine ali ndi pakati kapena akukonzekera kutenga pakati, kapena ngati pakufunika kuyamba kugwiritsa ntchito carbamazepine pa nthawi yomwe ali ndi pakati, phindu lomwe lingapezeke ndi mankhwalawa liyenera kuwunikiridwa bwino poyerekeza ndi zomwe zingachitike pachiwopsezo, makamaka miyezi itatu yoyambirira ya pakati. Mlingo wothandiza wocheperako uyenera kufotokozedwa ndikuwunika milingo ya plasma.

Pa nthawi yoyembekezera, mankhwala othandizira antiepileptic sayenera kuimitsidwa, popeza kuchuluka kwa matendawa kumakhudza kwambiri mayi ndi mwana wosabadwayo.

Gwiritsani ntchito ndi amayi oyamwitsa

Carbamazepine amachotseredwa mkaka wa m'mawere (pafupifupi 25 - 60% ya ndende ya plasma). Ubwino wa kuyamwitsa uyenera kuwunikiridwa motsutsana ndi mwayi wachedwa zochitika zoyipa makanda. Amayi omwe amamwa carbamazepine amatha kuyamwitsa ngati amayang'aniridwa bwino kuti ana azitha kuzindikira zovuta zomwe zimachitika (mwachitsanzo, kugona kwambiri, khungu lawo siligwirizana).

Zotsatira zoyipa

Mlingo wothandizidwa ndi Mlingo umasowa patangopita masiku ochepa, zonse munthawi yomweyo ndipo pambuyo pochepetsedwa kwakanthawi mlingo wa mankhwala.

Kuchokera kumbali ya dongosolo lamkati lamanjenje: pafupipafupi - chizungulire, kuuma, kugona, kufooka, nthawi zambiri - kupweteka mutu, malo okhala, nthawi zina - kusunthika kwina kosafunikira (mwachitsanzo, kunjenjemera, "kusuntha" - kugwedezeka kwa madzi, thumbo, ma tyson, tst), nystagmus, kawirikawiri, dyskinesia wa orofacial, kusokonezeka kwa oculomotor, kusokonezeka kwa mawu (mwachitsanzo, dysarthria kapena mawu osakhazikika), zovuta za choreoathetoid, zotumphukira za neuritis, paresthesias, kufooka kwa minofu ndi zizindikiro za paresis.

Kuchokera pagawo lamalingaliro: kawirikawiri - kuyerekezera zinthu pang'ono (zowoneka kapena zowerengera), kukhumudwa, ndiwotsikakulakalaka, kuda nkhawa, kukhala wakhama, kukwiya, kusokonezeka, kawirikawiri - kuyambitsa kwa psychosis.

Thupi lawo siligwirizana: Nthawi zambiri - urticaria, nthawi zina - erythroderma, kawirikawiri - lupus-ngati matenda, kuyabwa kwa khungu, kawirikawiri - multiforme exudative erythema (kuphatikizapo Stevens-Johnson syndrome), poyizoni epermermal necrolysis (Lyell syndrome), photosensitivity. Pafupipafupi, mafupa ambiri amachedwa-mtundu wa hypersensitivity zimachitika ndi kutentha, zotupa za pakhungu, vasculitis (kuphatikizapo erythema nodosum, monga mawonekedwe a khungu vasculitis), lymphadenopathy, zizindikiro zofanana ndi zamitsempha, arthralgia, leukopenia, eosinophilia, hepatosplenomegaly, ndi hepatosplenomegaly, ndi hepatosplenomegaly. mawonetseredwe amapezeka mumitundu yosiyanasiyana). Ziwalo zina (mwachitsanzo, mapapu, impso, kapamba, myocardium, colon) zitha kutenga nawo mbali. Osowa kwambiri - aseptic meningitis ndi myoclonus ndi zotumphukira eosinophilia, anaphylactoid anachita, angioedema, chifuwa chachikulu cha pneumonitis kapena eosinophilic chibayo. Ngati zotupa zakumwambazi zikuchitika, kugwiritsa ntchito mankhwalawa kuyenera kusiyiratu.

Kuchokera pamimba yogaya chakudya: pafupipafupi - nseru, kusanza, kawirikawiri - mkamwa wowuma, nthawi zina - kutsegula m'mimba kapena kudzimbidwa, kupweteka kwam'mimba, kawirikawiri - glossitis, stomatitis, kapamba. Kuchokera ku chiwindi: pafupipafupi - kuwonjezeka kwa ntchito ya gamma-glutamyl transferase (chifukwa cha kuphatikizika kwa puloteniyi mu chiwindi), yomwe nthawi zambiri imakhala yopanda tanthauzo la matenda, nthawi zambiri - kuwonjezeka kwa ntchito ya transpase ya hepaline, kawirikawiri - chiwopsezo cha hepatitis, parenchymal hepatocellular) kapena mtundu wosakanikirana, jaundice, osowa kwambiri - granulomatous hepatitis, chiwindi.

Kuchokera ku CCC: kawirikawiri - kusokonezeka kwa mtima kuchepa kwa magazi, kuchepa kapena kuwonjezeka kwa magazi, kawirikawiri - bradycardia, arrhythmias, AV block ndi kukomoka, kugwa, kuwonjezeka kapena kukulitsa kwa mtima wodwala, kuchepa kwa matenda a mtima (kuphatikiza mawonekedwe kapena kuwonjezeka kwa matenda a angina) , thrombophlebitis, thromboembolic syndrome.

Kuchokera ku endocrine dongosolo ndi kagayidwe: kawirikawiri - edema, kusungunuka kwamadzi, kunenepa kwambiri, hyponatremia (kuchepa kwa osmolarity wa plasma chifukwa cha zotsatira zofanana ndi ADH, zomwe nthawi zambiri zimayambitsa kuchepetsedwa kwa hyponatremia, limodzi ndi kupunduka, kusanza, kupweteka mutu, kusokonezeka ndi zovuta zamitsempha), kawirikawiri - kuwonjezeka kwa milingo ya prolactin (ikhoza kutsagana ndi galactorrhea ndi gynecomastia), kuchepa kwa L-thyroxine (T4 yaulere, T4, TK) komanso kuchuluka kwa TSH (nthawi zambiri sikuyenda nawo) Ine mawonetseredwe matenda), zipolowe kashiamu ndi phosphorous kagayidwe mu minofu fupa (kuchepetsa mu ndende ya Ca2 + 25-o-cholecalciferol mu madzi a m'magazi): osteomalacia, kuchuluka kwa mafuta m'thupi (kuphatikizapo HDL mafuta) ndi hypertriglyceridemia.

Kuchokera ku genitourinary system: kawirikawiri - interstitial nephritis, kulephera kwa impso, kusokonezeka kwa impso (mwachitsanzo, albuminuria, hematuria, oliguria, kuchuluka kwa urea / azotemia), kuchuluka kukodza, kusungika kwamikodzo, kuchepa potency. Kuchokera ku minculoskeletal system: kawirikawiri - arthralgia, myalgia kapena kukokana. Kuchokera kumalingaliro am'maganizo: kawirikawiri - kusokonezeka kwa kulawa, kuyendetsa ma mandala, conjunctivitis, kuvulala kwamakutu, kuphatikiza tinnitus, hyperacusia, hypoacusia, amasintha kuzindikira kwa phula.

Zina: zovuta za pakhungu la khungu, purpura, ziphuphu, thukuta, alopecia.

Zolemba ntchito

Age mpaka zaka 5: kugwiritsa ntchito mankhwala a Carbamazepine-200-Maxpharma Retard osavomerezeka.

Kukopa pa kuyendetsa galimoto ndikugwira ntchito ndi njira zoyenda

Munthawi yamankhwala, ndikofunikira kupewa kuchita nawo zinthu zoopsa zomwe zimafuna kuti anthu azisamalira komanso azithamanga kwambiri.

Njira zopewera kupewa ngozi

Carbamazepine ali ndi anticholinergic ofooka; akaperekedwa kwa odwala omwe ali ndi vuto la intraocular, ayenera kusungidwa nthawi zonse.ndith ulamuliro. Kuthekera kwa kutsegula kwama psychoses koyenera kuyenera kukumbukiridwa, ndipo odwala okalamba, mwayi wokhala ndi chisokonezo kapena kukondwerera. Mpaka pano, pakhala pali malipoti osiyana abwinobwino a chonde cha abambo ndi / kapena vuto la spermatogenesis (ubale wa mavuto awa ndi carbamazepine sunakhazikitsidwe). Pali malipoti okhetsa magazi kwa azimayi pakati pa nthawi ya kusamba kwa amuna pamene milandu ya pakamwa imagwiritsidwa ntchito nthawi yomweyo. Carbamazepine ikhoza kusokoneza kudalirika kwa njira zakulera zam'mlomo, chifukwa chake amayi omwe ali ndi zaka zobereka ayenera kupatsidwa njira zina zolerera pakumwa. Carbamazepine iyenera kugwiritsidwa ntchito moyang'aniridwa ndi achipatala.

Ndikulimbikitsidwa kukana kugwiritsa ntchito Mowa.

Agranulocytosis ndi aplasic anemia amagwirizanitsidwa ndi carbamazepine, komabe, chifukwa chotsika kwambiri pamikhalidwe iyi, ndizovuta kudziwa kuchuluka kwa chiwopsezo cha carbamazepine. Chiwopsezo chonse cha anthu osaphunzitsidwa chimawerengera anthu 4.7 miliyoni miliyoni pachaka chifukwa cha agranulocytosis ndi anthu 2.0 miliyoni pachaka chifukwa cha kuchepa magazi m'thupi.

Fomu yotalikirapo imatha kutengedwa kamodzi, usiku.

Monotherapy ya khunyu imayamba ndi kukhazikitsidwa kwa Mlingo wocheperako, womwewo umawonjezera iwo kuti akwaniritse zofunikira zochizira.

Kutha kwadzidzidzi kwa carbamazepine kungayambitse kugwidwa. Ngati kuli kofunika kusokoneza mwadzidzidzi chithandizo, wodwalayo ayenera kusinthidwa kupita ku mankhwala ena antiepileptic motsogozedwa ndi mankhwala omwe akusonyezedwa milandu yotere (mwachitsanzo, diazepam kutumikiridwa kudzera mu minyewa kapena rectally, kapena phenytoin kutumikiridwa kudzera m`mitsempha. Pali milandu ingapo ya kusanza, kutsekula m'mimba ndi / kapena kuchepa kwa chakudya, kukomoka ndi / kapena kupsinjika kwa ana akhanda omwe amayi awo adatenga carbamazepine molumikizana ndi anticonvulsants ena (mwina zoterezi ndi mawonetseredwe achibwana).

Carbamazepine iyenera kuchotsedwa yomweyo ngati mawonekedwe a hypersensitivity kapena zizindikiro zikuwoneka, zomwe zikusonyeza kuti chitukuko cha matenda a Stevens-Johnson kapena Lyell's. Kutulutsa kofatsa kwa khungu (macularopacular exanthema) kapena ochepa kwambiri nthawi zambiri kumatha patatha masiku angapo kapena milungu ingapo, ngakhale ndi kupitiliza mankhwala kapena pambuyo pakuchepetsa mlingo (wodwalayo ayenera kuyang'aniridwa ndi adokotala panthawiyi).

Pankhani ya zovuta zosagwira monga kutentha thupi, zilonda zam'mimba, zotupa, zilonda zamkamwa, zotupa zopanda pake, zotupa m'matumbo a petechiae kapena purpura, ndikofunikira kufunsa dokotala nthawi yomweyo.

Musanayambe chithandizo, komanso nthawi ndi nthawi munkachitika chithandizo, kuyezetsa magazi kwa kachipatala kuyenera kuchitidwa, kuphatikizapo kuwerengera kuchuluka kwa ma cell ndi mwina reticulocytes, komanso kudziwa mulingo wachitsulo mu seramu yamagazi. Asymptomatic leukopenia yopanda patsogolo sikufunikira kuchoka, komabe, chithandizo chikuyenera kutha ngati leukopenia kapena leukopenia wapita patsogolo, limodzi ndi zizindikiro zamatenda a matenda opatsirana. Musanayambe chithandizo, ndikofunikira kuti mupange mayeso a ophthalmological, kuphatikiza kuyang'ana kwa fundus ndi nyali yoyenda ndi muyeso wa kukakamiza kwa intraocular ngati kuli kotheka. Pankhani yoika mankhwalawa kwa odwala omwe ali ndi kukhudzika kwa intraocular, kuyang'anira chizindikirocho kumafunikira. Zatsimikiziridwa kuti HLA-B * 1502 allele mwa anthu ochokera ku China ndi Thai amalumikizidwa ndi chiopsezo cha Stevens-Johnson syndrome (SJS) pa chithandizo cha carbamazepine. Pomwe zingatheke, odwala otere ayenera kufufuzidwa kuti apeze njira iyi yodalira musanalandire chithandizo ndi carbamazepine. Pankhani yotsatira yoyesedwa, kugwiritsa ntchito carbamazepine sikuyenera kuyamba, pokhapokha ngati palibe njira ina yothandizira. Odwala omwe amawonedwa ngati alibe chifukwa cha kukhalapo kwa HLA-B * 1502, chiopsezo chotenga matenda a Stevens-Johnson ndi chochepa kwambiri, ngakhale izi zimachitika kawirikawiri, koma zimatha kuyamba. Chifukwa chosowa deta, sizikudziwika ngati anthu onse ochokera ku Southeast Asia ali pachiwopsezo chotere. Zawonetsedwa kuti alumali ya HLA-B * 1502 siyimayenderana ndi Stevens-Johnson syndrome pamagulu oyera azithamanga. The HLA-B * 1502 alile sichikulosera chiopsezo chosakhudzana kwambiri chokhudza khungu la carbamazepine, monga hypersensitivity syndrome kwa anticonvulsants kapena totupa yoopsa (maculopapular zidzolo).

Mankhwala

Mankhwala
Mankhwala antiepileptic, dibenzazepine zotumphukira. Pamodzi ndi antiepileptic, mankhwalawa amakhalanso ndi neurotropic komanso psychotropic.

Njira yochitira carbamazepine mpaka pano yakhala ikufotokoza pang'onopang'ono. Carbamazepine imakhazikitsa zimitsempha za overexcited neurons, imachepetsa kutsitsa kwa ma neuron ndikuchepetsa kupatsirana kwa ma transaptor osangalatsa.Mwinanso, njira yayikulu yogwirira ntchito ya carbamazepine ndikupewa kuyambiranso kwa zinthu zomwe zimadalira mphamvu ya sodium mu ma neuroni ofooka chifukwa cha kutsekeka kwa njira zotseguka zamagetsi zamagetsi.

Ikagwiritsidwa ntchito ngati monotherapy kwa odwala omwe ali ndi khunyu (makamaka ana ndi achinyamata), zotsatira zamankhwala zimadziwika, zomwe zimaphatikizira zabwino pazizindikiro za nkhawa komanso kukhumudwa, komanso kuchepa kwa kusakwiya komanso kukwiya. Palibe chidziwitso chosagwirizana ndi mphamvu ya mankhwalawa pazinthu zokhudzana ndi kuzindikira: mu maphunziro ena, zotsatira zowonjezera kawiri kapena zoyipa, zomwe zimatengera mlingo wa mankhwalawa; m'maphunziro ena, zotsatira zabwino za mankhwalawa ndikuwonetsetsa.

Monga wothandizira neurotropic, mankhwalawa amagwira ntchito mu matenda angapo amitsempha. Chifukwa chake, mwachitsanzo, ndi idiopathic ndi yachiwiri ya trigeminal neuralgia, amalepheretsa kuwonekera kwa kupweteka kwa paroxysmal.

Pankhani ya kusiya mowa, mankhwalawa amakweza poyambira kukonzekera, komwe nthawi zambiri amachepetsa, komanso amachepetsa kuuma kwamatenda akuwonekera kwa matenda, monga kuwonjezereka kwa mkwiyo, kunjenjemera, ndi vuto la gait.

Odwala odwala matenda a shuga insipidus, mankhwalawa amachepetsa diuresis ndi ludzu.

Monga psychotropic wothandizila, mankhwalawa amagwira ntchito pamavuto othandizira, monga, mankhwalawa pachimake manic, ndimathandizo othandizira matenda amtundu wa bipolar (manic-depression) (onse monga monotherapy komanso kuphatikiza antipsychotic, antidepressants kapena lithiamu). kuukira kwa schizoaffective psychosis, ndimisala, kumene imagwiritsidwa ntchito limodzi ndi ma antipsychotic, komanso psychic-depression psychosis yokhala ndi mayendedwe othamanga.

Kuthekera kwa mankhwalawa kupondera mawonetsero a manic mwina chifukwa choletsa kusinthana kwa dopamine ndi norepinephrine.

Pharmacokinetics
Mafuta
Pambuyo pakukonzekera pakamwa, carbamazepine imatengedwa pafupifupi kwathunthu, kuyamwa kumachitika pang'onopang'ono (kudya zakudya sikumakhudza kwambiri kuchuluka ndi mayamwidwe). Pambuyo pakukonzekera kwamlomo (kamodzi kapena mobwerezabwereza) mapiritsi olimbikitsidwa otulutsa, kuchuluka kwa plasma ndende (C_max) imatheka mkati mwa maola 24, mtengo wake umakhala wofanana ndi 25% poyerekeza ndi piritsi lokhazikika. Mukamamwa mapiritsi a nthawi yayitali, kusinthasintha kwa kuchuluka kwa carbamazepine mu plasma kumakhala kocheperako, pomwe palibe kuchepa kwakukulu kwa kuchuluka kwa ndende yolingana. Mukamamwa mankhwalawa monga mapiritsi osinthika kawiri patsiku, kusinthasintha komwe kumachitika chifukwa cha mphamvu ya m'magazi kumachepa kwambiri.

The bioavailability wa yogwira mankhwala kuchokera mapiritsi okhazikika kumasulidwa ndi pafupifupi 15% kutsika kuposa mitundu ina yamkamwa ya carbamazepine.

Kufanana kwa plasma kwa carbamazepine kumatheka pambuyo pa masabata 1-2. Nthawi ya kukwaniritsidwa kwake ndi payekhapayekha ndipo zimatengera kuchuluka kwa kuphatikiza kwa chiwindi cha encyme kudzera mu carbamazepine, kupatsidwa kwa hetero-mankhwala ena omwe amagwiritsidwa ntchito munthawi yomweyo, komanso momwe wodwalayo alili poika mankhwala, kuchuluka kwa mankhwalawa komanso nthawi yayitali. Kusiyanitsa kofanana pakati pamakhalidwe azofanana pamalingaliro azithandizo zimayang'aniridwa: mwa odwala ambiri, izi zimayambira ku 4 mpaka 12 μg / ml (17-50 μmol / l).

Kugawa
Kumangiriza kwa mapuloteni a plasma mwa ana - 55-59%, mwa akulu - 70-80%. Kuchulukitsa komwe kukuwoneka ndikugawa ndi 0.8-1.9 l / kg. Kuzindikira kumapangidwa mu madzi am'magazi ndi malovu, omwe ali olingana ndi kuchuluka kwa zinthu zomwe sizimagwira ndi mapuloteni (20-30%).Imalowa mkati mwa chotchinga chachikulu. Kulowerera mkaka wa m'mawere ndi 25-60% ya plasma.

Popeza kuyamwa kwathunthu kwa carbamazepine, voliyumu yowoneka ndi 0,8-1.9 l / kg.

Kupenda
Carbamazepine imapukusidwa mu chiwindi. Njira yayikulu ya biotransfform ndi njira ya epoxydiol, chifukwa chomwe ma metabolites apangidwira amapangidwa: kutuluka kwa 10.11-transdiol ndikugwirizana kwake ndi glucuronic acid. Kusintha kwa carbamazepine-10,11-epoxide kukhala carbamazepine-10,11-transdiol mu thupi la munthu kumachitika pogwiritsa ntchito microsomap enzyme epoxide hydrolase.

Kuchuluka kwa carbamazepine-10,11-epoxide (pharmacologically yogwira metabolite) pafupifupi 30% ya kuchuluka kwa carbamazepine mu plasma.

Isoenzyme yayikulu yomwe imapatsa biotransfform ya carbamazepine kwa carbamazepine-10,11-epoxide ndi cytochrome P450 ZA4. Chifukwa cha izi kagayidwe kameneka, kagayidwe kenakake kamapangidwe ena kamapangidwanso - 9-hydroxymethyl-10-carbamoylacridane.

Njira ina yofunika ya kagayidwe ka carbamazepine ndikumapangidwa kwa zinthu zingapo zotuluka za monohydroxylated, komanso N-glucuronides, motsogozedwa ndi UGT2B7 isoenzyme.

Kuswana
Hafu ya moyo wosasinthika wa carbamazepine pambuyo pakamwa kamodzi pamankhwala amapezeka pafupifupi maola 36, ndipo pambuyo pobwereza Mlingo wa mankhwalawa - pafupifupi maola 16 mpaka 24, kutengera nthawi ya mankhwalawa (chifukwa cha kuyambitsa kwamphamvu kwa machitidwe a chiwindi). Odwala omwe amatenga nthawi yomweyo mankhwala ena omwe amalimbikitsa michere ya chiwindi (mwachitsanzo, phenytoin, phenobarbital), kuthetseratu theka la moyo wa carbamazepine pakadutsa maola 9 mpaka 10%. 2% ya mlingo wovomerezeka umapukutidwa ndi impso mu mawonekedwe a carbamazepine osasinthika, pafupifupi 1% - mu mawonekedwe a pharmacologically yogwira 10,11-epoxy metabolite. Pambuyo pakamwa limodzi, 30% ya carbamazepine amachotsedwa mu mkodzo mwa njira yotsiriza ya njira ya epoxydiol metabolic.

Zambiri za pharmacokinetics m'magulu odwala
Mu ana, chifukwa cha kuchotsedwa msanga kwa carbamazepine, pangafunike kugwiritsa ntchito mankhwala okwanira kilogalamu imodzi yolemera, poyerekeza ndi akulu.

Palibe umboni kuti pharmacokinetics of carbamazepine kusintha kwa odwala okalamba (poyerekeza ndi achikulire achinyamata).

Zambiri pa pharmacokinetics za carbamazepine mwa odwala omwe ali ndi vuto la Impso kapena kwa chiwindi sanapezebe.

Gwiritsani ntchito pa nthawi yoyembekezera komanso nthawi yoyamwitsa.

Carbamazepine imalowera mu placenta ndikukulitsa kuchuluka kwa chiwindi ndi impso za mwana wosabadwayo.

Kuwunika pafupipafupi kuchuluka kwa zinthu zomwe zimagwira m'madzi a m'magazi, EEG ikulimbikitsidwa.

Mimba ikachitika, ndikofunikira kuyerekeza phindu lomwe mungayembekezere la chithandizo chamankhwala ndi zovuta zomwe zingatheke, makamaka munthawi yoyamba kubereka.

Amadziwika kuti ana a amayi omwe ali ndi vuto la khunyu amakhala okonzekera kutukuka kwa intrauterine, kuphatikizapo kusokonekera. Carbamazepine amatha kuwonjezera chiwopsezo cha zovuta izi. Pali malipoti apadera a matenda obadwa nawo komanso kusokonezeka, kuphatikizapo kusatseka kwa ziphuphu zakumaso (spina bifida) ndi zovuta zina zobadwa nazo: zolakwika pakukula kwa zida za craniofacial, mtima ndi ziwalo zina, hypospadias.

Malinga ndi a North America Pregnant Register, kuchuluka kwa zolakwika zomwe zimakhudzana ndi mawonekedwe achilengedwe omwe amafunikira opaleshoni, mankhwala osokoneza bongo kapena zodzikongoletsera, omwe amapezeka mkati mwa milungu 12 atabadwa, anali 3.0% mwa amayi apakati omwe amamwa carbamazepine mu trimester yoyamba ngati monotherapy, ndipo 1.1% mwa amayi apakati omwe sanamwe mankhwala oletsa antiepileptic.

Chithandizo cha carbamazepine retard-Akrikhin amayi oyembekezera omwe ali ndi khunyu iyenera kuchitika mosamala kwambiri. Carbamazepine retard-Akrikhin ayenera kugwiritsidwa ntchito muyezo wogwira ntchito. Kuwunikira pafupipafupi kuchuluka kwa yogwira mankhwala a m'magazi kumalimbikitsidwa.Pankhani yoyeserera moyenera anticonvulsant, mayi woyembekezera ayenera kukhala ndi kuchuluka kwa carbamazepine m'magazi am'magazi (achire osiyanasiyana 4-12 μg / ml), chifukwa pali malipoti a chiwopsezo chodalira mlingo wa kukulira malformations (mwachitsanzo, kuchuluka kwa zosokoneza mukamagwiritsa ntchito mlingo wochepera 400 mg patsiku anali otsika kuposa mankhwala okwera).

Odwala ayenera kudziwitsidwa za kuthekera kowonjezera chiwopsezo cha kusasinthika ndi kufunikira, pankhaniyi, kuti adziwe kuti ali ndi vuto la kugona.

Pa nthawi ya pakati, chithandizo chokwanira cha antiepileptic sichiyenera kusokonezedwa, chifukwa kupita patsogolo kwa matendawa kungakhale ndi vuto lililonse kwa mayi ndi mwana wosabadwayo.

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

Zochitika zingapo za kugwidwa khunyu ndi / kapena kupuma zimafotokozedwa mwa makanda omwe amayi awo adamwa mankhwalawo nthawi imodzi ndi anticonvulsants ena. Kuphatikiza apo, milandu yambiri ya kusanza, kutsekula m'mimba ndi / kapena kuperewera kwa zakudya m'thupi mwa akhanda omwe amayi awo adalandira carbamazepine adanenedwanso. Mwinanso izi zimachitika kuti akuwoneka kuti wakhanda.

Carbamazepine akudutsa mkaka wa m'mawere, ndende yomwe ilimo ndi 25-60% ya ndende ya m'magazi, motero maubwino ndi zotsatira zoyipa za kuyamwitsa ziyenera kufananizidwa pamankhwala omwe akupitilira chithandizo. Ndi kupitiriza kuyamwitsa pamene mukumwa mankhwalawa, muyenera kukhazikitsa kuwunika kwa mwanayo kuti athe kuyambika mosiyanasiyana (mwachitsanzo, kugona kwambiri, khungu lawo siligwirizana). Mwa ana omwe amalandila carbamazepine modzidzimutsa kapena mkaka wa m'mawere, milandu yodwala hepatitis imafotokozedwa, chifukwa chake, ana otere ayenera kuyang'aniridwa kuti adziwe zoyipa kuchokera ku hepatobiliary system.

Odwala a msinkhu wobereka ayenera kuchenjezedwa za kuchepa kwa mphamvu ya njira zakulera pakamwa pogwiritsa ntchito carbamazepine.