Momwe mungagwiritsire ntchito mankhwala Simbalta?

Tsoka ilo, chaka chilichonse kuchuluka kwa anthu omwe adakumana ndi mavuto a nkhawa, mantha amisala komanso malingaliro kumangokulira. Ndizovuta kunena kuti chifukwa chake ndi chiyani, koma kuthamanga kwa moyo, ntchito yabwino, kusamvetsetsa m'mabanja, mavuto m'moyo wamunthu - zonsezi zimatha kuyambitsa mantha, kupsinjika kapena kubweretsa vuto la neurosis kapena kukhumudwa.

Ndi matenda otere kapena kukayikira kwawo, ndikofunikira kulumikizana ndi psychotherapists, neurologists. Nthawi zambiri, popanda thandizo lawo, munthu sangathe kuchoka pamavuto ndikupitiliza kukhala ndi moyo wabwinobwino. Kuphatikiza apo, nthawi zambiri matendawa amasintha kukhala ovuta: kudzipha, kufa, chifukwa cha mkhalidwe wopanda chiyembekezo, kusowa kwa chisangalalo ndi tanthauzo m'moyo.

Nthawi zambiri, kuti abwezeretse thupi, madokotala amalimbikitsa kutenga njira yolerera yotsutsana, yomwe m'nthawi yochepa ingathe kuukitsa munthu.

Chimodzi mwa mankhwala a gulu lantidepressant ndi mankhwala a Simbalta, omwe nthawi zambiri amawerengedwa ndi madokotala kwa odwala.

Simbalta ndi mankhwala oopsa, kulandiridwa kwake komwe sikovomerezeka popanda kuikidwa ndi dokotala ndikuwunikira nthawi zonse wodwala!

Zochita zamankhwala

Malangizo a mankhwala Symbalta akuti zotsatira za mankhwalawa zimakhudzana ndi kubwezeretsa kwa serotonin, monga mankhwala ena ambiri okhala ndi mawonekedwe ofanana. Ngati tikunena za dzina lapadziko lonse la mankhwalawo, ndiye kuti likhoza kupezeka pansi pa dzina la Duloxetine. Ndi chinthu ichi chomwe chimagwira.

Contraindication

Monga mankhwala aliwonse, mankhwala a Symbalt ali ndi contraindication. Mu matenda ndi zinthu zotsatirazi, chithandizo cha mankhwalawa sichichita:

• ndi chidwi chogwira ntchito duloxetine,
• kugwiritsa ntchito mankhwala - Mao zoletsa,
• mukamayamwa,
• ndi matenda am'maso -otseka glaucoma,
• wosakwana zaka 18.

Chenjezo komanso pokhapokha poyang'aniridwa ndi dokotala, mankhwalawa amatha kugwiritsidwa ntchito pochulukitsa machitidwe a manic ndi hypomanic, osati pakadali pano, komanso m'mbiri. Zomwezo zikugwiranso ntchito pa khunyu (kuphatikizapo mbiri yakale ya zamankhwala). Moyang'aniridwa ndi dokotala ayenera kukhala odwala aimpso ndi kwa chiwindi, omwe ali pachiwopsezo chotukuka cha khungu.

Pa nthawi yoyembekezera, mankhwalawa amayikidwa mosamalitsa malinga ndi malangizo a katswiri. Ngati mungayesere kwambiri kudzipha, mutha kugwiritsa ntchito Simbalta kokha moyang'aniridwa ndi dokotala.

Zotsatira zoyipa za mankhwala

Mankhwalawa ndi akulu kwambiri, chifukwa malangizo a Simbalta ali ndi mndandanda wathunthu wazotsatira zoyipa zomwe zitha kuonekera mukamawagwiritsa ntchito.

1. Pafupifupi 10% ya milandu (ndipo izi zimachitika ngati zimachitika pafupipafupi), chizungulire, kusokonezeka kwa tulo (kugona tulo, kusinza), nseru, pakamwa kowuma, kudzimbidwa, komanso kupweteka kwa mutu kumatha kuchitika mutatenga Simbalt.
2. Zomwe sizachilendo pakati pa odwala omwe amamwa mankhwalawa ndi kusanza, kutsegula m'mimba, kuchepa kwa chidwi ndi thupi kumbuyo, kunjenjemera, kutuluka thukuta, kuchepa kwa kugonana, mavuto amawonedwe mu mawonekedwe azithunzi, azimayi ali ndi kutentha kwakukulu, ndipo amuna achepetsa potency, kusokonezeka kwamisempha .
3. Odwala omwe ali ndi matenda a diabetes a neuropathy mukamalandira chithandizo ndi Simbalt atha kukhala okwera m'magazi a shuga mukamayesedwa wopanda kanthu m'mimba.

Kuphatikiza apo, zotsatira zoyipa zimathanso kuchitika ngati mankhwalawo atachotsedwa: pakati pa zomwe zimachotsedwedwa, odwala adanenanso za kupweteka mutu, chizungulire, komanso mseru.

Mu nkhani ya mankhwala osokoneza bongo, kusanza, kuchepa kudya, ataxia, kupweteka, kugwedezeka, n`zotheka. Mankhwala a Simbalta sanatchulidwe, chifukwa cha mankhwalawa, amayenera kuyang'anitsitsa mlingo womwe dokotala watchulidwa.

Momwe mungamwe mankhwalawa

Kulandila kwa Simbalta sikudalira chakudya. Mawonekedwe a mankhwalawa ndi enteric kapisozi. Ayenera kumezedwa popanda kuphwanya kapena kutafuna. Kuchepetsa madzi kapena kusakaniza ndi chakudya sikulimbikitsidwa.

Nthawi zambiri zotchulidwa kamodzi patsiku la 60 mg. Ngati ndi kotheka, onjezani mlingo ku 120 mg ndi kumwa mankhwalawa kawiri pa tsiku. Mlingo wa 120 mg umadziwika kuti ndiwo gawo lalikulu lomwe lingagwiritsidwe ntchito tsiku lililonse.

Pakulephera kwa aimpso, muyeso woyamba umachepetsedwa mpaka 30 mg patsiku.

Tiyenera kukumbukira kuti kutenga Simbalta kumalepheretsa zochitika zama psychomotor, kumachepetsa kukumbukira kukumbukira.

Chifukwa chake, pamankhwala othandizirana ndi mankhwalawa, munthu ayenera kuchepetsa ntchito kuti azikhala ndi zoopsa zomwe zimafunikira kuti anthu azikhala ndi chidwi komanso azithamanga kwambiri.

Kutulutsa mawonekedwe ndi kapangidwe kake

Fomu ya Mlingo - makapisozi: zolimba, gelatin, opaque:

• 30 mg: kukula No. 3, yokhala ndi chifanizo cha buluu komwe chizindikiritso cha "9543" chimayikidwa mu inki yobiriwira, ndipo choyera chomwe mwala womwe umalembedwa kuti "30 mg" mu inki wobiriwira,
• 60 mg: kukula No. 1, wokhala ndi chifanizo cha buluu pomwe chizindikiritso cha "9542" chimayikidwa mu inki yoyera ndi chikwangwani chobiriwira chomwe mlingo wake ndi "60 mg" mu inki yoyera.

Zomwe zili m'mabotolo: mapalesi oyera kuyambira oyera mpaka oyera.

Kuyika makonzedwe: 14 makapisozi a chithuza, pamakatoni okhala ndi matuza 1, 2 kapena 6.

Zogwira ntchito: duloxetine (mu mawonekedwe a hydrochloride), mu 1 kapisozi - 30 kapena 60 mg.

• zomwe zili ndi kapisozi: triethyl citrate, shuga wopaka m'mimba, sucrose, hypromellose, chikuku, hypromellose acetate, talc, utoto woyera (hypromellose, titanium dioxide),
• chipolopolo: gelatin, indigo carmine, sodium lauryl sulfate, titanium dioxide, ndi utoto wa ayidi wachikasu - m'mapiritsi a 60 mg,
• overprint: 30 mg makapisozi - TekPrint ™ SB-4028 wobiriwira inki, 60 mg makapisozi - TekPrint ™ SB-0007P inki yoyera.

Zizindikiro zogwiritsidwa ntchito

• matenda a nkhawa (GAD),
• kukhumudwa
• kupweteka mawonekedwe a zotumphukira matenda ashuga,
• aakulu ululu matenda a musculoskeletal dongosolo (kuphatikizapo amene amayamba ndi nyamakazi ya bondo olowa ndi fibromyalgia, komanso ululu wammbuyo kumbuyo.

Mlingo ndi makonzedwe

Mapiritsi ayenera kumwedwa pakamwa: kumeza lonse ndikumwa ndi madzi. Kudya sikukhudza kutha kwa mankhwalawa, komabe, mapiritsi sayenera kuwonjezeredwa ku chakudya kapena kusakanikirana ndi zakumwa!

Malangizo othandizira:

• kupsinjika: koyamba komanso muyezo wokonza - 60 mg kamodzi patsiku. Kusintha kumawonedwa pambuyo pa milungu iwiri kapena itatu ya kumwa mankhwalawa, komabe, pofuna kupewa kubwereranso, chithandizo chikuyenera kupitilizidwa kwa miyezi ingapo. Mobwerezabwereza kuvutika kwa odwala omwe amatsatira bwino chithandizo cha duloxetine, chithandizo cha nthawi yayitali pa mlingo wa 60-120 mg nchotheka,
• nkhawa yamavuto ambiri: mlingo woyenera ndi 30 mg, ngati zotsatira zake zilibe, amakwezedwa mpaka 60 mg. Pankhani ya kukhudzika kwapakati, koyamba ndi kukonza tsiku lililonse ndi 60 mg, poyankha mosakwanira pazamankhwala, ukuwonjezeka mpaka 90 kapena 120 mg. Popewa kuyambiranso, chithandizo chikuyenera kupitilizidwa kwa miyezi ingapo,
• mawonekedwe opweteka a zotumphukira za shuga: neuropathy woyambira ndi muyezo - 60 mg kamodzi patsiku, zina zimatheka kuti tsiku lililonse muwonjezere mlingo wa 120 mg. Kuyesa koyambirira kwa mayankho kumachitika pambuyo pa miyezi iwiri ya chithandizo, ndiye - kamodzi kamodzi pamiyezi itatu,
• aakulu ululu matenda a minofu ndi mafupa dongosolo: sabata loyamba la mankhwala - 30 mg kamodzi patsiku, ndiye 60 mg kamodzi patsiku. Kugwiritsa ntchito Mlingo wapamwamba sikupereka bwino, koma kumalumikizidwa ndi zovuta zambiri. Kutalika kwa chithandizo mpaka miyezi itatu. Lingaliro pakufunika kwakula kwamaphunziro limapangidwa ndi adokotala.

M'milungu iwiri yoyambirira ya chithandizo cha GAD, odwala okalamba amapatsidwa Simbalt tsiku lililonse 30 mg, ndiye, ndi kulolera bwino, mlingo umakulitsidwa mpaka 60 mg. Mukamapereka mankhwala pazomwe zikuwonetsedwa, okalamba safuna kusintha kwa mlingo.

Kuchepetsa kwakanema kwa mankhwalawa kuyenera kupewedwa, popeza kuti mutha kuyamba kukhala ndi matenda ena achifwamba. Ndikulimbikitsidwa kuti muchepetse mlingo pang'onopang'ono kwa masabata 1-2.

Zotsatira zoyipa

Zotsatira zake zoyipa zambiri zimakhala zofatsa kapena zolimbitsa thupi, zomwe zinachitika kumayambiriro kwa chithandizo komanso nthawi ya chithandizo, zovuta zawo zimachepa.

M'maphunziro azachipatala, zoyipa zotsatidwa ndi machitidwe ndi ziwalo zotsatirazi zidadziwika:

• M`mimba thirakiti: Nthawi zambiri - youma mkamwa, nseru, kudzimbidwa, kawirikawiri dyspepsia, kusanza, kupweteka kwam'mimba, kutsegula m'mimba, kuphwanya masana, infrequent - kugona, dysphagia, gastritis, gastroenteritis, kutulutsa magazi m'mimba, kawirikawiri - kupuma koyipa stomatitis, ndowe zamagazi,
• Chiwindi ndi matenda amisili: kawirikawiri - kuwonongeka kwa chiwindi, chiwindi, kawirikawiri - jaundice, chiwindi,
• Metabolism ndi zakudya: pafupipafupi - kutaya mtima, kuchepa - hyperglycemia, kawirikawiri - hyponatremia, kuchepa madzi, chizindikiro cha kusakwanira katulutsidwe ka ADH (mahomoni antidiuretic),
• Mtima dongosolo: Nthawi zambiri - hyperemia, palpitations, pafupipafupi - kuchuluka magazi, orthostatic hypotension, tachycardia, ozizira malekezero, kukomoka, supraventricular arrhythmia, kawirikawiri - matenda oopsa,
• Njira yodzikakamira: Nthawi zambiri - kupweteka kwa oropharynx, kutsegulira, mosapumira - mphuno, kumverera kokhoseka pakhosi,
• Matenda a minofu ndi mafupa: Nthawi zambiri minofu imagwira, kupweteka kwa minofu ndi mafupa, kukokana kwa minofu, kukokana kwa minofu kawirikawiri,
• Khungu ndi minyewa yodukiza: nthawi zambiri - kuyabwa, kuzimiririka, thukuta, pafupipafupi - kulumikizana ndi khungu, photosensitivity, urticaria, kuphulika, thukuta lozizira, thukuta la usiku, kawirikawiri - angioedema, Stevens-Johnson syndrome, kawirikawiri - minofu yovuta,
• Njira ya kwamikodzo: pafupipafupi - kukodza pafupipafupi, pafupipafupi - kukomoka, nocturia, kufooka kwa mkodzo, kusungika kwamikodzo, kuvuta kuyambitsa kukodza, kawirikawiri - kununkhira kwachilendo kwa mkodzo,
• Mimbulu ndi chithokomiro cha mammary: Nthawi zambiri - kukomoka, kugona, kugona, kutaya mtima, kuchepa kwamkati, kupweteka kwa ma testicles, kusamba kwa msambo, kuchepa magazi, osowa - galactorrhea, zizindikiro za kusamba, hyperprolactinemia,
• Mitsempha yam'mimba ndi psyche: Nthawi zambiri - kupweteka mutu, kugona, chizungulire, kugona, nkhawa zambiri, kusokonekera, kusokonekera kwa mitsempha, kuchepa kwa libido, maloto osazolowereka, kuvulala kwa mantha, kunjenjemera, kusamva bwino, kuvulala, kuperewera, kugona bwino, kugona , chidwi, kusowa kwa miyendo, kupuma kwamiyendo, kupindika, kukayikira, malingaliro ofuna kudzipha, kukhumudwitsa, kukhumudwa, psychopotor, kupsinjika, serotonin syndrome, vuto la extrapyramidal, kuyerekezera zinthu m'maganizo, masuti Wotsatira khalidwe, kukonda, kudana ndi waukali,
• Ziwalo zomvera: pafupipafupi - tinnitus, masomphenya osalongosoka, mawonekedwe osokonezeka, mydriasis, kupweteka m'makutu, vertigo, osowa - maso owuma, glaucoma,
• Endocrine dongosolo: kawirikawiri - hypothyroidism,
• Thupi lamatenda: kawirikawiri - hypersensitivity, anaphylactic reaction,
• Zambiri kuchokera ku zowerengera za labotale ndi zothandizira: pafupipafupi - kuchepa kwa thupi, kuchepa - kuchuluka kwa potaziyamu m'magazi, kuwonjezeka kwa kuchuluka kwa bilirubin, creatine phosphokinase, alkaline phosphatase, transpases ya hepatic, kuchuluka kwa thupi, kuwonjezeka kwa m'magazi, kuwonjezeka kwa chiwindi. magazi cholesterol
• Matenda opatsirana: pafupipafupi - laryngitis,
• Mavuto ambiri: pafupipafupi - kutopa kwambiri, nthawi zambiri - kusintha kwa kulawa, kugwa, pafupipafupi - kumva kuzizira, kuzizira, kumva kutentha, ludzu, malaise, gayidwe lamkati, zotukumika zamkati, kupweteka pachifuwa.

Ndi kufooka kwadzidzidzi kwa mankhwalawa, nthawi zambiri, mankhwala a Sybalta amapanga mtundu wa "kusiya", womwe umawonetsedwa ndi zizindikiro zotsatirazi: kusokonezeka kwa malingaliro, kugona, kufooka, kusokonezeka, chizungulire, nkhawa kapena kukwiya, kusokonezeka kwa kugona, kupweteka mutu, kugwedezeka, mseru komanso / kapena kusanza, kutsekula m'mimba, vertigo ndi hyperhidrosis.

Malangizo apadera

Pa chithandizo ndi Simbalt odwala omwe ali ndi matenda oopsa kapena matenda ena a mtima, tikulimbikitsidwa kuti muchepetse kuthamanga kwa magazi.

Odwala omwe ali ndi chiopsezo chowonjezeka cha kudzipha panthawi ya pharmacotherapy ayenera kuyang'aniridwa ndi achipatala.

Munthawi yamankhwala, kusamala kumalangizidwa mukamagwiritsa ntchito zida zamagetsi komanso mukamagwiritsa ntchito zida zoopsa.

Kuyanjana kwa mankhwala osokoneza bongo

Mankhwala Simbalta sayenera kugwiritsidwa ntchito nthawi yomweyo ndi monoamine oxidase inhibitors, komanso mkati mwa masiku 14 atachokapo chifukwa choopseza kukhala ndi serotonin syndrome. Pambuyo pakutha kwa duloxetine, osachepera masiku 5 ayenera kutha asanafike monoamine oxidase zoletsa.

Duloxetine imayikidwa mosamala komanso mosachepera Mlingo wofanana ndi ma inhibitors a CYP1A2 isoenzyme (mwachitsanzo, mankhwala a antiinolone), mankhwala omwe amapangidwa makamaka ndi CYP2D6 isoenzyme system ndipo ali ndi index yocheperako yamankhwala.

Ndi munthawi yomweyo makonzedwe ena njira / zinthu serotonergic kanthu, kukula kwa serotonin syndrome ndikotheka.

Mankhwala a Symbalt amagwiritsidwa ntchito mosamala nthawi yomweyo ndi ma tridclic antidepressants (amitriptyline kapena clomipramine), triptans kapena venlafaxine, tramadol, wort wa St. John, tryptophan ndi finidine.

Pogwiritsa ntchito munthawi yomweyo mankhwala a anticoagulants ndi antithrombotic, chiopsezo chotaya magazi chimatha kuchuluka, chifukwa chake, duloxetine ndi mankhwalawa imayikidwa mosamala.

Mwa osuta, kuchuluka kwa duloxetine mu plasma kumachepera pafupifupi 50% poyerekeza ndi osasuta.

Gulu la mankhwala

Simbalta ndi m'gulu la antidepressants. Gulu laling'ono la mankhwalawa limasankha serotonin ndi norepinephrine reuptake inhibitors. Monga mankhwala ambiri m'gululi, Symbalta imatha kuletsa komanso kubwezeretsa dopamine, yomwe imayambitsa mavuto ambiri chifukwa cha mankhwalawo.

Mankhwala

Symbalta ndi ya gulu la kusankha serotonin ndi noradrenaline reuptake inhibitors. Izi zikutanthauza kuti mankhwalawa amaletsa kulowa kwa zinthu ziwiri zokha kuchokera kumalo amanjenje amanjenje mu neurons: norepinephrine ndi serotonin. Komabe, monga oimira ambiri a gululi, kuyerekezera pang'ono kumakhudza kagayidwe ka dopamine.

Okhalapakati atatu awa: serotonin, norepinephrine ndi dopamine - amachititsa gawo loyendetsa zochitika mu psyche. Ndi kuchepa kwa chidwi chawo, kukhumudwa, kuda nkhawa, kusokonezeka kwa kugona komanso zovuta zamalingaliro ndi chikhalidwe zimakula. Potere, ndikofunikira kuti muchepetse ndende osati mkati mwa maselo, koma m'malo anu.

Kufanizira kumawonjezera zomwe zili pakati pa maselo, zomwe zimabweretsa kuwonjezeka pang'onopang'ono kwa kaphatikizidwe kake ndi maselo ndi chimbudzi mu malo oyanjana. Njira iyi imayambitsa kuwonjezeka kwa kayendetsedwe ka mankhwala ndi kutsika kwa nkhawa.

Simbalta ili ndi mndandanda wochepa kwambiri wazomwe ungagwiritse ntchito. Cholinga cha mankhwalawa chimavomerezeka mu milandu iyi:

• Chithandizo cha kubwerezabwereza kwachisokonezo, gawo lamakono lazachisoni chachikulu,
• Vuto limodzi lokhumudwitsa kwambiri,
• Zowawa za neuropathic ululu,
• Neuropathies odwala matenda a shuga,
• Kuda nkhawa.

Simbalta sagwiritsidwa ntchito pochiza matenda ofatsa pang'ono, samagwiritsidwa ntchito popewa kupsinjika ndikuchiritsa matenda. Odwala omwe ali ndi phobias amalangizidwanso kuti amwe mankhwalawa. Pafupifupi, Symbalta imagwiritsidwa ntchito ngati chithandizo ndi othandizira ena chikhoza kukhala chosakwanira.

Bongo

M'mayeso azachipatala, palibe chowopsa chomwe chimawonedwa ndi mankhwala osokoneza bongo ambiri. Kuonjezera mlingo womwe ungayambitsidwe kungayambitse kukula kwa serotonin syndrome, limodzi ndi boma labwino, kutsekemera ndi kuyerekezera zinthu m'magazi. Kuphatikiza apo, kuphwanya chikumbumtima ndikuthekera mpaka kukomoka. Nthawi zambiri ndimakhala ndi bongo wochepa, kugona, kusanza, ndi kuwonjezeka kwa kugunda kwa mtima. Nthawi zina, wodwala matenda opatsirana.

Palibe chithandizo chazomwe chimagwiritsidwa ntchito mopitirira muyeso wa Symbalta. Detoxification mankhwala ikuchitika.

Malangizo ogwiritsira ntchito

Kwa matenda okhumudwitsa komanso kupweteka kwambiri, pafupifupi mlingo wa mankhwala ndi 60 mg. Mankhwalawa amayenera kuledzera kamodzi patsiku, posankha m'mawa kapena madzulo. Zikachitika kuti mankhwalawa anali osathandiza, mlingo umachulukitsidwa mpaka momwe mungathere - 120 mg. Potere, mlingo wa tsiku ndi tsiku umagawika kawiri - m'mawa ndi madzulo, kapisozi imodzi. Mphamvu ya chithandizo imatha kuyesedwa pambuyo pa masabata 8.

Pazovuta, nkhawa yoyambira ndiyotsika. Pankhaniyi, Symbalta imasankhidwa 30 mg kamodzi patsiku. Ngati mankhwalawa amalephera, mankhwalawa amathanso kuwirikiza kawiri, ndikugawa pawiri. Pang'onopang'ono, mutha kuwonjezera kuchuluka kwa 30 mg wina, kenako 30 mg, kufikira mlingo waukulu wa 120 mg. Kuchulukitsa mtengo sikulimbikitsidwa chifukwa choopsa cha mavuto. Zotsatira zomwe zikuyembekezeka zidzawonekera pakatha milungu 4 yolamulira.

Makapisozi amatsukidwa pansi ndi madzi ambiri, kudya zakudya sizimakhudza kuyamwa kwa mankhwalawa.

Pali ma analogu ochepa omwe ali ndi chinthu chofanana ndi Symbalta, awa ndi awa:

Kuphatikiza apo, pali mankhwala omwe ali m'gulu limodzi la mankhwala omwe ali ndimayendedwe ofanana. Izi zikuphatikiza:

Mankhwala onsewa sasinthika.

Regina P.: “Ndinatenga Symbalt kwa miyezi isanu ndi umodzi yokhudzana ndi kupsinjika mtima. Mankhwalawa adandithandiza, koma osatero. Pafupifupi mwezi woyamba ndinali chizungulire ndi mutu, koma sindinawone momwe mankhwalawo amathandizira. Pafupifupi mwezi umodzi, zotsatira zonse zoyipa zidapita, ndipo kusinthaku kunayamba kuyenda pang'onopang'ono. Ndatenga Simbalt kwa miyezi 4 mpaka nditathetseratu nkhawa. ”

Denis M.: “Ndinayamba kumwa Simbalt chifukwa ndimakhala ndi nkhawa nthawi zonse. Ndakhala ndikuvutika ndi nkhawa kuyambira ndili mwana ndipo nthawi zambiri ndimalandira chithandizo kuchipatala. Anatenga 30 mg, koma sizinachitike. Mlingo utachuluka, nkhawa yanga inayamba kuchepa, koma kunjenjemera kwa mikono ndi miyendo, magazi amayambanso kuchuluka. Ndinafunika kusiya kumwa Simbalt ndikusinthana ndi mankhwala ena. ”

Ndemanga ya wochita zamisala: "Pamsika wa antidepressants, Symbalta si mankhwala otchuka kwambiri. Amamenya nkhondo mwamphamvu ngakhale atakhala kuti anakhumudwa kwambiri, koma pali zovuta zingapo. Choyamba, zotsatira zoyipa zambiri zimachepetsa cholinga cha mankhwalawo. Wodwala amayenera kuunikidwa bwino asanalandire mankhwalawo. Kuphatikiza apo, chizindikirocho chikuyenera kumwedwa kokha kuchipatala choyang'aniridwa. Izi zimagwirizanitsidwa ndi chiwopsezo chowonjezeka cha kuyesa kudzipha mwa odwala omwe atengeka ndi nkhawa kwambiri. Monga lamulo, madokotala amakonda mankhwala otetezeka, kugwiritsa ntchito fanizo ngati njira yosungira. Anzathu akumayiko ena amati ndi a Symbol nthawi zambiri. ”

Mankhwala

Duloxetine ndi mankhwala ochepetsa nkhawa, a serotonin ndi a norepinephrine reuptake inhibitor, ndipo zotengera za dopamine siziponderezedwa bwino. Thupi mulibe ubale wofunika wa histaminergic, dopaminergic, adrenergic ndi cholinergic receptors.

Mu kukhumudwa, limagwirira ntchito duloxetine zachokera kukakamiza kubwezeretsanso kwa serotonin ndi norepinephrine, chifukwa chomwe noradrenergic ndi serotonergic neurotransication imachulukana mkati mwa dongosolo lamanjenje.

Thupi limakhala ndi gawo lapakati lothandizira kupondereza ululu, chifukwa cha kupweteka kwa mitsempha ya neuropathic izi zimawonetsedwa makamaka ndi kuwonjezeka kwa malire a kupsinjika kwa kupweteka.

Pharmacokinetics

Duloxetine pambuyo pakamwa makonzedwe bwino. Mafuta amayamba 2 mawola atatenga Simbalta. Nthawi yoti mufikire C_max (pazipita kuchuluka kwa thunthu) - 6 maola. Kudya C_max Zilibe kanthu, pomwe pali kuwonjezeka kwa nthawi yomwe imatenga chizindikiro ichi mpaka maola 10, omwe amachepetsa mosavomerezeka mayeso (pafupifupi 11%).

Kuchuluka kwa magawidwe a duloxetine kuli pafupifupi 1640 malita. Thupi limalumikizidwa bwino ndi mapuloteni a plasma (> 90%), makamaka ndi albumin ndi α₁asidi globulin. Zovuta za chiwindi / impso sizimakhudza kuchuluka kwa zomanga mapuloteni a plasma.

Duloxetine imagwira metabolism yogwira, ma metabolites ake amachotsedwa mu mkodzo. Ma isoenzymes CYP2D6 ndi CYP1A2 amathandizira kupangidwa kwa metabolites awiri akuluakulu - 4-hydroxyduloxetine glucuronide ndi 5-hydroxy, 6-methoxyduloxetine sulfate. Sakhala ndi zochitika zamankhwala.

T_1/2 (theka-moyo) wa thunthu - maola 12. Chilolezo chapakati ndi 101 l / h.

Odwala kwambiri mkhutu aimpso ntchito (mu kudwala matenda aimpso kulephera) akudwala hemodialysis, C mfundo_max ndi AUC (kukhudzana kwapakatikati) kwa kuchuluka kwa duloxetine kuwonjezeka nthawi 2. Muzochitika izi, ndikofunikira kulingalira kuthekera kwa kuchepetsa kuchuluka kwa Symbalta.

Ndi matenda a chiwindi kulephera, kuchepa kwa kagayidwe kachakudya ndi katemera wa chinthu chitha kuzindikirika.

Kuchita

Chifukwa cha chiwopsezo cha serotonin syndrome mankhwalawa sayenera kugwiritsidwa ntchito ndi zoletsa MAO ndi masabata ena awiri atasiya Mao zoletsa.

Kulandila limodzi enzyme zoletsaCYP1A2ndi CYP1A2 zingayambitse kuchuluka kwa mankhwala osokoneza bongo.

Chenjezo liyenera kugwiritsidwa ntchito limodzi ndi mankhwala ena omwe amakhudza dongosolo lamanjenje, kuphatikizapo mowa.

Nthawi zina, mukamagwiritsa ntchito ndi ena serotonin zimagwira zoletsa ndi mankhwala a serotonergic mawonekedwe otheka serotonin syndrome.

Muyenera kusamala mukamagwiritsa ntchito Zizindikiro zophatikizana ndi mankhwala omwe amapangidwa ndi puloteni.CYP2D6.

Kulandila ndi anticoagulants zimatha kupezeka magazi amatuluka mogwirizana ndi chikhalidwe cha mankhwala a pharmacodynamic.

Ndemanga za Simbalt

Ndemanga za madotolo za Simbalt ndikuwunika kwa Simbalt pamabwalo akuwunikiranso bwino mankhwala ngati mankhwala kukhumudwa ndi mitsemphaKomabe, mankhwalawa ali ndi malire pazomwe angagwiritse ntchito chifukwa cha chiwopsezo chachikulu cha "kusiya" matenda.

Simbalta, malangizo ogwiritsira ntchito: njira ndi mlingo

Makapisozi ophiphiritsa amatengedwa pakamwa, mosasamala chakudyacho, kuwameza kwathunthu, popanda kuphwanya nembana ya enteric.

• kupsinjika: mlingo woyambirira ndi kukonza - 60 mg kamodzi patsiku. Achire zotsatira nthawi zambiri amapezeka 2-2 milungu milungu. Kafukufuku wachipatala wokhudza kuthekera ndi chitetezo cha Mlingo womwe uli pamtunda wopitilira 60 mg mpaka 120 mg patsiku kwa odwala omwe satsatira mlingo woyamba sanatsimikizire kusintha kwa wodwalayo. Popewa kuyambiranso, tikulimbikitsidwa kuti mupitirize kutenga Zizindikiro kwa masabata 8 mpaka 12 mutatha kuyankha. Odwala omwe ali ndi mbiri ya kukhumudwa komanso yankho labwino ku chithandizo cha duloxetine amawonetsedwa kuti alandire Symbalt pa mlingo wa 60-120 mg patsiku kwa nthawi yayitali,
• nkhawa nkhawa: koyamba mlingo ndi 30 mg patsiku, ndi osakwanira poyankha mankhwala, mutha kuwonjezera 60 mg, yomwe ndi mlingo wokonza kwa odwala ambiri. Mlingo woyambirira komanso wokonza kwa odwala omwe ali ndi nkhawa ya 60% patsiku. Ndi kulekerera kwabwino kwa mankhwala, kuwonjezeka kwa mlingo mpaka 90 mg kapena 120 mg akuwonetsedwa kuti akwaniritse kufunikira kachipatala. Pambuyo pakuwongolera momwe wodwalayo alili, chithandizo chikuyenera kupitilizidwa kwa milungu 8 mpaka 12 kupewa kupewa kuyambanso kudwala. Kwa odwala okalamba, mlingo woyambirira wa 30 mg uyenera kutengedwa kwa milungu iwiri musanasinthe mpaka 60 mg kapena kuposa patsiku,
• kupweteka mawonekedwe a matenda ashuga zotumphukira neuropathy: koyamba ndi yokonza mlingo - 60 mg kamodzi patsiku, ngati kuli kotheka, akhoza kuchuluka. The achire zotsatira ziyenera kuwunikira pambuyo 8 milungu ntchito Simbalta. Palibe kuyankha kokwanira kumayambiriro kwa zamankhwala, pambuyo pa nthawi yino, kusintha sikungatheke. Dokotala amayenera kuwunika matenda pafupipafupi, masabata 12 aliwonse,
• aakulu kupweteka musculoskeletal dongosolo: koyamba mlingo 30 mg 1 nthawi patsiku sabata limodzi, ndiye wodwala mankhwala 60 mg 1 nthawi patsiku. Njira ya mankhwala ndi milungu 12. Kukula kwa kugwiritsika ntchito kwakutali kumatsimikiziridwa ndi dokotala aliyense payekhapayekha, poganizira za kulekerera kwa Simbalta komanso mkhalidwe wa odwala.

Pakulephera kwa aimpso ndi CC 30-80 ml / min, kusintha kwa mankhwala sikofunikira.

Chifukwa cha chiwopsezo chosiya kudzipereka, kusiya kwa mankhwalawa ndikofunikira pochepetsa pang'onopang'ono mlingo wa Zizindikiro mkati mwa masabata 1-2.

Mimba komanso kuyamwa

• mimba: Symbalta itha kugwiritsidwa ntchito pokhapokha pakuyang'aniridwa kuchipatala pokhapokha ngati phindu la mayiyo ndilokwera kwambiri kuposa chiopsezo cha mwana wosabadwayo, popeza chidziwitso chogwiritsa ntchito mankhwalawa sichimveka bwino,
• mkaka wa m`mawere: mankhwala ndi contraindicated.

Mukamalandira mankhwala a duloxetine, pokonzekera kapena nthawi yoyamba kubereka, ndikofunikira kudziwitsa wothandizira zaumoyo wanu za izi.

Kugwiritsa ntchito mankhwala osokoneza bongo a serotonin kubwezeretsanso panthawi yomwe muli ndi pakati, makamaka m'magawo apambuyo, kumatha kuwonjezera mwayi wokhala wolimba m'mapapo a ziwopsezo kwa akhanda.

Pankhani yogwiritsidwa ntchito ndi Simbalta ndi amayi panthawi yotsatila ya kubereka, akhanda angayang'anenso, omwe amadziwika kuti akunjenjemera, kuthamanga kwa magazi, zovuta pakudya, chizindikiro cha kuchuluka kwa kukondwerera kwa neuro-Reflex, kupweteka, komanso kupuma. Ambiri mwa mavuto awa nthawi zambiri amawonedwa pakubadwa kwa mwana kapena masiku ochepa atabadwa.