Carbamazepine wa mankhwala: malangizo ogwiritsira ntchito

Carbamazepine: malangizo ogwiritsa ntchito ndi kuwunikira

Dzina lachi Latin: Carbamazepine

Code ya ATX: N03AF01

Zogwira pophika: carbamazepine (carbamazepine)

Wopanga: LLC Rosfarm (Russia), CJSC ALSI Pharma (Russia), OJSC Synthesis (Russia)

Kusintha malongosoledwe ndi chithunzi: 07/27/2018

Mitengo muma pharmacies: kuchokera ku ma ruble 58.

Carbamazepine ndi mankhwala okhala ndi psychotropic, antiepileptic.

Kutulutsa mawonekedwe ndi kapangidwe kake

Carbamazepine imapangidwa ngati mapiritsi (10, 15, 25 ma PC.) M'matumba otukusira, mapaketi 1-5 mu makatoni, 20, ma PC 30. M'matumba otupa, 1, 2, 5, 10 mapaketi pamakatoni paketi, 20, 30, 40, 50, ma PC ma 100. mu chikho, 1 angathe mu mtolo wa makatoni).

Piritsi limodzi lili ndi:

The yogwira mankhwala: carbamazepine - 200 mg,
Zothandiza: talc - 3.1 mg, povidone K30 - 14.4 mg, colloidal silicon dioxide (aerosil) - 0.96 mg, polysorbate 80 - 1.6 mg, wowuma wa mbatata - 96.64 mg, magnesium stearate - 3 , 1 mg.

Mankhwala

Carbamazepine ndi buku la dibenzoazepine, lomwe limadziwika ndi antiepileptic, neurotropic ndi psychotropic.

Pakadali pano, kagwiridwe kake ka zinthu izi kamangophunziridwa pang'ono. Imalepheretsa kupatsirana kwa ma pulaptic okondweretsa, kumalepheretsa kupatsirana kwa ma neuron, ndikubweretsa membrane wa overexcited neurons ku khola. Mwina njira yayikulu yogwiritsira ntchito carbamazepine ndikuletsa kupangika kwa zinthu zomwe zimadalira mphamvu ya sodium mu ma neuroni ofooka chifukwa cha "zochita" blockade - njira yodalira komanso yodalira magetsi.

Pogwiritsa ntchito mankhwalawa monga monotherapy odwala omwe ali ndi khunyu (makamaka, ana ndi achinyamata), zotsatira za psychotropic zimawonedwa, pochotsa zizindikiro za nkhawa komanso kukhumudwa, komanso kuchepa kwaukali komanso kusakwiya. Palibe chidziwitso chosagwirizana ndi zotsatira za carbamazepine pazinthu zodziwikiratu komanso zama psychomotor: mu maphunziro ena, zotsatira zowonjezera kawiri kapena zoyipa zidawululidwa zomwe zimadalira mlingo wa odwala, maphunziro ena adatsimikizira kuyipa kwa mankhwalawa pokumbukira ndi chidwi.

Monga othandizira a neurotropic, carbamazepine imagwira mu matenda ena amitsempha. Mwachitsanzo, ndi sekondale ndi idiopathic trigeminal neuralgia, zimalepheretsa kupweteka kwa paroxysmal.

Odwala omwe amachotsa zakumwa zoledzeretsa, carbamazepine imakhazikitsa gawo lokhazikika, komwe mu izi zimachepetsedwa nthawi zambiri, ndikuchepetsa kuzama kwawonekera kwamankhwala amtunduwu (monga kuphatikiza kusokonezeka, kunjenjemera, kuwonjezeka kwa msana).

Odwala omwe ali ndi matenda a shuga insipidus, carbamazepine amachepetsa diuresis ndikuchotsa ludzu.

Monga psychotropic wothandizila, mankhwalawa amalembedwa ngati amakumana ndi zovuta, kuphatikizapo mankhwalawa okhudzana ndi vuto la kupuma (caricamazepine) amagwiritsidwa ntchito ngati mankhwalawa komanso munthawi yomweyo mankhwala a lithiamu, antidepressant kapena antipsychotic). psychology yovutitsa, yomwe imayendetsedwa ndimayendedwe othamanga, ndikuwukira kwamankhwala, pomwe carbamazepine imagwiritsidwa ntchito limodzi ndi antipsychotic, ndipo komanso kuukira kwa schizoaffective psychosis. Kutha kwa mankhwalawa kupondera mawonetsedwe a manic kungathe kufotokozedwa ndikulepheretsa kusintha kwa norepinephrine ndi dopamine.

Pharmacokinetics

Ndi makonzedwe apakamwa, carbamazepine imalowetsedwa m'matumbo oyandikira pafupifupi. Kumwa mankhwala piritsi ndi limodzi ndi kuyamwa pang'onopang'ono. Pakadutsa kamodzi piritsi limodzi la carbamazepine, pafupifupi, ndende yake yambiri imadziwika pambuyo pa maola 12. Pambuyo pa limodzi mlingo wa mankhwala osokoneza bongo a 400 mg, kuchuluka kwa kuchuluka kwa carbamazepine kosasinthika pafupifupi 4.5 μg / ml.

Mukamamwa carbamazepine nthawi yomweyo ndi chakudya, kuchuluka ndi mayamwidwe a mankhwala amakhalabe osasinthika. Kufanana kwa ndende ya plasma kumachitika pakadutsa masabata awiri. Nthawi ya kukwaniritsidwa kwake ndi payekha ndipo imatsimikiziridwa ndi kuchuluka kwa kuphatikizira kwa chiwindi cha encyme kachitidwe ka carbamazepine, mkhalidwe wa wodwalayo isanayambike maphunziro, mlingo wa mankhwala, nthawi yayitali ya mankhwala, komanso hetero-induction ndi mankhwala ena omwe amagwiritsidwa ntchito limodzi ndi carbamazepine. Pali zosiyana zophatikiza pamagawo ofanana azofanana pamankhwala othandizira: odwala ambiri, izi zimayambira 4 mpaka 12 μg / ml (17-50 μmol / l).

Carbamazepine amawoloka chotchinga chachikulu. Popeza chimakhala cholozeka kotheratu, voliyumu yowoneka ndi 0.8-1.9 l / kg.

Kupanga kwa carbamazepine kumachitika mu chiwindi. Njira yofunikira kwambiri yopangira biotransfform ya chinthu ndi kuphatikizika kwa metabolites, chachikulu pakati pawo ndi 10,11-transdiol yomwe imachokera komanso zomwe zimapanga kuphatikizika kwake ndi glucuronic acid. Carbamazepine-10,11-epoxide mu thupi la munthu imadutsa carbamazepine-10,11-transdiol pochita nawo microsomal enzyme epoxide hydrolase. Kuchulukitsidwa kwa carbamazepine-10,11-epoxide, yomwe ndi yogwira metabolite, pafupifupi 30% ya zomwe zili carbamazepine m'madzi a m'magazi. Isoenzyme yayikulu yomwe ikusintha carbamazepine kukhala carbamazepine-10,11-epoxide imadziwika kuti ndi cytochrome P4503A4. Chifukwa cha kagayidwe kachakudya, kagayidwe kena kakang'ono kamapangidwanso - 9-hydroxymethyl-10-carbamoylacridane.

Njira yofunika kwambiri ya carbamazepine metabolism ndi kupangidwa kwa zinthu zosiyanasiyana za monohydroxylated, komanso N-glucuronides, pogwiritsa ntchito isoenzyme UGT2B7.

Hafu ya moyo wa yogwira mankhwala osasinthika pambuyo pakamwa kamodzi pakumwa mankhwala amakhala pafupifupi maola 36, ndipo pambuyo pobwereza mankhwala - pafupifupi maola 16 mpaka 24, kutengera nthawi ya mankhwalawa (izi zikuchitika chifukwa cha kudzimbidwa kwa dongosolo la chiwindi monoo oxygenase). Zimatsimikiziridwa kuti odwala omwe amaphatikiza carbamazepine ndi mankhwala ena omwe amalimbikitsa michere ya chiwindi (mwachitsanzo, phenobarbital, phenytoin), theka la moyo wa mankhwalawa nthawi zambiri siliposa maola 9-10.

Ndi pakamwa makonzedwe a carbamazepine-10,11-epoxide, pafupifupi theka la moyo wake ndi pafupifupi maola 6.

Pambuyo pakamwa kamodzi pa carbamazepine pa mlingo wa 400 mg, 72% ya chinthucho imatulukanso impso ndi 28% kudzera m'matumbo. Pafupifupi 2% ya mankhwalawa amatengedwa mu mkodzo, kuyimira carbamazepine wosasinthika, ndipo pafupifupi 1% mwa mawonekedwe a metabolism a 10.11-epoxy metabolite. Pambuyo pakamwa kamodzi, 30% ya carbamazepine amachotsedwa kudzera mu impso ngati zinthu zomalizira.

Ana amachotsedwa msanga kwa carbamazepine, motero, nthawi zina ndikofunikira kupereka mankhwala okwanira, omwe amawerengedwa potengera kulemera kwa mwana, poyerekeza ndi odwala akuluakulu.

Zambiri pazakusintha kwa pharmacokinetics of carbamazepine mwa odwala okalamba poyerekeza ndi odwala ang'onoang'ono sikupezeka.

The pharmacokinetics of carbamazepine mwa odwala aimpso ndi kwa chiwindi dysfunctions sanaphunzire mpaka pano.

Zizindikiro zogwiritsidwa ntchito

Matenda a khunyu (kupatula kugwidwa mwachisawawa kapena myoclonic, kusowa kwina) - mitundu iwiri ya kukomoka kwachiwiri komanso koyambirira, limodzi ndi kugwidwa kwamatoni, kugwidwa pang'ono ndi zizindikiro zosavuta komanso zovuta, kukomoka kosakaniza (monotherapy kapena kuphatikiza mankhwala ena opha anticonvulsant),
Polyuria ndi polydipsia yokhala ndi matenda a shuga a insipidus, ululu wokhudzana ndi matenda a shuga a polyneuropathy, neuralgia ya trigeminal yokhala ndi sclerosis ambiri, idiopathic trigeminal neuralgia, syndrome yoletsa mowa, matenda osokoneza bongo a glidiopathic glossopharyngeal neuralgia.
Mavuto oyenda m'magawo, kuphatikiza zovuta za schizoaffective, manic-depression psychosis, etc. (kupewa).

Contraindication

Atrioventricular block
Kuphwanya mafupa a hematopoiesis,
Pachimake porphyria (kuphatikizapo mbiri)
Kugwiritsa ntchito limodzi ndi monoamine oxidase zoletsa ndipo kwa masiku 14 atachotsedwa,
Mimba komanso kuyamwa
Hypersensitivity zigawo zikuluzikulu za mankhwalawo, komanso mankhwala osokoneza bongo ofanana ndi yogwira mankhwala (tricyclic antidepressants).

Malinga ndi malangizo, carbamazepine iyenera kugwiritsidwa ntchito mosamala nthawi yomweyo kumwa mowa, odwala okalamba, komanso odwala omwe ali ndi vuto lalikulu la mtima, kuchepetsedwa hyponatremia, kuchuluka kwazowonjezera, kutsekeka kwa mafupa a hematopoiesis pamene akumwa mankhwala (mbiri), chifuwa cham'magazi aakulu aimpso kulephera.

Zotsatira zoyipa

Pogwiritsa ntchito carbamazepine, zotsatirazi mavuto omwe amabwera:

Pakati mantha dongosolo: ataxia, chizungulire, kufooka, kugona, oculomotor kusokonezeka, mutu, nystagmus, paresis malo okhalamo, tics, kugwedezeka, orofacial dyskinesia, choreoathetoid matenda, zotumphukira neuritis, dysarthria, paresthesia, paresis, kufooka kwa minofu,
Mtima wamitsempha: kuchepa kapena kuwonjezeka kwa kuthamanga kwa magazi, kusokonezeka kwa mtima, kusokonekera, bradycardia, arrhythmias, atrioventricular block ndi kukomoka, kukulira kapena kukulira kwa kufooka kwa mtima, kuwonjezereka kwa matenda a mtima (kuphatikizira kuwonjezeka kapena kupezeka kwa kugunda kwa angina), thrombotic thrombosis ,
Matumbo: Kukamwa kowuma, kusanza, nseru, kudzimbidwa kapena kutsekula m'mimba, kupweteka kwam'mimba, stomatitis, glossitis, kapamba,
Genitourinary dongosolo: aimpso kulephera, pakati, nephritis, matenda aimpso (hematuria, albuminuria, oliguria, azotemia / kuchuluka urea), kwamikodzo posungira, kuchuluka kukodza, kusabala / kugona,
Endocrine dongosolo ndi metabolism: hyponatremia, kulemera, edema, kuchuluka kwa prolactin (mwina munthawi yomweyo ndi kukula kwa galactorrhea ndi gynecomastia), kuchepa kwa L-thyroxine (free T4, TK) komanso kuchuluka kwa mahomoni olimbikitsa chithokomiro (kawirikawiri popanda chiwonetsero chazachipatala) motsatana), osteomalacia, kusokonezeka kwa calcium-phosphorism metabolism mu mafupa minofu (kutsitsa kuchuluka kwa 25-OH-cholecalciferol ndi mawonekedwe ionized a calcium mu plasma yamagazi), hypertcholesterolemia,
Machitidwe a minofu ndi mafupa: arthralgia, kukokana, myalgia,
Chiwindi: ntchito yowonjezereka ya kusintha kwa gamma-glutamyl (monga lamulo, ilibe tanthauzo), kuchuluka kwa zochitika za alkaline phosphatase ndi "chiwindi" transaminases, hepatitis (granulomatous, kusakaniza, cholestatic kapena mtundu wa parenchymal (hepatocellular), kulephera kwa chiwindi,
Hemopoietic ziwalo: thrombocytopenia, leukopenia, leukocytosis, eosinophilia, lymphadenopathy, aplastic anemia, pachimake porphyria, agranulocytosis, meippblastic anemia, erythrocytic aplasia, hemolytic anemia, reticulocytosis
Ziwalo zam'maso: Kusintha kwa mawonekedwe a kukwera, kutsika kwa mandimu, kusokonezeka kwa kakomedwe, conjunctivitis, hypo- kapena hyperacusia,
Magawo a m'malingaliro: kuda nkhawa, kuyerekezera zinthu, kusowa chilala, kukhumudwa, kuchita zamtopola, kusokoneza, kukalamba, kuyambitsa psychosis,
Thupi lawo siligwirizana: lupus-ngati syndrome, dermatitis, urticaria, Stevens-Johnson syndrome, erythroderma, poyidermerm necrolysis, photosensitivity, nodular ndi erythema multiforme. Multi-organised-type hypersensitivity reaction with vasculitis, fever, lymphadenopathy, zotupa za pakhungu, eosinophilia, zizindikiro zokhala ngati zamitsempha, zotupa za leukopenia, arthralgia, kusintha kwa chiwindi ndi hepatosplenomegaly ndizotheka (mawonekedwe awa amatha kuchitika mosiyanasiyana). Ziwalo zina, monga impso, mapapu, myocardium, kapamba, ndi m'matumbo, zimathanso kutenga nawo mbali. Osowa kwambiri - aseptic meningitis ndi myoclonus, angioedema, anaphylactic reaction, hypersensitivity zimachitika m'mapapu, zodziwika ndi kufupika kwa thupi, kutentha thupi, chibayo kapena chibayo,
Zina: purpura, zovuta za pakhungu la pakhungu, thukuta, ziphuphu zakumaso, alopecia.

Bongo

Ndi mankhwala osokoneza bongo a carbamazepine, zizindikiro zotsatirazi zimawonedwa makamaka:

Kuchokera pamtima: kukweza kapena kuchepa kwa kuthamanga kwa magazi, tachycardia, matenda a conduction, limodzi ndi kufalikira kwa zovuta za QRS, kumangidwa kwa mtima ndi kukomoka, kuyipitsidwa ndi kumangidwa kwamtima.
kuchokera kumbali ya chapakati mantha dongosolo: mydriasis, kukomoka, kukhumudwa kwa chapakati mantha dongosolo, hypothermia, kusokonezeka m'malo, kuyerekezera zinthu zina, kugona, kugona, kusokonezeka, chikomokere, vuto loyipa, kukomoka, kuyamwa, kuchepa kwa masisitiridwe (hyperreflexia) ndi hyporeflexia (apa), ma psychomotor akuti, dyskinesia, kugwidwa,
Kuchokera pamimba: Kutuluka kwa chakudya kuchokera m'mimba, kusanza, kufooka kwa matumbo,
Kuchokera pakapumidwe: kukhumudwa kwa malo opumira, mapapu a edema,
Kuchokera kwamikodzo dongosolo: madzi kuledzera (dilution hyponatremia) ogwirizana ndi zotsatira za carbamazepine, ofanana ndi zochita za antidiuretic timadzi, kusungiramo madzi, kusungika kwamikodzo, anuria kapena oliguria,
Kusintha kwa magawo a ma labotale: Kukula kwa hyperglycemia kapena metabolic acidosis, kuchuluka kwa gawo la minyewa ya creatine phosphokinase ndikotheka.

Mankhwala enieni a carbamazepine sakudziwika. Njira ya mankhwala osokoneza bongo iyenera kutengera wodwala, ndipo tikulimbikitsidwa kuti aikidwe kuchipatala.

Plasma carbamazepine ndende ayenera kutsimikiza kutsimikiza poizoni wa mankhwala ndi kuwunika kukula kwa bongo.

Ndikofunikira kutsuka m'mimba ndikuthamangitsa zomwe zili mkati mwake, komanso ndikuthanso makala. Kutulutsidwa mochedwa m'matumbo kumachitika kawirikawiri kumathandizira kuti muchepetse kuyamwa, zomwe zingayambitse kuyambiranso kwa zizindikiro za kuledzera panthawi yopuma. Zizindikiro zothandizira, zomwe zimachitika m'chipinda chothandizira kwambiri ndipo zimayendetsedwa ndikuwunika ntchito zamtima ndikusamala mosamala zakusokonekera muyezo wamagetsi wamagetsi, zimaperekanso zotsatira zabwino.

Ndi anapeza ochepa hypotension, mtsempha wa magazi makonzedwe a dobutamine kapena dopamine akusonyezedwa. Ndi kukula kwa arrhythmia, chithandizo chimasankhidwa payekha.Pankhani yakukhudzidwa kosakhudzidwa, ndikulimbikitsidwa kuyendetsa benzodiazepines, mwachitsanzo, diazepam kapena anticonvulsants ena monga paraldehyde kapena phenobarbital (wotsirizirawa amagwiritsidwa ntchito mosamala chifukwa chowonjezera chiopsezo cha kupuma kwamatenda).

Ngati wodwala wakonza kuledzera kwamadzi (hyponatremia), makina amadzimadzi ayenera kukhala ochepa ndipo njira ya 0,9% ya sodium kolorayidi iyenera kuperekedwa mosamala, yomwe nthawi zambiri imalepheretsa kukula kwa ubongo. Hemosorption pa sorberts zamalaala zimapereka zotsatira zabwino. Peritoneal dialysis, hemodialysis, ndi kukakamizidwa diuresis amadziwika kuti sangakwanitse pochotsa carbamazepine m'thupi. Lachiwiri ndi lachitatu pambuyo kuonekera kwa mankhwala osokoneza bongo, Zizindikiro zake zimakulirakulira, zomwe zimafotokozedwa ndi kuchepetsedwa kwa mankhwalawa.

Malangizo apadera

Musanayambe kugwiritsa ntchito Carbamazepine, muyenera kuchita zoyesa: kuwunika mkodzo ndi magazi (kuphatikiza kuwerengetsa ma reticulocytes, mapulateleti), kutsimikiza kwa mulingo wazitsulo, kuchuluka kwa urea ndi ma elekitiroma mu seramu yamagazi. M'tsogolomo, izi zikuyenera kuwunikiridwa sabata iliyonse mwezi woyamba wa chithandizo, kenako - kamodzi pamwezi.

Mukamapereka mankhwala a carbamazepine kwa odwala omwe ali ndi kukhudzika kwa intraocular, nthawi zina ndikofunikira kuiwongolera.

Therapy iyenera kutha ngati leukopenia ikukula pang'onopang'ono kapena leukopenia, yomwe imayendera limodzi ndi matenda am'matenda a matenda opatsirana (osagwiritsa ntchito asymptomatic leukopenia sikufuna kusiya kwa carbamazepine).

Pochiza, chisamaliro chikuyenera kuthandizidwa poyendetsa magalimoto ndi kugwira ntchito zina zowopsa zomwe zimafuna kuti anthu aziganiza mwachangu komanso aziganiza mwachangu.

Mimba komanso kuyamwa

Zimatsimikiziridwa kuti ana omwe abadwa kwa amayi omwe ali ndi vuto la khunyu amakhala pachiwopsezo chachikulu cha zovuta za chitukuko cha intrauterine, kuphatikizapo kukulitsa kusokonezeka. Pali umboni kuti carbamazepine ikhoza kupititsa patsogolo chidwi ichi, ngakhale pakadali pano palibe chitsimikizo chotsimikizika chotsimikiza ichi chomwe chikadapezeka mukuyesedwa kwa mayesero azachipatala omwe amalembedwa ndi mankhwala monga monotherapy.

Pali malipoti a milandu yamatenda obadwa nawo, kusokonezeka, kuphatikizapo spina bifida (osatsekeka kwa ma vertebral arches), komanso zovuta zina zobadwa nazo, monga hypospadias, zolakwika pakukula kwa dongosolo lamtima ndi ziwalo zina, komanso machitidwe a craniofacial.

M'pofunika kugwiritsa ntchito carbamazepine mosamala mwa amayi apakati omwe ali ndi khunyu. Ngati mayi yemwe amamwa mankhwalawa amakhala ndi pakati kapena akukonzekera kukhala ndi pakati, ndipo ngati pakufunika kugwiritsa ntchito carbamazepine pa nthawi yomwe ali ndi pakati, ndikulimbikitsidwa kuyesa mosamala phindu loyembekezeredwa lamankhwala la mayi ndi kuopsa kwa zovuta zomwe zingakhalepo, makamaka munthawi yoyamba kubereka.

Ndi mphamvu yokwanira yamankhwala, odwala omwe ali ndi zaka zakubadwa ayenera kutsegula carbamazepine kokha ngati monotherapy, popeza pafupipafupi kusokonezedwa kwa mwana wosabadwa panthawi yopanga antiepileptic mankhwala kumakhala kwakukulu kuposa ndi monotherapy.

M'pofunika kupereka mankhwala osachepera ogwira mlingo. Muyeneranso kuwunika nthawi zonse zomwe zimapezeka mu madzi a m'magazi.

Odwala ayenera kudziwa kuwopsa kwa kusokonezedwa. Ndikofunikanso kuti apatsidwe matenda oyembekezera.

Pa nthawi ya pakati, kusokonezeka kwa antiepileptic mankhwala kumapangidwa, chifukwa kufalikira kwa matendawa kumatha kukhala ndi zotsatirapo zoyipa kwa mayi ndi mwana wosabadwayo.

Pali umboni kuti carbamazepine imathandizira kuperewera kwa folic acid yomwe imayamba panthawi ya pakati. Izi zitha kuthandizira kukulira kwa vuto la kubadwa kwa ana obadwa kwa amayi omwe amamwa mankhwalawa. Chifukwa chake, musanakhale ndi pakati, pakulimbikitsidwa kuti muthe kuwonjezera Mlingo wa folic acid.

Monga njira yolepheretsa kutaya magazi ochulukirapo mwa ana akhanda, amayi omwe ali m'milungu yotsiriza ya mimba, komanso akhanda, ayenera kupatsidwa vitamini K₁.

Milandu ingapo ya kukhumudwa kwa malo opumira komanso / kapena khunyu mwa ana akhanda omwe amayi awo amaphatikiza carbamazepine ndi anticonvulsants ena afotokozedwa. Milandu ya kutsekula m'mimba, kusanza komanso / kapena kuchepa kwa kudya mwa makanda omwe amayi awo adatenga carbamazepine amapezekanso nthawi zina. Amaganiza kuti izi zimawonetsa kuwonekera kwa akhanda.

Carbamazepine imatsimikiza mu mkaka wa m'mawere, mulingo wake mkati mwake muli 25-60% ya kuchuluka kwa zinthu m'madzi am'magazi. Chifukwa chake, tikulimbikitsidwa kuyerekeza maubwino ndi zotheka chifukwa choyamwitsa panthawi yayitali ndi mankhwala. Ngakhale akumamwa carbamazepine, amayi amatha kuyamwitsa ana awo, pokhapokha ngati amawunikidwa pafupipafupi pazotsatira zoyipa (mwachitsanzo, kusintha kwa thupi lawo pakhungu ndi kugona kwambiri.

Kuyanjana kwa mankhwala osokoneza bongo

Ndi munthawi yomweyo kugwiritsa ntchito carbamazepine ndi mankhwala ena, zosayenera zimachitika:

CYP3A4 zoletsa: kuchuluka kwa plasma kwa carbamazepine,
Dextropropoxyphene, verapamil, felodipine, diltiazem, viloxazine, fluoxetine, fluvoxamine, desipramine, cimetidine, danazole, acetazolamide, nicotinamide (kokha mu milingo yayikulu mwa akuluakulu), macrolides (josamycin, erythromycinycinolelenole ,oleryoleoleole ,olezolecincincinazole ,cinazole, azerezole, azerezole, azere, azerezolezi. ), loratadine, terfenadine, isoniazid, msuzi wa mphesa, propoxyphene, HIV protease zoletsa zomwe zimagwiritsidwa ntchito pochiza HIV: kuchuluka kwa plasma ndende ya carbamazepine,
Pelbamate, fensuximide, phenobarbital, primidone, phenytoin, metsuximide, theophylline, cisplatin, rifampicin, doxorubicin, mwina: valpromide, clonazepam, valproic acid, oxcarbazepine ndi mankhwala azitsamba ndi hypericum hyperfin,
Valproic acid ndi primidone: kusamutsidwa kwa carbamazepine kuchokera ku mapuloteni a plasma ndikuwonjezereka kwa kuchuluka kwa pharmacologically yogwira metabolite (carbamazepine-10,11-epoxide),
Isotretinoin: kusintha kwa bioavailability ndi / kapena chilolezo cha carbamazepine ndi carbamazepine-10,11-epoxide (kuyang'anira plasma ndende ndikofunikira),
Clobazam, clonazepam, primidone, ethosuximide, alprazolam, valproic acid, glucocorticosteroids (prednisone, dexamethasone), haloperidol, cyclosporine, doxycycline, methadone, mankhwala amkamwa okhala ndi progesterone ndipo / kapena mankhwala a antiocological ayenera kuchitapo kanthu ngati njira yotsalira ikugwirira ntchito. fenprocoumone, warfarin, dicumarol), topiramate, lamotrigine, tricyclic antidepressants (imipramine, nortriptyline, amitriptyline, clomipramine), felbamate, clozapine, tiagabin, protease zoletsa, zomwe ntchito mankhwalawa matenda a HIV (ritonavir, indinavir, saquinavir), oxcarbazepine, itraconazole, calcium njira blockers (gulu la dihydropyridones, mwachitsanzo, felodipine), midazolam, levothyroxine, praziquantel, olazapine, risperidone Kuchepetsa kapena kusanja kwathunthu zotsatira zawo, kukonza milingo yoyenera kungafunike),
Phenytoin: kuchuluka kapena kutsika kwa plasma,
Mefenitoin: kuwonjezereka (nthawi zina) pamlingo wamagazi,
Paracetamol: kuwonjezeka kwa chiwopsezo cha chiwopsezo chake pachiwindi ndi kuchepa kwa chidziwitso chothandizira (kufulumizitsa kagayidwe ka paracetamol),
Phenothiazine, pimozide, thioxanthenes, molindone, haloperidol, maprotiline, clozapine ndi tricyclic antidepressants: onjezerani zoletsa zamkati pazokhudzana ndi mantha amthupi ndikuchepetsa mphamvu ya anticonvulsant ya carbamazepine,
Diuretics (furosemide, hydrochlorothiazide): chitukuko chotsatira ndi chiwonetsero cha matenda a hyponatremia,
Osapweteka m'misempha yopuma (pancuronium): kuchepa kwa zotsatira zawo,
Ethanol: kuchepa kwa kulolera kwake,
Ma anticoagulants osadziwika, kupatsirana kwa mahomoni, folic acid: imathandizira kagayidwe kachakudya,
Njira zochitira opaleshoni yotupa (enflurane, halotane, fluorotan): zimathandizira kagayidwe kachakudya ndi chiwopsezo cha zotsatira za hepatoxic,
Methoxiflurane: kukula kwa mapangidwe a nephrotoxic metabolites,
Isoniazid: kuchuluka kwa hepatotoxicity.

Carbamazepine analogues akuphatikizapo: Finlepsin, Finlepsin retard, Tegretol, Tegretol TsR, Zeptol, Karbaleks, Karbapin, Mezakar, Timonil.

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 kwa pakamwa, carbamazepine imatengedwa pafupifupi kwathunthu, kuyamwa kumachitika pang'onopang'ono (kudya zakudya sizimakhudza kuchuluka ndi mayamwidwe). Patatha kamodzi, ndende yayikulu (C_max idakwaniritsidwa pambuyo maola 12. Pambuyo pakamwa kamodzi pa 400 mg ya carbamazepine, mtengo wapakati wa C_maxpafupifupi 4.5 μg / ml. Kuyanjana kwa mankhwalawa kwa plasma kumatheka pambuyo pa masabata 1-2. Nthawi ya kukonzekera kwake ndi payekha ndipo zimatengera kuchuluka kwa kuphatikiza kwa chiwindi cha encyme kudzera mu carbamazepine, kupatsidwa kwa hetero-mankhwala ena omwe amagwiritsidwa ntchito munthawi imodzimodzi, komanso pamankhwala a wodwala musanayambe chithandizo, mlingo wa mankhwalawa komanso nthawi yayitali. Kusiyanitsa kwakukulu pamalingaliro azitsulo zomwe anthu amawerengera amawerengedwa: 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%. Mu madzi osokoneza bongo a cerebrospinal fluid (omwe amatchedwa CSF) ndi malovu, magawo a zinthu amapangidwa molingana ndi kuchuluka kwa zinthu zomwe sizigwira ntchito 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 microsomal enzyme epoxyhydrolase.

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. Zotsatira zamagetsi izi, mphamvu yochepa ya metabolite ina, 9-hydroxymethyl-10-carbamoylacridane, imapangidwanso. 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 wa carbamazepine wosasinthika (T_1/2) pambuyo pakamwa kamodzi pakumwa mankhwalawa ndi 25-65 maola (pafupifupi maola makumi atatu ndi atatu), mutatha kutulutsa - pafupifupi maola 16 mpaka 24 kutengera nthawi ya mankhwalawa (chifukwa cha kufooka kwa machitidwe a monoo oxygenase a chiwindi). Odwala omwe amamwa mankhwala ena omwe amachititsa microsomal chiwindi michere (mwachitsanzo, phenytoin, phenobarbital) nthawi yomweyo, T_1/2 carbamazepine pafupifupi maola 9 mpaka 10. Pambuyo pakamwa kamodzi pa 400 mg ya carbamazepine, 72% ya mankhwalawa amatengedwa mu mkodzo ndi 28% mu ndowe. Pafupifupi 2% ya mankhwalawa amatengedwa mu mkodzo mwa mawonekedwe a carbamazepine osasinthika, pafupifupi 1% mu cellacologically yogwira 10,11-epoxy metabolite. Pambuyo pakamwa limodzi, 30% ya carbamazepine amachotsedwa mu mkodzo mwa njira yotsiriza ya njira ya epoxydiol metabolic.

Pharmacokinetics m'magulu a 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.

Kwa amayi omwe ali ndi zaka zobereka, carbamazepine nthawi iliyonse yomwe angafotokozedwe ngati monotherapy, munthawi yochepetsetsa kwambiri, chifukwa pafupipafupi zolakwika zatsopano za akhanda kuchokera kwa amayi omwe amamwa mankhwala othandizira antiepileptic ndi apamwamba kuposa ndi monotherapy.Kutengera mankhwalawa omwe ndi gawo limodzi la mankhwala othandizira, chiopsezo chokhala ndi vuto lobadwa nacho chitha kuchuluka, makamaka ngati valproate ikuwonjezeredwa ku mankhwala.

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.

Carbamazepine-Akrikhin chithandizo cha amayi apakati omwe ali ndi khunyu iyenera kuchitika mosamala kwambiri. Carbamazepine-Akrikhin ayenera kugwiritsidwa ntchito muyezo wogwira ntchito. Kuwunikira pafupipafupi kuchuluka kwa yogwira mankhwala a m'magazi kumalimbikitsidwa. Pankhani yoyendetsa bwino 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 wokhala ndi vuto lobadwa nalo (mwachitsanzo, kufupika kwa kusokonezeka pamene mukugwiritsa ntchito mlingo wosakwana 400 mg patsiku anali ochepa 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 komanso 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 adalandira carbamazepine antenatally kapena mkaka wa m'mawere, milandu yodwala hepatitis imafotokozedwa, chifukwa chake, ana oterowo amayenera kuyang'aniridwa ndi unyolo wazidziwitso zamavuto am'thupi kuchokera ku hepatobiliary system. Odwala a msinkhu wobereka ayenera kuchenjezedwa za kuchepa kwa mphamvu ya njira zakulera pakamwa pogwiritsa ntchito carbamazepine.

Mlingo ndi makonzedwe.

Poganizira momwe mankhwalawa amagwiritsidwira ntchito ndi mankhwala ena ndi pharmacokinetics a antiepileptic mankhwala, odwala okalamba ayenera kusankhidwa mosamala.

Khunyu
Ngati izi zitheka, carbamazepine-Akrikhin ayenera kuyesedwa ngati monotherapy. Chithandizo chimayamba ndikugwiritsa ntchito mlingo wocheperako tsiku lililonse, womwe umayamba kuwonjezeka pang'onopang'ono mpaka utakwaniritsidwa. Kusankha mulingo woyenera wa mankhwalawa, tikulimbikitsidwa kuti chikhazikitso cha omwe agwira ntchito m'madzi a m'magazi azitsimikizika. Mankhwalawa khunyu, mankhwala a carbamazepine amafunikira, mogwirizana ndi kuchuluka kwa plasma ya carbamazepine pamlingo wa 4-12 μg / ml (17-50 μmol / L). Kupezeka kwa mankhwalawa Carbamazepine-Akrikhin ku mankhwala othandizira antiepileptic kuyenera kuchitika pang'onopang'ono, pomwe Mlingo wa mankhwala omwe amagwiritsidwa ntchito sasintha kapena, ngati pakufunika kutero, akukonzedwa. Ngati wodwalayo wayiwala kumwa mlingo wotsatira wa mankhwalawa munthawi yake, mlingo womwe watayika uyenera kumwedwa nthawi yomweyo mukazindikira izi, ndipo simungathe kumwa mankhwalawo pawiri.

Akuluakulu
Mlingo woyambirira ndi 200-400 mg 1 kapena 2 kawiri patsiku, ndiye kuti mwambowu umakulitsidwa pang'onopang'ono mpaka zithe. Mlingo wokonza ndi 800-1200 mg tsiku lililonse, womwe umagawidwa pawiri Mlingo wa 2 patsiku.

Ana.
Mlingo woyambirira wa ana kuyambira zaka 4 mpaka 15 ndi 200 mg patsiku (muyezo zingapo), ndiye kuti mwambowu umakulitsidwa pang'onopang'ono ndi 100 mg patsiku mpaka zotsatira zabwino zithe.

Mlingo wa makonzedwe a ana a zaka 4-10 - 400-600 mg patsiku, kwa ana azaka 11-15 - 600-1000 mg patsiku (Mlingo zingapo).

Dongosolo lotsatira la dosing likulimbikitsidwa:
Akuluakulu: kumwa koyamba ndi 200-300 mg madzulo, mlingo wokonza ndi 200-600 mg m'mawa, 400-600 mg madzulo.

Ana kuyambira zaka 4 mpaka 10: mlingo woyambirira - 200 mg madzulo, yokonza - 200 mg m'mawa, 200-400 mg madzulo, ana kuyambira zaka 11 mpaka 15: woyamba mlingo - 200 mg madzulo, yokonza mlingo - 200 -400 mg m'mawa, 400-600 mg madzulo. Ana kuyambira zaka 15 mpaka 18: mlingo regimen 800-1200 mg / tsiku, pazipita tsiku - 1200 mg / tsiku.

Kutalika kwa nthawi ya ntchito kumatengera zomwe wodwala akalandira ndi chithandizo. Lingaliro la kusamutsa wodwalayo ku Carbamazepine-Akrikhin, nthawi yayitali yogwiritsidwa ntchito kwake komanso kuthetsedwa kwa mankhwalawa amatengedwa ndi dokotala. Kutheka kuchepetsa kuchuluka kwa mankhwalawa kapena kusiya kumwa mankhwala kumaganiziridwa patatha zaka zitatu kusakhalapo kwathunthu pakugwidwa.

Kuchiza kumayimitsidwa, pang'onopang'ono kuchepetsa mlingo wa mankhwalawa kwa zaka 1-2, moyang'aniridwa ndi EEG. Mu ana, ndi kuchepa kwa mlingo wa tsiku ndi tsiku wa mankhwalawa, kuwonjezeka kwa thupi ndi msinkhu kuyenera kukumbukiridwa.

Trigeminal neuralgia, idiopathic glossopharyngeal neuralgia.
Mlingo woyambirira ndi 200-400 mg patsiku, womwe umagawidwa pawiri. Mlingo woyambirira umachulukitsidwa mpaka ululuwo utazimiririka, pafupifupi mpaka 400-800 mg patsiku (katatu patsiku). Pambuyo pake, mu gawo lina la odwala, chithandizo chitha kupitilizidwa ndi mlingo wochepetsetsa wa 400 mg.

Mlingo woyenera kwambiri ndi 1200 mg / tsiku, pakubwera pakukonzekera kwachipatala, mlingo wa mankhwalawa uyenera kuchepetsedwa pang'onopang'ono mpaka vuto lotsatira lipweteke.

Kwa odwala okalamba ndi odwala omwe amazindikira kwambiri carbamazepine, Carbamazepine-Akrikhin amalembedwa muyeso yoyamba ya 100 mg kawiri pa tsiku, ndiye kuti mlingo umakulitsidwa pang'onopang'ono mpaka matenda a ululu atatsimikiza, omwe amapezeka kawiri pa 200 mg katatu patsiku. Chotsatira, muyenera kuchepetsa pang'ono pang'onopang'ono mlingo.

Ndi trigeminal neuralgia mu gulu ili la odwala, mlingo woyenera kwambiri ndi 1200 mg / tsiku. Mukakonza ululu wamankhwala, ululu womwe umagwiritsidwa ntchito ndi mankhwalawa uyenera kutha pang'onopang'ono mpaka vuto lotsatira lipweteke.

Chithandizo cha kumwa mchipatala.
Wapakati tsiku ndi tsiku ndi 600 mg (200 mg katatu patsiku). Woopsa milandu, m'masiku oyamba, mlingo utha kuwonjezeka mpaka 1200 mg patsiku, womwe umagawidwa 3 Mlingo. Ngati ndi kotheka, Kapbamazepine-Akrikhin akhoza kuphatikizidwa ndi zinthu zina zomwe zimagwiritsidwa ntchito pochotsa zakumwa, kupatula sedative-hypnotics. Pa mankhwala, ndikofunikira kuwunika pafupipafupi zomwe zili m'magazi a carbamazepine. Pokhudzana ndi kukhazikika kwa zoyipa kuchokera ku chapakati komanso zam'magazi azinthu, odwala amayang'aniridwa mosamala kuchipatala.

Pachimake manic zinthu ndi thandizo mankhwala othandizira (kupuma) mavuto.
Mlingo watsiku ndi tsiku ndi 400-1600 mg. Wapakati tsiku ndi tsiku ndi 400-600 mg (mu 2-3 waukulu).

Munthawi yodwala, mankhwalawa amayenera kuchuluka msanga. Ndi mankhwala othandizira okhudzana ndi kupuma, kuti muonetsetse kuti mukulumikizana bwino, kuchuluka kulikonse kwa mankhwalawa kuyenera kukhala kochepa, mlingo wa tsiku ndi tsiku umawonjezeka pang'onopang'ono.

Kuchotsa kwamankhwala.
Kuthana kwadzidzidzi kwa mankhwalawa kumayambitsa kukomoka. Ngati kuli koyenera kusiya mankhwalawa wodwala yemwe ali ndi khunyu, kusintha kwa mankhwala ena antiepileptic kuyenera kuchitika pansi pa chivundikiro cha mankhwala chomwe chawonetsedwa mu milandu yotere (mwachitsanzo, diazepam kutumikiridwa pamitsempha kapena rectally, kapena phenytoin kutumikiridwa mkati.

Zotsatira zoyipa.

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 wachibale bongo wa mankhwala kapena kusinthasintha kwakukulu mu ndende ya yogwira mankhwala mu madzi am`magazi. Zikatero, tikulimbikitsidwa kuwunikira kuchuluka kwa zomwe zimagwira m'madzi a m'magazi.

Poyesa kuchuluka kwa zomwe zimachitika mosiyanasiyana, zotsatirazi zidagwiritsidwa ntchito: nthawi zambiri - 10% kapena kuposerapo, nthawi zambiri - 1-10%, nthawi zina -0.1-1%, kawirikawiri -0.01-0.1%, osowa kwambiri 0.01%

Kukula kwa zoyipa zimachitika ku chapakati mantha dongosolo mwina chifukwa cha wachibale bongo wa mankhwala kapena kusinthasintha kwakukulu mu ndende ya carbamazepine mu madzi am`magazi.

Kuchokera ku dongosolo lamanjenje lalikulu: Nthawi zambiri - chizungulire, ataxia, kugona, kufooka, kupweteka mutu, malo okhala, nthawi zina zosasangalatsa mosasunthika (mwachitsanzo, kunjenjemera, "kuthamanga" kugwedezeka - asterixis, dystonia, tics), nystagmus, kawirikawiri - kuyerekezera zinthu (zowoneka kapena zowoneka), kupsinjika, kulephera kudya, kuda nkhawa, kuchita zinthu mwamtopola, kupsinjika kwa psychomotor, kusokoneza, kuyambitsa matenda a psychosis, orysacial dyskinesia, kusokonekera kwa oculomotor, kusokonezeka kwa mawu (mwachitsanzo dysarthria kapena kuyankhula kwamwano), kusokonekera kwa choreoathetoid, kufalikira. Malemba, paresthesia, kufooka kwa thupi, ndipo paresis wa zizindikiro, n'kovuta kwambiri - chisokonezo kulawa, neuroleptic zilonda matenda, dysgeusia.

Zotsatira zoyipa: Nthawi zambiri - matupa a khungu, nthawi zambiri - urticaria, nthawi zina - exfoliative dermatitis, erythroderma, magulu osiyanasiyana zimachitika mochedwa-Hypersensitivity wa thupi ndi malungo, zotupa za pakhungu, vasculitis (kuphatikizapo erythema nodosum, monga mawonekedwe a khungu la vasculitis), lymphadenopathy, zizindikiro, , arthralgia, leukopenia, eosinophilia, hepatosplenomegaly ndi zizindikiro zosinthika za ntchito ya chiwindi (mawonekedwe awa amapezeka mosiyanasiyana). Ziwalo zina (mwachitsanzo, mapapu, impso, kapamba, myocardium, colon), aseptic meningitis yokhala ndi myoclonus ndi zotumphukira za eosinophilia, anaphylactoid reaction, angioedema, chifuwa cha m'mimba kapena chibayo cha eosinophilic chitha kugwiranso ntchito. Ngati zotupa zomwe zili pamwambazi zikuchitika, kugwiritsa ntchito mankhwalawa kuyenera kuleka, osawoneka - lupus ngati matenda, kuyabwa pakhungu, erythema multiforme exudative (kuphatikizapo Stevens-Johnson syndrome), erythema nodosum, poyizoni epermermal necrolysis (matenda a Lyell), photosensitivity.

Kuchokera ku ziwalo za hemopoietic: Nthawi zambiri leukopenia, thrombocytopenia, eosinophilia, kawirikawiri leukocytosis, lymphadenopathy, kuperewera kwa asidi, agranulocytosis, aplasic anemia, zoona erythrocytic aplasia, megaloblastic anemia, pachimake porphyria, reticulocytemia, reticulocytemia porphyria, porphyria wa mitundu yosiyanasiyana.

Kuchokera m'mimba: Nthawi zambiri mseru, kusanza, pakamwa owonjezera, kuchuluka kwa kufalikira kwa gamma-glutamyl (chifukwa cha kupatsidwa mphamvu kwa chiwindi), komwe nthawi zambiri kumakhala kopanda tanthauzo la matenda, kuchuluka kwa alkaline phosphatase, nthawi zina - kuchuluka kwa transpase ya hepatic, kudzimbidwa, m'mimba kupweteka, kawirikawiri - glossitis, gingivitis, stomatitis, kapamba, hepatitis ya cholestatic, parenchymal (hepatocellular) kapena mtundu wosakanikirana, jaundice, granulomatous hepatitis, chiwindi kulephera, kuwonongeka kwa intrahepatic bile x amakula ndi kuchepa kwa chiwerengero chawo.

Kuchokera pamtima: kawirikawiri - mtima conduction kusokonezeka, kuchepa kapena kuwonjezeka kwa magazi, bradycardia, arrhythmias, atrioventricular block ndi kukomoka, kugwa, kuwonjezeka kapena kukulira kwa mtima kulephera, kukokomeza kwa matenda a mtima (kuphatikiza mwadzidzidzi kapena kuwonjezeka kwa matenda a angina), thrombophlebitis, thromboembolism matenda

Kuchokera pa endocrine dongosolo ndi kagayidwe: Nthawi zambiri - edema, madzimadzi posunga, kulemera, hyponatremia (kuchepa kwa osmolarity wa plasma chifukwa cha zotsatira zofanana ndi zochitika za mahomoni antidiuretic, omwe nthawi zina amatsogolera ku dilution hyponatremia, limodzi ndi ulesi, kusanza, kupweteka mutu, kusokonezeka kwa mitsempha komanso kusokonezeka kwa mitsempha), kawirikawiri - kuwonjezeka kwa kuchuluka kwa prolactin (kungakhale limodzi ndi galactorrhea ndi gynecomastia), kuchepa kwa ndende ya L-thyroxine komanso kuwonjezeka kwa kuchuluka kwa mahomoni olimbikitsa kwambiri a chithokomiro (nthawi zambiri satsatiridwa ndi chipatala) E mawonetseredwe), zipolowe kashiamu-phosphorous kagayidwe mu zimakhala fupa (kuchepa ndende kashiamu ndi 25-0N, cholecalciferol plasma): osteomalacia, kufooka kwa mafupa, hypercholesterolemia (kuphatikizapo mkulu-kachulukidwe lipoprotein mafuta), ndi gipertrigpitseridemiya lymphadenopathy, hirsutism.

Kuchokera ku genitourinary system: kawirikawiri interstitial nephritis, aimpso kulephera, aimpso ntchito (mwachitsanzo, albinuria, hematuria, oliguria, kuchuluka urea / azotemia), kukodza kwamkodzo, kusungika kwamkodzo, kutsika kwa potency, kuchepa kwa spermatogenesis (kuchepa kwa umuna ndi kufalikira).

Kuchokera ku minculoskeletal system: Nthawi zambiri kutopa, kawirikawiri kufooka kwa minofu, arthralgia, myalgia, kapena kukokana.

Kuchokera pamalingaliro: Nthawi zambiri - kusokonezeka kwa malo okhala (kuphatikiza masomphenya osawoneka bwino), kawirikawiri - kusokonezeka kwa kulawa, kuchuluka kwa kukakamira, kutsika kwa mandala, conjunctivitis, kusokonezeka makutu, kuphatikizatinnitus, hyperacusia, hypoacusia, amasintha kuzindikira kwa phula.

Zovuta za kupuma, kawirikawiri - mphamvu ya hypersensitivity yodziwika ndi kutentha thupi, kufupika, chibayo kapena chibayo.

Zambiri zasayansi: kawirikawiri - hypogammaglobulinemia.

Zina: zovuta zamtundu wa khungu, phenura, ziphuphu zakumaso, thukuta, alopecia.

Zochitika zosintha malinga ndi zomwe ena atawona pambuyo pakutsatsa (pafupipafupi sikudziwika)
Matenda owononga chitetezo chamthupi: zotupa mankhwala ndi eosinophilia ndi zokhudza zonse mawonekedwe.

Zovuta za pakhungu ndi minofu yolowera: pachimake kukhathamiritsa chikumbumtima, lichenoid keratosis, onychomadesis.

Matenda opatsirana komanso parasitic: kukonzanso kwa herpes simplex virus mtundu 6.

Kusokonezeka kwa magazi ndi dongosolo la lymphatic: kufooka kwa mafupa.

Kuphwanya kwamanjenje: kukumbukira kwakasokonekera.

Matenda am'mimba: mitengo.

Kuphwanya minofu: zophulika.

Kuchita ndi mankhwala ena.

Onjezani kuchuluka kwa carbamazepine mu madzi a m'magazi verapamil, diltiazem, felodipine, dextropropoxyphene, viloxazine, fluoxetine, fluvoxamine, nefazodone, paroxetine, trazodone, olanzapine, cimetidine, omeprazole, acetazolamide, danazole, desipramine, nicotinamide (akuluakulu, , troleandomycin), ciprofloxacin, styripentol, vigabatrin, azoles (itraconazole, ketoconazole, fluconazole, voriconazole), terfenadine, loratadine, isoniazid, propoxyphene, oxybutynin, dantrolene, ticlopedin ntchito mankhwalawa matenda a HIV (mwachitsanzo, ritonavir) - kusintha kwa mankhwalawa kapena kuwunika kwa carbamazepine mu plasma ndikofunikira.

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

Mankhwala omwe angapangitse kuchuluka kwa carbamazepine-10,11-epoxide m'madzi am'magazi: loxapine, quetiapine, primidone, progabide, vaproic acid, valnoktamide ndi valpromide.

Popeza kuwonjezeka kwa kuchuluka kwa carbamazepine-10,11-epoxide m'madzi am'magazi kungayambitse zovuta (mwachitsanzo, chizungulire, kugona, ataxia, diplopiki), muzochitika izi mlingo wa mankhwala uyenera kusinthidwa komanso / kapena kuchuluka kwa carbamazepine-10.11 -pamwamba mu plasma.

Kuzunza kwa carbamazepine kumachepa phenobarbital phenytoin (kupewa kuledzera phenytoin ndi zochitika woipa subtherapeutic wa carbamazepine analimbikitsa plasma ndende ya phenytoin akhale osapitirira 13 .mu.g / mL pamaso kuwonjezera mankhwala carbamazepine), fosphenytoin, primidone, metsuksimid, fensuksimid, theophylline, aminophylline rifampicin, cisplatin, doxorubicin, zotheka: clonazepam, valpromide, vaproic acid, oxcarbazepine ndi mankhwala azitsamba omwe amakhala ndi St. John wa wort (Hypericum perforatum).

Pogwiritsa ntchito pamodzi ndi mankhwala omwe ali pamwambawa, kusintha kwa carbamazepine kungafunike.

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). Ndi kuphatikiza kwa carbamazepine ndi valproic acid, pazochitika zapadera, chikomokere ndi chisokonezo zimatha kuchitika. Isotretinoin amasintha bioavailability ndi / kapena chilolezo cha carbamazepine ndi carbamazepine-10,11-epoxide (kuwunika kuchuluka kwa carbamazepine mu plasma ndikofunikira).

Carbamazepine akhoza kuchepa ndende mu plasma (kuchepetsa kapena kusintha kwathunthu zotsatira) ndipo amafuna kusintha kwa mankhwalawa: methadone, kukonzekera kwapakamwa komwe kumakhala ndi estrogens ndi / kapena progesterone (kusankha njira zina zakulera ndikofunikira), theophylline, anticoagulants mkamwa (warfarin, fenprocoumone, dicumarol, aceno Umarolum), lamotrigine, topiramate, tricyclic antidepressants (imipramine, amitriptyline, nortriptyline, clomipramine), kupropion, citalopram, mianserin, sertraline, clozapine, felbamate, tiagabine, oxarbazepineivrivratein, antiarbratevirigine, oxarbazitorine, oxarbazitorine, oxarbazitorine, oxarbazitorine ), mankhwala ochizira matenda amitsempha yamagazi ("osakwiya" a calcium calcium blockers (gulu la dihydropyridones, mwachitsanzo, felodipine), simvastatin, atorvastatin, lovastatin, cerivastatin, ivabradine, it rakonazola, levothyroxine, midazolam, olanzapine, ziprasidone, aripiprazole, paliperidone, praziquantel, risperidone, tramadol, ziprasidone, buprenorphine, phenazone, aprepitant, albendazole, imatinib, cyclophosphamide, lapatinib, everolimus, tacrolimus, sirolimus, temsirolimus, tadapafila. 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 kapena metoclopramide, zotsatira zoyipa za zinthu zonse zogwira ntchito 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 mwayi wokhala ndi vuto la hyperpyretic, kusokonekera kwa magazi, kugwidwa, ndi kufa (monoamine oxidase inhibitors ayenera kuthetsedweratu Carbamazepine asanacheze milungu iwiri kapena, ngati vutoli limalola, 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. Ndi munthawi yomweyo kugwiritsa ntchito carbamazepine ndi levetiracetam, nthawi zina, kuwonjezereka kwa poizoni wa carbamazepine kunadziwika.

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 isoniaeid.

Kuchita ndi serological zimachitika. Carbamazepine imatha kubweretsa zotsatira zabodza zodziwitsa kuchuluka kwa perphenazine ndi ntchito yayitali yamadzimadzi. Carbamazepine ndi carbamazepine 10,11-epoxide zimatha kubweretsa zotsatira zabodza zodziwika bwino za kuchuluka kwa antidepressant a tricyclic ndi polarization fluorescence immunoassay.

Mlingo ndi makonzedwe

Mapiritsi a Carbamazepine adapangidwira kuti azigwiritsidwa ntchito pakamwa ndi zakudya.

Zochizira khunyu, akulu ndi mankhwala mankhwala koyamba piritsi 1 mapiritsi 1-2 pa tsiku. Okalamba amalimbikitsidwa kumwa mapiritsi ½ kawiri pa tsiku. Pambuyo pake, mlingo uyenera kuwonjezeka pang'onopang'ono mpaka mapiritsi awiri atengedwa katatu patsiku. Pazipita tsiku lililonse la carbamazepine sayenera kupitilira mapiritsi 6.

Mlingo wa tsiku lililonse wa carbamazepine wa ana osakwana chaka chimodzi ndi mapiritsi a 0,5-1 patsiku, zaka 1-5 - mapiritsi 1-2, zaka 5-10 - mapiritsi 2-3, zaka 10-15 - mapiritsi a 3-5. Mlingo wa tsiku ndi tsiku uyenera kugawidwa pawiri.

Zochizira neuralgia ndi syndromes zopweteka zamitundu yosiyanasiyana, tsiku ndi tsiku ndi mapiritsi awiri a carbamazepine, omwe amagawidwa 2-3. Pakadutsa masiku atatu chiyambireni mankhwalawa, mlingo umatha kuchuluka kwa mapiritsi atatu. Kutalika kwa mankhwalawa ndi masiku 7-10. Pambuyo pakuwongolera mkhalidwe wa wodwalayo kuti adziwe, mlingo uyenera kuchepetsedwa pang'onopang'ono kuti ukhale wothandiza pang'ono. Mlingo wokonza umalimbikitsidwa kwa nthawi yayitali.

Ngati nthenda yochotsa, mogwirizana ndi malangizo, carbamazepine amayenera kumwa piritsi limodzi katatu patsiku. Woopsa milandu, masiku atatu oyamba, kuchuluka kwa mankhwalawa kumalimbikitsidwa - mapiritsi 2 katatu patsiku.

Zochizira polydipsia ndi polyuria mu matenda a shuga insipidus, piritsi limodzi liyenera kumwedwa katatu patsiku.

Zowonjezera

Chithandizo cha carbamazepine ziyenera kuyamba ndi milingo yaying'ono, pang'onopang'ono kuwafikitsa pamlingo wofunikira wazithandizo.

Munthawi ya chithandizo ndi mankhwalawa, tikulimbikitsidwa kukana kugwira ntchito yomwe imafuna kuwonjezeredwa chidwi, chifukwa mankhwalawa amakhudza ntchito za mtima wamanjenje.

Malangizo a carbamazepine akuwonetsa kuti ndikofunikira kusunga mankhwalawo mumdima, ozizira komanso osatheka ndi ana. Moyo wa alumali ndi miyezi 36.

Chenjezo ndi malingaliro

Kuti mukwaniritse zochizira zowonjezera bwino, carbamazepine monga monotherapy imayikidwa ndi Mlingo wocheperako pang'onopang'ono. Kuphatikiza mankhwala kusintha kwa mlingo, m`pofunika kudziwa kuchuluka kwa carbamazepine mu madzi am`magazi. Chithandizo cha carbamazepine sichitha kutha mwachangu, popeza khunyu yatsopano imalembedwa nthawi zambiri. Koma ngati mankhwalawo amafunikira kuchoka, ndiye kuti wodwalayo ayenera kusamutsidwanso mosiyanasiyana kwa mankhwala ena a antiepileptic. Chifukwa chake, pochizira ndi carbamazepine, ndikofunikira kuwunika kuwerengera kwamagazi ndi ntchito ya chiwindi.

Carbamazepine imawonetsa anticholinergic kwenikweni, kotero kukakamiza kwa intraocular kuyenera kuyendetsedwa nthawi yonse ya mankhwalawa. Carbamazepine imatha kuchepetsa njira zakulera zapakati, choncho njira zowonjezera zotetezera pathupi ziyenera kugwiritsidwa ntchito.

Carbamazepine amagwiritsidwa ntchito pofuna kuchiza matenda obwera chifukwa chomwa mowa. Mankhwala amasintha mkhalidwe wa wodwalayo. Koma carbamazepine pazolinga zotere ziyenera kugwiritsidwa ntchito kuchipatala kokha, chifukwa kuphatikiza zinthu ziwiri izi kumabweretsa kukhumudwitsa kwamanjenje.

Mankhwala angakhudze ndende. Chifukwa chake, munthawi yamankhwala omwe mumalandira ndi mankhwalawa, ndikofunikira kupewa zochitika zowopsa, kuyendetsa magalimoto, ndi kugwira ntchito yofunika chidwi.

Kugwirizana kwina ndi mankhwala ena

Kutenga CYP 3A4 isoenzyme inhibitor kungayambitse kuchuluka kwa plasma carbamazepine. Kutenga zinthu za CYP 3A4 isoenzyme limodzi ndi carbamazepine kungayambitse kuchepa kwa chidwi cha antiepileptic mankhwala ndikuthamangitsa kagayidwe kake. Kugwiritsa ntchito nthawi yomweyo kwa carbamazepine ndimankhwala omwe amapangidwa ndi CYP 3A4 isoenzyme kumatanthauza kuphatikizidwa kwa metabolism komanso kuchepa kwa mankhwalawa mu plasma.

Mankhwala omwe amalimbikitsa kuchuluka kwa carbamazepine: ibuprofen, macrolide mankhwala dextropropoxyphene, danazol, fluoxetine, nefazodone, fluvoxamine, trazodone, paroxetine, viloksazin, loratadine, vigabatrin, stiripentol, azoles, terfenadine, quetiapine, loxapine, isoniazid, olanzapine, tizilombo protease zoletsa zochizira HIV, verapamil, omeprazole, acetazolamide, diltiazem, dantrolene, oxybutynin, nicotinamide, ticlopidine. Primidone, cimetidine, valproic acid, desipramine imatha kukhala ndi zotsatira zofanana.

Mankhwala omwe amachepetsa kuchuluka kwa carbamazepine: paracetamol, methadone, tramadol, antipyrine, doxycycline, anti-coagulants (pakamwa), bupropion, trazodone, citalopram, antidepressants (tricyclics), clonazepam, clobazam, lamotrigine, felbamate, ethosuximide, primamidididoneone, imatinib, praziquantel, itraconazole, haloperidol, olanzapine, bromperidol, quetiapine, ziprasidone, ritonavir, saquinavir, ritonavir, indinavir, alprazolam, calcium channel blockers, theophylline, midazolam, perazolam , glucocorticosteroids, levothyroxine wa sodium, everolimus, cyclosporine, progesterone, estrogens.

Kuphatikiza kwa kulingalira.

Isoniazid + carbamazepine - kuchuluka kwa hepatotoxicity.

Levetiracetam + carbamazepine - kuchuluka kwa carbamazepine.

Kukonzekera kwa Carbamazepine + lifiyamu, metoclopramide, haloperidol, thioridazan ndi ma antipsychotic ena - kuwonjezeka kwa zosafunikira zamitsempha.

Carbamazepine + diuretics, monga furosemide, hydrochlorothiazide - kumachitika kwa hyponatremia wokhala ndi zizindikiro zazikulu zamankhwala.

Carbamazepine + minofu relaxants - kuponderezana zochita minofu omasuka, omwe amasiya msanga njira zawo zochiritsira, koma vutoli likhoza kuwongoleredwa ndikuwonjezera mlingo wawo wa tsiku ndi tsiku.

Carbamazepine + madzi a mphesa - kuchuluka kwa carbamazepine mu plasma.