Saroten retard - malangizo a boma ogwiritsira ntchito

3- (10,11-dihydro-5H-dibenzoa, d annulled-5-ylidene) -N, N- dimethylpropane-1-amine hydrochloride

Fomu ya Mlingo:

yaitali zochita makapisozi.

Zogwira ntchito - amitriptyline hydrochloride 56.55 mg (womwe umafanana ndi 50 mg ya amitriptyline).

Othandizira - magawo a shuga 123.074 mg, stearic acid 0,123 mg, shellac (chipolopolo chosapindika) 8.480-14.140 mg, talcum 16.016-29.610 mg, povidone 0,724-1.086 mg.

Kuphatikizika kwa kapisozi kopanda kanthu - gelatin 65.0 mg, utoto wachitsulo wofiyira (E 172) 0.98 mg, titanium dioxide (E 171) 0,33 mg.

olimba, makapisozi a gelatin, opaque, thupi ndi chivindikiro chofiirira. Kukula kwa kapasi No. 2.

Zambiri za Capsule - ma pellets kuyambira pafupifupi oyera mpaka chikasu.

Mankhwala

Amitriptyline ndi mankhwala antidepressant atatu. Amitriptyline ndi amineti wa ma tertiary, omwe amakhala pamalo apakati pa antidepressant atatu, chifukwa pafupifupi imagwira mu vivo monga choletsa kukokoloka kwa serotonin ndi norepinephrine mwa mapangidwe a mitsempha ya Presynaptic. Metabolite yayikulu ya phula nortriptyline imatha kuyambitsa matenda a norepinephrine, komanso imalepheretsa kupezeka kwa serotonin. Amitriptyline ili ndi anticholinergic, antihistaminergic komanso mphamvu yosintha ndipo imatha kuyambitsa zotsatira za catecholamines.

Kuletsa gawo logona kwambiri (BDG) kwachangu kumawerengedwa ngati chizindikiro cha ntchito yoletsa kuponderezana. Ma Tricyclic antidepressants, komanso kusankha ma serotonin ndi ma MAII obwezeretsanso, kupondereza gawo la BDH ndikuthandizira kugona pang'onopang'ono.

Amitriptyline imawonjezera kuchepa kwam'magazi.

Chifukwa cha kusunthika kwake, amitriptyline ndi yofunika kwambiri pothandizira kukhumudwa, limodzi ndi nkhawa, kukwiya, nkhawa komanso kusowa tulo.

Mphamvu ya analgesic ya mankhwalawa sikugwirizana ndi antidepressant, chifukwa analgesia imachitika kale kwambiri kuposa momwe masinthidwe amasinthidwe amtundu uliwonse, ndipo nthawi zambiri chifukwa chotsatira kumwa pang'onopang'ono kuposa momwe mukufunikira kuti mutsimikizire kusintha kwa kusintha kwa thupi.

N`zotheka kuchitira bwino usiku enuresis.

Mafuta Kukonzekera kwamlomo wamankhwala m'mapiritsi kumatsimikizira kukwaniritsa kwapamwamba kwambiri mu seramu ya magazi pambuyo pa 4:00 (t _max = 3.89 ± 1.87 maola, maola 1.03-7.98 maola). Mutatenga 50 mg, phindu la C _max = 30.95 ± 9.61 ng / ml, osiyanasiyana 10.85-45.70 ng / ml (111.57 ± 34.64 nmol / L, osiyanasiyana 39.06-164, 52 nmol / L). Wapakati pakamwa bioavailability ndi 53% (F _abs = 0.527 ± 0.123, osiyanasiyana 0.219-0.756). Kugawa. Plasma kumanga mapuloteni pafupifupi 95%. Amitriptyline ndi metabolite yake yayikulu - nortriptyline - kulowa mkati mwa chotchinga. Kupenda. Amitriptyline metabolism imachitika makamaka ndi demethylation (CYP2C19, CYP3A) ndi hydroxylation (CYP2D6), motsatiridwa ndi conjugation ndi glucuronic acid. Kuphatikiza apo, kagayidwe kake kamadziwika ndi ma polymorphism. Metabolite yofunikira ndi yachiwiri ya amine nortriptyline. Nortriptyline ndi wamphamvu kwambiri woletsa kusintha kwa norepinephrine kuposa serotonin, pomwe amitriptyline imalepheretsa kuthana kwa ma neurotransmitters onse. Zowonjezera metabolites (cis ndi trans-10-hydroxyamitriptyline, komanso cis ndi trans-10-hydroxyinortriptyline) zimadziwika ndi mbiri yofanana ndi ya nortriptyline, yokhala ndi potency yotsika kwambiri. Demethylnortriptyline ndi amitriptyline-N-oxide amapezeka m'madzi am'magazi ochepa okha, omwe kumapeto kwake kulibe ntchito.

Kutupa kumachitika makamaka ndi mkodzo. Kutulutsa kwa amitriptyline kosasinthidwa ndi impso sikungatheke (pafupifupi 2%).

Mwa amayi omwe amayamwitsa ana akhanda, amitriptyline ndi nortriptyline amadutsa mkaka wa m'mawere pang'ono. Chiwerengero cha kuchuluka kwa kuchuluka kwa mkaka ndi seramu yamagazi mwa akazi ndi 1: 2. Chiwerengero cha tsiku lililonse (amitriptyline + nortriptyline) chomwe chimaperekedwa kwa mwana ndi pafupifupi 2% ya amayi amitriptyline, monga kulemera kwa thupi la mwana (mg / kg).

Magulu a plasma okwanira amitriptyline ndi nortriptyline amapezeka mwa odwala ambiri mkati mwa sabata limodzi. Munthawi imeneyi, kuchuluka kwa madzi am'madzi masana kumakhala kofanana ndi amitriptyline ndi nortriptyline pamene amathandizidwa ndi mapiritsi amodzi 3 pa tsiku.

Odwala okalamba amakhala ndi moyo wautali chifukwa cha kuchepa mphamvu kwambiri.

Kuwonongeka kwa chiwindi cha zovuta zina kumachepetsa kuyamwa, komwe kumapangitsa kuti pakhale kuchuluka kwa mankhwalawa m'madzi a m'magazi.

Kulephera kwamkati sikukhudza kinetics ya mankhwalawa.

Polymorphism. Kagayidwe kake ka mankhwalawa kamatengera ma genetic polymorphism (isoenzymes CYP2D6 ndi CYP2C19). Ubwenzi wa Pharmacokinetic / pharmacodynamic. Magetsi a plasma achire pazovuta zazikulu zowonjezera ndi 100-250 ng / ml (≈370-925 nmol / l) (pamodzi ndi amitriptyline ndi nortriptyline).

Kupsinjika kwakukuru, makamaka ndi mawonekedwe a nkhawa, kukalamba, ndi vuto la kugona.

Mavuto azovuta kwa odwala omwe ali ndi schizophrenia osakanikirana ndi ma antipsychotic kuteteza kukokomeza kwa kuyerekezera zinthu m'magazi ndi paranoid mania.

Matenda opweteka kwambiri.

Nocturnal enursis posakhalapo organic matenda.

Contraindication

Hypersensitivity kuti amitriptyline kapena chilichonse cha mankhwala.

Posachedwa anavutika ndi myocardial infaration. Mtundu uliwonse wa blockade kapena mtima arrhythmias, komanso coronary artery insufficiency.

Kuchitira limodzi munthawi yomweyo kugwiritsa ntchito MAOI (Mao inhibitors) kumatsutsana (onani Gawo "Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana").

Kukhazikitsa pamodzi kwa amitriptyline ndi MAOI kumatha kuyambitsa kukula kwa serotonin syndrome (kuphatikiza zizindikiro, komwe kungaphatikizepo kuda nkhawa, chisokonezo, kunjenjemera, myoclonus ndi hyperthermia).

Kuchiza ndi amitriptyline kumatha kuyamba masiku 14 mutasiya kugwiritsa ntchito ma-AMOIs osaneneka, komanso osapitirira tsiku 1 mutachotsa mankhwalawa osinthika moclobemide ndi selegiline.

Kuchiza pogwiritsa ntchito MAOI kumatha kuyamba masiku 14 mutasiya kuyimira amitriptyline.

Kuyanjana ndi mankhwala ena ndi mitundu ina yoyanjana

Mao inhibitors (osasankha, komanso kusankha A moclobemide ndi B selegiline) - chiopsezo cha "serotonin syndrome" (onani gawo "Contraindication").

Sympathomimetics: amitriptyline imatha kupititsa patsogolo mtima wa adrenaline, ephedrine, isoprenaline, norepinephrine, phenylephrine ndi phenylpropanolamine.

Adrenergic neuron blockers: ma tridclic antidepressants amatha kusokoneza antihypertensive zotsatira za guanethidine, betanidine, reserpine, clonidine, ndi methyldopa.

Anticholinergics: ma tridclic antidepressants amatha kuwonjezera zotsatira za mankhwalawa mogwirizana ndi maso, mantha am'kati, matumbo ndi chikhodzodzo, kugwiritsa ntchito nthawi imodzimodziyo pachiwopsezo cha kutsekeka kwamatumbo, hyperpyrexia iyenera kupewedwa.

Mankhwala omwe amachititsa kuti pakhale nthawi yayitali ya QT ya electrocardiograms, kuphatikiza mankhwala a antiarrhythmic (quinidine), antihistamines (astemizole ndi terfenadine), mankhwala ena a antipsychotic (makamaka pimozide ndi sertindole), cacapride, halofantrine ndi sotalol angachitike chifukwa cha kuchuluka kwa zochitika zina. ndi ma tridclic antidepressants.

Othandizira antifungal, monga fluconazole ndi terbinafine, amalimbikitsa kuchuluka kwa antidepressants mu seramu yamagazi ndi kuopsa kwa concomitant kawopsedwe. Pakhala pali zochitika zolephera ndi arrhythmias monga torsade de point.

Kuphatikiza komwe kumafunikira chisamaliro chapadera

Zopsinjika za CNS: amitriptyline imatha kupititsa patsogolo zovuta za mowa, barbiturates, ndi zina zamkati zama neva zomwe zimataya mtima.

Zotsatira za mankhwala ena pa pharmacokinetics of tridclic antidepressants

Ma Tricyclic antidepressants, kuphatikizapo amitriptyline, amakonzedwa ndi chiwindi cytochrome P450 isoenzyme CYP2D6. CYP2D6 imadziwika ndi polymorphism mwa anthu ndipo ntchito yake ikhoza kupanikizidwa ndi ma psychotropic ambiri komanso mankhwala ena, monga antipsychotic, serotonin reuptake inhibitors kupatula citalopram (yomwe ili yofooka kwambiri isoenzyme inhibitor), β-adrenergic blockers, komanso antiarrhythmic . Ma isoenzymes CYP2C19 ndi CYP3A amakhudzidwanso ndi kagayidwe ka amitriptyline.

Ma Barbiturates, monga othandizira enzyme ena, rifampicin ndi carbamazepine, amatha kukulitsa kagayidwe ndipo potero amachititsa kuchepa kwa zomwe zili m'magazi a ma pridclic m'magazi am'magazi komanso kuchepa kwa mphamvu yotsutsana.

Cimetidine ndi methylphenidate, komanso kukonzekera kwa calcium blockers, kumawonjezera milingo ya mankhwala othandiza kwambiri m'magazi a plasma komanso kawopsedwe ofanana.

Ma Tricyclic antidepressants ndi ma antipsychotic onse amakanikizana kagayidwe ka zinthu izi, izi zitha kuchititsa kuchepa kwa madandaulo komanso mawonekedwe a kugwidwa.

Othandizira antifungal monga fluconazole ndi terbinafine ochulukitsa kuchuluka kwa seramu ya amitriptyline ndi nortriptyline. Pamaso pa ethanol, kuchuluka kwa plasma kwa amitriptyline komanso kuchuluka kwa nortriptyline kunakulitsidwa.

Zolemba ntchito

Amitriptyline sayenera kukhazikitsidwa nthawi imodzi ndi Mao inhibitors (onani Magawo "Contraindication" ndi "Kuchita ndi mankhwala ena ndi mitundu ina ya zochitika").

Mukamagwiritsa ntchito mlingo waukulu wa mankhwalawa, mwayi wokhala ndi vuto la mtima komanso misempha yayikulu kwambiri. Kukula kwa zinthu zoterezi ndizotheka ndikugwiritsa ntchito Mlingo wachilengedwe kwa odwala omwe ali ndi matenda amtima.

Amitriptyline iyenera kuthandizidwa mosamala kwa odwala omwe ali ndi vuto losakhazikika, chosunga mkodzo, matenda oopsa a chifuwa, Hyperthyroidism, pakakhala zizindikiro za paranoid, komanso matenda oopsa a chiwindi kapena mtima.

Kukhumudwa kumalumikizidwa ndi chiwopsezo chowonjezeka cha kudzipha. Chiwopsezo chotere chitha kukhalapo mpaka chikhululukiro chokhazikika chikafika pomwepo pa nthawi yamankhwala. Popeza kusintha sikungachitike m'milungu ingapo yoyambirira kapena chithandizo chambiri, odwala ayenera kuyang'aniridwa kwambiri mpaka kusintha koteroko kuchitika. Kuchokera pazomwe zachitika pachipatala, zimadziwika kuti chiopsezo chodzipha chitha kuchuluka magawo oyambirirawo. Odwala omwe ali ndi mbiri ya zochitika zodzipha kapena kuchuluka kwa malingaliro ofuna kudzipha asanalandire chithandizo amadziwika kuti ali pachiwopsezo chachikulu chodzipha kapena kuyesa kudzipha, ndipo ayenera kuyang'aniridwa mosamala pakumwa. Kuwunikira kwa meta kwa mayesero owongolera a placebo olimbana ndi odwala omwe ali ndi vuto lamaganizidwe akuwonetsa kuwopsa kwa kudzipha akamagwiritsa ntchito antidepressants poyerekeza ndi placebo mwa odwala osakwana zaka 25.

Chisamaliro chofunikira chimafunikira pakupereka amitriptyline kwa odwala omwe ali ndi hyperthyroidism kapena iwo omwe akukonzekera kukonzekera kwa chithokomiro, chifukwa kukhazikitsa mtima wa arrhythmias ndikotheka.

Okalamba odwala amatha kutengeka kwambiri ndi matenda a postural hypotension panthawi ya mankhwala ndi amitriptyline.

Odwala omwe ali ndi vuto la kukhumudwa, kusintha kwa matenda mu manic gawo ndikotheka, kuyambira chiyambi cha matenda a manicritis, chithandizo cha amitriptyline chiyenera kusiyidwa.

Mukamagwiritsira ntchito amitriptyline kwa chinthu chododometsa cha schizophrenia, kuwonjezereka kwa zizindikiro za psychotic ndikotheka. Amitriptyline iyenera kuperekedwa limodzi ndi antipsychotic.

Odwala omwe ali ndi vuto losaya kwambiri lakuchepa kwa chipinda chamaso cha maso, kuukira kwa glaucoma chifukwa cha kufooka kwa mafinya kumatha kupweteka.

Kugwiritsa ntchito mankhwala oletsa kupweteka panthawi ya mankhwala omwe ali ndi mankhwala ochepetsa mphamvu ya mankhwalawa kungayambitse chiopsezo cha arrhythmias ndi ochepa hypotension. Ngati ndi kotheka, siyani kugwiritsa ntchito mankhwala amitriptyline masiku ochepa musanachite opareshoni. Ngati opaleshoni yodzidzimutsa ndiyotheka, kudziwitsa anesthetist za chithandizo cha amitriptyline ndizovomerezeka.

Monga mankhwala ena a psychotropic, amitriptyline imatha kusintha chidwi chathupi kuti ikhale ndi insulin komanso glucose, zomwe zimafunikira kukonza kwa antiidiabetesic therapy kwa odwala omwe ali ndi matenda a shuga.

Milandu ya hyperpyrexia yogwiritsira ntchito mankhwala ochepetsa mphamvu ya mankhwala oletsa kupezeka kwa minyewa imanenedwa kuti nthawi yomweyo amakhazikitsidwa ndi mankhwala a anticholinergic kapena antipsychotic, makamaka nyengo yotentha.

Kutha mwadzidzidzi kwa chithandizo chamankhwala atatenga nthawi yayitali kumayambitsa matenda ammutu, malaise, kusowa tulo komanso kusakwiya.

Amitriptyline iyenera kugwiritsidwa ntchito mosamala odwala omwe amatenga SSRIs.

Othandizira: Mapiritsi a mankhwala ali ndi lactose monohydrate. Odwala omwe ali ndi vuto losowa mwanjira ina yamatenda a galactose, kuperewera kwa lactase kapena malabsorption a glucose-galactose sayenera kumwa mankhwalawa.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Amitriptyline sayenera kukhazikitsidwa panthawi yomwe ali ndi pakati, pokhapokha ngati phindu lomwe akuyembekeza limadutsa silidutsa chiopsezo cha mwana wosabadwayo. Kukhazikitsidwa kwa Mlingo wambiri wamankhwala osokoneza bongo wachitatu pa nthawi yachitatu ya mimba kumatha kubweretsa zovuta mu makanda. Mwa ana obadwa kumene, malinga ndi malipoti, milandu yokhazikika yokha yomwe idakhazikika chifukwa cha zotsatira za amitriptyline ndi posungira kwamkodzo chifukwa chodziwikiridwa ndi nortriptyline (an amitriptyline metabolite), ngati mankhwalawa adalembera azimayi oyembekezera asanabadwe.

Mankhwala amapita mkaka wa m'mawere otsika, chifukwa chake zimakhudzanso mwana akamamwa mankhwala othandizira sizingatheke. Mlingo womwe mwana amalandira umakhala pafupifupi 2% ya amayi ake, pafupifupi kulemera kwa mwanayo (mg / kg). Ngati ndi kotheka kuthandizira, kuyamwitsa kumapitirirabe nthawi ya chithandizo cha amitriptyline, koma kuyang'anira mwana ndikofunikira, makamaka masabata 4 atabadwa.

Zizindikiro zogwiritsidwa ntchito

Kukhumudwa (makamaka ndi kuda nkhawa, kukwiya, ndi kusowa kwa kugona, kuphatikizapomu ubwana, endo native, othira kwina, wogwira ntchito, wamanjenje, mankhwala osokoneza bongo, kuwonongeka kwa ubongo), psychizophrenic psychoses, kusokonezeka kwamaganizidwe, kusokonezeka kwa machitidwe (zochitika ndi chidwi), kuvutikira kwausiku (kupatula kwa odwala omwe ali ndi vuto la chikhodzodzo), bulimia amanosa, aakulu ululu syndrome (kupweteka kwambiri kwa odwala khansa, migraine, matenda amitsempha, kupweteka kwa nkhope, postherpetic neuralgia, post-traumatic neuropathy ia, matenda ashuga kapena zotumphukira neuropathy, mutu, migraine (kupewa), zilonda zam'mimba ndi duodenum.

Momwe mungagwiritsire ntchito: Mlingo ndi njira ya chithandizo

Mkati, osafuna kutafuna, mutangodya (kuchepetsa mkwiyo wa m'mimba). Mlingo woyamba wa akulu ndi 25-50 mg usiku, ndiye kuti mankhwalawa amawonjezereka masiku 5-6 kufika pa 150-200 mg / tsiku mu 3 Mlingo (gawo lalikulu la mankhwalawo limatengedwa usiku). Ngati palibe kusintha mkati mwa milungu iwiri, mlingo wa tsiku ndi tsiku umachulukitsidwa mpaka 300 mg. Ngati zizindikiro za kukhumudwa zitha, mankhwalawa amachepetsedwa kukhala 50-100 mg / tsiku ndipo chithandizo chimapitilizidwa kwa miyezi itatu. Mukakalamba, ndimavuto osaneneka, mlingo wa 30-100 mg / tsiku (usiku) umalembedwa, atatha kupeza chithandizo chamankhwala, amasinthana ndi mlingo wochepa - 25-50 mg / tsiku.

Intramuscularly kapena iv (jekeseni pang'onopang'ono) pa mlingo wa 20-40 mg 4 pa tsiku, pang'onopang'ono m'malo mwa kumeza. Kutalika kwa chithandizo sikupitilira miyezi 6-8.

Ndi usiku ma enursis mu ana a zaka 6 - 10 - 20 mg / tsiku usiku, zaka 11-16 - 25-50 mg / tsiku.

Ana ngati antidepressant: kuyambira zaka 6 mpaka 12 - 10-30 mg kapena 1-5 mg / kg / tsiku pang'ono, muubwana - 10 mg 3 katatu patsiku (ngati kuli kotheka, mpaka 100 mg / tsiku).

Pofuna kupewa migraine, kupweteka kwakanthawi kwamatenda a neurogenic (kuphatikizapo mutu wotalika) - kuyambira 12,5-25 mpaka 100 mg / tsiku (mlingo waukulu umatengedwa usiku).

Zotsatira za pharmacological

Ma antidepressant (tricyclic antidepressant). Ilinso ndi ma analgesic (apakatikati), H2-histamine-blocking ndi antiserotonin kanthu, amathandizira kuthetsa kugona kwamikodzo usiku ndikuchepetsa chilakolako chofuna kudya.

Ili ndi mphamvu yozungulira komanso yapakati pa anticholinergic, chifukwa chogwirizana kwambiri ndi ma m-cholinergic receptors, mphamvu yolimba yokhudzana ndi ubale wa H1-histamine receptors, ndi alpha-adrenergic blocking. Ili ndi mphamvu ya antiarrhythmic mankhwala a subgroup Ia, monga quinidine mu achire Mlingo, imachepetsa kuchepetsa kwamitsempha yamagazi (ngati mankhwala osokoneza bongo amatha kuyambitsa chipika cha intraventricular block).

Kupanga kwa antidepressant kanthu kumalumikizidwa ndi kuwonjezeka kwa kuchuluka kwa norepinephrine mu ma synapses ndi / kapena serotonin pakati chapakati mantha dongosolo (kuchepa kwawo kosinthira mayamwidwe). Kudzikundikira kwa ma neurotransmitters amenewa kumachitika chifukwa choletsa kutembenuka kwawo kosakanikirana ndi ma membala am'mimba a presynaptic neurons. Pogwiritsa ntchito nthawi yayitali, amachepetsa magwiridwe antchito a beta-adrenergic ndi serotonin receptors mu ubongo, imasinthanso kufalikira kwa adrenergic ndi serotonergic, ndikubwezeretsanso malire a machitidwe awa, omwe amasokonezeka m'maiko ovuta. M'mayiko omwe muli ndi nkhawa, amachepetsa nkhawa, kukwiya ndi zofooka.

Kapangidwe ka antiulcer kanthu chifukwa cha luso lotchinga ma H2-histamine receptors m'matumbo am'mimba, komanso kukhala ndi sedative and m-anticholinergic effect (peptic ulcer of the m'mimba ndi zilonda zam'mimba, zimachepetsa ululu komanso zimathandizira kuchiritsa zilonda zam'mimba.

Kuchita bwino pa bedwetting kumachitika makamaka chifukwa cha ntchito ya anticholinergic, zomwe zimapangitsa kukulitsa kwa chikhodzodzo, kusuntha mwachindunji kwa beta-adrenergic, zochitika za alpha-adrenergic agonists, limodzi ndi kuchuluka kwa kamvekedwe ka sphincter, komanso kupindika kwapakati pa serotonin.

Imakhala ndi ma analgesic apakati, omwe amakhulupirira kuti amasintha chifukwa cha kusuntha kwa monoamines mkati mwa mantha amitsempha, makamaka serotonin, komanso momwe amawonongera maselo a opioid.

Makina a zochita za bulimia amanosa sakudziwika bwino (atha kukhala ofanana ndi omwe ali ndi nkhawa). Zovuta zakuchuluka za mankhwalawa mu bulimia mwa odwala onse popanda kupsinjika ndi kupezeka kwake zimawonetsedwa, pomwe kuchepa kwa bulimia kumatha kuonedwa popanda kufooka mwanjira ina yocheperako.

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

Mphamvu yotsitsa ikukula mkati mwa masabata awiri atatha kugwiritsa ntchito.

Zotsatira zoyipa

Zotsatira za anticholinergic: kusawona bwino, kufooka malo ogona, mydriasis, kuchuluka kwa kukakamira (kokha mwa anthu omwe ali ndi chiyembekezo cham'tsogolo - mbali yaying'ono ya chipinda cham'kati), tachycardia, pakamwa pouma, chisokonezo, kupunduka, kuyerekezera m'mimba, kuvulala kwamatumbo thukuta latsika.

Kuchokera ku dongosolo lamanjenje: kugona, asthenia, kukomoka, kuda nkhawa, kusokonezeka, kuyerekezera zinthu zina (makamaka odwala ndi odwala omwe ali ndi matenda a Parkinson), nkhawa, kukwiya, nkhawa zamagalimoto, manic state, hypomanic state, ukali, kusokonezeka kwa kukumbukira, kutsitsa , kuchuluka kwa nkhawa, kuchepa kwa chidwi, kusowa tulo, "maloto" osokoneza bongo, kugona, asthenia, kutsegula kwa zizindikiro za psychosis, mutu, myoclonus, dysarthria, kugwedezeka Oil minofu, makamaka mikono, manja, mutu ndi lilime, neuropathy zotumphukira (paresthesia), myasthenia gravis, myoclonus, ataxia, syndrome extrapyramidal, mathamangitsidwe ndi intensification a khunyu, akugwirira chimasintha.

Kuchokera ku CCC: tachycardia, palpitations, chizungulire, orthostatic hypotension, kusintha kwa chisangalalo cha ECG (ST interval kapena T wave) mwa odwala opanda matenda a mtima, arrhasmia, kuthamanga kwa magazi (kuchepa kapena kuchuluka kwa magazi), intraventricular conduction kusokoneza (kukulira kwa zovuta) QRS, kusintha kosinthika kwa PQ, blockade ya miyendo yake.

Kuchokera pamimba yodyetsera: nseru, kusowa hepatitis (kuphatikizapo kuwonongeka kwa chiwindi ndi cholendatic jaundice), kutentha kwa mtima, kusanza, gastralgia, kuchuluka kwa chilimbikitso ndi thupi kapena kuchepa kwa chilimbikitso cha thupi ndi thupi, stomatitis, kusintha kwa kakomedwe, kutsegula m'mimba, kuyambitsa lilime.

Kuchokera ku dongosolo la endocrine: kuwonjezeka kwa kukula (edema) kwa ma testicles, gynecomastia, kukula kwa kukula kwa tiziwalo ta mammary, galactorrhea, kuchepa kapena kuwonjezeka kwa libido, kuchepa kwa potency, hypo- kapena hyperglycemia, kuchepa kwa maselo a vasopressin).

Kuchokera ku ziwalo za hemopoietic: agranulocytosis, leukopenia, thrombocytopenia, purpura, eosinophilia.

Thupi lawo siligwirizana: zotupa pakhungu, kuyabwa kwa khungu, urticaria, photosensitivity, kutupa kwa nkhope ndi lilime.

Zina: kusowa kwa tsitsi, tinnitus, edema, hyperpyrexia, zotupa zamitsempha, kusungika kwamkodzo, polakiuria, hypoproteinemia.

Zizindikiro zochotsa pamimba: kusiya mwadzidzidzi pambuyo povulaza kwa nthawi yayitali - kusanza, kusanza, kupweteka m'mimba, kupweteka m'mimba, kusokonezeka kwa tulo, maloto osazolowereka, kukomoka kopanda tanthauzo, kupweteka kwapang'onopang'ono pambuyo povomerezeka kwa nthawi yayitali - kusokonekera, nkhawa zamagalimoto, kusokonezeka kwa tulo, maloto osazolowereka.

Kulumikizana ndi kayendetsedwe ka mankhwala sikunakhazikitsidwe: lupus-like syndrome (nyamakazi yosamukasamu, maonekedwe a antinuclear antibodies and a rheumatoid factor), chiwopsezo cha ntchito ya chiwindi, Ageusia.

Momwe zimachitikira kukhudzana ndi iv: thrombophlebitis, lymphangitis, kutentha kwa moto, thupi lawo siligwirizana. Zizindikiro Kuchokera kumbali ya chapakati mantha dongosolo: kugona, stupor, chikomokere, kuyerekezera zinthu m`maganizo, nkhawa, psychomotor mukubwadamuka, kutsika luso lozama, kusokonezeka, chisokonezo, dysarthria, hyperreflexia, minofu kuuma, choreoathetosis, khunyu.

Kuchokera ku CCC: kuchepa kwa magazi, tachycardia, arrhythmia, kusokonezeka kwa intracardiac conduction, kusintha kwa ECG (makamaka QRS), kugwedezeka, kulephera kwa mtima, mawonekedwe a tricyclic antidepressant kuledzera, mantha, kulephera kwa mtima nthawi zina.

Zina: kupuma, kupuma movutikira, cyanosis, kusanza, hyperthermia, mydriasis, kuchuluka thukuta, oliguria kapena anuria.

Zizindikiro zimakhazikika patatha maola 4 pambuyo pa bongo, kufikira patatha maola 24 komanso masiku anayi otsiriza. Ngati mankhwala osokoneza bongo amakayikiridwa, makamaka mwa ana, wodwala ayenera kuchipatala.

Chithandizo: ndi pakamwa: kutsuka kwamatumbo, kugwiritsa ntchito makala othandizira, operewera komanso othandizira, pogwiritsa ntchito mphamvu ya anticholinergic (kuchepa kwa kuthamanga kwa magazi, arrhythmias, chikomokere, kukomoka kwa myoclonic) - makonzedwe a cholinesterase inhibitors ; Kuwongolera kwa ntchito za CCC (kuphatikiza ECG) kwa masiku 5 akuwonetsedwa (kuyambiranso kumatha kuchitika patatha maola 48 kapena mtsogolo), mankhwala othandizira, kupuma kwamphamvu, komanso njira zina zothandizira kuyambiranso. Hemodialysis ndi kukakamiza diuresis sikuthandiza.

Malangizo apadera

Musanayambe chithandizo, kayendetsedwe ka magazi kofunikira ndikofunikira (kwa odwala omwe ali ndi vuto lochepa kapena lolemetsa amatha kuchepa kwambiri), munthawi ya chithandizo ndikofunikira kuwongolera magazi aziphuphu (nthawi zina, agranulocytosis imatha kupezeka, chifukwa chake imalimbikitsidwa kuyang'anira chithunzi cha magazi, makamaka ndi kuchuluka kwa kutentha kwa thupi, kukulira kwa zizindikiro zofanana ndi chimfine ndi zilonda zapakhosi), ndi chithandizo cha nthawi yayitali - kuyang'anira ntchito za CVS ndi chiwindi. Okalamba ndi odwala omwe ali ndi matenda a CCC, kuwongolera kuthamanga kwa mtima, kuthamanga kwa magazi, ECG ikuwonetsedwa. Kusintha kwakanthawi kochepa kumawoneka pa ECG (kusintha kwa T wave, kukhumudwa kwa gawo la S-T, kukulira kwa QRS tata).

Kugwiritsa ntchito kwa makolo kumatheka kokha kuchipatala, moyang'aniridwa ndi dokotala, ndikupumula pabedi masiku oyamba a zamankhwala.

Kusamala kumafunikira pamene mwadzidzidzi akusunamira pamalo ofukula kuchokera pakama kapena pampando.

Pa mankhwala, Mowa uyenera kupatula.

Musaperekane kale kuposa masiku 14 atachotsedwa ma MA inhibitors, kuyambira pa Mlingo wochepa.

Ndi kutha kwadzidzidzi kwa makonzedwe atatenga nthawi yayitali, kukula kwa matenda a "achire" ndikotheka.

Amitriptyline mu Mlingo pamwambapa 150 mg / tsiku amachepetsa kugunda kwa ntchito yogwira mtima (chiwopsezo cha kugwidwa kwa khunyu kwa odwala oyembekezeredwa, komanso pamaso pazinthu zina zomwe zimayambitsa kupezeka kwa matenda opatsirana, mwachitsanzo, kuwonongeka kwa ubongo kwa etiology iliyonse, kugwiritsa ntchito mankhwala a antipsychotic (antipsychotic) pa kukana ethanol kapena kusiya mankhwala omwe ali ndi anticonvulsant katundu, monga benzodiazepines.

Kupsinjika kwakukulu kumadziwika ndi chiopsezo chodzipha, chomwe chitha kupitilira mpaka kukhululukidwa kwakukulu. Pankhaniyi, kumayambiriro kwa chithandizo, kuphatikiza ndi mankhwala ochokera ku gulu la benzodiazepine kapena mankhwala a antipsychotic ndikuwunikira pafupipafupi (kuwalangiza odalirika kuti asunge ndikutulutsa mankhwala).

Odwala omwe ali ndi vuto la cyclic, panthawi yovutitsa, mikhalidwe ya manic kapena hypomanic imatha kuchitika pakubwera kwa mankhwala (kuchepetsa mankhwala kapena kusiya mankhwala ndi mankhwala a antipsychotic ndikofunikira). Pambuyo pakuleka izi, ngati zikuwonetsa, chithandizo chochepa kwambiri chitha kuyambiranso.

Chifukwa cha zotsatira za mtima ndi vuto, kusamala kumafunikira pochiza odwala a thyrotoxicosis kapena odwala omwe amalandila kukonzekera kwa mahomoni a chithokomiro.

Kuphatikiza ndi mankhwala a electroconvulsive, amangoikidwa ndi kuyang'aniridwa mosamala kuchipatala.

Mwa odwala omwe ali ndi chiyembekezo komanso odwala okalamba, zimatha kuyambitsa kupangika kwa psychoses ya mankhwala, makamaka usiku (atasiya kumwa mankhwalawa, amawonekera patangotha masiku ochepa).

Zingayambitse kufooka kwamatumbo, makamaka mwa odwala omwe ali ndi kudzimbidwa, okalamba kapena odwala omwe amakakamizidwa kuti agone.

Asanayambe opaleshoni wamba, opaleshoni yachipatala ayenera kuchenjezedwa kuti wodwala akutenga amitriptyline.

Chifukwa cha anticholinergic zochita, kuchepa kwa lacilation komanso kuchuluka kwa ntchofu mu kapangidwe ka madzi osungunuka ndikotheka, zomwe zingayambitse kuwonongeka kwa corneal epithelium mwa odwala omwe amagwiritsa ntchito magalasi.

Pogwiritsa ntchito nthawi yayitali, kuwonjezeka kwa zochitika za mano kumawonedwa. Kufunika kwa riboflavin kungakulitsidwe.

Kafukufuku wokhudzana ndi kubereka nyama adawonetsa kuyipa kwa mwana wosabadwayo, ndipo maphunziro oyenerera komanso okhwima mwa amayi apakati sanatengepo. Mwa amayi apakati, mankhwalawa amayenera kugwiritsidwa ntchito pokhapokha ngati phindu lomwe lingapereke kwa mayi likupereka chiwopsezo kwa mwana wosabadwayo.

Imalowa mkaka wa m'mawere ndipo imapangitsa kugona mwa makanda.

Pofuna kupewa kufalikira kwa matenda obwera chifukwa chongobadwa kumene (kuwonetsedwa ndi kupuma, kugona, matumbo, kuchuluka kwakuchuluka, Hypotension kapena matenda oopsa, kunjenjemera kapena kutenthedwa kwa zinthu), amitriptyline imathetsedwa pang'onopang'ono masabata 7 mwana asanabadwe.

Ana amamvera kwambiri bongo wambiri, womwe ungawonedwe wowopsa komanso wowopsa.

Munthawi yamankhwala, chisamaliro chikuyenera kuchitika poyendetsa magalimoto ndi kuchita zina zomwe zingakhale zoopsa zomwe zimafuna kuti chidwi ndi kuthamanga kwa ma psychomotor kuchitike.

Ndi chisamaliro

Matenda opatsirana, kusungika kwamkodzo, matenda a chiwindi, matenda amchiberekero, matenda a chithokomiro, matenda obwera chifukwa cha kupuma (pambuyo poti asokonezeke kwambiri), intraocular matenda oopsa (mwa anthu omwe ali ndi vuto lakumaso - mbali yaying'ono

chipinda cham'mbuyo), uchidakwa wolephera, chotupa cha m'matumbo a hematopoiesis, kupindika kwa chikhodzodzo, kuchepa kwa chifuwa, kutsika kwa magalimoto ntchito ya m'mimba thirakiti.

Mlingo ndi makonzedwe

Mukamatenga makapisozi a Saroten Retard, bwino bwino kumamwa ndi madzi. Makapisozi, komabe, amatha kutsegulidwa ndipo zomwe zili mkati mwake (ma pellets) zimatha kumwedwa ndi pakamwa. Mapelesi sayenera kutafunidwa.

Chigawo chokhumudwitsa. Mavuto azovuta mu schizophrenia. Imafotokozedwa kamodzi pa tsiku kwa maola 3-4 asanagone.

Kuchiza ndi Saroten Retard kuyenera kuyambitsidwa ndi kapisozi 50 mg imodzi yamadzulo. Ngati ndi kotheka, pakatha sabata, tsiku ndi tsiku mlingo ungathe kuwonjezeka pang'onopang'ono mpaka mapiritsi 2 - 3 madzulo (100-150 mg). Mukakwaniritsa kusintha kwakukulu, mlingo wa tsiku ndi tsiku umatha kuchepetsedwa pang'ono, mwinanso mpaka makapisozi a 1-2 (50-100 mg / tsiku).

Vutoli limapangitsa pakapita milungu iwiri kapena inayi.Chithandizo cha kupsinjika maganizo ndichizindikiro, chifukwa chake, tikulimbikitsidwa kupitiliza kugwiritsa ntchito mankhwala ochepetsa nkhawa, kuphatikizapo Saroten Retard, mutakwanitsa kutchulidwa kokwanira kwa nthawi yayitali - mpaka miyezi isanu ndi umodzi kuti musabwererenso. Odwala omwe ali ndi vuto la kubwerezabwereza (unipolar), makonzedwe a nthawi yayitali a Saroten Retard angafunike, mpaka zaka zingapo, mukukonzekera Mlingo womwe umakhala ndi zotsutsa.

Odwala okalamba (a zaka zopitilira 65) Mmodzi kapisozi 50 mg wamadzulo.

Ntchito ya impso

Amitriptyline akhoza kutumikiridwa mwachizolowezi Mlingo wa odwala ndi aimpso kulephera.

Kuchepa kwa chiwindi

Muyenera kusamala mukamagwiritsa ntchito mankhwalawa odwala omwe ali ndi vuto la chiwindi, ma seramu amitriptyline ayenera kuyang'aniridwa ngati kuli kotheka.

Mukamaliza chithandizo, kusiya mankhwala kumalimbikitsidwa kuti zizichitika pang'onopang'ono kwa milungu ingapo kuti mupewe kusintha kwakakhudzidwe ndi "kusiya" (onani gawo "Zotsatira zoyipa").

Gwiritsani ntchito pa nthawi yoyembekezera kapena mkaka wa m'mawere

Amitriptyline sayenera kukhazikitsidwa panthawi yomwe ali ndi pakati, pokhapokha ngati phindu lomwe akuyembekeza limadutsa silidutsa chiopsezo cha mwana wosabadwayo. Kukhazikitsidwa kwa Mlingo wambiri wamankhwala osokoneza bongo wachitatu pa nthawi yachitatu ya mimba kumatha kubweretsa zovuta mu makanda. Mwa ana obadwa kumene, malinga ndi malipoti, milandu yokhazikika yokha yomwe idakhazikitsidwa chifukwa cha zotsatira za amitriptyline ndi kusungika kwamikodzo chifukwa cha zotsatira za nortriptyline (metabolite ya amitriptyline), ngati mankhwalawa adalembera azimayi oyembekezera asanabadwe.

Bongo

Zizindikiro zamtima: arrhythmias (ventricular tachyarrhythmias, flutter-flicker, ventricular fibrillation). ECG nthawi zambiri imawonetsa kupendekera kwakutali kwa PR, kukulitsa kwa QRS zovuta, kukulitsa kwa QT, kukulitsa kapena kutembenuza kwa T wave, kukhumudwa kwa gawo la ST, komanso magawo osiyanasiyana amitunda ya mtima kufikira kumangidwa kwa mtima. Kuchulukitsa kwa QRS kuphatikiza kumafanana bwino ndi kuwopsa kwa poizoni pambuyo pa Mlingo wambiri. Kulephera kwa mtima, ochepa hypotension, kugunda kwa mtima kumayamba. Metabolic acidosis ndi hypokalemia zikuchulukirachulukira. Pambuyo kudzutsanso chisokonezo, nkhawa zodukiza, kuyerekezera zinthu m'maganizo ndi ataxia.

Chithandizo: Kugonekedwa kuchipatala (m'chipinda chothandizira kwambiri). Mankhwalawa ndiwachizindikiro komanso amandithandiza. Kutulutsa kwam'mimba ndi zotupa, ngakhale pambuyo pake pakukhazikitsa, komanso kukonzekera kwa kaboni kumasonyezedwa. Ndikofunikira kuyang'anitsitsa vutolo, ngakhale ndi vuto lofatsa. Onaninso za kuzindikira, momwe zimakhalira, zimachitika bwanji, kuthamanga kwa magazi ndi ntchito ya kupuma, pakanthawi kochepa muyenera kudziwa zomwe zili zamagetsi amagetsi ndi mpweya. Onetsetsani kuti panjira ngati pakufunika kutero ndi intubation. Mokulira, chithandizo chokhala ndi mpweya wokwanira chikulimbikitsidwa kuti mupewe kupuma kwamphamvu. Kuwunikira kopitilira ECG kuyenera kuchitika mkati mwa masiku 3-5. Ndi kukulira kwa nthawi ya QRS, kulephera kwa mtima, komanso kusintha kwamitsempha yamagazi, mbali ya alkaline ikhoza kukhala yothandiza (makonzedwe a bicarbonate solution kapena hyperventilation) mothandizidwa mwachangu ndi hypertonic solution ya sodium chloride (100-200 mmol Na +). Ndi ventricular arrhythmias, n`zotheka kugwiritsa ntchito mankhwala achikhalidwe cha antiarrhythmic, monga 50-100 mg wa lidocaine (1-1,5 mg / kg) kudzera mu kulowetsedwa mwachangu kwa 1-3 mg / min.

Ngati ndi kotheka, ikani mtima ndi kupunduka. Olondola kuzungulira kwa magazi mothandizidwa ndi plasma choloweza, ndipo ovuta kwambiri, mwa kulowetsedwa kwa dobutamine (poyamba pamlingo wa 2-3 μg / kg pa mphindi) ndi kuchuluka kwa mankhwalawa, kutengera mphamvu yake. Kukondoweza ndi kupweteketsa mtima kumatha kuyimitsidwa ndi oyang'anira a diazepam.

Kuzindikira kwambiri Mlingo makamaka payekha. Nthawi yomweyo, ana amakonda kwambiri kukulitsa zochitika za mtima ndi khothi.

Akuluakulu, Mlingo wa 500 mg ungayambitse kuledzera kwambiri, pomwe Mlingo wochepera 1000 mg ndi woopsa.

Zotsatira zoyipa

Amitriptyline imatha kuyambitsa zovuta zofanana ndi zomwe zimachitika tikamamwa mankhwala ena atriceclic antidepressants. Zina mwazotsatira zomwe zili pansipa (kupweteka mutu, kunjenjemera, kusowa chidwi, kudzimbidwa, komanso kuchepa kwa libido) zitha kukhalanso zizindikiro za kukhumudwa ndipo nthawi zambiri zimatsika pomwe boma lokhumudwa likukwera.

Misonkhano yotsatirayi imagwiritsidwa ntchito pamndandanda womwe uli pansipa. WHO inakonda mawu a MedDRA pamakalasi a system system: nthawi zambiri (> 1/10), nthawi zambiri (> 1/100, 1/1000, 1/10 000,

Mogwirizana ndi mankhwala ena:

Amitriptyline imatha kukulitsa mphamvu ya mowa, barbiturates ndi zinthu zina zomwe zimachepetsa dongosolo lamanjenje lamkati.

Kugwiritsa ntchito limodzi ndi MaO inhibitors kungayambitse vuto lalikulu kwambiri. Popeza amitriptyline imathandizira zochita za anticholinergics, kuyendetsa pamodzi munthawi yomweyo kuyenera kupewedwa.

Zimalimbikitsa machitidwe a sympathomimetics a adrenaline, norepinephrine, ndi zina, chifukwa cha izi, mankhwala opezeka pano omwe ali ndi zinthuzi sayenera kugwiritsidwa ntchito munthawi yomweyo ndi amitriptyline.

Kuchepetsa mphamvu ya antihypertensive ya clonidine, betanidine, ndi guanethidine.

Mukaphatikizana ndi ma antipsychotic, muyenera kukumbukira kuti ma tridclic antidepressants ndi ma antipsychotic onse amalepheretsa kagayidwe kalikonse, kutsitsa njira yolimbirana.

Ndi ntchito munthawi yomweyo ndi cimetidine, n`zotheka kuchepetsa kagayidwe ka amitriptyline, kuonjezera ndende yake mu madzi am`magazi komanso kukula kwa poizoni.

Mankhwala

Amitriptyline ndi gawo la gulu la atatu. Awa ndi mtundu wapamwamba wa amine, womwe ndi chinthu chapamwamba kwambiri m'gululi, chifukwa umakhala wofanana mu vivo monga choletsa serotonin ndi norepinephrine zomwe zimapangidwa ndi preynaptic nerve receptors.

Chochita chachikulu chobowola, nortriptyline, ndichopinga champhamvu kwambiri cha norepinephrine, koma chitha kuletsa kutenga kwa serotonin. Amitriptyline ili ndi mphamvu ya anticholinergic, sedative ndi antihistaminergic, ndipo kuwonjezera pamenepo imatha kuyambitsa zotsatira za catecholamines.

Kuponderezedwa kwa DBD ya gawo la kugona ndi chizindikiro cha zovuta zogwira ntchito pa antidepressants. Tricyclics, kuphatikiza pa iwo kusankha maserotonin reuptake inhibitors, komanso ma MAOI, amalepheretsa gawo la BDH, komanso kukonza gawo logona kwambiri (pang'ono pang'onopang'ono).

Amitriptyline amathandiza matenda amochepetsa kuchepa kwa thupi.

Zovuta zoyeserera za amitriptyline ndi gawo lofunikira kwambiri pochiza nkhawa momwe mumakhala chisangalalo chowonjezereka, nkhawa, nkhawa, komanso mavuto ogona. Zotsatira za antidepressant zimayamba kuonekera patatha milungu 2-4 kuyambira chiyambi cha mankhwalawa, pomwe mphamvu yovuta ya mankhwalawa sichepa.

Mphamvu ya analgesic ya mankhwala imagwiritsidwa ntchito limodzi ndi mankhwala antidepressant, chifukwa analgesia imayamba kale kwambiri kuposa kusintha kwa kusintha komwe kumachitika. Nthawi zambiri, mlingo wotsikirapo umakwanira kuti mupeze zoterezi kuposa kusintha momwe wodwalayo akumvera.

Pharmacokinetics

Pambuyo pakukonzekera kwamkati, chizindikiro cha bioavailability cha amitriptyline ndi pafupifupi 60%. Plasma kumanga mapuloteni pafupifupi 95%. Chiwonetsero chachikulu cha magazi mkati mwa seramu yogwira ntchito chimafikira pafupifupi maola 4 mpaka 10 kuchokera kugwiritsidwa ntchito ndipo amakhalabe okhazikika.

Njira ya kagayidwe kazigawo yogwira imachitika ndi hydroxylation, komanso demethylation. Chinsinsi chachikulu cha kuwola ndi nortriptyline.

Hafu ya moyo wa amitriptyline ili mumtunda wamaola 16 mpaka 40 (pafupifupi maola 25), ndipo theka la moyo wa nortriptyline ndi maola pafupifupi 27. Kuphatikizika kwa zamafuta kumakhazikitsidwa pambuyo pa masabata 1-2.

Kutupa kwa amitriptyline kumachitika makamaka ndi mkodzo, ndipo kuphatikiza, ndizochepa kwambiri, zotulutsidwa mu ndowe.

Amitriptyline, ndipo nortriptyline, imatha kudutsa mwa chikhomo ndi kulowa mkaka wa m'mawere yaying'ono.

Zotsatira zoyipa

Amitriptyline imatha kuyambitsa zovuta zofanana ndi zomwe zimayambitsidwa ndi ma antidepressants ena a tricyclic. Zina mwazotsatira zomwe zalembedwa pansipa, monga kupweteka mutu, kunjenjemera, kusowa chidwi, kudzimbidwa, komanso kuchepa kwa libido, zimatha kukhalanso zizindikiro za kukhumudwa ndipo zimatha kuchepa ndikusintha kwa kukhumudwa.

Zotsatira zoyipa zimasonyezedwa ngati:

nthawi zambiri (> 1/10), nthawi zambiri (kuchokera> 1/100 mpaka 1/1000 mpaka 1/10000 kuti