Yuav ua li cas noj (haus) Saroten retard tsiav tshuaj

Thaum noj Saroten Retard tsiav tshuaj, nws raug nquahu kom haus nrog dej. Cov tshuaj ntsiav tau, txawm li cas los xij, tuaj yeem qhib thiab lawv cov ncauj lus (pellets) tuaj yeem muab qhov ncauj nrog dej. Pellets yuav tsum tsis txhob zom.

Ntxim ntxub tiag. Nyuaj siab cov mob hauv schizophrenia. Nws yog tshuaj ib hnub ib zaug 3-4 teev ua ntej yuav mus pw.

Kev kho mob nrog Saroten Retard yuav tsum tau pib nrog ib qho 50 mg tshuaj ntsiav thaum yav tsaus ntuj. Yog tias tsim nyog, tom qab ib lub lim tiam qhov tshuaj txhua hnub tuaj yeem hloov maj mam ntxiv mus rau 2 - 3 tsiav tshuaj thaum yav tsaus ntuj (100-150 mg). Tom qab ua tiav cov cim txhim kho, qhov kev noj tshuaj txhua hnub tuaj yeem txo qis kom muaj txiaj ntsig yam tsawg kawg, feem ntau nce txog 1-2 tsiav tshuaj (50-100 mg / hnub).

Kev tiv thaiv kab mob feem ntau tshwm sim tom qab 2-4 lub lis piam. Txoj kev kho rau kev nyuaj siab yog mob tshwm sim, yog li ntawd, nws raug nquahu kom siv cov tshuaj tiv thaiv kev ntxhov siab, nrog rau Saroten Retard, tom qab ua tiav cov lus hais rau lub sijhawm txaus txog li - 6 lub hlis kom tsis txhob rov ua dua. Hauv cov neeg mob uas muaj kev nyuaj siab mob hlwb (unipolar), kev tswj hwm ntev ntawm Saroten Retard yuav tsum, ntev txog ob peb xyoos, hauv kev saib xyuas cov tshuaj uas muaj qhov ua rau rov ua dua.

Cov neeg laus (laus dua 65 xyoos)

Ib qho 50 mg tshuaj ntsiav thaum yav tsaus ntuj.

Kev ua rau lub raum tsawg dua

Amitriptyline tuaj yeem kho nyob rau hauv cov tshuaj ntau dua rau cov neeg mob raum tsis ua haujlwm.

Kev ua haujlwm rau daim siab tsawg

Kev ceev faj yuav tsum tau siv thaum siv cov tshuaj hauv cov neeg mob uas lub siab ua tsis tau zoo, cov tshuaj amitriptyline concentration yuav tsum soj ntsuam thaum ua tau.

Thaum txiav tawm kev kho mob, kev thim tawm yeeb tshuaj pom zoo yuav tsum tau ua kom maj mam dhau ob peb lub lis piam txhawm rau kom tsis txhob muaj kev txhim kho "kev tshem tawm" cov tshuaj tiv thaiv (saib ntu "Sab Phiv").

Pharmacological kev txiav txim

Amitriptyline yog ib qho tricyclic tshuaj tiv thaiv. The tertiary amine, amitriptyline, hauv vivo kwv yees li sib npaug inhibits qhov rov qab ntawm norepinephrine thiab serotonin hauv presynaptic hlab ntsha xaus. Nws lub ntsiab metabolite, nortriptyline, inhibits qhov rov coj norepinephrine piv rau kev muaj zog ntau dua li serotonin. Amitriptyline muaj m-anticholinergic, antihistamine thiab sedative zog, txhim kho kev txiav txim ntawm catecholamines.

Saroten Retard txhim kho lub pathological depressive lub xeev, nws siv yog qhov ua tau zoo tshaj plaws rau kev kho mob ntawm endogenous thiab atypical depressions, tab sis nws tseem tuaj yeem txo cov tsos mob ntawm lwm cov kev ntshaus siab.

Vim nws cov nyhuv sedative, Sarotin Retard tau zoo rau kev kho mob kev nyuaj siab nrog kev ntxhov siab, ntxhov siab, ntxhov siab thiab pw tsaug zog. Raws li txoj cai, cov nyhuv tshuaj tiv thaiv kev ntxhov siab tshwm sim nyob rau hauv 2-4 lub lis piam

Cov Tshuaj Pharmacokinetics

Vim yog qeeb tso tawm ntawm amitriptyline los ntawm qhov ua tiav ntawm cov tshuaj, nws cov plasma ntau ntau nce ceev,

qhov siab tshaj plaws no yog kwv yees li 50% piv nrog cov ntsiav tshuaj nrog kev tso tawm sai sai. Qhov siab tshaj plaws hauv cov ntshav ntshav (T_tah) tau mus txog hauv 4 teev.

Qhov ncauj ntawm lub qhov ncauj: txog 48%. Nortriptyline tsim thaum lub sij hawm presystemic metabolism tseem muaj cov nyhuv tshuaj tua kabmob.

Cov ntim pom tseeb ntawm kev faib tawm yog li 14 l / kg. Qib ntawm kev khi rau cov ntshav plasma protein yog kwv yees li 95%.

Amitriptyline thiab nortriptyline hla qhov tsis sib haum xeeb.

Kev siv tshuaj metabolism ntawm amitriptyline yog nqa tawm feem ntau vim yog demethylation (isoenzymes CYP2D19, CYP3A) thiab hydroxylation (isoenzyme CYP2D6), tom qab los ntawm kev sib txuas nrog glucuronic acid. Kev mob ntshav tawm yog ua los ntawm polymorphism caj ces tseem ceeb. Lub ntsiab nquag metabolite yog theem nrab amine - nortriptyline. Cov metabolites cis- thiab trans-10-hydroxyamitriptyline thiab cis- thiab trans-10-hydroxynortriptyline yog cov cim los ntawm cov haujlwm zoo sib xws rau nortriptyline, txawm hais tias lawv cov nyhuv tsis tshua tshaj tawm. Demethylnortriptyline thiab amitriptyline-I-oxide yog tam sim no nyob rau hauv cov ntshav hauv qhov tsis txaus ntseeg ntau, qhov kawg metabolite yog xyaum tsis ua cov haujlwm pharmacological. Piv nrog amitriptyline, tag nrho cov metabolites muaj qhov tsis tshua muaj txiaj ntsig m-anticholinergic nyhuv.

Ib nrab-lub neej ntawm amitriptyline yog kwv yees li 16 (± 6) teev. Ib nrab-lub neej ntawm nortriptyline yog txog 31 (± 13) teev. Qhov nruab nrab tag nrho kev tshem tawm ntawm amitriptyline yog 0.9 l / min.

Nws yog tawm tsuas yog los ntawm lub raum. Cov kev hloov pauv tsis tau hloov, kwv yees li 2% ntawm kev lees txais ntawm amitriptyline yog excreted.

Amitriptyline thiab nortriptyline yog tawm hauv niam cov kua mis. Qhov ntsuas kev sib piv hauv cov kua mis thiab ntshav ntshav yog li 1: 1.

Kev sib luag plasma ntau yam ntawm amitriptyline thiab nortriptyline hauv feem ntau cov neeg mob tau mus txog hauv 7-10 hnub. Thaum siv lub caij nyoog ntev-tso cov tshuaj ntsiav thaum yav tsaus ntuj, qhov tseem ceeb ntawm amitriptyline mus txog nws cov txiaj ntsig ntau tshaj plaws thaum hmo ntuj thiab poob qis thaum nruab hnub, thaum lub siab ntawm nortriptyline tseem nyob ruaj khov thaum nruab hnub.

Tag nrho cov tshuaj kho ntshav plasma concentration ntawm amitriptyline thiab nortriptyline hauv kev kho mob ntawm kev nyuaj siab yog 370-925 nmol / L (100-250 ng / ml). Cov ntsiab lus siab tshaj 300-400 ng / ml muaj feem cuam tshuam nrog kev pheej hmoo ntawm lub plawv dhia tsis txaus thiab tshwm sim ntawm AV block thiab QRS nthuav dav

Cov neeg mob uas lub raum tsis ua hauj lwm zoo

Lub raum khiav tsis zoo tsis cuam tshuam rau pharmacokinestic, shedgiptilina lossis nortriptyline, txawm li cas los xij, kev tsis tuaj yeem ua tiav ntawm cov khoom noj metabolites tau qeeb.

Cov neeg mob uas muaj lub siab ua haujlwm tsis zoo

Lub siab ua haujlwm ua haujlwm tuaj yeem ua rau cov metabolism hauv tricyclic cov tshuaj tiv thaiv kev ntxhov siab. Cov.

Cov Ntaub Ntawv Muaj Kev Nyab Xeeb Ua Ntej

Tricyclic cov tshuaj tiv thaiv kev ntxhov siab muaj qhov mob toxicity siab.

Cov kev tshawb fawb tshuaj lom toxicity tau pom tias cov tshuaj lom neeg mob lom ntawm amitriptyline hauv kev tsim cov tshuaj tso tawm ntau npaum li cas tsawg dua piv rau tib lub koob tshuaj ntawm amitriptyline nrog kev tso tawm sai sai.

Rau ntau dua 40 xyoo thaum siv thaum cev xeeb tub, feem ntau mob hnyav lossis cov yam ntxwv ntawm kev yug tus me nyuam tsis tau tshaj tawm.

Kev ntsuas rau siv

Kev nyuaj siab (tshwj xeeb nrog kev ntxhov siab, ntxhov siab thiab pw tsaug zog ntxhov siab, suav nrog thaum menyuam yaus, endogenous, muaj kev tsis txaus siab, hnov mob, mob hlwb, tshuaj, nrog rau cov kab mob hauv lub hlwb, haus cawv tawm), mob hlwb schizophrenic, kev xav sib xyaw ua ke, kev coj tus cwj pwm (kev ua si) cuam tshuam thiab saib xyuas), nocturnal enuresis (tshwj tsis yog rau cov neeg mob lub zais zis), bulimia nervosa, mob ntsws mob ntsws (mob mus ntev hauv cov neeg mob qog nqaij hlav, mob migraine, mob rheumatic, atypical mob hauv thaj av) thiab cov tib neeg, mob postherpetic neuralgia, mob hlab ntsha hlwb tom qab, mob ntshav qab zib lossis lwm cov hlab hlwb o, mob taub hau, mob taub hau (tiv thaiv), mob rwj thiab 12 duodenal mob.

Cov Yuav Tsum Tau Ua

Kev siv tshuaj tiv thaiv kab mob, siv ua ke nrog MAO inhibitors thiab 2 lub lis piam ua ntej pib kho, myocardial infarction (mob ntev thiab subacute lub sijhawm), qaug cawv qaug cawv, mob qaug cawv nrog tshuaj tsaug zog, tshuaj loog thiab lub hlwb, tshuaj tiv thaiv lub ntsej muag kaw, kev txhaum loj ntawm AV thiab kev ua haujlwm ntawm lub cev (thaiv) Gisa, AV block II theem), lactation, menyuam lub hnub nyoog (txog 6 xyoo - daim ntawv hais ntawm ncauj, nce txog 12 xyoos nrog i / m thiab iv) .C Ceev Faj. Kev haus cawv mus ntev, mob hawb pob, ua rau lub siab puas hlwb, txhawb kev mob hlwb pob txha hematopoiesis, mob ntshav qab zib CVD (mob hlab ntsha hauv lub cev, tsis tuaj yeem ua haujlwm, lub plawv thaiv, CHF, myocardial infarction, hlab ntsha tawg), mob ntshav qab zib, lub plab hnyuv tsis ua haujlwm (muaj kev pheej hmoo ntawm cov hlab ntsha txhaws tsis tuaj sab hauv), , mob siab thiab / lossis lub raum tsis ua haujlwm, thyrotoxicosis, mob prostatic hyperplasia, tso zis cia, zais zis hypotension, mob schizophrenia (mob hlwb tuaj yeem ua haujlwm), mob vwm, cev xeeb tub (tshwj xeeb tshaj yog kuv peb hlis), hnub nyoog laus.

Yuav siv li cas: noj ntau thiab hom tshuaj kho

Sab hauv, tsis tas yuav zom, tam sim ntawd tom qab noj mov (kom txo qis kev mob ntawm cov plab hnyuv). Thawj koob tshuaj rau cov neeg laus yog 25-50 mg thaum tsaus ntuj, tom qab ntawd qhov koob tshuaj tau nce siab nyob rau hauv 5-6 hnub txog 150-200 mg / hnub hauv 3 koob (qhov ntau kawg ntawm koob tshuaj thaum hmo ntuj). Yog tias tsis muaj kev txhim kho nyob rau hauv 2 lub lis piam, koob tshuaj txhua hnub tau nce rau 300 mg. Yog tias cov cim ntawm kev nyuaj siab ploj, koob tshuaj txo qis rau 50-100 mg / hnub thiab kev kho mob txuas ntxiv mus tsawg kawg 3 hlis. Hauv lub hnub nyoog laus, nrog cov mob sib khuav me, ib koob tshuaj 30-100 mg / hnub (tsaus ntuj) yog tus kws kho mob, tom qab mus txog qhov kho tau zoo, lawv hloov mus rau qhov tsawg kawg yog siv tau zoo - 25-50 mg / hnub.

Intramuscularly lossis iv (txhaj tshuaj maj mam) ntawm ib koob ntawm 20-40 mg 4 zaug hauv ib hnub, maj mam hloov los ntawm kev noj. Lub sijhawm tiv thaiv tsis ntau tshaj 6-8 lub hlis.

Nrog rau cov nocturnal enuresis hauv cov menyuam muaj 6-10 xyoo - 10-20 mg / hnub thaum tsaus ntuj, 11-16 xyoo - 25-50 mg / hnub.

Cov menyuam yaus ua tshuaj tiv thaiv kab mob: los ntawm 6 txog 12 xyoo - 10-30 mg lossis 1-5 mg / kg / hnub fractionally, thaum tiav hluas - 10 mg 3 zaug hauv ib hnub (yog tias tsim nyog, txog 100 mg / hnub).

Rau kev tiv thaiv mob qog, nrog mob ntev ntawm ib leeg neurogenic (nrog rau mob taub hau ntev) - txij li 12.5-25 txog 100 mg / hnub (qhov siab tshaj plaws noj thaum hmo ntuj).

Sab sij huam

Cov tshuaj tiv thaiv anticholinergic: qhov muag plooj, txhawm rau chaw nyob, mydriasis, mob siab ntxiv (tsuas yog hauv cov neeg uas muaj lub cev pob txha caj qaum - lub cev tsis muaj zog), tachycardia, lub qhov ncauj qhuav, tsis meej pem, delirium los yog mob plab, quav tawv, txhaws txhaws qhov quav, nyuaj rau tso zis. tawm hws tsawg.

Los ntawm cov kab mob hauv lub paj hlwb: tsaug zog, asthenia, tsaus muag, ntxhov siab, tsis meej pem, kev pom meej (tshwj xeeb tshaj yog cov neeg laus thiab cov neeg mob Parkinson tus kab mob), ntxhov siab, ntxhov siab, lub cev muaj zog, lub xeev manic, xeev lub xeev hypomanic, txhoj puab, nco qab, tsis nco qab, depersonalization , muaj kev nyuaj siab ntau ntxiv, poob qis rau kev muaj peev xwm mloog zoo, insomnia, "npau suav phem" npau suav, yawning, asthenia, ua kom cov tsos mob ntawm kev mob hlwb, mob taub hau, myoclonus, dysarthria, tshee tshee. FIR nqaij, tshwj xeeb tshaj yog cov caj npab, txhais tes, lub taub hau thiab tus nplaig, peripheral neuropathy (paresthesia), myasthenia Heavy kev, myoclonus, ataxia, extrapyramidal syndrome, acceleration thiab intensification mob chua leeg hlwb, EEG hloov.

Los ntawm CCC ib sab: tachycardia, palpitations, kiv taub hau, mob orthostatic hypotension, tsis tseem ceeb ECG hloov (ST ntu lossis T yoj) hauv cov neeg mob uas tsis muaj mob plawv, arrhythmia, ntshav siab lability (txo lossis nce ntshav siab), intraventricular conduction cuam tshuam (nthuav dav ntawm txoj ua haujlwm. QRS, hloov pauv PQ ntu, cuam tshuam ntawm ob txhais ceg ntawm lub pob khoom ntawm Nws).

Los ntawm lub plab zom mov: xeev siab, tsis tshua muaj kab mob siab (nrog rau lub siab ua haujlwm tsis txaus thiab cholestatic jaundice), kub siab, ntuav, gastralgia, qab los noj mov thiab lub cev hnyav los yog tsis qab los noj mov thiab lub cev nyhav, stomatitis, hloov pauv, raws plab, tsaus nti ntawm tus nplaig.

Los ntawm cov kab mob endocrine: kev nce ntxiv ntawm qhov loj me (edema) ntawm cov noob qes, kev mob gynecomastia, qhov nce ntawm qhov loj ntawm cov qog mammary, galactorrhea, txo qis lossis nce ntxiv ntawm libido, txo qis ntawm potency, hypo- lossis hyperglycemia, hyponatremia (kev txo qis ntawm kev tsim cov vasopressin), thiab cov tsos mob ntawm tsis txaus.

Los ntawm cov kabmob hemopoietic: agranulocytosis, leukopenia, thrombocytopenia, purpura, eosinophilia.

Kev ua xua: ua pob khaus tawv, ua pob khaus rau ntawm daim tawv nqaij, urticaria, ua kom lub ntsej muag, o ntawm lub ntsej muag thiab tus nplaig.

Lwm yam: plaub hau ploj, tinnitus, edema, hyperpyrexia, o cov qog ntshav, tso zis tawm, pollakiuria, hypoproteinemia.

Tshem cov tsos mob: nrog tshem tawm sai sai tom qab kev kho mob ntev - xeev siab, ntuav, raws plab, mob taub hau, mob siab, pw tsaug zog, npau suav txawv, tsis meej pem, nrog maj mam tshem tawm tom qab kho mob ntev ntev - chim siab, ntxhov siab lub cev, pw tsaug zog, npau suav txawv.

Cov kev sib txuas nrog kev tswj hwm yeeb tshuaj tsis tau tsim: kab mob zoo li lupus (mob caj dab mob, qhov tshwm sim ntawm cov tshuaj tiv thaiv kab mob thiab qhov ua rau mob rheumatoid zoo), ua rau lub siab ua haujlwm tsis zoo, muaj hnub nyoog.

Cov tshuaj tiv thaiv hauv ib cheeb tsam mus rau kev tswj hwm: thrombophlebitis, lymphangitis, kev hnov mob ntawm cev, kev tawv nqaij ua xua. Cov tsos mob Los ntawm ib sab ntawm lub hauv nruab nrab cov hlab ntsha: tsis txaus ntseeg, poob ntsej muag, tsis nco qab, tsis nco qab, ataxia, hnovqab, ntxhov siab, mob hlwb ntxhov siab, qis muaj peev xwm mloog zoo, tsis meej pem, tsis meej pem, mob plab, hyperreflexia, mob leeg, txha caj qaum, mob caj dab, mob vwm.

Los ntawm CCC: txo cov ntshav siab, tachycardia, arrhythmia, kev tsis hnov qab ntawm lub cev, kev hloov pauv ECG (tshwj xeeb yog QRS), kev poob siab, lub plawv tsis ua haujlwm, yam ntxwv ntawm tricyclic antidepressant intoxication, poob siab, lub plawv tsis ua haujlwm hauv qee qhov xwm txheej tsawg.

Lwm yam: kev nyuaj siab ua pa, ua pa luv, cyanosis, ntuav, hyperthermia, mydriasis, nce tawm hws, oliguria lossis anuria.

Cov tsos mob yuav tshwm sim 4 teev tom qab siv sijhawm ntau kawg, mus txog qhov siab kawg tom qab 24 teev thiab kawg 4-6 hnub. Yog tias muaj qhov xav kom noj ntau dhau, tshwj xeeb yog menyuam yaus, tus neeg mob yuav tsum tau mus pw hauv tsev kho mob.

Kev kho mob: nrog kev tswj hwm ntawm lub qhov ncauj: lub plab zom zaub mov, kev tswj hwm ntawm kev siv hluav taws xob, kev mob tshwm sim thiab kev txhawb nqa, nrog cov kev tiv thaiv mob hnyav (txo cov ntshav siab, arrhythmias, coma, myoclonic epileptic qaug dab peg) - kev qhia txog cholinesterase inhibitors (physostigmine tsis pom zoo vim tias muaj kev pheej hmoo ntawm qaug dab peg) ), tswj cov ntshav siab thiab dej-electrolyte tshuav nyiaj li cas. Kev tswj ntawm CCC lub luag haujlwm (suav nrog ECG) rau 5 hnub yog pom (rov qab tuaj yeem tshwm sim nyob rau hauv 48 teev lossis tom qab), kev kho mob anticonvulsant, kev kho qhov cua, thiab lwm yam kev ntsuas kom rov ua dua. Hemodialysis thiab yuam diuresis yog qhov tsis muaj txiaj ntsig.

Cov lus qhia tshwj xeeb

Ua ntej pib kev kho mob, kev tswj ntshav siab yog qhov tsim nyog (hauv cov neeg mob ntshav qis los yog labile ntshav nws tuaj yeem txo qis dua txawm tias), lub sijhawm kho mob, kev tswj ntshav hauv ntshav (qee qhov, agranulocytosis tuaj yeem txhim kho, thiab yog li ntawd nws raug nquahu los saib xyuas ntshav daim duab, tshwj xeeb nrog nce lub cev qhov kub thiab txias, kev txhim kho cov khaub thuas zoo li cov tsos mob thiab mob caj pas), nrog kev kho ntev - tswj lub luag haujlwm ntawm CVS thiab mob siab. Hauv cov neeg laus thiab cov neeg mob CCC muaj kab mob, tswj hwm lub plawv dhia, ntshav siab, ECG yog qhia. Clinically qhov kev hloov pauv tseem ceeb tshwm sim ntawm ECG (kev hloov pauv ntawm T nthwv dej, kev nyuaj siab ntawm ntu S-T, nthuav dav ntawm QRS txoj haujlwm).

Kev siv niam txiv yog siv tau nyob hauv tsev kho mob, hauv qab kev saib xyuas ntawm tus kws kho mob, nrog pw hauv thawj hnub ntawm kev kho mob.

Ceev faj yog xav tau thaum ceev ceev mus rau ib txoj hauj lwm ntsug los ntawm kev dag lossis chaw zaum.

Thaum kho, ethanol yuav tsum raug cais tawm.

Txheeb tsis pub ntxov dua 14 hnub tom qab MAO inhibitors tso tawm, pib nrog cov koob tshuaj me me.

Nrog rau kev tso tseg sai sai ntawm kev tswj hwm tom qab kev kho mob ntev ntev, kev txhim kho ntawm qhov "tshem tawm" mob yog ua tau.

Amitriptyline nyob rau hauv cov koob tshuaj saum toj no 150 mg / hnub txo qhov pib ntawm kev ua si (qhov kev pheej hmoo ntawm qaug dab peg hauv cov neeg mob uas tsis yog, nrog rau lwm tus, yuav tsum tau xav txogyam ua rau muaj kev cuam tshuam ntawm kev mob tshwm sim, piv txwv li, lub hlwb raug mob ntawm ib qho kev ua si, kev siv tshuaj tiv thaiv kab mob ib ce (cov tshuaj tiv thaiv kev ntxhov siab), thaum lub sijhawm tsis kam ethanol lossis tshem tawm cov tshuaj uas muaj cov tshuaj anticonvulsant, xws li benzodiazepines).

Kev nyuaj siab hnyav yog tus cwj pwm txaus ntshai los ntawm kev tua tus kheej, uas tuaj yeem ua mus kom txog thaum daws tau qhov teeb meem loj. Hauv qhov no, thaum pib txoj kev kho mob, kev sib xyaw nrog cov tshuaj los ntawm pab pawg benzodiazepine los yog cov tshuaj tiv thaiv kev tiv thaiv thiab kev tshuaj xyuas tas li (qhia cov neeg ntseeg siab khaws cia thiab muab tshuaj) yuav qhia tau

Hauv cov neeg mob uas muaj kev cuam tshuam txog mob khaub thuas, thaum lub sijhawm muaj kev nyuaj siab, qhov mob ntawm cev lossis kev ntshaus siab yuav tshwm sim thaum kho (txo qis los yog tshem tawm cov tshuaj thiab cov tshuaj tiv thaiv tshuaj uas tsim nyog). Tom qab nres cov kev mob no, yog tias muaj kev qhia, kev kho mob hauv koob tshuaj tsawg tuaj yeem rov ua dua.

Vim yog qhov ua tau rau cardiotoxic muaj txiaj ntsig, yuav tsum tau ceev faj thaum kho cov neeg mob thyrotoxicosis lossis cov neeg mob tau txais cov thyroid hormones txaus.

Ua ke nrog kev kho mob electroconvulsive, nws yog tsuas yog nrog kev saib xyuas mob kom zoo.

Hauv kev tiv thaiv cov neeg mob thiab cov neeg laus laus, nws tuaj yeem ua rau kev loj hlob ntawm cov tshuaj psychoses, feem ntau yog thaum tsaus ntuj (tom qab tsis siv tshuaj, lawv ploj nyob hauv ob peb hnub).

Tej zaum yuav ua rau tuag tes tuag taw txoj hnyuv, feem ntau yog rau cov neeg mob cem quav, cov neeg laus lossis cov neeg mob uas raug yuam kom tsom kwm mus pw.

Ua ntej ua cov tshuaj loog dav dav lossis hauv zos, cov tshuaj loog yuav tsum ceeb toom tias tus neeg mob noj amitriptyline.

Vim yog qhov kev txiav txim siab anticholinergic, ib qho kev txo qis ntawm lacrimation thiab ib tus txheeb ze nce ntxiv ntawm cov hnoos qeev hauv cov dej ntawm cov lacrimal yog qhov ua tau, uas tuaj yeem ua rau kev puas tsuaj rau lub corneal epithelium hauv cov neeg mob siv tsom iav.

Nrog kev siv lub sijhawm ntev, kev nce ntxiv ntawm qhov tshwm sim ntawm cov hniav caries yog pom. Qhov xav tau ntawm riboflavin yuav nce ntxiv.

Ib txoj kev kawm txog kev tawm tsiaj txhu tau tshwm sim tsis zoo ntawm tus me nyuam hauv plab, thiab kev tshawb fawb tau txaus thiab nruj me ntsis hauv cov poj niam cev xeeb tub tsis tau ua. Hauv cov poj niam cev xeeb tub, cov tshuaj yuav tsum tsuas yog siv yog tias cov txiaj ntsig tau pab rau leej niam outweighs qhov kev pheej hmoo rau tus me nyuam hauv plab.

Nws nkag mus rau hauv niam mis thiab ua rau cov menyuam mos pw tsaug zog.

Txhawm rau kom tsis txhob muaj kev txhim kho ntawm "kev tshem tawm" cov kabmob ntawm cov menyuam mos (tshwm sim los ntawm kev ua pa luv, tsaug zog, mob plab hnyuv, ua rau muaj kev ntshaus siab, mob ntshav lossis mob ntshav siab, tshee lossis mob tshwm sim), amitriptyline yog maj mam tso tseg tsawg kawg 7 lub lis piam ua ntej hnub yug.

Cov menyuam yaus yuav nkag siab ntau dhau rau qhov haus luam yeeb ntau dhau, uas yuav tsum raug txiav txim siab tias yog qhov txaus ntshai thiab muaj feem ua rau tuag taus rau lawv.

Thaum lub sijhawm kho mob, yuav tsum tau saib xyuas thaum tsav tsheb thiab koom nrog lwm yam kev phom sij uas yuav tsum muaj kev mloog zoo thiab ceev ntawm cov kev tiv thaiv psychomotor.

Kev sib txuam

Nrog kev siv ua ke ntawm ethanol thiab tshuaj uas cuam tshuam rau lub hauv nruab nrab lub paj hlwb (suav nrog lwm cov tshuaj tiv thaiv kab mob, barbiturates, benzadiazepines thiab kev siv tshuaj loog), qhov nce siab hauv cov tshuaj tiv thaiv tsis txaus rau lub hauv nruab nrab cov hlab hlwb, ua pa nyuaj siab thiab cov nyhuv hypotensive yog tau.

Nce rhiab heev rau cov dej haus uas muaj ethanol.

Nce anticholinergic nyhuv ntawm cov tshuaj nrog cov kev ua anticholinergic (piv txwv li, phenothiazines, antiparkinsonian tshuaj, amantadine, atropine, biperidene, antihistamines), uas ua rau muaj kev pheej hmoo ntawm phiv (los ntawm lub hauv nruab nrab lub paj hlwb, lub zeem muag, lub plab thiab zais zis).

Thaum ua ke nrog cov tshuaj antihistamines, clonidine, kev nce ntxiv hauv cov nyhuv inhibitory rau lub hauv nruab nrab cov hlab ntsha, nrog atropine, ua rau muaj kev pheej hmoo ntawm cov leeg tuag tes tuag taw, thiab cov tshuaj uas ua rau cov neeg ua txhaum ntxiv ua rau muaj qhov cuam tshuam ntau dua thiab cuam tshuam ntxiv ntawm cov tshuaj ntxiv.

Nrog rau kev siv tib lub sijhawm ntawm amitriptyline thiab indirect anticoagulants (coumarin lossis indadione derivatives), qhov nce ntawm cov tshuaj tiv thaiv anticoagulant ntawm qhov tom kawg yog ua tau.

Amitriptyline tuaj yeem nce ntxiv kev nyuaj siab tshwm sim los ntawm corticosteroids.

Thaum ua ke nrog cov tshuaj anticonvulsant, nws muaj peev xwm nce cov nyhuv inhibitory nyob rau hauv lub hauv nruab nrab cov hlab ntsha, qis qis tshaj tawm rau qhov kev txiav txim siab (thaum siv ntau kawg) thiab txo qhov kev ua tau zoo ntawm tom kawg.

Tshuaj siv rau kev kho mob thyrotoxicosis nce siab ntawm agranulocytosis.

Txo cov txiaj ntsig ntawm phenytoin thiab alpha-blockers.

Cov tshuaj tiv thaiv ntawm microsomal oxidation (cimetidine) lengthen T1 / 2, ua kom muaj kev phom sij ntawm amitriptyline (koob tshuaj txo los ntawm 20-30% tej zaum yuav tsum tau), inducers ntawm microsomal daim siab enzymes (barbiturates, carbamazepine, phenytoin, nicotine thiab qhov ncauj txwv tsis pub muaj) txo plasma ntau ntau thiab txo cov txiaj ntsig ntawm amitriptyline.

Fluoxetine thiab fluvoxamine tsub kom nce ntxiv ntawm amitriptyline hauv ntshav (qhov koob tshuaj amitriptyline los 50% tej zaum yuav tsum tau).

Thaum ua ke nrog anticholinergics, phenothiazines thiab benzodiazepines - qhov kev sib nrig sib ntxiv ntawm sedative thiab central anticholinergic cov teebmeem thiab muaj kev pheej hmoo ntawm qaug dab peg (txo qis tshaj ntawm kev qaug dab peg), phenothiazines, ntxiv rau, tuaj yeem ua rau muaj kev pheej hmoo ntawm cov leeg mob neuroleptic.

Nrog rau kev siv amitriptyline nrog clonidine, guanethidine, betanidine, reserpine thiab methyldopa txo qis - qhov txo qis ntawm cov nyhuv hypotensive ntawm tom kawg, nrog cocaine - txoj kev pheej hmoo ntawm lub plawv dhia tsis meej.

Cov tshuaj estrogen muaj qhov ncauj txwv tsis pub muaj tshuaj tiv thaiv thiab estrogens tuaj yeem ua rau kom ntau dua ntawm cov amitriptyline, cov tshuaj antiarrhythmic (xws li quinidine) ua rau muaj kev pheej hmoo ntawm lub suab tsis sib xws (tejzaum ua kom cov metabolism ntawm amitriptyline).

Siv sib xyaw nrog disulfiram thiab lwm yam tshuaj tiv thaiv acetaldehydrogenase provokes delirium.

Kev tsis sib haum nrog MAO inhibitors (muaj peev xwm nce ntxiv ntawm lub sijhawm ntau zaus ntawm hyperpyrexia, mob hnyav, mob heev vim kev kub ntxhov thiab tus neeg mob tuag).

Pimozide thiab probucol tuaj yeem nce rau lub plawv dhia tsis ua hauj lwm, uas yog ua kom pom qhov ncua sij hawm Q-T luv ntawm ECG.

Nws txhim kho cov ntxim rau epilephrine, norepinephrine, isoprenaline, ephedrine thiab phenylephrine ntawm CVS (suav nrog thaum cov tshuaj no yog ib feem ntawm cov tshuaj loog hauv zos) thiab ua rau muaj kev pheej hmoo ntawm lub plawv tsis txaus, tachycardia, thiab mob ntshav siab heev.

Thaum siv sib koom ua ke nrog alpha-adrenostimulants rau kev tswj hwm intranasal lossis siv rau hauv ophthalmology (nrog rau qhov tseem ceeb ntawm cov kabmob kev cuam tshuam), cov nyhuv vasoconstrictor ntawm tom kawg tuaj yeem nce ntxiv.

Thaum ua ke nrog cov thyroid cov tshuaj hormones - ib qho kev sib txuam los ntawm kev ua kom zoo thiab muaj txiaj ntsig zoo (suav nrog lub plawv dhia tsis txaus thiab lub zog ua kom lub zog hauv lub hauv nruab nrab).

M-anticholinergics thiab cov tshuaj tiv thaiv kev tiv thaiv (tshuaj tiv thaiv) ua rau muaj kev pheej hmoo ntawm hyperpyrexia (tshwj xeeb hauv huab cua kub).

Nrog lub sijhawm sib koom ua ke nrog lwm cov tshuaj hematotoxic, kev nce siab ntawm hematotoxicity yog ua tau.

Saroten Retard (Saroten Retard) - tso tawm daim ntawv, muaj pes tsawg leeg thiab ntim khoom

Cov tshuaj ntsiav ntawm lub caij nyoog ntev yog qhov nyuaj gelatin, qhov loj No. 2, opaque, nrog lub cev thiab lub hau ntawm cov xim liab-xim av, cov ntsiab lus ntawm cov tsiav tshuaj yog pellets los ntawm yuav luag dawb mus rau daj.

1 lub kaus mom. amitriptyline hydrochloride 56.55 mg, uas sib haum rau cov ntsiab lus ntawm amitriptyline 50 mg.

Cov muaj mob: cov nplej qab zib (qab zib thaj), stearic acid, shellac (non-waxed shellac), talc, povidone.

Cov sib xyaw ua ke ntawm cov tshuaj pliav: gelatin, hlau zas oxide liab (E172), titanium dioxide (E171).

Saroten Retard (Saroten Retard) - pharmacokinetics

Qhov mob bioavailability ntawm amitriptyline yog li 60%. Plasma protein khi yog li 95%. Qhov siab ntawm amitriptyline hauv cov ntshav cov ntshav nce mus txog nws cov txiaj ntsig ntau tshaj li qeeb dua thaum noj Saroten hauv cov ntsiav tshuaj, tom qab 4-10 teev, tom qab ntawd, txawm li cas los xij, nws tseem nyob ruaj khov rau lub sijhawm ntev.

Ntawm cov koob tshuaj sib npaug, cov txiaj ntsig siab tshaj plaws ntawm kev xav ntawm cov tshuaj hauv ntshav muaj qis dua thaum noj cov tshuaj ntsiav, uas cuam tshuam nrog tsawg dua kev phiv cardiotoxic ntawm Saroten Retard.

Amitriptyline metabolism yog ua tiav los ntawm demethylation thiab hydroxylation. Nortriptyline yog suav hais tias yog lub ntsiab metabolite ntawm amitriptyline. T1 / 2 ntawm amitriptyline qhov nruab nrab 25 teev (16-40 teev), T1 / 2 ntawm nortriptyline - txog 27 teev. Css yog tsim los tom qab 1-2 lub lis piam. Amitriptyline yog tawm nrog kua thiab tsuas yog, ib nrab, nrog quav. Amitriptyline thiab nortriptyline hla lub cev placental thiab hauv qee qhov me me yog tawm hauv niam cov kua mis.

Kev qhia rau kev siv tshuaj

Kev ntxhov siab, tshwj xeeb nrog kev ntxhov siab, ntxhov siab, thiab pw tsaug zog:

kho kev nyuaj siab endogenous ntawm mono- thiab hom bipolar, kev tsis txaus siab, ua lub ntsej muag thiab mob ntshav siab,
dysphoria thiab cawv kev nyuaj siab,
kev nyuaj siab nti
kev nyuaj siab neurosis
kho kev puas siab mob schizophrenic (ua ke nrog tshuaj tiv thaiv kev ntxhov siab),
muaj mob tsis xis nyob.

Saroten Retard (Saroten Retard) - kev noj tshuaj ntau dua

Thaum noj Saroten Retard tsiav tshuaj, nws pom zoo kom haus nws nrog dej. Cov tshuaj ntsiav tau, txawm li cas los xij, tuaj yeem qhib qhib thiab lawv cov ncauj lus (granules) tuaj yeem coj lub qhov ncauj nrog dej. Granules txwv tsis pub zom.

Txog kev kho mob ntawm kev nyuaj siab, nws tau hais tseg 1 zaug / 3-4 teev ua ntej yuav mus pw rau hauv koob tshuaj raws li 2/3 ntawm kev noj tshuaj ntawm Saroten hauv cov ntsiav tshuaj.

Cov neeg laus yuav tsum pib kho nrog Saroten Retard nrog ib qho 50 mg ntsiav tshuaj thaum yav tsaus ntuj. Yog tias tsim nyog, tom qab 1-2 lub lis piam, qhov tshuaj rau niaj hnub tuaj yeem nce ntxiv 2-3 tsiav tshuaj thaum yav tsaus ntuj (100-150 mg). Tom qab ua tiav qhov cim txhim kho, qhov kev noj tshuaj txhua hnub tuaj yeem txo qis kom muaj qhov tsawg kawg nkaus, feem ntau yuav tsum ntau txog 1-2 tsiav tshuaj (50-100 mg /). Hauv kev kho mob kev nyuaj siab, nws tau hais kom txuas ntxiv siv cov tshuaj tiv thaiv kev ntxhov siab, suav nrog Saroten Retard, tom qab ua tiav cov lus tshaj tawm rau lwm 4-6 lub hlis. Hauv kev saib xyuas cov tshuaj uas muaj cov tshuaj ua kom rov zoo, Saroten Retard tuaj yeem siv sijhawm ntev, mus txog ntau xyoo.

Cov neeg laus yuav tsum pib kho nrog Saroten nrog cov ntsiav tshuaj - 30 mg / (3 txog 10 mg). Hauv ob peb hnub, nws yog qhov hloov pauv kom tau noj Saroten Retard tsiav tshuaj. Qhov tshuaj rau txhua hnub yog 1-2 tsiav tshuaj (50-100 mg), noj thaum yav tsaus ntuj.

Hauv kev mob hnyav rau cov neeg laus, cov tshuaj txhua hnub yog 1-2 tsiav tshuaj (50-100 mg), noj thaum yav tsaus ntuj. Nws yog qhov pib tuaj yeem pib kho nrog kev noj Saroten hauv 25 mg ntsiav tshuaj ib zaug thaum yav tsaus ntuj.

Cov kev mob tshwm sim nrog cov nyhuv anticholinergic: kev ua kom qhuav thiab / lossis iab hauv lub qhov ncauj, xeev siab, ntuav, stomatitis, tsis tshua muaj - cholestatic daj ntseg, qhov muag plooj, muaj kev mob siab dua, tachycardia, cem quav, ntau tsawg zaus - tso zis cia. Lawv feem ntau tshwm sim thaum pib kho, tom qab ntawd, feem ntau, txo qis.

Los ntawm sab ntawm cov hlab plawv: tachycardia, arrhythmias, orthostatic hypotension, mob intracardia conduction kev cuam tshuam, sau cia tsuas yog nyob rau ECG, tab sis tsis pom tseeb thaj chaw kuaj mob.
Los ntawm sab hauv nruab nrab ntawm lub hauv nruab nrab lub paj hlwb: tsis txaus ntseeg, tsis muaj zog, ua haujlwm tsis nco qab, mob taub hau, kiv taub hau. Cov kev tsis zoo no, ntau zaus tshwm sim thaum pib ntawm kev kho mob amitriptyline, raug txo qis thaum kho. Tsawg dua feem ntau, tshwj xeeb tshaj yog thaum pib siv ntau ntau, somnolence, tsis meej pem, tsis meej pem, ntxhov siab, pom kev tsis meej, tso cov yeeb yaj kiab tso, kev ntxhov siab thiab cramps tuaj yeem tshwm sim, tsis tshua ntxhov siab.

Kev ua xua rau: xoo pob khaus, khaus khaus tuaj yeem ua tau.

Lwm tus: xeev siab, tawm hws, nce phaus, txo qis libido yuav tshwm sim.

Cov Yuav Tsum Muaj

tsis ntev los no myocardial infarction,
mob raum tsis meej
mob lom los ntawm haus cawv, barbiturates lossis opiates,
lub qhov muag kaw lub ntsej muag daj,
siv ua ke nrog MAO inhibitors thiab mus txog 2 lub lis piam tom qab lawv tshem tawm,
lub cev tsis haum rau amitriptyline.

Saroten Retard - Cov Lus Qhia Tshwj Xeeb

Saroten Retard yuav tsum siv nrog kev ceev faj rau cov neeg mob uas muaj kev tsis txaus siab, tso zis cia, mob prostate hypertrophy, mob siab rau lub siab lossis mob plawv, thiab hyperthyroidism.

Muaj cov nyhuv sedative, nws tuaj yeem cuam tshuam rau kev muaj peev xwm tswj lub tsheb thiab lwm yam txheej txheem. Cov neeg mob uas siv Saroten Retard yuav tsum tau ceeb toom ua ntej los ntawm tus kws kho mob txog qhov no ntawm cov tshuaj.

Saroten Retard - Noj ntau tshaj

Cov tsos mob Kev tawm tsam lossis kev kub ntxhov ntawm lub hauv nruab nrab lub paj hlwb. Cov kev mob tshwm sim ntau ntawm cov tshuaj anticholinergic (tachycardia, cov leeg qhuav ua pa, tso zis cia) thiab cardiotoxic (arrhythmias, arterial hypotension, plawv tsis ua hauj lwm) cuam tshuam. Qhov pom tsis meej cov kev ntshawv siab. Hyperthermia.

Kev Kho Mob. Suav cov tsos mob. Yuav tsum tau nqa hauv tsev kho mob. Nrog kev tswj hwm ntawm qhov ncauj ntawm amitriptyline, lub plab zom zaub mov yuav tsum tau ua kom sai li sai tau thiab qhib cov pa hluav taws yuav tsum tau kho. Kev ntsuas yuav tsum raug coj los tswj kev ua pa ntawm cov hlab ntsws thiab cov hlab plawv. Saib xyuas ntawm kev ua haujlwm hauv lub plawv tsis pub dhau 3-5 hnub yog qhov tsim nyog. Epinephrine (adrenaline) yuav tsum tsis txhob muab tshuaj rau hauv cov xwm txheej zoo li no. Rau qhov muaj kev tsis haum siab, siv tshuaj diazepam.

Saroten Retard (Saroten Retard) - kev sib txuam tshuaj

Amitriptyline tuaj yeem txhim kho qhov cuam tshuam ntawm ethanol, barbiturates thiab lwm yam tshuaj uas cuam tshuam rau lub hauv nruab nrab cov hlab ntsha.

Kev siv sib xyaw nrog MAO inhibitors tuaj yeem ua rau tawg.

Txij li thaum amitriptyline txhim kho cov txiaj ntsig ntawm anticholinergics, kev coj ua ib txhij nrog lawv yuav tsum raug zam.

Nws txhim kho cov txiaj ntsig ntawm sympathomimetics ntawm epinephrine (adrenaline), norepinephrine (norepinephrine), vim qhov no, qhov tshuaj loog hauv zos uas muaj cov tshuaj no yuav tsum tsis txhob siv nrog amitriptyline.

Yuav txo qis cov nyhuv antihypertensive ntawm clonidine, betanidine, thiab guanethidine.

Thaum sib xyaw nrog cov tshuaj tiv thaiv kev tiv thaiv, nws yuav tsum tau nyob rau hauv lub siab tias tricyclic antidepressants thiab antipsychotics ob leeg cuam tshuam rau txhua tus kev cuam tshuam cov metabolism, txo qis qhov cuam tshuam rau kev npaj tos.

Nrog rau kev siv ua ke nrog cimetidine, ib qho kev txo qis hauv cov metabolism ntawm amitriptyline, qhov nce ntawm nws cov concentration hauv cov ntshav ntshav thiab kev txhim kho ntawm cov tshuaj lom yog yuav tshwm sim.