Carbamazepine Retard-Akrikhin > Kev khomob thiab kev tiv thaiv

Epilepsy (tsis suav nrog cov leeg ntshav, myoclonic lossis mob nkees qaug dab peg) - chua leeg ib nrab nrog cov tsos mob yooj yim thiab yooj yim, thawj thiab theem nrab ntawm tus mob chua leeg nrog tonic-clonic qaug dab peg, sib xyaw ua ke (monotherapy lossis nrog lwm cov tshuaj tiv thaiv).

Mob manic mob (kho neeg mob thiab suav nrog Li + thiab lwm cov tshuaj tiv thaiv kev ua kom tsis haum). Ntse-ntws cuam tshuam rau kev cuam tshuam (nrog rau bipolar) kev tiv thaiv ntawm exacerbations, kev qaug zog ntawm kev kuaj mob thaum lub sijhawm ua rau exacerbation.

Cov mob haus dej cawv ua kom muaj kev ntxhov siab (ntxhov siab, ua kom qaug dab peg, ua rau lub siab dhau mus, pw tsis tsaug zog).

Mob neuropathy mob nrog rau mob.

Mob ntshav qab zib insipidus ntawm lub hauv paus hauv paus. Polyuria thiab polydipsia ntawm neurohormonal xwm.

Daim ntawv thov tseem muaj peev xwm ua tau (cim qhia raws li kev paub dhau los, tsis muaj kev tswj hwm tau tshawb pom)

- nrog kev puas siab puas ntsws (nrog kev cuam tshuam thiab schizoaffective cuam tshuam, psychoses, ceeb ntshai, tiv taus kev kho tus mob schizophrenia, kev ua tsis tau zoo ntawm limbic system),

- nrog kev coj tus cwj pwm tsis zoo ntawm cov neeg mob ua rau cov paj hlwb organic puas, kev nyuaj siab, chorea,

- nyob rau hauv cov ntaub ntawv ntawm kev ntxhov siab, dysphoria, somatization, tinnitus, senile dementia, Kluver-Bucy syndrome (kev rhuav tshem ntawm amygdala txoj kev nyuaj siab), muaj kev cuam tshuam txog kev tsis txawj xav, tshem tawm ntawm benzodiazepine, cocaine,

- nrog mob mob ntawm cov keeb keeb neurogenic: nrog tus txha caj qaum, ntau tus sclerosis, mob ntsws idiopathic neuritis (Guillain-Barré syndrome), mob ntshav qab zib polyneuropathy, mob phantom, mob nkees ceg mob (Ekboma syndrome), mob hlab ntsha tawg, mob hlab ntaws thiab mob hlab ntaws. ,

- rau kev mob taub hau prophylaxis.

Dosage daim ntawv

Cov tshuaj txhawb nqa-tso tawm, 200 mg lossis 400 mg

cov tshuaj heev - carbamazepine 200 mg lossis 400 mg,

zam txim: eudragit RS 30D-ammonium methacrylate copolymer (hom B) dispersion, triacetin (glycerol triacetate), talc, eudragit L 30D-55 methacrylic acid-ethyl acrylate copolymer (1: 1) dispersion 30%, crospovidone, anhydrous silicon colloidal anhydrous, microcrystalline cellulose.

Cov ntsiav tshuaj yog xim dawb lossis daj hauv cov xim, puag ncig, nyob rau hauv cov duab ntawm nplooj caws nrog cov ntug beveled, nrog lub tiaj tiaj, nrog cov kab uas muaj tus ntoo cuam hla ntawm ob sab thiab 4 kos rau sab.

Cov Yuav Tsum Muaj

Hypersensitivity rau carbamazepine lossis tshuaj zoo sib xws (piv txwv li, tricyclic antidepressants) lossis rau lwm qhov tshuaj, cuam tshuam ntawm cov mob pob txha txha ntshav (ntshav liab, leukopenia), mob sib deev sai (nrog rau keeb kwm ntawm), AV thaiv, ib txhij noj MAO.C inhibitors nrog ceev faj. Decompensated lub plawv tsis ua hauj lwm, dilution hyponatremia (ADH hypersecretion syndrome, hypopituitarism, hypothyroidism, adrenal tsis txaus), kev quav dej cawv siab heev (CNS kev nyuaj siab yog txhim kho, carbamazepine metabolism yog nce), mob pob txha mob hematopoiesis yog suppressed, thiab lub siab tsis ua haujlwm nrog kev mob ntshav siab, thiab , prostatic hyperplasia, mob siab intraocular.

Yuav siv li cas: noj ntau thiab hom tshuaj kho

Sab hauv, tsis hais txog ntawm pluas mov nrog me me ntawm cov kua.

Retard ntsiav tshuaj (ib ntsiav tshuaj tag nrho lossis ib nrab) yuav tsum nqos tag nrho, tsis tas yuav zom, nrog ib qho kua tsawg tsawg, 2 zaug hauv ib hnub.Hauv qee tus neeg mob, thaum siv cov ntsiav tshuaj retard, nws yuav tsim nyog los nce qhov tshuaj ntawm cov tshuaj.

Tshuaj qaug dab peg Nyob rau hauv rooj plaub uas qhov no ua tau, carbamazepine yuav tsum tau kho raws li kev kho mob monotherapy. Kev kho mob pib nrog kev siv tshuaj rau ib qho me me txhua hnub, uas tom qab ntawd maj mam nce ntxiv kom txog thaum pom qhov txiaj ntsig zoo tshaj plaws.

Qhov sib ntxiv ntawm cov carbamazepine mus rau kev kho mob antiepileptic txuas ntxiv yuav tsum tau nqa tawm maj mam, thaum cov koob tshuaj ntawm cov tshuaj uas siv tsis hloov lossis, yog tias tsim nyog, kho.

Rau cov neeg laus, qhov pib koob tshuaj yog 100-200 mg 1-2 zaug ib hnub. Tom qab ntawd qhov koob tshuaj yog maj mam nce ntxiv kom txog rau qhov ua kom tau txiaj ntsig zoo tshaj plaws (feem ntau 400 mg 2-3 zaug hauv ib hnub, ntau tshaj 1.6-2 g / hnub).

Cov menyuam yaus txij thaum 4 xyoo - hauv koob pib 20-60 mg / hnub, maj mam nce ntxiv los ntawm 20-60 mg txhua lwm hnub. Hauv cov menyuam muaj hnub nyoog laus dua 4 xyoos - hauv thawj koob 100 mg / hnub, qhov tshuaj ntau dua tau nce zuj zus, txhua lub lim tiam los ntawm 100 mg. Txhawb tshuaj: 10-20 mg / kg ib hnub (hauv ntau ntau zaug): rau 4-5 xyoos - 200-400 mg (hauv 1-2 koob), 6-10 xyoo - 400-600 mg (hauv 2-3 koob ), rau 11-15 xyoo - 600-1000 mg (hauv 2-3 koob).

Nrog trigeminal neuralgia, 200-400 mg / hnub yog kho nyob rau thawj hnub, maj mam nce los ntawm tsis ntau tshaj 200 mg / hnub kom txog thaum qhov mob tsis tu (qhov nruab nrab 400-800 mg / hnub), thiab tom qab ntawd txo qis dua kev siv tshuaj kom tsawg. Thaum mob neurogenic keeb kwm, qhov pib koob tshuaj yog 100 mg 2 zaug ib hnub ntawm thawj hnub, tom qab ntawd cov koob tshuaj tau nce tsis ntau tshaj 200 mg / hnub, yog tias tsim nyog, nce nws los ntawm 100 mg txhua 12 teev kom txog thaum qhov mob hnov mob. Cov koob tshuaj txij nkawm yog 200-1200 mg / hnub hauv ntau qhov tshuaj.

Hauv kev kho cov neeg laus thiab cov neeg mob lub siab tsis zoo, qhov pib koob tshuaj yog 100 mg 2 zaug ib hnub.

Cawv kev tshem tawm cov dej cawv: cov tshuaj nruab nrab yog 200 mg 3 zaug hauv ib hnub, nyob rau hauv cov mob hnyav, nyob rau thawj ob peb hnub, qhov tshuaj yuav nce ntxiv rau 400 mg 3 zaug ib hnub. Thaum pib ntawm kev kho mob rau cov tsos mob hnyav tshem tawm, nws raug nquahu kom muab tshuaj nrog cov tshuaj sedative-hypnotic (clomethiazole, chlordiazepoxide).

Ntshav qab zib insipidus: qhov nruab nrab koob rau cov neeg laus yog 200 mg 2-3 zaug ib hnub. Hauv cov menyuam yaus, lub koob tshuaj yuav tsum raug txo kom nruj raws li lub hnub nyoog thiab lub cev qhov hnyav ntawm cov menyuam.

Mob ntshav qab zib neuropathy, nrog rau mob: qhov nruab nrab koob yog 200 mg 2-4 zaug ib hnub.

Hauv kev tiv thaiv mob rov huam tuaj ntawm kev xav thiab schizoaffective psychoses - 600 mg / hnub hauv 3-4 koob.

Hauv kev mob hnyav thiab qhov tsis haum (bipolar) cuam tshuam, kev txhaj tshuaj txhua hnub yog 400-1600 mg. Qhov nruab nrab txhua hnub koob tshuaj yog 400-600 mg (hauv 2-3 koob). Hauv lub xeev manic mob, qhov koob tshuaj tau nce nrawm dua, nrog kev kho kom zoo los ntawm kev cuam tshuam rau lub siab - maj mam (txhawm rau txhim kho kev zam).

Pharmacological kev txiav txim

Antiepileptic siv yeeb siv tshuaj (dibenzazepine derivative), uas kuj muaj cov tshuaj normotymic, antimaniacal, antidiuretic (hauv cov neeg mob ntshav qab zib insipidus) thiab analgesic (hauv cov neeg mob neuralgia).

Lub tshuab ntawm kev ua yog txuam nrog qhov thaiv ntawm voltage-gated Na + channels, uas ua kom muaj kev ruaj khov ntawm cov neuron membrane, inhibition ntawm cov tsos ntawm cov feem ntawm kev puas tsuaj ntawm neurons thiab txo qis ntawm kev sib txuas ntawm lub zog. Tiv thaiv qhov rov tsim ntawm Na + -cov kev txiav txim siab lub peev xwm nyob rau hauv depolarized neurons. Txo kev tso tawm ntawm qhov txaus siab neurotransmitter amino acid glutamate, nce qhov txo qhov qaug dab peg tsawg, thiab lwm yam. txo txoj kev pheej hmoo ntawm kev tsim muaj mob chwv leeg. Nws tsub kom qhov conductivity rau K +, modulates voltage-dependant Ca2 + channels, uas tseem tuaj yeem ua rau cov nyhuv anticonvulsant ntawm cov tshuaj.

Kho cov kev puas ntsoog tus kab mob hloov pauv thiab thaum kawg ua rau muaj kev cia siab rau cov neeg mob, pab txhawb lawv cov kev tsim kho kom rov zoo li qub. Nws tuaj yeem raug suav tias yog cov tshuaj kho mob tseem ceeb thiab hauv kev sib xyaw nrog lwm cov tshuaj anticonvulsant.

Ua tau zoo hauv focal (ib nrab) qaug dab peg (yooj yim thiab cov), nrog lossis tsis nrog los ntawm kev muaj feem thib ob, hauv kev kho tus mob feem ntau ua rau mob chonic, raws li kev sib txuas ntawm cov hom no (feem ntau tsis muaj txiaj ntsig ntawm qhov me me qaug dab peg - tso quav mal, tsis tuaj thiab myoclonic qaug dab peg) Cov.

Cov neeg mob qaug dab peg (tshwj xeeb tshaj yog nyob rau cov menyuam yaus thiab cov hluas) muaj cov txiaj ntsig zoo ntawm cov tsos mob ntawm kev ntxhov siab thiab kev nyuaj siab, nrog rau kev txo qis kev txob taus thiab kev txhoj puab heev. Qhov kev cuam tshuam ntawm kev txawj ntse ntawm lub hlwb kev ua haujlwm thiab psychomotor kev ua tau zoo yog qhov koob tshuaj thiab muaj kev hloov pauv siab.

Qhov pib ntawm cov nyhuv anticonvulsant sib txawv los ntawm ob peb teev mus rau ntau hnub (qee lub sijhawm txog li 1 hlis vim kev pib-pib ntawm cov metabolism).

Nrog rau qhov tseem ceeb thiab theem siab trigeminal neuralgia feem ntau nws txwv tsis pub muaj qhov tsos ntawm qhov mob tawm tsam. Ua tau zoo rau kev daws mob ntawm neurogenic mob nyob rau hauv lub dryness ntawm tus txha nqaj qaum, mob nraub qaum tom qab mob caj dab thiab postherpetic neuralgia. Kev daws qhov mob nyob rau hauv trigeminal neuralgia tau sau tseg tom qab 8-72 teev.

Yog hais tias haus dej haus cawv haus cawv, nws nce qhov pib ua rau qhov tsim nyog (uas feem ntau txo qis hauv tus mob no) thiab txo qhov mob tsis zoo ntawm cov chaw kuaj mob tshwm sim ntawm tus mob (nce excitability, tshee, gait tsis meej).

Hauv cov neeg mob uas muaj ntshav qab zib insipidus ua rau sai sai them nyiaj ntawm cov dej tshuav, txo cov diuresis thiab nqhis dej.

Antipsychotic (antimaniacal) kev ua tom qab 7-10 hnub, tuaj yeem yog vim yog inhibition ntawm cov metabolism hauv dopamine thiab norepinephrine.

Daim ntawv noj tshuaj ntau dua ua rau muaj kev saib xyuas ntawm lub zog ruaj khov dua ntawm carbamazepine hauv cov ntshav tsis muaj "peaks" thiab "dips", uas tso cai rau txo qhov zaus thiab qhov mob ntawm cov teeb meem tshwm sim ntawm kev kho, kom nce cov txiaj ntsig ntawm kev kho mob txawm tias siv cov koob tshuaj uas tsis tshua muaj. Dr. qhov txiaj ntsig tseem ceeb ntawm daim ntawv ntev ntev yog qhov ua tau ntawm kev noj 1-2 zaug ib hnub.

Sab sij huam

Thaum ntsuas qhov ntau zaus ntawm kev tshwm sim ntawm ntau yam kev tsis zoo, cov ntsiab lus hauv qab no tau siv: ntau zaus - 10% thiab ntau zaus, feem ntau 1-10%, qee zaum 0.1-1%, tsis tshua muaj 0.01-0.1%, tsis tshua muaj neeg 0.01%.

Kev noj tshuaj ntau-qhov muaj qhov tsis zoo tshwm sim feem ntau ploj hauv ob peb hnub, ob leeg nthawv thiab tom qab kev txo qis ib ntus hauv cov tshuaj ntawm cov tshuaj. Kev txhim kho cov kev phiv tshuaj los ntawm lub hauv nruab nrab cov hlab ntsha tuaj yeem yog vim tus txheeb ze ntau dhau ntawm cov tshuaj lossis qhov hloov pauv nyob rau hauv cov concentration ntawm cov tshuaj nquag nyob hauv cov ntshav. Hauv cov xwm txheej zoo li no, nws raug nquahu kom saib xyuas cov tshuaj txhawm rau hauv cov ntshav.

Los ntawm sab ntawm lub hauv nruab nrab ntawm cov hlab ntsha hauv lub cev: feem ntau - kiv taub hau, ataxia, tsaug zog, asthenia, feem ntau - mob taub hau, paresis ntawm kev pab, qee zaum - txawv txav ntawm lub cev tsis xws luag (piv txwv li tshee, "fluttering" tshee tshee - asterixis, dystonia, tics), nystagmus, tsis tshua - orofacial dyskinesia , oculomotor cuam tshuam, hais lus tsis meej (piv txwv li dysarthria), choreoathetoid cuam tshuam, peripheral neuritis, paresthesias, myasthenia gravis thiab paresis cov tsos mob. Lub luag haujlwm ntawm carbamazepine yog cov tshuaj uas ua rau lossis txhawb kev txhim kho ntawm cov neeg muaj kabmob tiv thaiv kabmob, tshwj xeeb tshaj yog thaum nws tau sau ua ke nrog cov tshuaj tiv thaiv kabmob, tseem tsis meej.

Los ntawm qhov kev xav ntawm lub paj hlwb: tsis tshua muaj - pom kev sib deev (pom lossis hnov), kev nyuaj siab, poob qis, ntxhov siab, tus cwj pwm ntxhov siab, ntxhov siab, tsis meej, tsis tshua muaj tshwm sim - kev ua kom mob hlwb.

Tsis tshua muaj, ntau yam hloov ncua-hom lub cev tsis haum lub cev nrog kub taub hau, tawm pob ntawm daim tawv nqaij, vasculitis (suav nrog erythema nodosum ua rau mob vasculitis), lymphadenopathy, muaj cov cim zoo li lymphoma, arthralgia, leukopenia, eosinophilia, ua haujlwm ntawm lub siab ua haujlwm thiab mob hepatosplenomegaly ( pom nyob rau hauv ntau yam kev sib txuas). Tuaj yeem koom tes, thiab lwm yam.cov plab hnyuv siab (piv txwv li mob ntsws, ob lub raum, tus neeg mob raum, myocardium, nyuv). Tsis tshua muaj - kev mob aseptic meningitis nrog myoclonus thiab peripheral eosinophilia, tshuaj tiv thaiv anaphylactoid, angioedema, kev tiv thaiv mob ntsws o lossis mob ntsws o eininophilic. Yog tias qhov kev tsis haum tshuaj rau saum toj no tshwm sim, kev siv cov tshuaj yuav tsum raug txiav tseg.

Hematopoietic plab hnyuv siab raum: feem ntau - leukopenia, feem ntau - thrombocytopenia, eosinophilia, tsis tshua muaj - leukocytosis, lymphadenopathy, folic acid deficiency, tsis tshua muaj tshwm sim - agranulocytosis, aplastic anemia, muaj tseeb erythrocytic aplasia, megaloblastic anemia, mob txaus los ntawm lub siab mob, mob ntshav qab zib. anemia

Nyob rau ib feem ntawm daim siab: ntau zaus - kev nce rau hauv cov dej num ntawm GGT (vim qhov induction ntawm qhov enzyme hauv lub siab), uas feem ntau tsis txawv, feem ntau - ib qho kev nce hauv cov kev ua ntawm alkaline phosphatase, qee zaum - ib qho kev nce ntawm kev ua si "mob siab" transaminases, tsis tshua muaj - kab mob siab cholestatic, parenchymal (hepatocellular) lossis hom sib xyaw, daj ntseg, tsis tshua muaj tshwm sim - kab mob siab, mob siab tsis ua haujlwm.

Los ntawm CCC: tsis tshua muaj - kev mob plawv rau hauv lub siab, txo qis lossis nce ntshav siab, tsis tshua muaj heev - bradycardia, arrhythmias, AV block nrog tsaus muag rau cov neeg mob, vau, aggravation lossis kev loj hlob ntawm lub plawv tsis ua haujlwm, exacerbation ntawm kev mob plawv (nrog rau kev tshwm sim lossis nce ntawm lub plawv nres), thrombophlebitis, mob ntsws thromboembolic.

Los ntawm cov kab mob endocrine thiab cov metabolism: feem ntau - edema, kua dej ceev, nce phaus, hyponatremia (ntshav plasma osmolarity tsis zoo vim muaj cov teebmeem zoo ib yam li ADH, uas muaj qee qhov tsis yooj yim ua rau cov ntshav tsis haum hyponatremia, nrog rau lub cev ntuav, ntuav, mob taub hau, tsis meej pem). thiab cov leeg mob hlwb), tsis tshua muaj tshwm sim - hyperprolactinemia (tej zaum yuav muaj nrog galactorrhea thiab gynecomastia), qhov kev txo qis ntawm L-thyroxine (tsis pub dawb T4, T4, T3) thiab nce siab ntawm TSH (feem ntau tsis nrog kev soj ntsuam cov kab mob), cuam tshuam ntawm cov calcium-phosphorus metabolism hauv cov pob txha mob (txo ntshav Ca2 + thiab 25-OH-colecalciferol): osteomalacia, hypercholesterolemia (suav nrog HDL roj) thiab hypertriglyceridemia.

Los ntawm cov kab mob genitourinary: tsis tshua muaj tshwm sim - interstitial nephritis, lub raum tsis ua haujlwm, lub raum tsis ua haujlwm (e.g. albuminuria, hematuria, oliguria, muaj zog urea / azotemia), tso zis ntxiv, tso zis cia, poob qis dua.

Los ntawm cov leeg musculoskeletal: tsis tshua muaj tshwm sim - arthralgia, myalgia lossis cramps.

Los ntawm cov khoom nruab nrog hauv lub cev: tsis tshua muaj - cuam tshuam hauv saj, txhaws ntawm lub lens, mob caj dab, tsis hnov lus, suav nrog tinnitus, hyperacusis, hypoacusia, hloov kev pom ntawm lub suab.

Lwm yam: kev cuam tshuam ntawm cov tawv nqaij pigmentation, purpura, mob ntxau, tawm hws, alopecia. Tsis tshua muaj neeg mob hirsutism tau tshaj tawm, tab sis qhov kev sib raug zoo hauv kev ua rau muaj kev cuam tshuam no nrog carbamazepine tswj hwm tseem tsis meej. Cov tsos mob: feem ntau cuam tshuam kev cuam tshuam ntawm cov hlab ntsha hauv nruab nrab, CVS, thiab lub tshuab ua pa.

Los ntawm sab nruab nrab ntawm lub hauv nruab nrab lub paj hlwb thiab lub cev ntawm lub cev - kev tsim txom ntawm lub hauv nruab nrab lub paj hlwb, tsis meej pem, tsaug zog, ntxhov siab, tsaus muag, tsaus muag, pom kev puas siab puas ntsoog ("pos huab" pem hauv ntej ntawm lub qhov muag), dysarthria, nystagmus, ataxia, dyskinesia, hyperreflexia (pib), hyporeflexia (tom qab) ), ua kom mob hlwb, mob hlwb (psychomotor cuam tshuam, myoclonus, mob hypothermia, mydriasis).

Los ntawm CCC: tachycardia, txo qis ntshav siab, qee zaum nce ntshav siab, cuam tshuam hauv kev sib txuam nrog kev nthuav dav nrog nthuav cov QRS complex, mob plawv.

Ntawm ib feem ntawm cov txheej txheem ua pa: kev nyuaj siab ntsws, ntsws ntsws ntsws.

Los ntawm lub plab zom mov: xeev siab thiab ntuav, ncua kev tshem tawm ntawm cov zaub mov los ntawm lub plab, txo lub zog ntawm cov nyuv.

Los ntawm cov kab mob urinary: urinary retention, oliguria lossis anuria, kua dej cia, hyponatremia dilution.

Qhov ntsuas pom: leukocytosis lossis leukopenia, hyponatremia, metabolic acidosis, hyperglycemia thiab glucosuria, nce ntxiv ntawm cov leeg nqaij ntawm KFK.

Kev Kho Mob: Tsis muaj ib qho tshuaj tua kab mob tshwj xeeb. Kev kho yog raws li tus neeg mob lub chaw kho mob, pw hauv tsev kho mob, kev txiav txim siab ntawm kev txiav txim siab ntawm cov carbamazepine hauv ntshav (kom paub tseeb tias muaj tshuaj lom nrog cov tshuaj no thiab ntsuas lub cev ntau dhau), mob plab zom mov, kev teem lub sij hawm qhib lub tshuab hluav ncaig (kev tshem tawm ntawm lub plab mus ntev yuav ua rau lub cev nqus tau mus ntev 2 thiab 3 hnub thiab rov thov dua) cov tsos ntawm cov tsos mob ntawm intoxication thaum lub sij hawm rov qab).

Kev yuam diuresis, hemodialysis, thiab peritoneal lim ntshav yog qhov tsis muaj txiaj ntsig (raug lim ntshav tau qhia nrog kev sib xyaw nrog kev lom loj thiab lub raum tsis ua haujlwm). Cov menyuam me yuav xav tau cov ntshav ntxiv. Cov tsos mob txhawb kev saib xyuas hauv chav saib xyuas mob siab, soj ntsuam lub siab lub zog, lub cev kub, qhov tsis zoo ntawm lub plawv, lub raum thiab lub zais zis, kho cov teeb meem electrolyte. Nrog ib qho kev txo qis hauv cov ntshav siab: ib txoj hauj lwm nrog lub taub hau kawg txo qis, ntshav hloov chaw, nrog qhov tsis muaj txiaj ntsig - iv dopamine lossis dobutamine, nrog lub plawv dhia ua kom tsis sib haum - kev kho mob yog xaiv ib qho zuj zus, nrog kev tawm tsam - cov lus qhia ntawm benzodiazepines (piv txwv li diazepam), nrog kev ceev faj (vim tias muaj peev xwm nce siab hauv kev nyuaj siab kev ua pa me) cov lus qhia ntawm lwm cov tshuaj tiv thaiv (piv txwv li, phenobarbital). Nrog rau txoj kev loj hlob ntawm dilution hyponatremia (dej intoxication) - txwv tsis pub cov kua dej thiab qeeb tso kua ntshav ntawm 0.9% NaCl tov (tuaj yeem pab tiv thaiv kev txhim kho ntawm ceema). Pom zoo Hemosorption ntawm cov pa roj carbon monoxide.

Cov lus qhia tshwj xeeb

Kev kho kab mob vwm pib ntawm kev teem caij txhaj tshuaj me me, ib tus zuj zus rau lawv kom ua tiav cov txiaj ntsig kho yam xav tau.

Nws raug nquahu los txiav txim siab qhov siab nyob hauv ntshav txhawm rau txhawm rau xaiv cov koob tshuaj kom zoo tshaj plaws, tshwj xeeb tshaj yog nrog kev sib koom ua ke.

Thaum hloov mus rau tus neeg mob mus rau carbamazepine, koob tshuaj ntawm cov tshuaj tiv thaiv antiepileptic yuav tsum maj mam txo kom txog thaum nws tso tag nrho.

Kev tsis ua sai sai ntawm carbamazepine tuaj yeem ua rau qaug dab peg. Yog tias nws yuav tsum tau txais kev kho mob sai sai, tus neeg mob yuav tsum tau hloov mus rau lwm cov tshuaj tiv thaiv kab mob hauv qab daim npog uas tau npaj tseg rau hauv cov xwm txheej zoo li no (piv txwv li, diazepam muab tshuaj rau txoj leeg lossis hauv qhov quav, lossis phenytoin muab tshuaj iv).

Muaj ntau tus neeg mob ntuav, raws plab thiab / lossis cov khoom noj tsis txaus, ua kom yuag thiab / lossis kev nyuaj siab ua pa ntawm cov menyuam tshiab uas lawv niam noj carbamazepine sib xyaw nrog lwm cov tshuaj anticonvulsants (cov kev coj ua no yuav yog qhov qhia tias "tshem tawm" cov kabmob ntawm cov menyuam mos).

Ua ntej sau cov tshuaj carbamazepine thiab thaum kho, nws yog qhov yuav tsum tau kawm kab mob siab, tshwj xeeb tshaj yog rau cov neeg mob uas muaj keeb kwm muaj kab mob siab, nrog rau cov neeg laus laus. Nyob rau hauv cov ntaub ntawv ntawm amplification ntawm twb muaj kev ua txhaum ntawm daim siab ua haujlwm lossis nrog cov tsos ntawm active daim siab mob, cov tshuaj yuav tsum tau txiav tam sim ntawd. Ua ntej pib kev kho mob, nws tseem yuav tsum ua qhov kev kawm txog cov ntshav ntshav (suav nrog platelet suav, reticulocyte suav), ntshiab Fe concentration, urinalysis, ntshav urea concentration, EEG, kev txiav txim siab cov ntshav electrolyte concentration (thiab qee zaus thaum kho, vim tias kev tsim kho tau ntawm hyponatremia). Tom qab, cov cim no yuav tsum tau saib xyuas thaum thawj lub hlis ntawm kev kho mob txhua lub lim tiam, thiab tom qab ntawd txhua hli.

Carbamazepine yuav tsum thim tawm sai sai yog tias muaj qhov tsis haum lossis cov tsos mob tshwm sim uas xav tias yog tsim ntawm Stevens-Johnson syndrome lossis Lyell's syndrome. Cov tawv nqaij me me (cais cov macular lossis maculopapular exanthema) feem ntau ploj mus li ob peb hnub lossis ntau lub hlis txawm hais tias muaj kev kho mob txuas ntxiv lossis tom qab txo cov koob tshuaj (tus neeg mob yuav tsum tau saib zoo los ntawm tus kws kho mob nyob rau lub sijhawm no).

Carbamazepine muaj qhov ua haujlwm tsis muaj zog anticholinergic, thaum kev kho mob rau cov neeg mob uas muaj kev mob siab ntxiv, nws txoj kev tshuaj xyuas tas li yog qhov tsim nyog.

Lub sijhawm ntawm kev ua haujlwm ntawm cov neeg mob hlwb tsis txaus ntseeg yuav tsum tau coj mus rau hauv tus lej, thiab hauv cov neeg mob laus, muaj peev xwm tsim kev tsis meej lossis npau taws.

Txog niaj hnub no, muaj cov ntawv tshaj tawm txawv ntawm cov txiv neej tsis taus thiab / los yog cov phev txiv neej tsis muaj peev xwm (qhov kev sib raug zoo ntawm cov kev tsis taus nrog carbamazepine tseem tsis tau tsim).

Muaj cov ntaub ntawv hais txog kev los ntshav rau cov poj niam thaum coj khaub ncaws hauv rooj plaub uas qhov ncauj tiv thaiv tau siv nyob rau tib lub sijhawm. Carbamazepine tuaj yeem cuam tshuam loj heev rau kev ntseeg tau ntawm cov tshuaj tiv thaiv qhov ncauj, yog li cov poj niam muaj hnub nyoog deev yuav tsum siv lwm txoj hauv kev tiv thaiv kev xeeb tub thaum kho.

Yuav tsum tau siv cov carbamazepine nkaus xwb hauv kev saib xyuas mob.

Nws yog ib qho tsim nyog yuav tsum tau qhia rau cov neeg mob txog cov tsos mob thaum ntxov ntawm kev muaj tshuaj lom neeg hauv kev muaj peev xwm ua rau cov ntshav tsis huv, nrog rau cov tsos mob ntawm daim tawv thiab daim siab. Tus neeg mob tau qhia txog qhov yuav tsum tau mus sab laj nrog tus kws kho mob tam sim ntawd yog tias muaj qhov tsis tsim nyog xws li ua npaws, mob caj pas, tawm pob, txhaws ntawm lub qhov ncauj ntawm qhov ncauj, ua rau mob doog ntshav, mob ntshav hauv daim petechiae lossis purpura.

Feem ntau, qhov ua kom txo qis hauv cov ntshav pliav plooj thiab / lossis cov qe ntshav dawb tsis yog qhov txhawm rau qhov pib ntawm mob ntshav qog lossis agranulocytosis. Txawm li cas los xij, ua ntej pib kev kho mob, nrog rau qee lub sijhawm thaum kho, kev kuaj ntshav hauv cov ntshav yuav tsum tau ua, suav nrog suav cov platelets thiab tejzaum reticulocytes, nrog rau kev txiav txim siab qhov concentration ntawm Fe hauv cov ntshav cov ntshav.

Tsis muaj kev hloov pauv hloov asymptomatic leukopenia tsis xav kom thim tawm, txawm li cas los xij, kev kho mob yuav tsum tsis ua mus ntxiv yog tias muaj mob leukopenia lossis leukopenia tshwm, nrog cov tsos mob ntawm tus kab mob kis.

Ua ntej pib txoj kev kho mob, nws raug nquahu kom ua qhov kev kuaj xyuas ophthalmological, suav nrog kev tshuaj xyuas cov nyiaj pob nrog lub pob hluav taws thiab ntsuas ntawm lub zog intraocular yog tias tsim nyog. Thaum muaj daim ntawv sau tshuaj rau cov neeg mob uas muaj kev cia siab ntau ntxiv, yuav tsum tau soj ntsuam tas li ntawm qhov ntsuas no.

Nws raug nquahu kom tso tseg kev siv ethanol.

Cov tshuaj nyob rau hauv daim ntawv ntev ntev tuaj yeem nqa ib zaug, thaum tsaus ntuj. Qhov xav tau nce cov koob tshuaj thaum hloov mus rau ntsiav tshuaj retard yog qhov tsawg kawg.

Txawm hais tias kev sib raug zoo ntawm koob tshuaj carbamazepine, nws qhov kev xav thiab kev soj ntsuam kev ua haujlwm lossis kev tso siab yog tsawg heev, txawm li cas los xij, kev txiav txim siab tsis tu ncua ntawm kev txiav txim siab ntawm carbamazepine yuav pab tau nyob rau hauv cov xwm txheej hauv qab no: nrog ntse nce rau hauv ntau zaus ntawm kev tawm tsam, txhawm rau tshuaj xyuas seb tus neeg mob tau noj tshuaj tsis raug cai, thaum lub sijhawm thaum cev xeeb tub, hauv kev kho mob ntawm menyuam yaus lossis tub ntxhais hluas, nrog kev xav tias tsis muaj tshuaj tiv thaiv kev tsis haum tshuaj, nrog kev xav tias muaj kev txhim kho tshuaj lom yog tias tus neeg mob tau noj maet ob peb tshuaj.

Hauv cov poj niam uas muaj hnub nyoog yug me nyuam, carbamazepine yuav tsum siv cov tshuaj kho mob thaum tsim nyog (siv tshuaj tsawg kawg nkaus) - qhov ntau zaus ntawm kev mob plab yug me nyuam hauv cov menyuam mos yug los rau cov poj niam uas tau ua ke nrog cov tshuaj tiv thaiv kab mob siab dua rau cov neeg uas tau txais txhua yam tshuaj no ua kev kho mob hlwb.

Thaum cev xeeb tub tshwm sim (thaum txiav txim siab txog kev teem caij carbamazepine thaum cev xeeb tub), nws yuav tsum ua tib zoo los sib piv cov txiaj ntsig ntawm kev kho thiab nws qhov teeb meem tshwm sim, tshwj xeeb tshaj yog nyob rau thawj 3 lub hlis thaum cev xeeb tub. Nws raug paub tias cov menyuam yaus yug los ntawm leej niam uas muaj kev puas ntsoog, tau mob rau txoj kev loj hlob ntawm intrauterine, suav nrog kev ua tsis tiav. Carbamazepine, zoo li tag nrho lwm cov tshuaj tiv thaiv kev mob, tuaj yeem ua rau muaj kev pheej hmoo ntawm cov mob no. Muaj cov ntaub ntawv sib cais los ntawm tus neeg mob ntawm cov kab mob ua tsis taus pa thiab tsis zoo, suav nrog kev tsis kaw cov pob txha caj qaum (spina bifida). Cov neeg mob yuav tsum tau muab cov ntaub ntawv hais txog qhov ua tau los txhawm rau txhawm rau txhawm rau txhawm rau qhov muaj feem ua txhaum thiab muaj peev xwm los soj ntsuam kev kuaj mob ua ntej.

Cov tshuaj antiepileptic nce folic acid deficiency, uas feem ntau pom thaum cev xeeb tub, uas tuaj yeem ua rau muaj qhov tsis zoo ntawm kev yug menyuam hauv menyuam yaus (ua ntej thiab thaum cev xeeb tub, folic acid ntxiv yog pom zoo). Txhawm rau tiv thaiv kev nce ntshav hauv cov menyuam yug tshiab, nws raug nquahu kom cov poj niam nyob hauv lub asthiv dhau los ntawm kev xeeb tub, nrog rau cov menyuam yug menyuam, yuav tsum tau muaj cov tshuaj vitamin K1.

Carbamazepine kis mus rau niam mis, cov txiaj ntsig thiab qhov tsis xav tau ntawm kev pub niam mis yuav tsum muab piv nrog kev kho mob txuas ntxiv. Cov niam cov niam noj carbamazepine tuaj yeem pub mis rau lawv cov menyuam tau noj, muab tau tias tus menyuam raug soj qab rau kev txhim kho kev pheej hmoo tsis zoo (piv txwv, tsaug zog hnyav, kev tsis haum tshuaj tawv nqaij).

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 tswj hwm tib lub sijhawm ntawm carbamazepine nrog CYP 3A4 inhibitors tuaj yeem ua rau muaj qhov nce ntxiv hauv nws cov concentration hauv cov ntshav ntshav thiab kev txhim kho kev tsis haum tshuaj. Kev sib xyaw ua ke ntawm CYP 3A4 inducers tuaj yeem ua rau kom muaj kev nrawm ntawm cov metabolism hauv carbamazepine, qhov kev poob qis hauv nws cov ntshav hauv cov ntshav plasma thiab qhov txo qis hauv cov nyhuv kho; qhov tsis sib xws, lawv txoj kev tshem tawm tuaj yeem txo tus nqi ntawm biotransformation ntawm carbamazepine thiab ua rau muaj kev nce ntxiv hauv nws cov kev xav.

Cov ntsiab lus ntawm carbamazepine hauv plasma yog nce los ntawm verapamil, diltiazem, felodipine, dextropropoxyphene, viloxazine, fluoxetine, fluvoxamine, cimetidine, acetazolamide, danazole, desipramine, nicotinamide (hauv cov neeg laus, tsuas yog thaum txhaj tshuaj ntau), macrolides. (itraconazole, ketoconazole, fluconazole), terfenadine, loratadine, isoniazid, propoxyphene, kua txiv kab ntxwv qaub, kab mob viral protease inhibitors siv los kho tus kab mob HIV (piv txwv, ritonavir) - kev hloov tshuaj yog tsim nyog. saib xyuas ntawm carbamazepine ntshav ntau.

Felmabat txo qhov kev txiav txim siab ntawm carbamazepine hauv plasma thiab nce qhov siab ntawm carbamazepine - 10.11 - epoxide, thaum tib lub sij hawm txo qis hauv cov concentration hauv cov ntshav felbamate yog ua tau.

Qhov kev nkag siab ntawm carbamazepine yog txo los ntawm phenobarbital, phenytoin, primidone, metsuximide, fensuximide, theophylline, rifampicin, cisplatin, doxorubicin, tej zaum: clonazepam, valpromide, valproic acid, oxcarbazepine thiab tshuaj ntsuab muaj cov tshuaj tsw qab.Muaj qhov ua tau ntawm kev hloov chaw ntawm carbamazepine nrog valproic acid thiab primidone vim muaj cov plasma protein thiab nce ntxiv ntawm cov tshuaj pharmacologically nquag metabolite (carbamazepine-10,11-epoxide). Nrog rau kev siv ua ke ntawm finlepsin nrog valproic acid, tshwj xeeb, tsis nco qab thiab tsis meej pem yuav tshwm sim.

Isotretinoin hloov kho cov teebmeem ntawm bioavailability thiab / lossis kev tshem tawm ntawm carbamazepine thiab carbamazepine-10,11-epoxide (tshuaj xyuas ntshav plasma carbamazepine yog qhov tsim nyog). Carbamazepine yuav txo tau cov ntshav concentration (txo los yog txawm kiag neutralize cov teebmeem) thiab tej zaum yuav tsum tau kho koob tshuaj nram qab no tshuaj: klobazama, clonazepam, digoxin, ethosuximide, primidone, valproic acid, alprazolam, corticosteroids (prednisone, dexamethasone), cyclosporine, tetracyclines (doxycycline) , haloperidol, methadone, qhov ncauj npaj uas muaj estrogen thiab / lossis progesterone (xaiv lwm txoj hauv kev tiv thaiv yog tsim nyog), theophylline, tshuaj tiv thaiv qhov ncauj (warf) rin, fenprocoumone, dicumarol), lamotrigine, topiramate, tricyclic antidepressants (imipramine, amitriptyline, nortriptyline, clomipramine), clozapine, felbamate, tiagabine, oxcarbazepine, protease inhibitors siv nyob rau hauv kev kho mob HIV-block, calcin, calciniv raws (ib pawg ntawm dihydropyridones, piv txwv li felodipine), itraconazole, levothyroxine, midazolam, olanzapine, praziquantel, risperidone, tramadol, ciprasidone. Muaj peev xwm nce ntxiv los yog txo qis npaum li cas ntawm phenytoin nyob rau hauv cov ntshav ntshav tawm tsam cov keeb kwm ntawm carbamazepine thiab nce qib ntawm mefenitoin. Nrog rau kev siv txeem carbamazepine thiab lithium npaj txhij, cov teebmeem ntawm neurotoxic ntawm ob qho tshuaj nquag tuaj yeem ua kom zoo dua.

Tetracyclines tuaj yeem ua raws li kev kho mob nyhuv ntawm carbamazepine. Thaum ua ke nrog paracetamol, qhov kev pheej hmoo ntawm nws cov kev ua rau lub siab ua rau lub siab nce ntxiv thiab cov tshuaj kho tau tsawg dua (nrawm cov metabolism ntawm paracetamol).

Kev tswj hwm tib lub sijhawm ntawm carbamazepine nrog phenothiazine, pimozide, thioxanthenes, mindindone, haloperidol, maprotiline, clozapine thiab tricyclic antidepressants ua rau muaj kev cuam tshuam ntau dua ntawm cov nyhuv hauv nruab nrab lub paj hlwb thiab ua rau lub cev tsis muaj zog ntawm cov tshuaj carbamazepine. Monoamine oxidase inhibitors tsub kom muaj kev pheej hmoo ntawm hyperpyretic crises, hypertensive crises, qaug dab peg, thiab kev tuag (monoamine oxidase inhibitors yuav tsum tau muab tso tseg ua ntej carbamazepine tshuaj rau tsawg kawg 2 lub lis piam lossis, yog tias qhov xwm txheej tso cai, txawm tias lub sijhawm ntev dua).

Ib txhij tswj hwm nrog kev siv tshuaj diuretics (hydrochlorothiazide, furosemide) tuaj yeem ua rau tus mob hyponatremia, nrog cov lus kuaj mob. Nws attenuates cov teebmeem ntawm qhov tsis-depolarizing nqaij relaxants (pancuronium). Kev siv los ntawm kev sib koom ua ke, nws yuav tsim nyog nce qhov koob tshuaj ntawm cov leeg ua kom lub zog, thaum ua tib zoo saib xyuas tus neeg mob nws yog qhov tsim nyog vim muaj kev txiav tawm ntawm cov nqaij ntshiv kom sai. Carbamazepine txo cov kev tsis haum siab ethanol. Myelotoxic tshuaj ntxiv rau hematotoxicity ntawm cov tshuaj.

Nws ua rau lub cev metabolism hauv kev tsis ncaj ntawm anticoagulants, tshuaj tiv thaiv kev tiv thaiv qog, tshuaj folic acid, praziquantel, thiab tuaj yeem txhim kho kev tshem tawm cov thyroid hormones.

Nws nrawm cov metabolism hauv cov tshuaj rau tshuaj loog (enflurane, halotane, fluorotan) thiab muaj kev pheej hmoo ntawm hepatotoxic zoo, ua rau muaj kev tsim cov nephrotoxic metabolites ntawm methoxyflurane. Ua kom zoo rau cov tshuaj hepatotoxic ntawm isoniazid.

Noj ntau dhau

Cov tsos mob feem ntau muaj kev cuam tshuam cuam tshuam ntawm lub hauv nruab nrab cov hlab hlwb, hlab plawv thiab lub tshuab ua pa.

Cov leeg hauv nruab nrab cev thiab cov pa hauv nruab nrog cev - kev tsim txom lub luag haujlwm ntawm lub hauv nruab nrab cov hlab hlwb, cuam tshuam, nkees, ntxhov siab, hnov qab, hnov qab, tsis pom kev, hais lus tsis meej, tsis txaus ntseeg, nystagmus, ataxia, dyskinesia, hyperreflexia (thaum pib), hyporeflexia (tom qab), nriaj, hlwb tsis meej, myoclonus, hypotherm mydriasis)

Mob plawv: tachycardia, txo cov ntshav siab, qee zaum nce ntshav siab, cuam tshuam hauv kev ua haujlwm sib luag nrog QRS txoj kev kho lub cev, tsaus muag, mob plawv,

Kab mob ua pa: kev nyuaj siab ntsws, ntsws ntsws ntsws,

Digestive system: xeev siab, ntuav, ncua kev tshem tawm ntawm cov zaub mov los ntawm lub plab, txo lub zog ntawm cov nyuv,

Cov kab mob zis: kev tso zis tawm, uriguria lossis anuria, kev saib xyuas ntshav tawm, tso ntshav hyponatremia.

Tsis muaj ib qho tshuaj tua kab mob tshwj xeeb. Cov tsos mob txhawb kev kho mob yog qhov yuav tsum tau ua hauv kev saib xyuas mob siab, soj ntsuam lub siab lub zog, lub cev kub, qhov muag tsis pom kev, lub raum kev ua haujlwm ntawm lub zais zis, thiab kho cov xaim hluav taws xob tsis zoo. Nws yog qhov tsim nyog los txiav txim siab qhov kev txiav txim siab ntawm carbamazepine hauv plasma kom paub meej tias lom nrog tus neeg sawv cev no thiab ntsuas qhov ntsuas ntawm kev haus dej ntau dhau, pais plab lav, kev teem caij ntawm cov roj carbon activated. Kev tshem tawm qeeb ntawm lub plab zom mov tuaj yeem ua rau ncua sij hawm nqus rau hnub 2 thiab 3 thiab rov tshwm sim cov tsos mob ntawm intoxication thaum lub sijhawm rov ua haujlwm.

Kev yuam diuresis, hemodialysis, thiab peritoneal lim ntshav yog qhov tsis muaj txiaj ntsig, txawm li cas los xij, lim ntshav tau qhia rau kev sib xyaw ua ke ntawm kev lom loj thiab lub raum tsis ua haujlwm. Hauv cov menyuam yaus, yuav muaj qhov xav tau hematotransfusion.

Cov ntawv tshaj tawm thiab ntim khoom

Ntawm 10 ntsiav tshuaj hauv lub ntsej muag hle khaub ncaws ntim los ntawm zaj duab xis ntawm polyvinyl chloride thiab txhuas ntawv ci.

5 blister ntim nrog rau cov lus qhia rau kev siv tshuaj hauv xeev thiab Lavxias lus muab tso rau hauv lub thawv ntawv thawv.

Cov Cai Siv Tshuaj So

Lub npe thiab lub teb chaws ntawm lub koom haumtsim kom muaj

“Teva Kev Ncig Poland Sp.z.o.o”

80 st. Mogilska, 31-546 Krakow, Poland

Lub npe thiab lub teb chaws hauvdaim npav sau npe

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

Lub npe thiab lub teb chaws ntawm lub koom haum ntim

“Teva Kev Ncig Poland Sp.z.o.o”, Poland

Chaw nyob ntawm lub koom haum lees txais kev tsis txaus siab los ntawm cov neeg siv khoom ntawm cov khoom lag luam zoo (cov khoom lag luam) hauv thaj chaw ntawm cov koom pheej ntawm Kazakhstan:

LLP "ratiopharm Kazakhstan"

050000, Koom pheej ntawm Kazakhstan Almaty, Al-Farabi Avenue 19,

Kev sib txuam

Cytochrome CYP3A4 yog lub enzyme tseem ceeb uas muab cov carbamazepine metabolism. Kev tswj hwm tib lub sijhawm ntawm carbamazepine nrog CYP3A4 inhibitors tuaj yeem ua rau muaj qhov nce ntxiv hauv nws cov ntshav siab thiab ua rau muaj kev phiv tshuaj. Kev siv CYP3A4 lub zog sib xyaw ua ke tuaj yeem ua rau muaj kev nrawm ntawm cov metabolism hauv carbamazepine, qhov kev txo qis ntawm cov pa carbamazepine hauv cov ntshav thiab txo qis hauv kev kho kom zoo, ntawm qhov tsis sib xws, lawv txoj kev tshem tawm tuaj yeem txo qhov kev zom zaub mov carbamazepine thiab ua rau muaj kev nce ntxiv hauv nws cov concentration.

Cov tshuaj plasma ntshav carbamazepine ntau ntxiv: verapamil, diltiazem, felodipine, dextropropoxyphene, viloxazine, fluoxetine, fluvoxamine, cimetidine, acetazolamide, danazole, desipramine, nicotinamide (hauv cov neeg laus, tsuas yog hauv koob tshuaj), macrolides, erythyryy, eryth, azoles (itraconazole, ketoconazole, fluconazole), terfenadine, loratadine, isoniazid, propoxyphene, kua txiv kab ntxwv, kua txiv viral inhibitors siv rau kev kho mob HIV (piv txwv ritonavir) - kev kho lub cev kev noj tshuaj yog yuav tsum tau txhaj. saib xyuas ntawm carbamazepine ntshav ntau.

Felbamate txo qhov kev txiav txim siab ntawm carbamazepine hauv plasma thiab nce qhov kev txiav txim siab ntawm carbamazepine-10,11-epoxide, thaum tib lub sij hawm txo qis hauv cov concentration hauv cov ntshav ntawm felbamate yog ua tau.

Qhov kev nkag siab ntawm carbamazepine yog txo los ntawm phenobarbital, phenytoin, primidone, metsuximide, fensuximide, theophylline, rifampicin, cisplatin, doxorubicin, tejzaum nws: clonazepam, valpromide, valproic acid, oxcarbazepine thiab cov zaub muaj cov khoom muaj Hypercum. Muaj cov ntaub ntawv qhia txog kev muaj peev xwm hloov chaw ntawm carbamazepine nrog valproic acid thiab primidone vim muaj cov plasma protein thiab muaj kev nce siab hauv cov tshuaj pharmacologically nquag metabolite (carbamazepine-10.11-epoxide).

Isotretinoin hloov kho cov teebmeem ntawm bioavailability thiab / lossis kev tshem tawm ntawm carbamazepine thiab carbamazepine-10,11-epoxide (plasma concentration ntawm carbamazepine yog tsim nyog).

Carbamazepine tuaj yeem txo ntshav plasma concentration (txo qis lossis txawm tias ua tiav cov teebmeem) thiab xav tau koob tshuaj rau cov tshuaj hauv qab no: clobazam, clonazepam, ethosuximide, primidone, valproic acid, alprazolam, GCS (prednisolone, dexamethasone), cyclosporine, doxycycorol, galixericadololine Cov tshuaj uas muaj cov tshuaj estrogens thiab / lossis progesterone (xaiv lwm txoj hauv kev tiv thaiv yog tsim nyog), theophylline, qhov ncauj anticoagulants (warfarin, fenprocoumone, dicumarol), lamotrigine, topiramate, tricyclic lawv cov tshuaj tiv thaiv kab mob (imipramine, amitriptyline, nortriptyline, clomipramine), clozapine, felbamate, tiagabin, oxcarbazepine, protease inhibitors siv nyob rau hauv kev kho mob HIV mob (indinavir, ritonavir, saquinovir), BMK (pawg ntawm dihydropyridine, dihydropididin, dihydropidin, dihydropidid, dihydropidin, dihydropidin, dihydropidin, dihydropidin, dihydropidin, dihydropidinin midazolam, olazapine, praziquantel, risperidone, tramadol, cyprasidone.

Muaj cov lus tshaj tawm tias thaum noj cov carbamazepine, theem ntawm phenytoin hauv cov ntshav tuaj yeem nce lossis txo qis, thiab theem ntawm mefenitoin tuaj yeem nce ntxiv (hauv qee qhov xwm txheej tsawg).

Carbamazepine thaum ua ke nrog paracetamol nce qhov kev pheej hmoo ntawm nws cov tshuaj lom rau daim siab thiab txo cov kev siv tshuaj kho mob (nrawm cov metabolism ntawm paracetamol).

MAO inhibitors nce kev pheej hmoo ntawm hyperpyretic crises, hypertensive crises, qaug dab peg, kev tuag (ua ntej kev teem caij carbamazepine, MAO inhibitors yuav tsum tso tseg tsawg kawg 2 lub lis piam lossis, yog tias qhov xwm txheej tso cai, txawm tias lub sijhawm ntev dua).

Ib txhij tswj hwm nrog kev siv tshuaj diuretics (hydrochlorothiazide, furosemide) tuaj yeem ua rau tus mob hyponatremia, nrog cov lus kuaj mob.

Nws attenuates cov teebmeem ntawm qhov tsis-depolarizing nqaij relaxants (pancuronium). Nyob rau hauv kev siv ntawm kev sib xyaw ua ke, nws yuav tsim nyog txhawm rau txhawm rau nce cov leeg ua kom cov leeg so, thaum nws yuav tsum tau saib xyuas cov neeg mob kom zoo, txij li kev txiav sai dua ntawm lawv qhov kev txiav txim siab tau).

Nws ua rau cov metabolism hauv kev tsis ncaj ntawm anticoagulants, tshuaj tiv thaiv hormonal tshuaj, folic acid, praziquantel, thiab tuaj yeem txhim kho kev tshem tawm cov thyroid hormones.

Nws ua rau cov metabolism hauv cov tshuaj rau cov tshuaj loog tshwj xeeb (enflurane, halotane, fluorotan) nrog kev pheej hmoo ntawm hepatotoxic zoo, txhim kho kev tsim cov nephrotoxic metabolites ntawm methoxyflurane.

Ua kom zoo rau cov tshuaj hepatotoxic ntawm isoniazid.

Myelotoxic tshuaj ntxiv rau qhov tshwm sim ntawm hematotoxicity ntawm cov tshuaj.

Pharmacodynamics thiab pharmacokinetics

Cov nquag tivthaiv tau muab los dibenzazepineCov. Cov tshuaj muaj antimaniacal, normotymic, antidiuretic (hauv cov neeg mob nrog ntshav qab zib insipidus), mob tshuaj kho mob (nrog neuralgia) thwm kev.

Lub hauv paus ntsiab lus ntawm cov nyhuv yog ua raws li qhov thaiv ntawm voltage-gated sodium channel, uas ua rau inhibition ntawm qhov tshwm sim ntawm neuron tawm, kev ruaj khov ntawm daim nyias nyias ntawm cov neurons, uas ua rau zoo txo qis ntawm kev sib txuas ntawm cov impulses.

Cov tshuaj txwv tsis pub rov ua cov sodium ntawm cov yeeb yaj kiab ua rau muaj peev xwm nyob hauv tus qauv ntawm depolarized neurons.

Carbamazepine ua rau kev txo qis hauv kev tso tawm glutamate (neurotransmitter amino acid), uas txo txoj kev pheej hmoo ntawm kev loj hlob qaug dab peg qaug dab pegCov. Hauv cov menyuam yaus thiab cov hluas nrog qaug dab peg thaum noj cov tshuaj, muaj qhov zoo nyob rau hauv kev sib raug zoo nrog tus mob ntawm kev nyuaj siab thiab ntxhov siab, nrog rau txo qis kev txhoj puab heev, txob taus.

Qhov cuam tshuam rau cov cim qhia psychomotor, kev ua haujlwm kom nkag siab yog koob tshuaj-rau hauv qhov xwm, hloov hauv txhua kis

Ntawm trigeminal neuralgia (qhov tseem ceeb, theem ob) muaj qhov txo qis ntawm qhov nquag ntawm mob mob.

Ntawm postherpetic neuralgiarau tom qab kev poob siab paresthesias, txhav qaum qaum - Carbamazepine pab txo cov leeg mob neurogenic.

Ntawm haus dej cawv cov tshuaj tuaj yeem txo qhov hnyav ntawm cov tsos mob tseem ceeb (tshee tshee ntawm lub siab, nce ntxiv kev npau taws, lub siab gait), ua rau lub luag haujlwm ntau ntawm qhov muaj peev xwm nyeem tau.

Hauv cov neeg mob nrog mob ntshav qab zib cov tshuaj txo cov kev xav ntawm tshav kub, diuresis, ua rau kom them nyiaj sai ntawm cov dej tshuav.

Antimaniacal (antipsychotic) cov txiaj ntsig tau sau tseg tom qab 7-10 hnub ntawm txoj kev kho, muaj kev txhim kho qhov tshwm sim ntawm kev txwv tsis pub muaj cov metabolism hauv norepinephrine, dopamine.

Kev siv lub sijhawm ntev ntawm cov carbamazepine tso cai rau koj kom ua tiav lub peev xwm ruaj khov ntawm cov khoom tseem ceeb hauv cov ntshav, tsis tas yuav sau npe "dips" thiab "peaks".

Cov ntsiav tshuaj Carbamazepine, cov lus qhia rau kev siv (qauv thiab ntau npaum li cas)

Cov tshuaj tau noj ntawm qhov ncauj nrog dej txaus. Cov ntsiav tshuaj noj ntev ntev (Carbamazepine Retard) tsis zom, tsis nqos tag nrho, ob zaug ib hnub.

Nrog qaug dab peg cov tshuaj yog kws kho li sai tau raws li kev kho mob monotherapy. Txoj kev kho yog pom zoo kom pib nrog cov koob tshuaj me nrog kev maj mam nce ntxiv hauv kev ntau npaum, uas tso cai rau ua tiav qhov txiaj ntsig zoo. Thawj zaug tshuaj rau cov neeg laus yog 100-200 mg 1-2 zaug nyob rau ib hnub, maj mam muab cov tshuaj ntxiv rau.

Mob hlwb neuralgia: thawj hnub ntawm txoj kev kho yog 200-400 mg, nrog nce me ntsis rau 400-800 mg ib hnub, tom qab ntawd cov tshuaj carbamazepine yog maj mam tso tseg.

Thawj zaug muab tshuaj nrog kev hnov mob mob ntawm cov keeb keeb neurogenic yog 100 mg ob zaug ib hnub, nrog nce ntxiv rau hauv koob tshuaj txhua 12 teev kom txog thaum hnov mob mob. Cov kev saib xyuas txij nkawm yog 200-1200 mg rau ib hnub, tsim los rau ob peb koob tshuaj.

Qhov nruab nrab ntau npaum nrog tus neeg mob haus cawv haus cawv yog 200 mg peb zaug ib hnub, nyob rau hauv mob hnyav, qhov koob tshuaj tau nce rau 400 mg peb zaug ib hnub.

Hauv cov hnub thaum ntxov ntawm kev kho, nws yog qhov pom zoo kom ntxiv tshuaj chlordiazepoxide, clomethiazole thiab lwm yam sedative-hypnotics.

Ntawm ntshav qab zib insipidus cov neeg laus tau muab tshuaj 200 mg 2-3 zaug ib hnub.

Ntawm mob ntshav qab zib neuropathy nrog mob mob 200 mg yog tshuaj 2-4 zaug nyob rau ib hnub.

Kev Tiv Thaiv schizoaffective thiab kev cuam tshuam rau lub hlwb: 600 mg rau 3-4 koob tshuaj ib hnub.

Cov koob tshuaj txhua hnub nrog bipolar, muaj kev cuam tshuam kev cuam tshuam, manic tej yam kev mob nplooj 400-1600 mg.

Cov lus qhia rau kev siv Carbamazepine Acry zoo sib xws.

Carbamazepine thiab dej cawv

Cov tshuaj yog siv los kho mob tshem tawm cov tsos mob tom qab haus cawv. Txhim kho cov kev xav hauv lub xeev ntawm tus neeg.Txawm li cas los xij, qhov kev kho mob no yuav tsum tsuas yog siv hauv tsev kho mob, thiab nws tsis pom zoo siv ob hom tshuaj no ua ke kom tsis txhob muaj kev xav ntau dhau ntawm cov hlab ntsha tsis zoo.

Kev txheeb xyuas ntawm carbamazepine

Muaj ob peb tshuaj xyuas nyob rau hauv cov ntsiab lus hais txog cov tshuaj siv rau cov laj thawj tshuaj. Yeej, kev tawm tswv yim tawm txog cov nyhuv ntawm cov tshuaj yog tshuaj.

Thaum cov tshuaj siv rau hauv kev kho mob ntawm ntau yam kev mob tsis txaus siab thiab kev puas siab puas ntsws, cov ntsiab lus pom tau hais txog nws txoj kev ua haujlwm tsis zoo hauv kev sib piv nrog ntau cov analogues niaj hnub no, uas tib lub sij hawm muaj tsawg dua phiv. Hauv kev kho mob trigeminal neuralgia, nws ntseeg tau tias qhov tshuaj ua haujlwm tsis zoo.

Tsis tas li, ib lub txim ntawm kev siv cov tshuaj yuav yog insomnia.

Kev tshuaj xyuas txog carbamazepine evkawj muaj qhov zoo sib xws.

Cov tshuaj muaj pes tsawg leeg

Carbamazepine retard ntsiav tshuaj muaj nyob nrog cov ntsiab lus sib txawv ntawm cov nquag muaj feem:

Lub cev nquag ua haujlwm: 200 lossis 400 mg ntawm carbamazepine
Cov khoom xyaw ntxiv: carbomer, CMC, Aerosil, E 572, sodium CMC.

Cov tshuaj uas muaj lub cev ntev, uas yog ua tiav los ntawm cov mis tshwj xeeb ntawm cov tshuaj: tom qab noj, cov tshuaj nquag yuav tswj tau nws cov nyhuv ntev dua li ib txwm.

200 mg tshuaj - dawb, greyish los yog beige ntsiav tshuaj nyob rau hauv daim ntawv ntawm lub tiaj tus kheej. Cov ntawv dawb yog ua tau, tsim cov nyhuv marbling. Xws li tus qauv yeej siv tau thiab tsis suav tias yog qhov tsis xws luag. Cov tshuaj muab tso rau hauv lub xov tooj ntawm tes ntawm 10 daim. Pob: 1/2/5 daim hlau, nrog lus annotation.

Cov tshuaj 400 mg - puag ncig, nrog thaj chaw voluminous ntawm cov ntsiav tshuaj nyob rau hauv daim ntawv ntawm ellipse. Ntim hauv hwj ntawm PET rau 50 daim. Hauv lub thawv - 1 ntim, cov lus qhia.

Kho thaj chaw

Qhov ua haujlwm anticonvulsant ntawm cov tshuaj tau tiav vim yog lub zog ntawm carbamazepine, ib qho kev tso dag ntawm tricyclic iminostilbene compound. Nws ntseeg tau tias lub peev xwm anticonvulsant ntawm cov khoom siv tau ua nws tus kheej los ntawm kev siv tshuab los txo cov haujlwm ntawm Na + channels. Raws li qhov tshwm sim, cov leeg neural yog ruaj khov thiab synaptic impulses yog txo. Nyob rau tib lub sijhawm, qhov kev tso tawm glutamate amino acid txo, theem ntawm qhov pib ntawm qhov tsis haum yog ib txwm muaj, uas txo qhov muaj feem ntawm kev qaug dab peg. Ntawm cov nyhuv anticonvulsant, lub tshuab ntawm kev txhim kho K + kev coj ua thiab kev ua kom lub cev calcium ntxiv kuj ua haujlwm.

Qee lub sijhawm tom qab tus neeg mob pib noj cov carbamazepine, cov cim ntawm kev txhim kho kev muaj peev xwm ntawm tus neeg mob kuj tshwm sim, uas pab nws sib txuas lus nrog lwm tus.

Hauv cov menyuam yaus, cov tshuaj yuav txo ntau dhau kev ntxhov siab, ntxhov siab, kev ntxhov siab. Qhov cuam tshuam ntawm kev muaj peev xwm tshwm sim yog ua raws li cov koob tshuaj siv.

Qhov pib ntawm cov nyhuv anticonvulsant yog qhov sib txawv - los ntawm ob peb teev lossis hnub tom qab kev coj noj coj ua (hauv qee cov neeg mob, nws yuav tsim tau tom qab ib hlis ntawm kev kho mob).

Tom qab lub qhov ncauj tswj hwm, cov tshuaj yuav luag tag nrho los ntawm cov hnyuv,, ntawm cov tshuaj khi rau cov ntshav plasma.

Nws yog metabolized hauv daim siab nrog kev koom tes ntawm nws cov enzymes. Kev tshem tawm ib nrab-lub neej yuav siv sijhawm li 12 mus rau 30 teev. Nws yog tsuas yog tawm nrog cov zis (yuav luag 70-75 feem pua), tus so nrog quav.

Txoj kev ntawm daim ntawv thov

Nws raug nquahu kom nqa carbamazepine retard, raws li cov lus qhia rau kev siv, thaum noj mov lossis tom qab ua tiav. Yog hais tias tus neeg mob muaj teeb meem nrog nqos, ces cov ntsiav tshuaj tau tso cai rau hauv daim ntawv yaj, txij li lub sijhawm ntev ntawm cov tshuaj yog khaws cia.

Kev noj tshuaj txhua hnub yog los ntawm 400 txog 1200 mg (hauv ntau ntau koob), qhov siab tshaj plaws, uas txwv tsis pub tshaj, yog 1600 mg.

Tshuaj qaug dab peg

Cov tshuaj tiv thaiv kab mob tshuaj tiv thaiv kev ua haujlwm ntev yog raug pom zoo kom ua kom tau sai li sai tau nrog daim monocourse.Cov tshuaj pib yuav tsum yog tsawg heev, tom qab ntawd kawm txog kev tawm tsam ntawm lub cev, nws tuaj yeem nce ntxiv txog qib uas xav tau. Txhua lub sijhawm koj yuav tsum saib xyuas qhov kev ntsuas ntawm cov khoom nquag hauv cov ntshav.

Yog tias cov tshuaj siv tau ntev tau ntxiv rau qhov kev kho mob antiepileptic uas twb tau tsim, ces qhov no yuav tsum tau ua kom maj mam, qhia nws me ntsis. Yog tias vim li cas tus neeg mob tsis tuaj yeem haus cov tshuaj, tom qab ntawd cov ntsiav tshuaj tau noj thaum thawj zaug hauv kev siv ntau npaum li cas, nws raug txwv tsis pub haus ib lossis ob zaug koob tshuaj.

Cov neeg laus: qhov pib pib noj ib hnub ntawm 200 mg carbamazepine ntsiav tshuaj yog los ntawm 1 mus rau 2 pcs, tom qab ntawd cov tshuaj txhua hnub yuav raug hloov kho, yog tias tsim nyog, rau cov txiaj ntsig ntau dua. Rau kev kho tu, nws raug tso cai siv ntawm 800 txog 1200 mg nyob rau hauv 1-2 koob. Cov tshuaj pom zoo: tus nqi pib - noj 200-300 mg thaum yav tsaus ntuj, nrog chav kawm txij nkawm - thaum sawv ntxov - 200-600 mg, yav tsaus ntuj - los ntawm 400 txog 600 mg.
Cov menyuam yaus thiab tub ntxhais hluas (4-15 xyoo): thaum xub thawj - 200 mg / hnub. Tom qab ntawd nce ntxiv los ntawm 100 mg / hnub. rau qib yam tsim nyog. Rau kev saib xyuas kev kho mob ntawm cov neeg mob 4-10 xyoo - ib koob tshuaj txhua hnub ntawm 400 txog 600 mg, rau cov menyuam loj dua (11-15 xyoo) - txij li 600 txog 1000 mg / hnub.

Lub sijhawm sijhawm ntawm kev tswj xyuas yog nyob ntawm qee qhov kev cuam tshuam ntawm lub cev mus rau tshuaj. Qhov kev txiav txim siab hloov tus neeg mob mus rau ib cov tshuaj nrog cov kev ua ntev, lub sijhawm ua haujlwm, thiab lwm yam nuances raug txiav txim siab ib tus zuj zus. Qhov xav tau los txo cov tshuaj ntawm carbamazepine yog txiav txim los ntawm tus kws kho mob uas koom nrog. Qhov kev txiav txim siab ntawm kev muaj peev xwm ua tiav kev tshem tawm yeeb tshuaj muaj peev xwm ua tau yog tias tus kab mob tsis tshwm sim nws tus kheej thaum lub sijhawm 2-3 lub xyoos ntawm kev kho. Txoj kev kho yuav tsum tau tsum txiav ua ntu zus, 1-2 xyoos tau muab txo los txo cov tshuaj.

Ua rau mob hlwb neuralgia, idiopathic glossopharyngeal hlab ntsha neuralgia

Thaum pib ntawm txoj kev kho, 200 mus rau 400 mg ntawm cov tshuaj yog kws kho nyob hauv ob txoj kev faib tawm. Kev noj cov carbamazepine tuaj yeem nce ntxiv kom txog thaum qhov mob ploj, nce txog 400-800 mg / hnub. Tom qab ua tiav cov txiaj ntsig kho, nws muaj peev xwm siv cov tshuaj txo qis kom tswj qhov ua tiav - 400 mg txhua hnub. Qhov niaj hnub ntau yog 1.2 g.

Cov neeg laus cov neeg mob thiab cov neeg mob rhiab rau cov tshuaj nquag tau txhaj tshuaj 100 mg ob zaug ib hnub, kev nce ntxiv tau tsuas yog ua tau nrog kev saib xyuas zoo kom txog thaum qhov mob tsis tu lawm. Hauv nruab nrab, koj yuav tsum tau noj 3-4 p. / Hnub. 200 mg txhua. Tom qab ploj ntawm cov cim ntawm tus kab mob, qhov nyiaj ntawm cov tshuaj maj mam txo mus rau theem ntawm kev kho kho mob.

Yuav ua li cas rho Carbamazepine Retard

Qhov kev tso tseg ntawm kev tswj hwm yuav tsum coj mus rau hauv tus lej peculiarity ntawm kev ua ntawm kev siv lub sijhawm ntev. Kev tshem tawm sai sai tuaj yeem ua rau mob tawm tsam mob vwm, yog li cov tshuaj yuav tsum tau maj mam txo. Nyob rau hauv kev hloov pauv ntawm tus neeg mob los ntawm cov tshuaj no mus rau lwm qhov tshuaj tiv thaiv kev ntxhov siab, nws yuav tau noj tshuaj ntxiv kom txiav tawm cov tsos mob tsis txaus siab.

Thaum cev xeeb tub thiab pub niam mis

Kev siv cov carbamazepine thaum cev xeeb tub thiab lactation yuav tsum muaj kev saib xyuas zoo.

Rau cov poj niam nrog lub luag haujlwm ntawm kev ua me nyuam, nws raug nquahu kom siv cov tshuaj hauv kev kho tshuaj, vim tias qhov kev pheej hmoo ntawm anomalies thiab pathologies hauv tus menyuam yog qhov qis dua thaum nqa tawm kev kho mob sib kis nrog siv lwm cov tshuaj tiv thaiv kab mob.

Yog tias tus poj niam cev xeeb tub thaum lub sijhawm carbamazepine, lossis yog tias nws yuav tsum tau siv nws thaum lub sijhawm cev xeeb tub, nws yuav tsum tau soj ntsuam cov txiaj ntsig ntawm kev kho thiab qhov tshwm sim uas tuaj yeem ua rau txoj kev loj hlob ntawm tus menyuam mos-plab. Qhov no tseem ceeb tshaj yog tias cov tshuaj tiv thaiv kab mob tau siv hauv thawj peb lub hlis.

Thaum sau tshuaj, koj yuav tsum noj cov tshuaj qis kawg nkaus uas muab cov txiaj ntsig kho kom zoo, thiab soj ntsuam cov qib ntawm cov tshuaj lom neeg nquag hauv cov ntshav ntshav.

Kev cuam tshuam los ntawm kev kho thaum lub caij cev xeeb tub yuav tsum tsis txhob ua, vim tias nws paub tias kev ua kom lub zog ntawm pathology yog qhov txaus ntshai rau leej niam thiab nws tus menyuam hauv plab. Nws yog qhov muaj kev cia siab hais tias nyob rau hauv cov menyuam yaus uas lawv niam muaj kev txom nyem los ntawm kev mob vwm, kev ntshawv siab hauv kev txhim kho intrauterine feem ntau tshwm sim. Nyob rau tib lub sijhawm ntawd, muaj kev ua xyem xyav tias carbamazepine muaj peev xwm ua rau kev nthuav dav ntawm pathologies, txij li cov xwm txheej ntawm cov menyuam yug los ntawm kev mob plab hnyuv txha caj qaum thiab tus txha caj qaum muaj lub zog, craniofacial deformities, kev ua haujlwm hauv lub cev, kev mob plawv tsis txaus thiab lwm yam kev mob tau raug kaw tseg. Txawm hais tias txoj kev sib raug zoo ntawm cov nyhuv ntawm cov tshuaj thiab cov anomalies tseem tsis tau muaj pov thawj tag nrho, qhov ntxim nyiam ntawm lawv txoj kev txhim kho tsis tuaj yeem txiav tawm.

Cov poj niam yuav tsum raug qhia paub txog cov teeb meem uas muaj peev xwm ntawm tus me nyuam hauv plab, thiab tau kuaj mob ua ntej.

Zoo li txhua yam tshuaj antiepileptic, carbamazepine tuaj yeem ua kom muaj kev noj cov tshuaj folic acid ntau hauv lub cev, uas tuaj yeem ua rau muaj kev pheej hmoo ntawm kev yug menyuam hauv cov menyuam. Yog li, thaum cev xeeb tub, yuav tsum tau noj tshuaj vitamin ntxiv.

Yog tias tus poj niam cev xeeb tub tau noj cov tshuaj nyob rau theem kawg (tshwj xeeb tshaj yog nyob rau lub limtiam tsis ntev los no), tom qab ntawd tus menyuam yug tshiab yuav tsum muaj vitamin K1 kom txo qis cov kev siv uas muaj peev xwm tshem tawm cov mob. Pathology tshwm sim los ntawm kev chua leeg, ua pa luv, mob plab zom mov, tsis qab los.

Kab Mob Siab

Carbamazepine muaj peev xwm yuav tawm hauv mis, yog li thaum sau tshuaj nws yog qhov yuav tsum tau soj ntsuam cov txiaj ntsig ntawm kev kho mob thiab qhov pheej hmoo ua rau tus menyuam. Thaum txoj kev kho, lactation yuav tsum muab pov tseg. Yog tias tus kws kho mob tau txiav txim siab tias tsis tas yuav tsis kam lees HB, tom qab ntawd tus menyuam yuav tsum tau saib xyuas tas li kom nws tuaj yeem txheeb xyuas thiab tshem tawm cov kev mob tshwm sim ntawm Carbamazepine hauv lub sijhawm.

Hla kev sib txuam yeeb tshuaj

Kev siv cov carbamazepine Retard yuav tsum tau nqa tawm mus rau hauv tus account peculiarities ntawm kev cuam tshuam ntawm cov tshuaj nquag nrog lwm cov tshuaj.

Kev hloov pauv ntawm carbamazepine tshwm sim nrog kev koom tes ntawm cytochrome CYP3A4. Kev sib txuas ua ke nrog nws nrog cov tshuaj uas sim cov kab mob ntawm cov enzymes no, cov tshuaj antiepileptic hauv plasma nce ntxiv, uas pab txhawb tsis tau tsuas yog kho cov tshuaj kho kom zoo, tab sis kuj muaj kev phiv. Ib txhij tswj hwm nrog rau cov tsim tawm pab ua kom nrawm cov metabolism ntawm cov tshuaj thiab txo nws cov ntsiab lus hauv plasma thiab txo cov txiaj ntsig kho kom zoo.
Qhov kev nkag siab ntawm cov carbazepine hauv lub cev nce hauv qab ntawm verapamil, felodipine, fluoxetine, trazodone, cimetidine, acetazolamide, macrolides, cirofloxacin, azoles, stiripentol, terfenadine, isoniazid, oxygenbutynin, ticlopidine, ritonav thiab lwm tus. Yog li ntawd, nrog kev tswj hwm tib lub sijhawm, ib qho kev txhim kho ntawm cov tshuaj tau siv yog tsim nyog yuav tsum ua raws li kev nyeem ntawv ntawm cov tshuaj yeeb dej caw hauv lub cev.
Qib ntawm carbazepine concentration poob qis thaum ua ke nrog felbamate, thiab cov ntsiab lus ntawm cov tshuaj kawg kuj tuaj yeem hloov pauv.
Loxapine, primidone, valproic acid thiab nws cov txiaj ntsig, thaum noj ua ke nrog carbamazene, tuaj yeem nce nws cov ntsiab lus ntau ntxiv.
Carbamazepine tuaj yeem hloov chaw los ntawm cov ntshav ntshav los ntawm valproic acid thiab primidone, thiab yog li nce nws cov ntsiab lus metabolite. Thaum noj ua ke nrog valproic acid, nws yuav tsum tau yug los rau hauv lub siab tias xws li kev sib xyaw ua ke tuaj yeem ua rau tus mob tsis xeev thiab cuam tshuam nyob hauv kev nco qab.
Carbamazepine tuaj yeem txo cov ntshav plasma concentration ntawm clobazam, digoxin, primidone, glucocorticosteroids, cyclosporine, tetracyclines, tshuaj hormonal nrog estrogen lossis progesterone, theophylline, qhov ncauj anticoagulants, TCAs, bupropion, sertraline, felbamate, occlazazine, clupazep, clupazep, clupazep, clupazep, clupazep, clupazep, clupazep, clupazep, clupazep, clupazep, clupazepp thiab ntau lwm yam tshuaj.Ib qho tshuaj twg ntawm ib qho yeeb tshuaj twg yuav tsum tau kuaj xyuas seb puas sib haum nrog carbamazepine, thiab cov ntau npaum li cas ntawm lawv yuav tsum kho raws li cov txiaj ntsig.
Thaum ua ke cov carbamazepine nrog phenytoin, ib tus yuav tsum coj mus rau hauv tus lej muaj peev xwm sib cuam tshuam ntawm cov kev kho kom zoo, nrog rau qhov nce ntxiv hauv theem ntawm mefenitoin.
Kev sib koom tes ntawm cov tshuaj nrog cov tshuaj uas muaj cov roj ntsha lithium lossis metoclopramide tuaj yeem txhim kho lawv cov tshuaj lom rau hauv lub cev.
Cov nyhuv ntawm carbamazepine tsis muaj zog los ntawm kev sib koom ua ke nrog cov tshuaj tetracycline.
Thaum kho, kev ceev faj yuav tsum tau siv thaum siv cov tshuaj paracetamol, vim nws cov nyhuv ua rau lub siab ua rau lub siab ua kom zoo dua qub thiab kho cov nyhuv txo qis (vim qhov ua kom nrawm nrawm ntawm cov txheej txheem hauv lub cev).
Carbamazepine ua rau kev ua kom zoo ntawm lub zog nruab nrab ntawm NS ntawm phenothiazine, thioxanthene, haloperidol, clozapine, TCA, tab sis nws tsis muaj zog nrog kev sib xyaw no.
IMAO muaj peev xwm nce kev hem thawj ntawm hyperpyretic thiab kub siab ua rau muaj kev nyuaj siab, mob hlwb ua ke, tuag. Txhawm rau zam kev tuag taus txheej txheem, ntawm lub sijhawm ntawm carbamazepine thiab MAO, lub sijhawm sib nrug ntawm tsawg kawg ob lub lis piam yuav tsum raug tswj kav.
Kev sib koom tes ntawm cov tshuaj antiepileptic nrog diuretics tuaj yeem ua rau mob hyponatremia.
Carbamazepine ua rau cov tshuaj kho tsis muaj zog ntawm cov nqaij ntshiv kom tsis txhob mob, yog li, nws yuav tsim nyog los ua kom ntau ntau nrog kev soj ntsuam tas li ntawm lawv lub xub ntiag hauv plasma.
Qee qhov xwm txheej, thaum muab cov tshuaj antiepileptic nrog levetircetam, cov tshuaj lom dhau ntawm cov tshuaj kawg yuav nce ntxiv.
Carbamazepine muaj peev xwm txo qis kev zam ntawm kev quav cawv ethyl.
Myelotoxic tshuaj potentiate hematotoxicity ntawm cov tshuaj.
Cov tshuaj tiv thaiv ua kom nrawm nrawm hloov qhov kev hloov pauv ntawm kev tsis raug anticoagulants, kev tiv thaiv tshuaj tiv thaiv kab mob, tshuaj folic acid, nrog rau praziquantel, tshuaj loog thiab tshem tawm cov thyroid hormones. Txhim kho lub zog ua kom muaj tshuaj lom ntawm isoniazid ntawm daim siab.

Phiv thiab haus tshaj

Qee qhov tshwm sim tsis zoo ntawm lub cev (feem ntau yog los ntawm lub hauv nruab nrab lub paj hlwb, daim tawv nqaij thiab lub plab zom mov) feem ntau tshwm sim thaum pib ntawm txoj kev kho mob, tom qab siv cov tshuaj loj los yog hauv cov neeg laus.

Kev noj tshuaj ntxiv rau qhov tshuaj tus kheej ploj lossis tom qab noj tshuaj tsawg dua. Cov tsos mob ntawm tus mob NS nruab nrab yuav tshwm sim vim yog kev qaug cawv me ntsis lossis vim muaj qhov sib txawv ntawm cov tshuaj lom neeg nyob hauv cov ntshav. Hauv qhov no, koj yuav tsum tau saib xyuas cov cim qhia ntawm cov tshuaj kom tiv thaiv kev loj hlob ntawm pathology.

Thaum kho, feem ntau cov kev mob tshwm sim ntawm carbamazepine yog:

Nyob rau ntawm cov kabmob ntawm cov ntshav: leukopenia, leukocytosis, ntshav qab zib ntshav qis pathologically platelet suav, eosinophilia, lymph node hloov, folic acid deficiency, tsis txaus ntshav dawb muaj ntshav cell suav, erythrocyte aplasia, ntau yam kev mob ntshav tsis txaus (aplastic / megoblastic / hemolytic, thiab lwm yam), porphyria, dysfunction. txha caj qaum.
Kev tiv thaiv: ua pob khaus, vasculitis, mob pob txuv, mob ntsws mob txha caj qaum, anaphylaxis, Quincke's edema.
Endocrine system thiab metabolism: edema, kua txuam nrog, ua kom yuag, hyponatremia, tsis tshua muaj ntshav siab (nrog rau lub cev tsis muaj zog, mob taub hau, kiv taub hau, mob puas hlwb), hyperprolactinemia nrog lossis tsis muaj galactorrhea, mob qog, txo cov calcium pob txha, roj hauv plhaws.
Lub siab: ua kom pom tseeb (pom kev, "lub suab"), kev nyuaj siab, poob qis lossis tsis qab los, ntxiv kev ntxhov siab, ntxhov siab, ntxhov siab, tsis meej, puas tsuaj ntawm cov hlwb.
NS: kev ua kom loog, tshee, dystonia, tics, kev tsis sib haum xeeb ntawm lub pob txha musculature, hais lus lub tshuab, peripheral neuropathy, ploj ntawm qhov hnov, nqaij tsis muaj zog, distorted saj tsis zoo, CNS, nco puas.
Lub zeem muag, hnov lus: kev cuam tshuam txog chaw nyob, muaj tus kab mob siab B siab, nce ntawm lub lens, tinnitus / tinnitus, hypo- lossis hyperacusia.
Cov kab mob ntawm lub plawv thiab cov hlab ntshav: kev mob plawv rau hauv lub plawv, mob ntshav tawm ntshav (hypo- hypo- hypertension), mob ntshav dhia (bradycardia), mob plawv dhia ceev ceev, lub plawv khiav tsis zoo, mob plawv, mob ntsws, mob ntsws txhaws.
Kev ua pa tawm: kev ua xua ntawm lub ntsws (ua npaws, mob apnea, mob ntsws, thiab lwm yam).
Lub plab zom mov: qhov ncauj qhuav, cem quav / raws plab, mob, mob pancreatitis, o ntawm tus nplaig.
Mob siab: kev hloov pauv ntawm cov kev ua ub no thiab kev xav ntawm cov enzymes, daim siab ua haujlwm.
Dermis thiab s / c fiber: dermatitis, urticaria (mob hnyav ua tau), SLE, khaus, Stevens-Johnson syndromes, Lyell, photosensitivity, erythema (polyform, knobby), pigmentation cuam tshuam, pob txuv, purpura, tawm hws loj, txiv neej hom plaub hau. plaub hau poob.
Musculoskeletal system: kev sib koom tes mob, mob leeg nqaij, mob plab, ua rau muaj pob txha lov.
Cov kab mob genitourinary system: lub raum tsis ua haujlwm, nephritis, tso zis nce ntxiv, tso zis tsis zoo, impotence, spermatogenesis mob.
Lwm cov tsos mob: qaug zog, rov ua dua ntawm hom 6 herperovirus.

Carbamazepine tuaj yeem cuam tshuam koj lub peev xwm kev xav thiab txiav txim siab sai. Yog li, lub sijhawm nws siv, yuav tsum tau ceev faj thaum tsav tsheb lossis koom nrog ib yam haujlwm twg ua rau muaj kev phom sij rau kev noj qab haus huv lossis lub neej ntawm tus neeg mob.

Kev mob plab yog pom tshwm los ntawm kev ua pa nyuaj siab, hyperreflexia, tom qab ntawd hloov mus rau hyporeflexia, qhov kub tsawg dua, mob plab hnyuv mob, thiab muaj kev phiv ntau heev.

Txij li thaum tsis muaj ib qho kev tiv thaiv kab mob rau carbamazepine, kev noj tshuaj ntau dhau yog tshem tawm los ntawm kev ntxuav lub plab, noj sorbents, thiab kho cov tsos mob.

Tus neeg mob yuav tsum tau saib xyuas tas li kom txog thaum cov tsos mob ntawm intoxication ploj tag nrho. Yog tsim nyog, menyuam yaus yuav raug tso ntshav.

Carbamazepine analogues thiab cov lus ua tau yuav tsum tau xaiv tshwj xeeb los ntawm cov neeg tuaj koom tshwj xeeb.

Sun Pharma (Is Nrias teb)

Nqe: rub tawm. tab. 200 mg (30 pcs.) - 81 rubles., 400 mg (30 pcs.) - 105 rubles.

Tshuaj nrog cov ib txwm ib txwm los yog lub caij ntev. Kev ua kom zoo ntawm cov tshuaj yog ua tiav ua tsaug rau cov carbamazepine uas muaj. Cov lus qhia rau kev siv thiab yam ntxwv ntawm kev siv - raws li kev cim tus kheej.

Cov Tshuaj Pharmacokinetics

Kev nqus tau qeeb tab sis ua tiav (kev noj mov tsis cuam tshuam loj npaum li cas thiab qhov nqus tau npaum li cas). Tom qab txhaj ib koob tshuaj ntawm lub ntsiav tshuaj li niaj zaus, Stax tau mus txog tom qab 12 teev. Tsis muaj qhov sib txawv ntawm qhov sib txawv ntawm qhov nqus ntawm cov tshuaj nquag tom qab siv ntau hom tshuaj ntawm cov tshuaj rau qhov ncauj tswj hwm (bioavailability thaum noj cov ntsiav tshuaj rov qab yog 15% qis dua thaum noj lwm cov tshuaj noj). Tom qab cov tshuaj noj ib qhov ncauj ntawm 400 mg ntawm carbamazepine, 72% ntawm cov koob tshuaj noj tau tawm hauv cov zis thiab 28% nrog quav. Txog 2% ntawm cov koob tshuaj noj tau tawm hauv cov zis ua tus tsis hloov pauv carbamazepine, li 1% - raws li 10.11-epoxy metabolite. Hauv cov menyuam yaus, vim kev cuam tshuam sai dua cov carbamazepine, kev siv ntau dua ntawm cov tshuaj rau ib kg ntawm lub cev hnyav tuaj yeem xav tau, piv nrog cov neeg laus. Tsis muaj pov thawj pom tias qhov chaw muag tshuaj ntawm carbamazepine hloov pauv hauv cov neeg mob laus (piv nrog cov neeg hluas). Tsis muaj ntaub ntawv khaws tseg rau hauv lub pharmacokinetics ntawm carbamazepine hauv cov neeg mob uas lub raum tsis zoo lossis lub siab ua haujlwm tsis zoo.

Cev xeeb tub thiab lactation

Cov poj niam cev xeeb tub uas muaj mob vwm yuav tsum tau ua nrog kev ceev faj heev.

Yog tias tus poj niam noj carbamazepine cev xeeb tub los yog tab tom npaj lub cev xeeb tub, lossis yog tias nws yuav tsum pib siv cov carbamazepine thaum cev xeeb tub, cov txiaj ntsig zoo ntawm cov tshuaj yuav tsum tau ua tib zoo ntsuas hauv kev sib piv nrog kev pheej hmoo muaj feem, tshwj xeeb tshaj yog nyob rau thawj peb lub hlis thaum cev xeeb tub. Cov koob txhaj tshuaj uas yuav tsum tau txhaj tsawg kawg yuav tsum yog cov tshuaj thiab ntshav kuaj ntshav.

Thaum cev xeeb tub, kev kho tus mob antiepileptic zoo yuav tsum tsis txhob tso tseg, vim tias kev tsim txom ntawm tus kab mob muaj qhov tsis zoo rau leej niam thiab tus menyuam hauv plab.

Siv los ntawm cov poj niam laus

Carbamazepine ua rau hauv cov kua mis ntxiv (kwv yees li 25 - 60% ntshav ntshav). Cov txiaj ntsig ntawm kev pub niam mis yuav tsum raug ntsuas ua rau muaj kev cuam tshuam nrog cov xwm txheej tsis zoo hauv cov menyuam mos. Cov niam uas noj cov carbamazepine tuaj yeem pub niam mis tau yog lawv ua tib zoo saib xyuas cov menyuam yaus kom paub qhov kev phiv uas tsis zoo (piv txwv li, nkees nkees ntau dhau, ua rau tawv nqaij ua xua).

Sab sij huam

Kev noj tshuaj ntau-qhov muaj qhov tsis zoo tshwm sim feem ntau ploj hauv ob peb hnub, ob leeg nthawv thiab tom qab kev txo qis ib ntus hauv cov tshuaj ntawm cov tshuaj.

Los ntawm ib sab ntawm lub hauv nruab nrab ntawm cov hlab ntsha hauv lub cev: feem ntau - kiv taub hau, ataxia, qaug zog, dav dav tsis muaj zog, feem ntau - mob taub hau, paresis ntawm kev pab, qee zaum - txawv txav tsis tuaj yeem txav (piv txwv, tshee, "fluttering" tshee tshee - asterixis, dystonia, tics), nystagmus, tsis tshua muaj, orofacial dyskinesia, oculomotor cuam tshuam, hais lus tsis meej (piv txwv li, dysarthria lossis hais lus tsis meej), choreoathetoid cuam tshuam, peripheral neuritis, paresthesias, leeg tsis muaj zog thiab paresis cov tsos mob.

Los ntawm sab hauv ntawm qhov kev xav ntawm lub hlwb: tsis tshua muaj - pom kev tsis meej (pom lossis hnov), kev nyuaj siab, nrogqis duaqab los noj mov, ntxhov siab vim, txhoj puab heev, ntxhov siab, cuam tshuam, tsis tshua muaj tshwm sim - ua kom mob hlwb.

Kev tsis haum tshuaj: feem ntau - urticaria, qee zaum - erythroderma, tsis tshua muaj - lupus-zoo li cov tsos mob, khaus ntawm daim tawv nqaij, tsis tshua muaj mob - multiforme exudative erythema (suav nrog Stevens-Johnson syndrome), tshuaj lom epidermal necrolysis (Lyell syndrome), kev paub tab. Tsis tshua muaj, ntau yam hloov ncua-hom lub cev tsis haum lub cev nrog kub taub hau, tawm pob ntawm daim tawv nqaij, vasculitis (suav nrog erythema nodosum, raws li muaj kev cuam tshuam ntawm cov tawv nqaij vasculitis), lymphadenopathy, cov cim zoo li cov qog ntshav, mob pob qij txha, mob leukopenia, eosinophilia, hepatosplenomegaly, thiab lub siab ua haujlwm thiab mob siab cov kev qhia pom muaj nyob hauv ntau yam kev sib txuas). Lwm yam hauv nruab nrog cev (xws li mob ntsws, ob lub raum, tus neeg mob raum, myocardium, nyuv) kuj tseem tuaj koom nrog. Tsis tshua muaj - kev mob aseptic meningitis nrog myoclonus thiab peripheral eosinophilia, tshuaj tiv thaiv anaphylactoid, angioedema, kev tiv thaiv mob ntsws o lossis mob ntsws o eininophilic. Yog tias qhov kev tsis haum tshuaj rau saum toj no tshwm sim, kev siv cov tshuaj yuav tsum raug txiav tseg.

Los ntawm lub plab zom mov: feem ntau - xeev siab, ntuav, ntau zaus - lub qhov ncauj qhuav, qee zaum - raws plab los yog cem quav, mob plab, tsis tshua muaj tshwm sim - glossitis, stomatitis, pancreatitis. Los ntawm lub siab: ntau zaus - kev nce ntxiv hauv kev ua si ntawm gamma-glutamyl transferase (vim qhov pib ntawm qhov enzyme hauv lub siab), uas feem ntau tsis muaj qhov tseem ceeb hauv chaw kho mob, feem ntau - kev nce ntxiv hauv kev ua si ntawm alkaline phosphatase, qee zaum - kev nce ntawm kev ua si ntawm "hepatic" transaminases, tsis tshua muaj - kab mob siab cholestatic, parenchymal ( hepatocellular) lossis tshuaj sib xyaw hom, daj ntseg, tsis tshua muaj neeg mob - kab mob siab, mob siab.

Los ntawm CCC: tsis tshua muaj - kev mob plawv rau hauv lub siab, txo qis lossis nce ntshav siab, tsawg kawg - bradycardia, arrhythmias, AV block nrog tsaus muag, tsaus muag, aggravation lossis txhim kho kev mob plawv tsis ua hauj lwm, exacerbation ntawm kab mob plawv (nrog rau cov tsos mob lossis nce ntawm angina tawm tsam) , mob thrombophlebitis, mob ntsws thromboembolic.

Los ntawm cov kab mob endocrine thiab cov metabolism: feem ntau - edema, kua dej ceev, nce phaus, hyponatremia (ntshav plasma osmolarity tsis zoo vim muaj cov teebmeem zoo ib yam li ADH, uas muaj qee qhov tsis yooj yim ua rau cov ntshav tsis haum hyponatremia, nrog rau lub cev ntuav, ntuav, mob taub hau, tsis meej pem). thiab mob neurological), tsis tshua muaj tshwm sim - kev nce qib ntawm prolactin (tej zaum yuav muaj nrog galactorrhea thiab gynecomastia), qhov txo qis ntawm L-thyroxine (tsis pub dawb T4, T4, TK) thiab nce TSH theem (feem ntau tsis nrog Kuv soj ntsuam ces), teeb ntawm calcium thiab phosphorus nyob rau hauv cov metabolism hauv cov pob txha cov ntaub so ntswg (yuav txo tau nyob rau hauv lub concentration ntawm Ca2 + thiab 25-OH-cholecalciferol nyob rau hauv cov ntshav ntshav): osteomalacia, roj (xws li roj HDL) thiab hypertriglyceridemia.

Los ntawm cov kab mob genitourinary: tsis tshua muaj tshwm sim - interstitial nephritis, lub raum tsis ua haujlwm, lub raum tsis ua haujlwm (piv txwv li, albuminuria, hematuria, oliguria, muaj zog urea / azotemia), tso zis ntxiv, tso zis cia, poob qis dua. Los ntawm cov leeg musculoskeletal: tsis tshua muaj tshwm sim - arthralgia, myalgia lossis cramps. Los ntawm cov khoom nruab nrog hauv lub cev: tsis tshua muaj - cuam tshuam hauv saj, txhaws ntawm lub lens, mob caj dab, tsis hnov lus, suav nrog tinnitus, hyperacusis, hypoacusia, hloov kev pom ntawm lub suab.

Lwm yam: kev cuam tshuam ntawm cov tawv nqaij pigmentation, purpura, pob txuv, tawm hws, alopecia.

Daim ntawv thov nta

Lub hnub nyoog txog 5 xyoos: kev siv tshuaj Carbamazepine-200-Maxpharma Retard tsis pom zoo.

Cawv rau ntawm kev muaj peev xwm tsav tsheb thiab ua haujlwm nrog kev txav mus los

Thaum lub sijhawm kho mob, nws yog ib qho tsim nyog yuav tsum tsis kam ua qhov tsis zoo ntawm cov haujlwm uas yuav muaj kev phom sij uas xav tau ntau ntxiv ntawm kev saib xyuas thiab ceev ntawm psychomotor kev tsis haum.

Kev tiv thaiv kev nyab xeeb

Carbamazepine muaj cov tshuaj tiv thaiv ua kom tsis muaj zog; thaum sau ntawv rau cov neeg mob uas muaj kev cia siab ntau ntxiv, yuav tsum tau ceev cia tas li.nnath tswj. Lub sijhawm ntawm kev ua haujlwm ntawm cov neeg mob hlwb tsis txaus ntseeg yuav tsum tau coj mus rau hauv tus lej, thiab hauv cov neeg mob laus, muaj peev xwm ua kom tsis meej lossis npau taws. Txog niaj hnub no, muaj cov ntawv tshaj tawm txawv ntawm cov txiv neej tsis taus thiab / los yog cov phev txiv neej tsis muaj peev xwm (qhov kev sib raug zoo ntawm cov kev tsis taus nrog carbamazepine tseem tsis tau tsim). Muaj cov ntaub ntawv hais txog kev los ntshav rau cov poj niam thaum coj khaub ncaws hauv rooj plaub uas qhov ncauj tiv thaiv tau siv nyob rau tib lub sijhawm. Carbamazepine tuaj yeem cuam tshuam loj heev rau kev ntseeg tau ntawm kev tiv thaiv qhov ncauj, yog li cov poj niam ntawm lub hnub nyoog yug yuav tsum tau muab lwm txoj kev tswj kom tsis txhob muaj menyuam thaum lub sijhawm kho. Yuav tsum tau siv cov carbamazepine nkaus xwb hauv kev saib xyuas mob.

Nws raug nquahu kom tso tseg kev siv ethanol.

Agranulocytosis thiab aplasic anemia muaj feem cuam tshuam nrog carbamazepine, txawm li cas los xij, vim muaj cov xwm txheej qis heev, nws tsis yooj yim los txiav txim siab kev pheej hmoo ntawm kev pheej hmoo rau carbamazepine. Tag nrho cov kev pheej hmoo ntawm cov pej xeem tsis tau kho yog kwv yees 4,7 cov neeg toj ib lab nyob rau ib xyoo rau agranulocytosis thiab 2.0 tus neeg ib plhom hauv ib xyoos rau cov ntshav tsis txaus.

Lub caij nyoog ntev tuaj yeem nqa ib zaug, thaum tsaus ntuj.

Kev kho kab mob vwm pib ntawm kev teem caij txhaj tshuaj me me, ib tus zuj zus rau lawv kom ua tiav cov txiaj ntsig kho yam xav tau.

Kev tsis ua sai sai ntawm carbamazepine tuaj yeem ua rau qaug dab peg. Yog tias nws yuav tsum tau txais kev kho mob sai sai, tus neeg mob yuav tsum pauv mus rau lwm cov tshuaj tiv thaiv kev puas tsuaj raws li kev ua txhaum ntawm cov tshuaj uas tau qhia nyob rau hauv cov xwm txheej zoo li no (piv txwv li, diazepam muab tshuaj rau txoj leeg lossis kho, lossis phenytoin muab tshuaj rau txoj leeg). Muaj ntau tus neeg mob ntuav, raws plab thiab / lossis cov khoom noj tsis txaus, ua kom yuag thiab / lossis kev nyuaj siab ua pa hauv cov menyuam tshiab uas lawv niam coj carbamazepine sib xyaw nrog lwm cov tshuaj tiv thaiv kab mob (tej zaum cov kev cuam tshuam no tshwm sim ntawm kev tshem tawm mob hauv cov menyuam mos).

Carbamazepine yuav tsum thim tawm tam sim ntawd yog tias muaj qhov tsis haum lub ntsej muag lossis cov tsos mob tshwm sim, tawm tswv yim txog kev loj hlob ntawm Stevens-Johnson syndrome lossis Lyell's syndrome. Cov tawv nqaij me me (cais cov macular lossis maculopapular exanthema) feem ntau ploj mus li ob peb hnub lossis ntau lub lim tiam, txawm hais tias muaj kev kho mob txuas ntxiv lossis tom qab txo cov koob tshuaj (tus neeg mob yuav tsum tau saib zoo los ntawm tus kws kho mob nyob rau lub sijhawm no).

Yog tias muaj qhov tsis tsim nyog xws li ua npaws, mob caj pas, tawm pob, txhaws ntawm lub qhov ncauj ntawm qhov ncauj, tsis muaj laj thawj tshwm sim ntawm doog ntshav, cov ntshav tawm hauv daim petechiae lossis purpura, nws yog qhov yuav tsum tau sab laj nrog kws kho mob sai.

Ua ntej pib kev kho mob, nrog rau qee lub sijhawm nyob hauv cov txheej txheem kev kho mob, kev kuaj ntshav hauv cov ntshav yuav tsum tau ua, suav nrog suav cov platelets thiab tejzaum reticulocytes, nrog rau kev txiav txim siab txog qib ntawm cov hlau hauv ntshav cov ntshav. Tsis muaj kev hloov pauv hloov asymptomatic leukopenia tsis xav kom thim tawm, txawm li cas los xij, kev kho mob yuav tsum tsis ua mus ntxiv yog tias muaj mob leukopenia lossis leukopenia tshwm, nrog cov tsos mob ntawm tus kab mob kis. Ua ntej pib txoj kev kho mob, nws raug nquahu kom ua qhov kev kuaj xyuas ophthalmological, suav nrog kev tshuaj xyuas cov nyiaj pob nrog lub pob hluav taws thiab ntsuas ntawm lub zog intraocular yog tias tsim nyog. Tus kws kho mob muab tshuaj rau cov neeg mob uas muaj kev cia siab ntau ntxiv, yuav tsum tau soj ntsuam tas li ntawm qhov ntsuas no. Nws tau raug pov thawj tias HLA-B * 1502 allele hauv cov neeg ntawm Suav thiab Thaib tau nqis los cuam tshuam nrog kev pheej hmoo ntawm Stevens-Johnson syndrome (SJS) thaum kho nrog carbamazepine. Thaum twg los xij uas ua tau, cov neeg mob zoo li no yuav tsum tau kuaj xyuas seb puas muaj qhov no allele ua ntej kev kho mob nrog carbamazepine. Thaum kuaj pom qhov ua tau zoo, kev siv cov carbamazepine yuav tsum tsis txhob pib, tshwj tsis yog thaum tsis muaj lwm txoj kev kho ntxiv. Hauv cov neeg mob uas suav hais tias yog qhov tsis zoo rau qhov muaj HLA-B * 1502, qhov kev pheej hmoo ntawm kev tsim mob Stevens-Johnson syndrome tseem tsawg heev, txawm hais tias qhov kev tawm tsam no tshwm sim tsawg heev, tab sis nws tuaj yeem txhim kho. Vim tias cov ntaub ntawv tsis txaus, nws tseem tsis tau paub meej meej tias txhua tus neeg los ntawm Cov Neeg Esxias Qab Teb Hnub Tuaj nyob rau qhov muaj qhov kev pheej hmoo tsis zoo no. Nws tau pom tias HLA-B * 1502 allele tsis cuam tshuam nrog Stevens-Johnson syndrome hauv cov neeg mob tawv nqaij dawb. Lub HLA-B * 1502 allele tsis kwv yees qhov kev pheej hmoo ntawm kev pheej hmoo tsis tshua mob tawv nqaij ntawm carbamazepine, xws li kev tiv thaiv kev mob tsis haum rau anticonvulsants lossis ua pob xoo tsis loj (mob maculopapular).

Cov chaw muag tshuaj

Cov Tshuaj Hauv Tshuaj
Antiepileptic siv yeeb tshuaj, dibenzazepine derivative. Nrog rau cov tshuaj tiv thaiv hlwb, cov tshuaj kuj tseem muaj cov nyhuv neurotropic thiab psychotropic.

Tus txheej txheem ntawm kev ua ntawm carbamazepine tau txog tam sim no tsuas yog ib nrab piav qhia. Carbamazepine tswj lub zog ntawm lub hlwb neurons, txhawb kev tawm ntawm cov hlab hlwb thiab txo cov kev xa xov ntawm lub plawv dhia.Tej zaum, lub tswv yim tseem ceeb ntawm kev ua ntawm carbamazepine yog tiv thaiv kev rov ua dua ntawm sodium-depended muaj peev xwm nyob rau hauv depolarized neurons vim yog kev thaiv ntawm qhib voltage-gated sodium channels.

Thaum siv raws li kev kho mob monotherapy hauv cov neeg mob uas muaj mob vwm (tshwj xeeb tshaj yog nyob rau cov menyuam yaus thiab cov hluas), cov teebmeem kev xav ntawm cov tshuaj tau raug sau tseg, uas suav nrog kev cuam tshuam zoo rau cov tsos mob ntawm kev ntxhov siab thiab kev ntxhov siab, nrog rau kev txo qis ntawm kev txob taus thiab kev txhoj puab heev. Tsis muaj cov ntaub ntawv tsis qhia txog kev cuam tshuam ntawm cov tshuaj rau ntawm kev txawj ntse thiab lub hlwb kev ua haujlwm: hauv qee qhov kev tshawb fawb, pom qhov tshwm sim ob lossis tsis zoo, uas nyob ntawm qhov tshuaj ntawm qhov tshuaj; hauv lwm txoj kev tshawb nrhiav, qhov zoo ntawm cov tshuaj rau ntawm kev saib xyuas thiab cim xeeb tau tshwm sim.

Raws li tus neeg sawv cev neurotropic, cov tshuaj muaj txiaj ntsig hauv ntau cov kab mob neurological. Yog li, piv txwv li, nrog idiopathic thiab secondary trigeminal neuralgia, nws txwv tsis pub cov tsos ntawm paroxysmal mob tawm tsam.

Thaum raug haus dej haus cawv haus yeeb tshuaj, yeeb tshuaj nce qib pib ntawm kev tsim txom, uas nyob hauv tus mob no feem ntau txo qis, thiab txo qhov mob tsis zoo ntawm cov chaw kuaj mob tshwm sim ntawm tus mob, xws li nce siab tsis meej, tshee tshee, thiab gait tsis zoo.

Hauv cov neeg mob uas muaj ntshav qab zib insipidus, cov tshuaj txo cov diuresis thiab nqhis dej.

Raws li tus neeg sawv cev mob hlwb, cov tshuaj muaj txiaj ntsig hauv kev tiv thaiv kev mob, uas yog, nyob rau hauv kev kho mob ntawm qhov mob tshwm sim, nrog kev txhawb nqa ntawm kev mob siab ntsws bipolar mob (manic-depressive) cuam tshuam (ob qho tib si li monotherapy thiab hauv kev sib xyaw nrog tshuaj tiv thaiv tshuaj, tshuaj tiv thaiv kab mob lossis tshuaj lithium), kev tawm tsam ntawm schizoaffective psychosis, nrog kev tawm tsam manic, qhov twg nws yog siv nrog cov tshuaj tiv thaiv kev ntxhov siab, nrog rau kev nyuaj siab mob hlwb nrog rau cov kev mus ceev.

Lub peev xwm ntawm cov tshuaj kom txo cov kev mob tshwm sim yog vim muaj kev cuam tshuam ntawm kev sib pauv ntawm dopamine thiab norepinephrine.

Cov Tshuaj Pharmacokinetics
Kev Tsis Txaus Siab
Tom qab lub qhov ncauj tswj hwm, carbamazepine yog nqus yuav luag tag nrho, kev nqus tshwm sim kuj maj mam tshwm sim (kev noj zaub mov tsis muaj kev cuam tshuam loj npaum li cas thiab feem ntau ntawm kev nqus). Tom qab kev tswj hwm ntawm qhov ncauj (ib zaug lossis rov ua dua) ntawm cov ntsiav tshuaj uas muaj kev tiv thaiv-tso tawm, qhov siab tshaj plaws ntshav plasma concentration (C_max) tau tiav hauv 24 teev, nws tus nqi kwv yees li 25% tsawg dua ntawm kev noj cov ntsiav tshuaj tsis tu ncua. Thaum noj cov tshuaj ntev-tso tawm, qhov kev hloov pauv nyob rau hauv kev nkag siab ntawm carbamazepine hauv ntshav yog tsawg dua, thaum tsis muaj qhov tseem ceeb txo qhov tsawg kawg nkaus tus nqi ntawm qhov sib npaug. Thaum noj cov tshuaj nyob rau hauv daim ntawv ntawm kev txhawb nqa-ntsiav tshuaj 2 zaug hauv ib hnub, kev hloov pauv nyob rau hauv kev saib xyuas ntawm cov tshuaj nquag nyob rau hauv cov ntshav muaj tsawg heev.

Lub bioavailability ntawm lub tshuaj nquag los ntawm kev tsim tawm tshuaj ntsiav yog kwv yees li 15% tsawg dua ntawm lwm cov tshuaj hauv qhov ncauj ntawm carbamazepine.

Kev ua kom sib luag plasma ntau ntawm carbamazepine tiav tom qab 1-2 lub lis piam. Lub sijhawm ntawm nws qhov kev ua tiav yog ib tus neeg thiab nyob ntawm qhov kev txiav txim siab ntawm pib ntawm lub siab ua haujlwm ntawm lub siab enzyme los ntawm carbamazepine, hetero-induction los ntawm lwm cov tshuaj siv ib txhij, nrog rau tus neeg mob lub sijhawm rau kev teem sijhawm kho, qhov tshuaj ntawm lub sijhawm thiab lub sijhawm kho. Cov neeg tseem ceeb sib txawv hauv qhov tseem ceeb ntawm qhov muaj nuj nqis sib luag hauv kev kho ntau yam tau pom: hauv cov neeg mob feem ntau, cov nqi no nyob ntawm 4 txog 12 μg / ml (17-50 μmol / l).

Kev xa Khoom
Kev khi rau ntshav cov ntshav protein nyob hauv cov menyuam yaus - 55-59%, rau cov laus - 70-80%. Cov pom pom tseeb ntawm kev faib tawm yog 0.8-1.9 l / kg. Kev nqus yog tsim nyob rau hauv cerebrospinal kua thiab qaub ncaug, uas yog sib npaug rau cov nyiaj ntawm cov tshuaj nquag tsis txuam nrog cov protein (20-30%).Nkag tau los ntawm thaj chaw siab. Kev sib xyaw hauv cov kua mis yog 25-60% ntawm qhov ntawd hauv ntshav.

Muab qhov ua tiav kev nqus ntawm carbamazepine, qhov pom tseeb ntawm qhov kev faib tawm yog 0.8-1.9 l / kg.

Kev zom zaub mov
Carbamazepine yog metabolized hauv lub siab. Txoj hauv kev tseem ceeb ntawm biotransformation yog epoxydiol txoj hauv kev, los ntawm qhov ua kom cov metabolites tseem ceeb raug tsim: 10.11-transdiol derivative thiab nws cov conjugate nrog glucuronic acid. Kev hloov pauv ntawm carbamazepine-10,11-epoxide rau hauv carbamazepine-10,11-transdiol hauv tib neeg lub cev tshwm sim siv microsomap enzyme epoxide hydrolase.

Qhov kev kub siab ntawm carbamazepine-10,11-epoxide (pharmacologically active metabolite) yog kwv yees li 30% ntawm kev mloog ntawm carbamazepine hauv cov ntshav.

Lub ntsiab isoenzyme uas muab cov biotransformation ntawm carbamazepine rau carbamazepine-10,11-epoxide yog cytochrome P450 ZA4. Raws li qhov tshwm sim ntawm cov kev hloov pauv ntawm cov metabolic, ib qho tsis txaus ntawm lwm qhov metabolite kuj tau tsim - 9-hydroxymethyl-10-carbamoylacridane.

Lwm txoj hauv kev tseem ceeb ntawm cov carbamazepine metabolism yog qhov tsim ntawm ntau cov monohydroxylated derivatives, thiab N-glucuronides, nyob rau hauv UGT2B7 isoenzyme.

Chaw Sau Ntawv
Ib nrab ntawm lub neej ntawm kev hloov pauv carbamazepine tom qab ib qho kev tswj hwm qhov ncauj ntawm qhov tshuaj yog nruab nrab 36 teev, thiab tom qab rov qab haus tshuaj ntau dua - nruab nrab 16-24 teev, nyob ntawm lub sijhawm kho (vim nws pib siv lub siab ua haujlwm rau lub siab ua rau lub siab). Hauv cov neeg mob noj ib txhij lwm cov tshuaj uas ua rau lub siab enzymes (piv txwv li, phenytoin, phenobarbital), kev tshem tawm ib nrab ntawm lub neej ntawm carbamazepine yog nyob rau nruab nrab 9-10 teev. Tom qab ib lub qhov ncauj tswj hwm ntawm 400 mg ntawm carbamazepine, 72% ntawm cov koob tshuaj noj tau tawm los ntawm lub raum thiab 28% ntawm cov hnyuv, nrog txog 2% ntawm cov koob tshuaj uas tau lees txais yog tawm los ntawm lub raum hauv daim ntawv ntawm cov tsis hloov pauv carbamazepine, li 1% - nyob rau hauv daim ntawv ntawm tus kws tshuaj ua haujlwm 10,11-epoxy metabolite. Tom qab ib qho kev tswj hwm ntawm qhov ncauj, 30% ntawm carbamazepine yog tawm hauv cov zis hauv daim ntawv ntawm cov khoom lag luam kawg ntawm epoxydiol metabolic txoj kev.

Cov yam ntxwv ntawm pharmacokinetics hauv cov neeg mob ib leeg
Hauv cov menyuam yaus, vim kev cuam tshuam sai dua cov carbamazepine, nws yuav tsum tau siv ntau dua ntawm cov tshuaj rau ib phaus ntawm lub cev hnyav, piv nrog cov neeg laus.

Tsis muaj pov thawj pom tias qhov chaw muag tshuaj ntawm carbamazepine hloov pauv hauv cov neeg mob laus (piv nrog cov neeg hluas).

Cov ntaub ntawv ntawm cov tshuaj pharmacokinetics ntawm carbamazepine hauv cov neeg mob uas tsis zoo los yog lub raum tsis zoo los tseem tsis tseem muaj.

Siv thaum cev xeeb tub thiab thaum pub niam mis.

Carbamazepine sai sai rau lub cev nqaij daim tawv thiab tsim kom muaj qhov muaj zog ntau ntxiv hauv daim siab thiab ob lub raum ntawm tus me nyuam.

Kev tshuaj xyuas tas li ntawm kev saib xyuas ntawm cov tshuaj nquag nyob hauv ntshav ntshav, EEG raug pom zoo.

Thaum cev xeeb tub tshwm sim, nws yog ib qho tsim nyog los sib piv cov txiaj ntsig ntawm kev kho thiab qhov muaj peev xwm ua tau tshwm sim, tshwj xeeb tshaj yog nyob rau thawj peb lub hlis thaum cev xeeb tub.

Nws raug paub tias cov menyuam yaus ntawm leej niam uas muaj kev txom nyem los ntawm kev mob vwm tuaj yog thawj coj rau txoj kev loj hlob ntawm intrauterine, suav nrog kev ua tsis tiav. Carbamazepine muaj peev xwm ua kom muaj kev pheej hmoo ntxiv ntawm cov mob no. Muaj cov ntawv tshaj tawm raug rho tawm ntawm cov kab mob ntawm cov kab mob ua tsis taus haujlwm thiab tsis ua haujlwm, suav nrog tsis kaw cov leeg caj qaum (spina bifida) thiab lwm qhov kev mob tsis txaus ntseeg: qhov tsis xws luag hauv kev txhim kho craniofacial cov qauv, hlab plawv thiab lwm yam hauv nruab nrog cev, hypospadias.

Raws li North American cev xeeb tub rau npe, qhov tshwm sim ntawm tag nrho cov lus tsis txaus ntseeg txuam nrog cov kev teeb tsa uas xav tau kev phais mob, tshuaj los yog kho kom zoo nkauj, kuaj pom tsis pub dhau 12 lub lis piam tom qab yug, yog 3.0% ntawm cov poj niam cev xeeb tub noj carbamazepine li kev kho mob hauv thawj lub hlis, thiab 1.1% ntawm cov poj niam cev xeeb tub uas tsis noj cov tshuaj tiv thaiv kab mob.

Kev kho mob nrog carbamazepine retard-Akrikhin cov poj niam cev xeeb tub uas muaj mob vwm yuav tsum tau ua nrog ceev faj. Carbamazepine retard-Akrikhin yuav tsum tau siv rau qhov kev siv tsawg kawg nkaus. Kev soj ntsuam tsis tu ncua ntawm kev saib xyuas ntawm cov tshuaj nquag nyob hauv ntshav ntshav tau pom zoo.Thaum tswj tau cov tshuaj anticonvulsant zoo, tus poj niam cev xeeb tub yuav tsum muaj lub siab yam tsawg kawg ntawm carbamazepine nyob rau hauv cov ntshav ntshav (kev kho thaj tsam 4-12 μg / ml), vim tias muaj lus tshaj tawm txog koob tshuaj muaj feem yuav ua kom muaj kabmob tsis zoo (piv txwv li, qhov tshwm sim ntawm malformations thaum siv koob tshuaj tsawg dua 400 mg rau ib hnub tau qis dua nrog ntau dua kev txhaj tshuaj dua).

Cov neeg mob yuav tsum tau qhia txog qhov ua tau los txhawm rau txhawm rau ua kom muaj kev phom sij thiab qhov xav tau, hais txog qhov no, rau kev kuaj mob ua ntej yug menyuam.

Thaum cev xeeb tub, kev kho tus mob antiepileptic zoo yuav tsum tsis txhob cuam tshuam, vim tias qhov tshwm sim ntawm tus kab mob tuaj yeem muaj qhov tsis zoo rau leej niam thiab tus me nyuam hauv plab.

Cov tshuaj antiepileptic nce folic acid deficiency, uas feem ntau pom thaum cev xeeb tub, uas tuaj yeem ua rau muaj qhov tsis zoo ntawm kev yug menyuam hauv menyuam yaus, yog li noj folic acid pom zoo ua ntej npaj lub sijhawm cev xeeb tub thiab thaum cev xeeb tub. Txhawm rau tiv thaiv hemorrhagic muaj teeb meem hauv cov menyuam mos, nws raug pom zoo tias cov poj niam nyob rau lub lim tiam dhau los ntawm cev xeeb tub, nrog rau cov menyuam yug menyuam, yuav tsum tau muaj tshuaj vitamin K.

Ntau qhov teeb meem ntawm qaug dab peg thiab / lossis kev nyuaj siab ntsws tau piav qhia hauv cov menyuam tshiab uas lawv niam noj cov tshuaj ib txhij nrog rau lwm cov tshuaj anticonvulsants. Ib qho ntxiv, ntau qhov mob ntawm ntuav, raws plab thiab / lossis kev noj haus tsis zoo rau cov menyuam mos uas lawv niam tau txais carbamazepine kuj tseem tau tshaj tawm. Tej zaum cov kev mob no yog tshwm sim ntawm cov tsos mob tshem tawm hauv cov menyuam tshiab.

Carbamazepine kis mus rau niam mis, qhov ua kom pom tseeb hauv nws yog 25-60% ntawm cov ntsiab lus hauv cov ntshav ntshav, yog li cov txiaj ntsig thiab qhov tsis xav tau ntawm kev pub niam mis yuav tsum muab piv rau cov ntsiab lus ntawm kev kho mob tsis tu ncua. Nrog kev pub mis niam txuas ntxiv thaum noj cov tshuaj, koj yuav tsum tsim kev soj ntsuam rau tus menyuam hauv kev txuas nrog qhov muaj feem ua rau muaj kev phiv tshuaj (piv txwv, tsaug zog heev, kev tsis haum ntawm daim tawv nqaij). Hauv cov menyuam yaus uas tau txais cov carbamazepine antenatally lossis nrog rau niam mis, cov mob cholestatic kab mob siab tau piav qhia, thiab yog li ntawd, cov menyuam yaus no yuav tsum raug saib xyuas txhawm rau txhawm rau kuaj kev mob tshwm sim los ntawm cov kab mob hepatobiliary.

Cov neeg mob ntawm lub hnub nyoog yug menyuam yuav tsum tau ceeb toom txog qhov txo qis hauv cov txiaj ntsig ntawm kev tiv thaiv qhov ncauj thaum siv cov carbamazepine.