Cov tshuaj carbamazepine: cov lus qhia rau kev siv

Carbamazepine: cov lus qhia rau kev siv thiab tshuaj xyuas

Lub npe Latin: Carbamazepine

ATX Code: N03AF01

Tus nquag ua hauj lwm: carbamazepine (carbamazepine)

Cov chaw tsim khoom: LLC Rosfarm (Russia), CJSC ALSI Pharma (Russia), OJSC Synthesis (Russia)

Qhia kho cov lus piav qhia thiab yees duab: 07/27/2018

Cov nqi hauv khw muag tshuaj: los ntawm 58 rubles.

Carbamazepine yog cov tshuaj nrog lub hlwb hlwb, cov nyhuv antiepileptic.

Tso tawm daim ntawv thiab muaj pes tsawg leeg

Carbamazepine yog tsim nyob rau hauv daim ntawv ntawm cov ntsiav tshuaj (10, 15, 25 pcs. Hauv cov hlwv ntim, 1-5 ntim rau hauv ib daim ntawv cardboard, 20, 30 pcs. Hauv cov hlwv pob, 1, 2, 5, 10 ntim hauv ib daim ntawv ntim, 20, 30, 40, 50, 100 pcs. hauv ib tau, 1 tuaj yeem hauv pob ntawv qhwv pob).

Cov muaj pes tsawg leeg ntawm 1 ntsiav tshuaj suav nrog:

Cov tshuaj kom nquag: carbamazepine - 200 mg,
Ntu cov khoom siv: talc - 3.1 mg, povidone K30 - 14.4 mg, colloidal silicon dioxide (aerosil) - 0.96 mg, polysorbate 80 - 1.6 mg, qos hmoov txhuv - 96.64 mg, magnesium stearate - 3 , 1 mg.

Cov Tshuaj Hauv Tshuaj

Carbamazepine yog lub dibenzoazepine derivative, uas yog tus cwj pwm los ntawm antiepileptic, neurotropic thiab psychotropic teebmeem.

Thaum lub sijhawm tam sim no, lub tshuab ntawm kev ua ntawm cov tshuaj no tsuas yog ib nrab kawm. Nws inhibits qhov sib kis ntawm kev xa xov ntawm cov roj zoo nkauj, txwv tsis pub cov dej ntws tawm ntawm cov neurons, thiab ua rau lub xeev tsis ruaj khov ntawm cov qog ntawm overexcited neurons. Tej zaum, qhov tseem ceeb ntawm kev ua ntawm carbamazepine yog los tiv thaiv qhov tsim ntawm sodium-depended muaj peev xwm nyob rau hauv depolarized neurons vim "kev txiav txim siab" thaiv - kev tiv thaiv thiab cov xaim hluav taws xob sodium raws.

Thaum siv cov tshuaj raws li kev kho mob monotherapy hauv cov neeg mob vwm (tshwj xeeb, menyuam yaus thiab tub ntxhais hluas), cov teebmeem kev xav ntawm lub hlwb tau pom zoo, qhia txog kev tshem tawm cov tsos mob ntawm kev ntxhov siab thiab kev ntxhov siab, nrog rau kev txo qis kev txhoj puab heev thiab kev npau taws. Tsis muaj cov ntaub ntawv tsis qhia txog kev cuam tshuam ntawm carbamazepine ntawm kev txawj ntse thiab psychomotor lub luag haujlwm: hauv qee qhov kev tshawb fawb, muaj ob zaug lossis tsis zoo raug nthuav tawm uas tau siv tshuaj ntau dua, lwm qhov kev tshawb fawb tau lees paub qhov zoo ntawm cov tshuaj ntawm lub cim xeeb thiab kev saib xyuas.

Ua ib tus neeg sawv cev neurotropic, carbamazepine ua tau zoo rau qee cov kab mob neurological. Piv txwv li, nrog cov theem nrab thiab idiopathic trigeminal neuralgia, nws tiv thaiv qhov tshwm sim ntawm paroxysmal mob tawm tsam.

Hauv cov neeg mob uas muaj kev haus cawv haus cawv, carbamazepine tsa qhov chaw pib ntawm qhov tsim nyog, uas qhov no txo qis hauv feem ntau, thiab txo qhov mob ntawm cov kev mob tshwm sim ntawm cov tsos mob (qhov no suav nrog ua rau muaj kev ntxhov siab, tshee, nce ntxiv).

Hauv cov neeg mob ntshav qab zib insipidus, carbamazepine txo cov diuresis thiab tshem tawm kev nqhis dej.

Raws li tus neeg sawv cev mob siab, cov tshuaj yog tshuaj rau cov kev mob tshwm sim, suav nrog kev kho mob ntawm qhov mob tshwm sim, rau kev txhawb nqa kev kho mob bipolar tiv thaiv (kev mob siab-mob siab) (carbamazepine yog siv ob qho tib si xws li monotherapy thiab tib lub sijhawm nrog lithium, antidepressant lossis antipsychotic), thaum manic depressive psychosis, nrog cov kev mus ncig ceev ceev, nrog kev tawm tsam manic, thaum carbamazepine siv nrog tshuaj tiv thaiv kabmob, thiab kuj nrog kev tawm tsam ntawm schizoaffective psychosis. Lub peev xwm ntawm cov tshuaj kom txo cov kev mob tshwm sim tuaj yeem piav qhia los ntawm inhibition ntawm kev sib pauv ntawm norepinephrine thiab dopamine.

Cov Tshuaj Pharmacokinetics

Nrog rau kev tswj hwm qhov ncauj, carbamazepine yog nqus rau hauv cov hnyuv yuav luag tag. Kev noj tshuaj hauv cov ntawv hauv lub cev yog nrog los ntawm kev nqus sai. Tom qab txhaj ib koob tshuaj 1 ntsiav tshuaj ntawm carbamazepine, ntawm qhov nruab nrab, nws qhov siab tshaj plaws tau txiav txim siab tom qab 12 teev. Tom qab siv ib zaug tshuaj hauv ib koob tshuaj 400 mg, kwv yees tus nqi ntawm qhov siab tshaj plaws ntawm cov tshuaj carbamazepine tsis txawv txav yog kwv yees li 4.5 μg / ml.

Thaum noj cov carbamazepine ib txhij nrog zaub mov, qhov qib thiab tus nqi ntawm kev nqus ntawm cov tshuaj tseem tsis hloov. Qhov sib xyaw ua ke ntawm ib qho khoom hauv ntshav tau ua tiav hauv 1-2 lub lis piam. Lub sijhawm ntawm nws qhov kev ua tiav yog tus neeg thiab txiav txim siab los ntawm kev txiav txim siab ntawm pib ntawm lub siab ua haujlwm ntawm lub siab ua rau lub siab ua haujlwm los ntawm carbamazepine, tus neeg mob lub sijhawm ua ntej pib ntawm txoj kev kho, qhov tshuaj ntawm lub sijhawm, lub sijhawm kho, nrog rau hetero-induction los ntawm lwm cov tshuaj uas siv nrog carbamazepine. Muaj qhov sib txawv ntawm qhov sib txawv hauv qhov tseem ceeb ntawm qhov muaj nuj nqi sib luag hauv cov kev kho ntau yam: hauv cov neeg mob feem ntau, cov ntsuas no ntawm 4 txog 12 μg / ml (17-50 μmol / l).

Carbamazepine hla qhov chaw ntawm lub txim. Txij li nws yuav luag yaim, qhov pom meej faib khoom ntau yog 0.8-1.9 l / kg.

Kev mob npaws carbamazepine yog nqa tawm hauv lub siab. Txoj hauv kev tseem ceeb ntawm biotransformation ntawm cov tshuaj yog epoxidation nrog kev tsim cov metabolites, qhov tseem ceeb uas yog 10.11-transdiol derivative thiab cov khoom lag luam ntawm nws cov kev sib txuas nrog glucuronic acid. Carbamazepine-10,11-epoxide hauv tib neeg lub cev hla mus rau carbamazepine-10,11-transdiol nrog kev koom tes ntawm microsomal enzyme epoxyhydrolase. Qhov kev nkag siab ntawm carbamazepine-10,11-epoxide, uas yog ib qho ua kom mob metabolite, kwv yees li 30% ntawm cov ntsiab lus ntawm carbamazepine hauv cov ntshav ntshav. Lub ntsiab isoenzyme lub luag haujlwm rau kev hloov pauv ntawm carbamazepine rau carbamazepine-10,11-epoxide yog suav tias yog cytochrome P4503A4. Raws li cov txiaj ntsig ntawm cov khoom noj ntawm lub cev, ib qho me me ntawm lwm cov khoom siv metabolite kuj tau tsim - 9-hydroxymethyl-10-carbamoylacridane.

Lwm txoj hauv kev tseem ceeb rau carbamazepine metabolism yog kev tsim ntawm ntau hom monohydroxylated derivatives, zoo li N-glucuronides, siv isoenzyme UGT2B7.

Ib nrab ntawm lub neej ntawm cov tshuaj yeeb dej caw nyob hauv daim ntawv hloov pauv tsis tau tom qab kev tswj hwm ib zaug ntawm qhov tshuaj yog nyob rau nruab nrab 36 teev, thiab tom qab rov qab haus tshuaj ntau ntxiv - txog 16-24 teev, nyob ntawm lub sijhawm kho (qhov no yog vim autoinduction ntawm lub siab monooxygenase system). Nws yog qhov ua pov thawj tias hauv cov neeg mob sib xyaw nrog carbamazepine nrog lwm yam tshuaj uas ua rau lub siab enzymes (piv txwv li, phenobarbital, phenytoin), ib nrab-lub neej ntawm cov tshuaj feem ntau tsis pub tshaj 9-10 teev.

Nrog lub qhov ncauj tswj hwm ntawm carbamazepine-10,11-epoxide, qhov nruab nrab ib nrab-lub neej ntawm nws yog kwv yees li 6 teev.

Tom qab ib qho kev noj tshuaj hauv qhov ncauj ntawm carbamazepine ntawm ib koob ntawm 400 mg, 72% ntawm cov tshuaj tau tawm hauv cov raum thiab 28% los ntawm txoj hnyuv. Kwv yees li 2% ntawm cov koob tshuaj uas tau tso tawm hauv cov zis, sawv cev rau cov carbamazepine tsis hloov pauv, thiab kwv yees li 1% hauv daim 10.11-epoxy metabolite nthuav qhia kev ua haujlwm ntawm cov khoom hauv lub cev. Tom qab ib qho kev tswj hwm ntawm qhov ncauj, 30% cov carbamazepine yog dhau los ntawm lub raum ua cov khoom lag luam kawg ntawm cov txheej txheem epoxidation.

Cov menyuam yaus muaj kev tshem tawm sai ntawm carbamazepine, yog li ntawd, qee zaum, qee zaum yuav tsum tau muab tshuaj ntau dua ntawm cov tshuaj, uas yog xam raws lub cev qhov hnyav ntawm tus menyuam, piv nrog cov neeg mob laus.

Cov ntaub ntawv hais txog kev hloov pauv hauv cov khw muag tshuaj ntawm carbamazepine hauv cov neeg laus piv rau cov neeg hluas tsis muaj.

Cov chaw muab tshuaj ntawm carbamazepine hauv cov neeg mob raum thiab mob rau daim tawv nqaij tsis ua haujlwm tau tseem tsis tau kawm txog hnub no.

Kev ntsuas rau siv

Epilepsy (tshwj tsis yog rau tus mob chua leeg lossis myoclonic qaug dab peg, tsis tuaj kawm ntawv) - theem nrab thiab thawj cov qauv ntawm kev qaug dab peg, nrog los ntawm tonic-clonic qaug dab peg, ntu ib nrab nrog cov tsos mob yooj yim thiab nyuaj, cov qaug dab peg (kev kho mob los yog ua ke nrog lwm cov tshuaj nrog cov tshuaj tiv thaiv kab mob).
Polyuria thiab polydipsia muaj ntshav qab zib insipidus, mob mob nrog mob ntshav qab zib polyneuropathy, trigeminal neuralgia nrog rau ntau yam sclerosis, idiopathic trigeminal neuralgia, cawv tawm mob syndrome, idiopathic glossopharyngeal neuralgia, cuam tshuam cuam tshuam,
Phase-ntws cuam tshuam rau kev cuam tshuam, nrog rau schizoaffective ntshawv siab, manic-depressive psychosis, thiab lwm yam. (kev tiv thaiv).

Cov Yuav Tsum Muaj

Atrioventricular thaiv
Ua txhaum ntawm pob txha hlwb hematopoiesis,
Mob sib quas ntus porphyria (suav nrog keeb kwm)
Siv cov tshuaj tsis haum nrog cov tshuaj monoamine oxidase inhibitors thiab rau 14 hnub tom qab lawv rho tawm,
Cev xeeb tub thiab lactation
Cov tshuaj tiv thaiv tsis haum rau cov tshuaj ntawm cov tshuaj, nrog rau cov tshuaj kom sib haum xeeb zoo rau cov tshuaj nquag (tricyclic antidepressants).

Raws li cov lus qhia, carbamazepine yuav tsum tau siv nrog ceev faj tib lub sijhawm noj haus cawv, cov neeg laus, nrog rau cov neeg mob lub plawv tsis ua hauj lwm, mob ntshav siab hypoatremia, muaj zog intraocular siab, inhibition ntawm pob txha mob hematopoiesis thaum noj tshuaj (keeb kwm), prostatic hyperplasia, mob siab mob raum tsis ua hauj lwm.

Sab sij huam

Thaum siv cov carbamazepine, cov kev mob tshwm sim hauv qab no tuaj yeem tsim:

Lub hauv nruab nrab hauv lub cev: ataxia, kiv taub hau, dav dav tsis muaj zog, nkees nkees, oculomotor cuam tshuam, mob taub hau, nystagmus, paresis ntawm kev pab, tics, tshee, orofacial dyskinesia, choreoathetoid mob, peripheral neuritis, dysarthria, paresthesia, paresis, leeg tsis muaj zog,
Lub plawv mob: txo qis lossis nce siab hauv cov ntshav siab, lub plawv tsis sib haum, vau, pob txha taub hau, arrhythmias, atrioventricular thaiv nrog tsaus muag, txoj kev txhim kho lossis mob ntxiv ntawm txhaws lub plawv tsis ua hauj lwm, exacerbation ntawm kev mob plawv (nrog rau kev nce los yog tshwm sim ntawm angina nres), mob thrombotic thrombosis ,
Cov kab mob hauv lub cev: qhov ncauj qhuav, ntuav, xeev siab, cem quav lossis zawv plab, mob plab, mob plab, txhaws ntswg, txhaus ntswg,
Cov kab mob genitourinary: lub raum tsis ua haujlwm, interstitial nephritis, lub raum tsis ua haujlwm (hematuria, albuminuria, oliguria, azotemia / nce urea), tso zis cia, nce mus tso zis, impotence / kev ua niam txiv tsis ua haujlwm,
Endocrine system thiab cov metabolism: hyponatremia, hnyav ntxiv, edema, nce ntawm qib prolactin (tej zaum ib txhij nrog kev txhim kho ntawm galactorrhea thiab gynecomastia), qhov txo qis hauv L-thyroxine (tsis pub dawb T4, TK) thiab nce qib ntawm cov thyroid-txhawb cov tshuaj hormones (feem ntau tsis muaj kev soj ntsuam kuaj mob). nrog), osteomalacia, kev tsis txaus siab ntawm cov calcium-phosphorus metabolism hauv cov pob txha nqaij (txo qis qhov kev xav ntawm 25-OH-cholecalciferol thiab ionized daim ntawv hauv calcium hauv cov ntshav ntshav), hypertriglyceridemia, hypercholesterolemia,
Cov leeg mob ua pob: arthralgia, cramps, myalgia,
Mob siab: nce kev ua si ntawm gamma-glutamyl transferase (raws li txoj cai, tsis muaj qhov tseem ceeb hauv kev kho mob), kev ua si ntawm alkaline phosphatase thiab "mob siab" transaminases, kab mob siab (kab mob siab, sib xyaw, cholestatic lossis parenchymal (hepatocellular) yam), mob siab,
Hemopoietic plab hnyuv siab raum: thrombocytopenia, leukopenia, leukocytosis, eosinophilia, lymphadenopathy, anplastic anemia, mob sib kis mob ntshav khov, mob txhaws ntshav, mob ntshav siab, megaloblastic anemia, tseeb erythrocytic aplasia, mob ntshav qab zib siab, reticulocytosis
Cov plab hnyuv siab raum: kev hloov pauv hauv qhov kev nkag siab ntawm lub suab, sib dhos ntawm lub lens, cuam tshuam hauv saj, mob pob txha hlaws, hypo- lossis hyperacusia,
Kev puas siab puas ntsws: ntxhov siab, pom dheev, ploj ntawm qab los, kev nyuaj siab, txhoj puab heev, tsis meej pem, ntxhov siab, ua kom mob hlwb,
Kev tsis haum tshuaj: lupus-zoo li mob syndrome, exfoliative dermatitis, urticaria, Stevens-Johnson syndrome, erythroderma, mob lom rau daim tawv nqaij tsis haum, ua kom lub ntsej muag zoo nkauj, mob taub hau thiab mob erythema multiforme. Ntau yam hloov ncua-hom kev tiv thaiv qhov tsis haum nrog vasculitis, kub taub hau, lymphadenopathy, tawv nqaij ua pob, eosinophilia, zoo li mob qog, mob leukopenia, arthralgia, hloov lub siab ua haujlwm thiab hepatosplenomegaly yog ua tau (cov kev tshwm sim no tuaj yeem tshwm sim hauv ntau yam kev sib txuas). Lwm yam hauv nruab nrog cev, xws li lub raum, lub ntsws, myocardium, tus neeg ua haujlwm txiav, thiab txoj hnyuv, kuj tseem tuaj yeem cuam tshuam. Tsis tshua muaj tshwm sim - aseptic meningitis nrog myoclonus, angioedema, anaphylactic cov tshuaj tiv thaiv, kev tsis haum lub ntsws, qhov cim los ntawm kev ua pa luv, ua npaws, mob ntsws lossis mob ntsws,
Lwm yam: purpura, tawv nqaij pigmentation cuam tshuam, tawm hws, mob ntxau, alopecia.

Noj ntau dhau

Nrog kev noj tshuaj ntau dhau ntawm carbamazepine, cov tsos mob hauv qab no feem ntau pom:

los ntawm cov hlab plawv: cov ntshav siab los sis ntshav qis, tachycardia, kev sib txuas lus tsis sib haum, nrog kev nthuav dav QRS, kev ntes plawv thiab tsaus muag, npau taws los ntawm lub plawv dhia,
los ntawm ib sab ntawm lub hauv nruab nrab cov hlab ntsha: mydriasis, kev ua kom tsis haum, kev nyuaj siab ntawm lub hauv nruab nrab lub paj hlwb, kev mob ntshav siab, tsis meej pem hauv qhov chaw, hnov qab, ntxhov siab, tsaug zog, tsis hnov qab, tsis nco qab, myoclonus, dysarthria, hais lus tsis meej, ataxia, pom kev plooj plooj, muaj plooj, qhov tsis hnov qab, mob ntshav qab zib (thaum pib) thiab hyporeflexia (txuas ntxiv mus), psychomotor xeev, dyskinesia, qaug dab peg,
los ntawm lub plab zom mov: txo tus nqi txav mus los ntawm kev txav tawm ntawm cov zaub mov los ntawm lub plab, ntuav, ua kom tsis muaj zog ntawm cov nyuv,
los ntawm cov txheej txheem ua pa: kev nyuaj siab ntawm lub chaw ua pa, pulmonary edema,
los ntawm cov kab mob tso zis: dej intoxication (dilution hyponatremia) cuam tshuam nrog cov nyhuv ntawm carbamazepine, zoo ib yam li kev ua ntawm antidiuretic hormone, kua dej tsis txaus, tso zis cia, anuria lossis oliguria,
cov kev hloov hauv chav ntsuas: qhov kev loj hlob ntawm hyperglycemia lossis metabolic acidosis, kev ua ub no ntawm cov leeg nqaij ntawm creatine phosphokinase yog ua tau.

Cov tshuaj tiv thaiv tshwj xeeb rau carbamazepine yog tsis paub. Lub chav kawm ntawm kev kho mob ntawm kev siv tshuaj ntau dhau lawm yuav tsum tau ua raws li qhov mob hauv lub chaw kuaj mob ntawm tus neeg mob, thiab nws raug pom zoo tias nws tau muab tso rau hauv tsev kho mob.

Plasma carbamazepine concentration yuav tsum txiav txim siab kom paub meej txog tshuaj lom tshuaj thiab ntsuas qhov hnyav ntawm kev haus ntau dhau.

Nws yog ib qho tsim nyog los ntxuav lub plab thiab tshem tawm nws cov ncauj lus, nrog rau kev siv lub tshuab hluav ncaig. Kev tshem tawm qeeb ntawm lub plab zom mov feem ntau pab txhawb qhov kev nqus sai, uas tuaj yeem ua rau rov txhim kho cov tsos mob ntawm intoxication thaum lub sijhawm rov qab los. Cov tsos mob txhawb nqa kev kho mob, uas yog nqa hauv chav saib xyuas mob hnyav thiab yog nrog los ntawm kev saib xyuas lub plawv ua haujlwm thiab ua tib zoo kho ntawm cov dej-electrolyte tsis txaus, kuj muab cov txiaj ntsig zoo.

Nrog pom tus kab mob arterial hypotension, tso ntshav saib xyuas ntawm dobutamine lossis dopamine tau qhia. Nrog rau kev loj hlob ntawm arrhythmia, kev kho mob yog xaiv tus kheej.Thaum muaj kev qaug dab peg, nws raug nquahu kom tswj hwm benzodiazepines, piv txwv li, diazepam lossis lwm yam anticonvulsants xws li paraldehyde lossis phenobarbital (tom kawg yog siv nrog kev ceev faj vim tias muaj kev pheej hmoo ntawm kev ua pa nyuaj).

Yog tias tus neeg mob tau tsim cov dej ua kom lub cev tsis haum (hyponatremia), kev tswj hwm cov kua dej yuav tsum tau ua kom tsawg thiab 0.9% sodium chloride tov yuav tsum ua tib zoo saib xyuas kom ncaj, uas muaj ntau zaus tiv thaiv kev txhim kho ntawm lub hlwb puas. Hemosorption ntawm thee sorbents muab cov txiaj ntsig zoo. Peritoneal lim ntshav, hemodialysis, thiab yuam diuresis suav hais tias tsis muaj txiaj ntsig hauv kev tshem tawm carbamazepine tawm ntawm lub cev. Nyob rau hnub thib ob thiab thib peb tom qab qhov pom ntawm cov tsos mob ntawm kev siv ntau tshaj, nws cov tsos mob yuav muaj zog, uas tau piav qhia los ntawm kev ncua sij hawm nqus ntawm cov tshuaj.

Cov lus qhia tshwj xeeb

Ua ntej koj pib siv cov Carbamazepine, koj yuav tsum ua qhov kev soj ntsuam: kev txheeb xyuas dav dav ntawm cov zis thiab ntshav (suav nrog suav cov reticulocytes, platelets), kev txiav txim siab txog qib hlau, siab ntawm urea thiab electrolytes hauv cov ntshav ntshav. Hauv lub neej tom ntej, cov ntsuas no yuav tsum tau saib xyuas txhua lub lim tiam hauv thawj lub hlis ntawm kev kho mob, thiab tom qab ntawd - ib hlis ib zaug.

Thaum muab tshuaj carbamazepine rau cov neeg mob uas muaj kev cia siab ntau ntxiv, nws yog qee lub sijhawm yuav tau tswj hwm nws.

Txoj kev kho yuav tsum tsis ua mus ntxiv yog muaj tus mob leukopenia los yog leukopenia, uas nrog cov tsos mob ntawm tus mob uas kis tau (tsis mob asymptomatic leukopenia tsis xav tau kev pab cuam ntawm carbamazepine).

Thaum kho, kev saib xyuas yuav tsum tau saib xyuas thaum tsav tsheb thiab ua lwm yam kev muaj peev xwm ua haujlwm uas xav tau kev nce siab ntawm cov xim thiab cov kev xav psychomotor ceev.

Cev xeeb tub thiab lactation

Nws yog qhov tseeb tias cov menyuam yaus yug los ntawm leej niam uas kuaj pom muaj tus kabmob ບ້າ ຫມູ tau muaj kev pheej hmoo ntau ntxiv ntawm kev mob hlwb intrauterine, suav nrog kev loj hlob tsis meej. Muaj pov thawj qhia tias carbamazepine tuaj yeem txhim kho qhov kev xav ua ntej no, txawm hais tias tam sim no tsis muaj lus pom zoo kawg ntawm qhov tseeb uas yuav tau txais nyob rau hauv kev tswj xyuas cov kev soj ntsuam nrog cov tshuaj ntawm cov tshuaj raws li kev kho mob.

Muaj cov ntawv tshaj tawm ntawm cov kab mob ua ntej, ua haujlwm tsis xws luag, suav nrog spina bifida (tsis yog kaw lub pob txha caj qaum), thiab lwm yam kev mob tsis txaus ntseeg, xws li hypospadias, muaj teeb meem hauv kev txhim kho cov hlab plawv thiab lwm cov kab mob hauv lub cev, nrog rau cov craniofacial qauv.

Nws yog ib qho tsim nyog los siv cov carbamazepine nrog kev ceev faj hauv cov poj niam cev xeeb tub uas muaj mob vwm. Yog tias tus poj niam noj tshuaj tsis xeeb tub lossis npaj ua kom cev xeeb tub, thiab yog tias yuav tsum tau siv cov carbamazepine thaum cev xeeb tub, nws raug nquahu kom hnyav lub txiaj ntsig qhov txiaj ntsig ntawm txoj kev kho mob rau tus niam thiab qhov muaj feem yuav muaj teeb meem, tshwj xeeb tshaj yog nyob rau thawj lub hlis ntawm cev xeeb tub.

Nrog cov chaw kho mob ua tau txaus, cov neeg mob ntawm lub hnub nyoog yug me nyuam yuav tsum tau kho carbamazepine ib leeg zoo li kev kho mob monotherapy, txij li thaum lub cev muaj peev xwm tsis ua haujlwm ntawm lub cev xeeb tub thaum lub sijhawm sib xyaw ua ke los kho tus mob siab dua qhov kev kho mob monotherapy.

Nws yog ib qho tsim nyog yuav tau sau tshuaj rau hauv cov tshuaj tsawg kawg nkaus. Koj yuav tsum tau saib xyuas cov ntsiab lus tseem ceeb ntawm cov ntshav txuam nrog rau cov ntshav ntshav.

Cov neeg mob yuav tsum paub txog kev pheej hmoo ntawm kev ua tsis tiav. Nws kuj tseem pom zoo rau lawv mus rau kev kuaj mob ua ntej yug menyuam.

Thaum cev xeeb tub, qhov cuam tshuam ntawm kev kho tus mob ua kom zoo yog contraindicated, txij li kev muaj mob ntawm tus kab mob tuaj yeem muaj qhov tsis zoo rau leej niam thiab tus me nyuam hauv plab.

Muaj cov ntaub ntawv pov thawj tias carbamazepine txhim kho cov folic acid tsis txaus uas ua rau lub cev xeeb tub. Qhov no tuaj yeem pab txhawb ntxiv qhov tshwm sim ntawm cov me nyuam tsis zoo thaum yug los ntawm cov poj niam uas tau noj cov tshuaj no. Yog li, ua ntej thiab thaum cev xeeb tub, nws raug nquahu kom noj cov tshuaj folic acid ntau ntxiv.

Raws li kev tiv thaiv kabmob los tiv thaiv kom tsis txhob muaj ntshav ntau ntxiv hauv cov menyuam yug menyuam, cov poj niam lub lim tiam dhau los ntawm kev xeeb tub, nrog rau cov menyuam yug menyuam tshiab, yuav tsum tau muab cov vitamin K₁.

Ntau qhov teeb meem kev mob siab ntsws ntawm lub chaw ua pa thiab / lossis mob qaug dab peg hauv cov menyuam tshiab uas lawv niam ua ke carbamazepine nrog lwm cov anticonvulsants tau piav qhia. Kuj muaj qee tus neeg muaj mob raws plab, ntuav thiab / lossis tsis qab los noj mov hauv cov menyuam mos uas lawv niam noj carbamazepine kuj tseem pom muaj. Nws xav tias cov kev tawm no yog kev tshwm sim ntawm kev tshem tawm cov tsos mob hauv cov menyuam tshiab.

Carbamazepine yog txiav txim siab nyob rau hauv leej niam cov kua mis, nws qib hauv nws yog 25-60% ntawm cov qib khoom hauv ntshav ntshav. Yog li, nws raug nquahu kom sib piv cov txiaj ntsig thiab qhov ua tsis tau yam tsis xav tau ntawm kev pub niam mis thaum kho lub sijhawm ntev nrog cov tshuaj. Thaum noj cov tshuaj carbamazepine, cov niam tuaj yeem pub niam mis rau menyuam tau noj, tab sis tsuas yog tias lawv tau soj ntsuam txhua qhov ua rau muaj kev phiv (piv txwv, kev fab tshuaj rau ntawm daim tawv nqaij thiab tsaug zog hnyav).

Yeeb tshuaj sib cuam tshuam

Nrog rau kev siv carbamazepine tib lub sij hawm nrog qee yam tshuaj, cov teebmeem tsis zoo yuav tshwm sim:

CYP3A4 inhibitors: nce ntshav ntau ntawm carbamazepine,
Dextropropoxyphene, verapamil, felodipine, diltiazem, viloxazine, fluoxetine, fluvoxamine, desipramine, cimetidine, danazol, acetazolamide, nicotinamide (tsuas yog hauv kev txhaj tshuaj ntau hauv cov neeg laus), macrolides (josamycin, erythromycinzolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezolezole ), loratadine, terfenadine, isoniazid, kua txiv kab ntxwv qaub, propoxyphene, HIV protease inhibitors siv hauv txoj kev kho mob HIV: kev muaj ntshav ntau ntxiv ntawm carbamazepine,
Pelbamate, fensuximide, phenobarbital, primidone, phenytoin, metsuximide, theophylline, cisplatin, rifampicin, doxorubicin, muaj peev xwm: valpromide, clonazepam, valproic acid, oxcarbazepine thiab tshuaj ntsuab npaj nrog hypericum hyperfin,
Valproic acid thiab primidone: kev hloov chaw ntawm carbamazepine los ntawm cov ntshav muaj protein ntau thiab nce qhov nce ntawm pharmacologically nquag metabolite (carbamazepine-10,11-epoxide),
Isotretinoin: kev hloov pauv hauv lub cev kev nyab xeeb thiab / lossis kev tshem tawm ntawm carbamazepine thiab carbamazepine-10,11-epoxide (plasma concentration xyuas yog tsim nyog),
Clobazam, clonazepam, primidone, ethosuximide, alprazolam, valproic acid, glucocorticosteroids (prednisone, dexamethasone), haloperidol, cyclosporine, doxycycline, methadone, tshuaj noj hauv qhov ncauj uas muaj progesterone thiab / lossis kev kho tshuaj, tshuaj tiv thaiv kab mob (nws yog qhov tsim nyog yuav tau noj tshuaj fenprocoumone, warfarin, dicumarol), topiramate, lamotrigine, tricyclic antidepressants (imipramine, nortriptyline, amitriptyline, clomipramine), felbamate, clozapine, tiagabin, protease inhibitors, uas raug siv rau hauv kev kho mob HIV (ritonavir, indinavir, saquinavir), oxcarbazepine, itraconazole, calcium channel blockers (ib pawg ntawm dihydropyridones, piv txwv li, felodipine), midazolam, levothyroxine, praziquantel, olazapine, risperidone, lawv cov ntsiab lus ntawm tram txo lossis txawm tias ua tiav qib ntawm lawv cov teebmeem, kho ntawm cov tshuaj txhaj yuav tsum tau),,
Phenytoin: nce lossis txo qis hauv nws cov ntshav ntshav,
Mefenitoin: kev nce ntxiv (hauv qee zaus) ntawm nws qib hauv ntshav ntshav,
Paracetamol: kev nce ntxiv ntawm kev pheej hmoo ntawm nws cov tshuaj lom rau lub siab thiab txo qis hauv kev siv tshuaj kho (ua kom lub cev sai ntawm paracetamol),
Phenothiazine, pimozide, thioxanthenes, molindone, haloperidol, maprotiline, clozapine thiab tricyclic antidepressants: ua rau kom muaj kev cuam tshuam rau lub hauv nruab nrab cov hlab ntsha thiab ua kom cov nyhuv anticonvulsant ntawm carbamazepine,
Diuretics (furosemide, hydrochlorothiazide): kev loj hlob nrog los soj ntsuam cov tsos mob ntawm hyponatremia,
Kev tsis ua rau cov leeg ua kom mob siab dua (pancuronium): txo qis rau lawv cov teebmeem,
Ethanol: ib qho kev txo qis hauv nws txoj kev kam taus,
Indirect anticoagulants, tshuaj tiv thaiv hormonal, folic acid: ua kom cov metabolism sai sai,
Txhais tau rau kev siv tshuaj loog (enflurane, halotane, fluorotan): cov metabolism nrawm nrawm nrog kev pheej hmoo ntawm hepatoxic zoo,
Methoxiflurane: nce tsim ntawm nephrotoxic metabolites,
Isoniazid: nce hepatotoxicity.

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

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 cuam tshuam rau tus nqi thiab qib ntawm kev nqus). Tom qab txhaj ib koob, qhov siab tshaj plaws (C_max mus txog tom qab 12 teev. Tom qab ib qho kev tswj hwm ntawm qhov ncauj ntawm 400 mg ntawm carbamazepine, tus nqi nruab nrab ntawm C_maxyog li 4.5 μg / ml. Qhov sib luag siab ntawm cov tshuaj hauv plasma tau tiav tom qab 1-2 lub lis piam. Lub sijhawm ntawm nws qhov kev ua tiav yog tus neeg thiab nyob ntawm qhov kev txiav txim siab ntawm pib ntawm lub siab ua haujlwm ntawm lub siab ua kab mob siab los ntawm carbamazepine, hetero-induction los ntawm lwm cov tshuaj siv ib txhij, nrog rau tus neeg mob ua ntej pib kho, qhov tshuaj ntawm lub sijhawm thiab lub sijhawm kho. Cov neeg tseem ceeb qhov sib txawv ntawm qhov muaj nuj nqis sib luag ntawm cov kev kho kom zoo yog 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%. Hauv cerebrospinal kua (tso tawm tom qab no hu ua CSF) thiab cov qaub ncaug, ntau ntau yog tsim nyob rau hauv kev faib ua feem rau cov nyiaj ntawm cov tshuaj nquag tsis muaj kab mob nrog cov nqaijrog (20-30%). Cais tau los ntawm qhov tsis muaj teeb meem. 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 carbamazepine-10,11-transdiol hauv tib neeg lub cev tshwm sim siv microsomal enzyme epoxyhydrolase.

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 cov metabolite, 9-hydroxymethyl-10-carbamoylacridane, kuj tau tsim. 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-lub neej ntawm kev hloov pauv carbamazepine (T_1/2) tom qab ib qho kev tswj hwm qhov ncauj ntawm cov tshuaj yog 25-65 teev (thaj tsam li 36 teev), tom qab rov qab noj dua - thaj tsam li 16-24 teev nyob ntawm lub sijhawm kho mob (vim kev kho mob ntawm lub monooxygenase ntawm lub siab). Hauv cov neeg mob noj lwm yam tshuaj uas ua rau lub siab mob microsomal siab (piv txwv li, phenytoin, phenobarbital) tib lub sijhawm, T_1/2 carbamazepine thaj tsam li 9-10 teev. Tom qab kev noj tshuaj ib zaug ntawm 400 mg carbamazepine, 72% ntawm koob tshuaj yog tawm hauv cov zis thiab 28% hauv kev quav. Txog 2% ntawm cov koob tshuaj noj tau tawm hauv cov zis hauv daim ntawv ntawm cov tsis hloov pauv carbamazepine, kwv yees li 1% hauv cov tshuaj pharmacologically nquag 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.

Pharmacokinetics ntawm 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 muaj kev ua haujlwm.

Siv thaum cev xeeb tub thiab thaum pub niam mis.

Rau cov poj niam ntawm lub hnub nyoog yug me nyuam, carbamazepine yog thaum twg ua tau raws li kev kho mob monotherapy, nyob rau hauv kev siv tshuaj qis tshaj plaws, txij li lub sijhawm ntawm kev tsis txaus ntseeg ntawm cov me nyuam yug tshiab los ntawm cov niam uas tau noj tshuaj tiv thaiv antiepileptic siab dua nrog kev kho mob hlwb.Ua raws li cov tshuaj uas yog ib feem ntawm kev sib xyaw ua ke, txoj kev pheej hmoo ntawm kev txhim kho kev yug menyuam tsis zoo yuav nce ntxiv, tshwj xeeb tshaj yog thaum valproate ntxiv rau kev kho.

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 qhia cuam tshuam nrog cov kev teeb tsa uas xav tau kev phais mob, siv tshuaj kho mob lossis 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 nyob rau thawj lub hlis thaum kho mob monotherapy, thiab 1.1% ntawm cov poj niam cev xeeb tub uas tsis noj cov tshuaj tiv thaiv kab mob.

Kev kho mob Carbamazepine-Akrikhin ntawm cov poj niam cev xeeb tub uas muaj mob vwm yuav tsum tau ua nrog ceev faj. Carbamazepine-Akrikhin yuav tsum tau siv rau qhov kev siv tshuaj 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 qhov muaj peev xwm-ncua kev pheej hmoo ntawm kev txhim kho kev tsis txaus ntseeg (piv txwv li, ntau zaus ntawm malformations thaum siv koob tshuaj tsawg dua 400 mg ib hnub yog qis dua nrog ntau dua koob).

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 hla mus rau niam mis, qhov ua kom pom tseeb hauv nws yog 25-60% ntawm cov ntsiab lus hauv cov ntshav ntshav, yog li ntawd, 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 tau saib xyuas nrog cov xov ntawm kev txheeb xyuas kev phiv los ntawm cov kab mob hepatobiliary. Cov neeg mob ntawm lub hnub nyoog yug menyuam yuav tsum tau ceeb toom txog qhov txo qis kev ua tau zoo ntawm kev tiv thaiv qhov ncauj thaum siv cov carbamazepine.

Tsuas tshuaj thiab tswj hwm.

Muab cov tshuaj sib cuam tshuam nrog lwm cov tshuaj thiab cov pharmacokinetics ntawm cov tshuaj antiepileptic, cov neeg laus yuav tsum tau xaiv nrog ceev faj.

Tshuaj qaug dab peg
Nyob rau hauv rooj plaub uas qhov no ua tau, carbamazepine-Akrikhin 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. Txhawm kom xaiv cov tshuaj noj kom zoo hauv qhov tshuaj, nws raug nquahu tias cov ntsiab lus ntawm cov khoom tseem ceeb hauv cov ntshav ntshav tau txiav txim siab. Hauv kev kho kab mob vwm, koob tshuaj carbamazepine yog qhov yuav tsum tau, sib haum rau tag nrho cov ntshav plasma concentration ntawm carbamazepine ntawm qib 4-12 μg / ml (17-50 μmol / L). Kev nkag mus ntawm cov tshuaj Carbamazepine-Akrikhin mus rau qhov kev kho tshuaj txuas ntxiv yuav tsum tau nqa tawm maj mam, thaum lub koob tshuaj ntawm cov tshuaj siv tsis hloov lossis, yog tias tsim nyog, kho qhov tseeb. Yog tias tus neeg mob tau hnov qab noj cov tshuaj txuas ntxiv ntawm lub sijhawm, lub sijhawm ncua tsis tau yuav tsum noj tam sim ntawd qhov kev ncua tseg no tau pom, thiab koj tsis tuaj yeem noj ob npaug ntawm cov tshuaj.

Cov neeg laus
Thawj koob tshuaj yog 200-400 mg 1 lossis 2 zaug hauv ib hnub, tom qab ntawd cov koob tshuaj tau maj mam nce mus txog thaum pom cov txiaj ntsig zoo tshaj plaws. Qhov kev saib xyuas txij nkawm yog 800-1200 mg rau ib hnub, uas tau muab faib ua 2-3 koob tshuaj ib hnub.

Cov menyuam.
Thawj koob tshuaj rau cov menyuam yaus ntawm 4 txog 15 xyoos yog 200 mg rau ib hnub (hauv ntau qhov koob tshuaj), tom qab ntawd cov koob tshuaj yog maj mam nce los ntawm 100 mg rau ib hnub kom txog thaum pom kev zoo dua.

Cov koob tshuaj txij nkawm rau cov menyuam yaus 4-10 xyoo - 400-600 mg ib hnub, rau cov menyuam yaus hnub nyoog 11-15 xyoo - 600-1000 mg ib hnub (hauv ntau ntau zaug).

Cov sijhawm noj tshuaj nram no yog qhov pom zoo:
Cov neeg laus: thawj koob tshuaj yog 200-300 mg thaum yav tsaus ntuj, koob tshuaj txij nkawm yog 200-600 mg thaum sawv ntxov, 400-600 mg thaum yav tsaus ntuj.

Cov menyuam yaus hnub nyoog 4 txog 10 xyoo: pib siv - 200 mg thaum yav tsaus ntuj, koob tshuaj txij nkawm - 200 mg thaum sawv ntxov, 200-400 mg thaum yav tsaus ntuj, menyuam yaus hnub nyoog 11 txog 15 xyoos: koob tshuaj pib - 200 mg thaum yav tsaus ntuj, koob tshuaj txij nkawm - 200 -400 mg thaum sawv ntxov, 400-600 mg thaum yav tsaus ntuj. Cov menyuam yaus hnub nyoog 15 txog 18 xyoo: noj ntau npaum 800-1200 mg / hnub, ntau kawg ib hnub -1200 mg / hnub.

Lub sijhawm siv yog nyob ntawm qhov ntsuas thiab tus neeg teb ntawm tus neeg mob rau kev kho. Qhov kev txiav txim siab hloov tus neeg mob rau Carbamazepine-Akrikhin, lub sijhawm siv nws thiab kev tshem tawm txoj kev kho yog coj tus kheej los ntawm kws kho mob. Lub sijhawm ntawm txo qis ntawm cov tshuaj lossis tso tseg kev kho mob yog txiav txim siab tom qab 2-3 xyoo lub sijhawm ntawm kev ua tsis tiav ntawm chua leeg.

Txoj kev kho mob tau nres, maj mam txo qhov ntau cov tshuaj rau 1-2 xyoos, nyob rau hauv kev saib xyuas ntawm EEG. Hauv cov menyuam yaus, nrog rau qhov txo qis hauv cov tshuaj ib hnub, nce hauv lub cev qhov hnyav nrog lub hnub nyoog yuav tsum raug txiav txim siab.

Ua rau mob hlwb neuralgia, idiopathic glossopharyngeal neuralgia.
Qhov tshuaj thawj zaug yog 200-400 mg ib hnub twg, uas tau muab faib ua 2 koob tshuaj. Thawj koob tshuaj thawj tau nce ntxiv txog thaum qhov mob ploj zoo kiag li, qhov nruab nrab nce mus txog 400-800 mg ib hnub twg (3-4 zaug hauv ib hnub). Tom qab ntawd, hauv qee qhov ntawm cov neeg mob, kev kho tuaj yeem txuas ntxiv nrog kev tswj xyuas qis dua ntawm 400 mg.

Qhov kev pom zoo ntau tshaj plaws yog 1200 mg / hnub, thaum nce mus txog qhov kev txhim kho hauv chaw kho mob, cov koob tshuaj ntawm cov tshuaj yuav tsum maj mam txo kom txog thaum qhov mob nres tom ntej tshwm sim.

Rau cov neeg mob laus thiab cov neeg mob rhiab carbamazepine, Carbamazepine-Akrikhin raug tso rau hauv thawj koob 100 mg 2 zaug hauv ib hnub, tom qab ntawd cov tshuaj tau maj mam nce ntxiv kom txog thaum qhov cov tsos mob hnov mob, uas feem ntau ua tiav ntawm koob tshuaj 200 mg 3-4 zaug hauv ib hnub. Tom ntej no, koj yuav tsum maj mam txo qhov koob tshuaj kom tsawg kawg nkaus txij nkawm.

Nrog trigeminal neuralgia hauv pawg no ntawm cov neeg mob, qhov siab tshaj plaws pom zoo yog 1200 mg / hnub. Thaum daws qhov mob ua kom tus mob, kev kho nrog cov tshuaj yuav tsum maj mam txiav tawm mus txog thaum hnov mob ntxiv.

Kho mob hauv cawv tso rau hauv tsev kho mob.
Qhov nruab nrab txhua hnub koob yog 600 mg (200 mg 3 zaug hauv ib hnub). Hauv cov xwm txheej loj, hauv thawj hnub, qhov tshuaj yuav muab ntau ntxiv rau 1200 mg ib hnub, uas tau muab faib ua 3 koob tshuaj. Yog tias tsim nyog, Kapbamazepine-Akrikhin tuaj yeem txuas nrog lwm cov tshuaj uas siv los kho kev haus cawv, tshwj tsis yog sedative-hypnotics. Thaum kho, nws yog ib qho tsim nyog yuav tsum soj ntsuam cov ntsiab lus ntawm cov carbamazepine hauv cov ntshav ntshav. Hauv kev sib txuas nrog txoj kev txhim kho tau ntawm kev mob tshwm sim los ntawm lub hauv nruab nrab thiab lub hlwb tsis muaj zog, cov neeg mob tau ua tib zoo saib nyob hauv tsev kho mob.

Mob manic thiab kev pab txhawb kev kho mob los ntawm qhov muaj mob (bipolar).
Qhov tshuaj rau txhua hnub yog 400-1600 mg. Qhov nruab nrab txhua hnub koob tshuaj yog 400-600 mg (hauv 2-3 koob).

Hauv lub xeev kev mob siab, qhov tshuaj yuav tsum tau nce ntxiv kom nrawm. Nrog kev kho kom zoo rau kev puas siab puas ntsws bipolar, txhawm rau kom ntseeg tau tias qhov ua kom tau zoo tshaj plaws, txhua qhov kev nce qib ntxiv yuav tsum muaj tsawg, qhov kev noj tshuaj txhua hnub nce zuj zus.

Kev tsum tsis siv cov tshuaj.
Kev tsis tu ncua cov tshuaj tam sim ntawd tuaj yeem ua rau qaug dab peg. Yog tias nws yuav tsum tau txiav tawm cov tshuaj hauv tus neeg mob qaug dab peg, kev hloov pauv mus rau lwm cov tshuaj tiv thaiv kev puas tsuaj yuav tsum tau ua nyob rau hauv kev npog ntawm cov tshuaj uas qhia hauv cov xwm txheej zoo li no (piv txwv li, diazepam muab tshuaj rau txoj leeg lossis hauv qhov quav, lossis phenytoin muab tshuaj rau txoj leeg).

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. Kev txhim kho ntawm cov kev phiv tshuaj los ntawm cov hlab ntsha hauv nruab nrab yog qhov tshwm sim los ntawm kev noj qab haus huv ntau dhau ntawm cov tshuaj lossis qhov txawv txav hauv qhov kev xav ntawm cov tshuaj nquag hauv cov ntshav ntshav. Hauv cov xwm txheej zoo li no, nws raug nquahu kom saib xyuas cov khoom tseem ceeb hauv cov ntshav ntshav.

Thaum ntsuas qhov ntau zaus ntawm kev tshwm sim ntawm ntau qhov kev tsis zoo, cov ntsuas kab hauv qab no tau siv: ntau zaus - 10% lossis ntau dua, feem ntau - 1-10%, qee zaum -0.1-1%, tsis tshua -0.01-0.1%, tsis tshua muaj-tsawg 0.01%

Kev txhim kho ntawm cov kev phiv tshuaj los ntawm lub hauv nruab nrab cov hlab ntsha tuaj yeem yog qhov tshwm sim ntawm kev noj qab haus huv ntau dhau ntawm cov tshuaj lossis cov kev hloov pauv tseem ceeb hauv cov tshuaj carbamazepine hauv cov ntshav ntshav.

Los ntawm lub hauv nruab nrab hauv lub paj hlwb: feem ntau - kiv taub hau, ataxia, nkees nkees, feem ntau tsis muaj zog, mob taub hau, paresis ntawm kev pab, qee zaum qias neeg tsis tuaj yeem txav (piv txwv, tshee, "viav vias" tshee tshee - asterixis, dystonia, tics), nystagmus, tsis tshua pom - kev pom (pom lossis hnov) kev nyuaj siab, ploj, qab los noj mov, ntxhov siab, coj tus cwj pwm, psychomotor ntxhov siab, tsis meej pem, ua kom mob hlwb, orofacial dyskinesia, oculomotor cuam tshuam, hais lus tsis meej (piv txwv li dysarthria lossis hais lus tsis meej), choreoathetoid ntshawv siab, peripheral Writ, paresthesia, nqaij tsis muaj zog, thiab paresis ntawm cov tsos mob, nws yog heev tsawg - saj ua cuam tshuam, neuroleptic phem syndrome, dysgeusia.

Kev tsis haum tshuaj: feem ntau - kev ua xua dermatitis, feem ntau - urticaria, qee zaum - deteratiative dermatitis, erythroderma, ntau yam kev hloov ntawm cov mob ncua ntev uas muaj lub cev tsis haum nrog kub taub hau, tawm pob ntawm daim tawv nqaij, vasculitis (suav nrog erythema nodosum, raws li cov tsos mob ntawm daim tawv nqaij vasculitis), lymphadenopathy, cov cim, , arthralgia, leukopenia, eosinophilia, hepatosplenomegaly thiab cov kev hloov pauv ntawm kev ua haujlwm ntawm daim siab ua haujlwm (cov kev qhia no tshwm sim hauv ntau yam kev sib txuas). Lwm yam hauv nruab nrog cev (xws li mob ntsws, ob lub raum, mob thiav, myocardium, mob hnyuv tws), mob aseptic meningitis nrog myoclonus thiab peripheral eosinophilia, anaphylactoid cov tshuaj tiv thaiv, angioedema, kev tiv thaiv mob ntsws o lossis mob ntsws oosinophilic kuj yuav koom tes nrog. Yog tias muaj kev tsis haum rau saum toj no tshwm sim, kev siv cov tshuaj yuav tsum raug txiav tawm, tsis tshua muaj - lupus-zoo li cov tsos mob, khaus ntawm daim tawv nqaij, erythema multiforme exudative (suav nrog Stevens-Johnson syndrome), erythema nodosum, tshuaj lom epidermal necrolysis (Lyell's syndrome), photosensitivity.

Los ntawm cov kabmob hemopoietic: feem ntau leukopenia, thrombocytopenia, eosinophilia, tsis tshua muaj leukocytosis, lymphadenopathy, folic acid deficiency, agranulocytosis, aplastic anemia, muaj tseeb erythrocytic aplasia, megaloblastic anemia, me ntsis mob sib chwv, mob hlwb, reticulocytemia, ntshav tsawg tsis txaus, ntshav tsawg porphyria, variegated porphyria.

Los ntawm lub plab zom mov: feem ntau xeev siab, ntuav, lub qhov ncauj qhuav, muaj kev ua si ntau dua 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, nce kev ua si ntawm alkaline phosphatase, qee zaum - nce kev ua haujlwm ntawm hepatic transaminases, raws plab lossis quav tawv, plab mob, tsis tshua muaj - glossitis, gingivitis, stomatitis, pancreatitis, kab mob siab rau cholestatic, parenchymal (hepatocellular) lossis hom sib xyaw, daj ntseg, mob ntshav siab, daim siab tsis ua hauj lwm, ua kom muaj kab mob siab rau hauv lub plab. x ducts nrog kev txo qis hauv lawv tus lej.

Los ntawm cov kab mob plawv: tsis tshua muaj - kev mob plawv rau lub sijhawm tsis txaus siab, txo qis lossis nce siab hauv cov ntshav siab, bradycardia, arrhythmias, atrioventricular block nrog tsaus muag, tsaus muag, kev tsim txom lossis kev loj hlob ntawm lub plawv tsis ua hauj lwm, exacerbation ntawm kev mob plawv (nrog rau qhov tshwm sim lossis nce ntawm lub ntsws nres), thrombophlebitis, thromboembolism tus mob ntsws

Los ntawm cov kab ke endocrine thiab metabolism: feem ntau - edema, kua dej cia, lub cev hnyav, hyponatremia (txo qis ntshav ntshav osmolarity vim muaj cov txiaj ntsig zoo ib yam li cov tshuaj tiv thaiv antidiuretic, uas tsis tshua muaj tshwm sim ua rau cov ntshav tsis haum hyponatremia, nrog ua kom nkees, ntuav, mob taub hau, tsis meej pem thiab mob hlwb), tsis tshua muaj - kev nce siab hauv cov concentration ntawm prolactin (tej zaum yuav yog nrog galactorrhea thiab gynecomastia), qhov kev txo qis ntawm cov concentration ntawm L-thyroxine thiab qhov nce ntawm cov concentration ntawm cov thyroid-stimulating hormone (feem ntau tsis nrog los soj ntsuam. E ces), teeb ntawm calcium-phosphorus metabolism hauv cov pob txha ntaub so ntswg (poob nyob rau hauv concentration ntawm calcium thiab 25-0N, cholecalciferol ntshav): osteomalacia, txha, hypercholesterolemia (xws li high-density lipoprotein cholesterol), thiab gipertrigpitseridemiya lymphadenopathy, hirsutism.

Los ntawm genitourinary system: tsis tshua muaj mob cuam tshuam ntawm nephritis, lub raum tsis ua haujlwm, lub raum lub plawv tsis ua haujlwm (piv txwv li, albuminuria, hematuria, oliguria, muaj urea / azotemia), nce mus tso zis, tso zis, tso tsawg, muaj phev (phev tsawg) thiab tsis muaj zog.

Los ntawm cov leeg musculoskeletal: feem ntau ua rau qaug zog, tsis tshua muaj leeg mob ua kom tsis muaj zog, mob caj dab, mob leeg nqaij me me, lossis mob plab.

Ntawm qhov txhia chaw: feem ntau - kev ntxhov siab ntawm kev pab (nrog rau qhov pom kev plooj plooj), tsis tshua muaj - tsis hnov qab, nce siab ntawm lub ntsej muag, ob lub qhov muag, lub ntsej muag, tsis hnov lus, suav nrogtinnitus, hyperacusis, hypoacusia, hloov kev pom ntawm lub suab.

Kev ua tsis taus ntawm lub tshuab ua pa, hauv siab thiab mediastinal kabmob: tsis tshua muaj heev - qhov tsis haum lub cev tsis haum lub cev yog kub ib ce, ua tsis taus pa, mob ntsws los yog mob ntsws.

Kuaj thiab ntsuas cov ntaub ntawv: Tsis tshua muaj heev - hypogammaglobulinemia.

Lwm yam: kev cuam tshuam ntawm daim tawv nqaij pigmentation, purpura, mob ntxau, tawm hws, alopecia.

Cov xwm txheej tsis zoo raws li kev soj ntsuam tom qab tshaj tawm (qhov tsis paub ntau zaus)
Lub cev tsis muaj zog tiv thaiv kab mob: tshuaj tawm pob nrog eosinophilia thiab ua rau pom tseeb.

Kev ua tsis taus los ntawm daim tawv nqaij thiab cov nqaij mos subcutaneous: mob nyhav rau thaj yeeb pzulatous pustulosis, lichenoid keratosis, onychomadesis.

Kis thiab cov kab mob cab: kev thiav ntawm tus mob herpes simplex virus hom 6.

Kev cuam tshuam los ntawm cov ntshav thiab cov lymphatic system: hlwb pob txha tsis ua haujlwm.

Ua txhaum ntawm lub paj hlwb: tsis nco qab.

Kev mob plab zom mov: tus kaus.

Kev ua txhaum ntawm cov leeg nqaij thiab pob qij txha: txha lov.

Kev cuam tshuam nrog lwm yam tshuaj.

Ua kom cov concentration ntawm carbamazepine hauv cov ntshav ntshav verapamil, diltiazem, felodipine, dextropropoxyphene, viloxazine, fluoxetine, fluvoxamine, nefazodone, paroxetine, trazodone, olanzapine, cimetidine, omeprazole, acetazolamide, danazole, desipramine, nicotinamide ( , troleandomycin), ciprofloxacin, styripentol, vigabatrin, azoles (itraconazole, ketoconazole, fluconazole, voriconazole), terfenadine, loratadine, isoniazid, propoxyphene, oxygenbutynin, dantrolene, ticlgraedin siv nyob rau hauv kev kho mob los ntawm kev kho mob HIV (piv txwv, ritonavir) - kev kho ntawm cov tshuaj ntau npaum li cas lossis kev saib xyuas qhov kev nkag siab ntawm lub cev ntawm carbamazepine nyob rau hauv cov ntshav ntshav yuav tsum yog.

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 ntshiab ntawm felbamate yog ua tau.

Cov tshuaj uas tuaj yeem ua rau nce qhov siab ntxiv ntawm carbamazepine-10,11-epoxide hauv cov ntshav plasma: loxapine, quetiapine, primidone, progabide, vaproic acid, valnoktamide thiab valpromide.

Txij li ib qho kev nce ntxiv ntawm qhov kev txiav txim siab ntawm carbamazepine-10.11-epoxide nyob rau hauv cov ntshav ntshav tuaj yeem ua rau muaj kev phiv tshuaj (piv txwv, kiv taub hau, tsaug zog, ataxia, diplopia), nyob rau hauv cov xwm txheej no cov tshuaj ntawm cov tshuaj yuav tsum tau kho thiab / lossis kev txiav txim siab ntawm carbamazepine-10.11 yuav tsum tau txiav txim siab tsis tu ncua. -epoxide nyob hauv ntshav.

Qhov muaj zog ntawm carbamazepine tsawg dua phenobarbital, phenytoin (rau tsis txhob qaug cawv phenytoin thiab tshwm sim subtherapeutic ntau ntawm carbamazepine pom zoo ntshav concentration ntawm phenytoin yuav tsum tsis ntau tshaj li 13 .mu.g / mL ua ntej yuav muab rau txoj kev kho carbamazepine), fosphenytoin, primidone, metsuksimid, fensuksimid, theophylline, aminophylline, rifampicin, cisplatin, doxorubicin, ua tau: clonazepam, valpromide, vaproic acid, oxcarbazepine thiab tshuaj ntsuab npaj muaj St. John lub wort (Hypericum perforatum).

Nrog rau kev siv thooj txhij nrog cov tshuaj saum toj no, yuav tsum tau txhaj tshuaj carbamazepine koob tshuaj.

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 kev siv ua ke ntawm carbamazepine nrog valproic acid, nyob rau hauv qhov xwm txheej tshwj xeeb, tsis nco qab thiab tsis meej pem yuav tshwm sim. Isotretinoin hloov kho cov bioavailability thiab / lossis kev tshem tawm ntawm carbamazepine thiab carbamazepine-10,11-epoxide (kev saib xyuas ntawm cov concentration ntawm carbamazepine hauv ntshav yog tsim nyog).

Carbamazepine tuaj yeem txo qis qis hauv plasma (kom txo qis lossis cuam tshuam txog qib dhau los) thiab xav kom txhaj tshuaj kho cov tshuaj hauv qab no: clobazam, clonazepam, digoxin, ethosuximide, primidone, zonisamide, valproic acid, alprazolam, glucocorticosteroids (prednisolone, dexamethasone), cyclosporin, tetracycline, tetracycline, tetracycline tshuaj txiav yeeb, qhov ncauj npaj uas muaj estrogens thiab / los yog progesterone (xaiv lwm txoj kev tswj kom tsis txhob muaj menyuam yog tsim nyog), theophylline, qhov ncauj anticoagulants (warfarin, fenprocoumone, dicumarol, aceno Umarolum), lamotrigine, topiramate, tricyclic antidepressants (imipramine, amitriptyline, nortriptyline, clomipramine), bupropion, citalopram, mianserin, sertraline, clozapine, felbamate, tiagabine, oxarbazepine, tshuaj tiv thaiv kab mob HIV, tshuaj tiv thaiv kab mob, tiv thaiv kab mob ), tshuaj rau kev kho mob ntawm cov kab mob ntawm cov hlab plawv ("qeeb" calcium channel blockers (ib pawg ntawm dihydropyridones, piv txwv li, felodipine), simvastatin, atorvastatin, lovastatin, cerivastatin, ivabradine), nws rakonazola, levothyroxine, midazolam, olanzapine, ziprasidone, aripiprazole, paliperidone, praziquantel, risperidone, tramadol, ziprasidone, buprenorphine, phenazone, aprepitant, albendazole, imatinib, cyclophosphamide, lapatinib, everolimus, tacrolimus, sirolimus, temsirolimus, tadapafila. 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 tib lub sijhawm ntawm carbamazepine thiab lithium kev npaj lossis metoclopramide, cov teebmeem 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 loj ntxiv ntawm hyperpyretic crises, tawg kev kub ntxhov, 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. Nrog rau kev siv cov carbamazepine sib xyaw ua ke nrog levetiracetam, nyob rau qee qhov xwm txheej, qhov nce ntawm cov tshuaj lom carbamazepine tau sau tseg.

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 kab mob hepatotoxic ntawm isoniaeid.

Kev cuam tshuam nrog kev tawm tsam serologicalCov. Carbamazepine tuaj yeem ua rau qhov tsis zoo-tshwm sim los ntawm kev txiav txim siab qhov kev xav ntawm perphenazine los ntawm kev ua tau zoo siab ua kua nyeem. Carbamazepine thiab carbamazepine 10.11-epoxide tuaj yeem ua rau qhov tsis zoo-qhov tshwm sim ntawm kev txiav txim siab qhov kev xav ntawm tricyclic antidepressant los ntawm polarization fluorescence immunoassay.

Tsuas tshuaj thiab tswj hwm

Carbamazepine ntsiav tshuaj yog npaj rau kev siv qhov ncauj nrog zaub mov noj.

Txog kev kho kab mob vwm, cov neeg laus tau qhia txog cov tshuaj hauv thawj koob tshuaj 1 ntsiav tshuaj 1-2 zaug ib hnub. Cov neeg laus yog qhov pom zoo kom noj ½ ntsiav tshuaj ib hnub 1-2 zaug. Tom qab, cov koob tshuaj yuav tsum tau nce ntxiv kom txog 2 ntsiav tshuaj noj 2-3 zaug hauv ib hnub. Qhov siab tshaj plaws txhua hnub koob tshuaj carbamazepine yuav tsum tsis pub tshaj 6 ntsiav tshuaj.

Kev noj tshuaj carbamazepine rau cov menyuam hnub nyoog qis dua 1 xyoos yog 0.5-1 ntsiav tshuaj ib hnub, 1-5 xyoos - 1-2 ntsiav tshuaj, 5-10 xyoo - 2-3 ntsiav tshuaj, 10-15 xyoo - 3-5 ntsiav tshuaj. Qhov koob tshuaj txhua hnub yuav tsum tau muab faib ua 2 koob.

Txog kev kho mob ntawm neuralgia thiab mob syndromes ntawm ntau yam keeb kwm, koob tshuaj txhua hnub yog 1-2 ntsiav tshuaj carbamazepine, muab faib ua 2-3 koob. 2-3 hnub tom qab pib noj tshuaj, muab koob tshuaj tuaj yeem nce siab ntxiv 2-3 ntsiav tshuaj. Lub sijhawm kho yog 7-10 hnub. Tom qab kev txhim kho ntawm tus neeg mob lub cim tau teev tseg, cov koob tshuaj yuav tsum maj mam txo kom tsawg yam tsawg kawg nkaus. Kev kho txij nkawm yog pom zoo rau lub sijhawm ntev.

Yog tias tus neeg mob thim tawm, raws li cov lus qhia, carbamazepine yog tau hais kom noj 1 lub tshuaj 3 zaug ib hnub. Hauv kev ua txhaum loj, nyob rau thawj peb hnub, nce ntxiv ntawm cov tshuaj pom zoo - 2 ntsiav tshuaj 3 zaug hauv ib hnub.

Rau kev kho mob ntawm polydipsia thiab polyuria hauv ntshav qab zib insipidus, ib ntsiav tshuaj yuav tsum tau noj 2-3 zaug ib hnub.

Cov Ntaub Ntawv Ntxiv

Kev kho nrog carbamazepine yuav tsum tau pib nrog kev noj tshuaj me me, maj mam coj lawv mus rau theem kev kho mob uas tsim nyog.

Nyob rau lub sijhawm kho mob nrog cov tshuaj no, nws raug nquahu kom tsis txhob ua haujlwm uas yuav tsum muaj kev kub siab ntxiv, vim tias cov tshuaj cuam tshuam rau lub luag haujlwm ntawm lub hauv nruab nrab cov hlab hlwb.

Cov lus qhia rau carbamazepine qhia tau tias nws yuav tsum tau khaws cov tshuaj cia hauv qhov chaw tsaus, txias thiab tawm ntawm cov menyuam yaus. Txee lub neej yog 36 lub hlis.

Ceev faj thiab cov lus pom zoo

Txhawm rau kom ua tau zoo tshaj plaws hauv kev kho mob, carbamazepine raws li kev kho mob monotherapy yog kho nrog cov tshuaj me me nrog lawv cov kev txhim kho ib qib zuj zus. Hauv kev ua ke nrog kev kho mob rau kev hloov kho tshuaj, nws yog qhov tsim nyog los txiav txim siab qhov kev txiav txim siab ntawm carbamazepine hauv ntshav ntshav. Kev kho mob nrog carbamazepine tsis tuaj yeem thim sai sai, vim tias mob qaug dab peg tshiab feem ntau tau sau cia. Tab sis yog tias cov tshuaj yuav tsum tau thim tawm, tom qab ntawd tus neeg mob yuav tsum tau khi mus rau lwm cov tshuaj pleev ib ce. Yog li, thaum kho carbamazepine, nws yog ib qhov tsim nyog los soj ntsuam cov ntshav thiab lub siab ua haujlwm.

Carbamazepine nthuav tawm cov nyhuv anticholinergic me me, yog li cov leeg hauv siab yuav tsum tswj thoob plaws txhua lub sijhawm ntawm kev kho. Carbamazepine tuaj yeem txo cov txiaj ntsig ntawm kev tiv thaiv qhov ncauj, yog li siv cov hau kev ntxiv ntawm kev tiv thaiv kev tiv thaiv cev xeeb tub yuav tsum tau siv.

Carbamazepine yog siv los kho mob tawm cov tsos mob uas tshwm sim los ntawm kev haus cawv. Cov tshuaj txhim kho lub siab ntsws ntawm tus neeg mob lub cev. Tab sis carbamazepine rau cov laj thawj zoo li no yuav tsum tsuas yog siv hauv tsev kho mob, vim tias qhov sib xyaw ntawm ob yam tshuaj no ua rau cov tsis xav tau ntawm lub paj hlwb.

Cov tshuaj yuav cuam tshuam rau kev txiav txim siab. Yog li no, nyob rau lub sij hawm ntawm txoj kev kho nrog cov tshuaj no, nws yog ib qho tsim nyog yuav tsum ua kom tsis txhob muaj kev phom sij, tsav tsheb, thiab ua haujlwm xav tau kev saib xyuas ntau ntxiv.

Sib xyaw nrog lwm yam tshuaj

Kev noj CYP 3A4 isoenzyme inhibitor tuaj yeem ua rau nce ntshav plasma carbamazepine ntau dua. Noj cov inducers ntawm CYP 3A4 isoenzyme ua ke nrog carbamazepine tuaj yeem ua rau kom txo qis ntawm cov tshuaj antiepileptic thiab ua kom nws cov metabolism. Kev siv txab carbamazepine nrog rau kev siv yeeb tshuaj uas cuam tshuam los ntawm CYP 3A4 isoenzyme cuam tshuam qhov induction ntawm metabolism thiab txo qis hauv cov tshuaj no hauv plasma.

Cov tshuaj uas ua rau kom cov carbamazepine ntau ntxiv: ibuprofen, macrolide tshuaj tua kab mob, dextropropoxyphene, danazol, fluoxetine, nefazodone, fluvoxamine, trazodone, paroxetine, viloksazin, loratadine, vigabatrin, stiripentol, azoles, terfenadine, quetiapine, loxapine, Isoniazid, olanzapine, kis protease inhibitors rau cov kev kho mob ntawm tus kab mob HIV, verapamil, omeprazole, acetazolamide, diltiazem, dantrolene, oxygenbutynin, nicotinamide, ticlopidine. Primidone, cimetidine, valproic acid, desipramine tuaj yeem muaj cov txiaj ntsig zoo ib yam.

Cov tshuaj uas txo cov tshuaj carbamazepine: paracetamol, methadone, tramadol, antipyrine, doxycycline, anti-coagulants (qhov ncauj), bupropion, trazodone, citalopram, antidepressants (tricyclics), clonazepam, clobazam, lamotrigine, felbamate, ethosuximide, primamidamidone, primamidamidone, primamidamidone,, imatinib, praziquantel, itraconazole, haloperidol, olanzapine, bromperidol, quetiapine, ziprasidone, ritonavir, saquinavir, ritonavir, indinavir, alprazolam, calcium channel blockers, theophylline, midazolam, perazolam , glucocorticosteroids, sodium levothyroxine, everolimus, cyclosporine, progesterone, estrogens.

Kev sib txuas ua ke los txiav txim siab.

Isoniazid + carbamazepine - nce hepatotoxicity.

Levetiracetam + carbamazepine - muaj tshuaj lom ntau dua ntawm carbamazepine.

Carbamazepine + lithium kev npaj, metoclopramide, haloperidol, thioridazan thiab lwm cov tshuaj tiv thaiv kev tiv thaiv - nce ntxiv ntawm cov tsis xav tshuaj neurological.

Carbamazepine + diuretics, xws li furosemide, hydrochlorothiazide - qhov tshwm sim ntawm hyponatremia nrog cov tsos mob hnyav soj ntsuam.

Carbamazepine + cov leeg ua kom tsis txhob ua lub zog - tswj kev txiav txim ntawm cov nqaij ntshiv, uas tau tso tseg sai sai rau lawv txoj kev kho kom zoo, tab sis qhov xwm txheej yuav kho tau los ntawm kev nce qib lawv ib hnub.

Carbamazepine + kua txiv txiv hmab - kev nce qib ntawm carbamazepine hauv ntshav.