Saroten retard - cov lus qhia ntawm kev siv > Kev khomob thiab kev tiv thaiv

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

Daim ntawv noj tshuaj:

Lub caij nyoog txiav txim tsiav tshuaj.

Yam khoom muaj sia - amitriptyline hydrochloride 56.55 mg (uas sib haum rau 50 mg ntawm amitriptyline).

Tshwjxeeb - suab thaj spheres 123.074 mg, stearic acid 0.123 mg, shellac (tsis muaj tshuaj pleev pliav) 8.480-14.140 mg, talcum 16.016-29.610 mg, povidone 0.724-1.086 mg.

Kev sib xyaw ntawm ib qho tshuaj ntsiav khoob - gelatin 65.0 mg, hlau zas hlau oxide liab (E 172) 0.98 mg, titanium dioxide (E 171) 0.33 mg.

nyuaj, gelatin tsiav tshuaj, opaque, lub cev thiab lub hau liab-xim av. Capsule loj No. 2.

Ntsiab Lus Qhia Txog - pellets los ntawm yuav luag dawb rau daj.

Cov chaw muag tshuaj

Amitriptyline yog ib qho tricyclic tshuaj tiv thaiv. Amitriptyline yog tertiary amine, nyob hauv nruab nrab qhov chaw nruab nrab ntawm tricyclic antidepressants, vim nws yog kwv yees li ib yam nkaus hauv vivo raws li lub zog tshuaj ntawm kev sib deev ntawm serotonin thiab norepinephrine los ntawm presynaptic cov leeg paj. Lub ntsiab metabolite ntawm lub compoundripriptyline yog qhov muaj zog heev qhov tsis haum ntawm norepinephrine uptake, tab sis nws kuj tseem cuam tshuam rau kev siv serotonin. Amitriptyline muaj cov tshuaj anticholinergic zoo heev, antihistaminergic thiab sedative zog thiab kuj potentiates cov teebmeem ntawm catecholamines.

Kev txwv tsis pub lub qhov muag ceev nrawm theem ntawm kev pw tsaug zog (BDG) tau suav hais tias yog lub cim ntawm kev ua haujlwm tiv thaiv kev ntxhov siab. Tricyclic cov tshuaj tiv thaiv kev ntxhov siab, nrog rau kev xaiv serotonin thiab MAOI reuptake inhibitors, txwv qhov theem ntawm BDH thiab txhim kho kev pw tsaug zog qeeb qeeb.

Amitriptyline nce qib kev txo qis pathologically nce siab.

Vim nws cov nyhuv sedative, amitriptyline yog qhov tshwj xeeb hauv kev kho kev nyuaj siab, nrog rau kev ntxhov siab, ntxhov siab, ntxhov siab thiab pw tsaug zog.

Qhov ua kom loog rau kev siv tshuaj tsis cuam tshuam nrog tshuaj tiv thaiv kab mob, vim tias kev ua kom loog tshwm sim ntau dua li cov kev hloov pauv hauv lub siab, thiab feem ntau yog qhov tshwm sim los ntawm kev noj ntau dua qis dua qhov tsim nyog los xyuas kom hloov mus ob peb vas hloov.

Nws yog ua tau kom zoo kho nocturnal enuresis.

Kev Tsis Txaus Siab Kev saib xyuas qhov ncauj ntawm cov tshuaj hauv cov ntsiav tshuaj txiav txim siab qhov kev ua tiav ntawm qhov ntau kawg nyob hauv ntshav cov ntshav tom qab kwv yees li 4:00 (t _max = 3.89 ± 1.87 teev, thaj tsam 1.03-7.98 teev). Tom qab noj 50 mg, qhov nqi nruab nrab ntawm C _max = 30.95 ± 9.61 ng / ml, ntau 10.85-45.70 ng / ml (111.57 ± 34.64 nmol / L, khwv tau 39.06-164, 52 nmol / L). Qhov nruab nrab ntawm lub qhov ncauj nruab nrab yog 53% (F _abs = 0.527 ± 0.123, khwv 0.219-0.756). Kev xa Khoom. Plasma protein khi yog kwv yees li 95%. Amitriptyline thiab nws cov metabolite tseem ceeb - nortriptyline - txeem tawm ntawm cov nyom placental. Kev zom zaub mov. Amitriptyline metabolism tshwm sim ntau heev los ntawm demethylation (CYP2C19, CYP3A) thiab hydroxylation (CYP2D6), tom qab los ntawm kev sib txuas nrog glucuronic acid. Ntxiv mus, cov metabolism hauv yog pom los ntawm kev hloov caj ces polymorphism. Lub ntsiab metabolite nquag yog theem nrab amine nortriptyline. Nortriptyline yog cov muaj zog ntau dua qhov tsis haum ntawm norepinephrine tshaj li cov serotonin, thaum amitriptyline ntse inhibit qhov kev cuam tshuam ntawm ob leeg neurotransmitters. Ntxiv metabolites (cis thiab trans-10-hydroxyamitriptyline, as Well as cis thiab trans-10-hydroxyinortriptyline) yog tus cwj pwm los ntawm cov duab zoo ib yam li ntawd ntawm nortriptyline, nrog rau qis dua potency. Demethylnortriptyline thiab amitriptyline-N-oxide yog tam sim no nyob rau hauv cov ntshav ntshav tsuas yog hauv cov khoom me me, tom kawg ntawm kev ua kiag li tsis muaj dab tsi.

Kev cais tawm feem ntau tshwm sim nrog zis. Kev tsim tawm ntawm amitriptyline tsis hloov pauv los ntawm ob lub raum yog qhov tsis lees paub (txog 2%).

Hauv cov niam tsev uas pub mis rau menyuam noj, amitriptyline thiab nortriptyline kis mus rau niam cov kua mis tau tsawg. Qhov feem ntawm kev saib xyuas hauv cov kua mis thiab ntshav cov ntshav hauv cov poj niam yog 1: 2. Qhov kwv yees txhua hnub (amitriptyline + nortriptyline) xa mus rau tus menyuam yog kwv yees li 2% ntawm leej niam cov tshuaj amitriptyline, txheeb ze rau lub cev qhov hnyav ntawm tus menyuam (hauv mg / kg).

Kev ruaj khov tag nrho cov ntshav ntawm amitriptyline thiab nortriptyline tau tiav hauv feem ntau cov neeg mob tsis pub dhau 1 lub lim tiam. Hauv lub xeev no, qib hauv cov ntshav ntshav thaum nruab hnub yog kwv yees li ntawm amitriptyline thiab nortriptyline thaum kho nrog cov tshuaj ntsiav 3 zaug ib hnub.

Cov neeg laus muaj lub sijhawm ntev dua ib nrab vim yog cov metabolism hauv lub cev tsawg dua.

Kev puas tsuaj rau lub siab ua rau muaj qee yam mob hnyav tuaj yeem ua kom tsis txhob muaj kabmob hepatic, uas ua rau lub siab ntawm cov tshuaj ntau dua hauv cov ntshav ntshav.

Cov hlwv tsis zoo tsis cuam tshuam qhov kev hloov ntawm cov tshuaj.

Polymorphism. Cov metabolism ntawm cov tshuaj yog nyob ntawm caj ces polymorphism (isoenzymes CYP2D6 thiab CYP2C19). Pharmacokinetic / pharmacodynamic kev sib raug zoo. Kev kho ntshav plasma concentration rau qhov tsis txaus siab loj yog 100-250 ng / ml (70370-925 nmol / l) (ua ke nrog amitriptyline thiab nortriptyline).

Kev nyuaj siab loj, tshwj xeeb yog cov yam ntxwv ntawm kev ntxhov siab, ntxhov siab, thiab pw tsaug zog.

Cov kev nyuaj siab hauv cov neeg mob schizophrenia txuam nrog cov tshuaj tiv thaiv kev tiv thaiv kom tiv thaiv kev ua kom tsis txhob nkag siab thiab tsis nco qab.

Mob Suab Mob

Nocturnal enuresis hla qhov organic pathology.

Cov Yuav Tsum Tau Ua

Hypersensitivity rau amitriptyline lossis ib yam ntawm cov tshuaj ntawm cov tshuaj.

Tsis ntev los no raug kev txom nyem myocardial infarction. Txhua yam blockade lossis mob plawv arrhythmias, raws li cov leeg cov hlab ntsha pom tsis txaus.

Kev kho tib lub sijhawm nrog kev siv MAOI (MAO inhibitors) yog contraindicated (saib Ntu "Kev cuam tshuam nrog lwm cov tshuaj thiab lwm hom kev sib cuam tshuam").

Kev tswj hwm ib txhij ntawm amitriptyline thiab MAOI tuaj yeem ua rau kev txhim kho ntawm serotonin syndrome (kev sib txuam ntawm cov tsos mob, uas yuav suav nrog kev ntxhov siab arousal, tsis meej pem, tshee, myoclonus thiab hyperthermia).

Kev kho mob nrog amitriptyline tuaj yeem pib 14 hnub tom qab tsum tsis siv MAOIs uas tsis muaj kev sib tham tau, thiab tseem tsis pub tsawg dua 1 hnub tom qab tshem tawm cov tshuaj thim rov qab moclobemide thiab selegiline.

Kev kho mob nrog kev siv MAOI tuaj yeem pib 14 hnub tom qab txiav tawm amitriptyline.

Kev sib cuam tshuam nrog lwm yam tshuaj thiab lwm yam kev sib cuam tshuam

MAO inhibitors (tsis xaiv, zoo li xaiv tau A moclobemide thiab B selegiline) - qhov kev pheej hmoo ntawm "serotonin syndrome" (saib ntu "Contraindications").

Sympathomimetics: amitriptyline muaj peev xwm txhim kho cov teebmeem mob plawv adrenaline, ephedrine, isoprenaline, norepinephrine, phenylephrine thiab phenylpropanolamine.

Adrenergic neuron blockers: tricyclic antidepressants tuaj yeem cuam tshuam nrog kev tiv thaiv tsis zoo ntawm guanethidine, betanidine, reserpine, clonidine, thiab methyldopa.

Anticholinergics: tricyclic antidepressants muaj peev xwm txhim kho cov teebmeem ntawm cov tshuaj no cuam tshuam nrog lub qhov muag, lub hauv nruab nrab lub plab, lub plab hnyuv thiab zais zis, kev siv tib lub sijhawm rau lawv txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau ntshav, hyperpyrexia yuav tsum zam.

Cov tshuaj uas ua rau ncua sijhawm ntev ntawm QT ntu ntawm electrocardiograms, nrog rau cov tshuaj antiarrhythmic (quinidine), antihistamines (astemizole thiab terfenadine), qee cov tshuaj tiv thaiv kev tiv thaiv (tshwj xeeb pimozide thiab sertindole), cisapride, halofantrine thiab sotalol tuaj yeem ua rau muaj kev cuam tshuam ntawm ventricular. nrog tricyclic cov tshuaj tiv thaiv kev ntxhov siab.

Cov tshuaj tua kab mob, xws li fluconazole thiab terbinafine, ua rau muaj kev cia siab ntau ntxiv ntawm tricyclic antidepressants hauv cov ntshav cov ntshav thiab cov mob ua kom mob concomitant toxicity. Tau muaj tus mob ntawm tsaus muag thiab arrhythmias xws li torsade de pointes.

Kev sib xyaw ua ke xav tau kev saib xyuas tshwj xeeb

CNS depressants: amitriptyline tuaj yeem txhim kho sedative zoo ntawm cawv, barbiturates, thiab lwm yam kev mob siab rau lub zog tsis txaus.

Cov nyhuv ntawm lwm cov tshuaj rau ntawm pharmacokinetics ntawm tricyclic antidepressants

Tricyclic cov tshuaj tiv thaiv kab mob, nrog rau amitriptyline, yog metabolized los ntawm daim siab cytochrome P450 isoenzyme CYP2D6. CYP2D6 yog tus cwj pwm los ntawm polymorphism nyob rau hauv cov pej xeem thiab nws cov haujlwm tuaj yeem raug tshuaj los ntawm ntau cov kev mob hlwb, zoo li lwm yam tshuaj, xws li tshuaj tiv thaiv kab mob, serotonin reuptake inhibitors tsuas yog citalopram (uas yog isoenzyme inhibitor tsis muaj zog), ad-adrenergic blockers, zoo li tshuaj antiarrhythmic Cov. Cov isoenzymes CYP2C19 thiab CYP3A kuj tseem muaj feem cuam hauv cov metabolism hauv amitriptyline.

Barbiturates, zoo li lwm yam tshuaj tiv thaiv enzyme, rifampicin thiab carbamazepine, tuaj yeem txhim kho cov metabolism thiab yog li ua rau cov ntsiab lus ntawm tricyclic antidepressants hauv cov ntshav plasma thiab txo qis hauv cov nyhuv antidepressant.

Cimetidine thiab methylphenidate, nrog rau kev npaj cov calcium channel blockers, nce qib ntawm tricyclic sib txuas hauv cov ntshav ntshav thiab cov tshuaj lom raug mob.

Tricyclic cov tshuaj tiv thaiv kev ntxhov siab thiab tshuaj tiv thaiv kev ua kom sib luag hauv lub cev tsis ua haujlwm, qhov no tuaj yeem ua rau txo qis ntawm qhov qaug dab peg thiab cov tsos ntawm qaug dab peg.

Cov tshuaj tua kab mob xws li fluconazole thiab terbinafine nce qib ntau ntawm amitriptyline thiab nortriptyline. Hauv lub xub ntiag ntawm ethanol, cov ntshav dawb ntau ntau ntawm amitriptyline thiab cov ntsiab lus ntawm nortriptyline tau nce.

Daim ntawv thov nta

Amitriptyline yuav tsum tsis txhob raug tshuaj ib txhij nrog MAO inhibitors (saib Ntu "Kev Tshawb Nrhiav" thiab "Kev cuam tshuam nrog lwm cov tshuaj thiab lwm hom kev sib cuam tshuam").

Thaum siv cov tshuaj loj siab, qhov ntxim nyiam ntawm kev txhim kho lub plawv tsis sib haum thiab ua rau cov ntshav khov ntau heev. Kev txhim kho ntawm cov xwm txheej zoo li no tseem ua tau nrog kev siv cov koob tshuaj ntau dua hauv cov neeg mob uas muaj kab mob plawv.

Amitriptyline yuav tsum tau ua ntawv kho nrog ceev faj rau cov neeg mob uas muaj kev tsis txaus siab, tso zis cia, mob ntshav qab zib, mob hyperthyroidism, nyob rau hauv muaj cov tsos mob paranoid, zoo li mob siab lossis mob plawv.

Kev ntxhov siab yog cuam tshuam nrog kev pheej hmoo ntawm kev tua tus kheej. Xws li qhov kev pheej hmoo tuaj yeem muaj txog thaum kev daws teeb meem ruaj khov tau tshwm sim thiab tshwm sim nthawv thaum lub sij hawm txoj kev kho. Txij li kev txhim kho yuav tsis tshwm sim hauv thawj ob peb lub lis piam ntawm kev kho mob lossis ntev dua, cov neeg mob yuav tsum ua tib zoo saib xyuas kom txog thaum muaj kev txhim kho zoo li no. Los ntawm cov kev paub hauv chav kho mob dav dav, nws tau paub tias txoj kev pheej hmoo ntawm kev tua tus kheej tuaj yeem nce ntxiv nyob rau theem pib ntawm kev rov zoo los. Cov neeg mob uas muaj keeb kwm ntawm kev tua tus kheej lossis tseem ceeb ntawm kev xav tua tus kheej ua ntej kev kho mob tau paub tias muaj kev pheej hmoo ntau dua los ntawm kev tua tus kheej lossis npaj tua tus kheej, thiab yuav tsum tau txais kev tshuaj xyuas zoo thaum kho. Kev soj ntsuam meta-soj ntsuam cov chaw soj ntsuam cov tshuaj tiv thaiv kev ntxhov siab hauv cov neeg mob cov neeg laus uas muaj kev puas siab ntsws pom tias muaj kev pheej hmoo tua tus kheej thaum siv cov tshuaj tiv thaiv kab mob piv nrog cov placebo hauv cov neeg mob hnub nyoog qis dua 25 xyoos.

Yuav tsum tau saib xyuas tshwj xeeb thaum qhia tshuaj amitriptyline rau cov neeg mob hyperthyroidism lossis cov neeg noj cov thyroid hormones npaj, vim tias kev txhim kho ntawm lub plawv dhia tsis ua haujlwm tau.

Cov neeg laus laus yog cov muaj kev cuam tshuam tshwj xeeb rau kev txhim kho ntawm cov nqaij tom qab lub cev thaum kho nrog amitriptyline.

Hauv cov neeg mob uas muaj mob manic-kev nyuaj siab, qhov hloov ntawm tus kab mob hauv theem manic yog ua tau, txij thaum pib ntawm theem manic ntawm tus neeg mob tus mob, amitriptyline kev kho yuav tsum tau tsum txiav.

Thaum siv amitriptyline rau qhov cuam tshuam los ntawm kev mob schizophrenia, kev nce siab ntawm cov tsos mob psychotic yog tau. Amitriptyline yuav tsum tau muab sau ua ke nrog cov tshuaj tiv thaiv kev tawm tsam.

Hauv cov neeg mob uas tsis tshua muaj lub xeev ntawm qhov tob ntiav thiab qhov nqaim kaum sab xis ntawm chav sab xub ntiag ntawm lub qhov muag, kev tawm tsam ntawm lub ntsej muag txhawm rau vim tias lub ntsej muag ntawm cov tub ntxhais kawm tuaj yeem ua rau npau taws.

Kev siv cov tshuaj loog thaum kho nrog tri- / tetracyclic antidepressants yuav ua rau muaj kev pheej hmoo ntawm arrhythmias thiab arterial hypotension. Yog tias ua tau, nres siv cov amitriptyline ob peb hnub ua ntej kev phais mob. Yog tias kev phais mob ceev ceev uas tsis tuaj yeem ua tiav, qhia rau tus neeg siv tshuaj loog txog kev kho mob amitriptyline yog qhov yuav tsum tau ua.

Zoo ib yam li lwm cov tshuaj rau cov neeg mob hlwb, amitriptyline tuaj yeem hloov lub cev lub cev mus rau insulin thiab ntshav qabzib, uas yuav tsum tau kho cov tshuaj tiv thaiv kab mob hauv cov neeg mob ntshav qab zib mellitus, ntxiv rau, ib qho kev mob siab tsis txaus, qhov tseeb, yuav tshwm sim nws tus kheej hauv kev hloov ntawm cov piam thaj hauv tus neeg mob lub cev.

Cov neeg muaj mob hyperpyrexia nrog kev siv tricyclic cov tshuaj tiv thaiv kev ntxhov siab tau tshaj tawm txog qhov tau teem sijhawm tib lub sijhawm nrog tshuaj anticholinergic lossis antipsychotic, tshwj xeeb tshaj yog huab cua kub.

Kev tso tseg tsis muaj kev kho sai sai tom qab kev kho mob ntev ntev tuaj yeem ua rau tshem tawm cov tsos mob hauv daim ntawv ntawm mob taub hau, malaise, insomnia thiab txob taus.

Amitriptyline yuav tsum siv nrog kev ceev faj rau cov neeg mob uas siv SSRIs.

Cov muaj tswv yim: ntsiav tshuaj ntawm cov tshuaj muaj lactose monohydrate. Cov neeg mob uas tsis tshua muaj mob muaj keeb hauv cov qauv ntawm rhiab rau galactose, lactase deficiency lossis malabsorption ntawm qabzib-galactose yuav tsum tsis txhob noj cov tshuaj no.

Siv thaum cev xeeb tub thiab lactation

Amitriptyline yuav tsum tsis txhob siv tshuaj tiv thaiv thaum cev xeeb tub, tshwj tsis yog qhov txiaj ntsig kev cia siab rau tus neeg mob tsis pub dhau qhov theoretical pheej hmoo rau tus me nyuam hauv plab. Kev tswj hwm ntawm kev txhaj tshuaj ntau ntawm tricyclic antidepressants thaum lub sijhawm thib peb lub hlis ntawm cev xeeb tub tuaj yeem ua rau cov leeg mob hauv cov menyuam mos. Hauv cov menyuam mos yug tshiab, raws li cov lus ceeb toom, tsuas yog tus neeg mob qog ua kom cov txiaj ntsig ntawm amitriptyline thiab tso zis tawm ntawm cov tshuaj tiv thaiv los ntawm nortriptyline (ib qho tshuaj amitriptyline metabolite), yog tias cov tshuaj tau tawm rau cov poj niam cev xeeb tub ua ntej yug menyuam.

Cov tshuaj kis rau leej niam cov kua mis hauv qhov muaj zog tsawg, yog li nws cov nyhuv rau tus menyuam thaum noj cov tshuaj kho tsis zoo. Cov koob tshuaj uas tau txais los ntawm tus menyuam yog kwv yees li 2% ntawm leej niam lub koob tshuaj, piv rau qhov hnyav ntawm tus menyuam (hauv mg / kg). Yog tias xav tau hauv chaw kho mob, kev pub mis niam tuaj yeem txuas ntxiv thaum kho mob amitriptyline, tab sis saib xyuas tus menyuam raug pom zoo, tshwj xeeb yog hauv thawj 4 lub lis piam tom qab yug.

Kev ntsuas rau siv

Kev ntxhov siab (tshwj xeeb nrog kev ntxhov siab, ntxhov siab, thiab pw tsaug zog, suav nroghauv cov menyuam yaus, endogenous, muaj kev cuam tshuam, hnov mob, neurotic, tshuaj, nrog rau cov organic lub hlwb puas tsuaj, haus dej cawv haus cawv), mob hlwb schizophrenic, kev xav sib xyaw, kev xav tsis meej (kev ua thiab kev saib xyuas), nocturnal enuresis (tshwj tsis yog rau cov neeg mob zais zis) bulimia nervosa, mob ntsws mob ntev (mob mus ntev rau cov neeg mob qog nqaij hlav, mob taub hau, mob rheumatic, atypical mob ntawm lub ntsej muag, postherpetic neuralgia, mob hlab ntsha hlwb tom qab ia, mob ntshav qab zib los yog lwm qhov peripheral neuropathy), mob taub hau, mob taub hau (tiv thaiv), peptic rwj ntawm lub plab thiab duodenum.

Yuav siv li cas: noj ntau thiab hom tshuaj kho

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

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

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

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

Rau kev tiv thaiv mob qog, nrog mob ntev ntawm ib leeg neurogenic (nrog rau mob ntev taub hau) - los ntawm 12,5-25 txog 100 mg / hnub (qhov siab tshaj plaws noj thaum hmo ntuj).

Pharmacological kev txiav txim

Cov tshuaj tiv thaiv kab mob (tricyclic antidepressant). Nws kuj tseem muaj qee qhov ua kom loog (lub hauv paus keeb kwm), H2-histamine-thaiv thiab cov tshuaj tiv thaiv kab mob, pab ua kom tsaus ntuj tso zis tsis zoo thiab txo qhov qab los noj mov.

Nws muaj lub zog loj peripheral thiab nruab nrab anticholinergic nyhuv, vim muaj qhov sib thooj siab rau m-cholinergic receptors, muaj zog sedative cuam tshuam cuam tshuam nrog affinity rau H1-histamine receptors, thiab alpha-adrenergic block effect. Nws muaj cov khoom ntawm cov tshuaj antiarrhythmic ntawm pab pawg Ia, zoo li quinidine hauv kev kho tshuaj, ua rau qeeb ntawm ventricular conduction (nyob rau hauv kev siv tshuaj ntau dhau, nws tuaj yeem ua rau muaj kev cuam tshuam loj ntawm intraventricular blockade).

Kev ua haujlwm ntawm cov tshuaj tiv thaiv kab mob ua rau muaj kev cuam tshuam nrog kev nce siab ntxiv ntawm norepinephrine nyob hauv synapses thiab / lossis serotonin hauv nruab nrab lub paj hlwb (txo qis hauv lawv qhov kev cuam tshuam rov qab). Cov tsub zuj zuj ntawm cov neurotransmitters tshwm sim los ntawm inhibition ntawm lawv rov qab ntes los ntawm daim nyias nyias ntawm presynaptic neurons. Nrog rau kev siv ntev, nws txo cov haujlwm kev ua haujlwm ntawm beta-adrenergic thiab serotonin receptors hauv lub hlwb, normalizes adrenergic thiab serotonergic kis, thiab rov kho qhov sib npaug ntawm cov kab ke no, uas cuam tshuam hauv cov xeev tsis txaus siab. Hauv kev ntxhov siab-kev nyuaj siab, nws txo cov kev ntxhov siab, ntxhov siab thiab mob tshwm sim.

Lub tshuab ua haujlwm ntawm cov tshuaj tiv thaiv yog vim muaj peev xwm los thaiv H2-histamine receptors hauv lub parietal hlwb ntawm lub plab, nrog rau kom muaj qhov ua kom loog thiab m-anticholinergic nyhuv (nyob rau hauv qhov mob peptic ua rau lub plab thiab duodenal mob rau lub plab, nws alleviates mob, thiab ua kom sai kho ntawm qhov mob).

Kev ua haujlwm zoo thaum pw tsaug zog yog pom meej vim muaj kev ua haujlwm anticholinergic, ua rau muaj kev muaj peev xwm ntxiv ntawm lub zais zis kom ncab, ncaj qha beta-adrenergic stimulation, kev ua haujlwm ntawm alpha-adrenergic agonists, nrog los ntawm kev nce hauv lub suab sphincter, thiab qhov nruab nrab thaiv ntawm serotonin uptake.

Nws muaj cov ua haujlwm hauv lub hauv paus analgesic, uas ntseeg tau tias yog vim muaj kev hloov pauv hauv cov concentration ntawm monoamines hauv nruab nrab lub paj hlwb, tshwj xeeb tshaj yog serotonin, thiab cov nyhuv ntawm cov tshuab opioid endogenous.

Lub tshuab ntawm kev ua rau bulimia nervosa tsis meej (tej zaum yuav zoo ib yam li ntawd rau kev nyuaj siab). Qhov txawv txav ntawm cov tshuaj hauv bulimia hauv cov neeg mob ob leeg tsis muaj kev nyuaj siab thiab hauv nws lub xub ntiag yog qhia, thaum txo qis ntawm bulimia tuaj yeem raug soj ntsuam yam tsis muaj concomitant tsis muaj zog ntawm kev nyuaj siab nws tus kheej.

Thaum coj ua tshuaj loog, nws txo qis ntshav siab thiab lub cev kub. Tsis inhibit MAO.

Kev tiv thaiv kab mob nyhuv tshwm sim li ntawm 2-3 lub lis piam tom qab pib siv.

Sab sij huam

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cov lus qhia tshwj xeeb

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

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

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

Thaum kho, ethanol yuav tsum raug cais tawm.

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

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

Amitriptyline nyob rau hauv cov koob tshuaj saum toj no 150 mg / hnub txo qhov pib ntawm kev ua si (qhov kev pheej hmoo ntawm qaug dab peg hauv cov neeg mob, nrog rau lwm qhov cuam tshuam txog qhov tshwm sim ntawm qhov mob huam, piv txwv li, lub hlwb puas ntawm txhua yam kev sib deev, thaum siv cov tshuaj tiv thaiv kev tiv thaiv (tshuaj tiv thaiv) yuav tsum tau txiav txim siab thaum lub sij hawm tsis kam ntawm ethanol lossis tshem tawm cov tshuaj uas muaj cov anticonvulsant, xws li benzodiazepines).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Nrog saib xyuas

Cuam tshuam tsis zoo, tso zis cia, mob prostatic hyperplasia, mob siab rau lub siab lossis mob plawv, cov thyroid caj pas ua haujlwm siab, cov tsos mob tsis meej, bipolar muaj kev cuam tshuam tsis zoo (tom qab tawm ntawm qhov tsis txaus siab), mob ntshav siab (nyob rau hauv cov tib neeg nrog anatomical predisposition - lub kaum kev nqaim

anterior chamber), mob ntev cawv, kev saib xyuas cov leeg pob txha hematopoiesis, kev ua haujlwm siab ntawm lub zais zis, mob ntsws bronchial, txo lub cev muaj zog ntawm lub plab zom mov (muaj kev pheej hmoo ntawm cov kab mob tuag tes tuag taw), kev tswj hwm ib txhij nrog kev xaiv serotonin reuptake inhibitors (SSRIs), kev laus, cev xeeb tub.

Tsuas tshuaj thiab tswj hwm

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

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

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

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

Cov neeg laus laus (laus dua 65 xyoos) Ib qho tshuaj ntsiav 50 mg thaum yav tsaus ntuj.

Kev ua rau lub raum tsawg dua

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

Kev ua haujlwm rau daim siab tsawg

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

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

Siv thaum cev xeeb tub lossis lactation

Amitriptyline yuav tsum tsis txhob siv tshuaj tiv thaiv thaum cev xeeb tub, tshwj tsis yog qhov txiaj ntsig kev cia siab rau tus neeg mob tsis pub dhau qhov theoretical pheej hmoo rau tus me nyuam hauv plab. Kev tswj hwm ntawm kev txhaj tshuaj ntau ntawm tricyclic antidepressants thaum lub sijhawm thib peb lub hlis ntawm cev xeeb tub tuaj yeem ua rau cov leeg mob hauv cov menyuam mos. Hauv cov menyuam mos yug tshiab, raws li cov lus ceeb toom, tsuas yog tus neeg mob qog ua rau cov txiaj ntsig ntawm amitriptyline thiab tso zis tawm ntawm cov txiaj ntsig ntawm nortriptyline (tshuaj metabolite ntawm amitriptyline), yog tias cov tshuaj tau tawm rau cov poj niam cev xeeb tub ua ntej yug menyuam.

Noj ntau dhau

Cov tsos mob plawv: arrhythmias (ventricular tachyarrhythmias, flutter-flicker, ventricular fibrillation). Ib qho ECG ib txwm qhia txog ncua PR luv, nthuav dav QRS cov nyom, txuas ntxiv ntawm QT, nthuav dav lossis thim rov qab ntawm T nthwv dej, ST ntu kev nyuaj siab, nrog rau kev sib txawv ntawm lub siab thaiv kom txog thaum lub plawv nres. Kev ua haujlwm ntawm QRS cov nyom feem ntau qhia meej txog qhov muaj kuab lom ntawm cov tshuaj lom tom qab cov koob tshuaj ntau dhau heev dhau lawm. Lub plawv tsis ua hauj lwm, arterial hypotension, cardiogenic shock tsim tawm. Cov kab mob metabolic acidosis thiab ntshav qab zib hypokalemia muaj ntau zuj zus. Tom qab rov tsim dua qhov tsim nyog yuav rov quav niab, ntxhov siab vim arousal, hnov meej thiab ataxia.

Kev Kho Mob: Tsev Kho Mob (hauv tsev kho mob hnyav). Txoj kev kho yog mob yam ntxwv thiab txhawb nqa. Lub plab zom zaub mov ntawm lub plab thiab lavage, txawm tias nyob rau hauv cov theem tom qab tom qab kev tswj hwm, nrog rau kev ua kom muaj pa roj carbon ntau npaj tau qhia. Nws yog qhov yuav tsum tau ua tib zoo saib xyuas tus mob, txawm tias qee kis muaj mob me. Txheeb xyuas lub xeev ntawm kev nco qab, qhov xwm ntawm cov mem tes, tus nqi ntawm cov ntshav siab thiab lub ntsws ua haujlwm, thaum ncua sijhawm luv yuav tsum txiav txim siab cov ntsiab lus ntawm electrolytes thiab ntshav roj. Xyuas kom lawv txoj hlab pa yog tsim nyog los ntawm kev tsim. Feem ntau, kev kho mob nrog cua tshuab tsis zoo yog pom zoo kom tiv thaiv kev ua pa ua pa. Kev tshuaj xyuas ECG txuas ntxiv yuav tsum tau nqa tawm hauv 3-5 hnub. Nrog nthuav dav ntawm QRS luv, lub plawv tsis ua haujlwm, thiab lub plawv dhia ua pa, pH hloov ntshav mus rau sab alkaline tuaj yeem ua haujlwm tau zoo (tswj hwm ntawm cov tshuaj bicarbonate lossis hyperventilation) nrog kev tswj hwm sai ntawm hypertonic daws ntawm sodium chloride (100-200 mmol Na +). Nrog ventricular arrhythmias, nws muaj peev xwm siv cov tshuaj antiarrhythmic, xws li 50-100 mg ntawm lidocaine (1-1.5 mg / kg) txhaj tshuaj, tom qab los ntawm infusion ntawm qhov ceev ntawm 1-3 mg / min.

Yog tias tsim nyog, thov cardioversion thiab defibrillation. Kho cov roj ntsha tsis txaus nrog kev pab cuam ntawm ntshav hloov chaw, thiab qhov mob hnyav, los ntawm kev lis ntshav ntawm dobutamine (ua ntej ntawm 2-3 μg / kg ib feeb) nrog nce ntxiv ntawm koob tshuaj, nyob ntawm cov nyhuv. Lub cev nqaij daim tawv thiab pov thawj tuaj yeem nres los ntawm cov thawj coj ntawm diazepam.

Qhov rhiab ntawm cov tshuaj ntau dhau yog feem ntau ntawm ib tug neeg. Nyob rau tib lub sijhawm, cov menyuam yaus tshwj xeeb rau kev txhim kho kev mob plawv thiab lub tsev hais plaub.

Hauv cov laus, cov tshuaj ntawm 500 mg tuaj yeem ua rau mob hnyav mus rau mob hnyav, thaum cov koob tshuaj me dua li 1000 mg tau ua rau tuag taus.

Kev phiv tshuaj

Amitriptyline tuaj yeem ua rau cov kev mob tshwm sim zoo ib yam li cov uas tshwm sim thaum noj lwm tricyclic antidepressants. Qee qhov kev mob tshwm sim hauv qab no (mob taub hau, tshee, tsis hnov qab, cem quav, thiab txo qis libido) kuj yuav yog cov tsos mob ntawm kev nyuaj siab thiab feem ntau zuj zus lawm zuj zus thaum lub xeev muaj kev nyuaj siab.

Cov rooj sib txoos hauv qab no yog siv rau hauv cov kab hauv qab no. LEEJ TWG nyiam MedDRA lus rau cov chav haujlwm hauv nruab nrog cev: feem ntau (> 1/10), feem ntau (> 1/100, 1/1000, 1/10 000,

Kev cuam tshuam nrog lwm cov tshuaj:

Amitriptyline tuaj yeem txhim kho cov txiaj ntsig ntawm kev haus cawv, barbiturates thiab lwm yam tshuaj uas cuam tshuam rau lub hauv nruab nrab lub paj hlwb.

Kev siv sib xyaw nrog MAO inhibitors tuaj yeem ua rau tawg. Txij li thaum amitriptyline txhim kho kev txiav txim siab ntawm anticholinergics, kev coj ua ke nrog lawv yuav tsum raug zam.

Nws txhim kho qhov kev txiav txim ntawm sympathomimetics ntawm adrenaline, norepinephrine, thiab lwm yam, vim qhov no, qhov tshuaj loog hauv zos uas muaj cov tshuaj no yuav tsum tsis txhob siv nrog amitriptyline.

Tej zaum yuav txo cov nyhuv antihypertensive ntawm clonidine, betanidine, thiab guanethidine.

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

Nrog rau kev siv ua ke nrog cimetidine, nws muaj peev xwm ua kom qeeb ntawm cov roj ntsha ntawm amitriptyline, nce nws cov tshuaj lom neeg hauv cov ntshav ntshav thiab kev txhim kho ntawm cov tshuaj lom.

Cov Tshuaj Hauv Tshuaj

Amitriptyline yog ib feem ntawm pawg tricyclic. Qhov no yog hom tertiary amine, uas yog qhov khoom tseem ceeb hauv tricyclic qeb, vim hais tias nws yuav luag sib luag nyob rau hauv vivo raws li kev cuam tshuam ntawm serotonin thiab norepinephrine uptake los ntawm presynaptic hlab ntsha receptors.

Lub ntsiab decomposition khoom, nortriptyline, yog qhov muaj zog ntau dua inhibitor ntawm norepinephrine uptake, tab sis nws tuaj yeem thaiv serotonin uptake. Amitriptyline muaj cov tshuaj anticholinergic muaj zog, ua kom loog thiab antihistaminergic, thiab ntxiv rau nws tuaj yeem ua kom muaj txiaj ntsig rau cov kev cuam tshuam ntawm catecholamines.

Kev txhawb nqa ntawm DBD ntawm kev pw tsaug zog theem yog qhov cim ntawm kev cuam tshuam ntawm cov tshuaj tiv thaiv kev ntxhov siab. Tricyclics, thiab ntxiv rau lawv xaiv serotonin reuptake inhibitors, as Well as MAOs, inhibit tus txheej txheem ntawm theem BDH, thiab tseem txhim kho theem ntawm kev pw tsaug zog (qeeb-yoj).

Amitriptyline pab txoj kev mob siab ntsws txo qis.

Qhov mob tshwm sim ntawm amitriptyline yog qhov tseem ceeb ntawm kev kho kev nyuaj siab uas muaj kev ntxhov siab ntau ntxiv, ntxhov siab, ntxhov siab thiab pw tsaug zog. Cov tshuaj tiv thaiv kev ntxhov siab pib tshwm sim tom qab 2-4 lub lis piam txij li hnub pib kho, thaum cov nyhuv sedative tsis txo qis.

Cov tshuaj analgesic ntawm cov tshuaj tsis cuam tshuam nrog cov tshuaj tiv thaiv kab mob, vim tias kev ua kom loog pib sai dua li kev hloov pauv hauv kev xav tshwm sim. Feem ntau, qhov kev txo qis me me txaus kom tau txais cov nyhuv no dua li muab cov kev hloov pauv hauv tus neeg mob lub siab.

Cov Tshuaj Pharmacokinetics

Tom qab kev tswj hwm sab hauv, qhov qhia tau ntawm bioavailability ntawm amitriptyline yog kwv yees li 60%. Plasma protein khi yog kwv yees li 95%. Qhov kev cia siab tshaj plaws hauv cov ntshav cov tshuaj tiv thaiv kom txog li 4-10 teev tom qab siv thiab tseem nyob ruaj khov.

Cov txheej txheem ntawm cov metabolism ntawm cov khoom tivthaiv nquag tshwm sim los ntawm hydroxylation, nrog rau demethylation. Lub ntsiab ua kom tiav lub zog yog nortriptyline.

Ib nrab-lub neej ntawm amitriptyline yog nyob rau thaj tsam ntawm 16-40 teev (qhov nruab nrab yog 25 teev), thiab ib nrab-lub neej ntawm nortriptyline yog kwv yees li 27 teev. Cov tshuaj nyob ruaj ruaj hauv cov chaw kho cov tshuaj yog tsim los tom qab 1-2 lub lis piam.

Qhov kev tshem tawm ntawm amitriptyline feem ntau tshwm sim nrog zis, thiab ntxiv rau, hauv cov khoom me me, tawm hauv cov quav.

Amitriptyline, thiab nrog nws nortriptyline, tuaj yeem hla dhau cov txiaj ntsig thiab nkag rau hauv niam cov kua mis hauv kev txhaj tshuaj me.

Sab sij huam

Amitriptyline tuaj yeem ua rau cov kev mob tshwm sim zoo ib yam li cov mob los ntawm lwm cov tricyclic antidepressants. Qee qhov kev mob tshwm sim hauv qab no, xws li mob taub hau, tshee, tsis hnov qab, cem quav, thiab txo qis libido, kuj tuaj yeem yog cov tsos mob ntawm kev nyuaj siab thiab zoo li poob qis nrog kev txhim kho hauv kev nyuaj siab.

Qhov tshwm sim ntawm cov kev mob tshwm sim yog qhia raws li:

heev ntau (> 1/10), feem ntau (los ntawm> 1/100 txog 1/1000 txog 1/10000 rau