Amitriptyline - antidepressant bakeng sa mefuta e matla ea khatello ea maikutlo

Tlhaloso e amanang le 22.09.2014

• Lebitso la Latin: Ammitriptyline
• Khoutu ea ATX: N06AA09
• Lintho tse sebetsang: Amitriptyline
• Moetsi: Grindeks (Latvia), Nycomed (Denmark), Synthesis (Russia), Ozone (Russia), ALSI Pharma (Russia)

Li-dragees le litafole Amitriptyline li na le 10 kapa 25 mg ea ntho e sebetsang ka sebopeho sa amitriptyline hydrochloride.

Lintho tse ling matlapeng ke microcrystalline cellulose, talc, lactose monohydrate, silicon dioxide, magnesium stearate, stgelatinized starch.

Lintho tse ling tse fumanehang ka har'a dragees ke: magnesium stearate, starch ea litapole, talc, polyvinylpyrrolidone, lactose monohydrate.

1 ml ea tharollo e na le 10 mg ea ntho e sebetsang. Lintho tse ling ke: hydrochloric acid (sodium hydroxide), dextrose monohydrate, metsi a infusion, sodium chloride, benzetonium chloride.

Pharmacodynamics le pharmacokinetics

Moriba o fokotsa takatso ea lijo, o felisa ho robala, o na le ketso ea antiserotonin. Lithethefatsi li na le phello e phatlalalitsoeng e le pherekano ea anticholinergic. Phello ea khatello ea maikutlo fihlelloa ka ho eketsa khatello ea serotonin tsamaisong ea methapo ea kutlo le norepinephrine ho li-synapses. Pheko ea nako e telele e lebisa ho fokotseha hoa ts'ebetso e sebetsang ea serotonin le li-beta-adrenergic receptors bokong. Amitriptyline e fokotsa botebo ba lipontšo tse nyahamisang, ho ferekanamatšoenyeho nakong ho tšoenyeha le khatello ea maikutlo. Ka ho thibela li-receptor tsa H2-histamine leboteng la mpa (lisele tsa parietal) ho fanoa ka phello ea antiulcer. Moriana o khona ho theola mocheso oa 'mele, khatello ea mali ka mokhoa o thibelang maikutlo ka kakaretso. Setlhare ha se thibele monoamine oxidase. Matla a antidepressant a hlaha kamora libeke tse 3 tsa kalafo.

Khokahano e phahameng ea ntho maling e hlaha kamora lihora tse 'maloa, hangata kamora 2-12. E fetoha metabolites ka moroto. E tlama hantle le liprotheine.

Contraindication

Ho latela sefuba, setlhare ha se sebelisoe bakeng sa infraction ea myocardial, mamello ho karolo ea mantlha, ka angle-ukuvalwa glaucomaho tahoa ho sa feleng le psychoactive, analgesic, hypnotics, le tahi e matla ea joala. Moriana o kopantsoe le ho anyesa, litlolo tse matla tsa infraventricular conduction, antioventricular conduction. Ka lefu la pelo le methapo ea pelo, le thibelo ea masapo a hematopoiesis, manic-nyenyefatsang psychoses, asthma ea bronchial, ho lemalla joala bo sa foleng, ho fokolitse ts'ebetso ea ts'ebetso ea tšilo ea lijo, stroke, sebete le liphio. intraocular khatello ea mali, ho boloka urine, hyperplasia ea masapo, ka ho phatloha ha lesapo la mokokotlo, thyrotooticosis, ho ima, lefu la sethoathoa Amitriptyline e fanoa ka hloko.

Bongata

Liponahatso tse tsoang tsamaiso ea methapo: coma, stupor, ho otsela ho eketsehileng, matšoenyeho, hallucinations, ataxia, lefu la sethoathoa, choreoathetosishyperreflexia dysarthria, ho ruruha ha mesifa ea mesifa, pherekano, ho ferekana, khatello ea kelello, ho ferekana kelellong.

Lipontšo tsa overdose ea Amitriptyline le tsamaiso ea methapo ea pelo: tlolo ea intracardiac conduction, arrhythmia, tachycardia, lerotholi la khatello ea mali, ho ts'oha, ho nyekeloa ke peloka seoelo - ho tšoaroa ha pelo.

E boetse e hlokometsoe anuriaoliguria, mofufutso o eketsehileng, hyperthermia, ho hlatsa, ho hema hanyane, khatello ea maikutlo ea ho hema, cyanosis. Mohlomong chefo ea lithethefatsi.

Bakeng sa ho qoba litlamorao tse mpe tsa ts'ebeliso e feteletseng, tlhokahalo ea tšohanyetso ea mpa le tsamaiso ea li-inhibitors tsa choline li hlokahala bakeng sa lipontšo tse matla tsa anticholinergic. E boetse e hloka ho boloka tekanyo ea motlakase oa motlakase, boemo ba khatello ea mali, ho lekola ts'ebetso ea pelo le methapo, haeba ho hlokahala. Qobelloa diuresis, le hemodialysis ha e so bontšoe hore e sebetsa hantle haeba ho ka ba le lithethefatsi tse ngata tsa amitriptyline.

Tšebelisano

Matla a antihypertensive, khatello ea maikutlo, phello e sithabetsang tsamaisong ea methapo e bonoa ka lengolo le kopaneng la meriana e thibelang tsamaiso ea methapo e akaretsang: lithibela-mafu ka kakaretso, benzodiazepines, barbiturates, antidepressants le ba bang. Lithethefatsi li ntlafatsa botebo ba litlamorao tsa anticholinergic ha e nkuoa amantadine, antihistamines, biperiden, atropine, lithethefatsi tsa antiparkinsonia, phenothiazine. Setlhare se ntlafatsa tšebetso ea anticoagulant ea indadione, li-coumarin derivatives, anticoagulants tse sa tobang. Fokotseha ka katleho alpha blockersphenytoin. Fluvoxamine, fluoxetine eketsa khatello ea moriana maling. Kotsi ea ho ba le ts'oaetso ea lefu la sethoathoa e eketseha, 'me litlamorao tsa anticholinergic le sedative le tsona li matlafatsoa ka phekolo e kopaneng le li-benzodiazepines, phenothiazines le lithethefatsi tsa anticholinergic. Ho amohela batho ka nako e tšoanangmethyldopa, reserpine, betanidine, guanethidine, clonidine e fokotsa botebo ba phello ea bona e matlafatsang. Ha o sebelisa koae, ho ba le kemiso ea khanye. Delirium e hlaha ha o nka li-acetaldehydrogenase inhibitors, disulfiram. Amitriptyline e ntlafatsa phello mo tsamaisong ea pelo le pelo phenylephrinenorepinephrine epinephrineisoprenaline. Kotsi ea hyperpyrexia e eketseha ka tšebeliso ea li-antipsychotic, m-anticholinergics.

Litaelo tse khethehileng

Pele o etsa kalafo, ho tlamehile ho laola boemo ba khatello ea mali. Tsamaiso ea botsoali ea amitriptyline e fanoa feela ka taolo ea bongaka maemong a sepetlele. Matsatsing a pele a kalafo, ho phomola bethe hoa hlokahala. Ho hlokahala ho lahloa ka botlalo ethanol. Ho hana kalafo ka matla ho ka baka syndrome ea ho ntša maikutlo. Lithethefatsi ka tekanyetso ea tse fetang 150 mg ka letsatsi li lebisa ho fokotseha ha monyako oa ts'ebetso ea ts'ebetso, e leng ho bohlokoa ho e nahanisisa ha ho ts'oaroa lefu la sethoathoa ho bakuli ba nang le koluoa ​​pelehi. Mohlomong nts'etsopele ea hypomanic kapa manic e re bathong ba nang le mathata a potoloho ea methapo, le mathata nakong ea khatello ea maikutlo. Haeba ho hlokahala, kalafo e qala hape ka litekanyetso tse nyane kamora ho emisa maemo ana. Ho lokela hore ho sebelisoe tlhokomeliso kalafong ea bakuli ba nkang meriana ea qoqotho ea qoqotho kalafong ea bakuli ba nang le thyrotoxicosis ka lebaka la kotsi e ka hlahang ea ho ba le litlamorao tsa pelo. Moriana ona o ka baka nts'etsopele ea ho holofala ha mala ka hara botsofe, le ho tloaela ho sokela ka nako e telele. Ho tlameha ho lemosa li-anesthetists mabapi le ho nka amitriptyline pele u etsa opereishene ea lehae kapa e akaretsang. Pheko ea nako e telele e tsosa nts'etsopele caries. Tlhokahalo e eketsehang ea riboflavin. Amitriptyline e fetela lebeseng; ho masea, e baka ho otsela ho eketsehileng. Moriana o na le phello ea ho khanna.

Moriana o hlalositsoe ho Wikipedia.

Ketso ea pharmacological

Tharollo ea khatello ea maikutlo. Fokotsa matšoenyeho, matšoao a matla a ho tsosa maikutlo, matšoao a sithabetsang. Molao-motheo oa ts'ebetso khahlano le khatello ea maikutlo o bakoa ke keketseho ea palo ea norepinephrine ho li-synapses le / kapa serotonin tsamaisong ea methapo ea methapo (ho fokotseha ha bokhoni ba bona ba ho khutlisa). Ho bokellana ha li-neurotransmitters tsena ho bonoa ka lebaka la khatello ea ho koeteloa ha tsona ka morao ke li-membrane tsa li-neurons tsa "presynaptic neurons".

Ketso ea antidepressant e etsahala nakong ea libeke tse peli ho isa ho tse tharo ho tloha ha puso ea lithethefatsi e qala.
Amitriptyline e na le tšusumetso, M-anticholinergic, antihistamine, antiserotonin, timoleptic, anxiolytic le analgesic, antiulcer.

Nakong ea anesthesia ka kakaretso, e theola khatello ea mali le mocheso oa 'mele.
Ha e thibele monoamine oxidase.

Mefuta ea Litekanyetso

Amitriptyline e etsoa ke baetsi ba bangata. Mefuta e ka sehloohong ea meriana - litafole, tharollo ea ente:

• tharollo ea ente - ampoules 20 mg / 2 ml, vials 10 mg / ml,
• matlapa a 0,025 g
• matlapa a tsoekere a 10 mg, 25 mg,
• matlapa, lifilimi tse koahetsoeng 10 mg, 25 mg, 50 mg, 75 mg,
• dragee 25 mg
• li-capsules tse matlafalitsoeng-li-50 mg.

Bokaholimo ba sethethefatsi, hammoho le matla a khoheli a ntho e sebetsang, li ka fapana.

Sebopeho sa tharollo ea ente:

• moemeli ea sebetsang - amitriptyline hydrochloride,
• Excipients - tsoekere (dextrose), metsi bakeng sa ente.

Sebopeho sa matlapa a koahetsoeng ka filimi:

• ntho e sebetsang ke amitriptyline hydrochloride,
• excipients - magnesium stearate, talc, povidone, starch ea litapole, cellcose ea microcrystalline, lactose monohydrate.

Sebopeho sa Shell: propylene glycol, hypromellose, titanium dioxide, talc.
Sebopeho sa matlapa:

• ntho e sebetsang - amitriptyline,
• excipients - lactose, magnesium stearate, microcrystalline cellulose, croscarmellose sodium, polyethylene glycol 6000, talc, polysorbate 80, colloidal silicon dioxide, hypromellose, titanium diode (E 171), carmoisine (E 122).

Sebopeho sa li-capsules tse matlafalitsoeng:

• ntho e sebetsang ke amitriptyline hydrochloride,
• li-excipients - stearic acid, likarolo tsa tsoekere, shellac (shellac (e sa tlotsoeng bokahare), talc, povidone.

Sebopeho sa khase ea lefeela ke gelatin, dae oxide e khubelu (E 172), titanium dioxide (E 171).

• mefuta e matla ea khatello ea maikutlo, haholo-holo ka matšoao a tloaelehileng a ho tšoenyeha, ho tsosa maikutlo, ho robala: ho pheta-pheta (ho pheta-pheta), ho ikoetlisa (kamora ho sithabela kelellong), neurotic, lithethefatsi, ka ho khaotsa joala, ho senyeha hoa boko, ho kenyeletsa le bongoaneng.
• lefu la kelello le mafu a kelello a amang bakuli ba nang le lefu la kelello,
• likhathatso le maikutlo a fapaneng a maikutlo,
• tlhokomelo e sa bonahaleng, ts'ebetso,
• nocturnal enursis (ntle le bakeng sa bakuli ba nang le molumo o fokolitsoeng oa marako a bladder),
• bulimia mothosa
• syndrome ea bohloko bo sa foleng - bohloko ba bakuli ba mofetše, migraine, mafu a ramatiki sefahlehong, neuralgia ea morao-rao, neuropathies ea methapo e fapa-fapaneng (lefu la tsoekere, lefu la morao-rao, bohloko bo bong ba pherekano).
• hlooho e bohloko
• migraine prophylaxis,
• peptic ulcer ea mala le duodenum.

Li-antidepressants tsa Tricyclic li fetoha lithethefatsi tsa mola oa pele bakeng sa mafu a tebileng.

Mokhoa oa tsamaiso le litekanyetso

Amitriptyline e nooa ka molomo ntle le ho hlafuna hang kamora ho ja ho fokotsa ho teneha ha mucosa ea gastric.
Tekanyetso ea pele ho batho ba baholo ke 25-50 mg ka nako ea ho robala, joale litekanyetso li eketseha ka matsatsi a 5-6 ho isa ho 150-200 mg ka letsatsi ho litekanyetso tse tharo, karolo e kholo ka ho fetisisa ea lethal dose e behiloe nakong ea ho robala. Haeba kamora matsatsi a 14 ho se na ntlafatso, tekanyetso ea letsatsi le letsatsi e eketsoa ho 300 mg.

Haeba matšoao a khatello ea maikutlo a nyamela, tekanyo e fokotsoa ho 50-100 mg ka letsatsi mme kalafo e ntse e tsoela pele bonyane likhoeli tse tharo.
Botsofaling, ka mathata a fokolang, ho nooa tekanyetso ea 30-100 mg ka bosiu, kamora ho fihlela phello ea kalafo, ba fetohela litekanyetso tse tlase tse 25-50 mg ka letsatsi.

Liente li kenngoa butle butle ka tekanyetso ea 20-40 mg makhetlo a mane ka letsatsi, butle-butle li nkeloa sebaka ke ho kenella. Nako ea kalafo ha e sa feta likhoeli tse 6-8.
Ka li-enisis ea bosiu:

• ho bana ba lilemo tse 6 ho isa ho tse 10 - 10 ho isa ho 20 mg ka letsatsi bosiu,
• ho bana ba lilemo tse 11-16 - 25-50 mg / letsatsi.

Bana joaloka antidepressant:

• ho tloha ho lilemo tse 6 ho isa ho 12 - 10-30 mg kapa 1-5 mg ka kilogram ea boima ba 'mele ka letsatsi,
• bacha - 10 mg makhetlo a mararo ka letsatsi, haeba ho hlokahala - ho fihlela 100 mg ka letsatsi.

Bakeng sa thibelo ea migraine, le bohloko bo sa foleng ba neurogenic, hlooho e telele e telele - ho tloha ho 12,5 - 25 ho isa ho 100 mg ka letsatsi. Tekanyo e phahameng e nkuoa bosiu.

Litla-morao

Ntle le phello ea lits'ebetso tsa neural, amitriptyline e tšoauoa ka litla-morao tse ngata tsa morao-rao tse khethollang litlamorao tsa tsona:

• antagonism mabapi le M1-cholinergic receptors e etsa qeto ea nts'etsopele ea anticholinergic syndrome - tachycardia, molomo o omileng, sebaka sa bolulo se senyehileng, ho sokela, ho boloka mokokotlo, pherekano (delirium kapa hallucinations), ho sitisoa ha mala
• blockade of alpha1-adrenergic receptors e baka mathata a ho potoloha ha methapo ea methapo (kizungu, bofokoli, ho fifala ha letsoalo, ho akheha), Reflex tachycardia,
• blockade ea li-receptor tsa H1-histamine - sedation, phaello ea boima ba 'mele,
• phetoho ea metabolism ea ion methapong ea boko le pelo e fokotsa sekhahla sa ho ba le boikemisetso bo matla ebile e kenya letsoho ponahalong ea ketso ea cardiotoxic - morethetho oa liphatlalatso le litšusumetso ho myocardium li tlotsoe.

Botebo ba litla-morao hangata bo halefisa lingaka ho sebelisa litekanyetso tse tlase tse sa lokelang, hape e fokotsa haholo ho khomarela ha bakuli kalafo, e fokotsang katleho ea kalafo.

Ka lebaka la kotsi ea chefo e matla ke li-antidepressants tsa triceclic, ba khethoa ke bakuli ba nang le tšekamelo ea ho ipolaea ho fihlela litabatabelo tsa bona. Ka hona, ho fanoa ka lithethefatsi e le hore mokuli a se ke a bokella palo e lekaneng ea ho ipolaea.

Amitriptyline analogues

Litokisetso tseo motsoako oa tsona o ka sehloohong e leng amitriptyles ke Amizol, Elivel, Saroten retard. Kopano, li-analogues tsa lithethefatsi li kenyelletsa lithethefatsi tsa sehlopha sa li-antidepressants tsa tricyclic: imipramine, clomipramine, desipramine, doxepin, pipofesin, tianeptine. Leha ho le joalo, ts'ebetso ea bona ea pharmacological e fapana.

Ka kakaretso, phello ea kalafo ea mang kapa mang ea loantšang khatello ea maikutlo, haholo-holo ka tšebeliso ea nako e telele, e bonahala ka phello e rarahaneng ea lits'ebetso tsa methapo e mengata ea methapo ea kutlo. Ka hona, ponelopele ea motho ka mong ea litla-morao tsa psychotropic, neurotropic le somatotropic tsa lithethefatsi khahlano le khatello ea maikutlo ho latela tekanyo ea mantlha le matla a litlamorao tsena. Ts'ebetso ea bona ea akhaonto e kopaneng e u lumella ho khetha moriana o le mong oa 'nete boemong bo bong le bo bong, bo qetellang bo khetholla katleho ea kliniki.

Hlokomela! Tlhaloso ea lithethefatsi ke mofuta o bonolo le o tlatselletsang oa litaelo tsa semmuso bakeng sa tšebeliso. Tlhahisoleseling mabapi le lithethefatsi e fanoa molemong oa tlhahisoleseling feela mme ha ea lokela ho sebelisoa e le tataiso bakeng sa kalafo ea hau.

Foromo ea litekanyetso

Matlapa a koahetsoeng, 25 mg

Letlapa le leng le na le

ntho e sebetsang - amitriptyline hydrochloride ho latela amitriptyline 25 mg,

Baeti: lactose monohydrate, cellcose ya microcrystalline, croscarmellose sodium, hypromellose, magnesium stearate, colloidal silicon dioxide, polyethylene glycol 6000, titanium dioxide (E 171), talc, polysorbate 80, carmoisin (E 122).

Matlapa a pota-potile, a koahetsoe, ho tloha ho pinki e bobebe ho isa ho pinki, ka libaka tse holimo le tse tlase tsa khanyetsi. Ka phoso tlasa khalase e holisang, u ka bona konokono e pota-potiloe ke mokato o le mong o tsoelang pele.

Melemo ea pharmacological

Mofumahali

Amitriptyline e kenngoe hantle ho tsoa pampiring ea mala, khubung ea plasma e phahameng e fihlella ka nako ea lihora tse ka bang tse 6 ka mor'a taolo ea molomo.

Bioavailability ea amitriptyline ke 48 ± 11%, 94.8 ± 0.8% e amana le liprotheine tsa plasma. Litekanyetso tsena ha lia itšetleha ka lilemo tsa mokuli.

Bophelo bo halofo ke lihora tse 16 ± 6, bophahamo ba thomello ke 14 ± 2 l / kg. Maemo ka bobeli a eketseha haholo ka lilemo tse ntseng li eketseha tsa mokuli.

Amitriptyline e nyenyefalitsoe haholo ka har'a sebete ho metabolite ea mantlha - nortriptyline. Litsela tsa Metabolic li kenyelletsa hydroxylation, N-oxidation, le khokahano le glucuronic acid. Lithethefatsi li tšeloa ka har'a moroto, haholo ka sebopeho sa metabolites, ka mokhoa oa mahala kapa o kopaneng. Ho hlakisoa ke 12.5 ± 2.8 ml / min / kg (ha ho ea itšetleha ka lilemo tsa mokuli), ka tlase ho 2% e pepesitsoe moroto.

Mofumahali

Amitriptyline ke antidepressant e boima. E phatlalalitse antimuscarinic le thepa ea ho hlohlona. Phello ea kalafo e thehiloeng ho fokotseha ha reuptake ea presynaptic (mme, ka lebaka leo, inactivation) ea norepinephrine le serotonin (5HT) ka presynaptic nerve endings.

Leha e le taba ea hore phello e phatlalalitsoeng e le antidepressant, joalo ka molao, e iponahatsa matsatsi a 10-14 kamora ho qala kalafo, thibelo ea ts'ebetso e ka bonoa esale pele kamora hora kamora puso. Sena se fana ka maikutlo a hore mochini oa ts'ebetso o ka tlatselletsa likarolo tse ling tsa pharmacological ea moriana.

Tekanyetso le tsamaiso

Phekolo e lokela ho qala ka litekanyetso tse nyane, butle-butle li li eketsa, li lekole karabelo ea kliniki le lipontšo tsa ho hloka mamello.

Batho ba baholo: Motsoako oa ho qala o khothalelitsoeng ke 75 mg ka letsatsi, o nooa litlhare tse fapaneng kapa bosiu bosiu. Ho latela phello ea tleliniki, lethal dose le ka eketsoa ho 150 mg / ka letsatsi. Ho bohlokoa ho eketsa litekanyetso qetellong ea letsatsi kapa ka nako ea robala.

Hangata ketso ea Sedative e iponahatsa ka potlako. Matla a antidepressant a lithethefatsi a ka hlaha kamora matsatsi a 3-4, bakeng sa nts'etsopele e lekaneng ea phello, e ka nka matsatsi a 30.

Bakeng sa ho fokotsa menyetla ea ho khutlela bothateng, ho lokela ho noe tekanyetso ea tlhokomelo ea 50-100 mg ka shoalane kapa pele u robala.

Bana: lithethefatsi ha li khothalletsoe bana ba ka tlase ho lilemo tse 16.

Bakuli ba tsofetseng (ba fetang lilemo tse 65): Tekanyetso ea pele e khothalelitsoeng ke 10-25 mg makhetlo a mararo ka letsatsi ka keketseho ea butle-butle haeba ho hlokahala. Bakeng sa bakuli ba sehlopha sena sa lilemo ba sa khoneng ho mamella tekanyetso e phahameng ea tekanyetso, tekanyetso ea letsatsi le letsatsi ea 50 mg e kanna ea lekana. Tekanyetso e hlokahalang ea letsatsi le letsatsi e ka khethoa ho litekanyetso tse 'maloa, kapa hang, ka ho khetheha ka shoalane kapa pele u robala.

Matlapa a lokela ho metsoa a felletse ntle le ho hlafuna le ho nooa ka metsi.

Moriana o lokela ho nooa ho latela lipehelo tse boletsoeng ke ngaka, hobane ho itšeha kalafo ho ka ba kotsi bophelong. Ho haella ha boemo ba mokuli ho ka bonoa ho fihlela libeke tse 4 kamora ho qala kalafo.

Litlamorao

Joalo ka lithethefatsi tse ling, amitriptyline, matlapa a koahetsoeng ka linako tse ling a ka baka karabelo e mpe ho bakuli ba bang, haholo ha ba laetsoe ka lekhetlo la pele. Ha se litla-morao tsena kaofela tse ileng tsa bonoa nakong ea kalafo le amitriptyline, tse ling tsa tsona li etsahetse ha ho sebelisoa lithethefatsi tse ling tsa sehlopha sa amitriptyline.

Liphetoho tse mpe li khetholloa ke makhetlo a etsahalang: hangata haholo (> 1/10), hangata (ho tloha 1/100 ho isa 1/1000 ho isa ho 1/10000 ho