06 May, 2024
    Phekolo le thibelo

    Finlepsin 400 Retard Carbamazepine

    Lefu la ho akheha (ho sa kenyeletsane le li-abscesses, myoclonic kapa ho ts'oaroa ka mokhoa o bolaeang) - ho ts'oaroa ka nakoana le matšoao a rarahaneng le a bonolo, ho ts'oaroa ka mantlha le ho boemo bo phahameng ka bobeli ka ho ts'oaroa ha tonic-clonic, ho ts'oaroa ha motsoako (monotherapy kapa hammoho le li-anticonvulsants tse ling).

    Maemo a hlobaetsang a manic (monotherapy hape a kopantsoe le Li + le lithethefatsi tse ling tsa antipsychotic). Mathata a amanang le maemo a amanang le phallo (a kenyeletsang le phapang) ho thibela ho feteletseng, ho fokolisa lipontšo tsa bongaka nakong ea ho ata.

    Lefu la ho tlohela joala (ho tšoenyeha, ho tsitsipana, khatello ea maikutlo, khatello ea boroko).

    Lefu la tsoekere la lefu la tsoekere le bohloko.

    Lefu la tsoekere la mantlha. Polyuria le polydipsia ea tlhaho ea neurohormonal.

    Kopo e ea khonahala (matšoao a ipapisitse le boiphihlelo ba bongaka, ha ho lithuto tse laoloang tse kileng tsa etsoa):

    - ka mathata a kelello (a nang le mathata a amanang le mathata a amanang le lefu la kelello le kelello, ho tšoenyeha, ho tšoha, ho loants'oa kalafo ea lefu la kelello le ts'ebetso ea litho tsa tsamaiso ea litho tsa methapo),

    - ka boits'oaro bo mabifi ba bakuli ba nang le ts'enyo ea ts'ebetso ea boko, khatello ea maikutlo, chorea,

    - molemong oa matšoenyeho, dysphoria, somatization, tinnitus, senile dementia, Kluver-Bucy syndrome (ts'ebetso e 'ngoe ea ts'ebetso ea amygdala tata), mathata a ho qhekella, ho tlosoa ha benzodiazepine, cocaine,

    - ka bohloko ba lefu la tšimoloho ea neurogenic: mokokotlo oa lesapo la mokokotlo, lefu la mokokotlo oa methapo, lefu la sethoathoa la methapo (lefu la Guillain-Barré), lefu la tsoekere la lefu la tsoekere, bohloko ba phantom, lefu la maoto le khathetse (lefu la Ekboma), hemogacial spasm, neuropathy ea morao-rao le neurological ,

    - bakeng sa migraine prophylaxis.

    Foromo ea litekanyetso

    Matlapa a lokisitsoeng a lokolotsoeng, 200 mg kapa 400 mg

    ntho e sebetsang - carbamazepine 200 mg kapa 400 mg,

    baamohelang: eudragit RS 30D-ammonium methacrylate Copolymer (mofuta B) qhalakanyo, triacetin (glycerol triacetate), talc, eudragit L 30D-55 methaconic acid-ethyl acrylate Copolymer (1: 1) ho qhalana 30%, crospovidone, anhydrous silicon collo microcrystalline cellulose.

    Matlapa a na le 'mala o mosoeu kapa o mosehla ka' mala, ho pota, ka sebopeho sa lekhasi la clover le likharetene tse nang le likarolo tse bopehileng, tse nang le mela e sephara e tšekaletsoeng ka mahlakoreng a mabeli le likotopo tse 4 lehlakoreng le ka lehlakoreng.

    Contraindication

    Hypersensitivity ho carbamazepine kapa lithethefatsi tse tšoanang le lik'hemik'hale (mohlala, li-antidepressants) kapa ho motsoako leha e le ofe oa lithethefatsi, mathata a masapo a hematopoiesis (anemia, leukopenia), porphyria ea pherekano (e kenyeletsang nalane ea), thibelo ea AV, nako e tšoanang ho nka li-inhibitors tsa MAO.C ka hloko. Ho hloleha ha pelo, ho hlapolla hyponatremia (ADH hypersecretion syndrome, hypopituitarism, hypothyroidism, adrenal insuffanele), joala bo tsoetseng pele (khatello ea maikutlo ea CNS e ea eketseha, metabolism ea carbamazepine e hatelletsoe, mme ho hloleha ha sebete ho amana le phokolo ea mali, mme , Prostatic hyperplasia, khatello e eketsehileng ea methapo.

    Mokhoa oa ho sebelisa: litekanyetso le kalafo

    Ka hare, ho sa tsotelehe lijo ka sengoathoana se metsi.

    Letlapa la retard (Letlapa lohle kapa halofo) le lokela ho metsoa kaofela, ntle le ho hlafuna, ka mokelikeli o fokolang, makhetlo a 2 ka letsatsi.Ho bakuli ba bang, ha u sebelisa matlapa a khutlang, ho ka hlokahala ho eketsa tekanyetso ea moriana.

    Lefu la ho akheha Maemong moo sena se ka khonehang, carbamazepine e lokela ho khethoa e le monotherapy. Phekolo e qala ka ho sebelisa tekanyetso e nyane ea letsatsi le letsatsi, eo ka mor'a moo e eketsoang butle butle ho fihlela phello e ntle e fihlella.

    Ho kenyelletsoa ha carbamazepine kalafong e tsoelang pele ea antiepileptic ho lokela ho etsoa butle butle, ha litekanyetso tsa lithethefatsi tse sebelisitsoeng li sa fetohe kapa, haeba ho hlokahala, li fetohe.

    Bakeng sa batho ba baholo, tekanyetso ea pele ke 100-200 mg makhetlo a 1-2 ka letsatsi. Ebe moriana o eketsoa hanyane ka hanyane ho fihlela phello e nepahetseng ea kalafo e fumaneha (hangata 400 mg makhetlo a 2-3 ka letsatsi, boholo ba 1,6-2 g / ka letsatsi.

    Bana ba tsoang ho lilemo tse 4 - ka tekanyetso ea pele ea 20-60 mg / ka letsatsi, butle-butle ba eketseha ka 20-60 mg letsatsi le leng le le leng. Ho bana ba baholo ho feta lilemo tse 4 - ka tekanyetso ea pele ea 100 mg / ka letsatsi, lethal dose le eketseha butle butle, beke e 'ngoe le e ngoe ka 100 mg. Motsoako o tšehetsang: 10-20 mg / kg ka letsatsi (ka tekanyetso e 'maloa): lilemo tse 4-5 - 200-400 mg (ka litekanyetso tse 1-2), lilemo tse 6-10 - 400-600 mg (ka litekanyetso tse peli) ), bakeng sa lilemo tse 11-15 - 600-1000 mg (ka litekanyetso tse 2-3).

    Ka neuralgia ea trigeminal, 200-400 mg / ka letsatsi e beoa ka letsatsi la pele, butle-butle e eketseha ka se fetang 200 mg / ka letsatsi ho fihlela bohloko bo khaotsa (ka karolelano 400-800 mg / ka letsatsi), ebe o fokotseha ho lethal dose le sebetsang hanyane. Maemong a bohloko ba tšimoloho ea neurogenic, lethal dose la pele ke 100 mg makhetlo a 2 ka letsatsi ka letsatsi la pele, ebe lethalamo le eketseha ka se fetang 200 mg / ka letsatsi, haeba ho hlokahala, le le eketsa ka 100 mg ka mor'a lihora tse 12 ho fihlela bohloko bo kokobela. Tekanyetso ea tlhokomelo ke 200-1200 mg / ka letsatsi ho litekanyetso tse 'maloa.

    Molemong oa kalafo ea bakuli ba tsofetseng le bakuli ba nang le hypersensitivity, lethal dose la pele ke 100 mg makhetlo a 2 ka letsatsi.

    Syndrome ea ho tlohela joala: tekanyetso e tloaelehileng ke makhetlo a 200 mg makhetlo a 3 ka letsatsi, maemong a boima, matsatsing a 'maloa a pele, lethal dose le ka eketsoa ho 400 mg makhetlo a 3 ka letsatsi. Qalong ea kalafo bakeng sa matšoao a matla a tlisoang ke ho ikhula, ho khothalletsoa ho fana ka litlhare hammoho le lithethefatsi tse tlisoang ke ho ruruha.

    Lefu la tsoekere: tekanyetso e tloaelehileng ea batho ba baholo ke 200 mg makhetlo a 2-3 ka letsatsi. Ho bana, lethal dose le lokela ho fokotsoa ho latela lilemo le boima ba 'mele ba ngoana.

    Lefu la tsoekere le lefu la tsoekere, le tsamaeang le bohloko: tekanyetso e tloaelehileng ke 200 mg makhetlo a 2-4 ka letsatsi.

    Thibelo ea ho khutla hape ka litekanyetso tse hlonepheng le tse sebetsanang le kelello - 600 mg / letsatsi ka tekanyetso ea 3-4.

    Maemong a hlobaetsang a manic le mathata a amanang le "botolar", litekanyetso tsa letsatsi le letsatsi ke 400-1600 mg. Karolelano ea litekanyetso tsa letsatsi le letsatsi ke 400-600 mg (ho litekanyetso tse 2-3). A hlobaetsang le ho feta, lethal dose le eketseha ka potlako, le kalafo ea ho lokisa mathata a amanang le ts'oaetso - butle-butle (ho ntlafatsa mamello).

    Ketso ea pharmacological

    Lithethefatsi tsa antiepileptic (dibenzazepine derivative), eo hape e nang le standardotymic, antimaniacal, antidiuretic (ho bakuli ba nang le lefu la tsoekere la lefu la tsoekere) le analgesic (ho bakuli ba nang le neuralgia).

    Mochine oa ts'ebetso o hokahane le blockade ea li-channels tsa voltage + tsa gated Na, tse lebisang ho tsitsitseng ea membrane ea neuron, thibelo ea ponahalo ea li-serial discharges tsa neuron le ho fokotseha ha ho tsamaisoa ha synaptic ea impulses. E thibela ho etsoa botjha ha bokhoni ba ts'ebetso ba Na + - ho itšetleha ka ts'ebetso ho li-neuron tse senyehileng. Fokotsa ho lokolloa ha glotamate e khahlisang ea neurotransmitter amino acid, e eketsang sekhahla se fokolitsoeng sa ho ts'oaroa joalo-joalo. e fokotsa kotsi ea ho tšoaroa ke sethoathoa. E eketsa sephethephethe bakeng sa liteishene tsa K +, modulates voltage-gated Ca2 +, tse ka bakang phello ea anticonvulsant ea lithethefatsi.

    E lokisa liphetoho tsa botho ba sethoathoa mme qetellong e eketsa boiketlo ba bakuli, e kenya letsoho ntlafatsong ea bona ea sechaba. E ka hlalosoa e le lithethefatsi tse ka sehloohong tsa kalafo hape hammoho le lithethefatsi tse ling tsa anticonvulsant.

    E sebetsa hantle ho tsitsipuoeng (e bonolo) le e rarahaneng (e bonolo le e rarahaneng), e tsamaellanang kapa e sa tsamaeeng le kakaretso ea bobeli, ka ho ts'oaroa ka kakaretso ha tonic-clonic epileptic, hammoho le ho kopanya mefuta ena (hangata e sa sebetseng hantle ho tsitsipano e nyane - petit mal, ho ba sieo le ho ts'oaroa ka mokhoa o tenang maikutlo) .

    Bakuli ba nang le lefu la sethoathoa (haholoholo baneng le lilemong tsa bocha) ba na le phello e ntle matšoao a ho tšoenyeha le khatello ea maikutlo, hammoho le ho fokotseha ha ho teneha le ho ba mabifi. Kameho ea ts'ebetso ea kelello le ts'ebetso ea psychomotor e itšetlehile ka tekanyetso mme e fapana haholo.

    Qaleho ea phello ea anticonvulsant e fapana ho tloha lihora tse 'maloa ho isa matsatsing a' maloa (ka linako tse ling ho fihlela khoeli e le 'ngoe ka lebaka la auto-induction ea metabolism).

    Ka neuralgia ea bohlokoa le ea bobeli maemong a marang-rang e thibela ho hlaha ha litlhaselo tsa bohloko. E sebetsa hantle bakeng sa ho phomola ha bohloko ba neurogenic ho omeng ha lesapo la mokokotlo, paresthesias ea post-traumatic le postherpetic neuralgia. Ho fokola ha bohloko ka bohloko le neuralgia ea trigeminal ho hlokomeloa ka mor'a lihora tse 8-72.

    Maemong a lefu la ho itlopa joala, e eketsa monyetla oa ho ikemisetsa ho ikoahlaela (hangata ho fokotsoang boemong bona) le ho fokotsa botebo ba lipontšo tsa bongaka tsa lefu lena (ho eketseha hoa thabo, ho thothomela, mathata a gait).

    Ho bakuli ba nang le lefu la tsoekere insipidus e lebisa puseletso ea metsi kapele, e fokotsa phapang ea lenyora le lenyora.

    Ketso ea antipsychotic (antimaniacal) e hlaha kamora matsatsi a 7- 7, e kanna ea ba ka lebaka la thibelo ea metabolism ea dopamine le norepinephrine.

    Foromo ea nako e telele ea litekanyetso e tiisa ho boloka motsoako o tsitsitseng oa carbamazepine maling ntle le "litlhoro" le "marapo", e lumellang ho fokotsa khafetsa le ho teba ha mathata a teng a kalafo, ho eketsa katleho ea kalafo leha o sebelisa litekanyetso tse tlase. Dr. monyetla oa bohlokoa oa foromo e telele ke monyetla oa ho nka makhetlo a 1-2 ka letsatsi.

    Litlamorao

    Ha ho lekola sekhahla sa ho hlaha hoa mefuta e fapaneng e fapaneng ea karabelo, ho sebelisitsoe li-gradation tse latelang: khafetsa - 10% le ho feta hangata, hangata%, ka linako tse ling ke 0.1-1%, ka seoelo 0,01-0.1%, ka seoelo haholo ke 0.01%.

    Hangata karabelo e mpe e tsamaeang le tekanyetso ea meriana e nyamela kamora matsatsi a 'maloa, ka boithatelo le kamora phokotso ea nakoana ea lethal dose la lithethefatsi. Nts'etsopele ea karabelo e mpe e tsoang ho tsamaiso ea methapo e kholo e ka ba ka lebaka la ts'ebeliso e feteletseng ea lithethefatsi kapa ho fetoha ha maemo ho matla ha khatello ea ntho e sebetsang plasma. Maemong a joalo, ho khothalletsoa ho beha leihlo leihlo la lithethefatsi ho plasma.

    Ho tloha lehlakoreng la ts'ebetso ea methapo e bohareng: khafetsa - ho tsekela, ho otsela, ho otsela, hangata - ho opeloa ke hlooho, linako tsa bolulo, ka linako tse ling - ho sisinyeha ho sa tsitsang ha motho (mohlala, ho thothomela, "ho fofa" ho thothomela - asterixis, dystonia, li-tics), nystagmus, hangata , mathata a oculomotor, mathata a ho bua (mohlala, dysarthria), mathata a choreoathetoid, peripheral neuritis, paresthesias, myasthenia gravis le matšoao a paresis. Karolo ea carbamazepine e le lithethefatsi tse bakang kapa tse khothaletsang nts'etsopele ea lithethefatsi tse mpe tsa antipsychotic, haholo ha e laetsoe hammoho le li-antipsychotic, e lula e sa tsejoe.

    Ho tsoa sebakeng sa kelello: ka seoelo - hallucinations (pono kapa tlhaiso-leseling), khatello ea maikutlo, ho fokotseha takatso ea lijo, ho tšoenyeha, boits'oaro bo mabifi, ho ferekana, ho ferekanya kelello, hangata - ts'ebetso ea psychosis.

    Litla-morao: khafetsa - urticaria, ka linako tse ling - erythroderma, ka seoelo - lupus-syndrome, ho hlohlona ha letlalo, ka seoelo - litumellano tse ngata tsa 'mele (ho kenyeletsa le Stevens-Johnson syndrome), chefo e nang le chefo ea epidermal necrolysis (lefu la Lyell), photosensitivity.

    Khafetsa, mekhahlelo e liehang ea mefuta e mengata ea lietsahala mofuta oa hypersensitivity ka feberu, lekhopho la letlalo, vasculitis (ho kenyelletsa erythema nodosum e le ponahatso ea vasculitis ea letlalo), lymphadenopathy, matšoao a tšoanang le lymphoma, arthralgia, leukopenia, eosinophilia, ts'ebetso ea sebete le ts'oaetso ea sebete. e fumanoang ka metsoako e fapaneng). E kanna ea ameha, jj.litho tsa 'mele (mohlala, mats'oafo, liphio, manyeme, myocardium, colon). Ke ka seoelo - meneptitis ea aseptic e nang le myoclonus le eosinophilia, ho se sebetse hantle ka anaphylactoid, angioedema, pneumonitis ea allergic kapa pneumonia ea eosinophilic. Haeba litla-morao tsena li ka mpefala, tšebeliso ea lithethefatsi e lokela ho emisoa.

    Hematopoietic litho: khafetsa - leukopenia, hangata - thrombocytopenia, eosinophilia, ka seoelo - leukocytosis, lymphadenopathy, folic acid e haellang, ka seoelo haholo - agranulocytosis, anemia ea aplasiki, anemia ea 'nete ea erythrocytic, anemia. phokolo ea mali

    Ho tsoa ts'ebetsong ea tšilo ea lijo: hangata khafetsa - ho nyekeloa, ho hlatsa, hangata - molomo o omileng, ka linako tse ling - lets'ollo kapa ho sokela, bohloko ba ka mpeng, ka seoelo - glossitis, stomatitis, pancreatitis.

    Ka lehlakoreng la sebete: khafetsa haholo - keketseho ea ts'ebetso ea GGT (ka lebaka la ho kenella ha enzyme ena ka har'a sebete), eo hangata e sa tsotelleng, hangata - keketseho ea ketsahalo ea alkaline phosphatase, ka linako tse ling - keketseho ea mosebetsi oa "transaminase" ea "sebete", ka seoelo - hepatitis ea cholestatic, parenchymal (hepatocellular) kapa mofuta o tsoakaneng, jaundice, ka seoelo - granulomatous hepatitis, ho hloleha ha sebete.

    Ho tsoa ho CCC: khafetsa - ho ferekana ha pelo ho emisang, ho fokotseha kapa ho eketseha ha khatello ea mali, ka seoelo - bradycardia, arrhythmias, AV block e nang le maemo a ho akheha, ho oa, ho ts'oaroa kapa nts'etsopele ea lefu la pelo, ho mpefala ha lefu la pelo (ho kenyelletsa le ho hlaha kapa ho eketseha ha litlhaselo tsa angina), thrombophlebitis, thromboembolic syndrome.

    Ho tloha tsamaisong ea endocrine le metabolism: khafetsa - edema, ho boloka mokelikeli, ho nona haholo, hyponatremia (ho fokotseha ha osmolarity ka lebaka la phello e ts'oanang le ADH, eo maemong a sa tloaelehang e lebisang ho hyponatremia ea dilution, e tsamaeang le mokoka, ho hlatsa, ho opisa hlooho, ho ferekanya kelello le mathata a methapo ea kutlo), ka seoelo - hyperprolactinemia (e ka tsamaellana le galactorrhea le gynecomastia), ho fokotseha ha mahloriso a L-thyroxine (mahala T4, T4, T3) le keketseho ea mahloriso a TSH (hangata ha a tsamaee). lipontšo tsa kliniki), metabolism e fokolisang calcium-phosphorus metabolism ea masapo (e fokotsehile plasma Ca2 + le 25-OH-colecalciferol): osteomalacia, hypercholesterolemia (ho kenyelletsa cholesterol ea HDL) le hypertriglyceridemia.

    Ho tsoa ho tsamaiso ea genitourinary: hangata ka seoelo - interstitial nephritis, ho se sebetse hantle ha masapo, ts'ebetso ea mokokotlo oa mokokotlo (mohlala, albinuria, hematuria, oliguria, urea / azotemia), ho eketseha ha urination, urine ho boloka, ho fokotseha potency.

    Ho tsoa tsamaisong ea musculoskeletal: ka seoelo - arthralgia, myalgia kapa cramps.

    Ho tsoa liphoofolong tsa kutlo: ka seoelo - likhathatso ka tatso, leru la lense, conjunctivitis, ho senyeha ha kutlo, ho kenyeletsa tinnitus, hyperacusis, hypoacusia, liphetoho ponong ea molumo.

    Tse ling: mathata a ho fifala ha letlalo, aimura, makhopho, mofufutso o eketsehileng, alopecia. Maemo a hirsutism a sa tloaelehang a tlalehiloe, empa kamano ea lebaka lena le tsamaiso ea carbamazepine e ntse e sa hlaka. Matšoao: hangata a bontša mathata a tsamaiso ea methapo e kholo, CVS le tsamaiso ea ho hema.

    Ho tloha lehlakoreng la tsamaiso ea methapo e bohareng le litho tsa methapo ea kutlo - khatello ea tsamaiso ea methapo e kholo, ho soetseha, ho otsela, ho ruruha, ho bona lipono, ho akheha, ho ferekana, ho bona lintho tse ferekanyang ("moholi" ka pel'a mahlo), dysarthria, nystagmus, ataxia, dyskinesia, hyperreflexia (qalong), hyporeflexia (hamorao) ), ho tsitsipana, mathata a psychomotor, myoclonus, hypothermia, mydriasis).

    Ho tsoa ho CCC: tachycardia, ho fokotseha khatello ea mali, ka linako tse ling ho ne ho eketsa khatello ea mali, ho ferekana ho kenelletseng kahare ho kenyelletso ea phallo ea kahare ea QRS, ho ts'oaroa ha pelo.

    Karolong ea sistimi ea ho phefumoloha: khatello ea maikutlo, phepelo ea methapo.

    Ho tsoa ho tsamaiso ea tšilo ea lijo: ho nyekeloa le pelo le ho hlatsa, ho lieha ho tsoa ka lijo ka mpeng, ho fokolitse matla a koloneng.

    Ho tsoa ts'ebetsong ea moroto: ho boloka urine, oliguria kapa anuria, ho boloka mokelikeli, hyponatremia dilution.

    Matšoao a laboratori: leukocytosis kapa leukopenia, hyponatremia, metabolic acidosis, hyperglycemia le glucosuria, keketseho ea karolo ea mesifa ea KFK.

    Phekolo: ha ho na litlhare tse tobileng. Phekolo e ipapisitse le boemo ba bongaka ba mokuli, ho kena sepetlele, boikemisetso ba phepelo ea carbamazepine ho plasma (ho netefatsa chefo ka setlhare sena le ho lekola tekanyo ea ts'ebetso e ngata), ho phatloha ha mpa ea mpa, ho ts'oaroa ha mashala a ts'ebetsong (ho tlosoa ha nakoana ka sethong sa gastric ho ka lebisa ho liehisoa ho amoheloa ha matsatsi a 2 le a 3 mme a sebetsa hape). ponahalo ea matšoao a ho tahoa nakong ea ho hlaphoheloa).

    Qobello ea diuresis, hemodialysis, le peritoneal dialysis ha e na thuso (dialysis e bontšoa ka motsoako oa chefo e matla le ho hloleha ha renal). Bana ba banyenyane ba ka hloka tšelo ea mali. Tlhokomelo ea matšoao a tšebetsang setsing sa tlhokomelo e matla, ho hlokomela mesebetsi ea pelo, mocheso oa 'mele, matla a khoheli, ts'ebetso ea liphio le senya, ho lokisa mathata a electrolyte. Ka ho fokotseha ha khatello ea mali: boemo bo nang le hlooho bo theotsoe, ho emisoa ka plasma, ka ho se sebetse - iv dopamine kapa dobutamine, ka meferefere ea pelo - ts'ebetso e khethoa ka bonngoe, ka tsitsipano - ho kenngoa ha benzodiazepines (k.v. diazepam), ka tlhokomeliso (ka lebaka la keketseho ea khatello ea maikutlo phefumoloho) kenyelletso ea li-anticonvulsants tse ling (mohlala, phenobarbital). Ka nts'etsopele ea dilution hyponatremia (ho taoa ha metsi) - thibelo ea ho kenella ha metsi le ho kenella butle-butle ka tharollo ea 0.9% NaCl (ho ka thusa ho thibela nts'etsopele ea "edema"). Hemosorption ho li-sorwts tsa khabone e khothalletsoa.

    Litaelo tse khethehileng

    Monotherapy ea lefu la sethoathoa e qala ka ho khethoa ha litekanyetso tse nyane, 'me ka bomong li li eketsa ho fihlela sephetho se lakatsehang sa kalafo.

    Ho bohlokoa ho tseba hore na khatello ea mali le "plasma" e joang e le hore u tsebe ho khetha lethal dose e nepahetseng, haholo-holo ka mofuta oa phekolo.

    Ha u fetisetsa mokuli ho carbamazepine, litekanyetso tsa moriana oa antiepileptic tse boletsoeng esale pele li lokela ho fokotsoa butle butle ho fihlela li hlakoloa ka botlalo.

    Ho khaotsa ka tšohanyetso ha carbamazepine ho ka baka ho ts'oaroa ha sethoathoa. Haeba ho hlokahala hore o emise ka tšohanyetso kalafo, mokuli o lokela ho fetisetsoa ho litlhare tse ling tsa antiepileptic tlasa sekoaelo sa boitokisetso se bonts'itsoeng maemong a joalo (mohlala, diazepam e fanoa kahare kapa ka rectally, kapa phenytoin e tsamaisitsoeng iv).

    Ho na le maemo a mangata a ho hlatsa, lets'ollo le / kapa ho fokotseha hoa phepo e nepahetseng, ho tsitsinyeha ha maikutlo le / kapa khatello ea phefumoloho ho masea a bona bao bo-mme ba nkile carbamazepine ka mokhoa o tšoanang le li-anticonvulsants tse ling (litlhaloso tsena e kanna ea ba lipontšo tsa "ho tlosoa" ha bana ba sa tsoa hlaha).

    Pele o fana ka carbamazepine le nakong ea kalafo, ho hlokahala hore ho etsoe lipatlisiso mabapi le ts'ebetso ea sebete, haholo ho bakuli ba nang le nalane ea lefu la sebete, hammoho le bakuli ba tsofetseng. Tabeng ea keketseho ea ho senyeha ha sebete ho teng kapa ha lefu le sebetsang la sebete le hlaha, moriana o lokela ho emisoa hanghang. Pele o qala kalafo, ho hlokahala hape ho etsa phuputso ea setšoantšo sa mali (ho kenyelletsa palo ea liplatele, palo ea reticulocyte), serum Fe mahloriso, urinalysis, mali urea mahloriso, EEG, boikemisetso ba mahloriso a serum electrolyte (le nako le nako nakong ea kalafo, hobane kholo ea kholo ea kholo ea hyponatremia). Kamora nako, matšoao ana a lokela ho beoa leihlo nakong ea khoeli ea pele ea kalafo beke le beke, mme e be ka khoeli le khoeli.

    Carbamazepine e lokela ho tlosoa hanghang ha ho hlaha lintho kapa matšoao a ho kula a belaelloang ho nts'etsopele ea Stevens-Johnson syndrome kapa lefu la Lyell. Boitšoaro bo bobe ba letlalo (macular kapa maculopapular exanthema) hangata bo nyamela kamora matsatsi kapa libeke tse 'maloa esita le kalafo e tsoelang pele kapa kamora ho fokotseha ha tekanyetso (mokuli o lokela ho beoa leihlo le haufi le ngaka ka nako ena).

    Carbamazepine e na le ts'ebetso e fokolang ea anticholinergic, ha e laeloa bakuli ba nang le khatello e eketsehileng ea intraocular, ho lekola nako le nako hoa hlokahala.

    Monyetla oa ts'ebetso ea li-psychoses tse sa tsoa etsahala o lokela ho tsotelloa, le ho bakuli ba tsofetseng, monyetla oa ho thefuleha kapa ho hlasimoloha.

    Ho fihla joale, ho bile le litlaleho tse arohaneng tsa tsoalo e holofetseng ea monna le / kapa spermatogenesis e holofetseng (kamano ea liphokotso tsena le carbamazepine ha e e-so thehoe).

    Ho na le litlaleho tsa ho tsoa mali ho basali pakeng tsa ho ilela khoeli maemong a ho neng ho sebelisoa lithibela-pelehi ka molomo ka nako e le 'ngoe. Carbamazepine e ka ama hampe ts'ebetso ea lithethefatsi tse thibelang pelehi ka molomo, ka hona basali ba lilemo tse tsoalang ba lokela ho sebelisa mekhoa e meng ea ts'ireletso ea moimana nakong ea kalafo.

    Carbamazepine e lokela ho sebelisoa feela tlas'a tlhokomelo ea bongaka.

    Hoa hlokahala ho tsebisa bakuli ka matšoao a pele a chefo eo a ka bang le eona lipokellong tsa hematologic, le matšoao a tsoang letlalong le sebete. Mokuli o tsebisoa ka tlhokahalo ea ho ea ngakeng hang-hang le ngaka ha ho ka ba le mathata a itseng a kang feberu, 'metso, ho ruruha, ho ruruha ha mucosa ea molomo, sesosa sa ho longoa ke makhopho ka tsela ea petechiae kapa purpura.

    Maemong a mangata, ho fokotseha ka nakoana kapa ho phehella ha lisele tse tšoeu tsa mali ha se tšitiso ea ho qaleha ha lefu la setho sa boteng kapa "agranulocytosis". Leha ho le joalo, pele o qala kalafo, hammoho le nako le nako nakong ea kalafo, liteko tsa mali tsa kliniki li lokela ho etsoa, ​​ho kenyelletsa ho bala palo ea liplatelese le mohlomong li-reticulocytes, hammoho le ho khetholla mokokotlo oa Fe ho serum ea mali.

    Leukopenia e sa tsoeleng pele ha e hloke ho khaotsa, leha ho le joalo, kalafo e lokela ho khaotsa haeba leukopenia e tsoelang pele kapa leukopenia e hlaha, e tsamaisana le matšoao a kliniki a lefu le tšoaetsanoang.

    Pele o qala kalafo, ho kgothaletswa ho etsa tlhahlobo ea ophthalmological, ho kenyelletsa le tlhahlobo ea fundus ka lebone la slit le tekanyo ea khatello ea methapo haeba ho hlokahala. Tabeng ea ho fana ka lithethefatsi ho bakuli ba nang le khatello e eketsehileng ea intraocular, ho hlokahala ho lekola kamehla letšoao lena.

    Ho khothalletsoa ho tlohela tšebeliso ea ethanol.

    Setlhare se ka nako e telele se ka nooa hang, bosiu. Tlhokahalo ea ho eketsa tekanyetso ha o fetohela matlapeng a khutlang e fumaneha seoelo haholo.

    Leha kamano e teng lipakeng tsa lethal dose ea carbamazepine, ts'ebetso ea eona le ts'ebetso ea eona ea bongaka e le matla haholo, leha ho le joalo, boikemisetso ba khafetsa ba khatello ea carbamazepine bo ka ba molemo maemong a latelang: ka keketseho e potlakileng ea khafetsa ea litlhaselo, ho hlahloba hore na mokuli o sebelisa moriana hantle, nakong ea nakong ea bokhachane, kalafong ea bana kapa ea lilemong tsa bocha, ka ho belaelloa ha malaborption ea lithethefatsi, ka belaello ea menyetla ea chefo haeba mokuli a nkile maet lithethefatsi tse 'maloa.

    Ho basali ba lilemo tsa ho ba le bana, carbamazepine e lokela ho sebelisoa e le monotherapy neng kapa neng ha ho khonahala (sebelisa tekanyetso e sebetsang e tlase) - khafetsa liphapang tsa masea ho basali ba hlahileng kalafo ea antiepileptic li phahame ho feta bakeng sa ba fumanang e 'ngoe ea litlhare tsena e le monotherapy.

    Ha ho ima ho etsahala (ha u etsa qeto ea ho khethoa ha carbamazepine nakong ea kemolo), ho hlokahala hore u bapise ka hloko melemo ea phekolo le mathata a eona a ka hlahang, haholoholo likhoeling tse 3 tsa pele tsa kemaro. Hoa tsebahala hore bana ba tsoetsoeng ke bo-'mè ba nang le lefu la sethoathoa ba rerile ho ba le mathata a ntlafatso ea intrauterine, ho kenyelletsa le ho senyeha. Carbamazepine, joalo ka lithethefatsi tse ling tsohle tsa antiepileptic, e ka eketsa kotsi ea likotsi tsena. Ho na le litlaleho tse ikhethileng tsa linyeoe tsa maloetse a amanang le tlhaho le ho se sebetse hantle, ho kenyelletsa ho se koaloe ha li-vertebral arches (spina bifida). Bakuli ba lokela ho fuoa tlhaiso-leseling ka monyetla oa ho eketsa menyetla ea ho se sebetse hantle le bokhoni ba tlhahlobo ea bokhachane.

    Lithethefatsi tsa antiepileptic li eketsa khaello ea folic acid, e atisang ho utluoa nakong ea kemolo, e leng se ka eketsang kotsi ea bofokoli ba tlhaho ho bana (pele le nakong ea kemolo, ho khothalletsoa tlatsetso ea folic acid). Bakeng sa ho thibela ho tsoa mali ka bongata ho masea a sa tsoa hlaha, ho khothalletsoa hore basali ba libeke tsa ho qetela baimana, hammoho le masea, ba fuoe vithamine K1.

    Carbamazepine e fetela lebeseng; melemo le litlamorao tse sa batleheng tsa ho anyesa li lokela ho bapisoa le kalafo e tsoelang pele. Bo-'mè ba nkang carbamazepine ba ka fepa bana ba bona, ha feela ngoana a beiloe leihlo bakeng sa nts'etsopele ea lintho tse ka mo etsahallang tse mpe (mohlala, ho otsela ho tebileng, ho hlaseloa ke letlalo ka linako tsohle).

    Nakong ea kalafo, tlhokomelo e lokela ho nkuoa ha ho khannoa likoloi le ho etsa lintho tse ling tse ka bang kotsi tse hlokang ho tsepamisa mohopolo le ho potlakisa karabelo ea psychomotor.

    Tsamaiso e ts'oanang ea carbamazepine e nang le li-inhibitors tsa CYP 3A4 e ka lebisa ho eketseha ha khatello ea eona ea mali le nts'etsopele ea maikutlo a mabe. Ts'ebeliso e kopaneng ea li-inducers tsa CYP 3A4 e ka lebisa ho potlakisa ha metabolism ea carbamazepine, ho fokotseha ha khatello ea eona ka har'a plasma ea mali le ho fokotseha ha phello ea kalafo; ho fapana le hoo, ho felisoa ha bona ho ka fokotsa tekanyo ea biotransformation ea carbamazepine mme ea lebisa ho eketseha ha eona.

    Khokahano ea carbamazepine ho plasma e eketseha ka verapamil, diltiazem, felodipine, dextropropoxyphene, viloxazine, fluoxetine, fluvoxamine, cimetidine, acetazolamide, danazole, desipramine, nicotinamide (ho batho ba baholo, feela ka doses e phahameng, ecinythrythitis, ecinycinstcinoscincin, ecinnycinoscin. (itraconazole, ketoconazole, fluconazole), terfenadine, loratadine, isoniazid, propoxyphene, lero la morara, li-inhibitors tsa virase tse sebelisitsoeng kalafo ea ts'oaetso ea tšoaetso ea HIV (mohlala, ritonavir) - litekanyetso tsa kalafo ea litekanyetso li hlokahala. tlhokomelo ea concentrations carbamazepine lero la mali.

    Felmabat e fokotsa khatello ea carbamazepine ho plasma mme e eketsa khatello ea carbamazepine - 10,11 - epoxide, ha nako e tšoanang ea ho fokotseha hoa khatello ea serum ea felbamate e khonahala.

    Khokahano ea carbamazepine e fokotsoa ke phenobarbital, phenytoin, primidone, metsuximide, fensuximide, theophylline, rifampicin, sisplatin, doxorubicin, mohlomong: clonazepam, valpromide, valproic acid, oxcarbazepine le lihlahisoa tsa litlama tse nang le litlolo.Ho na le monyetla oa ho fallisoa ha carbamazepine e nang le valproic acid le primidone ka lebaka la liprotheine tsa plasma le keketseho ea khatello ea "metabolic" metabolism e sebetsang (carbamazepine-10,11-epoxide). Ka ts'ebeliso e kopaneng ea Finlepsin e nang le alproic acid, maemong a ikhethang, komello le pherekano li ka hlaha.

    Isotretinoin e fetola bioavailability le / kapa ho hlakisoa ha carbamazepine le carbamazepine-10,11-epoxide (tlhokomeliso ea plasma carbamazepine mahloriso e hlokahala). Carbamazepine ka fokotsa lero la mali mahloriso (fokotseha kapa esita le ka ho feletseng kokobetsa ho liphello) le ka 'na hloka tekanyetso khalemelo lithethefatsi tse latelang: klobazama, clonazepam, digoxin, ethosuximide, primidone, acid e valproic, alprazolam, corticosteroids (prednisone, dexamethasone), cyclosporine, tetracyclines (doxycycline) , haloperidol, methadone, litokisetso tsa molomo tse nang le estrogen le / kapa progesterone (khetho ea mekhoa e meng ea thibelo ea bokhachane e hlokahala), theophylline, anticoagulants ea molomo (warf rin, fenprocoumone, dicumarol), lamotrigine, topiramate, tricyclic antidepressants (imipramine, amitriptyline, nortriptyline, clomipramine), clozapine, extbamate, tiagabine, oxcarbazepine, proteinase inhibitors in calcinine inhibitorin liteishene (sehlopha sa dihydropyridones, ka mohlala felodipine), itraconazole, levothyroxine, midazolam, olanzapine, praziquantel, risperidone, tramadol, ciprasidone. Ho na le monyetla oa ho eketsa kapa ho fokotsa boemo ba phenytoin ka plasma ea mali khahlanong le semelo sa carbamazepine le ho eketsa boemo ba mefenitoin. Ka tšebeliso e tšoanang ea carbamazepine le lithium litokisetso, litlamorao tsa neurotoxic tsa lintho ka bobeli tse sebetsang li ka matlafatsoa.

    Tetracyclines e ka bonts'a phello ea kalafo ea carbamazepine. Ha e kopantsoe le paracetamol, kotsi ea eona e nang le chefo ho sebete e eketseha le katleho ea kalafo e fokotseha (e potlakisa metabolism ea paracetamol).

    Tsamaiso e ts'oanang ea carbamazepine e nang le phenothiazine, pimozide, thioxanthenes, mindindone, haloperidol, maprotiline, clozapine le li-antidepressants tsa trousclic li lebisa ho eketsong ea phello ea ts'ebetso ea methapo ea methapo le ho fokolisa phello ea anticonvulsant ea carbamazepine. Monoamine oxidase inhibitors e eketsa kotsi ea likotsi tsa hyperpyretic, likotsi tse matla tsa khatello ea methapo, ho ts'oaroa le lefu (monoamine oxidase inhibitors li lokela ho hlakoloa pele libeke tsa carbamazepine li ka fuoa libeke tse peli kapa, haeba boemo ba kliniki bo lumella, esita le ka nako e telele).

    Tsamaiso e tšoanang ka diuretics (hydrochlorothiazide, furosemide) e ka lebisa ho hyponatremia, e tsamaisana le liponahatso tsa bongaka. E bonts'a litlamorao tsa li-restores tse sa nyenyefatseng tsa mesifa (pancuronium). Tabeng ea ho sebelisa motsoako o joalo, ho ka 'na ha hlokahala hore u eketse tekanyetso ea boikhathollo ba mesifa, ha ho ntse ho hlokoa boemo ba mokuli ka hloko ka lebaka la monyetla oa ho khaotsa mesifa ka potlako. Carbamazepine e fokotsa mamello ea ethanol. Lithethefatsi tsa Myelotoxic li eketsa ho ata ha hematotoxicity ea lithethefatsi.

    E potlakisa metabolism ea li-anticoagulants tse sa tobang, lithibela-pelehi tsa lihormone, folic acid, praziquantel, 'me e ka ntlafatsa ho felisoa ha li-hormone tsa qoqotho.

    E potlakisa metabolism ea lithethefatsi bakeng sa anesthesia (enflurane, halotane, fluorotan) mme e eketsa kotsi ea litlamorao tsa hepatotoxic, e eketsa sebopeho sa nephrotoxic metabolites ea methoxyflurane. E ntlafatsa phello ea hepatotoxic ea isoniazid.

    Bongata

    Matšoao hangata ho bontša ho hloka taolo ha methapo e bohareng ea methapo, methapo ea pelo le ea ho hema.

    Tsamaiso ea methapo e bohareng le litho tsa methapo ea kutlo - khatello ea mesebetsi ea methapo e kholo ea methapo, ho ferekanya kelello, ho otsela, ho ruruha, ho ferekana kelellong, komello, pono e fifalitsoeng, puo e sa tsitsang, dysarthria, nystagmus, ataxia, dyskinesia, hyperreflexia (qalong), hyporeflexia (hamorao), tsitsipano ea kelello, mathata a kelello, kelello mydriasis)

    Ts'ebetso ea pelo: tachycardia, ho fokotseha ha khatello ea mali, ka linako tse ling ho eketsa khatello ea mali, ho ferekana ho kenelletseng kahare ho intraventricular le QRS complexation, ho koafala, ho ts'oaroa ha pelo,

    Sistimi ea khalemelo: khatello ea maikutlo ea phefumoloho, edema ea pulmonary,

    Sistimi ea lijo: ho nyekeloa ke pelo, ho hlatsa, ho lieha ho ntša lijo ka mpeng, ho fokotsa matla a koloneng.

    Sistimi ea Urinary: ho bolokoa ka moroto, oliguria kapa anuria, ho boloka mokelikeli, hyponatremia.

    Ha ho na litlhare tse tobileng. Phekolo e tšehetsang matšoao e hlokahala sebakeng sa tlhokomelo e matla, ho lekola mesebetsi ea pelo, mocheso oa 'mele, matla a khoheli, tšebetso ea liphio tsa senya, le khalemelo ea mathata a electrolyte. Hoa hlokahala ho tseba hore na motsoako oa carbamazepine ho plasma ho netefatsa chefo le moemeli le ho lekola tekanyo ea ts'ebeliso e feteletseng ea moriana, gastric lavage, le ho ts'oaroa ha mashala a entsoeng ka matla. Ho ntšoa kapele ha litaba tsa ka mpeng ho ka lebisa ho kenngeng ka nako ka matsatsi a 2 le a 3 le ho fumana matšoao a bota nakong ea pholiso.

    Qobello ea diuresis, hemodialysis, le peritoneal dialysis ha e na thuso, leha ho le joalo, dialysis e bontšoa bakeng sa motsoako oa chefo e matla le ho hloleha ha rems. Ho bana, ho ka ba le tlhoko ea hematotransfusion.

    Lokolla liforomo le liphutheloana

    Ho matlapa a 10 ka moqomo o tlotsitsoeng o tsoang filiming ea polyvinyl chloride le foil ea aluminium.

    Lipakete tse 5 tsa blister hammoho le litaelo tsa tšebeliso ea bongaka maemong a naha le lipuo tsa Serussia li kenngoa ka lebokoseng la karete.

    Lipehelo tsa Khefu ea Litlama

    Lebitso le naha ea mokhatlomohlahlami

    "Lits'ebetso tsa Teva Poland Sp.z.o.o"

    80 st. Mogilska, 31-546 Krakow, Poland

    Lebitso le naha hoea nang le karete ea ho ingolisa

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

    Lebitso le naha ea mokhatlo o hlophisang

    "Teva Operations Poland Sp.z.o.o", Poland

    Aterese ea mokhatlo e amohelang litletlebo tse tsoang ho bareki ka boleng ba lihlahisoa (thepa) sebakeng sa Rephabliki ea Kazakhstan:

    LLP "ratiopharm Kazakhstan"

    050000, Republic of Kazakhstan Almaty, Al-Farabi Avenue 19,

    Tšebelisano

    Cytochrome CYP3A4 ke enzyme ea mantlha e fanang ka metabolism ea carbamazepine. Tsamaiso e ts'oanang ea carbamazepine e nang le li-inhibitors tsa CYP3A4 e ka lebisa ho eketseha ha khatello ea eona ea plasma mme ea baka karabelo e mpe. Ts'ebeliso e kopaneng ea li-inducers tsa CYP3A4 e ka lebisa ho potlakisa ha metabolism ea carbamazepine, ho fokotseha ha khatello ea carbamazepine ka har'a plasma le ho fokotseha ha phello ea kalafo, ho fapana le hoo, ho felisoa ha bona ho ka fokotsa tekanyo ea metabolic ea carbamazepine mme ea lebisa ho eketseha ha eona.

    Keketseho e eketsehileng ea plasma carbamazepine: verapamil, diltiazem, felodipine, dextropropoxyphene, viloxazine, fluoxetine, fluvoxamine, cimetidine, acetazolamide, danazole, desipramine, nicotinamide (ho batho ba baholo, feela ka tekanyetso e phahameng), macrolides, eryromystromy, eryromystyley, eryphycincin, erymoscin. azoles (itraconazole, ketoconazole, fluconazole), terfenadine, loratadine, isoniazid, propoxyphene, lero la morara, li-inhibitors tsa viral tse sebelisitsoeng kalafo ea ts'oaetso ea HIV (mohlala ritonavir) - litekanyetso tsa regimen ea litekanyetso li hlokahala. tlhokomelo ea concentrations carbamazepine lero la mali.

    Felbamate e fokotsa bongata ba carbamazepine ho plasma mme e eketsa khatello ea carbamazepine-10,11-epoxide, ha nako e tšoanang ea ho fokotseha hoa khatello ea mali serum ea felbamate e khonahala.

    Khokahano ea carbamazepine e fokotsoa ke phenobarbital, phenytoin, primidone, metsuximide, fensuximide, theophylline, rifampicin, sisplatin, doxorubicin, mohlomong: clonazepam, valpromide, valproic acid, oxcarbazepine le lihlahisoa tsa meroho tse nang le Hypercum. Ho na le litlaleho tsa monyetla oa ho fallisoa ha carbamazepine e nang le valproic acid le primidone ka lebaka la liprotheine tsa plasma le keketseho ea khatello ea "metabolic" metabolism e sebetsang (carbamazepine-10.11-epoxide).

    Isotretinoin e fetola bioavailability le / kapa ho hlakisoa ha carbamazepine le carbamazepine-10,11-epoxide (plasma mahloriso a carbamazepine e hlokahala).

    Carbamazepine e ka fokotsa mahloriso a plasma (fokotsa esita le ho fokotsa litlamorao ka ho sa feleng) mme e hloka phetoho ea litekanyetso bakeng sa lithethefatsi tse latelang: clobazam, clonazepam, ethosuximide, primidone, valproic acid, alprazolam, GCS (prenisolone, dexamethasone), cyclosporine, doxycycoroline, galexopolol, grenxcolol, grenxcolol, grenxcolol, grenscorololololololololololololololololololololololololololololololololololololololololololololololololololololorol, gardasseportone Lithethefatsi tse nang le li-estrogens le / kapa progesterone (ho hlokahala mekhoa e meng ea thibelo ea bokhachane), theophylline, anticoagulants ea molomo (warfarin, fenprocoumone, dicumarol), lamotrigine, topiramate, tricyclic li-antidepressants tsa tsona (imipramine, amitriptyline, nortriptyline, clomipramine), clozapine, felbamate, tiagabin, oxcarbazepine, li-protease inhibitors tse sebelisitsoeng kalafo ea ts'oaetso ea HIV (indinavir, ritonavir, saquinovir), BMK (sehlopha sa dihydropyridine, dihydropyridine, diydropididone midazolam, olazapine, praziquantel, risperidone, tramadol, cyprasidone.

    Ho na le litlaleho tsa hore ha u ntse u nka carbamazepine, boemo ba phenytoin ho plasma bo ka nyoloha kapa ba fokotseha, mme boemo ba mefenitoin bo ka nyoloha (maemong a sa tloaelehang).

    Carbamazepine ha e kopantsoe le paracetamol e eketsa menyetla ea litlamorao tsa eona tse ka bang kotsi ho sebete 'me e fokotsa ts'ebetso ea kalafo (e potlakisang metabolism ea paracetamol).

    Ts'ebetso e ts'oanang ea carbamazepine e nang le phenothiazine, pimozide, thioxanthenes, mindindone, haloperidol, maprotiline, clozapine le li-antidepressants tsa triceclic li lebisa ho eketsong ea phello ea ts'ebetso ea methapo ea methapo le ho fokolisa phello ea anticonvulsant ea carbamazepine.

    Li-inhibitors tsa MAO li eketsa kotsi ea likotsi tsa hyperpyretic, likotsi tse matla tsa khatello ea methapo, ho ts'oaroa, lefu (pele ho khethoa ha carbamazepine, li-inhibitors tsa MAO li lokela ho hlakoloa bonyane libeke tse 2 kapa, haeba boemo ba kliniki bo lumella, leha e le nako e teletsana).

    Tsamaiso e tšoanang ka diuretics (hydrochlorothiazide, furosemide) e ka lebisa ho hyponatremia, e tsamaisana le liponahatso tsa bongaka.

    E bonts'a litlamorao tsa li-restores tse sa nyenyefatseng tsa mesifa (pancuronium). Tabeng ea ts'ebeliso ea motsoako o joalo, ho ka hlokahala ho eketsa tekanyetso ea ba phomotsang mesifa, ha ho ntse ho hlokahala ho beha leihlo bakuli ka hloko, hobane ho felisoa ha ts'ebetso ea bona ho ka etsahala ka potlako.

    E potlakisa metabolism ea li-anticoagulants tse sa tobang, lithethefatsi tsa thibelo ea bokhoni ba li-hormone, folic acid, praziquantel, mme e ka ntlafatsa ho felisoa ha li-hormone tsa qoqotho.

    E potlakisa metabolism ea lithethefatsi bakeng sa anesthesia ka kakaretso (enflurane, halotane, fluorotan) ka kotsi e eketsehang ea litlamorao tsa hepatotoxic, e ntlafatsa sebopeho sa nephrotoxic metabolites ea methoxyflurane.

    E ntlafatsa phello ea hepatotoxic ea isoniazid.

    Lithethefatsi tsa Myelotoxic li eketsa lipontšo tsa hematotoxicity ea lithethefatsi.

    Pharmacodynamics le pharmacokinetics

    Karolo e sebetsang e nkiloe dibenzazepine. Lithethefatsi li na le antimaniacal, standardotymic, antidiuretic (ho bakuli ba nang le lefu la tsoekere), meriana ea bohloko (le neuralgia) pontsho.

    Molao-motheo oa phello ea lithethefatsi o ipapisitse le li-blockade tsa lisele tsa sodium tse nang le gated, tse bakang tšitiso ea ho hlaha ha li-neuron, ho tsitsisa membrane ea li-neuron, tse lebisang hantle ho fokotseheng ha tlhahiso ea li-synaptic ea impulses.

    Moriba o thibela ho etsoa botjha ha bokhoni ba ts'ebetso ba ho sodium ho latela sebopeho sa li-neuron tse nyenyefalitsoeng.

    Carbamazepine e lebisa ho fokotseha hoa glutamate e lokollotsoeng (neurotransmitter amino acid), e fokotsang kotsi ea ho hola lefu la sethoathoa. Ka ho bana le lilemong tsa bocha le lefu la sethoathoa ha o ntse o sebelisa moriana o, ho na le mokhoa o nepahetseng o amanang le boima ba khatello ea maikutlo le matšoenyeho, hammoho le bohale bo fokotsehileng, ho hloka taolo.

    Tšusumetso matšoao a psychomotor, mesebetsi ea kutloisiso e itšetlehile ka tlhaho ka tlhaho, e fapana maemong ka mong.

    Ho trigeminal neuralgia (ea bohlokoa, bobeli) ho na le phokotso ea khafetsa ea litlhaselo tsa bohloko.

    Ho postherpetic neuralgiabakeng sa khatello ea maikutlo paresthesias, lesapo la mokokotlo le omeletseng - Carbamazepine e thusa ho kokobetsa bohloko ba neurogenic.

    Ho ho itlopa joala ea lithethefatsi e ka fokotsa botebo ba matšoao a mantlha a ho hlaka (ho thothomela hoa liphello, ho teneha ho hoholo, mathata a Gait), ho eketsang monyetla oa ho ikemisetsa ho ts'oaroa.

    Ho bakuli ba nang le lefu la tsoekere moriana o theola maikutlo a mocheso, diuresis, o lebisa pusong ea metsi kapele.

    Phello ea antimaniacal (antipsychotic) e tlalehiloe kamora matsatsi a 7000 a kalafo, ea hlaha ka lebaka la thibelo ea metabolism norepinephrine, dopamine.

    Tšebeliso ea mefuta e telele ea carbamazepine e u fa monyetla oa ho fihlela mokokotlo o tsitsitseng oa mantlha maling, ntle le ho ngolisa "dips" le "litlhoro".

    Matlapa a Carbamazepine, litaelo tsa tšebeliso (mokhoa le litekanyetso)

    Setlhare se nooa ka molomo ka metsi a lekaneng. Matlapa a nkileng nako e telele (Carbamazepine Retard) ha a hlafuna, a koenya a felletse habeli ka letsatsi.

    Ka lefu la sethoathoa moriana o laetsoe ka hohle kamoo ho ka khonehang joalo ka monotherapy. Phekolo e khothalletsoa ho qala ka litekanyetso tse nyane ka keketseho ea butle-butle ea litekanyetso, e lumellang ho fumana sephetho se nepahetseng. Tekanyetso ea pele bakeng sa batho ba baholo ke 100-200 mg makhetlo a 1-2 ka letsatsi, butle-butle palo ea meriana e eketsoa.

    Trigeminal neuralgia: letsatsi la pele la phekolo ke 200-400 mg, ka keketseho ea butle-butle ho 400-800 mg ka letsatsi, ebe sethethefatsi sa carbamazepine se hlakotsoe.

    Tekanyetso ea pele ka bohloko ba lefu la tšimoloho ea neurogenic ke 100 mg habeli ka letsatsi, ka keketseho ea tekanyetso lihora tse ling le tse ling tse 12 ho fihlela phomolo ea bohloko e fihlella. Motsoako oa tlhokomelo ke 200-1200 mg ka letsatsi, e etselitsoe litekanyetso tse 'maloa.

    Litharo tsa karolelano ka lefu la ho itlopa joala ke 200 mg makhetlo a mararo ka letsatsi, e le maemong a matla, lethal dose le eketseha ho 400 mg makhetlo a mararo ka letsatsi.

    Matsatsing a pele a kalafo, ho khothalletsoa hore ho be le kopano e 'ngoe chlordiazepoxide, clformazole le tse ling tse thetsang.

    Ho lefu la tsoekere batho ba baholo ba fuoa 200 mg makhetlo a 2-3 ka letsatsi.

    Ho lefu la tsoekere le lefu la tsoekere 200 mg e behiloe makhetlo a 2-4 ka letsatsi.

    Thibelo li-psychizo tsa kelello le tse sebetsang: 600 mg bakeng sa litekanyetso tsa 3-4 ka letsatsi.

    Tekanyetso ea letsatsi le letsatsi le ho ferekana, mathata a amanang le maemo a ho hlaka siea 400-1600 mg.

    Litaelo tsa Carbamazepine Acry le tsona lia tšoana.

    Carbamazepine le joala

    Setlhare se sebelisetsoa ho phekola matšoao a bang teng ka mor'a ho noa joala. E ntlafatsa boemo ba maikutlo ba motho.Leha ho le joalo, kalafo ena e lokela ho sebelisoa sepetlele feela, 'me ha ho kgothaletswe ho sebelisa lithethefatsi tsena tse peli mmoho ho qoba ho tsosa ts'ebetso ea methapo e kholo.

    Tlhahlobo mabapi le carbamazepine

    Ho na le litlhahlobo tse 'maloa liforomong mabapi le lithethefatsi tse sebelisetsoang meriana. Ha e le hantle, maikutlo a siea mabapi le phello ea lithethefatsi joalo ka lithethefatsi.

    Ha moriana o sebelisoa kalafo ea mefuta e fapaneng ea maemo a sithabetsang le mafu a kelello, ho hlahisoa lintlha ka ts'ebetso ea eona e mpe ha e bapisoa le li-analogues tsa sejoale-joale, tseo ka nako e tšoanang li nang le litlamorao tse fokolang. Ha ho phekoloa neuralgia ea trigeminal, ho lumeloa hore meriana eo ha e na thuso.

    Hape, sephetho sa tšebeliso ea lithethefatsi e ka ba ho hloka boroko.

    Litlhahlobo tsa acre ea carbamazepine lia tšoana.

    Sebopeho sa moriana

    Matlapa a khutlang a Carbamazepine a fumaneha ka lintho tse fapaneng tsa karolo e sebetsang.

    • Motsoako o sebetsang: 200 kapa 400 mg ea carbamazepine
    • Lisebelisoa tse ling: carbomer, CMC, Aerosil, E 572, sodium CMC.

    Setlhare se nang le ts'ebetso ea nako e telele, se fihletsoeng ka foromo e ikhethang ea lithethefatsi: ka mor'a ho kenella, ntho e sebetsang e boloka ts'ebetso ea eona nako e telele ho feta tloaelehileng.

    Lithethefatsi tse 200 mg - matlapa a tšoeu, a bohlooho kapa a beige ka mofuta oa silinda e sephara. Litlolo tse tšoeu li khonahala, li baka phello e makatsang. Sebopeho se joalo sea amoheleha ebile ha se nkoe e le sekoli. Moriana o kenngoa ka lipaneng tsa sele tsa likotoana tse 10. Sephutheloana: lipampiri tsa 1/2/5, e tsamaeang le sengoloa.

    Lithethefatsi tse 400 mg - ho potoloha, ka mealo e phatsimang ea letlapa ka mokhoa oa ellipse. E paka ka har'a linkhoana tsa PET likotoana tse 50. Ka lebokoseng - sets'oants'o se le 1, litaelo.

    Pholiso ea thepa

    Phello ea anticonvulsant ea lithethefatsi e fihlella ka lebaka la thepa ea carbamazepine, e leng motsoako oa motsoako oa li-trikingclic iminostilbene. Ho lumeloa hore bokhoni ba anticonvulsant ba ntho bo iponahatsa ka mochine ho fokotsa tšebetso ea liteishene tsa Na +. Ka lebaka la ho pepeseha, li-membrane tsa neural lia tsitsa mme litšusumetso tsa synaptic lia fokotseha. Ka nako e ts'oanang, ho lokolloa ha glutamate amino acid hoa fokotseha, boemo ba monyako o kholisang bo tloaelehile, bo fokotsang menyetla ea ts'enyo ea sethoathoa. Ka phello ea anticonvulsant, mochini oa ho ntlafatsa sephetho sa K + le ho tsitsisa liteishene tsa khalsiamo le ona oa sebetsa.

    Nakoana kamora hore mokuli a qale ho nka carbamazepine, matšoao a ntlafatso a boiketlo ba mokuli le a hlaha, a thusang puisanong ea hae le ba bang.

    Ho bana, lithethefatsi li fokotsa ho tšoenyeha ho feteletseng, ho tšoenyeha le ho ba mabifi. Tšusumetso ho bokhoni ba ho lemoha e bonahala ho latela tekanyetso e sebelisitsoeng.

    Qaleho ea phello ea anticonvulsant e fetoha - ho tloha lihora tse 'maloa kapa matsatsi ka mor'a tsamaiso (ho bakuli ba bang, e ka ba kamora khoeli ea kalafo).

    Kamora ho tsamaisoa ka molomo, ntho e batla e amohuoa ka botlalo ho tsoa ho tšilo ea lijo, ¾ ea litekanyetso li tlama liprotheine tsa plasma.

    E tšeloa ka har'a sebete le karolo ea li-enzyme tsa eona. Ho felisoa ha halofo ea bophelo ho nka lihora tse 12 ho isa ho tse 30. E pepisoa haholo ka moroto (hoo e ka bang liperesente tse 70-75), tse ling kaofela li na le mantle.

    Mokhoa oa kopo

    Ho khothalletsoa hore u nke phaello ea carbamazepine, ho latela litaelo tsa tšebeliso, nakong ea lijo kapa hang hoba e phethoe. Haeba mokuli a na le mathata a ho metsa, joale matlapa a lumelloa ho nooa ka mokhoa o qhibilihang, kaha phello ea nako e telele ea lithethefatsi e bolokiloe.

    Litekanyetso tsa letsatsi le letsatsi li tsoa ho 400 ho isa ho 1200 mg (ka tekanyetso e 'maloa), boholo, bo thibetsoeng ho feta, ke 1600 mg.

    Lefu la ho akheha

    Setlhare sa antiepileptic sa ketso ea nako e telele se khothaletsoa ho nkuoa kapele kamoo ho ka khonehang ka monocourse.Tekanyetso ea ho qala e lokela ho ba e fokolang, joale ka mor'a ho ithuta karabelo ea 'mele, e ka eketsoa ho ea boemong bo hlokahalang. Nako eohle eo u e hlokang ho beha leihlo mohopolo oa ntho e sebetsang plasma.

    Haeba lithethefatsi tse nkang nako e telele li eketsoa kalafo ea antiepileptic e seng e ntse e tsoela pele, joale sena se lokela ho etsoa butle butle, ho se hlahisa hanyane. Haeba ka lebaka lefe kapa lefe mokuli a sa khone ho noa lithethefatsi, joale matlapa a nooa ka lekhetlo la pele ka tekanyetso e tloaelehileng, ho thibetsoe ho noa tekanyetso e habeli kapa e meraro.

    • Batho ba baholo: tekanyetso ea letsatsi le letsatsi ea lipilisi tsa carbamazepine tsa 200 mg e tsoa ho 1 ho isa ho 2 li-pcs, ebe palo ea lithethefatsi tsa letsatsi le letsatsi e fetoloa haeba ho hlokahala, ho litekanyetso tse phahameng. Bakeng sa kalafo ea tlhokomelo, e lumelloa ho sebelisa ho tloha ho 800 ho isa ho 1200 mg ho tekanyetso ea 1-2. Regimen e khothalletsoang: palo ea pele - nka mantsiboea a 200-300 mg, ka thupelo ea tlhokomelo - hoseng - 200-600 mg, ka shoalane - ho tloha 400 ho isa ho 600 mg.
    • Bana le bacha (lilemo tse 4-15): qalong - 200 mg / letsatsi .. Ebe o eketseha ka 100 mg / ka letsatsi. ho fihla maemong a lakatsehang. Bakeng sa kalafo ea tlhokomelo ea bakuli ba lilemo li 4-10 - tekanyetso ea letsatsi le letsatsi ea 400 ho isa ho 600 mg, bakeng sa bana ba baholo (lilemo tse 11-15) - ho tloha ho 600 ho isa ho 1000 mg / ka letsatsi.

    Nako ea ts'ebetso ea marang-rang e itšetlehile ka karabelo ea motho ka mong ea setlhare. Qeto ea ho fetisetsa mokuli ho sethethefatsi ka ketso ea nako e telele, nako ea thupelo, joalo-joalo, li-nuances li ikemiselitsoe ka bonngoe. Tlhokahalo ea ho fokotsa litekanyetso tsa carbamazepine e khethoa ke ngaka e eang. Qeto mabapi le monyetla oa ho tlohela lithethefatsi ka botlalo e ka etsoa haeba lefu le sa iponahatse nakong ea phekolo ea lilemo tse 2-3. Phekolo e lokela ho khaotsa butle-butle, ho fanoe ka lilemo tse 1-2 ho fokotsa tekanyetso.

    Trigeminal neuralgia, idiopathic glossopharyngeal nerve neuralgia

    Qalong ea kalafo, li-200 ho isa ho 400 mg tsa moriana li boletsoe litekanyetso tse peli tse arohaneng. Motsoako oa carbamazepine o ka eketsoa ho fihlela bohloko bo nyamela, ho fihlela 400-800 mg / ka letsatsi. Kamora ho fumana phello ea kalafo, hoa khoneha ho sebelisa litekanyetso tse fokotsitsoeng ho boloka sephetho se fihletsoeng - 400 mg ka letsatsi. Boholo ba letsatsi le letsatsi ke 1,2 g.

    Bakuli ba tsofetseng le bakuli ba nang le kutloisiso ea ntho e sebetsang ba fuoa 100 mg habeli ka letsatsi, keketseho e eketsehileng e ka etsahala feela ka tlhokomeliso e kholo ho fihlela bohloko bo khaotsa. Ka karolelano, o hloka ho nka 3-4 p. / Letsatsi. 200 mg ka 'ngoe. Kamora ho nyamela hoa matšoao a lefu lena, butle-butle lithethefatsi li fokotseha ho ea ho tsa kalafo ea tlhokomelo.

    Mokhoa oa ho hlakola Carbamazepine Retard

    Ho felisoa ha tsamaiso ho lokela ho nahanela ho hlaka ha ketso ea kalafo ea nako e telele. Ho itokolla ka tšohanyetso ho ka baka tlhaselo ea lefu la sethoathoa, ka hona, litekanyetso li lokela ho fokotsoa butle butle. Boemong ba ho fetisetsa mokuli ho tsoa lithethefatsing tsena ho ea lithethefatsing tse ling tsa antiepileptic, ho ka hlokahala ho nka lithethefatsi tse ling ho emisa matšoao a sa rateheng.

    Nakong ea kemaro le kanyeso

    Ts'ebeliso ea carbamazepine nakong ea kemaro le lactation e hloka tlhokomelo e kholo.

    Bakeng sa basali ba nang le mesebetsi e bolokiloeng ea ho ba le bana, ho bohlokoa hore u sebelise lithethefatsi ho li-monotherapy, hobane maemong ana menyetla ea anomalies le pathologies ho ngoana e tlase haholo ho feta nakong ea ho etsa mofuta o kopaneng oa kalafo o sebelisa lithethefatsi tse ling tsa antiepileptic.

    Haeba mosali a ima nakong ea carbamazepine, kapa ho hlokahala hore a e sebelise nakong ea kemaro, ho a hlokahala ho sekaseka melemo ea kalafo le mathata a ka hlahang a ka hlahisang nts'etsopele ea lehe / lesea. Sena se bohlokoa haholo haeba antiepileptic e sebelisoa likhoeling tse tharo tse qalang.

    Ha u fana ka litlhare, o lokela ho nka tekanyetso e tlase haholo e fanang ka phello ea kalafo, 'me a lekole boemo ba khatello ea ntho e sebetsang maling a mali.

    Ho kenella ka hare ho kalafo nakong ea gestation ha ea lokela ho ba teng, hobane ho a tsebahala hore ho eketsoa hoa lefu la patsi ho kotsi ho mme le lesea la hae le e-s'o hlahe. Ho se ho tsebahala ka mokhoa o tšepahalang hore ho bana bao bo-mme ba bona ba nang le lefu la sethoathoa, mathata a ntlafalo ea intrauterine a hlaha hangata. Ka nako e ts'oanang, ho na le lipelaelo tsa hore carbamazepine e khona ho tsosa nts'etsopele ea methapo, hobane linyeoe tsa tsoalo ea bana ba nang le letsoalloa la spina bifida le li-pathologies tsa lesapo la mokokotlo, bofokoli ba pelo le mathata a boteng ba monna le mathata a mang a tlalehiloe. Leha kamano e teng lipakeng tsa phello ea lithethefatsi le litlolo tsena li e-so tiisoe ka botlalo, menyetla ea kholo ea eona e ke ke ea qheleloa ka thoko.

    Basali ba lokela ho tsebisoa ka mathata a ka bang teng a kholong ea bokhachane, le ho hlahlojoa hangata nakong ea bokhachane.

    Joalo ka moriana o mong le o mong oa antiepileptic, carbamazepine e ka eketsa tšebeliso ea folic acid 'meleng, e leng se ka eketsang menyetla ea bofokoli ba tlhaho ho bana. Ka hona, nakong ea kemaro, ho ka hlokoa tlhaiso e eketsehileng ea vithamine.

    Haeba mokhachane a noele moriana o methating e fetileng (haholo-holo libeke tse sa tsoa feta), lesea le sa tsoa tsoaloa le ka hloka mofuta oa vithamine K1 ho fokotsa matla a lefu lena le ka bang teng. Pathology e bonahatsoa ke ho tsitsipana, ho hema hanyane, mathata a ka mpeng, ho hloka takatso ea lijo.

    Lebone

    Carbamazepine e khona ho pepesoa ka lebese, kahoo ha ho fana ka taelo hoa hlokahala ho sekaseka melemo ea kalafo le kotsi e ka bang teng ho ngoana. Nakong ea kalafo, lactation e lokela ho khaoloa. Haeba ngaka e entse qeto ea hore ha ho na tlhoko ea ho hana HB, joale boemo ba lesea bo lokela ho lula bo beiloe leihlo e le hore ho ka etsahala ho tseba le ho tlosa litlamorao tsa Carbamazepine ka nako.

    Tšebelisano ea lithethefatsi

    Ts'ebeliso ea carbamazepine Retard e lokela ho etsoa ho nahanisisa ka pherekano ea ts'ebelisano ea ntho e sebetsang le meriana e meng.

    • Phetoho ea metabolic ea carbamazepine e etsahala ka ho nka karolo ha cytochrome CYP3A4. Tabeng ea ho e kopanya le lithethefatsi tse thibelang mokhoa ona oa li-enzyme, khatello ea li-antiepileptic ho plasma e eketseha, e sa hlahiseng feela ho ntlafatsa kalafo, empa le litla-morao. Tsamaiso e ts'oanang ka li-inducers e thusa ho potlakisa metabolism ea ntho le ho fokotsa litaba tsa eona ka har'a plasma le ho fokotsa sephetho sa kalafo.
    • Khatello ea carbazepine 'meleng e eketseha tlasa tšusumetso ea verapamil, felodipine, fluoxetine, trazodone, cimetidine, acetazolamide, macrolides, cirofloxacin, azoles, stiripentol, terfenadine, isoniazid, oxybutynin, ticlopidine, ritonavir le tse ling. Ka hona, ka taolo e tšoanang, tokiso ea moriana o sebelisitsoeng e hlokahala ho latela palo ea litaba tsa 'mele.
    • Boemo ba khatello ea carbazepine boa fokotseha ha bo kopantsoe le felbamate, 'me litaba tsa lithethefatsi tsa ho qetela le tsona li ka fetoha.
    • Loxapine, primidone, valproic acid le lintho tse tsoang ho eona, ha li nkuoa hammoho le carbamazene, e ka eketsa litaba tsa eona.
    • Carbamazepine e ka fallisoa ho plasma ka valproic acid le primidone, mme ka hona e eketsa litaba tsa metabolite. Ha e tsamaisoa hammoho le asproic acid, e lokela ho hopoloa hore motsoako ona o ka baka ho ferekana le ho ferekanya kelello.
    • Carbamazepine e ka fokotsa khatello ea mali ka har'a plasma ea clobazam, digoxin, primidone, GCS, cyclosporine, tetracyclines, lithethefatsi tsa lihormone tse nang le estrogen kapa progesterone, theophylline, anticoagulants ea molomo, TCAs, bupropion, sertraline, felbamate, calcipazine, kupropazazine le lithethefatsi tse ling tse ngata.Tlhahiso efe kapa efe ea moriana o mong le o mong e lokela ho hlahlojoa hore na e lumellana le carbamazepine, 'me litekanyetso tsa e' ngoe le e 'ngoe ea tsona li lokela ho fetoloa ho latela liphetho.
    • Ha o kopanya carbamazepine le phenytoin, motho o lokela ho nahanela tšusumetso e ka bang teng ea thepa ea pholiso, hammoho le ho phahama ha boemo ba mefenitoin.
    • Tsamaiso e kopanetsoeng ea lithethefatsi ka litokisetso tse nang le lithium kapa metoclopramide li ka ntlafatsa litlamorao tsa tsona tse kotsi 'meleng.
    • Kameho ea carbamazepine e fokolisoa ke thupelo e kopaneng ea lithethefatsi tsa tetracycline.
    • Nakong ea kalafo, tlhokomeliso e lokela ho sebelisoa ha paracetamol e sebelisoa, hobane phello ea eona e nang le chefo ho sebete e ntlafatsoa le phello ea kalafo e fokotsehile (ka lebaka la ho potlakisa ha lits'ebetso tsa metabolic).
    • Carbamazepine e ntlafatsa phello e hatellang ho NS e bohareng ea phenothiazine, thioxanthene, haloperidol, clozapine, TCA, empa e fokolisa motsoako ona.
    • IMAO e khona ho eketsa tšokelo ea likotsi tsa hyperpyretic le hypertgency, syndromes tse kholisang, lefu. Ho qoba lits'ebetso tse bolaeang, lipakeng tsa carbamazepine le iMAO, nako ea ho qeta bonyane libeke tse peli e lokela ho bolokoa.
    • Tsamaiso e kopanetsoeng ea lithethefatsi tsa antiepileptic tse nang le diuretics e ka baka hyponatremia.
    • Carbamazepine e fokolisa phello ea kalafo ea ba hlasimollang mesifa e sa nyenyefatso, ka hona, ho ka hlokahala ho eketsa litekanyetso tsa bona ka ho shebella ho ba teng ha bona ka har'a plasma.
    • Maemong a mang, ha o kopanya antiepileptic le levetircetam, phello e chefo ea lithethefatsi tsa ho qetela e ka eketseha.
    • Carbamazepine e na le bokhoni ba ho fokotsa mamello ea joala ba ethyl.
    • Lithethefatsi tsa Myelotoxic li hlahisa hematotoxicity ea lithethefatsi.
    • Antiepileptic e potlakisa phetoho ea metabolic ea li-anticoagulants tse sa tobang, lithibela-pelehi tsa li-hormone, folic acid, hammoho le praziquantel, anesthetics le ho felisoa ha li-hormone tsa qoqotho. E ntlafatsa mojaro o nang le chefo ea isoniazid bokong.

    Litla-morao le ho sebelisa overdose haholo

    Boitšoaro bo bong bo bobe ba 'mele (haholo-holo ho tsoa ho tsamaiso ea methapo e bohareng, letlalo le mpa) bo bonahala hangata qalong ea thupelo, kamora ts'ebeliso ea litekanyetso tse kholo kapa ho bakuli ba tsofetseng.

    Litlamorao tse tlatsitsoeng ke tekanyetso li nyamela ka botsona kapa kamora litekanyetso tse tlase. Matšoao a mathata a mantlha a NS a ka hlaha ka lebaka la ho taoa hanyane kapa ka lebaka la phapang ea khatello ea lithethefatsi maling. Tabeng ena, o hloka ho beha leihlo matšoao a sehlahisoa sa lithethefatsi kamehla ho thibela nts'etsopele ea methapo.

    Nakong ea kalafo, litlamorao tse atileng haholo tsa carbamazepine ke:

    • Karolong ea litho tsa mali: leukopenia, leukocytosis, palo ea methapo e tlase ea mali, eosinophilia, phetoho ea li-lymph, ho fokola ha acidic, palo e tlaase ea mali e tšoeu, erythrocyte aplasia, mefuta e fapaneng ea phokolo ea mali (aplasiki / megoblastic / hemolytic, jj) lesapo la mokokotlo.
    • Ho itšireletsa mafung: rashes, vasculitis, arthralgia, aseptic meningitis, anaphylaxis, edema ea Quincke.
    • Sistimi ea Endocrine le metabolism: edema, ho bokellana ha mokelikeli, ho eketsa boima ba 'mele, ho baka khatello ea maikutlo hangata (hyperprolactinemia e nang le galactorrhea kapa mafu a se nang galactorrhea, a fokolisang calcium masapo, cholesterol e eketsehileng.
    • Kelello: hallucination (lipono, "mantsoe"), khatello ea maikutlo, ho fokotseha kapa ho hloka takatso ea lijo, ho tšoenyeha ho eketsehileng, mabifi, ho ferekana, pherekano, ho eketsoa ha likelello tsa kelello tse teng.
    • NS: sedation, ho thothomela, dystonia, boloi, mathata a masapo a mokokotlo, lisebelisoa tsa puo, methapo ea kutlo, ho lahleheloa ke maikutlo, bofokoli ba mesifa, maikutlo a khopameng a tatso, CNS, ho senyeha ha mohopolo.
    • Pono, ho utloa: ho sitisoa ha bolulo, khatello e eketsehileng ea hepatitis B, ho koaheloa ke lense, tinnitus / tinnitus, hypo- kapa hyperacusia.
    • Mathata a pelo le methapo ea mali: lefu la pelo le amang methapo ea pelo, lefu la pelo, ho nyekeloa ke pelo, ho ata ha lefu la pelo, thrombophlebitis, pulmonary embolism.
    • Boiphetetso: Karabelo ea mafu a matšoafo (feberu, makhopho, nyumonia, jj.).
    • Litho tsa ho ja: molomo o ommeng, ho ruruha / lets'ollo, bohloko, pancreatitis, ho ruruha ha leleme.
    • Sebete: liphetoho mosebetsing le khatello ea li-enzyme, ho hloleha ha sebete.
    • Dermis le s / c fiber: dermatitis, urticaria (foromo e matla e ka etsahala), SLE, ho hlohlona, ​​Stevens-Johnson syndromes, Lyell, photosensitivity, erythema (polyform, knobby), mathata a pigmentation, makhopho, purpura, ho ruruha ho matla, moriri oa mofuta oa monna tahlehelo ea moriri.
    • Sistimi ea musculoskeletal: bohloko bo kopaneng, bohloko ba mesifa, cramping, pherekano ea ho robeha.
    • Sistimi ea genitourinary: ho se sebetse hantle ha renal, nephritis, ho ruruha ho eketsehileng, ho ruruha ha ho ruruha, ho hloka thari, mathata a spermatogenesis.
    • Matšoao a mang: mokhathala, ho nchafatsa mofuta oa 6 herperovirus.

    Carbamazepine e ka ama bokhoni ba hau ba ho tsepamisa mohopolo le ho etsa liqeto kapele. Ka hona, nakong ea ts'ebeliso ea eona, tlhokomeliso e eketsehileng ea hlokahala ha ho khannoa likoloi kapa ho etsa mofuta ofe kapa ofe oa ts'ebetso o ka behang bophelo bo botle ba bophelo kapa oa mokuli.

    Ho tsitsa ho bonahatsoa ke khatello ea maikutlo ea ho hema, hyperreflexia, e lateloang ke phetoho ea hyporeflexia, ho theoha ha mocheso, ho senyeha hoa liprotheine tsa mala, le litlamorao tse matla.

    Kaha ha ho na le litlhare tse tobileng tsa carbamazepine, ho tlosoa ka ho feteletseng ho tlosoa ka ho hlatsoa mpa, ho nka litlolo, le kalafo ea matšoao.

    Mokuli o lokela ho lula a beiloe leihlo ho fihlela matšoao a tahi a fela ka botlalo. Haeba ho hlokahala, bana ba tšeloa mali.

    Li-analogues tsa Carbamazepine le lipina li lokela ho khethoa feela ke setsebi se kenang.

    Letsatsi Pharma (India)

    Theko: lelefatsa. tab. 200 mg (li-pcs tse 30.) - li-ruble tse 81., 400 mg (30 li-pcs.) - li-ruble tse 105.

    Lithethefatsi ka mokhoa o tloaelehileng kapa oa nako e telele. Phello ea kalafo ea lithethefatsi e fumanoa ka lebaka la carbamazepine e fumanehang. Matšoao a ts'ebeliso le likarolo tsa ts'ebeliso - ho latela matšoao a motho.

    Mofumahali

    Ho thipa ho tsamaea butle empa ho felletse (ho ja ha ho ame haholo tekanyo ea ho monya). Kamora tekanyetso e le 'ngoe ea letlapa le tloaelehileng, Stax e fihlella kamora lihora tse 12. Ha ho na phapang e kholo litekanyetsong tsa ho amoheloa ha ntho e sebetsang ka mor'a ho sebelisa mefuta e fapaneng ea litekanyetso tsa lithethefatsi bakeng sa tsamaiso ea molomo (bioavailability ha o nka matlapa a khutlang a 15% e tlase ho feta ha o nka mefuta e meng ea litekanyetso). Kamora taolo e le 'ngoe ea molomo ea 400 mg ea carbamazepine, 72% ea lethal dose e nkoang e tsoa kahara moroto le 28% ka mantle. Hoo e ka bang 2% ea tekanyetso e nkuoeng e pepesitsoe ka har'a moroto joalo ka carbamazepine e sa fetoheng, e ka bang 1% - joalo ka metabolite ea 10.11-epoxy. Ho bana, ka lebaka la ho felisoa ha carbamazepine ka potlako, tšebeliso ea litekanyetso tse phahameng tsa lithethefatsi ka kilo e le ngoe ea boima ba 'mele e ka hlokoa, ha e bapisoa le batho ba baholo. Ha ho na bopaki ba hore pharmacokinetics ea phetoho ea carbamazepine ho bakuli ba tsofetseng (bapisoa le batho ba baholo ba banyenyane). Ha ho na data ho pharmacokinetics ea carbamazepine ho bakuli ba nang le bothata ba ho ruruha kapa ba hepatic function.

    Bokhachane le pelehi

    Bakhachane ba nang le lefu la sethoathoa ba tlameha ho tšoaroa ka hloko e kholo.

    Haeba mosali ea nkang carbamazepine a ima kapa a rera ho ima, kapa haeba ho hlokahala ho qala ho sebelisa carbamazepine nakong ea kemolo, melemo ea lithethefatsi e lokela ho hlahlojoa ka hloko ha e bapisoa le mabaka a neng a ka ba teng a kotsi, haholoholo likhoeling tse tharo tsa pele tsa pelehi. Methapo e fokolang e sebetsang e lokela ho khethoa le ho hlahlojoa maemo a plasma.

    Nakong ea kemolo, kalafo e sebetsang ea antiepileptic ha ea lokela ho emisoa, hobane ho ata ha lefu lena ho ama 'm'a le lesea ka matla.

    Sebelisa ke basali ba anyesang

    Carbamazepine e epuoa lebese la matsoele (hoo e ka bang 25 - 60% ea mahloriso a plasma). Melemo ea ho anyesa e lokela ho hlahlojoa ho latela monyetla oa liketsahalo tse bohloko tse liehang ho masea. Bo-'mè ba nkang carbamazepine ba ka anyesa haeba ba beiloe leihlo le lecha bakeng sa masea ho bona ho ka ba le liphetoho tse ka bang teng (mohlala, ho otsela ho feteletseng, ho se sebetse hantle ha letlalo).

    Litla-morao

    Hangata karabelo e mpe e tsamaeang le tekanyetso ea meriana e nyamela kamora matsatsi a 'maloa, ka boithatelo le kamora phokotso ea nakoana ea lethal dose la lithethefatsi.

    Ho tloha lehlakoreng la tsamaiso ea methapo e bohareng: khafetsa - ho tsekela, ho otsela, ho otsela, bofokoli bo akaretsang, khafetsa - ho opeloa ke hlooho, ka linako tse ling - ho sisinyeha ka tsela e sa tloaelehang (mohlala, ho thothomela, "ho fofa" ho thothomela - asterixis, dystonia, li-tics), nystagmus, ka seoelo, dyskinesia ea orofacial, likhathatso tsa oculomotor, mathata a puo (mohlala, dysarthria kapa puo e sa tsitsang), mathata a choreoathetoid, peripheral neuritis, paresthesias, bofokoli ba mesifa le matšoao a paresis.

    Ho tsoa karolong ea kelello: ka seoelo - hallucinations (tse bonoang kapa tse hlalosoang), khatello ea maikutlo, letlasetakatso ea lijo, ho tšoenyeha, ho ba mabifi, ho ferekana, ho ferekanya kelello, haholo seoelo - ts'ebetso ea psychosis.

    Litla-morao: khafetsa - urticaria, ka linako tse ling - erythroderma, ka seoelo - lupus-joalo ka lefu la letlalo, ho hlohlona ha letlalo, ho sa tloaelehang - e lengthemaele ea multiforme exudative (ho kenyeletsoa le Stevens-Johnson syndrome), chefo e thibelang lefu la cyermal necrolysis (Lyell syndrome), photosensitivity. Khafetsa, mekhahlelo e liehang ea mefuta e mengata ea lietsahala ea mofuta oa hypersensitivity e nang le feberu, lekhopho la letlalo, vasculitis (ho kenyelletsa erythema nodosum, joalo ka pontšo ea vasculitis ea letlalo), lymphadenopathy, matšoao a tšoanang le lymphoma, arthralgia, leukopenia, eosinophilia, hepatosplenomegaly, le hepatlenlengaly, le hepatlenlengaly, le hepatlenlengaly. liponahatso li fumaneha ka mekhoa e fapaneng). Ho ka ameha litho tse ling tsa 'mele (mohlala, mats'oafo, liphio, manyeme, myocardium, colon). Ke ka seoelo - meneptitis ea aseptic e nang le myoclonus le eosinophilia, ho se sebetse hantle ka anaphylactoid, angioedema, pneumonitis ea allergic kapa pneumonia ea eosinophilic. Haeba litla-morao tsena li ka mpefala, tšebeliso ea lithethefatsi e lokela ho emisoa.

    Hematopoietic litho: khafetsa - leukopenia, hangata - thrombocytopenia, eosinophilia, ka seoelo - leukocytosis, lymphadenopathy, folic acid e haellang, ka seoelo haholo - agranulocytosis, anemia ea aplasiki, anemia ea 'nete ea erythrocytic, anemia. phokolo ea mali

    Ho tsoa ts'ebetsong ea tšilo ea lijo: hangata khafetsa - ho nyekeloa, ho hlatsa, hangata - molomo o omileng, ka linako tse ling - lets'ollo kapa ho sokela, bohloko ba ka mpeng, ka seoelo - glossitis, stomatitis, pancreatitis. Ho tsoa ho sebete: khafetsa haholo - keketseho ea ts'ebetso ea phetisetso ea gamma-glutamyl (ka lebaka la ho kenella ha enzyme ena ka har'a sebete), eo hangata e se nang bohlokoa ba bongaka, hangata - keketseho ea ts'ebetso ea liprotheine tsa "hepatic", ka seoelo - hepatitis ea cholestatic, parenchymal hepatocellular) kapa mofuta o tsoakaneng, jaundice, ka seoelo - granulomatous hepatitis, ho hloleha ha sebete.

    Ho tsoa ho CCC: khafetsa - ho ferekana hoa pelo, ho fokotseha kapa ho eketseha ha khatello ea mali, ka seoelo - bradycardia, arrhythmias, AV block e nang le ho akheha, ho oa, ho eketseha kapa nts'etsopele ea lefu la pelo le sa foleng, ho mpefala ha lefu la pelo (ho kenyelletsa le ponahalo kapa kholo ea litlhaselo tsa angina) , thrombophlebitis, thromboembolic syndrome.

    Ho tloha tsamaisong ea endocrine le metabolism: khafetsa - edema, ho boloka mokelikeli, ho nona haholo, hyponatremia (ho fokotseha ha osmolarity ka lebaka la phello e ts'oanang le ADH, eo maemong a sa tloaelehang e lebisang ho hyponatremia ea dilution, e tsamaeang le mokoka, ho hlatsa, ho opisa hlooho, ho ferekanya kelello le mathata a methapo ea kutlo), ka seoelo - keketseho ea litekanyetso tsa prolactin (e kanna ea tsamaisoa le galactorrhea le gynecomastia), ho fokotseha hoa boemo ba L-thyroxine (mahala T4, T4, TK) le keketseho ea boemo ba TSH (hangata ha e tsamaisane le "TSH"). Ke liponahatso litleleniki tsa), meferefere ea khalsiamo le phosphorus metabolism ka dinama tse nyenyane tse lesapo (phokotso ea mahloriso ea Ca2 + le 25-OH-cholecalciferol ka lero la mali mali): osteomalacia, k'holeseterole e phahameng (ho akarelletsa le HDL k'holeseterole) le hypertriglyceridemia.

    Ho tsoa ho tsamaiso ea genitourinary: hangata ka seoelo - interstitial nephritis, ho se sebetse hantle ha masapo, ts'ebetso ea mokokotlo oa mokokotlo (mohlala, albinuria, hematuria, oliguria, urea / azotemia), ho eketseha ha urination, urine ho boloka, ho fokotseha potency. Ho tsoa tsamaisong ea musculoskeletal: ka seoelo - arthralgia, myalgia kapa cramps. Ho tsoa liphoofolong tsa kutlo: ka seoelo - likhathatso ka tatso, leru la lense, conjunctivitis, ho senyeha ha kutlo, ho kenyeletsa tinnitus, hyperacusis, hypoacusia, liphetoho ponong ea molumo.

    Tse ling: mathata a ho fifala ha letlalo, aimura, makhopho, mofufutso, alopecia.

    Likarolo tsa ts'ebeliso

    Ho fihlela lilemong tse 5: tšebeliso ea lithethefatsi Carbamazepine-200-Maxpharma Retard ha e khothalletsoe.

    Tšusumetso ho bokhoni ba ho khanna koloi le ho sebetsa ka mekhoa e tsamaeang

    Nakong ea phekolo, ho hlokahala hore u hane ho etsa lintho tse ka bang kotsi tse hlokang ho tsepamisa mohopolo le ho potlakisa karabelo ea psychomotor.

    Litlhokahalo tsa polokeho

    Carbamazepine e na le ts'ebetso e fokolang ea anticholinergic; ha e laeloa bakuli ba nang le khatello e eketsehileng ea methapo, e hloka ho bolokoa khafetsa.nadth laola. Monyetla oa ts'ebetso ea li-psychoses tse sa tsoa etsahala o lokela ho tsotelloa, le ho bakuli ba tsofetseng, monyetla oa ho thefuleha kapa ho hlasimoloha. Ho fihla joale, ho bile le litlaleho tse arohaneng tsa tsoalo e holofetseng ea monna le / kapa spermatogenesis e holofetseng (kamano ea liphokotso tsena le carbamazepine ha e e-so thehoe). Ho na le litlaleho tsa ho tsoa mali ho basali pakeng tsa ho ilela khoeli maemong a ho neng ho sebelisoa lithibela-pelehi ka molomo ka nako e le 'ngoe. Carbamazepine e ka ama hampe ts'ebetso ea lithibela-pelehi tsa molomo, kahoo basali ba lilemo tsa ho tsoala bana ba lokela ho fuoa mekhoa e meng ea taolo ea kemolo nakong ea kalafo. Carbamazepine e lokela ho sebelisoa feela tlas'a tlhokomelo ea bongaka.

    Ho khothalletsoa ho tlohela tšebeliso ea ethanol.

    Agranulocytosis le aplasic anemia li amahanngoa le carbamazepine, leha ho le joalo, ka lebaka la maemo a tlase haholo a maemo ana, ho thata ho tseba hore na ho na le kotsi e kae ea carbamazepine. Kotsi e felletseng ho palo e sa ratoang ea baahi e hakanyetsoa ho batho ba 4,7 ka milione ka selemo bakeng sa agranulocytosis le batho ba 2.0 ka milione ka selemo bakeng sa phokolo ea mali.

    Foromo ea nako e telele e ka nkuoa hang, bosiu.

    Monotherapy ea lefu la sethoathoa e qala ka ho khethoa ha litekanyetso tse nyane, 'me ka bomong li li eketsa ho fihlela sephetho se lakatsehang sa kalafo.

    Ho khaotsa ka tšohanyetso ha carbamazepine ho ka baka ho ts'oaroa ha sethoathoa. Haeba ho hlokahala hore motho a kene kalafong ka tšohanyetso, mokuli o lokela ho fetisetsoa ho sethethefatsi se seng sa antiepileptic tlasa tataiso ea sethethefatsi se bontšitsoeng maemong a joalo (mohlala, diazepam e fanoa kahare kapa ka rectally, kapa phenytoin e fanoa ka methapo). Ho na le maemo a 'maloa a ho hlatsa, lets'ollo le / kapa ho fokotseha hoa phepo e nepahetseng, ho tsitsipana le / kapa khatello ea maikutlo ho masea a sa tsoa hlaha bao bo-mme ba nkile carbamazepine ka mokhoa o tšoanang le li-anticonvulsants tse ling (mohlomong liphetoho tsena ke lipontšo tsa lefu la ho ikhula ho masea a sa tsoa hlaha).

    Carbamazepine e lokela ho tlosoa hang-hang haeba ho hlaha kapa ho hlaha matšoao a hypersensitivity, ho fana ka maikutlo a nts'etsopele ea Stevens-Johnson syndrome kapa lefu la Lyell. Boitšoaro bo bobe ba letlalo (macular kapa maculopapular exanthema) hangata bo nyamela kamora matsatsi kapa libeke tse 'maloa, esita le kalafo e tsoelang pele kapa kamora ho fokotsa tekanyetso (mokuli o lokela ho beoa leihlo le haufi le ngaka ka nako ena).

    Ha ho na le karabelo e sa rateheng e kang feberu, 'metso, ho ruruha, ho ruruha ha mucosa ea molomo, ho ba le liketsahalo tse sa utloahaleng tsa likotsi, li-hemorrhages ka mokhoa oa petechiae kapa purpura, ho hlokahala hore o buisane le ngaka hanghang.

    Pele o qala kalafo, hammoho le nako le nako nakong ea ts'ebetso ea kalafo, liteko tsa mali tsa kliniki li lokela ho etsoa, ​​ho kenyelletsa ho bala palo ea liplatelese le mohlomong li-reticulocytes, hammoho le ho khetholla boemo ba tšepe ea serum ea mali. Leukopenia e sa tsoeleng pele ha e hloke ho khaotsa, leha ho le joalo, kalafo e lokela ho khaotsa haeba leukopenia e tsoelang pele kapa leukopenia e hlaha, e tsamaisana le matšoao a kliniki a lefu le tšoaetsanoang. Pele o qala kalafo, ho kgothaletswa ho etsa tlhahlobo ea ophthalmological, ho kenyelletsa le tlhahlobo ea fundus ka lebone la slit le tekanyo ea khatello ea methapo haeba ho hlokahala. Tabeng ea ho fana ka lithethefatsi ho bakuli ba nang le khatello e eketsehileng ea intraocular, ho hlokahala ho lekola kamehla letšoao lena. Ho netefalitsoe hore HLA-B * 1502 allele ho batho ba mofuta oa Chaena le Thai e amana le kotsi ea Stevens-Johnson syndrome (SJS) nakong ea kalafo le carbamazepine. Nako le nako ha ho khonahala, bakuli ba joalo ba lokela ho hlahlojoa hore na o na le allele ena pele ho kalafo le carbamazepine. Tabeng ea sephetho se nepahetseng sa tlhahlobo, ts'ebeliso ea carbamazepine ha ea lokela ho qala, ntle le ha ho se na mokhoa o mong oa kalafo o ka khonehang. Ho bakuli ba nkuoang ba le mpe bakeng sa boteng ba HLA-B * 1502, kotsi ea ho ba le lefu la Stevens-Johnson e nyane haholo, leha karabelo e joalo e tlalehiloe ka seoelo, empa e ka hlaha. Ka lebaka la tlhaiso-leseling, ha ho tsejoe ka bonnete ba hore na batho bohle ba tsoang Asia Boroa-bochabela ba kotsing ea ho etsa joalo. Ho bontšitsoe hore HLA-B * 1502 allele ha e amane le lefu la Stevens-Johnson ho bakuli ba morabe o mosoeu. HLA-B * 1502 allele ha e bolele esale pele kotsi ea karabelo e mpe ea letlalo le lengata la carbamazepine, joalo ka hypersensitivity syndrome ho anticonvulsants kapa rash e seng kotsi (maculopapular rash).

    Melemo ea pharmacological

    Pharadodynamics
    Lithethefatsi tsa antiepileptic, dibenzazepine derivative. Hammoho le antiepileptic, sethethefatsi le sona se na le matla a amanang le methapo ea kelello le kelello.

    Mokhoa oa ts'ebetso ea carbamazepine ho fihlela joale o hlalositsoe hanyane feela. Carbamazepine e tiisa lisele tsa methapo e meng e emisang mahlo, e hatella ho tsoa ha li-neuron hape e fokotsa phetiso ea li-pulaptic tse thabisang.Mohlomong mochine o ka sehloohong oa ts'ebetso ea carbamazepine ke ho thibela ho pheta-pheta ha boits'oaro bo amanang le sodium ho li-neurons tse senyehileng ka lebaka la thibelo ea liteishene tse bulehileng tsa matla a sodium.

    Ha e sebelisoa e le monotherapy ho bakuli ba nang le lefu la sethoathoa (haholoholo baneng le lilemong tsa bocha), ho ile ha hlokomeloa phello ea kelello ea lithethefatsi, e neng e kenyelletsa phello e ntle matšoao a letsoalo le khatello ea maikutlo, hammoho le ho fokotseha ha ho teneha le ho ba mabifi. Ha ho na datha e makatsang mabapi le phello ea lithethefatsi mesebetsing ea kelello le psychomotor: lithutong tse ling, ho ile ha bontšoa phello e habeli kapa e mpe, e neng e itšetleha ka tekanyetso ea moriana; lithutong tse ling, ho ile ha senoloa phello e ntle ea lithethefatsi tlhokomelong le memong.

    Joaloka moemeli oa neurotropic, lithethefatsi li sebetsa ho tse ngata tsa maloetse a methapo. Ka hona, mohlala, ka idiopathic le ea bobeli ea trigeminal neuralgia, o thibela ponahalo ea tlhaselo ea bohloko ba paroxysmal.

    Maemong a nang le lefu la ho itlopa joala, lithethefatsi li hlahisa monyetla oa ho ba le letsoalo le tiileng, leo maemong ana hangata le fokotsehang, hape le fokotsa botebo ba lipontšo tsa bongaka tsa lefu lena, tse kang ho teneha ho hoholo, ho thothomela le lefu la tahi.

    Ho bakuli ba nang le lefu la tsoekere, "lithethefatsi" li fokotsa ho hlohlona le lenyora.

    Ha e le setsebi sa kelello, lithethefatsi li sebetsa hantle lits'ebetsong tse amanang le mathata a amanang le kalafo. Litlhaselo tsa lefu la kelello le likotsi tsa kelello, le litlhaselo tsa manic, moo le sebelisoang hammoho le li-antipsychotic, hammoho le psychic e nyahamisang psychosis e nang le potoloho e potlakileng.

    Bokhoni ba moriana oa ho hatella lipontšo tsa manic bo ka hlaha ka lebaka la thibelo ea phapanyetsano ea dopamine le norepinephrine.

    Mofumahali
    Ho fufuleloa
    Kamora ho tsamaisoa ka molomo, carbamazepine e kenngoa hoo e ka bang ka ho felletseng, ho monya ho hlaha butle butle (tšebeliso ea lijo ha e ame ka ho teba tekanyo le boemo ba ho monya). Kamora ho tsamaisoa ka molomo (e le 'ngoe kapa e pheta-phetoang) ea matlapa a matlafatsang a lokolloang, mohopolo o moholo oa plasma (Cmax) e fihlelleha nakong ea lihora tse 24, boleng ba eona bo ka ba 25% ka tlase ho tekanyetso ea ho nka letlapa le tloaelehileng. Ha u nka litafole tse lokolotsoeng nako e telele, ho feto-fetoha ha maemo ha carbamazepine plasma ho fokola haholo, ha ho sa fokotsehe haholo boleng bo tlase ba mahlakore a lekanang. Ha ho nooa moriana ka mokhoa oa matlapa a lokolotsoeng makhetlo a mabeli ka letsatsi, ho feto-fetoha ha maemo a paballo ea ntho e sebetsang ka plasma ho fokola haholo.

    Tekanyo ea bioavailability ea ntho e sebetsang ho tsoa matlapeng a lokolotsoeng a emisitsoeng e batla e le 15% e tlase ho feta mefuta e meng ea litekanyetso tsa molomo tsa carbamazepine.

    Tekanyetso ea plasma ea equilibrium ea carbamazepine e fihlelloa kamora libeke tse 1-2. Nako ea phihlello ea eona ke motho ka mong 'me e itšetlehile ka tekanyo ea ho kenella ha li-enzyme tsa sebete ka autobamazepine, ho kenngoa ka hetero ka lithethefatsi tse ling tse sebelisoang ka nako e le ngoe, hammoho le boemo ba mokuli ho khethoa ha kalafo, tekanyo ea lithethefatsi le nako ea kalafo. Phapang ea bohlokoa e pakeng tsa boleng bo fapaneng ba boleng ba ho lekana ha maemo a phekolo e bonoa: ho bakuli ba bangata, litekanyetso tsena li tloha ho 4 ho isa ho 12 μg / ml (17-50 μmol / l).

    Tsamaiso
    Ho kopanya liprotheine tsa plasma ho bana - 55-59%, ho batho ba baholo - 70-80%. Bophahamo bo bonahalang ba karolelano ke 0.8-1.9 l / kg. Likhakanyo li thehiloe mokelikeling oa mokomkomere le mathe, tse lekanang le palo ea ntho e sebetsang e sa koaheleng liprotheine (20-30%).E kenella ka har'a sethopo sa placental. Phokotso ea lebese la matsoele ke 25-60% ea plasma.

    Ha ho fanoa ka monko o felletseng oa carbamazepine, bophahamo bo bonahalang ba karolelano ke 0,8-1.9 l / kg.

    Metabolism
    Carbamazepine e tšeloa ka har'a sebete. Mmila o ka sehloohong oa biotransfform ke tsela ea epoxydiol, ka lebaka leo metabolites ea mantlha e thehiloeng ho eona: 10,10-transdiol derivative le kopano ea eona le glucuronic acid. Ho fetoha ha carbamazepine-10,11-epoxide ho carbamazepine-10,11-transdiol 'meleng oa motho ho etsahala ka microsomap enzyme epoxide hydrolase.

    Khatello ea carbamazepine-10,11-epoxide (metabolacologically mafolofolo metabolite) e batla e le 30% ea mahloriso a carbamazepine plasma.

    Leihloenzyme le ka sehloohong le fanang ka biotransformation ea carbamazepine ho carbamazepine-10,11-epoxide ke cytochrome P450 ZA4. Ka lebaka la liphetoho tsena tsa metabolic, palo e sa lekanyetsoang ea metabolite e 'ngoe le eona e thehoa - 9-hydroxymethyl-10-carbamoylacridane.

    Mokhoa o mong oa bohlokoa oa metabolism ea carbamazepine ke ho theha mefuta e meng e fapaneng ea monohydroxylated, hammoho le N-glucuronides, tlasa ts'usumetso ea UGT2B7 isoenzyme.

    Ho tsala
    Bophelo ba halofo ea carbamazepine e sa fetoheng kamora ho tsamaisoa ka mokhoa o le mong oa lithethefatsi ka karolelano ea lihora tse 36, mme kamora litekanyetso tse ngata tsa lithethefatsi - ka karolelano ea lihora tse 16 - 24, ho latela nako ea kalafo (ka lebaka la ho kenyelletsa tsamaiso ea methapo ea enzyme ea sebete). Bakeng sa bakuli ba noang ka nako e tšoanang lithethefatsi tse ling tse susumetsang li-enzymes tsa sebete (mohlala, phenytoin, phenobarbital), ho felisoa ha halofo ea bophelo ba carbamazepine ho karolelano ea lihora tse 9 ho isa ho tse 90. Kamora ts'ebetso e le 'ngoe ea molomo ea 400 mg ea carbamazepine, 72% ea lethal dose e nkuoeng e felisoa ke liphio le 28% ea mala. 2% ea tekanyetso e amoheloang e pepesoa ke liphio ka sebopeho sa carbamazepine, e ka bang 1% - ka sebopeho sa chemacologically 10,11-epoxy metabolite e sebetsang. Kamora taolo e le 'ngoe ea molomo, 30% ea carbamazepine e qhaloa ka har'a moroto ka tsela ea lihlahisoa tsa ho fela tsa epoxydiol metabolic.

    Litšobotsi tsa li-pharmacokinetics lihlopheng tsa bakuli ka bomong
    Ho bana, ka lebaka la ho felisoa ha carbamazepine ka potlako, ho ka hlokahala hore u sebelise litekanyetso tse phahameng tsa lithethefatsi ka kilogramu e le 'ngoe ea boima ba' mele, ha li bapisoa le batho ba baholo.

    Ha ho na bopaki ba hore pharmacokinetics ea phetoho ea carbamazepine ho bakuli ba tsofetseng (bapisoa le batho ba baholo ba banyenyane).

    Boitsebiso bo mabapi le pharmacokinetics ea carbamazepine ho bakuli ba nang le bothata ba ho ruruha kapa ba tšebetso ea hepatic ha bo fumanehe.

    Sebelisa nakong ea bokhachane le nakong ea ho anyesa.

    Carbamazepine e kena kahare ho placenta kapele 'me e baka keketseho e eketsehileng ka har'a sebete le liphio tsa lesea.

    Ho hlahlojoa khafetsa ha khatello ea ntho e sebetsang ka plasma ea mali, ho kgothaletsoa EEG

    Ha bokhachane bo etsahala, ho hlokahala hore ho bapisoe molemo o lebelletsoeng oa kalafo le mathata a ka bang teng, haholoholo molemong oa pele oa kemolo.

    Hoa tsebahala hore bana ba bo-'mè ba nang le lefu la sethoathoa ba reretsoe mathata a ntlafatso ea intrauterine, ho kenyelletsa le mathata. Carbamazepine e khona ho eketsa kotsi ea mafu ana. Ho na le litlaleho tse ikhethileng tsa linyeoe tsa maloetse a amanang le tlhaho le ho se sebetse hantle, ho kenyelletsa ho se koalehe ha methapo ea methapo ea mokokotlo (spina bifida) le liphoso tse ling tsa tlhaho: likoli nts'etsopele ea sebopeho sa methapo ea methapo, methapo ea pelo le lits'ebetso tse ling tsa setho, hypospadias.

    Ho latela Ngoliso ea Makhooa a Amerika Leboea, liketsahalo tsa ho senyeha ho hoholo ho amanang le tlhekefetso e hlokang ho hlatsuoa, lithethefatsi kapa litlolo, tse fumanoeng nakong ea libeke tse 12 kamora ho beleha, e ne e le 3.0% har'a basali baimana ba neng ba nka carbamazepine nakong ea pele e le monotherapy, le 1.1% har'a basali baimana ba sa kang ba nka lithethefatsi tsa antiepileptic.

    Kalafo e nang le carbamazepine retard-Akrikhin basali baimana ba nang le lefu la sethoathoa e lokela ho etsoa ka hloko e kholo. Carbamazepine retard-Akrikhin e lokela ho sebelisoa ka tekanyetso e sebetsang e tlase. Ho khothalletsoa ho lekola khafetsa mohopolo oa ntho e sebetsang ka plasma ea mali.Tabeng ea taolo e sebetsang ea anticonvulsant, mosali oa moimana o lokela ho boloka carbamazepine e ngata plasma ea mali (mofuta oa kalafo oa 4-12 μg / ml), kaha ho na le litlaleho tsa kotsi e bakiloeng ke tekanyetso ea ho holisa malgenations a tsoaloang (ka mohlala, ts'oaetso ea ho se sebetse hantle ha a sebelisa tekanyetso ea ka tlase ho 400 mg ka letsatsi e ne e le tlase ho feta ka litekanyetso tse phahameng).

    Bakuli ba lokela ho tsebisoa ka monyetla oa ho eketsa kotsi ea ho ba le phoso le tlhoko, ntlheng ena, bakeng sa tlhahlobo ea bokhachane.

    Nakong ea kemolo, kalafo e sebetsang ea antiepileptic ha ea lokela ho kena-kenana, hobane ho ata ha lefu lena ho ka ba le phello e mpe ho 'm'a le lesea.

    Lithethefatsi tsa antiepileptic li eketsa khaello ea folic acid, e atisang ho utluoa nakong ea kemolo, e leng se ka eketsang tšenyo ea bofokoli ba tlhaho ho bana, kahoo ho nka folic acid ho khothalletsoa pele ho nako ea kemolo le nakong ea kemolo. Bakeng sa ho thibela mathata a hemorrhagic ho masea a sa tsoa tsoaloa, ho khothalletsoa hore basali ba libeke tsa ho qetela tsa moimana, hammoho le masea, ba fuoe vithamine K.

    Maemo a 'maloa a ho ts'oaroa ha sethoathoa le / kapa khatello ea maikutlo a ho kula a hlalositsoe ho masea a sa tsoa hlaha ao bo-mme ba nkile moriana ka nako e tšoanang le li-anticonvulsants tse ling. Ntle le moo, ho bile le liketsahalo tse 'maloa tsa ho hlatsa, letšollo le / kapa hypotrophy ho masea a bona a sa tsoa amohela carbamazepine. Mohlomong likarabelo tsena ke lipontšo tsa lefu la ho ikhula ho masea a sa tsoa hlaha.

    Carbamazepine e fetela ka lebeseng la matsoele, molemong oa lona ke 25-60% ea mahloriso maling a mali, ka hona melemo le litlamorao tse sa rateheng tsa ho anyesa li lokela ho bapisoa molemong oa kalafo e tsoelang pele. Ka ho tsoela pele ho anyesa ha o ntse o sebelisa moriana, o lokela ho theha leihlo bakeng sa ngoana mabapi le monyetla oa ho ba le mathata a itseng (mohlala, ho otsela haholo, ho fetoha ha letlalo le mafu). Ho bana ba fumaneng carbamazepine pele kapa ka lebese la matsoele, linyeoe tsa cholestatic hepatitis lia hlalosoa, ka hona, bana ba joalo ba lokela ho hlahlojoa e le hore ba tsebe litla-morao tse tsoang tsamaisong ea hepatobiliary.

    Bakuli ba lilemo tsa ho ba le bana ba lokela ho lemosoa ka ho fokotseha ha katleho ea katleho ea lithibela-pelehi tsa molomo ha ba ntse ba sebelisa carbamazepine.

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